Thoracoscopic resection of pulmonary metastases.

To describe the use of thoracoscopic techniques to achieve parenchymal sparing wedge resection of peripheral lung lesions in patients with a history of malignancy, and to describe the morbidity, mortality, and hospital course associated with this approach. Case series. University hospital. Patients with a history of malignancy and lesions on computerized tomography in the outer one third of the lung parenchyma. Histologic analysis of resected lung lesions, operative findings, operative time, duration of chest tube drainage and hospital stay, operative morbidity, and mortality. Twenty-one thoracoscopic resections of pulmonary parenchymal lesions were performed on 15 patients. All peripheral lesions identified by computerized tomography were found at thoracoscopy and successfully resected with the Nd:YAG laser (n = 7), an endoscopic stapler (n = 10), or both (n = 4). The mean diameter of the lesions was 0.8 cm (range 0.2 to 1.5 cm). Histologic analysis revealed metastatic disease in 13 patients and benign disease in 2 patients. All resection margins were free of tumor. The mean duration of chest tube drainage and postoperative hospital stay were 1.8 +/- 0.1 and 3.3 +/- 0.1 days, respectively. Mean operative time was 111 min (range 45 to 155 min). One patient who underwent a right thoracoscopic resection developed a transient left vocal cord paresis. There were no other complications and no deaths. Thoracoscopy was successful in identifying peripheral lung lesions and allowed for parenchymal sparing resection identical in extent to that performed with open approaches. For select patients with peripheral lung nodules felt to be metastases, thoracoscopic resection may result in reduced morbidity, cost, hospital stay and allow for more rapid institution of therapy for the primary disease.


Mycobacterium kansasii infection following primary pulmonary malignancy.

The purpose of this study was to determine whether any of the Mycobacterium kansasii cases were the consequences of primary lung malignancy. The records and chest x-ray films of 295 patients with M kansasii pulmonary infection were reviewed. The infection was found to complicate the primary lung neoplasm in four cases. Three patients had had treatment for malignancy: one patient with small cell carcinoma received chemotherapy, steroids and radiation; one with adenocarcinoma underwent a lobectomy and radiation; and the third patient had a lobectomy and radiation for malignant fibrohistiocytoma. The fourth patient developed the infection three years after lung malignancy manifested itself, which was only a few months before the clinical evidence of distant metastasis with adenocarcinoma was detected. We suggest that this infection be considered in patients from M kansasii endemic areas, especially after they have received radiation treatment for lung malignancy. This association has never been described before.


Role of chronic Pseudomonas aeruginosa infection in the development of bronchiectasis.

To understand the role of Pseudomonas aeruginosa infection in the development of bronchiectasis, we investigated by CT the presence of bronchiectasis in two groups of chronic bronchitis patients and in a control group. There were no differences in clinical or laboratory findings between groups A and B. Three observers without any knowledge of these patients reported bronchiectasis on a scale of 0 to 3 and bronchial wall thickness on a scale of 0 to 3 in each lobe of both lungs. Bronchiectasis and wall thickness scores in group A (chronic bronchitis with P aeruginosa infection) were significantly higher than bronchiectasis scores and wall thickness in group B (chronic bronchitis without P aeruginosa infection). Both scores in group B were higher than those in group C (control group). These findings support the idea that chronic P aeruginosa infection plays a role in the development of bronchiectasis.


Immunosuppressive acidic protein in patients with lung cancer.

Using a single radial immunodiffusion method, serum immunosuppressive acidic protein (IAP) was determined in 117 patients with primary lung cancer, 34 patients with benign lung disease, and 45 healthy control subjects. The mean value of IAP for patients with lung cancer was significantly higher than that of normal control subjects. There were no significant differences in IAP levels among different histologic types and among different stages of lung cancer. It was concluded that serum IAP level was elevated in patients with lung cancer, especially during the early postoperative period, and serial measurements of serum IAP were of value in monitoring lung cancer patients.


Long-term effects of hormone replacement therapy on Doppler-derived parameters of aortic flow in postmenopausal women.

Eighteen postmenopausal women were examined by Doppler echocardiography before initiation of HRT (T1), then after ten weeks (T2) and one year (T3). This study group was compared with another in which HRT was not used. Flow velocity integral, which correlates with SV, and MA, an indicator of cardiac contractility, were calculated. In the study group, PFV was 107 +/- 18 cm/s at T1 and increased significantly at T2 and T3. Ejection time, which was prolonged at T2 compared to T1, returned to its basal value at T3. Flow velocity integral increased at T2, but this change was only partially sustained at T3. Mean acceleration maintained its increase throughout T2 to T3. None of the Doppler parameters showed a significant change in the controls from T1 to T3. Our results suggest that the peripheral hemodynamic effects of HRT, such as vasodilatation, are transient, whereas the central effects (increased inotropism) are long-lasting.


Clinical risk assessment after first myocardial infarction--is additional noninvasive testing necessary?

In order to assess whether the outcome of MI can be predicted by clinical data alone or whether and how much noninvasive testing is necessary to predict cardiac events or death, 361 patients were prospectively evaluated and followed for up to five years. A recursive partitioning analysis indicated that high-risk patients can be identified clinically after MI with a high degree of accuracy; to separate low-risk patients who need no further investigation or therapy, however, one additional noninvasive test is necessary which allows quantification of myocardial damage as well as exercise-induced ischemia. Additional tests added little to this risk prediction, indicating that multiple noninvasive testing should not be performed.


Rapid left ventricular filling in untreated hypertensive subjects with or without left ventricular hypertrophy.

In this study, independent contribution of age, HR, BMI, casual and ambulatory blood pressure, LVM and LVEF in evaluating diastolic filling have been investigated in 34 never-treated hypertensive patients and in 15 healthy normotensive subjects. All the subjects were free from coronary artery disease, valvular disease, heart failure, renal disease and psychiatric problems. All the hypertensive subjects (never treated) were subgrouped according to presence or absence of LVH. The PFR decreased significantly and tPFR increased significantly in hypertensive patients in comparison with normotensive subjects and they did not change in the presence vs absence of LVH. The PFR was inversely correlated with BMI, age, 24-h mean SBP and with 24-h DBP. In multiple regression analysis, PFR decreased with BMI, age, 24-h mean SBP and DBP but not with LVMI. These results suggest that BMI, age and 24-h mean blood pressure were the major determinants of PFR abnormalities in hypertensive patients.


Accuracy of capnography in nonintubated surgical patients.

Previous studies have reported mixed results when correlating etCO2 and PaCO2 in mechanically ventilated patients with underlying respiratory disease. However, the utility and accuracy of capnography in nonintubated patients, without chronic pulmonary disease, has received little attention. We studied 25 nonintubated surgical patients to (1) examine the correlation between PaCO2 and etCO2 and (2) describe the relationship between dead space (VD/VT), venous admixture and P(a-et)CO2. End tidal CO2 was lower than PaCO2 by an average of 3.6 mm Hg. Regression analysis found a close correlation between dead space and the P(a-et)CO2 gradient (r = 0.77, p < 0.001), while venous admixture was of lesser importance (r = 0.47). Capnographic estimates of PaCO2 can be useful for continuously monitoring the respiratory status of nonintubated spontaneously breathing patients weaned from mechanical ventilation. This may be of particular value in trauma victims and in selected surgical patients without underlying respiratory disease in whom other injuries require continued critical care.


Rhodotorula rubra contamination in fiberoptic bronchoscopy.

Rhodotorula rubra was recovered in 18 bronchoscopic specimens from 15 patients from May to November 1987. One hundred and twenty-one bronchoscopies were performed during that period by two bronchoscopists (W. W.; R.D.) at Letterman Army Medical Center in San Francisco. Isolation of R rubra occurred in 11 bronchoalveolar lavage (BAL) specimens, four bronchial washes, and three transbronchial biopsies. Clinical infection was not present in any of these patients, although five were immunocompromised hosts. After a stepwise infection control review of the laboratory, the bronchoscopy suite, bronchoscopists, and the fiberoptic bronchoscope failed to recover the organism, a systematic evaluation of the cleaning procedure was undertaken. We discovered that replacement of the suction valve and the rubber biopsy valve on the biopsy channel immediately after cleaning allowed moisture to accumulate in these areas. Removal of both the suction valve and biopsy valve during periods of nonuse resulted in adequate drying of the biopsy channel and eradication of contamination from December 1987 to May 1990 (350 bronchoscopies). Epidemiologic and infection control surveillance is critical for bronchoscopy, especially when possible pathogens are recovered by BAL in the immunocompromised patient.


Cardiac isoenzymes following heart transplantation.

Creatine phosphokinase (CPK) isoenzymes are commonly obtained after heart transplantation (HT) to assess myocardial injury of the donor heart. This investigation retrospectively evaluated the utility of this practice. Fifty-six recipients of orthotopic heart transplants had at least two daily CPK-MB studies following HT. All patients were followed up for at least one year (or until death). Nineteen patients had entirely negative CPK-MB determinations (NEG). Eighteen patients had a single positive CPK-MB determination, and were considered to be equivocal (EQUIV). Nineteen patients had more than one daily positive CPK-MB determination (POS). To evaluate the influence of positive CPK-MB determinations on the outcome of HT, we compared the results in the NEG and POS groups. There was no difference in the donor organ ischemic times between the two groups. The duration of follow-up for the two groups was also similar (1,192 days vs 1,020 days). The NEG and POS groups had no significant difference in: 1 year survival (84 percent vs 74 percent); freedom from treated rejection episodes in 3 months (39 percent vs 42 percent); and freedom from coronary artery disease (CAD) at 3 years (83 percent vs 86 percent). Additionally, the ejection fractions of the donor hearts were similar at 1 year post-transplant for the 2 groups (64 percent vs 59 percent). We conclude that myocardial injury, as reflected by post-transplant CPK-MB levels, does not predict one-year mortality, predisposition to rejection, predisposition to coronary artery disease, or ultimate graft dysfunction. In an effort to perform HT more economically, we no longer obtain CPK-MB levels following HT.


Preoperative corticosteroids. A contraindication to lung transplantation?

Regular preoperative application of corticosteroids has been considered as a contraindication to lung transplantation for fear of an increased risk of postoperative morbidity and mortality. Recently, however, we have accepted patients for transplantation in whom treatment with steroid medication could not be terminated preoperatively. Up to February 1991, 27 unilateral and bilateral transplantations in 26 patients were analyzed. Corticosteroid therapy was discontinued at least three months prior to transplantation in 13 patients (group 1), whereas in 14 cases, the patients continued their daily corticosteroid therapy to the time of transplantation (prednisolone, 0.1 to 0.3 mg/kg/day; group 2). There were no significant differences between the groups with respect to sex, age, diagnosis, or type of transplantation. One limited bronchial dehiscence occurred; the incidence of postoperative bronchial stenosis was identical in both cohorts; one patient died in each group. In conclusion, no increased morbidity or mortality could be found following lung transplantation with regular preoperative administration of prednisolone up to 0.3 mg/kg/day. Thus, patients who cannot be weaned from their steroid medication but who otherwise are acceptable candidates should not be excluded from lung transplantation.


Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation. A prospective study.

To investigate the safety of total intravenous anesthesia and spontaneous assisted ventilation during interventional rigid bronchoscopy (IRB). Prospective, noncomparative study. A university hospital thoracic endoscopy and laser center. Eighty-three patients underwent a total of 124 procedures (including Nd:Yag laser therapy, stent insertions, transbronchial biopsies/bronchoalveolar lavages (TBB/BALs) in transplant patients and others). Results of preanesthesia consultation, endoscopic and anesthesia intervention, perioperative complications, and time spent in recovery room were recorded prospectively. Respiratory complications occurred in 22 procedures (18 percent) and included severe intraoperative or postoperative oxyhemoglobin desaturations (19 cases), bronchospasms/laryngospasms (two cases), and one recurrent pneumothorax. These complications were mostly related to the endobronchial surgical procedure. Respiratory complications occurred more frequently in patients with American Society of Anesthesiologists (ASA) 3 and 4 status (p < 0.005) and in patients with a karnofsky Performance Scale (KPS) below 70 (p < 0.05). No cardiac complications were noted, although 13 patients had significant underlying heart disease. Propofol was used in 121 procedures. Etomidate was used 15 times for induction and three times for both induction and maintenance in patients with ASA status 4 or low blood pressure before induction. Total intravenous anesthesia and spontaneous assisted ventilation is a well-suited technique for IRB. Severe hypoxemia, however, may occur in approximately 15 percent of patients. This complication is usually related to the procedure itself and is easy to reverse. Propofol is well tolerated in the majority of patients but it must be used with care in patients with poor functional or cardiovascular status.


Effects of the implementation of a smoke-free policy in a medical center.

The implementation of a smoke-free policy in this medical center was associated with a decrease in the prevalence of regular cigarette smoking from 16.7 percent to 13.8 percent and a smoking cessation rate of 22.5 percent among regular smokers over the 2 1/2 years since the policy was announced. This decrease in prevalence is the result of both smoking cessation among existing employees and less frequent regular smoking among new employees. At two-year follow-up, the policy was overwhelmingly endorsed by medical center staff overall but was viewed less favorably by those who continued to smoke. Nevertheless, over the 2 1/2 years, many of these smokers have been in the action stage of cessation (37.1 percent made a serious attempt to stop smoking, 20.7 percent had used nicotine polacrilex in a smoking-cessation effort, and 13.8 percent had attended a formal cessation program). The implementation of a smoke-free policy has made a significant contribution toward providing a healthful work environment and toward encouraging nonsmoking behavior in staff and patients.


Unimodal distribution of bronchial hyperresponsiveness to methacholine in asthmatic patients.

Distribution of bronchial hyperresponsiveness to methacholine was assessed in 791 consecutive patients who were referred to the outpatient clinic of the pulmonary department due to asthmatic or persistent lower airway symptoms. Bronchial asthma was diagnosed in 319 patients. Clinical sensitivity of methacholine challenge for the disease was 89 percent and specificity, 76 percent. The degree of bronchial hyperresponsiveness in the entire group of asthmatic patients was unimodally log normal distributed. Of the 82 patients with allergic rhinitis without concurrent asthma, 27 percent had bronchial hyperresponsiveness, but of a markedly lesser degree than in the hyperresponsive asthmatic patients. In 49 patients with chronic bronchitis, 22 percent had hyperresponsiveness. The present data indicate that the degree of bronchial hyperresponsiveness in asthmatic patients is unimodally distributed, supporting the view that both genetic and environmental factors have an impact upon its development. Although the degree of bronchial hyperresponsiveness in asthma is more pronounced than in allergic rhinitis or in chronic bronchitis, a marked overlap exists.


Formoterol suspension aerosol. Comparison with formoterol solution aerosol for 12 weeks in asthmatic patients.

Formoterol solution aerosol has proved to be a fast and long-acting beta 2-sympathicomimetic drug in many clinical trials. The physical stability, however, was such that storage needed to be at 4 degrees C to 8 degrees C before first use; afterwards, the aerosol could be used for another three months at room temperature. To improve the stability, new ways have been investigated to formulate ann aerosol with improved shelf life and thus more convenient storage conditions, which was reached with a formoterol suspension aerosol. Equivalent single doses between the two formulations revealed no differences in onset or duration of action. In a double-blind, randomized parallel group multicenter study, organized in the Netherlands, 186 patients with stable asthma and reversible airway obstruction were treated either with one puff of 12 micrograms twice daily of formoterol metered dose inhaler (MDI) supension (SP) or a same dose of solution (SL) aerosol for 12 weeks to study the efficacy and tolerability of both presentations after a longer period of use. The following criteria of effectiveness were used: the FEV1 values on the mornings of the control days at 0, +4, +8, and + 12 weeks, the peak flow values (PEF) in the mornings and in the evenings before, and 1/2 to 1 h after treatment, the number of asthma attacks at night and during the day, the number of extra puffs at night and during day, and the subjective impression of patients and investigator. No statistically significant differences between the two formoterol preparations were found. There was no indication of tachyphylaxis. The results are consistent with the hypothesis that the biologic effects of formoterol when delivered from MDI containing the two different formulations of the drug are equivalent.


Pathogenesis of the lung in restrictive defects of Klinefelter's syndrome.

Patients with Klinefelter's syndrome show a high incidence of restrictive lung defects, the pathogenesis of which is not clear yet. We investigated the respiratory muscle force (PImax) and lung compliance in 13 patients with Klinefelter's syndrome who had not been receiving hormonal therapy for at least one year prior to being studied. Eleven were smokers and two were nonsmokers. None showed abnormalities of the chest wall. Five had normal lung volumes and eight showed a restrictive defect (TLC < 80 percent, VC < 85 percent, FEV1/FVC percent within normal values); DCOSB and arterial blood gases were within normal limits. PImax was similar in restricted (-115.9 +/- 26.7 cm H2O) and not restricted patients (-115.4 +/- 20.3 cm H2O), all within reference values. Lung compliance, however, was significantly decreased in the four patients studied (0.13 +/- 0.08 cm H2O-1) compared with five normal control subjects (0.29 +/- 0.05 cm H2O-1). We conclude that the likely cause of the lung restriction is a decrease of compliance of the lung matrix, probably related to the absence of testosterone.


Effects of inverse ratio ventilation on cardiorespiratory parameters in severe respiratory failure.

Inverse ratio ventilation, with prolonged inspiratory times, appears to improve gas exchange and arterial oxygenation in patients with severe respiratory failure; however, in previous studies, pressure-controlled inverse ratio ventilation (PC-IRV), which uses a rapidly decelerating inspiratory flow pattern, was compared to conventional volume-controlled ventilation, which uses a constant inspiratory flow rate. Pressure-controlled ventilation (PCV), with a decelerating inspiratory flow pattern and conventional inspiratory-to-expiratory (I/E) ratios, also has been shown to produce improvement in PaO2 when compared to volume-controlled ventilation. It therefore is unknown if the potentially beneficial effects of PC-IRV are due to the reversal of I/E ratios or to the use of the rapidly decelerating inspiratory flow pattern. In order to investigate this issue, cardiorespiratory values were measured in ten patients with severe respiratory failure ventilated first with PCV, then PC-IRV, and finally with a second period of PCV. Tidal volume, respiratory rate, end-expiratory pressure, and fraction of oxygen in inspired gas (FIO2) were maintained at the same value for both ventilatory modalities. The PC-IRV was associated with significant increases in PaO2, arterial pH, and mean airway pressure. Significant decreases in pulmonary shunt fraction, PaCO2, and cardiac index were found with PC-IRV. No significant changes in tissue oxygen delivery or consumption occurred with either PCV or PC-IRV. These results demonstrate that inversion of conventional I/E ratios produces no significant improvement in the overall cardiorespiratory profile of critically ill patients. This study also suggests that the clinical utility of PC-IRV is limited except in the setting of the adult respiratory distress syndrome with hypoxemia or hypercapnia refractory to other therapeutic options.


Pneumonia due to Haemophilus influenzae among mechanically ventilated patients. Incidence, outcome, and risk factors.

Incidence and potential risk factors for pneumonia due to Haemophilus influenzae in adults treated with mechanical ventilation in a medical-surgical ICU were investigated. Diagnosis was established in 91 episodes and H influenzae was isolated in 20 of them. Mean onset of ventilator-associated pneumonia (VAP) due to H influenzae was 10.8 days after intubation. Six patients with H influenzae VAP died in the ICU. Of 13 risk factors for developing VAP due to H influenzae, an absence of prior antibiotic treatment was the only variable which had statistical significance (p < 0.001). In these mechanically ventilated patients, Haemophilus influenzae was a common causative agent for VAP, frequently associated with Gram-positive cocci. Episodes of H influenzae VAP were associated with a lower mortality compared with other etiologies. The epidemiologic and clinical findings indicate that patients without a prior antimicrobial treatment have increased susceptibility to infections of the airway by H influenzae.


Assessing hypermetabolism and hypometabolism in the postoperative critically ill patient.

To determine whether a patient is hypermetabolic or hypometabolic, measured resting energy expenditure is compared with estimated (or predicted) energy expenditure. The latter is calculated using equations derived from measurements made in groups of healthy individuals. Body weight or body surface area are among the variables used in these equations. Yet, in critically ill patients, body weight often rises because of fluid resuscitation. This study examined the differences between using preoperative, postoperative, and ideal body weights on the determination of hypermetabolism and hypometabolism in mechanically ventilated, critically ill patients. When the elevated postoperative weights were used instead of the preoperative ones to predict energy expenditure, the degree of hypermetabolism was underestimated. Subtracting the weight of the cumulative net fluid balance from the postoperative weight was found to accurately reflect preoperative weight. The influence of various predictive equations on the magnitude of hypermetabolism was also explored. In conclusion, it is important, when determining hypermetabolism or hypometabolism, to consider the influence of the specific predictive equation used and the effect of resuscitation fluid.


Anomalous systemic arterial supply to normal basilar segments of the lower lobe of the left lung.

A 38-year-old man with an anomalous systemic arterial supply from the descending thoracic aorta to the normal basilar segments of the left lower lobe experienced symptoms of progressive exertional dyspnea. Although the pulmonary parenchyma was normal, there was no pulmonary arterial supply to the basilar segments of the left lower lobe. Left lower lobectomy was performed because of worsening left-to-left shunt. Aortography and pulmonary arteriography form the cornerstone for diagnosis, but a less invasive diagnostic method with less patient suffering is high-resolution computed tomography, which might replace bronchography for accurate evaluation of the distribution and patency of the bronchial tree and delineation of the characteristic "Medusa's hair"-like anomalous vascular supply penetrating into the nearly normal pulmonary parenchyma.


Experimental polyacrylamide-induced acute injury in rat lung.

We recently reported the first case of accidental aspiration of polyacrylamide occurring in a 26-year-old man. The patient developed severe airway obstruction and parenchymal lung damage and died. Autopsy revealed numerous polyacrylamide particles in his lungs, as well as extensive bronchiolar and alveolar damage. Gas chromatographic and mass spectrometric assessment of the lung tissue failed to reveal polyacrylamide activity, although assessment of the suspending solvent of the polyacrylamide showed a pattern characteristic of an aliphatic hydrocarbon mixture with a prominent dodecane peak. This experimental study was performed to determine the nature and extent of damage to rat bronchial and alveolar epithelia following endotracheal instillation of polyacrylamide, hydrocarbon mixture (petroleum distillate), dodecane (C12H26), or normal saline. The rat lungs were examined grossly and microscopically 10 min and 24, 72, and 96 h after endotracheal instillation, following inflation and fixation with 10 percent buffered formaldehyde. Gross examination revealed congested, mottled visceral pleural surfaces in the rats treated with polyacrylamide and dodecane. There were no pleural exudates or effusions. Microscopically, vascular engorgement, bronchiolitis, and focal pneumonia were observed. Vascular engorgement was most pronounced at 72 to 96 h in rat lungs treated with polyacrylamide and dodecane and was moderate at 24 h in rats treated with petroleum distillate. Focal organizing pneumonia was marked at 96 h in rats treated with petroleum distillate, at 72 h in those treated with polyacrylamide, and at 24 h in those treated with dodecane. The saline-treated control animals showed no change. Our findings suggest that polyacrylamide, dodecane, and petroleum distillate are strong irritants to the airways. However, a direct obstructive/mechanical effect of the polyacrylamide upon the airway has not been excluded. Airway exposure to polyacrylamide may result in lung injury secondary to the polyacrylamide itself, its suspending agents, or both.


Propylthiouracil-induced hypersensitivity vasculitis presenting as respiratory failure.

Hypersensitivity vasculitis associated with propylthiouracil therapy is a well-documented clinical entity. Although any organ system may be involved, it is most unusual for pulmonary manifestations to be the cardinal presenting features. We report a 72-year-old woman presenting with respiratory failure and hemoptysis following initiation of propylthiouracil therapy for Graves' disease. She had cutaneous stigmata of hypersensitivity vasculitis and diffuse pulmonary infiltrates. The infiltrates improved dramatically after discontinuation of the propylthiouracil therapy and initiation of intravenous corticosteroid therapy.


Pulmonary amyloidoma. Histologic proof yielded by transthoracic coaxial fine needle biopsy.

Nodular pulmonary amyloidosis was diagnosed by percutaneous transthoracic fine needle biopsy specimen in an 88-year-old woman. Congo red staining should be performed whenever band-like hyalinized material is obtained on aspiration of a solitary nodule. Dense calcifications can occur in pulmonary amyloidomas. In selected cases, fine needle biopsy appears to be preferable to transbronchial forceps biopsy since the risk of a possibly life-threatening pulmonary hemorrhage may be lower.


Thrombosed prosthetic valve in tricuspid position. Successful therapy with intravenous streptokinase.

The successful use of streptokinase therapy in a child with chronic thrombosis of a prosthetic valve (Carbomedics) in the tricuspid position is presented.


Isolation of Legionella pneumophila serogroup 5 from empyema following esophageal perforation. Source of the organism and mode of transmission.

A patient undergoing esophageal dilatation for carcinoma of the esophagus suffered esophageal perforation and development of an empyema. Culture of pleural fluid yielded multiple organisms, including Legionella pneumophila serogroup 5. Epidemiologic investigation showed that the source of L pneumophila was a tap used by the nursing personnel to fill patients' water pitchers. Whole-cell restriction endonuclease analysis of DNA from the clinical and environmental isolates of L pneumophila serogroup 5 yielded identical patterns. Our findings suggest that L pneumophila was acquired by the patient at least 12 h prior to the procedure causing the esophageal perforation and empyema, suggesting that the organism can persist in an infectious form in the upper aerodigestive tract.


Tuberculosis of the thymus.

Tuberculosis is increasing in prevalence in North America, mainly due to HIV infection. We describe an unusual case of TB of the thymus in a HIV sero-negative Filipino immigrant who preoperatively was thought to have a thymoma. We describe the clinical, radiologic and pathologic findings and review the literature on TB of the thymus.


Christmas candy maker's asthma. IgG4-mediated pectin allergy.

We evaluated a 29-year-old candy maker with no history of asthma who developed asthma after exposure to pectin, a compound manufactured from fruits and fruit rinds. Following eight years of employment during which he added pectin to a recipe for Christmas candies, the candymaker developed acute respiratory symptoms. Challenge testing with the pectin mixture caused a 40 percent decrease in FEV1. Skin prick testing was positive to the pectin extract. Total IgE was normal and pectin-specific IgE antibodies were not detected. A strongly positive pectin-specific IgG4 antibody response was present that was not detected in a control serum and could be inhibited by the addition of pectin. Antigen-specific IgG4 should be sought in IgE negative cases of occupational asthma.


Pulmonary diffuse amyloidosis and ankylosing spondylitis. A rare association.

We report herein the association of primary pulmonary amyloidosis and ankylosing spondylitis. To our knowledge, this rare association has never been reported. This case reemphasizes that not all pulmonary complications that appear in the course of ankylosing spondylitis are related to the seronegative spondyloarthropathy. Primary pulmonary amyloidosis should be considered in patients with interstitial pulmonary disease.


Early congestive heart failure due to origin of the right coronary artery from the pulmonary artery.

We describe a two-month-old infant with early congestive heart failure due to anomalous origin of the right coronary artery from the pulmonary artery. The diagnosis was made by two-dimensional and color flow Doppler echocardiography, confirmed by angiocardiography, and the case was successfully corrected at surgery. As opposed to the more frequent anomalous origin of the left coronary artery from the pulmonary trunk, this anomaly generally does not cause any typical clinical finding, often becoming an autoptic or surgical surprise after infancy or in adult age.


Empyema following percutaneous catheter drainage of upper abdominal abscess.

Percutaneous catheter drainage is a standard therapy for management of selected intra-abdominal abscesses. We describe three patients in whom this technique caused complicated thoracic empyemas. All patients required thoracotomy for decortication despite initial thoracostomy tube drainage. In each case, the percutaneously placed drainage catheter was found traversing the costophrenic angle, leading to direct communication between the pleural space and the abscess cavity. Review of the anatomic relationships of the inferior pleural margin to the lower ribs may help prevent this technical error.


Extensive diffuse pulmonary ossification.

Diffuse lung injury can either heal normally or progress to fibrosis. Calcification in the setting of fibrosis is common. The appearance of mature woven bone is not. We report a patient with extensive diffuse pulmonary ossification and discuss some of the theories relating to the development of this phenomenon.


Ultrastructurally normal and motile spermatozoa in a fertile man with Kartagener's syndrome.

The findings in a 40-year-old man with Kartagener's triad (sinusitis, bronchiectasis, and situs inversus) and corrected transposition of the great vessels are presented. Electron microscopy revealed normal ultrastructure of the axoneme in both respiratory cilia and sperm tails. Light microscopic evaluation of the spermatozoa showed 50 percent motility, suggesting normal fertility. This assumption is confirmed, as the patient has two children. We suggest that an abnormal, uncoordinated motility pattern of the ultrastructurally normal respiratory cilia results in improper mucociliary clearance. This coordination is not needed in swimming spermatozoa, which could explain the apparent paradox between bronchopulmonary symptoms and normal fertility in our patient.


Dynamic left ventricular outflow obstruction related to atrial fibrillation.

A 48-year-old male patient underwent mitral annuloplasty for severe mitral regurgitation secondary to myxomatous degeneration of the mitral valve, with ruptured chordae. Intraoperative transesophageal echocardiography showed satisfactory repair. The patient developed postoperative atrial fibrillation and clinical and echocardiographic evidence of left ventricular outflow obstruction. Following conversion to sinus rhythm, the evidence for left ventricular outflow obstruction markedly improved. We suggest that postoperative atrial fibrillation may precipitate dynamic left ventricular outflow obstruction following mitral annuloplasty.


Successful medical therapy of Rhodococcus equi pneumonia in a patient with HIV infection.

A 34-year-old HIV-infected man was successfully treated with antimicrobial therapy alone for Rhodococcus equi pneumonia and has survived longer than six months. In the current literature, only two of seven HIV-infected patients so treated have survived as long as six months. Based on our experience and the available literature, it seems reasonable to treat HIV-infected patients with R equi pneumonia who do not require surgical intervention with prolonged intravenous therapy followed by long-term oral therapy with at least two effective antibiotics. The optimal choice and duration of antibiotic therapy need to be determined.


Clearance of theophylline by hemodialysis in one patient with chronic renal failure.

The clearance of theophylline by hemodialysis was determined in one patient who had polycystic kidney with chronic renal failure and bronchial asthma. The serum levels of theophylline were determined by enzymatic immunoassay on two consecutive days, once on a dialysis day and again on a nondialysis day. Clearance of theophylline by hemodialysis was 119 ml/min, and the extraction efficiency was 0.56. The elimination half-life of theophylline shortened from 5.7 h to 1.6 h during hemodialysis. The dialysis rate constant (Kd) was 0.32/h, and 79 percent of the total body store of the drug was removed during a 4-h dialysis. Patients receiving theophylline who are maintained on hemodialysis should be closely monitored for bronchospasm during and after the hemodialysis procedure. Measurement of serum concentrations of theophylline should be employed to facilitate increases in dosage during hemodialysis.


Imaging of multiple coronary artery fistulas to right ventricle by transthoracic and transesophageal echocardiography.

A 20-year-old woman presented with extremely rare multiple coronary artery fistulas with left circumflex and right coronary arteries as the feeding vessels and two distinct sites of drainage into the posterior wall of the right ventricle near the apex in close proximity. The large left fistula was well depicted by transthoracic echocardiography, whereas the transesophageal approach better delineated part of the smaller right fistula.


Positive pressure mechanical ventilation augments left ventricular function in acute mitral regurgitation.

Although inconclusively established, positive pressure ventilation may augment cardiac function in congestive cardiomyopathies. We report a patient with acute mitral regurgitation who experienced enhanced myocardial performance and resolution of large pulmonary artery v waves during mechanical ventilation. This observation supports the existence of a cardiac booster effect from positive pressure ventilation.


The advantage of d-sotalol over dl-sotalol in a patient with ventricular arrhythmias and comorbid bronchospasm.

The anti-arrhythmic agent sotalol, a racemic mixture of d- and l-isomers, has inherent beta-adrenoceptor blocking activity due to the l-isomer form. For patients with contraindications to beta-adrenoreceptor blockade, dl-sotalol has potentially untoward effects that may limit its usefulness. The case of a man with resistant life-threatening ventricular arrhythmias who responded favorably to dl-sotalol, but developed worsening of underlying bronchospastic lung disease, is presented. A change in therapy to the d-isomer form of sotalol, d-sotalol, was effective in suppressing his ventricular arrhythmias without further aggravation of bronchospasm.


Right coronary artery-right atrium fistula in primary angiosarcoma of the heart.

We report a case of angiosarcoma of the heart, manifested as a continuous murmur. Right coronary arteriography disclosed a paracardiac mass with fistulas from the coronary vessel to the right atrium. Histologic study revealed this to be an angiosarcoma with sinusoidal pattern. To our knowledge, this is the first case of this kind of cardiac tumor presenting as a fistula from a coronary artery to the right atrium.


Hemodynamic and oxygen transport patterns for outcome prediction, therapeutic goals, and clinical algorithms to improve outcome. Feasibility of artificial intelligence to customize algorithms.

A generalized decision tree or clinical algorithm for treatment of high-risk elective surgical patients was developed from a physiologic model based on empirical data. First, a large data bank was used to do the following: (1) describe temporal hemodynamic and oxygen transport patterns that interrelate cardiac, pulmonary, and tissue perfusion functions in survivors and nonsurvivors; (2) define optimal therapeutic goals based on the supranormal oxygen transport values of high-risk postoperative survivors; (3) compare the relative effectiveness of alternative therapies in a wide variety of clinical and physiologic conditions; and (4) to develop criteria for titration of therapy to the endpoints of the supranormal optimal goals using cardiac index (CI), oxygen delivery (DO2), and oxygen consumption (VO2) as proxy outcome measures. Second, a general purpose algorithm was generated from these data and tested in preoperatively randomized clinical trials of high-risk surgical patients. Improved outcome was demonstrated with this generalized algorithm. The concept that the supranormal values represent compensations that have survival value has been corroborated by several other groups. We now propose a unique approach to refine the generalized algorithm to develop customized algorithms and individualized decision analysis for each patient's unique problems. The present article describes a preliminary evaluation of the feasibility of artificial intelligence techniques to accomplish individualized algorithms that may further improve patient care and outcome.


Pathogenesis and management of acute heart failure and cardiogenic shock: role of inotropic therapy.

Patients with acute heart failure or cardiogenic shock following myocardial infarction have a high mortality. The first priority is to salvage any remaining viable myocardium, either by thrombolytic agents or, if necessary, by coronary angioplasty. A mechanical cause for the heart failure or shock needs to be excluded. Thereafter, the optimal therapeutic regimen needs to be chosen on the basis of each patient's hemodynamic profile. Patients can be broadly classified into three groups: (1) patients with a high left ventricular filling pressure (> 18 mm Hg) and a cardiac index < 2.2 L/min/m2 but systolic arterial pressure > 100 mm Hg; (2) patients with a systolic arterial pressure < 90 mm Hg, left ventricular filling pressure > 18 mm Hg, and cardiac index < 2.2 L/min/m2; and (3) patients with an elevated right ventricular filling pressure (> 10 mm Hg) and cardiac index < 2.2 L/min/m2 and a systolic arterial pressure < 100 mm Hg. Patients in the first subset usually require the use of vasodilator therapy and/or dobutamine. The choice of inotropic agent in patients in the second hemodynamic subset depends on the degree of systemic hypotension; dopamine is usually preferred initially because it increases arterial pressure in addition to improving cardiac output. Once the systemic blood pressure has been stabilized, dobutamine can be substituted for superior augmentation of cardiac output and its additional beneficial effects on the left ventricular filling pressure. Norepinephrine may be indicated in cases of severe systemic hypotension. Patients in hemodynamic subset 3, ie, right ventricular infarction, are treated with volume expansion and dobutamine. Use of nonpharmacologic means of circulatory support, eg, intra-aortic balloon pump or left ventricular assist device may also be required in any of these subsets.


Cognitive therapy with young children.

This paper discusses the common cognitive features characterizing children's most frequently referred problems, with an emphasis on the difficulties' prevalence, gender ratio, and family incidence. The efficacy of cognitive treatments is examined in terms of dropping-out, regression, and generalization. In view of Piaget's notion on the concrete thinking of children, it is suggested that cognitive therapy be adopted for children by translating abstract, holistic concepts into concrete examples and by relating to day-to-day events which children can use, relate to and understand. Two cases studies are presented to illustrate the cognitive therapeutic process with young children.


PTSD in physically and sexually abused psychiatrically hospitalized children.

The history of sexual and physical abuse and the diagnosis of PTSD were examined in 98 psychiatrically hospitalized children. Relative to past studies, there was an increased incidence of abuse and of prevalence of PTSD. Specific instruments for assessing abuse and PTSD are suggested.


Emotional disorders in learning disabled adolescents.

We retrospectively reviewed patients discharged from the psychiatric inpatient adolescent service and correlated neuropsychological subtypes with the patient's psychiatric diagnoses. Depressed learning disabled patients had visual memory and processing deficits. Conduct or behaviorally disordered patients had expressive language deficits. Learning disability subtypes may affect psychotherapy and therefore should be known when planning psychotherapy.


The relationship of suicidality and psychiatric diagnosis in hospitalized pre-adolescent children.

Two structured interview measures of suicidal behavior were administered to 43 child psychiatric inpatients between the ages of 7 and 11 and their parents. DSM-III-R diagnoses were assigned to the children, with twenty-six Axis I and Axis II diagnostic categories represented. Generally, the interview measures of suicidal behavior were found to be unrelated to psychiatric diagnosis. The results suggest that to better understand pre-adolescent suicidal behaviors, it may be more useful to examine associations between these behaviors and the biopsychosocial dimensions that underlie the diagnostic categories.


Are children who steal different from those who are aggressive?

Data on 2181 children referred to a child psychiatry service were analyzed to determine if there were specific correlates for aggressive behavior and for stealing behavior. Compared with stealers, aggressive children tended to be younger and more immature males, and to come from stressed families with a history of mental illness. These findings support the notion that there are biological and reactive components to aggression.


Characteristics of effective, harm-free environments for children in out-of-home care.

The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.


Policy and practice for response to foster families when child abuse or neglect is reported.

For reasons discussed in this article, it is in the nature of family foster care that allegations of abuse and/or neglect in foster homes will arise. How an agency acts before, during, and after these eventualities has long-lasting implications for the well-being of foster children and of foster parents and their own children, as well as for foster home recruitment.


Different effects of estradiol and progesterone on the secretion of calcitonin in ovariectomized rats.

The basal and calcium-stimulated secretion of calcitonin (CT) was studied in ovarian steroid hormone-injected ovariectomized (Ovx) rats. Ovx rats were injected subcutaneously once daily for 3 days with estradiol benzoate (EB, 25 micrograms/kg), progesterone (P, 50 mg/kg), EB and P, or sesame oil. All rats were then infused with 10% CaCl2 at a rate of 2 ml/h for 30 min via a femoral vein catheter connected to a peristaltic pump. Blood samples (0.5 ml each) were collected from the right jugular vein at 0, 30, 60, and 120 min. The concentration of plasma CT was measured by a human calcitonin radioimmunoassay. The level of plasma calcium was determined by an automatic calcium analyzer. The basal plasma CT level was significantly higher (p less than 0.01) in Ovx rats injected with P and the combination of EB and P than that in rats injected with oil. Ovarian steroid hormones injection did not alter plasma CT concentrations at 30 and 60 min following calcium infusion when compared with those injected with oil. Ninety min following termination of calcium infusion, plasma CT levels were higher (p less than 0.01) in EB- and both EB and P-injected Ovx rats than in oil-injected animals. EB or P injection had no effect on the basal plasma calcium concentration. Plasma calcium concentration at 30 min following calcium challenge was higher (p less than 0.01) in EB-injected Ovx rats than in control (oil-injected). These results suggest that (1) progesterone stimulates the basal secretion of CT, and (2) CT secretion in response to calcium infusion is stimulated in estradiol-treated ovariectomized rats.(ABSTRACT TRUNCATED AT 250 WORDS)


Integrating special-needs adoption with residential treatment.

Current estimates indicate that 76% of Iowa children whose parents' rights have been terminated and who are listed on the adoption exchange are older children with emotional/behavioral disabilities. Residential treatment can play a significant role in preparing difficult-to-place children (e.g., seven- to 14-year-olds with moderate to severe emotional or behavioral problems) for adoptive placement [Powers and Powell 1982]. The SATT model offers the opportunity to effectively manage the risks in adoptive placement for these children.


Preliminary studies of duration and intensity of ultrasonic treatments on fracture repair.

Bone formation of fractured fibulae stimulated by ultrasound was evaluated with roentgenography and fluorochromes labelling. The fibulae of male New Zealand rabbits were fractured to create a 3 mm-gap. Ultrasounds at 0.5 or 1.0 W/cm2 were applied for various durations, 5, 15, and 25 min/day for 4 weeks. Ultrasonic treatments at 0.5 W/cm2, 1.5 MHz significantly accelerated bone formation at the fracture site for all durations, whereas the higher intensity at 1.0 W/cm2 suppressed the bone formation of the treated fractured fibula. Ultrasounds at 0.5 W/cm2 were stimulatory to fracture repair, if given for 15 min/day, and were recommended for future clinical trials. However, ultrasounds at the intensity of 1.0 W/cm2 were deleterious to the treated fracture and not recommended for clinical trials.


Cognitive-behavioral-expressive interventions with aggressive and resistant youths.

Research into the nature of aggressive behavior in youths has demonstrated that these youths are often the victims of abuse, exhibit aggressive behavior in early childhood, and remain aggressive into young adulthood. The treatment approach described in this article is a modification of Monahan's [1981] model of the prediction of violent behavior and the anger-management approach of Novaco [1985], and integrates the developmental models of Piaget [1963] and Erikson [1959]. The program is a combination of cognitive, behavioral, and expressive therapies and is targeted to the reduction of dysfunctional cognitive, affective, behavioral, and problem-solving patterns of aggressive youths. As referrals of such aggressive clients are often involuntary, interventions with unwilling and resistant clients are also presented.


Ultrasonic effect on fracture repair and prostaglandin E2 production.

Ultrasound has been recently recognized of its potential in promoting fracture healing. However, its effects on bone healing remain unclarified. The present study was initiated to compare the effects of frequency on fracture healing and the possible role of endogenous prostaglandin E2 in fracture healing stimulated by ultrasound. Histologic evaluation of callus formation with labelled fluorochromes indicated that the use of ultrasound at 1.5 MHz was most effective in accelerating bone healing. In addition, at this frequency, the endogenous PGE2 level was significantly elevated, which paralleled the accelerated bone healing. It is suggested that bone healing stimulated by ultrasound may be mediated via the production of PGE2.


The effects of heavy eccentric contractions on serum creatine kinase levels.

Post-exercise serum creatine kinase (CK) has been frequently used to evaluate muscle damage. The purpose of present study was to examine the effects of 45 eccentric contraction on serum creatine kinase levels during laboratory tests. Using a Lido isokinetic dynamometer, thirteen subjects (five distance runners and eight PE students), average age = 24.0 (yrs), height = 172.5 (cm), weight = 66.5 (kg), and percent body fat = 15.3 (%), completed 5 and 40 eccentric contractions at speed of 60 degrees C/s and 120 degrees/s, respectively. Blood sample was drawn before and 18, 42, 66, 90 hours after exercise protocol. Result indicated that PE students have a significant increase in serum CK levels post-exercise 18 hours (p less than 0.05) only. Both groups in absolute muscular strength or corrected strength have found non-significant difference (p greater than 0.05). Resulting findings showed that training effect may be an important factor for CK leakage rather than lean body mass. In the light of results, it is seem safe to say that the exercise protocol for distance runners using by this study would not contribute to severe CK elevations in blood. This testing protocol can be recommended as an appropriate test for students and distance runners with similar fitness level. Due to large variations occurred during CK testing, follow-up study should try to establish baseline serum CK level by repeated enzyme tests.


Drug effects on the ischemia- and reperfusion-induced arrhythmias in the conscious rats.

A simple model of coronary occlusion and reperfusion in conscious rat was used to test the effects of various drugs on the arrhythmias. Blood pressure and ECG were monitored on a Grass polygraph. Intravenous infusion of test agents started before coronary occlusion and continued through the periods of occlusion and reperfusion. The free radical scavengers (allopurinol 12.3 mg/kg, mannitol 33.0 mg/kg, N-2-mercapto-propionyl glycine 8.6 mg/kg and adenosine 10.0 mg/kg), class 1-4 antiarrhythmic drugs (lidocaine 10.2 mg/kg, quinidine 12.3 mg/kg, propranolol 4.9 mg/kg, amiodarone 5.6 mg/kg and verapamil 1.1 mg/kg), aspirin 24.5 mg/kg and benadryl 3.7 mg/kg reduced the incidence of ventricular fibrillation and shortened the duration of arrhythmias during occlusion and reperfusion. Cimetidine 6.9 mg/kg was ineffective to exert the antiarrhythmic action. These results implicate that multiple factors, such as ionic channels (Na, K and Ca), free radicals, arachidonate metabolites and histamine release may play significant roles in genesis of arrhythmias during myocardial ischemia and reperfusion.


Gay and no place to go: assessing the needs of gay and lesbian adolescents in out-of-home care settings.

Gay and lesbian adolescents, whether self-declared or in the throes of sexual identity struggles, are and have been in out-of-home care settings. Their placements are often negative experiences because their feelings of difference are frequently aggravated by the attitudes of those around them, including other children and some staff members. This article discusses factors that can help make placement a positive experience for these youths.


Junior life skills: an innovation for latency-age children in out-of-home care.

Children age seven to 13 in out-of-home care should be given instruction in basic life skills, just as their older counterparts are prepared for independent living. One program that provides such instruction is detailed here.


Fostering homeless children and their parents too: the emergence of whole-family foster care.

Children should not be placed in out-of-home care simply because their families lack the means to provide for their basic needs, yet this practice continues nationwide. A new program based in St. Paul, MN, gives county social service departments the placement option of whole-family foster care. The target population is adult parents and minor children without stable residences, where the children are at risk of placement in out-of-home care. Although the parents and children may have special needs, there are no safety risks that would necessitate separating children and parents. The program's design is described and policy questions discussed.


The treatment of congenital hip dislocation between the ages of 1 and 3.

A total of 81 patients (103 hips) with a diagnosis of congenital hip dislocation were reviewed, who had been treated between one and three years of age. All of the patients were initially treated with adhesive band traction prior to non-surgical reduction, which was performed under general anesthesia using gentle reduction maneuvers followed by immobilization in plaster. Non-surgical reduction was performed in 69 hips (67%), surgical in the remaining 34 (33%). A total of 91 associated surgical procedures were performed for the treatment of residual subluxation. Average follow-up was 12 years (minimum 5, maximum 19). The clinical results of the non-surgical reductions were excellent in 75% of the cases. Radiographically, 48% are hips which have a normal aspect, while 42% have a moderate degree of residual dysplasia or deformity of the femoral epiphysis and of the acetabulum. Hips that were initially classified as grade III dislocations show fair results. Hips treated non-surgically included 11 cases of avascular necrosis (16%); recovery was adequate. Hips treated surgically included 14 cases of avascular necrosis (30%), which was more accentuated in those hips that had initially been treated elsewhere, and in those classified as grade III. The clinical and radiographic results obtained for the hips treated surgically demonstrate poor results in 17% of the cases (6 out of 34), as a consequence of types III and IV osteochondrosis. It may be concluded that in this age group congenital hip dislocation is best treated by non-surgical reduction, possibly followed by surgery of the femur and acetabulum. Surgical reduction was only indicated when conservative methods failed.


Treatment of the sequelae of septic osteoarthritis of the hip during pediatric age.

A total of 69 cases (73 hips) of the sequelae of septic osteoarthritis of the hip are studied. The sequelae are classified based on whether or not the femoral epiphysis is present, and on stability of the joint according to Hunka (1982). Three of the hips were treated non-surgically. All of the others were submitted to from a minimum of 2 to maximum of 5 operations with the purpose of re-establishing joint relationships. The results were: good: 50 hips (72.5%); fair 12 (17.4%); poor: 11 (16%). The most significant sequelae were hip instability, joint function limitation, and shortening of the limb.


Traumatic lesions of the triradiate cartilage.

Traumatic lesions of the triradiate cartilage (TC) are a rare occurrence and at a high risk for premature closure with consequent acetabular dysplasia and subdislocation of the femoral epiphysis. Based on their experience (5 cases: 2 type II and 3 type V according to the Salter-Harris classification system) and on the literature, the authors affirm that the most significant prognostic factors of this acetabular dysplasia are the age of the patient (under 10 years) and the type of lesion (Salter-Harris type V). After emphasizing how difficult it is to make a diagnosis (which is often made later on), the authors take into consideration some traumatic lesions of the pelvis and hip which by means of different mechanisms may influence the TC: fracture of the ilio- and ischio-pubic branches, fracture of the neck and detachment of the proximal epiphysis of the femur, traumatic dislocation of the hip. These lesions are often the only indirect sign of lesion, even severe ones, of the TC, and require accurate diagnostic testing (ultrasonography, CAT, MRI).


Primary osteonecrosis in the knee evaluated by histopathology and specimen scintimetry related to clinical radiography, scintimetry and MR.

Arthroplasty for primary osteonecrosis of the femoral condyle of the knee was performed in 5 patients and the resected pieces of bone were studied histologically. The patients had been given 99 mm-Tc-MDP preoperatively and the scintimetric uptake in the resected bone pieces was determined. All patients had changes typical for osteonecrosis preoperatively on radiographs and scintimetry. In one case MRI investigation was performed. The histological investigation showed necrotic bone with empty lacunae and fatty degeneration corresponding to the osteonecrosis center. A reparative bone formation, osteoblastic activity, cartilage formation and bands of fibrovascular granulation tissue were observed at the borders to intact bone. The scintimetric uptake of the resected bone pieces showed a high uptake corresponding to the osteonecrosis center. The MR examination showed a well demarcated osteonecrotic region. The findings emphasize the localized nature of the osteonecrosis disease.


A method used to evaluate knee osteoarthritis secondary to ligament reconstruction.

Serious ligament injuries of the knee always involve early secondary arthritic lesion. Surgical reconstruction of the injured ligaments can partially prevent the degenerative process. Nonetheless, surgical trauma may, in turn, cause articular lesion. The authors suggest and discuss a new method used to evaluate knee osteoarthritis occurring after ligament reconstruction, which may be of use to an objective opinion based on long-term results. What makes this method original is that it is based on a comparison of radiographic parameters observed during examinations of the injured knee at the time of surgery and at follow-up.


Autoplastic grafting from the iliac wing: surgical technique, indications and complications.

The authors describe the surgical technique used to obtain (by anterior and posterior access) autoplastic bone from the ilium in 186 oncological cases. Indications, the results obtained and the principal causes of complications are discussed.


Arthroscopic arthrolysis of intra-articular knee stiffness.

The authors report 15 cases of intra-articular knee stiffness treated by arthroscopic arthrolysis with or without section of the alar ligaments. The advantages to using this type of treatment as compared to mobilization in narcosis or arthrotomic arthrolysis are emphasized.


One case of fracture of the tibial tuberosity in the adult.

The authors report a case of fracture of the anterior tibial tuberosity in an adult. The discussion involves the etiopathogenetic differences of fractures occurring in the adult, as compared to avulsion-fracture in the young patient. The individual features of an unusual direct trauma of the knee could explain the rareness of the clinical case presented.


Epiphyseal plate fracture-separation of the olecranon: description of one case.

A rare case of traumatic olecranal epiphyseal plate fracture-separation in a patient aged 14 years is described. Non-surgical treatment was not capable of guaranteeing fracture reduction. Thus, internal fixation with tension band wire method, like in fracture of the same type in the adult, was used.


Pulsing electromagnetic fields (PEMFs) in spinal fusion: preliminary clinical results.

Pulsing electromagnetic fields (PEMFs) were used during the postoperative management of 31 patients submitted to lumbosacral posterolateral fusion (PLF). The fusions were stimulated with PEMFs during the first 2 of the 4 months of postoperative immobilization. Consolidation of PLF was obtained in 20 of the 31 patients after 2 months of stimulation, thus, healing time was cut in half. After 4 months, fusion was observed in 30 out of the 31 cases submitted to stimulation (96%).


Avulsion of the long head of the triceps in kidney transplant.

The authors describe a case of avulsion of the long head of the triceps in a patient with kidney transplant. An analysis of the case and a review of the literature suggest weakening of the osteotendinous junction due to the associated action of renal osteodystrophy and cortisone therapy.


[Lung embolisms in a surgical patient sample. A retrospective study over 9 years].

In a retrospective study of surgical patients during a period of 9 years 296 cases of pulmonary embolism were recorded by analysing autopsy findings and perfusion pulmonary scans. The frequency of pulmonary embolism among patients who underwent a surgical procedure was 0.55%, the frequency of lethal pulmonary embolism was 0.15%. In autopsy disseminated micro-pulmonary embolism were often found (n = 129, 44%). With regard on the preceding operation a high frequency of pulmonary embolism after septic abdominal surgery (1.5%) and vascular surgery (0.9%) became obvious, especially after operations on the abdominal or thoracic aorta (2.1 resp. 4.8%). In 198 cases venous thrombosis were found. 104 (52%) of these were located in the cranial venous system and in 46 patients there was a connection to the site of central venous lines.


[Incidence of carcinoma in follicular neoplasia of the thyroid gland].

Within four years 1376 thyroid operations were performed. In 152 = 11% a follicular or oncocytic tumor was found, 20 = 13% of these were classified as carcinoma. Seven of these were of the grossly invading type, raising suspicion of malignancy already pre- and intraoperatively while 13 encapsulated tumors were found by the pathologist only. If preoperatively a cold nodule or a nodular goitre was described, the carcinoma incidence was about 16%, while warm or hot nodes showed a carcinoma in 2%. Besides tumors of < 1 cm in diameter where we found no carcinoma the size of follicular tumors had no influence on the incidence of carcinomas.


[Electromyography findings of pelvic floor muscles in patients with anorectal incontinence].

In the presented study the electromyographical signs of the sphincter muscle of 14 patients with incontinence of the faeces are described and compared with those of a group of continent controls. We found significant differences in the duration of the action potential, the average amplitude, the frequency of polarity turns and the integral of the curves. The application of automatic EMG-analysers allows exact differentiation between neurogenic and myogenic disturbances as well as conclusions about the functional integrity of the m. sphincter ani externus and m. puborectalis. The electromyography as a dynamic diagnostic method is a valuable enrichment of the equipment for diagnostic evaluation of the diseases of the pelvic floor. It will be of increasing importance in the differential diagnosis of the incontinence of the faeces and of pudendus nerve lesions as well as in any disease in which a denervation of the parietal or visceral muscles of the pelvic floor is involved.


[Necrotizing fasciitis. Case report and review of the literature].

The necrotizing fasciitis is an infection with no or only a small trauma. It is a rapidly progressing process especially with necrosis and edema of subcutaneous fat and adjacent fascia underlined by systemic toxicity but spearing of skin and muscle by the initial process. Late recognition and lack of immediate aggressive surgical treatment contribute to the distressingly high mortality. Early and complete debridement offers the best chance for cure.


Code domains in tandem repetitive DNA sequence structures.

Traditionally, many people doing research in molecular biology attribute coding properties to a given DNA sequence if this sequence contains an open reading frame for translation into a sequence of amino acids. This protein coding capability of DNA was detected about 30 years ago. The underlying genetic code is highly conserved and present in every biological species studied so far. Today, it is obvious that DNA has a much larger coding potential for other important tasks. Apart from coding for specific RNA molecules such as rRNA, snRNA and tRNA molecules, specific structural and sequence patterns of the DNA chain itself express distinct codes for the regulation and expression of its genetic activity. A chromatin code has been defined for phasing of the histone-octamer protein complex in the nucleosome. A translation frame code has been shown to exist that determines correct triplet counting at the ribosome during protein synthesis. A loop code seems to organize the single stranded interaction of the nascent RNA chain with proteins during the splicing process, and a splicing code phases successive 5' and 3' splicing sites. Most of these DNA codes are not exclusively based on the primary DNA sequence itself, but also seem to include specific features of the corresponding higher order structures. Based on the view that these various DNA codes are genetically instructive for specific molecular interactions or processes, important in the nucleus during interphase and during cell division, the coding capability of tandem repetitive DNA sequences has recently been reconsidered.


Meiotic chromosome condensation and pairing in Saccharomyces cerevisiae studied by chromosome painting.

Non-isotopic high resolution in situ hybridization was applied to cytological preparations of sporulating yeast cells. Ribosomal DNA (rDNA) and chromosome V-specific recombinant lambda clones were used to tag individual chromosomes and chromosome subregions. This allowed the study of chromosome behaviour during early meiotic prophase. It was found that chromatin becomes condensed and homologous DNA sequences then appear to become aligned prior to synaptonemal complex formation.


Gene mapping studies confirm the homology between the platypus X and echidna X1 chromosomes and identify a conserved ancestral monotreme X chromosome.

The identification of the sex chromosomes in the three extant species of Prototherian mammals (the monotremes) is complicated by their involvement in a multivalent translocation chain at the first division of male meiosis. The platypus X chromosome, identified by the presence of two copies in females and one in males, has been found to possess a suite of genes that have been mapped to the X chromosomes of all eutherian and metatherian mammals. We have extended gene mapping studies to a member of the only other extant monotreme family, the echidna, which has a G-band equivalent X1 chromosome, as well as a smaller X2. We find that the five human X-linked genes (G6PD, GDX, F9, AR and MCF2) map to the echidna X1 chromosome in locations equivalent to those on the platypus X. These results confirm that the echidna X1 is the original X chromosome in this species, and identify a conserved ancestral monotreme X chromosome.


Identification of human satellite DNA sequences associated with chemically resistant nonhistone polypeptide adducts.

A fraction of DNA fragments of highly purified and completely unfolded eukaryotic DNA inevitably remains associated with chemically resistant nonhistone DNA-polypeptide complexes. This fraction can be isolated by nitrocellulose filtration because the polypeptide-associated DNA fragments are retained on nitrocellulose filters while bulk DNA passes through the filters. The fraction of AluI-fragmented DNA from human placenta retained on filters as a result of the binding factors (R-DNA, approximately 12%) represents a subset of genomic sequences with a sequence complexity different from unfractionated DNA and DNA recovered in the filtrate (F-DNA). DNA sequences prevalent in the retained fraction were detected by differential plaque hybridization of a recombinant lambda gt10 library with radiolabeled F- and R-DNA fractions. Several recombinant phages showing much stronger hybridization signals with the R-DNA probe than with the F-DNA probe were selected, plaque-purified and analyzed. Analysis of the inserts of such clones showed that repetitive DNA sequences of the alphoid dimeric and tetrameric family, satellite III and satellite III-like sequences are highly enriched in the retained fraction, which indicates that these sequences specifically attract the polypeptides involved in the tightly bound and resistant complexes. This property of repetitive sequences is of interest since tandemly repetitive sequences have been suggested to code for locus-specific fixation and stabilization of the chromatin fiber in the cell nucleus.


A cDNA clone for a novel nuclear protein with DNA binding activity.

In an effort to identify trans-acting factors regulating specific genes, we cloned a novel human gene, DBP-5. The cDNA clone contains a predicted open reading frame coding for a potential 1,179 amino acid protein. The mRNA corresponding to DBP-5 is ubiquitously distributed, and the gene is phylogenetically conserved. Immunofluorescence analyses with several cell lines indicate that the protein is localized to the nucleus. Sequence analysis revealed unusual features of the predicted protein structure, including four completely conserved repeats. The phylogenetic conservation of DBP-5, the ubiquity of its expression, its nuclear localization, and its ability to bind DNA sequences, raise the possibility that DBP-5 may play a role in the organization of interphase chromatin and/or in transcriptional regulation.


MSA-36: a chromosomal and mitotic spindle-associated protein.

We have identified a novel M(r) 36,000 protein (MSA-36) that has a complex cell cycle dependent distribution. This protein is first detected in interphase nuclei just prior to the onset of chromosome condensation. MSA-36 is found along condensing chromosomes and is a component of the centromere through metaphase. At anaphase, this protein is no longer detected in association with the chromosomes but appears at the forming stembodies and subsequently within the intercellular bridge at either side of the midbody. At the completion of cell division, the amount of MSA-36 in the bridge appears to decline concurrent with the appearance of this protein briefly within the reforming nucleus. To investigate whether MSA-36 is an active component of the chromosome or a passive passenger protein, we studied the behaviour of this protein in cells exhibiting premature chromosome condensation and in cells during and following recovery from mitotic arrest. These studies suggest that MSA-36 is not essential for a variety of major chromosome-associated events.


Chromosome ends in Chironomus pallidivittatus contain different subfamilies of telomere-associated repeats.

Tandemly repeated 340 bp sequences, TA repeats, are present in seven of the eight pairs of chromosome ends in Chironomus pallidivittatus, being absent from the telocentric left end of chromosome four. We have previously shown that the family of TA repeats consists of four main subfamilies. One subfamily is composed of a master unit and the other three contain derived units, each of which has a small region where the master sequence is highly mutated. Here we find that there are considerable variations in numbers of TA repeats between animals and for the same telomere in different animals. We also show that the seven telomere pairs containing TA repeats differ with regard to the content of derived subfamilies. The master unit is probably present in all seven pairs. Two of the derived units are exclusively present in two telomere pairs. The third derived unit shows a more irregular distribution. Some of the telomeres have highly variable contents of such units among animals. Subfamilies thus have different behaviour as reflected in their stable and variable patterns of distribution between individual telomeres.


The DNA fragments produced by AluI and BstNI digestion of fixed mouse chromosomes.

AluI and BstNI restriction endonucleases were used to study cytological and biochemical effects on centromere DNA in fixed mouse chromosomes. These enzymes were employed, as it is known that AluI is incapable of attacking major satellite DNA, contrary to BstNI that is known to cut this DNA fraction into monomers of 234 bp. After digestion in situ, electrophoretic analysis was carried out to characterize the DNA purified (1) from the material remaining on the chromosomes and (2) from the material solubilized from chromosomes. The DNA was then transferred to a nylon filter and 32P-labelled major satellite DNA was used as a probe for hybridization experiments. Other preparations were simply stained with Giemsa after digestion in situ with AluI and BstNI. Our results show that although restriction endonuclease cleavage primarily depends on DNA base sequence, this factor is not always sufficient to explain nuclease-induced cytological effects. In fact, the structural organization of peculiar regions such as the centromeres of mouse chromosomes might affect cleavage efficiency when restriction enzyme digestion is performed in situ.


Distribution of XhoI and EcoRI family repetitive DNA sequences into separate domains in the chicken W chromosome.

Fluorescence in situ hybridization using as probes three biotinylated or digoxigenin-labeled chicken W chromosome-specific repeating DNA units (0.7 and 1.1 kb XhoI family and 1.2 kb EcoRI family units) suggested that a large fraction of one arm of the W chromosome was occupied by the EcoRI family sequences and that pericentromeric regions were widely occupied by the XhoI family sequences. A minor fraction of the EcoRI family was also present in a narrow region in the proximal half of the other arm. There was a region in the distal half of the latter arm where sequences from neither family hybridized. Evolutionary aspects of the presence of different domains occupied by different repetitive families and the significance of the unhybridized distal region are discussed.


Deficiency of X and Y chromosomal pairing at meiotic prophase in spermatocytes of sterile interspecific hybrids between laboratory mice (Mus domesticus) and Mus spretus.

The normal association between the X and Y chromosomes at metaphase I of meiosis, as seen in air-dried light microscope preparations of mouse spermatocytes, is frequently lacking in the spermatocytes of the sterile interspecific hybrid between the laboratory mouse strains C57BL/6 and Mus spretus. The purpose of this work is to determine whether the separate X and Y chromosomes in the hybrid are asynaptic, caused by failure to pair, or desynaptic, caused by precocious dissociation. Unpaired X-Y chromosomes were observed in air-dried preparations at diakinesis, just prior to metaphase I. Furthermore, immunocytology and electron microscopy studies of surface-spread pachytene spermatocytes indicate that the X and Y chromosomes frequently fail to initiate synapsis as judged by the failure to form a synaptonemal complex between the pairing regions of the X and Y chromosomes. Several additional chromosomal abnormalities were observed in the hybrid. These include fold-backs of the unpaired X or Y cores, associations between the autosome and sex chromosome cores, and autosomal univalents. The occurrence of abnormal autosomal and XY-autosomal associations was also correlated with cell degeneration during meiotic prophase. The primary breakdown in hybrid spermatogenesis occurs at metaphase I (MI), with the appearance of degenerated cells at late MI. In those cells, the X and Y are decondensed rather than condensed as they are in normal mouse MI spermatocytes. These results, in combination with the previous genetic analysis of spermatogenesis in hybrids and backcrosses with fertile female hybrids, suggest that the spermatogenic breakdown in the interspecific hybrid is primarily correlated with the failure of XY pairing at meiotic prophase, asynapsis, followed by the degeneration of spermatocytes at metaphase I. Secondarily, the failure of XY pairing can be accompanied by failure of autosomal pairing, which appears to involve an abnormal sex vesicle and degeneration at pachytene or diplotene.


Involvement of chromatid cohesiveness at the centromere and chromosome arms in meiotic chromosome segregation: a cytological approach.

Kinetochores and chromatid cores of meiotic chromosomes of the grasshopper species Arcyptera fusca and Eyprepocnemis plorans were differentially silver stained to analyse the possible involvement of both structures in chromatid cohesiveness and meiotic chromosome segregation. Special attention was paid to the behaviour of these structures in the univalent sex chromosome, and in B univalents with different orientations during the first meiotic division. It was observed that while sister chromatids of univalents are associated at metaphase I, chromatid cores are individualised independently of their orientation. We think that cohesive proteins on the inner surface of sister chromatids, and not the chromatid cores, are involved in the chromatid cohesiveness that maintains associated sister chromatids of bivalents and univalents until anaphase I. At anaphase I sister chromatids of amphitelically oriented B univalents or spontaneous autosomal univalents separate but do not reach the poles because they remain connected at the centromere by a long strand which can be visualized by silver staining, that joins stretched sister kinetochores. This strand is normally observed between sister kinetochores of half-bivalents at metaphase II and early anaphase II. We suggest that certain centromere proteins that form the silver-stainable strand assure chromosome integrity until metaphase II. These cohesive centromere proteins would be released or modified during anaphase II to allow normal chromatid segregation. Failure of this process during the first meiotic division could lead to the lagging of amphitelically oriented univalents. Based on our results we propose a model of meiotic chromosome segregation. During mitosis the cohesive proteins located at the centromere and chromosome arms are released during the same cellular division.(ABSTRACT TRUNCATED AT 250 WORDS)


The ultrastructure of the chromosome periphery in human cell lines. An in situ study using cryomethods in electron microscopy.

We studied the chromosome periphery in human HeLa and TG cells using cryomethods in electron microscopy. A contrasted layer of peripheral chromosomal material (PCM) was visible in cryo-ultrathin sections of mitotic cells. This PCM was composed of closely packed fibrils associated with granules. The PCM did not cover the entire chromosome surface but was found around most of the chromosomes and even between two chromatids. The organization of the PCM was not affected by colchicine treatment of mitotic cells. In cells prepared by quick-freezing, the PCM appeared to be a fibrous material at the chromosome periphery, and was also associated with granules that resembled inter-chromatin granules in size and shape. At higher magnification, direct contacts between the chromosomes and the fibrils of the PCM were observed. The cryotechniques used are known to preserve the native organization of cells. Therefore, the architecture of the perichromosomal region analysed presumably corresponds to that in vivo during mitosis. These observations show that in HeLa and TG cells, a particular structure present at the chromosome periphery in the form of PCM is persistent and ubiquitous. In addition, we showed by immunolabelling that the PCM is the specific site of accumulation of nucleolar antigens during mitosis. These two results, i.e. the identification of specific morphological structures and the compartmentation of proteins, indicate that this layer is a specific region of mitotic cells.


Male and female segregation distortion for heterochromatic supernumerary segments on the S8 chromosome of the grasshopper Chorthippus jacobsi.

The mode of inheritance of supernumerary segments located on three different chromosome pairs was investigated in controlled crosses with specimens of the grasshopper Chorthippus jacobsi. While extra segments located on chromosomes M5 and M6 showed Mendelian inheritance, that on S8 did not. Thus, the two supernumerary heterochromatic chromosome segments located distally on the S8 chromosome accumulated through non-Mendelian transmission through both sexes. The observed transmission patterns may be explained by gametic selection for spermatozoa carrying segmented S8 chromosomes, in addition to meiotic drive for segmented S8 chromosomes in heterozygous females. The significance of these findings for the maintenance of these polymorphisms in natural populations is discussed.


The Drosophila nuclear protein Bx42, which is found in many puffs on polytene chromosomes, is highly charged.

The Drosophila nuclear protein Bx42 is present in a set of transcriptionally active puffs on polytene chromosomes. cDNA clones coding for this protein were isolated from a lambda gt11 expression library. The two Bx42 transcripts are ubiquitously expressed and are already detectable in early stages of development. The corresponding genomic region, in 8C7-8, was isolated and sequenced. Both transcripts direct the production of the same basic, highly charged 547 amino acid protein with a calculated 61.1 kDa molecular weight.


[A study of the effect of fish oils on the risk factors of cardiovascular and cerebrovascular diseases].

In this study 22 normotensive (NT) and 12 essential hypertensive (EHT) subjects were included to test the possibility that fish oils might influence the blood pressure, plasma lipids and fibrinogen as well as the erythrocytic membrane lipid composition and pump activity. Each EHT subject was given capsules containing fish oils (6 g/d) for 18 days. At the end of the study, SBP fell (P < 0.05) and plasma fibrinogen level decreased (P < 0.05), while DBP, TG, TC, and HDL-C showed no significant change. The fatty acid composition of erythrocyte phosphatidyl ethanolamine (PE) and phosphatidyl choline (PC) showed the following changes: in PE, C22:6, C20:5 increased (P < 0.05; P < 0.01), CI18:1 decreased (P < 0.01); in PC C22:6, C22:4 increased (P < 0.05; P < 0.01). The activity of Na+, Ca2+ max, CaM-stimulated Ca2+ pumps increased (P < 0.05; P < 0.01; P < 0.01). As compared to NT, EHT subjects had higher C20:4 in both PE (P < 0.05) and PC (P < 0.01) and lower C18:2 in PC. It is also shown in this study that EHT subjects have higher C20:4 in both PE (P < 0.05) and PC (P < 0.01) and lower C18:2 in PC as compared to NT ones.


[Prognosis and factors predicting the long-term prognosis of myocardial infarction].

200 cases of consecutively admitted acute myocardial infarction (AMI), who had survived for at least 2 weeks, were studied prospectively. 193 cases were followed-up for 0.5-27 (average 15) months; 41 of them (21.2%) had cardiac events, including 3 sudden cardiac death (1.6%) and 35 obvious cardiac failure (18.1%). 11 patients died of heart failure and 4 of reinfarction. Before discharge, noninvasive tests were done: LVEF < or = 40%, age > or = 60, maximum value of creatinine-phosphokinase > or = 1000 IU/dl and positive ventricular late potential were the 4 factors of high risk. Patients with 3 or 4 positive risk factors had poorer prognosis, if they were compared with those with one or none.


[Evaluation of head-chest lead ECG in the diagnosis of acute right ventricular infarction].

The clinical features, hemodynamic parameters, Wilson's lead and head-chest (H-C) lead ECG of 23 cases with acute right ventricular infarction (ARVI) were analyzed. Results showed that 13 cases revealed clinical right heart failure, but 10 of them had clear lung fields. 11 cases showed hypotension. 20 cases had mean right atrial pressure (MRAP) > or = 10 mmHg. The remaining 3 cases had MRAP between 8 mmHg and 10 mmHg, but it was > or = 10 mmHg after volume loading. The ratio of MRAP to pulmonary wedge pressure was > 0.65 and the right ventricular stroke work index < 5.0 g.m/m2 in all the 23 cases. ST elevation > or = 1 mm in V3R to V6R was found in 12 cases (52%), while ST elevation > or = 1 mm in HV3R to HV8R in 20 cases (87%). The results showed that the diagnostic accuracy for ARVI with H-C lead (right chest) ECG is higher than that with Wilson's lead. H-C ECG is better correlated with hemodynamics in patients with ARVI.


[A study of measuring cardiac output in patients during mechanical ventilation with CO2 rebreathing method].

Measurement of cardiac output with CO2 rebreathing method and thermodilution method was carried out in seven COPD patients undergoing mechanical ventilation. Mixed venous PCO2 could be measured reasonably well with CO2 rebreathing method. There was a very significant positive correlation between the CO2 method and thermodilution method for measuring cardiac output (r = 0.9130, P < 0.01). The change of cardiac output before and after infusion of sodium nitroprusside could be reflected by CO2 rebreathing method. We conclude that the cardiac output in COPD patients undergoing mechanical ventilation could be measured reasonably well with CO2 rebreathing method.


[Renal lesions of post-hepatitis cirrhosis].

There have been many reports on renal lesions of alcoholic cirrhosis, but not on those of post-hepatitis cirrhosis (PHC) up to present. A clinical and pathological observation on PHC was carried out prospectively in 18 and retrospectively in 34 cases. Renal specimens were examined with light and electron microscopy and immunopathological methods (immunofluorescence and peroxidase anti-peroxidase). Clinically, recurrent gross hematuria was observed in 2 and wild urinary abnormality in 17 cases. One case developed renal failure and the remaining 32 cases had no clinical evidence of renal involvement. Light microscopy showed wild mesangial lesions in 44 cases and glomerular basement membrane (GBM) thickening with segmental splitting in 29 and diffuse splitting in 2 cases. Massive protein deposition was found in the GBM, mesangium (Ms) and tubular basement membrane as well as the epithelium and endothelium. Immunopathological examination showed massive deposition of various immunoglobulins and complements in GBM and Ms, with IgG dominant in 8, IgM dominant in 7, IgA dominant in 6 and "full house" in 11 cases. HBsAg was detectable in GBM and Ms in 5 cases (9.6%) and HBcAg in one. Focal interstitial fibrosis and lymphocytic infiltration were found in 15 (28.3%). Our data revealed that renal lesions of post-hepatitis cirrhosis are different from those of the so-called "cirrhotic glomerulonephritis" in certain aspects. They are characterized by definite GBM involvement and massive deposition of immunoglobulins and complements. Its pathogenesis may be more complicated than that of other types of liver cirrhosis.


[24-hour esophageal pH monitoring. An analysis of 21 cases].

Esophageal pH monitoring was carried out with self-made portable pH recorder in 21 subjects for 24 hours under normal conditions. The results were as follows: the number of physiological gastroesophageal reflux (GER, pH < 4) was less than 23 times; the percentage of GER duration calculated by dividing the cumulative time of pH less than 4 by the total monitoring time was less than 1.4; the percentage was about 2 in upright position and less than 0.2 in lying position; the duration of the longest reflux episode was less than 5 minutes; the physiological gastroesophageal reflux occurred more often in upright position; while the pathological GER took place both in upright and lying position. Our study also indicated that the degree of esophagitis had no relation with the type of GER.


[Analysis of 59 cases of non-traumatic sudden death in various neurological diseases].

Sudden death is a common complication of myocardial infarction, necrotic pancreatitis and other diseases. Physicians usually neglect the possibility of neurological disorders. 59 cases of sudden death among 314 autopsied cases with neurological diseases were analyzed. The most frequent cause of neurological sudden death was cerebrovascular disease (CVD). It was present in 53 (89.9%) cases. 48 of them had hemorrhagic CVD. 37 of these 48 cases were due to hypothalamic lesions. In 37 cases general autopsy was performed; pathological abnormalities of heart, lungs, stomach etc, were found in 28 of them. In conclusion, the size and location of the lesion correlated with the prognosis of the disease. Concomitant multiple organ damage may deteriorate the lesion. Awareness of sudden death resulting from CVD may elevate the rate of correct diagnosis.


[A comparative trial of levo-praziquantel and praziquantel in the treatment of human Clonorchis sinensis infection].

Seventy patients with clonorchis sinensis infection were divided randomly into two groups and treated with levo-praziquantel and praziquantel in the same dosage of 12.5 mg/kg twice a day for two consecutive days (total dosage of 75 mg/kg). Follow-up stool examination three and six months after treatment showed that the egg negative conversion rates with levo-praziquantel group were 92.86% and 92.59%, while those of praziquantel group were 58.62% and 53.57% respectively. The results showed that levo-praziquantel was significantly superior to praziquantel (P < 0.001). The side reactions in both group were mild and transient.


[A laboratory and clinical study of induced differentiation therapy by all trans-retinoic acid in acute promyelocytic leukemia].

According to investigations, it was shown that peripheral blood WBC count increased, percentage of promyelocytes increased, differentiation features emerged, protein kinase C (PK-C) activity elevated, intracellular lysozyme content increased, CFU-F productivity increased and typical t (15; 17) disappeared, when induced differentiation therapy with all trans-retinoic acid (RA) was carried out in patients with acute promyelocytic leukemia. Comparison between RA group and RA+Harringtonin/Ara-C group showed no significant difference in most of the parameters; the curative effect was same in both groups. Complete remission (CR) rate was achieved in 92.6% (25/27 cases) of the patients in the entire group. In order to increase CR rate, prevention and treatment for haemorrhagic complications are critical. Patients with hyperleukocytosis (WBC > or = 100 x 10(9)/L) should be treated with intensive combined therapy as well as aggressive prevention of haemorrhage and pathological changes of lung and brain.


The action of interleukin 6 and leukaemia inhibitory factor on liver cells.

The hepatic action of cytokines has generally been analysed in terms of the acute-phase response of the liver. The qualitative and quantitative changes in the expression of plasma proteins serve as defining criteria for cytokine function. Interleukin 6 (IL-6) and leukaemia inhibitory factor (LIF) are representatives of a group of cytokines which display strikingly similar effects in both human and rodent liver cells. Hallmarks of the action of these cytokines are the stimulation of type 2 acute-phase plasma proteins and enhancement of the effect of interleukin 1 (IL-1) or tumour necrosis factor alpha (TNF-alpha) on type 1 acute-phase plasma proteins. The transcriptional activation of the various acute-phase plasma protein genes involves common cis-acting regulatory elements whose sequences and location relative to the transcription start site vary from gene to gene. The activity of the IL-6- and LIF-responsive genes depends in part on transcription factors including several members of the C/EBP family, JunB and the glucocorticoid receptor. The expression of these transcription factors is in turn under cytokine-specific control. In a few cases, expression is temporally correlated with the activation of 'late' acute-phase protein genes. The finding that structurally distinct cytokines interact with separate receptors but elicit an almost identical liver cell response demands a reassessment of the contribution of each factor to the in vivo acute-phase response.


Further studies of the distribution of CDF/LIF mRNA.

Differentiation choices in the haemopoietic and nervous systems are controlled in part by instructive factors. The cholinergic differentiation factor (CDF, also known as leukaemia inhibitory factor, LIF) affects the development of cultured cells from both systems. To understand the role of CDF/LIF during normal development in vivo, we have begun to localize its mRNA in the late fetal and postnatal rat. Application of reverse transcriptase-polymerase chain reaction and RNase protection methods reveals that CDF/LIF mRNA levels are developmentally modulated in both haemopoietic and neural tissues. A target tissue of cholinergic sympathetic neurons, the footpads that contain the sweat glands, express high levels of this mRNA (relative to mRNA for actin and beta 2-microglobulin). Levels in targets of noradrenergic neurons are lower, but do undergo significant changes during development. Signals are also detected in selective regions of the adult brain, and in embryonic skeletal muscle. This finding in muscle may be significant for motor neurons, because CDF/LIF is a trophic factor for these neurons in culture. Embryonic liver, neonatal thymus and postnatal spleen express CDF/LIF mRNA, and expression in gut is the highest of all tissues examined. The selective tissue distribution and developmental modulation of CDF/LIF mRNA expression support a role for this factor in the normal development of several organ systems.


Leukaemia inhibitory factor and bone cell function.

A bone-resorbing product of mouse spleen cells found to have differentiation-inducing activity was most probably leukaemia inhibitory factor (LIF). This revealed that LIF is a cytokine active on bone, in addition to its several other sites of action. In organ culture of newborn mouse bone, recombinant LIF promoted bone resorption by a prostaglandin-dependent process. Resorption by isolated rat osteoclasts was also promoted by LIF through an initial action on osteoblasts which was receptor-mediated. Incorporation of [3H]thymidine into DNA was increased by LIF in cells (most probably osteoblasts) of the newborn mouse bones. Osteoblasts have been shown to produce LIF, and the amount is increased by treatment with retinoic acid or TNF-alpha. LIF also acts directly on osteoblasts to inhibit plasminogen activator activity, by stimulating the synthesis of plasminogen activator inhibitor 1 mRNA and protein. The latter actions are very similar to those of TGF-beta. Again like TGF-beta, LIF was ineffective in promoting bone resorption in vitro in fetal rat long bones. These results, together with the in vivo data showing that high circulating levels of LIF in the mouse are accompanied by a substantial increase in trabecular bone mass, indicate that LIF is another cytokine with potent actions on bone and potentially important interactions with other osteotrophic factors.