Serial imaging of the carotid bifurcation and cerebrovascular reserve after carotid endarterectomy

A radioisotopic method of quantifying mean cerebral transit time was used to assess the immediate effects of carotid endarterectomy on cerebrovascular reserve (CVR) in 69 patients. In addition, serial postoperative data were acquired on CVR, clinical status and non-invasive imaging of the internal carotid arteries in 56 patients over a period of 6-48 (median 24) months. Twenty-one patients (30 per cent) had preoperative evidence of impaired CVR in the symptomatic hemisphere. Within 4 days of surgery, however, reserve had returned to normal in 17 of the 21 patients. During follow-up, four of the 56 patients developed recurrent stenosis (> 50 per cent) or occlusion of the artery operated on but only two of these had impairment of CVR and none was symptomatic. Three patients suffered recurrent transient ischaemic attacks (TIAs) but none had recurrent internal carotid artery disease or impaired CVR. One patient suffered a TIA in the territory of the non-operated artery during follow-up in association with disease progression and CVR impairment. However, the TIA preceded recognition of either of these changes. Twelve other patients had (or developed) stenosis (> 50 per cent) in the non-operated artery during follow-up but none was symptomatic or developed impairment of CVR. Although assessment of CVR provided useful information on the frequency of haemodynamic compromise before carotid endarterectomy and on the natural history of disease progression, neither serial assessment of reserve nor non-invasive imaging of the carotid bifurcation influenced clinical practice during follow-up.

Bone single-photon emission tomography in recent meniscal tears: an assessment of diagnostic criteria

Bone single-photon emission tomography (SPET) was performed in 40 patients within 6 months of acute knee injury where internal derangement of the knee was suspected, and the results related to the arthroscopy findings. Scan features with high sensitivity, specificity, and predictive accuracy for a meniscal tear could not be obtained on planar imaging. However, a half-crescent or more of increased tibial plateau activity on transaxial SPET gave a sensitivity of 89%, a specificity of 76%, a positive predictive accuracy of 77% and a negative predictive value of 89%. For longitudinal (bucket handle) tears alone the optimum scan pattern was a full crescent of increased tibial plateau activity with adjacent femoral activity and increased blood pool activity which gave corresponding values of 78%, 94%, 78% and 93%. It is concluded that the inclusion of tibial plateau activity of less than a full crescent and the presence of femoral condyle and blood pool activity in the diagnostic criteria improves the ability of bone SPET to detect meniscal tears. The value of bone SPET in the diagnosis of meniscal tears suggests that it could have a significant role to play in the management of knee injuries.

Long-term effects of cimaterol in Friesian steers: II. Carcass composition and meat quality

The objectives of this study were to examine the effects of long-term administration of cimaterol to steers from 4 wk of age until slaughter at target live weights of 275, 375, and 475 kg on 1) carcass composition; 2) distribution and growth of the dissectible lean, fat, and bone; and 3) selected meat quality traits. Ninety calves were allocated to either control or cimaterol (4 ppm) treatment with 15 from each treatment scheduled for slaughter at the above target live weights. Of the 90 calves, 73 carcasses were dissected. Cimaterol increased the proportion of lean in the carcass of the three target slaughter groups from 653, 629, and 612 g/kg in control steers to 728, 728, and 723 g/kg in treated steers, respectively, and decreased the proportion of fat from 134, 169, and 197 g/kg in control steers to 88, 86, and 99 g/kg in treated steers, respectively. Cimaterol increased the longissimus muscle area from 46.4, 56.7, and 62.4 cm2 in control steers to 61.0, 73.4, and 90.8 cm2 in treated steers in the three target slaughter groups, respectively. The allometric growth coefficients for total lean, bone, and fat were .987, .869, and 1.406, respectively, for treated animals and .898, .771, and 1.654, respectively, for control animals. Cimaterol increased the 2-d drip loss and the fiber-optic probe value of longissimus muscle. Shear force values were 55, 145, and 118% higher in the treated animals in the three target slaughter groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of cimaterol in Friesian steers: I. Growth, feed efficiency, and selected carcass traits

The objectives of this experiment were: 1) to determine whether feeding cimaterol to male calves from 4 wk of age until slaughter at target live weights of 275, 375, or 475 kg would result in a sustained increase in growth rate and feed conversion efficiency (FCE) and 2) to determine whether the effects of cimaterol on selected carcass traits would increase with increased duration of treatment. Ninety male Friesian calves 4 wk old were assigned at random to either a control or cimaterol group. Each animal was fed 1 kg of chopped barley straw and had ad libitum access to a pelleted diet containing either 0 or 4 ppm of cimaterol. Neither ADG nor FCE was affected by cimaterol during the first 5 wk of treatment. Growth rate of cimaterol-treated steers was 20% higher during wk 25 to 33. However, cimaterol had no overall effect on growth rate. Feed conversion efficiency was improved by 15 and 63% during wk 9 to 16 and wk 25 to 33, respectively. Cimaterol-treatment increased dressing percentage by an average of 3%, improved conformation score (2.2 vs 4.0, 3.0 vs 3.9, and 2.9 vs 3.2), and reduced subcutaneous fat score (1.7 vs 1.9, 1.3 vs 3.1, and 2.1 vs 3.4) for treated and control animals at target slaughter live weights of 275, 375, and 475 kg, respectively, but had no effect on carcass weight. On average, cimaterol treatment decreased carcass length by 2.5 cm, hide weight by 2.75 kg, and the weight of kidney and pelvic fat by 3.5 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the levels of inositol metabolites in transformed haemopoietic cells and their normal counterparts

We have compared the levels of inositol metabolites in three pairs of normal and transformed cells which have been matched with respect to their cell lineage, differentiation and proliferation status: (i) normal human myeloid blast cells and the human promyelocytic leukaemic cell line, HL60; (ii) human umbilical-cord T-helper cells and C8166 cells, a HTLV-1-transformed T-helper cell line; and (iii) an interleukin 3-dependent long-term culture of murine pro-B-cells (BAF3) and BAF3 cells transformed by transfection with the bcr-abl oncogene. Complex patterns of inositol metabolites were present in each of the cell populations. Although there were a number of differences in the levels of certain inositol metabolites between individual cell populations in the paired groups, we did not observe any consistent difference in the levels of inositol metabolites between the proliferating normal and transformed cells. In particular, our data do not support the reported correlation between elevated glycerophosphoinositol (GroPIns) levels and transformation of cells by membrane and cytoplasmic oncogenes which has been reported by other workers. All the cells contained high concentrations of Ins(1,3,4,5,6)P5 (between 12 and 55 microM) and InsP6 (between 37 and 105 microM). The HTLV1-transformed T-helper cells had particularly high levels of total inositol phosphates (predominantly GroPIns, an unidentified inositol bisphosphate and InsP6). The observations are discussed with reference to cell transformation and to the differentiation status of the paired populations.

The role of the practice nurse in the management of depression in general practice: treatment adherence to antidepressant medication

This pilot study demonstrated the feasibility of providing practice nurse support as an adjunct to standard general practitioner treatment to patients with depressive disorders prescribed antidepressant medication. With respect to the measures used and pilot study objectives identified, there were no statistically significant differences between the study groups in treatment adherence to the prescription of antidepressant medication or in the incidence and severity of adverse events to medication. Large-scale randomized controlled trials are in progress to assess the effectiveness of practice nurse interventions in the management of depressive illness in general practice.

Medical and dental staffing prospects in the NHS in England and Wales 1991

This article offers some background information to help junior doctors, and those who advise them, to make decisions about their future careers. Further information can be obtained from the Regional tables, which the Department of Health circulate to Regional Postgraduate Deans, Health Authorities and clinical tutors. All the information presented here is retrospective. Comparing this with the previous annual articles in this series may help you to assess the likely future prospects in your particular specialty.

Medical and dental staffing prospects in the NHS in England and Wales 1992

This annual article is intended to help young doctors and dentists make informed decisions about their career paths, in the light of the current prospects of obtaining a career post in any specialty. Regional details of the national figures presented here may be obtained through individual Regional postgraduate deans, Health Authorities and clinical tutors. This article summarises the most recent figures available, and comparison with previous articles in this series may help to identify employment trends.

Differences in cardiac calcium release channel (ryanodine receptor) expression in myocardium from patients with end-stage heart failure caused by ischemic versus dilated cardiomyopathy

The molecular basis for the systolic and diastolic dysfunction characteristic of end-stage heart failure in humans remains poorly understood. It has been proposed that both abnormal calcium handling and defects in the contractile apparatus may contribute to the myocardial dysfunction. Two channels, the calcium release channel (CRC) or ryanodine receptor of the sarcoplasmic reticulum (SR), and the slow calcium channel or dihydropyridine receptor (DHPR) of the transverse tubule, play key roles in regulating intracellular calcium concentration and in excitation-contraction (E-C) coupling in the heart. The DHPR serves as the voltage sensor and plasma membrane calcium channel resulting in activation of the CRC during E-C coupling in heart muscle. In this study, we investigated the levels of CRC expression in several forms of end-stage heart failure in humans. A cardiac CRC cDNA was cloned from rabbit and used as a probe for Northern blot analyses to determine mRNA levels in the left ventricles of normal (n = 4) and cardiomyopathic (n = 34) human hearts from patients undergoing cardiac transplantation. Compared with normal patients, patients with ischemic cardiomyopathy (n = 18) showed a 28% decrease in CRC mRNA levels (p less than 0.025) and patients with idiopathic dilated cardiomyopathy (n = 14) a nonsignificant 12% increase. In these same hearts, alpha-actin levels were unchanged in end-stage heart failure, as has been previously reported. This is the first report indicating that the expression of the CRC mRNA is abnormal in end-stage human heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoimmune disease of the ovary induced by a ZP3 peptide from the mouse zona pellucida

We describe a novel experimental system in mice for the study of ovarian autoimmune disease, a condition encountered in women with premature ovarian failure. The ovarian autoimmune disease is induced in B6AF1 mice by a 15-amino acid peptide (Cys-Ser-Asn-Ser-Ser-Ser-Ser-Gln-Phe-Gln-Ile-His-Gly-Pro-Arg) from mouse ZP3, the sperm-binding component of the zona pellucida that surrounds growing and mature oocytes. Whereas the peptide induces both T cell and antibody responses, adoptive transfer of CD4+ T cell lines derived from affected animals causes oophoritis without observable antibodies to the zona pellucida peptide. The primacy of the T cell response in the pathogenesis of disease is further substantiated by defining oophoritogenic peptides as small as eight amino acids (Asn-Ser-Ser-Ser-Ser-Gln-Phe-Gln) that do not elicit an antibody response to the full-length ZP3 peptide. The identification of a well characterized peptide as a causative agent of autoimmune oophoritis should facilitate understanding of the pathogenesis of this T cell-mediated autoimmune disease. Because the proteins of the zona pellucida are conserved among mammals (the mouse and human ZP3 proteins are 67% identical), this murine model may lead to better understanding of the pathogenesis of human autoimmune oophoritis.

Stage I-II low-grade lymphomas: a prospective trial of combination chemotherapy and radiotherapy

Between 1984-1989, 44 patients with stage I-II low grade lymphoma were treated prospectively with sequential chemotherapy and involved-field radiotherapy. The chemotherapy was cyclophosphamide, vincristine, prednisone, and bleomycin (COP-Bleo); doxorubicin was included (CHOP-Bleo) for patients with adverse prognostic features (high LDH; extranodal sites; bulky nodes). Of the 44 patients, 37 had measurable disease and all have responded. With a median follow-up of 32 months, the 5-year survival and failure-free survival were 89% and 74%, respectively. Compared to past experience with involved-field radiotherapy alone, the failure-free survival is significantly better with COP-Bleo plus radiotherapy. The potentially cured fraction has risen from 40% to 74%.

Acute hyponatraemia following total hip replacement

An elderly woman who had been taking a fixed-dose combination of a thiazide and potassium-sparing diuretic for eight days, became severely hyponatraemic following total hip replacement. Her hyponatraemia resolved with fluid restriction, intravenous normal saline, and withdrawal of the drug. Hyponatraemia is a well-described side-effect of diuretic therapy; however, we are not aware of any previous reports of this condition developing acutely in the postoperative state. We attribute this to the natriuretic nature of the drug, compounded by the postoperative, anti-diuretic surge which itself may have been exacerbated by the drug. We thus advise caution in the use of this preparation in the elderly patient about to undergo major surgery.

Delineation of antigen contact residues on an MHC class II molecule

This report describes a detailed mutational analysis of a major histocompatibility complex class II molecule--the alpha chain of the Ak complex. Each residue from 50-79 was replaced by an alanine, and the effects on recognition of Ak by panels of antibodies and T cells determined. The results provide the strongest existing experimental evidence that the antigen binding site on a class II molecule can be modelled on the crystal structure of a class I molecule. The data have also permitted the delineation of residues that actually contact antigenic peptides.

Metabolism of normal skeletal muscle during dynamic exercise to clinical fatigue: in vivo assessment by nuclear magnetic resonance spectroscopy

In vivo nuclear magnetic resonance (NMR) spectroscopy was used to define several intracellular high energy phosphate variables of the gastrocnemius muscle of normal subjects during rest, graded plantar flexion exercise to exhaustion, and recovery. There were nine males and eight females with an average age of 34 +/- 8 years. At rest, pH averaged 7.09 +/- 0.03 and the energy cost index (ECI)--the ratio of inorganic phosphate to phosphocreatine--averaged 0.13 +/- 0.03. At peak exercise, the ECI increased markedly to 2.71 +/- 2.0 (P less than 0.001) and pH fell precipitately to 6.76 +/- 0.17 (P less than 0.001), indicating the high intensity of the exercise. Exercise endurance averaged 12 +/- 5 mins; it was not highly correlated with sex, age (r = 0.35), rest pH (r = 0.26), rest ECI (r = 0.38), peak exercise pH (r = 0.23) or peak exercise ECI (r = 0.38), nor exercise changes in pH (r = 0.17) and ECI (r = 0.28). At 23 mins post exercise all variables were similar to rest. Rest pH was the only variable different between males (7.10 +/- 0.03) and females (7.07 +/- 0.03) (P less than 0.05). Thus, dynamic exercise of large skeletal muscles in normal subjects was characterized by marked temporal changes in high energy phosphate profiles and very low pH at exhaustion. No single metabolic variable correlated highly with exercise endurance, suggesting that the intracellular pathophysiology of exhaustive muscle exercise and clinical fatigue may be multifactorial.