Cauda equina paraganglioma

Two paragangliomas resected from the cauda equina had similar morphology, both containing cells having dense core secretory granules with no associated sustentacular or supporting cells. The cells were arranged in characteristic lobules that were surrounded by basement membrane and separated by a fibrovascular stroma. This tumor, although rarely found elsewhere in the central nervous system, does occur in the region of the filum terminale, and causes a clinical syndrome typical of tumors in that area.

The incidence of B cell leukaemia and lymphopenia in B cell neoplasia in adults: a study using the Kiel classification of non-Hodgkin's lymphoma

The incidence of B cell leukaemia in 186 consecutive untreated patients with histologically defined B cell neoplasms is described. The lymphomas were classified by the Kiel convention. B cell leukaemia in the context of this paper refers to the situation where a neoplastic clone of B cells in the blood greatly outnumbers normal blood B cells. It is defined as an absolute blood B cell count greater than 0.75 X 10(9)1(-1) where either greater than 90% B cells express kappa immunoglobulin light chains or greater than 80% express lambda light chains. This was found in several patients where the total blood lymphocyte count was within normal limits. All patients with diffuse lymphocytic lymphoma with the histological appearances of B cell chronic lymphocytic leukaemia (ML-BCLL) were found to have B cell leukaemia. However, more than half these patients had blood B cell counts less than 10 X 10(9)1(-1). B cell leukaemia was also a feature in approximately 33% of patients with follicle centre cell tumours and 33% of those with lymphoplasmacytoid tumours. B cell leukaemia was not detected in 34/35 patients with myelomatosis. The 35th patient had plasma cell leukaemia. Only 3/22 patients with high grade lymphoma had B cell leukaemia. In the three principal tumour types associated with B cell leukaemia mu + delta was the most common immunoglobulin heavy chain phenotype. Spontaneous mouse red cell rosette formation also characterised leukaemic B cells in these three groups but high proportions of mouse rosetting cells were seen only in association with ML-BCLL. None of 4 cases of prolymphocytic leukaemia showed mouse red cell rosetting. HLA-DR alpha chain was found on the leukaemic cells of all patients except one with ML-BCLL. B cell lymphopenia was a frequent finding in all histological groups in those patients who did not have B cell leukaemia.

Determining pulmonary resistance to gas flow during sinusoidal pressure wave mechanical ventilation

Standard techniques for measuring pulmonary resistance (RP) to gas flow in newborn infants yield results that are widely dispersed and difficult to interpret. The purpose of this study is to describe and evaluate a new improved method for determining RP which utilizes a sinusoidal pressure wave generator. Measurements of respiratory flow rate and transpulmonary pressure were made in cats 1) breathing spontaneously, 2) mechanically ventilated with a time-cycled pressure-limited ventilator, and 3) mechanically ventilated with a sinusoidal pressure wave delivered to the airways. RP values were calculated using 2 methods: 1) at midinhalation (RPI) and midexhalation (RPE), and 2) at iso-volume times during inhalation and exhalation (RP(iso-V)). During spontaneous breathing, RP values were 65 +/- 16 (mean +/- SE), 90 +/- 23 and 78 +/- 27 cm H2O/L . sec for RPI, RPE, and RP(iso-V), respectively. Mechanical ventilation yielded RP values of 35 +/- 4 and 124 +/- 26 cm H2O/L . sec for RPI and RPE, respectively. During sinusoidal airway pressure ventilation, standard errors were reduced; PP values were 33 +/- 4, 54 +/- 6, and 42 +/- 4 cm H2O/L . sec for RPI, RPE, and RP(iso-V), respectively. The use of the sinusoidal pressure wave generator smoothed the pressure-flow data and improved the quality of RP determinations. Coefficients of variation were reduced by 45%. The methods used are simple to apply and may make the determination of RP in ICU patients more practical.

Discrimination of blood glucose levels in insulin-dependent diabetics

Three insulin-dependent diabetic adults were exposed to a blood glucose discrimination training program. Following baseline, during which subjects estimated their blood glucose levels twice daily, subjects received immediate feedback regarding the accuracy of their estimation. The procedure resulted in a large increase in accuracy of blood glucose level estimation. The implications of the findings are discussed.

Women's perceptions of change in relationships shared with children during pregnancy

This study examined women's perceptions of changing relationships shared with children during pregnancy. Fourteen women were interviewed at approximately monthly intervals from the third through the last month of their pregnancies. During these interviews, each woman indicated whether or not she shared an important relationship with a child or children and, if such a relationship was identified, the woman (a) identified the role position of the child, (b) gave an overall evaluation of the relationship as satisfactory or unsatisfactory, (c) described the specific changes which had influenced the relationship in the month prior to the interview, and (d) evaluated each of these specific changes as either good or worrisome. Only the nine multiparas participating in the study identified children in important relationships. Almost exclusively, their sons and daughters were named in these relational dyads. No important relationships with children were identified by the five primiparous women. This finding suggests that the social space of the multipara and primipara differ significantly. The findings of this study reveal that complex and stressful mother-child interactional processes characterize the pregnancy period. Multiparas described relationships with their children as changing over the months of their pregnancies and these changes were seen to effect significant alterations in the dyads. The women explained that their younger children "knew something was different" early in the pregnancies and that the children reacted in a diffuse, clinging manner. Apparently, maternal action patterns became different during pregnancy and the children sensed and reacted to these differences. Older children responded both to their fears of displacement and to the sexual aspects of their mother's pregnancies. Findings indicate that women with children need much support from others in order to deal with the changes they perceive in their mother-child relationships during pregnancy. Mothers who are not supported by others cannot, in turn, help and support their children through a difficult reorganizational period.

Properties of monoclonal antibodies to human immunoglobulin kappa and lambda chains

Hybridomas have been produced from mice immunized with human IgG. Culture supernates were assayed for the presence of antibody-producing cells by passive haemagglutination. Hybridomas producing antibodies to human kappa (kappa) and lambda (lambda) light chains have been cloned and grown as ascitic tumours in BALB/c mice. The antigen-binding characteristics of the monoclonal antibodies, contained in the ascitic fluid, were assessed by haemagglutination inhibition, ELISA and radioimmunoassay systems and by the binding of radiolabelled antigen in analytical flat-bed iso-electric focussing gels. One monoclonal anti-kappa reacted better with free than with combined kappa chains; for another the reverse was true. Antibody fractions separated by DEAE chromatography of ascitic fluids were coupled to ox red cells with chromic chloride and compared with polyclonal antibodies for the detection of cell-surface immunoglobulins.

Is there autonomic impairment in congestive (dilated) cardiomyopathy?

Autonomic function was investigated in patients with congestive (dilated) cardiomyopathy and compared with that in controls. Heart-rate and blood-pressure were recorded during physiological and pharmacological interventions and plasma noradrenaline concentration was measured at rest and when the physiological interventions produced a peak response. The results indicate that even at an early (pre-failure) stage of the disease parasympathetic function is impaired but no significant increase in sympathetic activity occurs at this stage.

Functional residual capacity and severity of respiratory distress syndrome in infants

Infants with respiratory distress syndrome (RDS) have insufficient surfactant systems and decreased functional residual capacity (FRC). This study attempts to relate FRC with severity of disease course. Measurements were made on 36 newborn infants with clinically diagnosed RDS. All infants were intubated and breathing on continuous positive airway pressure (CPAP) at the time studied. Infant CPAP levels were adjusted to 10 cm H2O; then FRC and arterial blood gas measurements were made. The infants were grouped according to their FRC per birth weight (BW). Volumes larger than or equal to 2 SD (larger than or equal to 42 ml/kg) of normal term infants not on CPAP were placed in the "large FRC" group. Volumes within +/- 2 SD (15-41 ml/kg) were in the "medium FRC: group, and infants smaller than or equal to 2 SD (< 14 ml/kg) of normal were in the "small FRC" group. The severity of RDS disease course was judged by the time duration the infants were managed on CPAP and FIO2 > 0.21 and by the maximum CPAP and FIO2 levels used. Twelve infants (33%) had small FRC, 18 (50%) medium FRC, and 6 (17%) large FRC. The time duration the infants with large FRC were on CPAP was significantly less than infants with medium FRC and the medium FRC group time was less than the small FRC group. The time duration on increased FIO2 and maximum FIO2 level used on the large FRC group was less than the medium and small FRC groups. Thus, FRC/BW appears related to the severity of RDS disease course. It is possible that the infants with FRC/BW larger than or equal to 42 ml/kg had pneumonia and were misdiagnosed as RDS. If so, FRC monitoring could have assisted in their diagnosis. BW and gestational ages of the groups were not different. Thus, variables other than these two play an important role in the degree of atelectasis occurring in infants with RDS. In patient management, where frequent changes in airway pressure and FIO2 are made, knowing the FRC/BW as well as blood gas values could aid the clinician in his choice of CPAP and FIO2 levels.

A method of estimating the functional residual capacity of infants with respiratory distress syndrome

This report describes and evaluates a new method of estimating the functional residual capacity (FRC) of newborn infants receiving continuous positive airway pressure (CPAP). Standard nitrogen washout methods of measuring lung volume are time consuming, frequently interfere with patient care, and may be hazardous to prematurely born infants. The authors are using a four-breath nitrogen washout technique to estimate the FRC of infants. The method was evaluated using: (1) a mechanical lung model, and (2) results from 32 newborn infants with RDS. The actual volume of the mechanical lung model was 21.6 ml and the estimated volume was 21.4 +/- 2.3 (SD) n = 13. Using different volumes in the mechanical lung model and comparing with estimated FRCs yielded a correlation coefficient of 0.96 (n = 15). Comparing the FRC of infants determined by standard nitrogen washout with the estimated FRC yielded a correlation coefficient of 0.92, n = 145. Thus, the results of the two methods are in good agreement. The new method reduces the period of breathing pure oxygen from several minutes to just a few seconds, thus, decreasing the dangers of absorption atelectasis and oxygen toxicity. The new system also lends itself well to micro-processor automation.

Percutaneous central venous cannulation

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Chorioretinitis with a combined defect in T and B lymphocytes and granulocytes. A new syndrome successfully treated with dialyzable leukocyte extracts (transfer factor)

A patient with immune deficiency, recurrent pyogenic infections and active chorioretinitis is described; in addition to agammaglobulinemia, both quantitative and qualitative T-cell deficiencies were documented. Furthermore, the patient's granulocytes (polymorphonuclear leukocytes), although normal in their bactericidal capacity for Staphylococcus, responded poorly to both leukocyte migration inhibition factor and neutrophil immobilizing factor obtained from normal cells. The immunologic features of this patient appear to comprise a new syndrome. Remarkable diminution of the ocular lesions and increased visual acuity occurred within two months after the initiation of therapy with dialyzable leukocyte extracts (transfer factor). Concurrent testing of the patient's cell-mediated immunity showed increased numbers of circulating T lymphocytes and improved T-cell function following dialyzable leukocyte extract [DLE] therapy. The dramatic clinical results indicate that similar therapy may prove to be beneficial in other patients with chorioretinitis and T-cell deficiency.

Hemodynamic effects of xylazine in the calf

The hemodynamic effects of sedative level doses of xylazine in five chronically instrumented calves were studied. These effects included immediate and prolonged reductions in heart rate, cardiac output, arterial blood pressure, and left ventricular dp/dt max. Stroke volume showed an initial decrease in value with a return in 15 minutes to base-line values. Total peripheral resistance, end-diastolic left ventricular pressure, end-diastolic left ventricular volume, and left ventricular residual fraction were increased after drug administration. The results indicate that a depressed myocardium results from xylazine administration. With one exception (the absence of a hypertensive response), these effects largely parallel, both quantitatively and qualitatively, those seen with this drug in other species. Sedation by xylazine is produced in cattle at doses which are small compared to those which is required for sedation in other species. These same small doses in cattle also cause hemodynamic changes.

Urine screening of arrestees as a source of drug abuse indicator data

The National Institute on Drug Abuse (NIDA) recently sponsored a study which examined the utility of jail urine screening programs as a source of drug abuse indicator data. During the study, short-term urine screening programs were set up in the central jail facilities of four urban counties. To determine whether jail urine screening programs have the capacity to detect patterns of drug use not readily detectable through existing indicators, the urinalysis findings for each county were compared with data generated by the DAWN and CODAP systems. The results of the study suggest that jail urine screening programs can be useful as a supplement to existing sources of information on drug use patterns in local communities.

Ensheathment and myelination of regenerating PNS fibres by transplanted optic nerve glia

Interactions between PNS axons and CNS glia were studied morphologically by transplanting optic nerves into peripheral nerves in groups of rats and mice. Four to 11 months after grafting, small numbers of axons from the peripheral nerves had penetrated the CNS grafts where they became ensheathed and myelinated by CNS glia. Glial protuberances observed at the CNS-PNS interfaces suggested that there had been an active glial response to innervation by PNS axons. These findings provide experimental evidence that denervated CNS glia can be reinnervated and form myelin.