Reliability of ratings of anesthesia's contribution to adverse surgical outcomes

The interrater reliability of physician ratings of anesthesia contribution to adverse outcomes was evaluated. A physician panel reviewed hospital records, anesthesia records, standard data collection forms, and, when available, autopsy reports for 28 patients experiencing severe morbidity or death within 48 hours following anesthesia for surgery. Consensus among reviewers about the contribution of anesthesia to adverse outcomes ranged from 82.1% to 92.9%. Kappa coefficients indicated excellent interrater reliability for the Edwards Scale and rating scale, and good interrater reliability for the percent scale.

Purification and characterization of glycolipid transfer protein from bovine brain

Bovine brain contains a lipid transfer protein that is specific for neutral glycosphingolipids and gangliosides but does not stimulate phospholipid or neutral lipid intermembrane transfer (Brown, R.E., Stephenson, F.A., Markello, T., Barenholz, Y. and Thompson, T.E. (1985) Chem. Phys. Lipids 38, 79-93). This report describes a new procedure for purifying glycolipid transfer protein from bovine brain as well as a characterization of the resulting protein. Chief among the newly introduced approaches are dye-ligand and fast protein cation-exchange liquid chromatography. Other modifications include increasing the overall scale of purification, incorporating a pH precipitation step and adding different proteinase inhibitors. The resulting procedure simplifies and accelerates the purification process while yielding a homogeneous protein. The purified protein has a molecular weight near 23 kDa as estimated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Chromatofocusing reveals that glycolipid transfer protein activity co-elutes with the 23 kDa protein and has an isoelectric point near pH 9.0. A similar isoelectric point is observed using denaturing isoelectric focusing conditions. The protein's amino acid composition reveals high levels of amino acids with non-polar side chains (48%). Based on the findings reported here and on previously published data, bovine brain glycolipid transfer protein has been compared to other lipid transfer proteins as well as lysosomal sphingolipid activator proteins.

Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study

Twenty-two digital nerve repairs were performed in the finger using autogenous vein grafts. Eighty-two percent of the repairs were available for follow-up. Results of sensibility return were assessed using moving two-point discrimination, Semmes-Weinstein monofilaments, and vibratory testing. Two-point discrimination averaged 4.6 mm for 11 acute digital nerve repairs using vein conduits 1 to 3 cm in length. Delayed digital nerve repair with vein conduits yielded poor results. Semmes-Weinstein values demonstrated comparable levels of return of slowly adapting fiber/receptors to the quickly adapting fiber/receptors, as evidenced by moving two-point discrimination tests. Vibratory sensibility was present in all. A review of previous experiences with end-to-end digital neurorrhaphies and digital nerve grafting suggests that repair of 1- to 3-cm gaps in digital nerves with segments of autologous vein grafts appears to give comparable results to nerve grafting. Further laboratory and clinical research is necessary to better define the role of interpositional vein conduits for repair of peripheral nerves.

Lipoperoxidation and T-cell leukemia of childhood. Effects of indomethacin

Serum thiobarbituric acid (TBA) reactivity for lipoperoxidation products was assessed at diagnosis in children with T-cell and common acute lymphocytic leukemia (ALL) and T-lymphoblastic lymphoma. Comparisons were made among these groups and with healthy controls. Mean TBA reactivity (mumol malondialdehyde/L serum) was increased (P less than 0.01) in the T-cell leukemia group versus common ALL and T-lymphoblastic lymphoma patients and controls, respectively. The increase in lipoperoxidation products in T-cell ALL appeared to bear a positive relation to peripheral leukocyte counts, and was accompanied by increased serum prostaglandin E2 (PGE2) levels in most representative cases. Indomethacin added to a childhood T-cell ALL line (SUP-T3), at a concentration known to inhibit prostaglandin synthesis in vitro (i.e., 3 micrograms/mL), effected significant increases in the numbers of natural killer (NK; Leu-11+ and Leu-19+) cells (P less than 0.01) and B-lymphocytes (P less than 0.05), and significant decreases in cell viability (P less than 0.01). Indomethacin may be a useful agent for enhancing the antileukemic immune response in T-cell ALL.

Class I and class II regions of the major histocompatibility complex both contribute to individual odors in congenic inbred strains of rats

The major histocompatibility complex (MHC) of the rat has three regions--A (class I), B/D (class II), and C/E (class I)--and congenic strains are available which differ in each of these regions. We used the habituation-dishabituation procedure to examine the ability of PVG-RT1u male rats to discriminate between the urinary odors of congenic rat strains which differ genetically only at certain individual regions of the MHC. The results of five experiments indicate that discrimination can be made between urine from rats which differ in all three regions of the MHC (PVG vs. PVG-RT1av1 donors), only in the class I A region (PVG vs. PVG.R1 donors), only in the class I C/E region (PVG.R19 vs. PVG-RT1av1 donors), only in the class II B/D region (PVG.R1 vs. PVG.R19 donors), and in all regions except the classical class IA locus (PVG-RT1av1 vs. PVG.R1 donors). These results indicate that all of the MHC regions may contribute to the individual odors of rats.

Protein measurement using bicinchoninic acid: elimination of interfering substances

Protein quantitation based on bicinchoninic acid (BCA) is simple, sensitive, and tolerant to many detergents and substances known to interfere with the Lowry method. However, certain compounds often used during protein purification do interfere with the BCA protein assay. The response of the BCA chromophore to various interfering substances has provided insight into the mechanism of protein quantitation by BCA. Certain substances (e.g., glucose, mercaptoethanol, and dithiothreitol) elicit a strong absorbance at 562 nm when combined with the BCA working reagent. The absorbance appears to be identical to the normal response elicited by protein. Other agents (e.g., ammonium sulfate and certain ampholytes) diminish the protein-induced color development and shift the wave-length of the color response. Both types of interference can be eliminated by selectively precipitating protein with deoxycholate and trichloroacetic acid (A. Bensadoun and D. Weinstein (1976) Anal. Biochem. 70,241-250) prior to reaction with bicinchoninic acid. The modifications described here permit quick, efficient removal of many interfering substances that are commonly utilized during protein purification.

3-(aminoalkyl)-1,2,3,4-tetrahydro-5H-[1]benzopyrano[3,4-c] pyridin-5-ones as potential anticholinergic bronchodilators

A series of 3-(aminoalkyl)benzopyrano[3,4-c]pyridin-5-ones was prepared and tested as potential orally active anticholinergic bronchodilators. Inhibition of methacholine-induced collapse in guinea pigs and inhibition of pilocarpine-induced bronchoconstriction in dogs served as in vivo models. Simultaneous measurement of salivary inhibition in the dog model allowed determination of a pulmonary selectivity ratio. The benzopyrano[3,4-c]pyridin-5-one parent ring system was prepared by Pechman condensation of phenols with a piperidine beta-keto ester. Alkylation with aminoalkyl halides, or with 1-chloro-2-propanone followed by reductive amination, yielded the 3-substituted target compounds. Bronchodilator potency was related to the extent of steric crowding surrounding the side-chain terminal amine function. Addition of a methyl substituent on the carbon alpha to the terminal amine often increased potency or pulmonary selectivity. After secondary pharmacological evaluation, compound 7a, designated CI-923, was selected for clinical trial as a bronchodilator.

Ulnar impingement syndrome after Darrach procedure: treatment by advancement lengthening osteotomy of the ulna

The Darrach procedure was the standard treatment for painful disorders of the radioulnar joint for several decades. However, recent articles have described unsatisfactory results after this procedure including dorso-palmar instability of the ulna, clicking upon rotation of the forearm, ulnar translocation of the carpus, and a painful ulnar impingement syndrome. Management of these problems following an ulnar shortening procedure requires restoration of ulnar length to provide stability to the triangular fibrocartilage complex and ulnar sling mechanism. Also, recurrent impingement must be prevented. A technique of ulnar lengthening by advancement step osteotomy in conjunction with a "matched" resection of the advanced ulna is presented. Three case reports illustrate its use.

Verification of NB2 lymphoma cell bioassay for the measurement of plasma and pituitary prolactin in the Mongolian gerbil (Meriones unguiculatus)

Serum and pituitary glands were taken from male Mongolian gerbils which had received bromocriptine implants, ether stress or no treatment (controls). Pituitary prolactin (Prl) and growth hormone (GH) mRNA were analyzed by Northern hybridization using rat cDNA probes. Pituitary and plasma Prl content were analyzed with the Nb2 lymphoma cell growth bioassay. These assays were sensitive to the decreases in Prl caused by bromocriptine and the elevation of Prl caused by ether stress. The inhibition of pituitary and plasma Prl levels by bromocriptine correlated with a marked inhibition of pituitary Prl mRNA content. In contrast, levels of GH mRNA did not change with treatment, indicating that gerbil GH does not contribute to the lactogenic activity measured in the Nb2 lymphoma cell bioassay. The results indicate that this bioassay is suitable for the measurement of gerbil pituitary and plasma Prl.

Serum lipoperoxidation products in an infant with hemolytic-uremic syndrome

We detected increased concentrations of lipoperoxidation products, as malondialdehyde, in the serum of an infant with classic hemolytic-uremic syndrome. The concentrations declined when peritoneal dialysis was initiated and eventually returned to normal after clinical recovery. Our observation adds to the existing body of evidence that links the pathogenesis of hemolytic-uremic syndrome to peroxidative damage and to the rationale for using antioxidant agents as part of the therapy for this disease process.

Serum lipoperoxidation products in an infant with hemolytic-uremic syndrome

We detected increased concentrations of lipoperoxidation products, as malondialdehyde, in the serum of an infant with classic hemolytic-uremic syndrome. The concentrations declined when peritoneal dialysis was initiated and eventually returned to normal after clinical recovery. Our observation adds to the existing body of evidence that links the pathogenesis of hemolytic-uremic syndrome to peroxidative damage and to the rationale for using antioxidant agents as part of the therapy for this disease process.

Microvascular reconstruction of a devascularized ileal segment during ileo-anal anastomosis

Endorectal ileo-anal anastomosis has become a mainstay of continent bowel reconstruction after total colectomy. However, the procedure is often aborted because of lack of vessel length for the formation of the ileal pouch. The use of microsurgical techniques to lengthen mesenteric vessels and to allow completion of this valuable procedure is reported.

Effects of peroxidized polyunsaturated fatty acids on mitochondrial function and structure: pathogenetic implications for Reye's syndrome

Linoleic acid, a polyunsaturated fatty acid, is a constituent of margosa oil which has been implicated as a cause of Reye's syndrome (RS) in infants. Increased concentrations of polyunsaturated fatty acids have been found in sera from patients with RS. Isolated rat liver mitochondria exposed to the peroxidized (but not unperoxidized) methyl esters of linoleic (C18:2) or linolenic (C18:3) acids showed decreases in state 3 and uncoupled respiratory rates and in respiratory control and ADP/O ratios. In addition, they caused mitochondrial swelling as demonstrated spectrophotometrically. Between the two, the peroxidized methyl ester of linolenic acid was more toxic and was capable of inducing high amplitude swelling ultrastructurally similar to that seen in the hepatocytes of RS victims. The ability of rat liver mitochondria to oxidize glutamate was inversely related to the peroxide concentration in the medium. This accords with the reports of reduced glutamic dehydrogenase activities in the livers of both patients with Reye's syndrome and rats treated with margosa oil.

Psoriatic arthritis mutilans: digital distraction lengthening: pathophysiologic and current therapeutic review

A patient with advanced arthritis mutilans secondary to psoriatic arthritis had distraction lengthening of the index and long fingers of his left hand followed by interphalangeal joint debridement and iliac crest bone grafting. After operation, he demonstrated improved pinch (1.5 pounds to 8 pounds) and grip function (40 pounds to 60 pounds) in the hand and maintenance of the achieved digital length.

Class I transplantation antigens in solution in body fluids and in the urine. Individuality signals to the environment

Classical class I transplantation antigens present in solution in the body fluids have been studied. These antigens have been found in a monomeric, soluble form in blood, lymph, and urine, and a major source is the hemopoietic system which gives rise to cells that secrete these molecules into the blood. The cell types most probably involved in their secretion are of the macrophage/dendritic cell lineage. The serum molecule is a heterodimer with a heavy chain of 39,000 mol wt associated noncovalently with beta 2-microglobulin and is present in serum at a concentration between 350 and 390 ng/ml. These molecules have a short half-life of 2.7 h and are excreted into the environment via the kidneys in the urine. In the urine, greater than 90% of the molecules are degraded into smaller fragments. This finding that normal metabolic processes lead to the excretion of classical highly polymorphic class I molecules in the urine provides a direct explanation in molecular terms of the ability of animals to identify individuals on the basis of urinary odor. Since intact class I molecules are unlikely to be the odoriferous component in the urine, two hypotheses have been suggested. Either small fragments of class I molecules are detected or the molecule acts as a carrier that transports volatiles from the serum into the urine where they are released, giving rise to the class I-associated odor.

Serum vitamin A status in acute lymphocytic leukemia of childhood

Serum vitamin A status was assessed at the diagnosis in 31 children with common acute lymphocytic leukemia (CALL) and seven with T-cell leukemia (T-ALL). A control population consisting of 22 children was established to serve as one basis for comparison. Mean concentrations of vitamin A, retinol-binding protein (RBP) and prealbumin (PA) were significantly less (p less than 0.01) in the sera of patients with T-ALL when compared with the controls. Similarly, mean RBP and PA levels were reduced (p less than 0.01) in the sera of patients with CALL. In addition, "euretinolemic" and "hyporetinolemic" subgroups of CALL were identified comprising 74.2 percent and 25.8 percent of the patient population, respectively. The latter differed from the euretinolemic patients by being younger and showing an even greater decrease in the serum concentrations of RBP and PA. These findings indicate that there are factors affecting carrier proteins of vitamin A in childhood T-cell and common ALL; also, the data provide further evidence of the heterogeneity of common acute lymphocytic leukemia of childhood.

Mate recognition by urine odors in the Mongolian gerbil (Meriones unguiculatus)

We examined the responses of male and female gerbils housed in opposite- or same-sex pairs to the urine odors from their cage-mate and those of an unfamiliar gerbil of the same sex. Gerbils housed in mated pairs spent more time investigating the odor of their partner. They also emitted more modulated ultrasonic vocalizations in the presence of their partner's odor than in the presence of the unfamiliar odor. Gerbils housed in same-sex pairs did not respond differentially to the odor of their cage-mate. There were sex differences in the frequency of ventral scent-marking and modulated vocalizations, with males showing more of these behaviors than females. The urine odor of the gerbil's mate can thus be discriminated from those of other gerbils. Recognition of individual odors may promote affiliative behavior and reduce aggression, thus playing an important role in pair maintenance in gerbils.

Individual odors of rats are discriminable independently of changes in gonadal hormone levels

Male Long-Evans hooded rats were tested for their ability to discriminate between the urine odors from individual outbred Long-Evans rats using the habituation-dishabituation method. There were discriminable differences between the urine odors of two individual intact males, castrated males, estrous/proestrous females, diestrous/metestrous females and ovariectomized females. Thus, individual outbred rats of both sexes can be discriminated on the basis of their urine odors using this technique and discrimination between individuals occurs despite changes in gonadal hormone levels. This suggests that individual recognition is independent of reproductive state and social status although these may influence the production of body odors used for individual discrimination in rats. Individual odors most likely reflect genetic differences between individuals within the outbred strain.