A combined experimental and theoretical study on the formation of interstellar C3H isomers

The reaction of ground-state carbon atoms with acetylene was studied under single-collision conditions in crossed beam experiments to investigate the chemical dynamics of forming cyclic and linear C3H isomers (c-C3H and l-C3H, respectively) in interstellar environments via an atom-neutral reaction. Combined state-of-the-art ab initio calculations and experimental identification of the carbon-hydrogen exchange channel to both isomers classify this reaction as an important alternative to ion-molecule encounters to synthesize C3H radicals in the interstellar medium. These findings strongly correlate with astronomical observations and explain a higher [c-C3H]/[l-C3H] ratio in the dark cloud TMC-1 than in the carbon star IRC+10216.

Ischemia-induced alteration of myocardial Na(+)-K(+)-ATPase activity and ouabain binding sites in hypercholesterolemic rabbits

The purpose of this study was to explore the effect of ischemia on the Na(+)-K(+)-ATPase activity and ouabain receptor of the myocardial sarcolemma in hypercholesterolemic rabbits. Male New Zealand white rabbits were fed with either standard chow or standard chow supplemented with 0.5% (w/w) cholesterol and 10% (w/w) coconut oil. After an 8 week feeding period, the rabbits underwent a thoracotomy and myocardial ischemia was induced by occlusion of the coronary artery. Myocardial samples from the ischemic and non-ischemic regions of the left ventricle of control and cholesterol-fed rabbits were taken for study. The cholesterol-fed group showed a decrease in both Na(+)-K(+)-ATPase activity and [3H]ouabain binding sites as compared to the control group. Ischemia caused a reduction in both Na(+)-K(+)-ATPase activity [3H]ouabain bindings sites in both control and cholesterol-fed rabbits. The combination of ischemia and hypercholesterolemia produced an additive effect, with a further decrease in both Na(+)-K(+)-ATPase activity and [3H]ouabain binding sites. Neither the activity of Mg+(+)-ATPase nor the binding affinity for [3H]ouabain was affected by either hypercholesterolemia or ischemia. These findings indicate that hypercholesterolemia may exaggerate certain aspects of functional deterioration arising during myocardial ischemia.

Case report: reversible systolic heart failure and deep jaundice in hyperthyroidism

Systolic heart failure because of hyperthyroidism in patients without preexisting heart disease is not common. Thyrotoxic systolic heart failure is rarely diagnosed during life. Reports about thyrotoxicosis-related systolic heart failure have been diagnosed postmortem. However, antemortem diagnosis of this fatal disease has important clinical implications because if detected early, thyrotoxicosis-related systolic heart failure is reversible. Here is a report a patient with Graves' disease, systolic heart failure, and deep jaundice, which resolved after the treatment of antithyroid drugs.

Changes of left ventricular function after percutaneous balloon mitral valvuloplasty in mitral stenosis with impaired left ventricular performance

The pathophysiological role of mechanical and myocardial factors for impairment of left ventricular performance in mitral stenosis is still not clear. To investigate this controversy, 27 patients of mitral stenosis with left ventricular ejection fraction < 50% were studied. Patients were divided into two groups: Group 1: 20 patients, left ventricular ejection fraction improved to > 50% after valvuloplasty, and Group 2: 7 patients, left ventricular ejection fraction still < 50% after valvuloplasty. The clinical and hemodynamic characteristics were comparable for the two groups before valvuloplasty. Follow-up catheterization done one week later showed similar changes in mitral valve area, cardiac index, pulmonary pressure, left ventricular end-diastolic volume index and systemic vascular resistance between the two groups. However, left ventricular end-systolic volume was significantly decreased after valvuloplasty in Group 1 but not in Group 2, resulting in significantly higher ejection fraction in Group 1 than in Group 2. Postoperatively, regional wall motion scores were lower in Group 1 than in Group 2 (2.0 +/- 0.6 vs. 2.7 +/- 0.5 at the anterolateral wall, P = 0.002; 1.9 +/- 0.6 vs. 2.9 +/- 0.4 at the posterobasal wall, P = 0.0003). Most of our mitral stenosis patients with impaired left ventricular ejection fraction showed improvement after mitral valvuloplasty had released the mechanical obstruction. However, in some patients, impaired ejection fraction persisted after valvuloplasty, suggesting the mechanism of myocardial failure. Thus, both myocardial and mechanical factors play important roles in the pathogenesis of left ventricular ejection performance impairment.

Medical care of illegal migrants intercepted on the high sea (Operation Prompt Return)

In July 1995, Operation Prompt Return was mounted to set up a facility on Wake Island in the mid-Pacific to process 158 illegal emigrants and return them to China. The deployed medical team screened and examined the travelers and the ship's crew. Initial major problems consisted of skin rashes, dental diseases, and signs of physical abuse. Subsequently, urogenital complaints, musculoskeletal pain, and newer cases of scabies were evaluated and treated. Problems relating to planning and provision of medical care to migrants were discussed and solutions were suggested.

Pyrimidinoceptor-mediated activation of phospholipase C and phospholipase A2 in RAW 264.7 macrophages

1. As well as the presence of P2Z purinoceptors previously found in macrophages, we identified pyrimidinoceptors in RAW 264.7 cells, which activate phospholipase C (PLC) and phospholipase A2 (PLA2). 2. The relative potency of agonists to stimulate inositol phosphate (IP) formation and arachidonic acid (AA) release was UTP = UDP > > ATP, ATP gamma S, 2MeSATP. For both signalling pathways, the EC50 values for UTP and UDP (3 microM) were significantly lower than that for ATP and all other analogues tested (> 100 microM). 3. UTP and UDP displayed no additivity in terms of IP formation and AA release at maximally effective concentrations. 4. UTP-, but not ATP-, evoked AA release was 60% inhibited by pertussis toxin (PTX), while stimulation of IP formation by both agonists was unaffected. Short-term treatment with phorbol 12-myristate 13-acetate (PMA) led to a dose-dependent inhibition of IP responses to UTP and UDP, but failed to affect the AA responses. Removal of extracellular Ca2+ inhibited the PI response to UTP, but abolished its AA response. 5. ATP-induction of these two transmembrane signal pathways was decreased in high Mg(2+)-containing medium but potentiated by the removal of extracellular Mg2+. 6. Suramin and reactive blue displayed equal potency to inhibit the IP responses of UTP and ATP. 7. Both UTP and UDP (0.1-100 microM) induced a sustained increase in [Ca2+]i which lasted for more than 10 min. 8. Taken together, these results indicate that in mouse RAW 264.7 macrophages, pyrimidinoceptors with specificity for UTP and UDP mediate the activation of PLC and cytosolic (c) PLA2. The activation of PLC is via a PTX-insensitive G protein, whereas that of cPLA2 is via a PTX-sensitive G protein-dependent pathway. The sustained Ca2+ influx caused by UTP contributes to the activation of cPLA2. RAW 264.7 cells also possess P2z purinoceptors which mediate ATP(4-)-induced PLC and PLA2 activation.

Expression in human endothelial cells of ADP-ribosylation factors, 20-kDa guanine nucleotide-binding proteins involved in the initiation of vesicular transport

ADP-ribosylation factors (ARFs) are approximately 20-kDa, guanine nucleotide-binding proteins, initially discovered as stimulators of cholera toxin ADP-ribosyltransferase activity and subsequently shown to participate in vesicular trafficking. Five of the six mammalian ARFs have been identified in human tissues by molecular cloning. They fall into three classes (class I: ARFs 1-3; class II: ARFs 4, 5; class III: ARF 6) based on deduced amino acid sequence, size, phylogenetic analysis, and gene structure. Similar to the rab family of approximately 20 kDa guanine nucleotide-binding proteins, the ARFs appear to function in specific trafficking pathways. The presence of a specific ARF might serve as a marker for that pathway. To verify expression of ARF mRNA and protein in human umbilical vein endothelial cells, immunoreactivity using antibodies specific for each ARF class, quantitative polymerase chain reaction (PCR) using ARF-specific, internal cRNA standards containing unique restriction enzyme cleavage sites introduced by point mutations, and Northern analysis with probes specific for ARFs 1, and 3-6, were utilized. PCR and Northern analysis were in agreement in showing that amounts of mRNA for ARF 1 and ARF 4 were similar and higher than those of ARF 3 and ARF 5 which were greater than ARF 6. Primarily, Class 1 ARF proteins were detected by immunoreactivity, with the majority in the supernatant fraction. The relative expression of ARFs in endothelial cells thus differs from that in neuronal tissues where it had been found that ARF3 is the predominant species.

Excessive papillary muscle traction and dilated mitral annulus in mitral valve prolapse without mitral regurgitation

This study demonstrated excessive papillary muscle displacement during peak systole but normal mitral annulus function during the cardiac cycle in patients with mitral valve prolapse and no mitral regurgitation. The excessive papillary muscle displacement may play an important role in the pathogenesis of the superior displacement of mitral leaflets in patients with mitral valve prolapse.

Usefulness of transdermal scopolamine for vasovagal syncope

We studied short-term effectiveness of transdermal scopolamine in a group of patients with unexplained syncope provoked during head-up tilt testing. This double-blind randomized trial of transdermal scopolamine demonstrated no significant effect of preventing vasovagal syncope.

Advantages of Total Laparoscopic Hysterectomy

We compared 112 total laparoscopic hysterectomies (TLH) with 72 laparoscopic hysterectomies (LH) performed from January 1, 1995, to September 30, 1995. Patient characteristics (age, weight, parity) and indications for surgery were similar between the groups. All surgeries were performed with electrosurgery or suture ligature, or both. Average uterine weight was slightly lower with TLH (193.1 &plusmn; 96.2 g) versus LH (237.4 &plusmn; 84.5 g). Thirty-three women (29.46%) undergoing TLH had had previous pelvic surgery, versus 12 having LH (16.67%). Operating time was significantly shorter for TLH (117.6 &plusmn; 38.2 min) than LH (134.9 &plusmn; 37.4 min). Less bleeding, as indicated by decreased postoperative hemoglobin, was noted with TLH (1.3 &plusmn; 0.7 g/ml) versus LH (1.7 &plusmn; 1.1 g/ml). Fewer cases of serious complications, such as genitourinary tract damage, and less formation of granulation tissues on the vaginal cuff associated with persistent leukorrhea and postcoital bleeding occurred with TLH, probably because more precise surgery can be done under direct vision. We believe TLH can be performed more safely and quickly than LH by an experienced surgeon. A potential advantage of TLH is less postoperative infection due to less vaginal manipulation. Other advantages are the lengthening of the vagina, less postoperative prolapse of the vagina, and less enterocele development because of more precise anatomic restoration of the pelvic structures under direct visualization. Since detailed pelvic structures can be visualized, excised, and restored, TLH has all the possible benefits of subtotal hysterectomy, if any, due to the maximum preservation of supporting structures (cardinal, uterosacral ligaments) and nerve plexus, thus making subtotal hysterectomy obsolete. Further studies and long-term follow-up are required.

Characterization of signaling pathways of P2Y and P2U purinoceptors in bovine pulmonary artery endothelial cells

The actions of ATP on the endothelium are mediated by P2 purinoceptors. We have shown that P2Y and P2U purinoceptors coexist in bovine pulmonary artery endothelial cells (CPAE), where they induce phosphoinositide (PI) turnover and Ca2+ mobilization. The relative order of potency (based on the threshold concentration) of nucleotide analogues (1-100 microM) in stimulating the accumulation of inositol phosphate (IP) was 2-methylthio-ATP (2MeSATP) = 2-methylthio-ADP (2MeSADP) > or = 2ClATP > UTP = ATP = ADP. alpha, beta-methylene ATP, beta, gamma-methylene ATP, UDP, adenosine-5'-tetraphospho-5'-adenosine, and adenosine-5'-pentaphospho-5'-adenosine had no effect at concentrations as high as 100 microM. At maximal concentrations, the IP responses to 2MeSATP and UTP were additive, whereas those to ATP and either 2MeSATP or UTP were not. Moreover, the maximal response to 2MeSADP was additive to that to UTP but not to that of 2MeSATP. Pretreatment with pertussis toxin slightly inhibited 2MeSATP- and UTP-stimulated IP generation by 15%. Under Ca(2+)-free conditions, UTP-induced IP formation was inhibited more markedly than that induced by 2MeSATP. Short-term treatment of the cells with phorbol 12-myristate-13-acetate (PMA) resulted in a dose-dependent inhibition of 2MeSATP-induced IP formation greater and more sensitive than that induced by UTP; similar results were obtained for the sensitivity of inhibition by suramin and reactive blue. Stimulation of the cells with either 2MeSATP or UTP induced a rapid increase in intracellular Ca2+ level, followed by a slow decrease to basal levels, followed by Ca2+ level oscillation. In the absence of extracellular Ca2+, [Ca2+]i responses were quantitatively less and did not show the slow phase and oscillation. Together these results suggest that both P2Y and P2U purinoceptors are expressed in bovine pulmonary artery endothelial cells and are coupled to phospholipase C (PLC) activation and Ca2+ mobilization through pertussis toxininsensitive G proteins.

Inoue balloon deformity and rupture during percutaneous balloon valvuloplasty

In the management of mitral stenosis, similar long-term results can be obtained by using either an Inoue balloon catheter or a double-balloon technique for percutaneous balloon valvuloplasty. There have been few reports concerning any deformity of an Inoue balloon. From January 1988 to June 1995, 263 procedures of either mitral or tricuspid valvuloplasty have been performed in this center. The Inoue balloon catheter technique was used for 245 procedures. A deformity of the Inoue balloon catheter was noted in 4 (1.6%) and actual rupture of deformed balloon occurred in one (0.4%). All deformities were found at the distal portion of the Inoue balloon. Valvular insufficiency became more severe after valvuloplasty in two cases. Following rupture of the balloon, neither arterial embolization nor perforation of the cardiac chambers developed. In conclusion, a deformity of the Inoue balloon, although rare, can develop during percutaneous balloon valvuloplasty. The deformity may portend balloon rupture if additional maximal dilatations are undertaken.

Tumor necrosis factor-alpha, platelet-activating factor, and hydrogen peroxide activate protein kinase C subtypes alpha and epsilon in human saphenous vein endothelial cells

Protein kinase C (PKC), the major receptor for tumor-promoting phorbol esters, consists of a family of at least 12 distinct lipid-regulated enzymes. We examined the expression and regulation of PKC isoforms in human saphenous vein endothelial cells (HSVEC). Western blot analysis with PKC isoform-specific antibodies indicated that PKC alpha, PKC epsilon and PKC zeta were expressed in these cells. Translocation and down-regulation of PKC alpha and epsilon but not zeta were detected by short-term and long-term treatment with TPA (12-O-tetradecanoylphorbol 13-acetate), respectively. Tumor necrosis factor-alpha (TNF-alpha 1,600 U/ml) and platelet activating factor (PAF 50 nM) increased the membrane content of PKC alpha and epsilon but not zeta. H2O2 (10 mM) induced the translocation of PKC alpha from the cytosol to the membrane and increased PKC epsilon content in both cytosol and membrane. However, 12-(S)-HETE (12-hydroxyeicosatetraenoic acid) (100 nM), a lipoxygenase metabolite of arachidonic acid, did not affect the two isoforms. These results suggest that the molecular action of TNF-alpha, PAF, and H2O2 in HSVEC might occur through PKC alpha and epsilon activation.

Transcatheter embolization of a coronary arteriovenous fistula with a complex, helical-fibered platinum coil

Transcatheter embolization was successfully performed on a 51-year-old man with a coronary arteriovenous fistula arising from the left circumflex coronary artery and draining into the superior vena cava. The patient presented with typical manifestations of angina pectoris that were first noticed during childhood but had worsened over the past 5 years. A 2 x 20 mm complex, helical-fibered platinum coil was placed in the mid-portion of the fistula and successfully occluded the fistula within 30 minutes. The patient has been free from angina pectoris since the procedure.

Successful treatment of acute myocardial infarction by thrombolytic therapy in a patient with primary antiphospholipid antibody syndrome

A dilemma must be faced when deciding whether or not to use thrombolytic therapy in patients with acute myocardial infarction and circulating antiphospholipid antibody. This report is about a patient whose infarct-related coronary artery was successfully revascularized by recombinant tissue plasminogen activator without any major bleeding complications. The nature of the infarct-related artery was described by the use of intravascular ultrasonography.

Muscle strength after successful total knee replacement: a 6- to 13-year followup

This study investigated the long term results of muscle strength of the knee joint after total knee replacement. Isokinetic testings of 120 degrees and 180 degrees per second and isometric testings at 30 degrees and 60 degrees knee flexion were studied on 1 healthy group and 3 groups of patients 6 to 13 years after total knee arthroplasty with prosthesis designs of total condylar, low contact stress meniscal bearing, or low contact stress rotating platform. The total condylar and low contact stress rotating platform prostheses were designed for use with a cut posterior cruciate ligament, whereas the low contact stress with meniscal bearing type was designed for use with a retained posterior cruciate ligament The muscle strength ratios of hamstring to quadriceps were compared among the prosthetic designs and there were no statistical differences among patient groups. Whether the posterior cruciate ligament was cut or retained did not affect the relative muscle strength of the quadriceps and hamstring. All hamstring to quadriceps ratios from the isokinetic testings of these 3 prostheses design groups were greater than those of the healthy group, but were quite close to those of patients with cut anterior cruciate ligaments or with lower levels of daily activity. The hamstring to quadriceps ratios after successful total knee replacement were not the same as those of the healthy group even after long term (6-13 years) functional adaptation.

Left subclavian artery bypass graft in complicated arterial switch operation

We report the successful use of left subclavian artery bypass graft in a newborn infant with complete transposition of the great arteries accompanied by an unusual coronary artery pattern, in whom left coronary artery insufficiency developed after the arterial switch operation. This procedure has shown good clinical results, with interesting follow-up angiographic findings 8 months after the operation.

Dobutamine stress echocardiography for detecting coronary artery disease

To assess the value of dobutamine stress echocardiography (DSE) to detect coronary artery disease (CAD) and to compare the diagnostic accuracy between DSE and treadmill exercise test (TXT), 104 patients (mean age 58 +/- 12 years) presenting for coronary angiography were prospectively studied. TXT was performed according to the Bruce protocol. Dobutamine (5-40 micrograms/kg/min) was infused in 3-min stages. Digital echocardiograms were recorded on-line at baseline, during low- and peak-dose dobutamine infusion, and at recovery. An echocardiogram positive for CAD was defined as the one showing a new wall motion abnormality (WMA) induced by dobutamine. There were no major complications during the study. Significant CAD (> or = 50% diameter stenosis) was present in 17 of 30 patients who had normal echocardiograms at baseline. The sensitivity for detecting CAD was 76% by TXT and 94% by DSE, and the specificity was only 38% by TXT and 92% by DSE, respectively. Seventy-four patients had localized rest WMAs. Twenty-four had no significant CAD or lesions only confined to regions with abnormal rest wall motion, and 50 had disease remote from these regions. The sensitivity for detection of remote disease was 60% by TXT and 76% by DSE, and the specificity was 75% by TXT and 96% by DSE, respectively. In conclusion, DSE is a safe and accurate diagnostic tool for identifying CAD and for predicting the extent of disease in those who have localized rest WMAs.

Endothelin-1 concentrations and optimisation of arterial oxygenation and venous admixture by selective pulmonary artery infusion of prostaglandin E1 during thoracotomy

In order to improve arterial oxygenation and venous admixture during one lung ventilation, the effect of selective infusion of prostaglandin E1 into the pulmonary artery of the ventilated lung was investigated in 12 adult patients undergoing thoracotomy. Patients' bronchi were intubated with a Mallinckrodt bronchial tube and ventilated with 66% oxygen in air. Cardiopulmonary factors such as systemic and pulmonary arterial pressures, pulmonary vascular resistance, blood gas analyses, cardiac output and airway pressure were measured before and during one-lung ventilation; venous admixture (Qs/Qt) was calculated. Serial blood samples were taken from the pulmonary artery of the ventilated lung for endothelin-1 estimation. One lung ventilation reduced the mean PaO2 from 42.1 (2.3) kPa to 11.8 (1.4) kPa (p < 0.001) and increased Qs/Qt from 10.8 (3.2)% to 39.2 (4.7)% (p < 0.001). Pulmonary vascular resistance also increased from 167 (24) dyne.s.cm-5 to 262 (38) dyne.s.cm-5 (p < 0.05) with a corresponding increase of plasma endothelin-1 (p < 0.05). After 30 min of one lung ventilation, PGE1 was infused continuously into the pulmonary artery of the ventilated lung at a rate which increased incrementally from 0.04-0.10 micrograms.kg-1.min-1. PaO2 increased to 20.7 (2.6) kPa (p < 0.01) and Qs/Qt decreased to 30.6 (3.5)% (p < 0.05). During the infusion, pulmonary vascular resistance reduced to 173 (30) dyne.s.cm-5 (p < 0.01). The plasma endothelin-1 concentration reached a plateau between the end of one lung ventilation (before closing the thorax) and 6 h postoperatively. This correlated inversely with the pre-operative forced expiratory volume in one second (r = -0.68, p < 0.005), declining to normal values 72 h after operation. The selective infusion of PGE1 into the pulmonary artery of the ventilated lung corrected pulmonary vasoconstriction and improved both arterial oxygenation and venous admixture during one lung ventilation for thoracotomy.

Mechanism of hydrogen peroxide and hydroxyl free radical-induced intracellular acidification in cultured rat cardiac myoblasts

After a transient ischemic attack of the cardiac vascular system, reactive oxygen-derived free radicals, including the superoxide (O2-.) and hydroxyl (.OH) radicals can be easily produced during reperfusion. These free radicals have been suggested to be responsible for reperfusion-induced cardiac stunning and reperfusion-induced arrhythmia. Hydrogen peroxide (H2O2) is often used as an experimental source of oxygen-derived free radicals. Using freshly dissociated single rat cardiac myocytes and the rat cardiac myoblast cell line, H9c2, we have shown, for the first time, that an intriguing pHiota acidification (approximately 0.24 pH unit) is induced by the addition of 100 micromol/L H2O2 and that this dose is without effect on the intracellular free Ca2+ levels or viability of the cells. Using H9c2 as a model cardiac cell, we have shown that it is the intracellular production of .OH, and not O2-. or H2O2, that results in this acidification. We have excluded any involvement of (1) the three known cardiac pHi regulators (the Na+-H+ exchanger, the Cl--HCO3 exchanger, and the Na+-HCO3 co-transporter), (2) a rise in intracellular Ca2+ levels, and (3) inhibition of oxidative phosphorylation. However, we have found that H2O2-induced acidosis is due to inhibition of the glycolytic pathway, with hydrolysis of intracellular ATP and the resultant intracellular acidification. In cardiac muscle and in skinned cardiac muscle fiber, it has been shown that a small intracellular acidification may severely inhibit contractility. Therefore, the sustained pHi decrease caused by hydroxyl radicals may contribute, in some part, to the well-documented impairment of cardiac mechanical function (ie, reperfusion cardiac stunning) seen during reperfusion ischemia.

Tuberculous peritonitis--do not miss it

Incidence of tuberculosis is sharply rising in the United States, and tuberculous peritonitis is often diagnosed late in the course of the disease, resulting in undue patient morbidity and mortality.

PURPOSE

Purpose of this study was to better identify which clinical, laboratory, radiologic, and invasive procedures were most useful in diagnosing tuberculous peritonitis.

METHODS

All cases of tuberculous peritonitis diagnosed between 1982 and 1994 were reviewed retrospectively to discern which laboratory, radiographic, and procedural tests were helpful in diagnosing the condition.

RESULTS

Twenty-eight cases of tuberculous peritonitis were diagnosed during the studied period. Two patients were not diagnosed until autopsy. Patients from all socioeconomic classes and multiple races ranged in age from 3 to 69 (mean, 29.5) years. Most patients presented with a chronic wasting illness, mild abdominal pain, and fever. Purified protein derivative was only positive in 5 of 16 patients. Chest radiographs were suggestive of pulmonary tuberculosis (TB) in five patients. Ultrasound examination of the abdomen was helpful in five patients, and computed tomographic scan was suspicious in 16 of 17 patients. Sputum for acid fast bacillus (AFB) smear was positive in 3 of 14 patients, and paracentesis for AFB smear was positive in 1 of 8 patients. Routine blood work was not helpful. Laparoscopy was diagnostic in five of seven patients. Laparotomy and tissue biopsy of characteristic tissue for AFB smear and culture was diagnostic in 20 of 20 patients. Once diagnosed, all patients responded rapidly to empiric antituberculous medical therapy, except one patient with miliary TB who died shortly after diagnosis. A trend in earlier diagnosis was noted in recent years and is felt to be the result of an elevated index of suspicion.

CONCLUSIONS

TB peritonitis may be fatal but is medically cured if diagnosed in a timely fashion. It is essential that the clinician suspect the disease in appropriate patients. Tests frequently associated with TB such as chest radiograph and purified protein derivative are not sensitive in detection of TB peritonitis. Computed tomographic scan is the most useful radiographic study. Mini laparotomy with tissue biopsy for smear and culture is the most sensitive and specific diagnostic procedure.

Local and regional recurrence of carcinoma of the colon and rectum: II. Factors relating to operative technique

Despite many recent advances in the field of radiation therapy, chemotherapy and even immunotherapy, surgical resection remains the mainstay of curative treatment for carcinoma of the colon and rectum. Locoregional recurrence is a recognized type of failure, and it is the most direct measurement of the relevance of surgery to cancer control. Factors that influence relapse rates and sites deserve in-depth and periodical review. Local or locoregional (LR) recurrence implies the reappearance of carcinoma after an intended complete removal of the tumour. It is usually defined as tumour regrowth at the anastomosis or immediately within or contiguous to the operative area. For rectal cancer, the adjacent organs include the perineum, bladder and vagina; and LR failure includes perineal or pelvic lesions. Many reports studied only patients with colon or rectal cancers, while others presented their data of the colon and rectum together. In this review, I shall use colon, rectum and colorectum to designate the composition of each patient population. Published results from all available English sources were reviewed, concentrating on reports of the last 10 years. Data analysed by statistical methods are emphasized, and a probability of occurrence of one in 20 or less (P < 0.05) is considered significant. Various clinicopathological factors of the tumour and host, and adjuvant radiotherapy that affected the LR recurrence rates have been presented in another paper (part 1, 283 - 293). Technical details and issues relating to performance of the operation will be discussed in this paper (part II). Quantitative information presented here predate the wide use of laparoscopic or minimal invasive surgery in treating the primary tumour, and the polar practice of periodic colonoscopy, carcinoembryonic antigen (CEA) or computed tomography as regular follow-up tests. Thus, these baseline data will be useful to study the changes in rates and sites of recurrence in the future.

Correlation between quantitative severity of stress thallium-201 myocardial perfusion defect and severity of coronary stenosis

The correlation between the quantitative myocardial perfusion defect severity of stress 201Tl single-photon emission computed tomography and the severity of coronary stenosis was investigated in 28 patients with angina pectoris. Among the 28 patients, four had normal or nearly normal coronary angiograms, seven had one-vessel disease, six had two-vessel disease and 11 had three-vessel disease. Seven patients had prior myocardial infarctions and two had collateral flows to the diseased vessels. The quantitative 201Tl defect severity score was obtained by summing the standard deviations of each pixel in which the counts fell > 2.5 SD below the mean normal counts. The severity of coronary stenosis was expressed as the Gensini score. The quantitative 201Tl defect severity score correlated significantly with the Gensini score. In patients without prior myocardial infarction or collateral flow, a more significant correlation between the quantitative 201Tl defect severity score and the Gensini score was found. Quantitative analysis of stress 201Tl defect severity provides a useful, noninvasive assessment of the functional severity of coronary stenosis compared with coronary angiography.