Nitrogen balance in patients treated with extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) is a commonly used technique in the management of newborn respiratory failure. However, few studies have addressed the optimal nutritional support of these critically ill neonates. Eleven newborns undergoing ECMO for respiratory failure were studied at various levels of intravenous caloric and nitrogen intake, using nitrogen balance techniques, to assess optimal nutritional support necessary to achieve positive nitrogen balance. Nonprotein nitrogen calories > 60 kcal/kg/d, and nitrogen > 240 mg/kg/d were necessary to achieve positive nitrogen balance, while maximum positive balance was seen with nitrogen intake > 400 mg/kg/d. These data suggest that newborns treated with ECMO can achieve positive nitrogen balance with modest amounts of caloric and nitrogen intake.

3D MPRAGE evaluation of the internal auditory canals

A heavily T1-weighted three-dimensional (3D) gradient echo sequence utilizing a 180 degrees inversion pulse has become available for clinical use, called magnetization prepared rapid acquisition gradient echo (MPRAGE). With the appropriate choice of repetition time, echo time, flip angle, and inversion time (TI), T1-weighted imaging can be performed with excellent anatomic detail and a good signal-to-noise ratio. We performed an initial evaluation of this sequence for detection of abnormalities of the internal auditory canals compared with conventional spin echo (SE) imaging. Fifteen men and 15 women were evaluated. Diagnoses included normal (n = 15 patients), acoustic neuromas (n = 7 tumors in 4 patients), cerebellopontine angle meningiomas (n = 3), postoperative for acoustic neuroma without residual tumor (n = 2), postoperative with evidence of residual tumor (n = 3), glomus jugulare (n = 1), Bell palsy (n = 1), and vestibular enhancement of probable viral etiology (n = 1). The 3D MPRAGE study consisted of 128 coronal partitions, (10/4/1), 10 degrees flip angle, 130 x 256 matrix, 2 mm slice thickness. TI time of 350 ms, 1 s recovery time, and 5.43 min examination time. All enhancing lesions identified on the conventional SE T1-weighted imaging were also identified on the MPRAGE imaging. No diagnostic difference existed between the MPRAGE and conventional SE sequences when pathology was present, but the MPRAGE sequence did have poorer resolution in the axial reformats related to the 130 x 256 in-plane matrix. While not currently able to replace conventional two-dimensional SE imaging, 3D MPRAGE may provide a valuable adjunct to the routine imaging protocol. This technique could replace the coronal T1-weighted SE sequence and provide excellent gray-white differentiation and many contiguous thin sections without a great increase in overall examination time.

Transient cortical blindness due to hypertensive encephalopathy. Magnetic resonance imaging correlation

Striking reversible signal intense magnetic resonance imaging (MRI) lesions were observed in the occipital cortex of a 16-year-old girl who presented with an attack of transient cortical blindness as the initial manifestation of hypertensive encephalopathy (HTE). The lesions were seen to best advantage on T2-weighted imaging and were not visible on computed tomography (CT). It is proposed that such occipital lobe MRI lesions likely reflect extravasation of fluid and proteins across the blood brain barrier, damaged as a consequence of cerebral autoregulation failure.

F reticulocyte response in sickle cell anemia treated with recombinant human erythropoietin: a double-blind study

Studies on baboons and preliminary observations in three patients with sickle cell anemia (SS) suggested that high doses of pulse administered recombinant human erythropoietin (rHuEPO) stimulate F-reticulocyte production. We now report on the administration of rHuEPO in a double-blind format to ascertain frequency of response and potential precipitation of side effects. Ten patients were enrolled, but one was discontinued due to the indication of a blood transfusion. Of the other nine, five received rHuEPO in escalating doses (from 400 to 1,500 U per kg twice daily [BID] per week), alternating with a placebo, in blinded fashion. The second group, consisting of four patients, followed an identical protocol (except starting dose was 1,000 U/Kg, BID per week) and were iron supplemented during treatment. The criterion of response was a transient doubling (as a minimum) of the steady-state F-reticulocyte level. We found that none of the five patients in the first group responded to rHuEPO, and two of them became iron deficient, as judged by a significant decrease in ferritin. Of the second group, four patients responded with F-reticulocyte increases. In three patients, open label administration of rHuEPO confirmed the effect. We observed seven painful episodes during this study, two during the EPO administration and five during the placebo arm. Three patients were phlebotomized because the hemoglobin level increased 1.5 g/dL more than steady-state levels. Of the six patients followed-up by percent dense cell determinations, one exhibited increased levels during periods of the treatment, whereas the other five showed no change. No anti-rHuEPO antibodies were detected. We conclude that rHuEPO can stimulate F-reticulocyte response in some patients with sickle cell anemia, without apparent negative clinical side effects. The state of iron stores may be critical. Whether higher doses of rHuEPO and/or a different regimen might induce sustained F cells and fetal hemoglobin increases remains to be determined.

Volume T1-weighted gradient echo MRI in multiple sclerosis patients

Three-dimensional (3D) volume turbo fast low angle shot (FLASH) techniques have become available which produce heavily T1-weighted images, similar to inversion recovery scans, utilizing the appropriate flip angle and inversion time. The purpose of this study was to compare the sensitivity of a rapid volume gradient echo technique [3D magnetization prepared rapid acquisition gradient echo (MP RAGE)] in identifying multiple sclerosis (MS) plaques with a conventional T2-weighted spin echo (SE) sequence. Ten patients with clinical MS were evaluated. Patients underwent a routine examination consisting of an axial T2-weighted SE sequence (2,500,22/90) and a coronal 3D MP RAGE, 10/4/10, acquired as 128 two mm partitions. In six patients, area measurements of 22 plaques were determined on both the axial T2-weighted SE examinations and the axial reformatted MP RAGE examinations. The overall number of plaques utilizing each technique was approximately the same. One hundred twenty-two plaques were visualized for the 3D MP RAGE sequence, and 128 plaques for the T2-weighted SE sequence. There were differences in detection of plaques in different regions, with plaques in gray matter better demonstrated utilizing the conventional T2-weighted SE sequence. Plaques in the corpus callosum, pons, and brachia pontis were better demonstrated utilizing 3D MP RAGE. No significant difference was found between the areas measured on the MP RAGE sequence and on the T2-weighted SE sequence. Three-dimensional MP RAGE provides a sensitive and complementary method to conventional T2-weighted SE sequences in the evaluation of patients with MS.

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

Control of scarring in adult wounds by neutralising antibody to transforming growth factor beta

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. We injected the margins of healing dermal wounds in adult rats with neutralising antibody (NA) to transforming growth factor-beta (TGF-beta). All control wounds (irrelevant antibody, or TGF-beta, or no injection) healed with scarring, whereas the NA-treated wounds healed without scar-tissue formation; NA-treated wounds had fewer macrophages and blood vessels, lower collagen and fibronectin contents, but identical tensile strength and more normal dermal architecture than the other wounds. Early manipulation of the concentrations of selected cytokines may be a new approach to the control of scarring.

Secular trend in body mass index in the adult population of three communities from the upper mid-western part of the USA: the Minnesota Heart Health Program

Secular trend in body mass index (BMI) over 7 years (1980-1987) was examined in the upper mid-western part of the USA using annual cross-sectional data collected by the Minnesota Heart Health Program. Significant secular increase in BMI adjusted for age and education was found in both men (0.08 kg/m2/year, P less than 0.02) and women (0.19 kg/m2/year, P less than 0.0001). In women, the secular increase occurred throughout the distribution of body weights but the change in the upper end was two to three times greater than that in the other parts of the distribution. In men, most of the increase in BMI occurred in the upper end of the distribution. Prevalence of obesity (defined as BMI greater than or equal to 85th percentile at year 1: men, 30.16 kg/m2; women, 29.94 kg/m2) increased by 0.6 percent/year (P = 0.1) in men and by 1.0 percent/year (P = 0.002) in women. The results indicate that body weight is increasing in upper mid-western adults, probably largely as a result of already overweight individuals becoming more obese. The secular increase in BMI was not accompanied by systemic change in reported food intake and exercise, and could not be explained by decreased prevalence of smoking. Large increases in body weight, especially among those who are already overweight, may have a significant public health impact.

Facial anthropometry in newborns in Pondicherry

Two hundred term healthy neonates were examined and 14 anthropometric measurements were taken in the face and ear region. Difference between the sexes was observed in ear length, ear breadth, and philtrum. Significant correlation was found between ear placement and ear length; and outer and inner canthal distances (p less than 0.001). The paper provides baselines data for facial growth measurements and discusses the utility of these measurements in detecting dysmorphogenesis in neonates.

Use of gadolinium-enhanced MR imaging for differentiating mucoceles from neoplasms in the paranasal sinuses

The purpose of this study was to determine whether additional clinically useful information could be obtained from gadolinium-enhanced magnetic resonance (MR) imaging compared with the information obtained from nonenhanced MR imaging and computed tomography (CT). Therefore, the authors selected 41 patients, whose results at CT examinations demonstrated a variety of pathologic conditions of the paranasal sinuses, to undergo MR imaging both with and without the use of gadopentetate dimeglumine for contrast enhancement. In 22 of 35 cases of neoplasms and mucoceles occurring separately, the lesions were correctly differentiated by established MR signal criteria alone. However, 32 of these 35 cases were accurately differentiated when gadolinium-enhanced MR images were obtained. Six cases demonstrated co-existing neoplasm and mucocele: Gadolinium-enhanced MR enabled correct differentiation of five of these lesions, while unenhanced MR enabled correct differentiation of three. On the basis of these results, the authors conclude that the use of gadopentetate dimeglumine for contrast enhancement at MR imaging is useful for differentiating mucoceles from neoplasms in the sinonasal tract.

Infarction of the left hepatic lobe in a neonate on serial CTs: evolution of a pseudomass to atrophy

We report a case of "hepatic mass" in a neonate caused by infarction of the left hepatic lobe with later atrophy. It is hoped that serial imaging can lead to recognition of this entity with avoidance of angiography and laparotomy.

Biodistribution, tissue reaction, and lung retention of pentamidine aerosolized as three different salts

Aerosolized pentamidine isoethionate is retained in the lung and appears to prevent Pneumocystis carinii pneumonia (PCP) in many AIDS patients. We evaluated alternative formulations of pentamidine that might reduce the airway irritation associated with aerosolized pentamidine isoethionate. Specifically, we assessed the biodistribution, histologic response, and lung retention of the isoethionate, gluconate, and lactate salts of pentamidine after aerosol administration to mice. For each of the three aerosolized salts tested, greater than 50% of the pentamidine initially recovered from the lungs after one dose was still retained there 14 days later. Thus, significant levels of pentamidine, aerosolized as three different salts, are retained in the lung for at least 2 wk after a single dose. The three salts of pentamidine each produced high lung to extrapulmonary drug ratios, the converse of that produced by intravenous injection of pentamidine isoethionate. At very high aerosol doses, the ability of the lung to retain pentamidine appeared saturable. Even aerosolized daily for 2 wk at very high doses, none of the three pentamidine salts produced histologic evidence of organ toxicity. A Phase 1 trial of aerosolized pentamidine gluconate in AIDS-PCP patients is now in progress to determine if this approach can reduce airway irritation.

Expression and secretion of rice alpha-amylase by Saccharomyces cerevisiae

We report the high level expression and secretion of rice alpha-amylase isozyme by Saccharomyces cerevisiae. Transcription of this gene was under control of the yeast enolase promoter. The synthesized protein had an approximate molecular size of 45 kDa and a pI of approx 4.7 to 5.0. The rice alpha-amylase signal peptide was recognized and efficiently processed by yeast and the active, glycosylated enzyme was secreted into the culture media. This enzyme was purified to homogeneity by affinity chromatography and its enzymatic properties were characterized. The Km and Vmax were found to be similar to those of alpha-amylases from other organisms. The high level of secretion observed in these studies may be due to the unique features of the rice signal peptide and/or to the glycosylation of the recombinant enzyme.

The effect of pre-anaesthetic fasting on blood glucose level in children undergoing surgery

Blood glucose concentrations were measured in 104 children aged 6 months- 10 years (mean 3.1 years) undergoing inpatient anaesthesia. The mean fasting period was 10.87 +/- 2.68 hours. Mean preanaesthetic and 1/2 hour post-anaesthetic blood glucose levels were 4.8 +/- 0.8 and 6.1 +/- 1.9 mmoles/L respectively. Pre- anaesthetic low blood glucose level (2.7-3.3 mmoles/L) could only be detected in 3.8% cases. Post-anaesthetic increase in blood glucose level was the same as reported in adults.

Laser action from 2,6,8-position trisubstituted 1,3,5,7-tetramethylpyrromethene-BF(2) complexes: part 1

Of the four new pyrromethene derivatives studied, 1,3,5,7,8-pentamethyl-2,6-diethylpyrromethene-BF(2) complex lased ~3 times more efficiently than rhodamine 560 under flashlamp excitation.

Immediate exposed skin grafting in children's burns

The technique of immediate exposed skin grafting following early tangential excision of burns in children overcomes the difficulties of applying dressings with the attendant risk of graft loss from shearing forces. We report on 36 patients treated by this method. Wound healing was achieved in all patients without the need for further surgery.

Chronic postoperative endophthalmitis from Staphylococcus aureus

We recently treated a patient with chronic postoperative endophthalmitis caused by Staphylococcus aureus, which usually presents with a fulminant clinical course. Because of the chronic course, the initial treatment was high dose steroids followed by lensectomy and vitrectomy. However, this was not effective, and intravitreal antibiotics and steroids were ultimately required. We now recommend that in patients with chronic postoperative inflammation unresponsive to high dose steroids, intraocular cultures followed by injection of intraocular antibiotics be considered.

Polyethylene glycol-electrolyte solution for rectal sunflower seed bezoar

We describe the successful use of polyethylene glycoelectrolyte solution (Golytely) in the management of a child who developed a rectal phytobezoar after ingestion of unshelled sunflower seeds. A brief review of the literature regarding the management of rectal phytobezoar is discussed.

Relationship between socio-demographic and behaviour variables, and body mass index in a population with high-normal blood pressure: Hypertension Prevention Trial

The relationship between socio-demographic and behaviour variables and body mass index (BMI: weight/height2) adjusted for age were studied in a population with high-normal blood pressure who participated in the Hypertension Prevention Trial. The BMI of the participants ranged from 19.1 to 35.1 kg/m2 in men and from 16.0 to 35.1 kg/m2 in women. The prevalence of obesity (BMI greater than or equal to 25.0 kg/m2) was 77 per cent in men and 61 per cent in women, with prevalence of severe obesity (BMI greater than or equal to 30.0 kg/m2) being 23 per cent and 19 per cent respectively. Stepwise regression was carried out to identify the most important correlates of BMI. In men, they were family income (+), occupation (-), leisure time exercise frequency (-), number of meals eaten out (-), alcohol intake (-), smoking (-), caffeinated drink intake (+), and meal planner. Men who planned meals with their partners had a higher BMI than men who planned their own meals or had someone else plan their meals. Correlates of little importance were marital status, race, education, number of members in household, energy intake, percentage of total calories from fat, occupation activity level, and vitamin/mineral supplement intake. In women the most important correlates of BMI were alcohol intake (-), caffeinated drink intake (+), and race. Black women had a higher mean BMI than white women. The important socio-demographic and behaviour variables in both men and women accounted for about 20 per cent of the variance in BMI which leaves about 80 per cent of the variation unexplained. This indicates the presence of other factor(s) which may be determining body weight.

Focal xanthogranulomatous pyelonephritis simulating a renal tumor: CT characteristics

Xanthogranulomatous pyelonephritis is the replacement of renal parenchyma by large lipid-filled macrophages clinically associated with an enlarged, nonfunctioning kidney containing a calculus in the diffuse form or tissue destruction in one pole of a duplicated kidney associated with a calculus in the focal form. We report a case where a focal mass in a functioning kidney with no evidence of calculus, duplication, or fat density simulated a primary renal tumor.

Mucin histochemistry of the lower gastrointestinal tract

Variations in the mucin secretion pattern in the mucosal lining of the colon and rectum have been studied. Mucins have been differentiated histochemically as neutral mucins, sialomucins and sulphomucins, using alcian blue/PAS and HID/alcian blue techniques. In the normal colonic mucosa, the goblet cells secrete predominantly sulphomucins with small amounts of sialomucins. Twenty one cases with benign lesions showed varying patterns of mucin secretion. In the 35 cases with adenocarcinoma studied, the transitional mucosa adjacent to the lesion showed a reversal of mucin secretion pattern, with an increase in sialomucins and a marked decrease in sulphomucins, suggesting a reaction to neoplasia.

Mucin histochemistry of the upper gastrointestinal tract

Histochemically differentiated mucins have been studied in the mucosal lining of the esophagus and the stomach. Acid mucin was differentiated from neutral mucin by the alcian blue/PAS technique and sulphomucin by the high iron diamine/alcian blue technique. Neutral mucin secreted normally by the stomach mucosa was replaced by acid mucin in 17 of the 19 mucin secreting adenocarcinomas involving the lower third of the esophagus, and in 24 of the 28 mucin secreting gastric adenocarcinomas studied. The intestinal metaplasia (IM) seen in the gastric mucosa associated with adenocarcinoma, chronic gastric ulcer and chronic gastritis was classified according to the type of mucin secreted by the goblet cells. IM secreting sulphomucins was seen to be associated with gastric adenocarcinoma.

Acute inflammatory demyelinating polyradiculoneuropathy presenting as complete heart block and Stoke-Adams attacks

A patient with acute inflammatory demyelinating polyradiculoneuropathy (AIDP, Guillain-Barré syndrome) whose presenting complaints were related to autonomic dysfunction in the form of parasympathetic and sympathetic overactivity is reported. Parasympathetic overactivity was severe enough to cause complete atrioventricular block (atropine-responsive) and Stoke-Adams attacks, for which a demand pacemaker was required. Limb weakness was apparent 48 hours later. To our knowledge no such presentation of AIDP has been previously recorded.

Lectin binding in colorectal mucosa

Lectin binding of goblet cell mucin in human colonic mucosa was studied in patients with irritable bowel syndrome, colorectal malignancy and ulcerative colitis using plant lectins, Dolichos biflorus agglutinin (DBA) and peanut agglutinin (PNA). Normal colonic mucosa demonstrated a strong binding with DBA (100%) but did not bind to PNA at all. Colonic carcinomas showed strong PNA binding (7 of 15 biopsies) while DBA binding was absent in 14 of 15 biopsies. The transitional mucosa showed reduced or absent DBA binding in 6 and positive PNA binding in 2 of 15 biopsies. During the active phase of ulcerative colitis, there was a loss of DBA binding in 10 of 15 biopsies, which was restored during remission in all. One biopsy with severe dysplasia showed PNA binding. It is concluded that normal colorectal mucosa binds DBA strongly but not PNA. Malignant tissue and transitional mucosa reveal PNA binding often, with decreased DBA binding. In ulcerative colitis DBA binding decreases during phases of activity.

Lower metabolic rates of post-obese versus lean women: thermogenesis, basal metabolic rate and genetics

Components of daily metabolic rate (thermogenesis, BMR and net exercise) were compared between 16 women predisposed to obesity (post-obese) and 16 naturally lean controls of matching age, weight and height, at three levels of activity, in a whole-body respirometer. At all levels of activity, the mean metabolic rate of the post-obese was 15 per cent lower than that of the lean controls. Expenditure on net exercise showed the same relationship, but BMR was only 10 per cent lower, while thermogenesis was 50 per cent lower. The latter was partly due to the smaller food intake of the post-obese and also to a lower thermogenic response. In absolute terms BMR accounted for less than half of the difference in total energy expenditure between the post-obese and the lean (45 per cent). Thermogenesis accounted for approximately 40 per cent of the difference, and 15 per cent after adjusting for the different energy intakes. Significantly more post-obese subjects had a family history of obesity (88 per cent) than lean subjects (38 per cent). Within the post-obese and lean groups there was a consistent trend at each level of activity for those with a family history to have lower metabolic rates, indicating that family history of obesity has an influence on energy expenditure over and above personal history of obesity.

Development of human palmar and digital flexion creases

To determine the timing of the development of the various palmar and digital creases, we examined the hands of 100 human fetuses obtained after therapeutic abortion. The fetuses ranged in age from 7 to 19 fetal weeks, with age being established by menstrual period dates and ultrasound examination before termination. Our observations show that palmar and digital creases develop between 8 and 13 fetal weeks. Digital creases are well defined by 10 weeks; palmar creases are consistently seen by 13 weeks of gestation. The volar pads are present from 8 to 14 fetal weeks. A hand malformation or specific insult that occurs before the time of crease development and that alters the form or function of the fetal hand can cause secondary alterations increase patterns of the hand.

Metabolic rate during and after aerobic exercise in post-obese and lean women

The effect of aerobic exercise (cycling on bicycle ergometer for four 10-min periods/60-80 per cent max VO2) on energy expenditure following the activity was investigated in 16 post-obese and 16 lean control women over 24 h and shorter periods. In addition, net energy expenditure during aerobic exercise was compared to that during prolonged mild activity (stepping for four 30-min periods at 12 steps/min). The measurements were made in a room respirometer. Aerobic exercise did not significantly stimulate the 24-h resting metabolic rate of either the post-obese (3 per cent, 50 kcal) or lean controls (2 per cent, 30 kcal), nor was there any significant stimulation over shorter periods: during waking hours RMR was non-significantly increased by 5 per cent in both the post-obese and lean controls. Sleeping expenditure remained the same in the post-obese and was decreased by 2 per cent in the lean controls. All subjects found the aerobic exercise to be quite uncomfortable, yet in both groups the net cost was smaller than that of prolonged mild exercise which was found to be acceptable (post-obese: aerobic 180 kcal, mild 250 kcal; lean controls: 220 kcal, 290 kcal). It is suggested that prolonged mild activity (eg, as in walking frequently) is more appropriate in increasing energy expenditure as a means of preventing or controlling obesity. Total expenditure at each level of activity is also expressed as multiples of BMR calculated from FAO/WHO/UNU (1985) prediction equations and from measured sleep values. The results show that the equations overestimated BMR in the post-obese.

The daily metabolic rate of the post-obese and the lean

Daily metabolic rates of 16 post-obese women and 16 matched, lean controls were measured at three different levels of activity in a room respirometer. Both groups had similar height, weight, age, and other anthropometric indices. Results show that the post-obese have metabolic rates approximately 15% lower than their controls at any level of activity. They also eat less. Slimmed-down, obese women have a normal body composition. For both groups, aerobic exercise did not have a prolonged stimulatory effect on metabolic rate after the exercise had finished. Mild exercise was more effective than aerobic exercise in increasing daily metabolic rate because it could be comfortably sustained for a longer time. Implications of these findings are discussed in relation to the etiology and treatment of obesity.

Graft versus host-like illness in a child with phenobarbital hypersensitivity

A child in whom a phenobarbital hypersensitivity drug reaction developed which consisted of fever, a pruritic desquamating erythrodermic rash, alopecia, icterus, protein-losing enteropathy, myositis, and nephritis, is described. Laboratory studies demonstrated eosinophilia, elevated serum IgE, and elevated T suppressor/cytotoxic cells in the peripheral blood. Findings from biopsy specimens of skin and jejunum suggested a cell-mediated pathogenesis, and lymphoproliferative studies of the patient's mononuclear cells revealed a positive response to phenobarbital. The clinical findings and laboratory studies suggested an autoimmune cell-mediated hypersensitivity reaction triggered by phenobarbital.

Effect of premedication with diazepam, morphine or nalbuphine on gastrointestinal motility after surgery

Premedication with nalbuphine and morphine delayed gastric emptying in the period after operation, but oral diazepam did not. All three drugs delayed co-ordinated intestinal motility, although nalbuphine did so for less than half as long as morphine. This property of nalbuphine, if confirmed, could make it a valuable analgesic drug in the period after operation.

Callosal syndrome: implications for understanding the neuropsychology of stroke

A case is presented of callosal syndrome following cerebral hemorrhage and amphetamine abuse in a 26-year-old right-handed man. There were few hemispheric findings but a full callosal syndrome including left apraxia to verbal commands, left tactile anomia, left agraphia, right constructional apraxia, failure of blindfolded side-to-side hand replication and form-board testing showing loss of interhemispheric transmission including intermanual interference. The "draw-a-clock" test showed left inattention when drawn with the right hand but not the left, and perseveration was noted for spatial tasks done with the right hand and symbolic tasks done with the left. The patient recovered functionally almost completely but testing demonstrated continued loss of interhemispheric transmission. The case is considered of most interest for its potential in explaining phenomena observed in severe unilateral hemispheric lesions. Our findings suggest that perseveration is not a dysfunction of the damaged portion of the brain, but a phenomenon associated with intact brain attempting unfamiliar tasks. The persistence of left hemi-inattention is attributed to the inability of the left hemisphere to utilize spatial information to compensate for the phenomenon of inattention. Left-sided dyskinesia following left hemisphere lesions was attributed to the lack of symbolic information necessary to perform some movements. Dysprosody was attributed to lack of tonal information to the left hemisphere. Recovery of function following severe unilateral lesions may be largely due to compensatory learning by the intact hemisphere and assertion of ipsilateral control. As our patient originally assumed an inverted left-handed writing posture, we assume the posture is controlled by the right hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic liposome administration in mice: effects on reticuloendothelial function and tissue distribution

Liposomes have a pronounced tendency to localize in the reticuloendothelial (RE) system, a major host defense system. We have examined, in mice, the effect of chronic i.v. administration of low to moderate liposome doses on drug metabolism, phagocytic index and spleen and liver size. Little effect on the rate of pentobarbital metabolism was noted, except when mice received 80 mg/kg of sphingomyelin-containing liposomes in a series of 10 injections over 3.5 weeks. Impairment of RE phagocytic function was found to be related to liposome size and composition, size and frequency of liposome dose and the presence of lipid peroxides. The effects on tissue distribution of liposome-entrapped [14C]sucrose was also determined in mice receiving chronic liposome injections. In RE blockaded mice there was a consistent trend in favor of decreased liver uptake and increased spleen uptake. No significant uptake of liposome contents was seen in non-RE tissues even in mice with severe RE blockade, indicating that the induction of RE blockade by predosing with empty liposomes may not be a successful strategy for increasing liposome uptake to non-RE tissues. Liver to spleen ratios of [14C]sucrose appeared to be a sensitive method for quantitating RE blockade. Sphingomyelin-containing liposomes produced the greatest RE blockade, distearoylphosphatidylcholine-cholesterol liposomes were intermediate and egg phosphatidylcholine-cholesterol liposomes produced the least impairment in RE function. Liposomes which contained 1% vitamin E as an antioxidant had slightly less effect on RE function than liposomes not containing vitamin E.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of face masks

Photographs of smoke particles expelled by coughing showed that the filtration type of face mask effectively prevents them from spreading far from the wearer.