Enlarging intratracheal tube cuff diameter: a quantitative roentgenographic study of its value in the early prediction of serious tracheal damage

A prospective study to radiographically document impending tracheal damage in patients on continuous mechanical ventilation was done in 135 intubated adult patients over an eighteen month period. The previously unrecognized enlarging cuff/trachea ratio over 150% was seen in 18 patients. Five of 9 patients who died with C/T ratio over 150% were autopsied; all had severe tracheal damage at the cuff site. Four of 5 patients who were decannulated/extubated developed tracheal stenosis at the cuff site, necessitating tracheal resection in 3 patients. Thus a C/T ratio over 150% is a reliable clinical indicator of tracheal damage. Some thoughts as to prevention of this iatrogenic disease are presented.

Conjunctival biopsy in sarcoidosis: A simple, safe, and specific diagnostic procedure

A prospective study was undertaken to determine the prevalence and specificity of granulomatous conjunctivitis in sarcoidosis. One hundred conjunctival biopsies were performed on patients with histologically confirmed sarcoidosis (60), pulmonary tuberculosis (25), and several nonspecific inflammatory diseases of the lung and eye (15). A positive biopsy was present in 33% of the patients with sarcoidosis, but in none of the other disease processes. Great care was taken to exclude the possibility of these granulomas being secondary to foreign body reaction or infection with tuberculosis or fungi. No predictive relationship could be established between eye symptoms or slit lamp findings in the conjunctiva and uveal tract, and the finding of positive conjunctival biopsies. Thus, it is suggested that this procedure, due to its ease, safety, and specificity, be the first biopsy performed in patients with clinical or chest x-ray abnormalities suggesting sarcoidosis.

Y-chromosomal genes in a phenotypic male with a 46XX karyotype

A number of patients with a male phenotype and a female (46XX) karyotype have been described. Although there is little or no evidence for the presence of a Y chromosome in their cells, these individuals resemble patients with Klinefelter syndrome (47XXY). Using a new serological assay for the presence of H-Y antigen, a cell surface component associated with the Y chromosome, we have demonstrated the presence of Y-chromosomal genes in a 46-year-old man with an XX karyotype. In addition, using standard cytological technique, we have located a minor population of XXY cells as well as cells bearing and abnormal chromosome 17 among the blood leukocytes of this individual.

Acute cardiomyopathy with recurrent pulmonary edema and hypotension following heroin overdosage

An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. Cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.

Emergence of overt diabetes in offspring of rats with induced latent diabetes

A single subdiabetogenic dose of alloxan administered to the weanling rat induces a persistent state of latent diabetes which progresses to fasting hyperglycemia by the seventh generation. Initial descendants of alloxan-treated animals have hyperinsulinism which progresses to insulinopenia in later generations. Later generation animals develop ketoacidosis when challenged with a dose of alloxan that has no effect on control animals. The significant sex difference in glucose tolerance rates disappears as the animals become more diabetic and decreased fertility and parity become apparent. One explanation for this data remains the hypothesis of paramutation, induced by alloxan, affecting regulator gene activity. Light microscopy of diabetic animals shows no pathology.