Radiographic differentiation between different etiologies of pulmonary edema

We compared the plain chest radiographs of critically ill patients who had different types of pulmonary edema and evaluated the radiographs according to a standardized score sheet of findings. We included 94 total cases of pulmonary edema: 49 with cardiogenic, 33 with permeability, and 12 with renal/overhydration pulmonary edema. Patients with cardiogenic edema had enlarged hearts, vascular engorgement, septal lines, and absence of air bronchograms significantly more often than patients with permeability pulmonary edema. Renal/overhydration patients had enlarged hearts significantly more often than patients with permeability edema. There were no other statistically significant differences. Heart size and presence or absence of septal lines could have been used to distinguish cardiogenic and permeability edema in 83% of cases.

A topographical model of clinical decision making and interviewing

A model linking clinical decision making, interviewing skills, and countertransference is presented. It derives from the psychoanalytical topographic model which is hierarchically organized into unconscious, preconscious, and conscious aspects of thought, feeling, and action. This model provides a format for understanding and teaching about physicians' unconscious, unrecognized responses to patients (countertransference), an important determinant of physician learning about clinical decision making and the clinical interview.

A randomised comparison of three drainage systems following cholecystectomy

The efficacy of low pressure, high pressure and passive drainage systems have been compared after cholecystectomy. Symptoms of pain, discomfort and nausea were compared using linear analogue scales and spirometry was used to examine pre-operative and postoperative respiratory function. The low pressure suction drain removed an intraperitoneal marker, gentamicin, more effectively than the high pressure suction drain, but not more effectively than the passive drain. There were no differences in postoperative respiratory function nor in the amount of pain or discomfort between the groups. The passive drain group reported less nausea than the suction drain groups. If a negative pressure drainage system is to be used, a low pressure suction drain should be used in preference to a high pressure system.

Successful replantation of amputated nose and auricle

Amputations of the nose and of the auricle present difficult management problems. Application of simple reattachment techniques, followed by aggressive medical therapy which consists of cooling, anticoagulation, antibiotic coverage, and multiple stab incisions in the amputated tissues, have resulted in the successful replantation of major portions of an amputated nose and an amputated auricle with satisfactory cosmetic results.

Multiplafform sampling (ship, aircraft, and satellite) of a Gulf Stream warm core ring

The purpose of this paper is to demonstrate the ability to meet the need to measure distributions of physical and biological properties of the ocean over large areas synoptically and over long time periods by means of remote sensing utilizing contemporaneous buoy, ship, aircraft, and satellite (i.e., multiplatform) sampling strategies. A mapping of sea surface temperature and chlorophyll fields in a Gulf Stream warm core ring using the multiplatform approach is described. Sampling capabilities of each sensing system are discussed as background for the data collected by means of these three dissimilar methods. Commensurate space/time sample sets from each sensing system are compared, and their relative accuracies in space and time are determined. The three-dimensional composite maps derived from the data set provide a synoptic perspective unobtainable from single platforms alone.

Antioxidant properties of 2-imidazolones and 2-imidazolthiones

Uric acid has been postulated to be an important antioxidant and free radical scavenger in humans. Other purines, such as xanthine, that lack an 8-oxo group on the imidazole ring do not show antioxidant properties. For this reason, the antioxidative activities of 2-imidazolones and 2-imidazolthiones were compared to that of uric acid. 2-Imidazolthiones reacted with the stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH) at rates comparable to those of uric acid and other antioxidants. 2-Imidazolones also reacted with DPPH, although at a much slower rate than the 2-imidazolthiones. The 2-imidazolthiones protected oxyhemoglobin from oxidation to methemoglobin by sodium nitrite; the 2-imidazolones had little effect on the oxidation of oxyhemoglobin by nitrate. Most of the 2-imidazolthiones and 2-imidazolones protected both porcine and bovine erythrocytes from hemolysis by t-butyl hydroperoxide. Although 2-imidazolthiones were more reactive than 2-imidazolones in the assays using DPPH and the oxidation of oxyhemoglobin, both types of compounds may be useful as antioxidants in vivo.

Do dreams reflect a biological state?

The purpose of this study was to prospectively evaluate the hypothesis that dreams reflect biological states. Inpatients on a nonacute cardiology service were studied. Dream material was gathered by an independent interviewer using the Staged Interview Technique, a newly developed interview technique that limited bias. The outcome measures used were obtained at the time of cardiac catheterization. Different levels of severity of cardiac disease with these measures were interpreted as representing different biological states. The patients' dreams were evaluated for the predicted correlations of the number of dream references to death (men) and separation (women) with different levels of severity of heart disease. The severity of heart disease was evaluated with anatomical (coronary angiography) and physiological (ejection fraction) measures obtained at cardiac catheterization, each represented by a 6-point scale of increasing severity. There was no correlation of the number of dream references with the severity of abnormalities on coronary angiography. However, the number of dream references to death and separation correlated with the severity of cardiac dysfunction, as measured by the ejection fraction, which is a more sensitive parameter of disease severity. The data provided prospective support for the hypothesis by showing that dreams reflected a biological state, the ejection fraction. This suggested a possible biological "meaning" of dreams.

Magnetic resonance imaging studies of the brains of schizophrenic patients

Magnetic resonance imaging studies of the brains of schizophrenic and control subjects were performed using a 0.3 Tesla superconducting magnet. Quantitative measurements of ventricular size, sulcal width, and standardized image intensity were performed. There were no significant differences between schizophrenic and comparison subjects for linear or area measures related to ventricular size, corpus collusum size, or cortical atrophy. However, schizophrenics had a significantly higher image intensity in the inversion recovery mode (IR-30). Since the IR-30 images are T1 weighted, this suggests that there may be differences in T1 relaxation times in tissues in some areas of the brains of schizophrenics as compared to controls. However, more precise measurements of T1 relaxation time are needed to confirm this finding.

Cortical atrophy and white matter density in the brains of schizophrenics and clinical response to neuroleptics

The relationship between clinical response to neuroleptics and brain morphology as revealed by CT scans was evaluated in a sample of 39 patients with schizophrenia and schizoaffective psychosis. Four measures of brain morphology previously shown to differ between schizophrenics and patients with headaches - white matter density, asymmetry in brain white matter density, sulcal width and global cortical atrophy - did not correlate with clinical improvement after 3 weeks treatment with constant doses of neuroleptics. These brain morphology measures also did not correlate with baseline psychopathology scores. The same results were found with scales or subscales reflecting primarily positive symptoms of schizophrenia as well as those reflecting primarily social withdrawal.

Reaction of methylated urates with 1,1-diphenyl-2-picrylhydrazyl

The kinetics of the reaction between the stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH) and methylated urates was studied. Urates that had methyl groups on the 1,3,9, or on the 1 and 3 or 1 and 9 nitrogens reacted with DPPH 15 to 77% faster than uric acid. Urates substituted with methyl groups on the 7 nitrogen or on both the 3 and 9 nitrogens reacted with DPPH at rates that were less than 0.1 that of uric acid. 3,7,9-Trimethyluric acid and 1,3,7,9-tetramethyluric acid reacted with DPPH at barely detectable rates. DPPH reacted with uric acid, the monomethylated urates, and some of the dimethylated urates in a ratio of 2:1. DPPH reacted with other dimethylated and trimethylated urates in a ratio of 1:1. Semiempirical MNDO calculations indicate that the most stable radical of uric acid is formed by hydrogen abstraction from the 3, 7 or 9 position. The most stable species resulting from loss of a second hydrogen lack hydrogens at the 3 and 7 positions or the 7 and 9 positions. For maximum reactivity with DPPH, methylated uric acid derivatives must have a hydrogen at nitrogen 7 and one of the hydrogens at either the 3 or 9 position.

Plasma levels and effects of nortriptyline in geriatric depressed patients

Pharmacokinetic, therapeutic effects, and side effects of nortriptyline were studied in geriatric depressed patients treated with a standard dose of 150 mg/day. Plasma levels and elimination half-life of nortriptyline were no different in geriatric patients than younger patients. The antidepressant therapeutic effects of nortriptyline appeared to be similar in geriatric patients as in younger depressed patients. Geriatric patients experienced few subjective side effects of nortriptyline. Overall, the drug produced no clinically significant changes in several parameters of the EKG, and no geriatric patient experienced tachycardia on nortriptyline. Nortriptyline did induce significant orthostatic hypotension in the systolic component, but not in the diastolic component. However, the orthostatic hypotension produced by nortriptyline was not greater in geriatric patients than in younger patients treated with the same dose.

Role of general practitioners in the care of disabled young adults

Services for handicapped children end when these patients become young adults. In the Exeter Health Authority district 383 disabled young adults were interviewed about their unmet needs. Many wished for advice and counselling. A quarter had not visited their general practitioner in the previous year, and two thirds of these had not had a general assessment or seen a specialist.

Prediction of postoperative complications by clinical and nutritional assessment

This study evaluated a battery of nutritional measures and pre-operative clinical assessment as predictors of postoperative morbidity. Fifty-seven consecutive patients about to undergo major elective abdominal or thoracic surgery were surveyed. Thirty-two per cent of patients had three or more abnormal measurements of nutritional indices. Thirty patients had a total of 52 complications and in 12 patients these were major. The Prognostic Nutritional Index (PNI), formulated by Mullen, was found to be the best predictor of postoperative outcome. It identified 10 of 12 (83%) patients who subsequently developed major complications with a specificity of 73%. Clinical assessment selected six of the 12 patients who developed major complications.

Studying the meaning of dreams: accurate definition of the independent variable

Studying the meaning of dreams is difficult and subject to many methodological pitfalls. One of these is vagueness and inconsistancy in defining dream content variables that are used as independent measures. This study evaluated the effect, upon accurate definition of the independent variable, of repeating the dream report and of using associative content as dream material. The importance of controlling these two sources of dream material was demonstrated: when the patient was allowed to repeat the dream and to report associative content, the number of initial references to death and separation variables nearly doubled in comparison to the standard single report of manifest content. Furthermore, there was minimal or no correlation of the number of these variables between manifest content and associative content, providing additional evidence for the unique contribution of associative content. This article also describes a new interview technique, the Staged Interview Technique, which provides a means to control, as well as measure, these potential distortions of the independent variable.

Organisation of Xenopus egg cytoplasm: response to simulated microgravity

The cytoplasm of Xenopus fertilised eggs appears to be organised into three major compartments based primarily on the uneven distribution of yolk platelets. There is a shift of these yolk compartments during the first cell cycle that is thought to be involved in the dorsal/ventral morphogenesis of the embryo. The involvement of gravity in Xenopus cytoplasmic organisation and in compartment shifts was addressed by examining, cytologically, the yolk compartments in embryos that developed under the simulated microgravity conditions of the horizontal clinostat. The cytoplasmic organisation into yolk compartments was found to be maintained, and the asymmetric movements of compartments still occurred in eggs that developed on the clinostat. It is suggested that the organisation of Xenopus egg cytoplasm into discrete compartments relies on forces other than those involving gravity (i.e., not density differences), and that the compartment shifts that take place during the first cell cycle are active movements. The variation in compartment size and composition observed from batch to batch of eggs, and to a lesser extent from egg to egg, during this study was addressed.

Protein synthesis and messenger RNA levels along the animal-vegetal axis during early Xenopus development

The patterns of proteins synthesized in animal and vegetal regions of Xenopus oocytes, eggs and embryos were examined by 2D gel electrophoresis. In oocytes and eggs, the only proteins synthesized asymmetrically along the animal-vegetal axis were a small number of proteins synthesized predominantly in the vegetal hemisphere. At the cleavage stage there were a total of four proteins synthesized unevenly in animal and vegetal regions: three synthesized predominantly in the vegetal hemisphere and one synthesized predominantly in the animal hemisphere. By the gastrula stage, when maternal messages have largely been replaced by embryonic transcripts, the number of differences in proteins synthesized in the animal-derived ectoderm and mesoderm, and the vegetal-derived endoderm started to increase rapidly with time of development with many more animal-characteristic proteins than vegetal-characteristic proteins appearing. Comparison of protein synthesis patterns with those obtained when extracted RNA was translated in vitro and run on 2D gels, showed that the asymmetry in protein synthesis along the animal-vegetal axis in the oocyte and early embryo reflected directly the distribution of their mRNAs along the axis. There was no evidence for localized 'masked' abundant messages along the animal-vegetal axis of oocytes and cleavage embryos.

Uric acid protects membranes and linolenic acid from ozone-induced oxidation

Aqueous preparations of linolenic acid, bovine serum albumin, and bovine erythrocyte membrane fragments were bubbled with ozone in the presence or absence of uric acid. Ozonation of the membrane fragments or the bovine serum albumin did not result in protein degradation. After 15 min of ozonation, the absorbance of the thiobarbituric acid-reactive material increased by 0.34 in the linolenic acid preparation and by 0.08 in the suspension of membrane fragments. In the presence of uric acid, these changes in absorbance were reduced to 0.14 for the fatty acid and to 0.01 for the membrane fragments. This result indicates that uric acid protects lipids from ozone-induced oxidation.

Uric acid protection of nucleobases from ozone-induced degradation

Uric acid has been proposed to be an important antioxidant and free radical scavenger in humans. Of the purine and pyrimidine compounds examined in this study, uric acid showed the greatest susceptibility to ozone-induced degradation. The parent compounds, purine and pyrimidine, were more resistant to ozonation than were the nucleobases. When the degradation of OH-substituted purines was examined, it was found that the more OH groups on the purine ring, the more readily the purine was degraded. Urea and allantoin were identified as degradation products of uric acid. The relative rates of nucleobase degradation in the presence and absence of uric acid were compared. Uric acid protected thymine, guanine, and uracil from degradation by ozone. In this system uric acid was found to protect the nucleobases as effectively as reduced glutathione.

Cigarette smoking and face lift: conservative versus wide undermining

The effects of cigarette smoking on the skin flaps of the face lift procedure are discussed. Reported elsewhere is a significant incidence of skin slough in smokers with use of wide undermining techniques. This complication is thought to be due to the vasoconstrictive effects of nicotine on the peripheral circulation. Our group has employed a conservative bilateral undermining technique in 407 face lifts. Of these, 32.4 percent were smokers and 67.6 percent were nonsmokers. No cases of skin slough were encountered. Our conservative undermining technique is briefly discussed. Among its advantages are shorter operative time, use of less local and/or general anesthesia, less intraoperative bleeding, adequate exposure for SMAS and platysmal surgery, and snugger skin closure without the risk of flap necrosis. As shown by our statistics, it is a safer procedure in smokers than the usually performed more radical procedure.

In situ carcinoma of the pancreas

Two cases of pre-invasive in situ carcinoma of the pancreas treated by surgery are reported. In each case the resection was carried out because of the probable diagnosis of invasive carcinoma of the pancreas. In situ carcinoma of the pancreas is not included in standard clinical classifications of pancreatic cancer. This is an important omission because of the prognostic implications of this diagnosis, and because of the difficulties in interpreting fine needle aspiration cytology or histology on needle biopsy in such cases.

Injectable silicone for facial soft-tissue augmentation

Medical-grade injectable silicone has been safely and efficiently used for facial soft-tissue augmentation in 235 patients. Our 20-year experience with the microdroplet technique included 2,811 treatments performed for camouflaging furrows and grooves, augmentation of facial eminences, and elevation of certain depressed scars. The indications and techniques of injection are discussed. The augmenting effect is greater than that produced by the small volumes of silicone injected. Our study supports other work indicating induction of collagen deposition in the patients around the microdroplets of silicone, thus providing augmentation from volumes of collagen and silicone as well.