Percutaneous gastrostomy with gastropexy: experience in 125 patients

We report our experience with radiologically guided percutaneous tube gastrostomy in 125 patients by using a gastropexy technique in which the anterior gastric wall is nonsurgically sutured to the anterior abdominal wall with percutaneously placed T-fasteners before catheter insertion. Short-term follow-up of up to 2 weeks was available in all patients. In 63 patients, long-term follow-up (greater than 4 weeks; average, 3.5 months; maximum, 1 year) was available. Catheter placement was successful in 124 (99%) of 125 patients, including three patients with anatomic changes after Bilroth II hemigastrectomy and two patients with failed endoscopic attempts. There were no deaths related to the procedure, and no patients required surgical intervention for complications attributable to the gastrostomy procedure. The 30-day mortality rate was 11% (n = 7). These deaths were due to cardiorespiratory arrest and were not attributable to the gastrostomy procedure. Major complications occurred in 1.6% (n = 1) and minor complications in 9.5% (n = 6). These results indicate that percutaneous gastrostomy with gastropexy is a safe and effective technique for placement of catheters in the stomach.

Pharmacokinetics of the acetylcholinesterase oxime reactivator, HI-6, in rhesus monkeys (Macaca mulatta): effect of atropine, diazepam, and methoxyflurane anesthesia

The pharmacokinetics of the bispyridinium oxime HI-6 (CAS reg. no. 34433-31-3; 1-(((4-aminocarbonyl)pyridinio)methoxy)methyl)-2-[hydroxy i mino)methyl)- pyridinium dichloride) was investigated in rhesus monkeys (Macaca mulatta). The effects of methoxyflurane anesthesia, administration of atropine with and without diazepam were determined on the serum half-life (t1/2), clearance rate (CL), and the volume of distribution (Vd) following intramuscular (IM) administration of HI-6 (30 mg kg-1). The control t1/2, CL and Vd of HI-offere 27 min, 8.6 ml min-1 kg-1 and 0.34 l kg-1, respectively. These parameters were unaffected by the co-administration of either atropine (0.5 mg kg-1, IM) or atropine and diazepam (0.5 mg kg-1, IM + 0.2 mg kg-1 IV, respectively). Methoxyflurane anesthesia resulted in a significant increase in the HI-6 t1/2 to 61 min concomitant with a decrease in the CL to 4.1 ml min-1 kg-1 with no change in the Vd. The increase in the t1/2 of HI-6 in methoxyflurane anesthetized monkeys is probably the result of a decrease in the clearance rate and, thus, excretion of HI-6 by the kidneys.

Effects of thiamine deficiency on hepatic cytochromes P450 and drug-metabolizing enzyme activities

To elucidate the mechanisms by which thiamine deficiency affects hepatic microsomal monooxygenase activities, the effect of thiamine deficiency on two constitutive cytochrome P450 isozymes, P450IIE1 and P450IIC11, was investigated, using weanling male Sprague-Dawley rats. The clinical signs of thiamine deficiency were apparent after feeding a thiamine-deficient diet for 3 weeks. Thiamine deficiency caused an increase in P450IIE1, which was determined by N-nitrosodimethylamine demethylase assay and immunoquantitation of P450IIE1. This increase in the P450IIE1 level was mainly attributed to thiamine deficiency per se but not to dietary restriction. Ketone bodies were not elevated in thiamine-deficient rats, whereas ketone bodies were elevated and may have served as inducing factors in calorically restricted pair-fed animals. Injections of pyruvate or pyrithiamine in addition to thiamine deficiency did not potentiate the induction effect. On the other hand, thiamine deficiency did not affect the level of P450IIC11 during the 3 weeks of feeding the thiamine-deficient diet. In addition, thiamine deficiency increased cytosolic glutathione S-transferase activity but not steroid isomerase activity. The present study demonstrates the specificity of thiamine deficiency per se in the induction of P450IIE1 which does not involve an increase in the ketone body level.

The differentiation process of intestinal epithelial cells is associated with the appearance of statin, a non-proliferation-specific nuclear protein

The expression of statin, a 57,000 Mr nuclear protein specifically present in non-proliferating cultured fibroblasts, was studied in vivo in the differentiating epithelial cells of the rat intestine. Using immunofluorescence microscopy we found that undifferentiated, proliferating crypt enterocytes are statin negative, whereas the differentiated non-proliferating villus enterocytes are statin positive. The epithelial cells of the intestine were isolated according to different stages of differentiation and the expression of statin was studied biochemically by immunoblotting assays. The prominent band (57,000 Mr) was present in abundance in villus cell fractions but undetectable in crypt cell fractions. These findings were also confirmed by immunofluorescence microscopy on individual intestinal epithelial cells of the different isolated fractions. The results presented here, which are similar to observations made in cell cultures, suggest that statin is a unique protein associated with the non-proliferative state of differentiated cells in tissue.

Femoral head collapse associated with anorexia nervosa in a 20-year-old ballet dancer

Femoral head collapse occurred in a 20-year-old ballet dancer with anorexia nervosa. The patient developed anorexia nervosa at the age of 11 years and had short stature. The condition never resolved, and she developed pain and stiffness in the right hip at the age of 18 years, with documentation of femoral head collapse on roentgenograms a year later. The patient had delayed pubertal maturation with a bone age of 13 years, primary amenorrhea, and hypoestrogenism. Evaluation for metabolic bone disease was negative, and dual-photon absorptiometry showed significantly decreased bone mass with a bone biopsy revealing only diffuse osteoporosis. Possible etiologic mechanisms of osteonecrosis including repetitive microtrauma and various factors predisposing to femoral head collapse in young women required further investigation.

Antibodies immobilized on inorganic supports

Antibodies and antigens can be covalently coupled to a variety of carriers, both organic and inorganic. The methods for coupling these proteins may be found scattered throughout the technical literature. This report, although it concentrates on inorganic supports, describes several of the more successful methods used in laboratories today. Each of these methods is described in enough detail for the reader to carry out the coupling method of interest in his or her own laboratory. The coupling methods have been divided into two groups, direct and silane. Under each of these general headings are described the specific methodologies.

Effect of chemical treatments on methane emission by the hindgut microbiota in the termiteZootermopsis angusticollis

Selective removal of symbiotic hindgut microorganisms by chemical treatments reduced methane emission by the termiteZootermopsis angusticollis. Methane emission from untreated termites incubated in 25% H2 increased 123%, from 10.3 nmol/termite/hour (U) to 22.9 U. Though linear with time, methane emission was not correlated with termite mass. Hyperbaric oxygen treatments reduced methane emission to unquantifiable levels and eliminated all but the protozoaTricercomitus andHexamastix. Exogenous H2 restored 5% of methane emission to 1.3 U. 2-bromoethanesulfonic acid, fed on filter papers to termites, eliminated methane production. Epifluorescence microscopy showed that this treatment selectively removed methanogens from symbioses withTricercomitus, Hexamastix, andTrichomitopsis, but the protozoa did not appear to be affected. The insect molting hormone 20-hydroxyecdysone reduced methane production 86% to 1.6 U from an initial level of 11.4 U. Hydrogen incubation increased this rate to 77% of the initial rate, 8.8 U. Hormone treatment reduced the number ofTrichonympha in the hindgut and induced sexuality in these protozoa. A model suggests thatTrichonympha evolve most of the hydrogen and that methanogenic bacteria symbiotic withTrichomitopsis produce most of the methane in this hindgut ecosystem.

Formation of hydroxy derivatives, aldehydes, and nitrite from N-nitrosomethyl-n-amylamine by rat liver microsomes and by purified cytochrome P-450 IIB1

The metabolism was examined of the esophageal carcinogen N-nitrosomethylamylamine (NMAA) by liver microsomes and slices from adult male Sprague-Dawley rats. Hydroxylation at C-2 to C-5 of the amyl group to give stable hydroxy-NMAAs was studied by gas chromatography-thermal energy analysis to determine the products. Microsomal metabolism produced mainly 4-hydroxy-NMAA, proceeded optimally in 100 mM phosphate at pH 7.4, and showed no sex differences. Induction by phenobarbital (PB) and 3-methylcholanthrene produced effects which were similar in slices and microsomes, with PB inducing hydroxylation at all positions and 3-methylcholanthrene specifically inducing 3-hydroxylation by factors of 2- and 6-fold. Clofibrate and isoniazid treatments did not affect NMAA metabolism by liver slices. Aroclor-1254 strongly induced microsomal 2- and 3-hydroxylation. For 2- to 5-hydroxylation, Km values for uninduced microsomes were, respectively, 1.6, 1.2, 0.3, and 1.1 mM, with Vmax of 0.08, 0.26, 1.06, and 0.15 nmol/min/mg protein. With PB-induced microsomes, all 4 Km values were 0.4-0.7 mM. Liver microsomal production of nitrite and aldehydes from NMAA was determined colormetrically or (for pentaldehyde) by high-pressure liquid chromatography of the 2,4-dinitrophenylhydrazone. Uninduced microsomes produced nitrite, formaldehyde and pentaldehyde from 0.6 mM NMAA at rates that were, respectively, 0.15, 0.72, and 1.15 times that for 4-hydroxylation. PB especially induced depentylation, whereas 3-methylcholanthrene induced depentylation and denitrosation, but suppressed demethylation. A reconstituted system containing cytochrome P-450 IIB1 gave metabolite ratios similar to those in PB-induced microsomes. The results account for most of the possible primary metabolites of NMAA and demonstrate the selectivity for metabolism at each position.

Intravenous sulbactam/ampicillin in the treatment of pediatric infections

A total of 82 patients involving 83 episodes of proven or presumed bacterial infection were treated with sulbactam/ampicillin. These included 36 cases of soft tissue infection or abscess, four cases of joint or bone infection, 20 cases of respiratory tract infection (17 cases of pneumonia, two of otitis media, and one of tonsillitis), 15 urinary tract infections, three cases of enterocolitis, one case of infective endocarditis, two cases of septicemia, and two of peritonitis. The causative pathogen was isolated in 48 cases (49 infections). These pathogens included Staphylococcus aureus 13 cases, Staphylococcus epidermidis one, Streptococcus pyogenes two, Streptococcus pneumoniae two, Viridans group streptococcus two, peptostreptococcus one, Haemophilus influenzae one, Escherichia coli 12, Enterobacter cloacae three, Proteus mirabilis one, Acinetobacter calcoaceticus one, Salmonella spp. two, Shigella sonnei one, Bacteroides fragilis one, and polymicrobial infections of various combinations in five cases. No bacterial pathogens were isolated in 34 infections, 14 cases of pneumonia and 15 soft tissue infections. Sulbactam/ampicillin was given by intravenous bolus in a dosage range of 75-450 mg/kg/day in four divided doses for variable periods of time depending on the type and severity of the infection. Of a total of 83 episodes of infections, 80 (96.4%) cases were either cured or improved. Bacteriologic eradication also occurred in 46 (93.9%) of 49 infections. Side effects were diarrhea in two patients, acute hemolytic anemia in one patient, and transient elevations in SGOT and leukopenia in one patient. Side effects disappeared upon completion of treatment. Sulbactam/ampicillin is a safe and effective antibiotic for the treatment of common pediatric infections.

A clinical evaluation of sulbactam/ampicillin in the treatment of pediatric infections

We have treated 42 episodes of pediatric infections with sulbactam/ampicillin since 1987. Included were 9 cellulitis, 9 urinary tract infections, 5 cervical lymphadenitis, 4 meningitis, 2 thoracic empyema, 2 osteomyelitis, 2 sepsis, 1 furuncle, 1 perianal abscess, 1 dental abscess, 1 peritonsillitis, 1 salmonellosis, 1 shigellosis, 1 peritonitis, 1 suppurative thyroiditis, 1 infective endocarditis. Responsible pathogens were Escherichia coli in 8, Staphylococcus aureus in 6, Hemophilus influenzae in 2, Streptococcus pneumoniae in 3, Streptococcus viridans in 2, Staphylococcus epidermidis in 1, Bacteroides fragilis in 1, Salmonella D1 in 1, Shigella sonnei in 1, Klebsiella pneumoniae in 1, Enterobacter agglomerans in 1, Acinetobacter calcoaceticus in 1, Enterobacter cloacae in 1, group A beta-hemolytic streptococcus in 1, and polymicrobial infection in 4 cases. Thirty-nine out of 41 (95%) clinically evaluable patients cured and all (34/34) bacteriologically evaluable patients eradicated their pathogens after treatment with sulbactam/ampicillin. Side reactions were seen in five patients; one maculopapular skin rash, one hemolytic anemia, two diarrhea, and one liver function impairment plus leukopenia. All these reactions were transient and did not require interruption of therapy. These results indicate that sulbactam/ampicillin is safe and effective in the treatment of common pediatric infections beyond the neonatal period.

Effect of 1,3-butanediol on rat liver microsomal NDMA demethylation and other monooxygenase activities

The administration of 1,3-butanediol (BD) previously has been shown to elevate blood concentrations of ketone bodies, to potentiate carbon tetrachloride hepatotoxicity, and to increase the hepatic microsomal content of cytochrome P450 and the activity of aniline hydroxylase. In the present study, oral treatment (10 g/kg) with racemic BD and each of its enantiomers (R-BD and S-BD) induced NDMA demethylase activity by approx. 1.5-fold in rat hepatic microsomes obtained 12 h later, suggesting an induction of P450IIE1, the acetone/ethanol-inducible form of P450. The results agreed with an immunochemically determined increase in the levels of this isozyme. No change in P450 content, NADPH-cytochrome-c reductase, or in pentoxyresorufin dealkylase activity were detected. Blood levels of acetone were determined during a 10-h period after BD administration and showed a higher initial rate of increase by R-BD, possibly due to steroselective metabolic oxidative metabolism. However, no difference in the induction of NDMA demethylase activity by the enantiomers could be detected. Induction of P450IIE1 probably contributes to the previously described potentiation of haloalkane-induced hepatotoxicity by BD administration.

Effect of dietary protein on cholesterol homeostasis in diabetic rats

Normal and streptozotocin (STZ)-diabetic rats were studied in order to examine the effects of altering the type of dietary protein on cholesterol homeostasis. Rats were fed a non-purified or a purified diet containing either casein or soybean protein. The results obtained on the specific aspects of lipid metabolism were remarkably similar in control rats fed the non-purified (Purina Lab Chow) diet or the purified diet with the soybean protein. However, most of the findings obtained with the above two groups were different from those obtained with rats fed the purified diet containing casein. In the latter group, plasma cholesterol was elevated following a 15-day feeding period as compared to the other two dietary groups. The excess plasma cholesterol in the casein-fed group was found in two lipoprotein fractions with densities of 1.023-1.045 g/ml and 1.045-1.086 g/ml, respectively. The latter lipoprotein fraction was also enriched with apolipoprotein E. The casein-fed animals also showed a lower fractional rate of plasma cholesterol esterification and an abnormal accumulation of cholesterol in the body despite inhibition of cholesterol synthesis in the liver and in the intestines. Twelve to 15 days after the induction of diabetes, plasma cholesterol increased to a similar extent in the rats on all three diets. However, the distribution of cholesterol among the lipoprotein fractions was markedly different. The percentage of cholesterol in fractions of d less than 1.086 g/ml was increased while that carried in the fraction of d 1.086-1.161 g/ml decreased in the rats fed the nonpurified diet and the casein diet. In contrast, there was no change in the distribution of lipoprotein cholesterol between the diabetic and the control rats fed the soybean protein diet. The hepatic synthesis of cholesterol was unaltered in diabetic rats fed the nonpurified diet and the purified diet with soybean protein, but was increased 2.4-fold in diabetic rats fed casein. Intestinal cholesterol synthesis was increased in all three dietary groups. The increase was highest in the rats fed casein and lowest in rats fed soybean protein. The rate of sterol synthesis in the kidneys was not significantly affected by the diet or diabetes. In all three dietary groups diabetes led to an abnormal accumulation of cholesterol in the body. This accumulation was highest in the casein-fed rats and lowest in those fed the soybean protein diet. The cholesterol content of the kidneys was markedly increased by dietary casein.(ABSTRACT TRUNCATED AT 400 WORDS)

Primary angiosarcoma of the spleen: a diagnosis to consider

We discuss a case of angiosarcoma of the spleen. Splenomegaly was discovered on a routine examination. At a later date it increased further in size and became painful. Peripheral smear and radio-isotope scannings suggested non-functioning spleen with haemorrhage within the tumour. Characteristic features of microangiopathic haemolysis, suggested in previous reports, was not found in our case.

Diethyl ether as a substrate for acetone/ethanol-inducible cytochrome P-450 and as an inducer for cytochrome(s) P-450

The ability of diethyl ether to serve as a substrate for microsomal and purified cytochrome P-450 (P-450) and as an inducer for rat hepatic microsomal monooxygenase activities was examined. Microsomal oxidation of ether to acetaldehyde, as monitored by high pressure liquid chromatography, was elevated 3- to 5-fold by treatment of rats with acetone or ethanol, 1.5- to 2-fold by treatment with ether, and only slightly by phenobarbital treatment. Ether also induced N-nitrosodimethylamine demethylase by up to 2-fold and 7-pentoxyresorufin dealkylation by up to 10-fold. These trends agreed with immunoblot experiments in which ether was a weak inducer of the P-450 isozyme IIE1 (encoded by the rat gene P450IIE1), but a stronger inducer of IIB1. A monoclonal antibody against IIE1 inhibited the deethylation by 78% in microsomes from acetone-treated rats and by 45% in controls. N-Nitrosodimethylamine, as well as common inhibitors of IIE1 such as hexane, benzene, pyrazole, and phenylethylamine, strongly inhibited ether deethylation. Using microsomes from acetone-induced rats, the apparent Km for deethylation was 13.4 +/- 2.4 microM and the Vmax was 8.2 +/- 0.2 (nmol of acetaldehyde/min/nmol of P-450). The Km for the controls was 71.3 +/- 9.5 microM. The rates of deethylation at 1 mM ether by purified, reconstituted IIE1 and IIB1 were 4.2 and 0.42 (nmol of acetaldehyde/min/nmol of P-450), respectively. Cytochrome b5 stimulated the rate due to IIE1 apparently by a decrease in the Km. These findings, along with previous work showing marked inhibition by ether of IIE1-dependent reactions, strongly support a major role for this isozyme in ether metabolism.

The plain chest radiograph after acute smoke inhalation

Serial chest radiographs of 45 patients from a major fire disaster were assessed for the effects of smoke inhalation injury. Thirty-three had abnormal chest radiographs on admission. Bronchial wall thickening was present in a total of 29 patients, subglottic oedema in 13, pulmonary oedema in seven, and patchy consolidation in three. Seven patients developed pulmonary oedema following initial exposure. This was the cause of death in two patients. Serial chest radiographs were useful in monitoring this very severe complication. Bronchial wall thickening and subglottic oedema were common early findings and thus may herald more serious subsequent respiratory embarrassment. Subglottic oedema is a previously undescribed finding. It not only indicates damage to the upper airways but may also indicate damage to the lung parenchyma. It may also make endotracheal intubation difficult. Therefore, the initial chest radiograph is an important predictor of significant smoke inhalation injuries enabling selection of patients likely to need ventilatory support.

Morphological characterization of a granulocytosis/hypercalcemia-inducing murine mammary carcinoma cell line

A newly established cell line of a granulocytosis/hypercalcemia-inducing murine mammary carcinoma (CE mammary carcinoma) grown in serum-free culture medium secretes factors that stimulate proliferation of granulocytes and embryonal bone cells. These cultured cells retain the ability to produce granulocytosis and hypercalcemia when they are transplanted back into mice. In culture these cells form clusters of organized cells. Studies by scanning, transmission, and freeze-fracture electron microscope techniques reveal that these in vitro tumor cells retain the structural epithelial characteristics of mammary epithelia. They maintain cellular polarity, microvilli, and complete tight junctions. Both the in vivo and in vitro tumor cells produce viral particles with the ultrastructural features of murine mammary tumor viruses. In both in vivo and in vitro conditions, A-type particles are present intracellularly. B viral particles are present predominantly in the intercellular spaces. Since the structural characteristics of the cultured tumor cells are consistent with the features of mammary adenocarcinomas, this is a prime culture system for studying the tumor-derived soluble factors.

Quantitative study of tissue collagen metabolism

A procedure for the quantification of various parameters of metabolism of collagen in fibrotic mouse liver has been developed. The method involves derivatization of hydroxyproline, a marker of collagen, with dansyl chloride, high-performance liquid chromatography of the derivative on an octadecyl C-18 column, and its detection by fluorescence. This assay improves upon existing procedures in several respects: It extends the analysis so that not only the collagen content of the tissue but also the metabolism of collagen is determined at levels found intracellularly. It is sensitive enough to quantify 0.1-10 nmol of hydroxyproline, and it includes three major amino acids (hydroxyproline, glycine, and proline) of collagen and two assay controls; it generates information on both the purity and quantity of collagen in each assay. The determination of specific activity of intracellular free [14C]proline, which is the precursor of protein-bound hydroxyproline, defines the specific activity of [14C]hydroxyproline of collagen converted from precursor residues of [14C]proline by the action of prolyl hydroxylase. The specific activity of [14C]hydroxyproline can be used for the evaluation of collagen synthesis and secretion and intracellular and extracellular degradation of the newly synthesized and secreted collagen in the tissue. The determination of specific activities of [14C]hydroxyproline and [14C]proline and of the ratio of [14C]hydroxyproline to [14C]proline of newly secreted collagen provides information concerning the extent of hydroxylation of [14C]proline residues of newly synthesized collagen.

Gallstones in women younger than thirty

In contrast to the usual 2:1 female:male ratio for the presence of gallstones, we found that the 12 patients with symptomatic gallstones under age 30 in this study were all female. This prompted a retrospective study of clinicopathologic findings in these 12 women with gallstones. Chemical analyses of the gallstones confirmed that all were cholesterol stones. Obesity and pregnancy proved to be the outstanding risk factors. The mechanism of obesity and pregnancy as lithogenic factors are reviewed and discussed.

Collagen metabolism in fibrotic liver. Effects of concanavalin A and aggregated myeloma immunoglobin G

We previously have shown [Takahashi & Kobayashi (1982) Hepatology 2, 249-254] that the administration of concanavalin A to mice with schistosomiasis caused liver collagen content to be reduced by 50%. Here we report the effects of concanavalin A and aggregated mouse myeloma IgG on liver lysyl oxidase activity and present further evidence concerning the possible mechanism by which the liver collagen content was decreased in infected-treated mice. The lysyl oxidase activity at 8 weeks after infection in both treated mice and untreated infected controls was about 28-fold greater than in the age-matched uninfected controls. The specific radioactivity of intracellular free [14C]proline, the rate of collagen synthesis, the ratio of collagenase-sensitive, protein-bound, hydroxyproline to proline of collagen and the intracellular degradation of newly synthesized collagen were similar in treated animals and in untreated infected controls. In contrast, the extracellular degradation of newly secreted collagen and the specific radioactivity of protein-bound [14C]hydroxyproline in the agent-treated groups were about 2-fold greater than those in the untreated infected controls. These results suggest that the observed 50% decrease in content of liver collagen of mice treated with the agents apparently was due to the increased extracellular degradation of newly secreted collagen.

Endoscopic retrograde cholangiopancreatography after acute pancreatitis

To assess the usefulness of endoscopic retrograde cholangiography (ERCP) in the study of acute pancreatitis, 101 of a possible 114 patients (89 per cent) with acute pancreatitis underwent ERCP after recovery from acute illness. In 81 per cent, ERCP was performed within two weeks of recovery. The biliary tract was successfully demonstrated in 87 per cent of the patients and the pancreatic duct in 73 per cent. Roentgenograms of the biliary tract showed stones in the gallbladder in 40 per cent of the patients and in 36 per cent in the biliary ducts. In addition, the gallbladder was not visualized in nine patients. In eight of those patients, the gallbladder was subsequently shown to be abnormal. Other findings of the biliary system included one patient each with clonorchiasis, ascariasis and malignant disease. Changes in the pancreatic duct were detected in 11 per cent of the patients. Most of the changes were consistent with acute or chronic pancreatitis. Minimal morbidity was encountered. ERCP is very accurate in identifying the biliary causes of pancreatitis. In areas where a significant proportion of acute pancreatitis has biliary causes, it should be performed upon all patients soon after resolution of the acute illness to identify those patients who will benefit from early operation upon the biliary tract.

Mammographic identification and biopsy of occult breast cancer

During a 9 year period we excised 70 suspicious non-palpable breast lesions detected by mammography. We found the most effective method of preoperative localisation to be insertion of a self retaining wire, and this procedure was facilitated by a Perspex grid incorporated in the mammography equipment. Thirty biopsies (43%) were found to be malignant, of which 14 contained invasive and 16 in situ carcinoma. The presence of malignancy could not be predicted from the mammographic appearance, although in situ cancer was always associated with microcalcification.

Postoperative flexible choledochoscopy for residual primary intrahepatic stones

Postoperative flexible choledochoscopy was carried out in 103 patients with residual biliary calculi. Forty-one patients had residual stones in the common duct, and 63 patients had residual stones in the intrahepatic ducts with or without stones in the common duct. The majority of the intrahepatic stones were primary stones. Postoperative choledochoscopy was very effective in removing residual common duct stones (95% removed, no morbidity). For intrahepatic stones, removal was more difficult and was associated with a higher morbidity (11.2%). Stone extraction through the stenotic intrahepatic ducts was made possible by the balloon dilatation of the ducts. Repeated endoscopic access to the biliary system was made easier by the construction of a hepatico-cutaneous-jejunostomy, which also provides a route to the biliary tree for future stone removal if stone reformation occurs. Complimented by these procedures, postoperative choledochoscopy was successful in removing the residual intrahepatic stones in 82.3% of the patients. At a median follow-up of 17 months, the majority of the patients who had all the stones removed as well as those who had stones left behind were symptom free.

Managing hospital census through physician/administrator teamwork

This article describes the process of successful implementation of a system to manage and control a hospital's inpatient census. The system has implications not only for every department, but for every profession within a hospital environment. Described here is the overall impact of the system within a hospital. Also presented are important factors which have contributed to the success of implementation in this complex setting.

The effect of topical povidone iodine on wound infection following abdominal surgery

The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder (Disadine DP) and 81 acted as a control group. The infection rate of 9.9 per cent in the patients treated with povidone iodine was significantly lower than that of 24.4 per cent in the control group (P less than 0.05). Bacterial contamination of the wound at the time of operation was shown to be of importance, being associated with a 52 per cent infection rate in the control group. However, spraying of contaminated wounds with povidone iodine reduced the infection rate to the significantly lower level of 11 per cent (P less than 0.05). We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery.

Respiratory depression produced by diazepam in cats: effect of anaesthesia

Diazepam (Valium, Roche; 0.37 mg/kg was given by slow injection into the left femoral vein and flushed in with 0.9 % saline. Within 3 min following the i.v. injection of diazepam spontaneous respiration ceased in rats anaesthetized with chloralose; mean arterial pressure fell from a control level of 99.4 (+/- 28.3) mmHg to 32.5 (+/- 13.44) mmHg. If artificial ventilation was initiated immediately upon cessation of respiration, the animal recovered. Cats anesthetized with ketamine (Ketaset, Roger; 44 mg/kg i.m.) showed no respiratory depression following i.v. diazepam injection.

Laser scalpel for solid organ surgery

Hemostasis remains a major technical problem in surgery of the liver and spleen. A high power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been coupled with a fiberoptic delivery system and quartz blade designed to yield maximal hemostasis and minimal tissue injury. In a series of experiments we were unable to demonstrate a significant advantage of its use in partial hepatic lobectomy.

The use of the argon laser-assisted quartz scalpel for burn wound excision to fascia

We have developed a new method for coupling the hemostatic capabilities of argon laser light with the mechanical advantages of a sharpened quartz blade using fiberoptics. Using the new laser-assisted scalpel, a series of symmetrical skin excisions was done in 20- to 30-kg pigs on one side and with electrosurgery on the other. The laser scalpel was superior in its hemostatic properties (p less than 0.01) with no statistically significant difference in surgical speed. Take of split-thickness skin grafts was 90% in beds excised with either the laser or the electrosurgical device. Histologic sections showed less tissue damage with the laser-assisted scalpel than with electrocautery.

Inhibition of monocyte esterase activity by organophosphate insecticides

Organophosphate insecticides, such as Vapona, Naled, and Rabon, are highly potent inhibitors of an enzyme found in human monocytes. The enzyme, a specific monocyte esterase, could be inhibited by Vapona in blood samples via airborne contamination at levels easily achieved from commercial slow-release insecticide strips. Fifty percent inhibition (I50)--as measured on the Hemalog D (Technicon Corp.)--occurred at solution concentrations of 0.22, 1.5, and 2.6 X 10(-6) g/liter for Vapona, Rabon, and Naled, respectively. Parathion (a thiophosphate) and Baygon (a carbamate) were less potent, with I50 values of 3.7 X 10(-5) and 1.5 X 10(-4) g/liter, respectively. Dursban (another thiophosphate) and Carbaryl (a carbamate) showed only marginal inhibition. Eserine, malathion, nicotine and pyrethrum had no inhibitory effect up to 0.5 g/liter. The occurrence of this effect in vivo has not yet been shown, nor is it clear what the implications of such an effect would be. The inhibition of this enzyme by airborne contaminants, however, may interfere with the proper functioning of the Hemalog D.

Reciprocal cooperative effects of multiple ligand binding to pyruvate kinase

The formation of multiple ligand complexes with muscle pyruvate kinase was measured in terms of dissociation constants and the standard free energies of formation were calculated. The binding of Mn2+ to the enzyme (KA = 55 +/- 5 X 10(-6) M; deltaF degrees = -5.75 +/- 0.05 kcal/mol) and to the enzyme saturated with phosphoenolpyruvate (conditional free energy) KA' = 0.8 +/- 0.4 X 10(-6) M; deltaF degrees = -8.22 +/- 0.34 kcal/mol) has been measured under identical conditions giving a free energy of coupling, delta(deltaF degrees) = -2.47 +/- 0.34 kcal/mol. Such a large negative free energy of coupling is diagnostic of a strong positively cooperative effect in ligand binding. The binding of the substrate phosphoenolpyruvate to free enzyme and the enzyme-Mn2+ complex was, by necessity, measured by different methods. The free energy of phosphoenolpyruvate binding to free enzyme (KS = 1.58 +/- 0.10 X 10(-4)M; deltaF degrees = -5.13 +/- 0.04 kcal/mol) and to the enzyme-Mn2+ complex (K3 = 0.75 +/- 0.10 X 10(-6)M; deltaF degrees = -8.26 +/- 0.07 kcal/mol) also gives a large negative free energy of coupling, delta(deltaF degrees) = -3.16 +/- 0.08 kcal/mol. Such a large negative value confirms reciprocal binding effects between the divalent cation and the substrate phosphoenolpyruvate. The binding of Mn2+ to the enzyme-ADP complex was also investigated and a free energy of coupling, delta(deltaF degrees) = -0.08 +/- 0.08 kcal/mol, was measured, indicative of little or no cooperativity in binding. The free energy of coupling with Mn2+ and pyruvate was measured as -1.52 +/- 0.14 kcal/mol, showing a significant amount of cooperativity in ligand binding but a substantially smaller effect than that observed for phosphoenolpyruvate binding. The magnitude of the coupling free energy may be related to the role of the divalent cation in the formation of the enzyme-substrate complexes. In the absence of the activating monovalent cation, the coupling free energies for phosphoenolpyruvate and pyruvate binding decrease by 40-60% and 25%, respectively, substantiating a role for the monovalent cation in the formation of enzyme-substrate complexes with phosphoenolpyruvate and with pyruvate.

Effect of calcium and magnesium on deoxyribonucleic acid synthesis in rat parathyroid glands in vitro

DNA synthesis in rat parathyroid glands in organ culture is significantly affected by the calcium concentration of the medium. 3-H-thymidine incorporation over a 46-hour period was more than 100 per cent greater at 1.3 mM calcium than at 3.0 mM calcium. Thymidine incorporation was greatest at 0.9 to 1.3 mM, and fell off sharply between 1.3 and 1.8 mM calcium. Variation of magnesium concentration between 0.3 and 1.5 mM had no appreciable effect on DNA synthesis at either 1.3 or 1.8 mM calcium. No effect on DNA synthesis in rat liver explants or mouse L cells was observed over these ranges of calcium concentration, but in cultured rat kidney fragments, an opposite effect of calcium was observed, i.e., DNA synthesis was more active at 3.0 mM calcium than at 1.3 mM calcium. Time course experiments showed that a significant difference between DNA synthesis rates in high and low calcium media was observable in parathyroid glands during the first 3 hours in culture, and persisted for at least 108 hours. The calcium effect on DNA synthesis was not mediated by any direct effect on the rate of thymidine uptake by the tissue. These results suggest that a small drop in ambient calcium concentration in vivo could significantly increase the rate of DNA synthesis in the parathyroid glands, and thus provide experimental support for the concept that parathyroid hyperplasia in chronic renal insufficiency is caused by lowered serum calcium levels.