[Angiodysplasias of the extremities]

The term "angiodysplasia" is defined and a historical review of vascular malformation given, particularly the Klippel-Trenaunay, F.P. Weber, and Servelle-Martorell syndromes. The casual, uncritical use of these terms in the past, especially the combination of these entities into one syndrome, has resulted in considerable confusion. Current classifications are based on nosologic, pathophysiologic, anatomical, clinical, and didactic criteria. Modern diagnostic methods and the results of surgical corrections of vascular malformations have led to a better understanding of the underlying pathomechanisms and have offered new prognostic and therapeutic aspects.

Comparison of the effects of three different treatment regimens of recombinant interferons (r-IFN alpha, r-IFN gamma, and r-IFN alpha + cimetidine) in disseminated malignant melanoma

A total of 30 patients with progressively growing visceral and/or cutaneous malignant melanoma metastases were entered in a prospective phase II trial comparing three different therapeutic regimens of recombinant interferons (r-IFN). The first group of 12 patients received r-IFN alpha A 9-36 IU/day i.m. on 5 consecutive days/week. A second group of 11 patients was treated with r-IFN alpha A and oral cimetidine, 1000 mg/day. The third group of 7 patients had i.v. infusions of r-IFN gamma 0.25-0.5 mg/m2 on 3 days/week. Of the 12 r-IFN alpha A-treated patients, 1 responded (complete response, CR), 5 patients exhibited no change (NC), 3 patients had progressive disease (PD), and 3 patients could not be evaluated after therapy. In the group treated with r-IFN alpha A plus cimetidine 3 patients responded (1 CR, 2 partial responses) and 3 exhibited NC. The remaining patients showed PD. Treatment responses were found exclusively in patients with cutaneous and/or lymph node metastases. In contrast, none of the r-IFN gamma-treated patients responded to therapy. Known IFN side effects of varying degrees, sometimes severe, were observed in all patients. Despite the small numbers of patients treated, our preliminary data indicate that r-IFN alpha A therapy seems (1) to be of some therapeutic value in the treatment of cutaneous melanoma metastases, (2) to be superior to r-IFN gamma therapy, and (3) that overall response rates improve with the addition of oral cimetidine to r-IFN alpha A treatment.

Human glomeruli release fatty acids which stimulate thromboxane synthesis in platelets

The cell-free medium of isolated human glomeruli exhibited a procoagulant activity and stimulated thromboxane (TXB2) synthesis in human platelets in a dose-dependent manner. The amount of TXB2 measured was 16-fold higher than what could have been predicted (TXB2 synthesized by the platelets under control conditions plus TXB2 present in the glomerular supernatant). The lipid extract of the glomerular supernatant and its purified fraction including the fatty acids was still able to stimulate--although at a lesser degree--TXB2 synthesis in platelets. Stimulation was abolished after treatment of this fraction by charcoal or albumin. Gas chromatography/mass spectrometry analysis demonstrated the presence in the purified glomerular fraction of several long-chain saturated or monoenoic fatty acids at a total concentration of 80 microM with the following order of abundance: stearic, palmitic, myristic and oleic acids. Addition to human platelets of these same exogenous synthetic acids resulted in a dose-dependent stimulation of TX synthesis. It was maximum with three or four fatty acids tested in combination, but still present with myristic acid used separately. Arachidonic acid was absent in the glomerular supernatant. Thus the stimulation observed could not be related to a greater availability of substrate. Fatty acids did not act on platelets through a non-specific detergent effect since addition of high doses of detergents inhibited TXB2 formation in platelets. The combination of fatty acids from glomerular origin identified in the present study represents a novel factor involved in the control of intracapillary hemostasis, but different from the procoagulant activity common to many tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative diagnostic value of a new computerized vectorcardiographic method (cardiogoniometry) and other noninvasive tests in medically treated patients with chest pain

The diagnostic value of cardiogoniometry (CGM), a new computerized vectorcardiographic method, for the identification of coronary artery disease was compared with other noninvasive tests in 48 medically treated patients with chest pain. Coronary angiography revealed one-vessel disease in 18, two- or three-vessel disease in 21, and normal coronary arteries in 9 patients. Cardiogoniometry was less sensitive (63%) than thallium-201 (201T1) scanning (82%), but slightly more sensitive than the exercise ECG (50%) or a recently proposed parameter of exercise performance (50%). On the other hand, specificity was comparable among these tests (exercise ECG 78%, thallium-201 scanning 72%, CGM 67%, new parameter of exercise performance 66%). Moreover, the false negative rate of noninvasive testing was reduced from 8 to 3% when CGM was added to thallium-201 scanning and exercise ECG. Our findings indicate that in view of the easier feasibility with computerized technology, the future role of vectorcardiographic methods such as CGM in the noninvasive diagnosis of coronary artery disease should be redefined.

[Severe poisoning with a cholinesterase inhibitor]

We report on a case of severe intoxication in an 18-year-old female who had ingested an insecticide with suicidal intent. The insecticide (thionacine) is a cholinesterase inhibitor used in gardening and agriculture. The resources of modern intensive care permitted successful treatment with artificial respiration and atropine. Treatment with oximes is controversial and may be dangerous. We suggest hospitalization even in mild cases of intoxication, in view of danger of changes in the course of the illness.

A technique for intubation of the difficult airway

Intubation of a patient with an obstructive friable tumor mass in the hypopharynx can be difficult. A technique for solving our most difficult cases evolved after all current methods had been tried. This technique combines the use of a tubular laryngoscope and a hollow wand (or guide), through which O2 can be delivered into the trachea as the endotracheal tube is advanced past the obstructing lesion. Existing techniques are also discussed.

The Limulus amebocyte lysate assay. A rapid and sensitive method for diagnosing early gram-negative peritonitis in patients undergoing continuous ambulatory peritoneal dialysis

The Limulus amebocyte lysate (LAL) assay was used in a blinded, prospective fashion to analyze peritoneal fluids from 35 consecutive patients undergoing continuous ambulatory peritoneal dialysis (CAPD), who presented with clinical peritonitis. The results were correlated with standard microbiologic culture results. The LAL assay was positive in all three patients with gram-negative peritonitis, was appropriately negative in 24 of 28 gram-positive infections (sensitivity, 100%; specificity, 86%) and was positive in two of five cases in which there was no microbiologic growth. One of the two patients in this last group yielded a gram-negative organism two days later. It was then demonstrated that therapeutic concentrations of a variety of antibiotics (cefazolin sodium, gentamicin sulfate, tobramycin sulfate, ticarcillin disodium, penicillin G potassium, vancomycin hydrochloride, metronidazole hydrochloride, piperacillin sodium, and trimethoprim/sulfamethoxazole) did not interfere with the LAL assay. Together, these data indicate that the LAL assay is useful for identifying patients at high risk for gram-negative peritonitis and for excluding from possible aminoglycoside exposure the majority of patients with peritonitis undergoing CAPD, most of whom will have gram-positive infections. Furthermore, lack of antibiotic interference allows the possibility of monitoring treatment efficacy.

Behavioral correlates of vitamin D deficiency

Rats deprived of vitamin D at weaning were compared to control rats on open field, stabilimeter, radial arm maze and spatial reversal tasks in order to test the hypothesis that vitamin D deficiency alters behavior and learning. The deficient animals engaged in statistically less open field rearing activity and spent more time each day negotiating the radial maze than did the control rats. These findings are consistent with the known influence of vitamin D on the musculoskeletal system. The deprived rats did not differ from the control animals on the learning measures. This would indicate that vitamin D deficiency may not significantly impair cognitive functions in young adult rats.

Relapses of idiopathic diffuse crescentic glomerulonephritis without immune deposits: report of 6 cases

Idiopathic diffuse crescentic glomerulonephritis without immune deposits is a variant of rapidly progressive glomerulonephritis which can account for up to 40% of crescentic nephritis. The prognosis may depend on both the severity of histological injury at presentation and the efficacy of treatment. Recent advances in therapy have improved the outlook further, and prolonged stable remissions with mild renal failure can occur which contrast with the previously common evolution towards end-stage renal failure within a few weeks. However, relapses in otherwise stable remission may be seen, and we describe a series of 6 acute relapses interrupting such prolonged remissions. The relapses were defined by clinical and histological means. This modification of the natural history of some crescentic glomerulonephritis may reflect new therapeutic strategies, and the relapses may reflect a cyclical nature to the disease evolution which was previously hidden by hemodialysis. The possibility of successive flares suggests that kidney biopsies should be repeated when a rapid deterioration of renal function occurs, since treatment such as high-dose steroids and/or plasma exchange can be again effective if started early.

[Acute effect of prostigmin on lung function and breathing of patients with myasthenia gravis at rest and following ergometric exercise]

The acute effects of a single intravenous Prostigmin injection (0.5 mg) on lung function and gas exchange during rest and bicycle ergometry were measured in 26 patients with myasthenia gravis. The mean age of the patients was 44.6 +/- 17.6 years and the mean duration of myasthenia gravis 5.4 +/- 6.3 years. Lung function parameters obtained from 15 patients showed a normal total lung capacity with an increase in functional residual capacity and residual volume, while vital capacity was diminished. While the application of Prostigmin showed no acute effects on these lung volumes, there was a significant increase in airway resistance, even into the pathologic range. Data obtained during spiro-ergometry concerning gas exchange, circulation and muscle metabolism correspond to those expected from healthy individuals; application of Prostigmin did only influence the heart rate, which can be explained by parasympathomimetic activity. We conclude that dyspnoea in patients with myasthenia gravis need not necessarily be a symptom of the illness itself but can also be caused by therapy; in the latter case bronchodilatators are required.

Effects of medial frontal cortex lesions on DRL performance in rats

Rats with medial frontal cortical lesions (MFC) and control animals with sham operations were tested on an ascending series of 8 DRL schedules of reinforcement ranging from 5 to 70 seconds. Rats with MFC lesions did not differ from the control group in performance when response rate, responses per reinforcement and efficiency were analyzed. These results indicate that deficits in "response inhibition" often displayed by rats with MFC lesions may be task-specific.

Large and small medial frontal cortex lesions and spatial performance of the rat

Rats with sham operations, or small or large medial frontal cortex lesions were compared for the acquisition of a position habit and for learning a series of 4 position habit reversals. No differences were found during acquisition of the position habit. On the reversals, the rats with the larger lesions were markedly impaired, while less severe deficits or control-like performance characterized the rats with the smaller ablations. Analyses of the error scores showed that the rats with the larger lesions made more perseverative errors than the other groups and performed more sporadically even after breaking a previous position habit. These results confirm the hypothesis that a strong relationship exists between medial frontal cortex lesion features (depth and length) and performance. The differences found in acquisition vs. reversal learning, and the nature of the errors observed, also suggest that this part of the brain functions as more than simply a spatial analyzer.

A rapid and simple method for efficient coating of microtiter plates using low amounts of antigen in the presence of detergent

Bio-Beads SM-2 have previously been used for the removal of non-ionic detergents from protein solutions. Addition of Bio-Beads SM-2 to detergent solubilized antigen significantly enhanced the immobilization of antigen to microtiter wells. Depending on the incubation time used 35-45% of the applied antigen could be immobilized to the microtiter wells. Using this method and a subsequent ELISA procedure it was possible to detect monoclonal antibodies in hybridoma supernatants after coating microtiter wells with 100 microliters of a solution containing 16 ng antigen/ml in the presence of 0.01% Triton X-100.

Very long chain fatty acids in genetic peroxisomal disease fibroblasts: differences between the cerebro-hepato-renal (Zellweger) syndrome and adrenoleukodystrophy variants

Very long chain fatty acids were investigated by gas chromatography in fibroblasts of patients with genetic peroxisomal diseases (cerebro-hepato-renal (Zellweger) syndrome, childhood adrenoleukodystrophy, adrenomyeloneuropathy, neonatal adrenoleukodystrophy) and of controls. Concentrations of C 26:0 were increased to about the same extent in all disorders investigated. C 26:1 concentrations, on the other hand, were considerably elevated only in the cerebro-hepato-renal syndrome. In all control, adrenoleukodystrophy, and adrenomyeloneuropathy cases the C 22:0 concentration was higher than the respective C 26:0 concentration; the reverse was found in the cerebro-hepato-renal syndrome. These differences seem to reflect different impairment of peroxisomes in the cerebro-hepato-renal syndrome and adrenoleukodystrophy variants, respectively. Additional experiments to characterize C 26:1 by thin layer chromatography, gas chromatography and mass spectrometry revealed the presence of two straight-chain C 26:1 isomers with similar fragmentation patterns.

[Oral leukoedema--sequela of an artifact]

A 23-year-old white female with a history of psychological instability presented with burning, adhesive, white plaques of the buccal mucosa. She had been unsuccessfully treated for 1.5 years with topical retinoids as well as topical and systemic corticosteroids. The differential diagnoses included leukoplakia, cheek biting and lichen planus. Clinical and histopathological examinations suggested the diagnosis of severe oral leukoedema. Careful history and clandestine surveillance of the patient finally revealed the lesions to be due to a caustic (over-the-counter product for the treatment of corns), which the patient regularly applied to her buccal mucosa.

Late metastases of cutaneous malignant melanoma

Although late recurrence of cutaneous malignant melanoma (CMM) is a known clinical phenomenon, only 12 adequately documented cases exist in the literature. We describe two female patients with CMM who developed melanoma metastases 18 years after radical excision of their primary tumours and presumed cure. Increasing numbers of reports of cases of delayed metastases of CMM might have implications for management and follow up of melanoma patients.

Interaction between calmodulin and five different spin-labelled chlorophenothiazines

The binding to purified calmodulin of five spin-labelled derivatives of chlorophenothiazine was investigated by e.s.r. spectrometry and by the antagonizing potency on the calmodulin-dependent activation of myosin light chain kinase. The results of a comparative study and the influence of pH and ionic strength on the binding support the occurrence of an electrostatic binding involving the terminal amino group of the side-chain of the chlorophenothiazine. These results are discussed in relation to the specificity of the interaction that holds the antipsychotic drug-calmodulin complex together.

Behavioral effects of severe and moderate early malnutrition

Rats with a history of prenatal and early postnatal undernutrition (6 or 8% casein diets) were "nutritionally rehabilitated" at weaning, and were compared to well-fed animals (25% casein) at maturity. The severely-malnourished (6%) animals were hyperactive in the open field and when tested in a stabilimeter. They also appeared to be highly active during the early trials in 8-arm radial maze testing where they made more arm entries and re-entry errors than the well-fed rats. In terms of trials to criterion, however, their scores on the radial maze and on a spatial alternation task fell within normal limits. The moderately-malnourished (8%) rats tended to perform at control levels on the learning measures, but these rats were not as active as the 6% rats on the measures of activity. Brain size and weight differences among the three groups of rats also are presented and discussed.

Severe early malnutrition and DRL performance in the rat

Rats with a history of severe early malnutrition (6% casein) were compared to well-fed control animals on an ascending series of DRL values ranging from 5 to 60 seconds. The 6% rats who were dietarily-rehabilitated at weaning did not differ from control animals in efficiency, responses per reinforcement or response rate. In contrast, rats chronically exposed to 6% diets performed so poorly during training with continuous reinforcement that they did not advance to even the first DRL (5-sec) condition. These findings show that severely-undernourished rats can perform within normal limits on even high DRL values, provided they are well trained and that they have adequate nutritional rehabilitation.

[Continuous sympathetic blockade in frostbite of the extremities]

Continuous epidural anesthesia, started 6 h after severe cold injury of the extremities and continued for 3 days, resulted in complete clinical remission of the frozen areas of the feet. In contrast, repeated stellate ganglion block, started 72 h after cold injury, failed to prevent the development of necroses in the frozen parts of the hands, so that plastic surgery was required.

The Costs of the Soviet Empire

A comprehensive framework is developed and applied to estimate the economic costs incurred by the Soviet Union in acquiring, maintaining, and expanding its empire. The terms "empire" and "costs" are explicitly defined. Between 1971 and 1980, the average ratio between empire costs and Soviet gross national product was about 3.5 percent; as a ratio to Soviet military spending, empire costs averaged about 28 percent. The burden imposed on Soviet economic growth by empire costs is also considered, as well as rates of change in these costs, and the important political, military, and strategic benefits associated by the Soviet leadership with maintenance and expansion of the empire. Prospective empire costs and changes in Soviet economic constraints resulting from the declining performance of the domestic economy are also considered.