A technique for correction of carotid kinks and coils following endarterectomy

This study presents a technique to correct kinking or coiling of the internal carotid artery using patch angioplasty following endarterectomy, resection, and anastomoses of the vessel. Since 1984, 579 carotid endarterectomies have been performed with 19 patients (3.3%) having arteriosclerotic carotid bulb and internal carotid artery disease associated with a carotid kink or coil. These have been treated successfully using the technique of resection and patch angioplasty. The indications for surgery included seven patients with transient ischemic attacks (36.8%); seven patients who had suffered a cerebrovascular accident (36.8%); amaurosis fugax in two patients (10.5%); and one patient each with Hollenhorst plaque (5.3%), central retinal artery occlusion (5.3%), and an asymptomatic critical stenosis (5.3%). All patients had successful repair of the vessel using saphenous vein or Dacron patch angioplasty. There were no perioperative strokes or deaths. Follow-up ranged from four months to 58 months (mean 25 months). All vessels are patent with no evidence of stenosis. One patient had an ipsilateral cerebrovascular accident but had no evidence of recurrent carotid disease. Surgical correction of the carotid kink or coil can present a difficult surgical problem, and resection, fixation, or transposition can be complicated. The technique of endarterectomy, resection of the redundant vessel with anastomosis of the back wall, and patch angioplasty has been used effectively and safely in this series of patients.

CD-ROM prototype applications within the Department of Veterans Affairs

The Department of Veterans Affairs (VA) has been actively involved in examining the benefits of Compact Disc Read Only Memory (CD-ROM) to its operations. Approximately twenty VA titles either have been produced or are scheduled for production by Summer of 1991. Both textual and database CDs have been prototyped. Several of the CDs have been integrated directly into the VA's MUMPS-based hospital information systems. Titles which contain patient information employ the Data Encryption Standard (DES) for sensitive information. A related project involves the installation of a system which allows common VDTs on the hospital system to access commercial CDs such as MEDLINE, PDR, and CCIS. The prototypes have been successful and very favorably received by users.

Time course of cellular infiltration in the nasal mucosa during the immediate allergic reaction

In 23 patients with allergic rhinitis, biopsies of the nasal mucous membrane were taken at one of the following times after challenge of one nostril with allergen: 0 (baseline) (n = 7), 1/2 h (n = 6), 1 h (n = 5), and 2 h (n = 5). In the nostril stimulated by allergen there was a transient early phase influx of eosinophils while the numbers of stainable mast cells decreased, probably due to their degranulation. In the contralateral unstimulated nostril, there was no change in numbers of eosinophils but the numbers of stainable mast cells decreased. These results support the proposed role in allergic rhinitis of the mast cell and eosinophil, and suggest that the eosinophil may be a rapidly mobilized effector cell.

Genetic mapping between Gli-B1 locus and a telomeric C-heterochromatin band in wheat

Using C-banding it has been possible to prove that the bread wheat varieties 'Holdfast' and 'CapelleDesprez' shows an intense band of telomeric heterochromatin on the short arm of chromosome 1B, while the variety 'Pané-247' presents a very thin band. Gliadin study using pH-acid electrophoresis revealed the existence of differences in the Gli-B1 locus in the three varieties. Analysis of the progeny of the (P x H) x CD hybrid revealed recombination between the heterochromatin C-band and locus Gli-B1, and allowed the genetic distance between the two markers to be calculated as 6.55±3.16 cMorgan. This is the first time the genetic distance from a locus to the chromosome telomere has been directly obtained in wheat. The heterochromatin C-band studied here gives us a cytological marker on chromosome 1B that can be used as a reference point in the localization of other genes.

Chronic myocardial damage in experimental T. cruzi infection of a New World primate, Cebus sp. monkey

Eighteen Cebus apella monkeys, (juvenile and adult of both sexes) were inoculated five years ago, with three Trypanosoma cruzi strains (CA1, n = 10; Colombian, n = 4 and Tulahuen, n = 4), either by conjunctival or intraperitoneal route, once or repeatedly. Parasitological, hematological, serological, enzymatic, radiographic, electro and echocardiographic findings have been previously published and they are similar to those observed in human pathology. The most frequent electrocardiographic alteration was right branch bundle block. Six animals, chosen at random, were sacrificed. Those sacrificed 20 to 25 months post-first inoculation showed focal accumuli of leukocytes with myocytolysis. Foci of diffuse interstitial fibrosis with mild infiltrate of leukocytes among fibers were observed in the animals sacrificed 36 to 47 months post-inoculation. No parasites were seen. The lesions were more prominent in the ventricular walls and the septum. The fact that the infiltrates were predominant in the animals sacrificed at a shorter time after first inoculation and that fibrosis was more severe in those sacrificed at a longer time suggests that there is a progression of the infiltrative lesions to fibrosis, with a leukocytic activity indicative of a chronic phase. These lesions are similar to those described in human chronic Chagas' disease. This would demonstrate that this model is useful in evaluating a progress in the knowledge of the pathogenesis which is still a controversial issue, immunology, immunogenesis and chemotherapeutic agents of the chronic and indeterminate phases of this disease.

Relationship between small intestinal fasting motility and vomiting in dogs

Preceding vomiting, several changes in small intestinal motility have been described. They consist mainly of high-amplitude retrograde contractions and inhibition of motility before and after these contractions. The recordings of 94 episodes of emesis occurring spontaneously, during manometric studies of intestinal motility by means of infused catheters in dogs with gastric and duodenal cannulae, showed that 95.7% of all episodes developed during phase II of the migratory motor complex. In order to establish whether different phases of the fasting cyclic activity are associated with a different sensitivity to emetic stimulus, two agents, apomorphine, a centrally acting drug and copper sulfate, a peripherally acting agent, were administered at the beginning of phases I and II of the migratory motor complex. Coincident with spontaneously occurring vomiting, a statistically significative greater number of responses to both emetic agents was observed during phase II as compared to phase I. This finding suggests that cyclic changes of the small bowel motility are related to changes in the threshold of the vomiting center.

Influence of jejunal hypertonic glucose infusion on sham-feeding-stimulated gastric acid secretion: evidence of a defective mechanism in duodenal ulcer patients

The aims of the present study were to determine in 14 healthy subjects and 14 duodenal ulcer patients the reproducibility of the acid secretory response to a modified sham-feeding test and the effect on this response of intrajejunal hypertonic glucose instillation, in order to evaluate the possibility of the existence of a defective inhibition of the cephalic phase of gastric acid secretion in duodenal ulcer disease. The reproducibility of the acid secretory response to a modified sham-feeding test was demonstrated in both groups in two consecutive tests. The hypertonic glucose instillation produced a significant inhibition of the acid secretory response to modified sham feeding only in the healthy subjects, suggesting that duodenal ulcer patients may have a defective mechanism of acid inhibition during vagal stimulation by modified sham feeding. Non-significant changes were observed in plasma gastrin and pancreatic glucagon levels.

Morphological integrity of the bronchial epithelium in mild asthma

In severe asthma bronchial epithelial cells are damaged and detached, and it has been proposed that such damage might lead to the bronchial hyperresponsiveness that characterises asthma. To investigate the relation between airway hyperresponsiveness and epithelial damage, biopsy specimens of the bronchial mucus membrane were obtained at fibreoptic bronchoscopy from 11 patients with mild atopic asthma and airway hyperresponsiveness (provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) less than 1.0 mg/ml), and from 17 healthy non-atopic subjects who did not have airway hyperresponsiveness (PC20 methacholine greater than 8.0 mg/ml). Observers who were blind to the presence or absence of asthma examined the biopsy specimens by light and electron microscopy. Epithelial cells, intercellular spaces, and goblet cells were counted. Intercellular junctional complexes were examined, and a semiquantitative assessment was made of ciliary loss, non-parallel central ciliary filaments, and vacuoles in ciliated cells. There were no differences between the asthmatic and healthy groups in any of these measurements. These findings indicate that airway hyperresponsiveness may be present when there is no apparent change in the structure of the bronchial epithelium.

Allergen-induced changes in the nasal mucous membrane in seasonal allergic rhinitis: effect of nedocromil sodium

We have obtained biopsy specimens of the nasal mucous membrane before and during the grass-pollen season in 22 patients with seasonal allergic rhinitis to grass pollen to assess the effects on cellular infiltration of natural exposure to allergen. Biopsy sections were examined by light microscopy, and quantitative assessment was made of numbers of mast cells and eosinophils. The patients were divided into 11 who were treated with placebo and 11 patients who were treated with topical nedocromil sodium. In the group as a whole, there was a significant (p less than 0.001) increase in mast cell density in tissue sections from biopsy specimens obtained during the season compared with out of season (median values, 55.0 and 15.5 cells per square millimeter, respectively). There was also a significant (p less than 0.02) increase in the density of eosinophil infiltration during the season compared with out of season (median values, 6.3 and 0 cells per square millimeter, respectively). Treatment with nedocromil sodium significantly (p less than 0.02) inhibited the accumulation of mast cells but not eosinophils. Compared with the placebo-treated group, the group treated with nedocromil demonstrated a significant (p less than 0.025) reduction in the requirements for treatment with concomitant medication (terfenadine tablets and xylometazoline/antazoline eye drops). These results indicate that natural exposure to allergen in patients with seasonal allergic rhinitis is accompanied by infiltration of mast cells and eosinophils into the nasal mucous membrane. The clinical efficacy of nedocromil sodium in this condition may be related to inhibition of infiltration by mast cells.

Anterior speech region. Asymmetry and weight-surface correlation

Results of this work show, in the inferior frontal gyrus and in the different portions into which it was divided, asymmetry of weight and cortical surface and left predominance in the posterior portion, which is concerned with language. In spite of the difference among the absolute individual values, the correlation between weight and surface values is excellent in all cases, and the weight and surface ratio is the same for the portions related to language and different for the remainder of the inferior frontal gyrus.

Computed tomography in acute alcoholic myopathy

We describe a case of acute alcoholic myopathy evaluated by computed tomography. Computed tomography showed a low-density, delimited area in the semimembranous muscle and edema of the subcutaneous cell tissue, permitting determination of the extent of the disease and its localization for purposes of biopsy and fasciotomy of the affected muscle.

The effect of nedocromil sodium on nasal provocation with allergen

We have investigated the effect of nedocromil sodium in preventing the symptoms of rhinitis occurring immediately after allergen provocation in 10 patients with allergic rhinitis. The study had a double-blind, placebo-controlled, crossover design. Nedocromil sodium (1% w/v) and placebo were administered intranasally from identical metered-dose inhalers 20 minutes before allergen provocation. Three variables were measured: nasal airway resistance, the production of secretion, and the number of sneezes. Nedocromil sodium was significantly more effective than placebo in preventing nasal obstruction (p less than 0.01), rhinorrhea (p less than 0.01), and sneezing (p less than 0.05), suggesting that this drug may be useful in the treatment of allergic rhinitis.

Relationship between antropyloric and intestinal motility and duodenogastric reflux in fasting dogs

Duodenogastric reflux was studied in fasting dogs with gastric and duodenal cannulae, by means of recovery from the gastric cannula of phenol red infused into the duodenum and bile acids recovered from the gastric cannula. Simultaneously, antropyloric and intestinal motility was studied in order to establish a relationship between motility and duodenogastric reflux. A different pattern of duodenogastric reflux was observed, depending on the method utilized. While a significantly higher reflux was observed during phase II in bile acid studies, an irregular pattern not related to the different phases of the interdigestive motor complex was observed in experiments with phenol red. Antral motility estimated by an antral motility index showed a statistically significant correlation with DGR estimated by both methods. Pyloric pressure and intestinal motility did not show a correlation with DGR. We concluded that the results obtained in studying duodenogastric reflux depend on the method used. The main factor related to increased duodenogastric reflux was the decreased antral motility.

Histochemical and functional characteristics of the human nasal mast cell

It is currently accepted that mast cell heterogeneity occurs not only in different species but also within the same organ in the same species. This study demonstrates that the majority of mast cells in the human nasal mucosa of non-atopic non-rhinitic subjects do not stain after fixation with 10% buffered formol saline and, although they stain with alcian blue, they do not counterstain with safranine O, indicating that nasal mast cells may contain a proteoglycan other than heparin. Further, mast cells in the nasal mucosa are essentially unaffected by the polyamine compound 48/80, indicating that they are functionally dissimilar to the connective tissue type mast cells exemplified by those present in the rat tongue.

Changes in nasal mast cell numbers in and out of the pollen season

Mast cells were counted in biopsies of the nasal mucous membrane from 8 patients with allergic rhinitis during (July 1985) and after (October 1985 and January 1986) the grass pollen season in both the superficial epithelium and the deeper lamina propria. There was an eightfold increase in the total number of mast cells in the nasal mucous membrane during the grass pollen season when compared to midwinter. In addition, there was a striking change in the number of mast cells present in the surface epithelial layer from almost total absence in biopsies taken in midwinter to counts of between 2,000 and 28,000/mm3 in all but 1 patient during the summer.