A district-wide anaesthetic audit

A district-wide anaesthetic audit has been implemented by the Derby anaesthetic department. Data for every anaesthetic are collected on a specially designed audit form which is read into a computerised database using an optical mark reader. The implementation of the audit, problems encountered and some benefits realised are described.

Value of splenic aspirate in the diagnosis of hairy cell leukaemia

We present a case with hairy cell leukaemia which was diagnosed on a splenic aspirate. The patient refused splenectomy.

Pain on injection and venous sequelae following two formulations of etomidate

In forty patients (aged 21-76 years) scheduled for elective surgery, anaesthesia was induced with either etomidate in propylene glycol (n = 20) or etomidate in ethanol (n = 20) injected via a 23-G needle over 30 s. The overall incidence of pain on injection was 60%. No statistically significant difference was found between the two groups. The incidence of venous sequelae was 5%, in both groups.

Early intervention with propranolol after acute myocardial infarction: serial left ventricular function determined by M-mode and cross-sectional echocardiography

Fifty patients (mean age 48.6 +/- 9.4 years) with uncomplicated acute myocardial infarction were randomly assigned to propranolol therapy (n = 25) or placebo (n = 25) in a double-blind manner within 24 hours of their presentation with acute symptoms. M-mode and cross-sectional echocardiography were performed at one week and three months to evaluate the left ventricular function. A comparison of the two groups revealed that the group receiving propranolol had higher left ventricular ejection fraction (69% vs 52%, P less than 0.001), fractional shortening (32% vs 24%, P less than 0.01), lower mitral E-point septal separation (6 mm vs 14 mm, P less than 0.001) and wall motion abnormality score (2.5 vs 6.0, P less than 0.001) than the group receiving placebo therapy. At three months there was further significant improvement in wall motion abnormality score (1.1 vs 2.5, P less than 0.001) in the propranolol-treated group as compared to the placebo group, whereas the other parameters remained unchanged. We conclude that the left ventricular function detected by M-mode and cross-sectional echocardiography showed significant improvement in patients with acute myocardial infarction after early intervention with propranolol. This is possibly due to a reduction in the size of infarction.

Identification of a novel stress-inducible glycoprotein in Saccharomyces cerevisiae. I. Preliminary characterization

We have identified a novel stress-inducible protein in Saccharomyces cerevisiae by pulse-labeling with [35S]methionine and two-dimensional gel analysis. The protein was characterized biochemically to gain further insight into mechanisms regulating the stress response. It has a Mr = 118,000 and exists in two forms of pI = 4.2 (p118A) and pI = 4.3 (p118B). p118A and p118B are modified by N-glycosylation. Tunicamycin treatment revealed the presence of precursor proteins of Mr = 105,000, pI = 4.1 (p105A) and pI = 4.25 (p105B). The synthesis of p118A and p118B was almost completely shut off in cycling cells and was increased 11-fold following a mild heat shock. Both forms of p118 decayed in a biphasic manner under induced conditions. A tight correlation was observed in the kinetics of thermotolerance induction and p118A synthesis. Other forms of stress such as sulfur starvation which lead to arrest in the unbudded phase also resulted in enhanced synthesis of both p118A and p118B. However, in cell division cycle mutants blocked at various stages at the restrictive temperature, p118A and p118B had different synthetic patterns. Taken together, these data imply a role for induced p118 in proliferation arrest in the unbudded state.

Modulation of expression of the stress-inducible p118 of Saccharomyces cerevisiae by cAMP. II. A study of p118 expression in mutants of the cAMP cascade

In the preceding paper, we have identified a protein of Mr = 118,000 which is induced by stress conditions that lead to cessation of DNA synthesis and cell division (Verma, R., Iida, H., and Pardee, A.B. (1988) J. Biol. Chem. 263, 8569-8575). In the current study, we have investigated the possible role this protein may play in cellular proliferation by studying p118 expression in mutants of the cAMP metabolic pathway. The cyr 1-2 mutant gene encodes a thermolabile adenylate cyclase whose activity is only 7% of wild type even at permissive temperatures (23 degrees C). We have found that at 23 degrees C, the G1 period was 5-fold longer in cyr 1-2 than in CYR1+ cells and that p118 was constitutively expressed in these slow cycling mutants. Addition of 8-bromo-cAMP to cyr 1-2 mutants restored growth at both the restrictive and permissive temperatures and resulted in a shut-off in the synthesis of p118. The effect of the analog on p118 expression was rapid, preceding the increase in cell number and percentage-budded cells. In contrast to wild type cells, p118 synthesis was not induced by sulfur starvation in RAS2val19 mutants possessing high levels of adenylate cyclase activity and bcy1 mutants defective in the regulatory subunit of cAMP-dependent protein kinase. A large body of evidence exists supporting a role of cAMP in positive control of cell proliferation. It is therefore possible that conditions which decrease cAMP arrest growth through a chain of events that include p118 induction.

Intrathoracic complications of acute pancreatitis

Acute pancreatitis has an incidence of approximately 50 cases per million of the United Kingdom population and a mortality of 10-18%. Intrathoracic complications have been implicated as the major factor in 22-29% and a contributing factor in a further 29-39% of all deaths. Sixty per cent of deaths occur in the first week of hospital admission and in these the pleuropulmonary complication rate is 94%. In the survivors there is little residual lung damage and the recovery of the pulmonary function is invariably complete. Knowledge of the pleuropulmonary complications of acute pancreatitis may aid with the identification of high risk groups so that supportive measures (including mechanical ventilation) can be implemented early in the course of the illness. This article reviews the major intrathoracic complications of acute pancreatitis (Fig. 1) under the broad headings of: 1. pleural effusion 2. acute pulmonary dysfunction (a) hypoxaemia without pulmonary infiltrates (b) hypoxaemia with pulmonary infiltrates (including the adult respiratory distress syndrome; ARDS).

Respiratory sensitivity to carbon dioxide in schizophrenia

Respiratory sensitivity was evaluated in 10 patients with schizophrenia and 10 normal control subjects utilizing a rebreathing system and measurements of the changes in the mouth occlusion pressure in 100 ms and ventilation in response to the increase in end-tidal PCO2 (PetCO2). Although ventilation response was similar in both groups, we noted that the occlusion pressure response was more variable (coefficient of variability, CV = 17.5%) and the correlation coefficient (r = 0.75 +/- 0.13) lower in the patients with schizophrenia compared to controls (CV = 4.6%; r = 0.90 +/- 0.04). Apnea threshold was also lower in patients with schizophrenia (29.03 +/- 12.73 Torr, mean +/- SD) compared to controls (39.5 +/- 4.5 Torr). Furthermore, schizophrenia patients showed a significant positive and negative correlation between occlusion pressure response and age (r = 0.73; p less than 0.001) and estimated duration of schizophrenia (r = 0.65; p less than 0.05). We conclude that the apnea threshold is lower and the respiratory sensitivity to CO2 is more variable in patients with schizophrenia compared to normal subjects.

Evaluation of blood loss during suction termination of pregnancy: ketamine compared with methohexitone

Blood loss during suction termination of pregnancy was estimated in patients anaesthetised with intravenous ketamine (n = 25) and compared with those anaesthetised with intravenous methohexitone (n = 25). Both groups received midazolam 0.15 mg/kg intravenously 3 min prior to induction of anaesthesia. No statistically significant difference was found in blood loss between the two groups (P = 0.66). There was no incidence of dreaming or psychomotor disturbances with ketamine in our study.

Inhalation of a minitracheotomy tube

Inhalation of a minitracheotomy tube during sputum aspiration in a patient with sputum retention is reported. Precautionary measures in the insertion and management of a minitracheotomy tube are discussed.

Spermine inhibits the phosphorylation of the 11,000- and 10,000-dalton nuclear proteins catalyzed by nuclear protein kinase NI in NB-15 mouse neuroblastoma cells

The nuclear protein kinase NI (NI kinase) was purified from NB-15 mouse neuroblastoma cells by phosphocellulose column and casein affinity column chromatography. The purified NI kinase exhibited (i) an apparent subunit molecular weight of about 37,000, (ii) autophosphorylation, and (iii) insensitivity to inhibition by heparin. When NI kinase was added to heat-treated neuroblastoma nuclei in the presence of [gamma-32P] ATP, two proteins with apparent subunit molecular weights of 11,000 and 10,000 were prominently phosphorylated. Other protein kinases tested including the nuclear protein kinase NII, Type I cAMP-dependent protein kinase, and protein kinase C did not catalyze the phosphorylation of these two proteins. The NI kinase-catalyzed phosphorylation of these two proteins was completely inhibited by 1 mM spermine. In contrast, 10 mM putrescine, 2 mM spermidine, 5 mM arginine, and 10 mM NH4Cl, had no inhibitory effect on this phosphorylation reaction. Our study also indicated that the phosphorylation of the 11,000- and 10,000-dalton proteins occurred in the nuclear matrix fraction but not in heterogeneous nuclear ribonucleoproteins, high mobility group proteins, or histone fractions. We have previously reported that spermine specifically inhibits the endogenous phosphorylation of an 11,000-dalton nuclear protein in various mammalian cell lines (Chen, K. Y., and Verma, R. (1984) Biochem. Biophys. Res. Commun. 118, 710-716). The present study suggests that the 11,000- and 10,000-dalton nuclear proteins may be native substrates of nuclear protein kinase NI and that their phosphorylation can be affected by physiological concentrations of spermine.

Tumor uptake of 5-fluorouracil, methotrexate, and adriamycin vs gallium

Since the imaging pattern of 67Ga-citrate is well known, it can be the benchmark for evaluation of potential tumor imaging agents. Tritium labeled 5-fluorouracil, Adriamycin, (doxorubicin/Adria) and Methotrexate/Lederle were compared at 2 h to 67Ga-citrate at 2 and 48 h by percent uptake per gram of various tissues and tumor in rats implanted with Walker 256 carcinosarcoma. 67Ga at 48 h showed approximately three times more uptake in the tumor than 5 fluorouracil and eight times more than the others. 5 Fluorouracil showed approximately three times greater uptake than Methotrexate or doxorubicin and 1.4 times the 2 h uptake of 67Ga. 5 Fluorouracil shows potential as an imaging agent especially where the waiting time between injection and imaging must be short.

Anesthesia for termination of pregnancy: midazolam compared with methohexital

Clinical effects of intermittent intravenous administration of midazolam were compared with those of methohexital in two groups of ten premedicated patients each undergoing suction termination of pregnancy under general anesthesia. Both groups received intravenous fentanyl (1 microgram/kg) 5 min prior to administration of the induction agent. No significant difference was found between the two groups in induction time and quality of anesthesia. The recovery time was significantly (17 min) longer in patients who received midazolam (P less than 0.0001).

Microcomputer database software for medical information management

Commercial software intended primarily for business applications may be used for medical information management. An inexpensive database may be established quickly and independently by busy clinicians working with limited resources. Desirable software features are discussed. A summary of 14 commercial data handling program packages is given.

Amebic liver abscess: a therapeutic approach

The clinical presentation of 48 patients with amebic liver abscess was no different than that reported in earlier studies. However, most patients were from countries endemic for parasitic disease. Failure to consider this diagnosis resulted in potentially avoidable surgery for six patients. Although metronidazole was successful primary therapy in 85% of 41 patients so treated, four of seven ruptured abscesses occurred in cases where metronidazole treatment failed. For assessment of factors that might predict metronidazole treatment failures, multiple parameters were analyzed. Of the factors evaluated, only timing of clinical response correlated with successful therapy. Ninety-four percent of metronidazole responders showed dramatic clinical improvement within 72 hours of initiation of therapy, whereas only 33% nonresponders had improved modestly during this time (P = .0014). Therefore, early diagnosis of amebic liver abscess in patients from endemic areas and treatment with metronidazole will result in successful therapy in 85% of cases. Surgical intervention or alternative medical therapy is indicated for those patients who do not respond after 72 hours of metronidazole therapy.

Spermine specifically inhibits the phosphorylation of an 11,000-dalton nuclear protein in various cultured mammalian cell lines

The effect of polyamines (putrescine, spermidine and spermine) on endogenous protein phosphorylation in mouse neuroblastoma cells was investigated by using techniques of sodium dodecyl sulfate-polyacrylamide gel electrophoresis and autoradiography. The results indicated that spermine at 1mM completely inhibited the phosphorylation of the 11,000-dalton and 120,000-dalton proteins in nuclear fractions. The inhibition of the phosphorylation of the 11,000-dalton but not the 120,000-dalton protein by spermine was also observed in five other cell lines examined and appeared to be a general phenomenon. The inhibitory effect of spermine on the phosphorylation of the 11,000-dalton protein was specific, other cations such as ammonium chloride, arginine, putrescine, cyclen and trien were ineffective at equal molar or much higher concentrations.