Everted cervical vein for carotid patch angioplasty

Because of the theoretic benefits of autologous vein we undertook an investigation to evaluate cervical veins (facial, external jugular) as patch material after carotid endarterectomy. A device that stimulated both circumferential fixation by sutures and radial tension exerted on in vivo patches was constructed to measure burst strength of tissue. Mean bursting pressure for groin saphenous vein (n = 10) was 94.5 +/- 15.1 pounds per square inch (psi), 75.5 +/- 8.9 psi for ankle saphenous vein (n = 10), 83.3 +/- 14.5 psi for everted (double layer) cervical vein (n = 5) and 10 +/- 3.3 psi for single layer cervical vein (n = 5). No significant differences between saphenous vein at any level and everted (double layer) cervical vein, but all were significantly different from single layer cervical vein (p less than 0.05). From June 1987 through November 1989, 19 patients underwent 21 carotid endarterectomies complemented with adjunctive everted cervical vein patch angioplasty. Indications for surgery were asymptomatic stenosis (53%), transient ischemic attack (29%), and cerebrovascular accident with recovery (18%). All patients were studied after surgery with duplex scanning. Asymptomatic recurrent stenosis was observed in one patient. Transient hypoglossal nerve dysfunction occurred in one other patient. One postoperative death occurred as a result of massive aspiration. These results indicate that everted cervical vein is comparable to the saphenous vein in resistance to bursting and can yield similar results as patch material after carotid endarterectomy. Accordingly, saphenous vein can be spared and lower extremity incisions avoided.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidural anesthesia as an adjunct to retroperitoneal aortic surgery

Recent developments in vascular surgery suggest that the retroperitoneal approach to the aorta and the use of epidural anesthesia for lower limb revascularization are associated with decreased morbidity and shorter hospital stays. By combining these principles, we sought to determine if retroperitoneal aortic surgery could be performed under epidural anesthesia and if this might be advantageous. Over a 16-month period, 57 patients underwent aortic surgery via the retroperitoneal (n = 33) or transperitoneal (n = 24) approach. In the former, epidural anesthesia was employed in 10 patients, general anesthesia in 3, and combined epidural anesthesia and general anesthesia in the remaining 20. In the transperitoneal group, general anesthesia was employed in 21 patients and combined epidural anesthesia and general anesthesia in 3. Both groups were similar in age and gender, but risk factors were predominant in the retroperitoneal group. With the exception of one death due to aspiration, there were no significant differences between the transperitoneal and retroperitoneal groups with respect to overall morbidity, pulmonary complications, and length of stay in the intensive care unit and hospital. Despite these findings, we favor the combination of epidural and general anesthesia for retroperitoneal aortic surgery. Morbidity was significantly decreased (p less than 0.05) in low-risk retroperitoneal patients when combined epidural anesthesia and general anesthesia were employed.

Purification and characterization of a cytosolic phosphoinositide-phospholipase C (gamma 2-type) from human platelets

A human platelet cytosolic phosphoinositide-specific phospholipase C, one of four PLC activity peaks separated by column chromatographies, designated as cPLC-I, was purified to homogeneity. The cPLC-I exhibited an apparent Mr of 145 kDa by SDS-polyacrylamide gel electrophoresis and was immunologically identified to be PLC-gamma 2. It hydrolyzed PI and PIP2 at optimum pH of 5.5-6.0. Deoxycholate and cholate inhibited the enzyme activity to hydrolyze two substrates. Calcium was required to obtain the maximal activity for PI- and PIP2-hydrolysis at concentration of 10(-3) M and 10(-5) M, respectively. Hg2+ (1 microM) inhibited strongly the enzyme activity.

Transcobalamin II deficiency presenting with methylmalonic aciduria and homocystinuria and abnormal absorption of cobalamin

An infant with deficiency of transcobalamin II (TCII) presented with virtually complete failure to thrive and life-threatening pancytopenia. Methylmalonic acid and homocystine were found in the urine. The concentration of B12 in the serum was 26 pg/ml. Fibroblasts derived from the patient failed to take up labeled cobalamin in the absence of a source of TCII. Uptake was normal in the presence of TCII. Treatment with parenteral cobalamin reversed the clinical and hematological manifestations of the disease but she developed glossitis when the interval between injections was lengthened. Intestinal absorption of 57Co-cobalamin was less than 1% and remained abnormal when highly purified human intrinsic factor was given along with the labeled B12. Absorption improved when the labeled B12 was given together with rabbit TCII. The data suggest that TCII as well as intrinsic factor is required for transport of cobalamin from the intestine to the blood.

Establishment of continuous cultures of T-cell acute lymphoblastic leukemia cells at diagnosis

We have devised methods facilitating the establishment of continuous cultures of T-cell blasts from patients with acute lymphoblastic leukemia of T-cell type at diagnosis. The cultured cells closely resemble those of the patients at the time of diagnosis with respect to surface markers, karyotype, and T-cell receptor gene rearrangements. Cultured T-cell acute lymphoblastic leukemia (diagnosis) cells (a) are lymphocytes with a convoluted nucleus; (b) have doubling times of 24-48 h; (c) are dependent for growth on interleukin 2; (d) are reverse transcriptase negative; (e) do not form colonies in methyl cellulose; and (f) are clonal with respect to T-cell receptor beta chain rearrangements. Three T-cell acute lymphoblastic leukemia cultures had a normal diploid karyotype, and one had a 6q- deletion which was also present at the time of diagnosis.

Xerostomia. Part II: Relationship to nonoral symptoms, drugs, and diseases

Five hundred twenty-nine adult outpatients were studied to determine the relationship of xerostomia to other oral symptoms and salivary flow (reported in part I) and to nonoral symptoms, drugs, and select diseases (reported here in Part II). It was observed that dry throat, blurred vision, dry eyes, dry skin, and vaginal itching and fungal infections are prominently associated with oral dryness. These nonoral symptoms were positively correlated with the oral symptoms cited in part I of this study and were inversely related to the flow of resting, but not stimulated, whole saliva. Several classes of drugs were associated with dry mouth. In addition, diabetes mellitus and hypertension were significantly associated with it. Approximately half of the diabetic and hypertensive patients complained of dry mouth. Although a majority of them were taking medications, the association between xerostomia and these diseases cannot be completely attributed to drugs, since many of these patients did not take any xerogenic medicaments. The data show that xerostomia and several other oral symptoms are valid indicators of salivary gland hypofunction. They suggest, moreover, that select nonoral symptoms are an indicator of generalized xerosis.

Contact dermatitis by sensitization to amine-type antioxidants

Numerous reports had been published implicating IPPD and other amine-type antioxidants as the causative agents in patients with allergic sensitization following the use of industrial and household products that have black rubber in their composition. The amine-type antioxidants, used to stabilize the polymer chains and to prevent rubber from cracking, are the agents more frequently implicated in this type of contact allergic dermatitis. Based on a case of a patient who had erythematous edematous and vesiculous processes in the periocular region that appeared a few hours after the use of a video camera with a black rubber eyepiece, we reviewed the clinical features, and the etiological agents of this infrequent form of contact dermatitis. This patient represents the first described case in the literature of allergic sensitivity after the use of a video camera eyepiece.

Control of prophage integration and excision in bacteriophage P2: nucleotide sequences of the int gene and att sites

Integration of bacteriophage P2 into the Escherichia coli host genome involves recombination between two specific attachment sites, attP and attB, one on the phage and the other on the host genome, respectively. The reaction is controlled by the product of the phage int gene, a basic polypeptide of about 37 kDa [Ljungquist and Bertani, Mol. Gen. Genet. 192 (1983) 87-94]. The int gene appears to be expressed differently by an infecting phage, as opposed to a prophage [Bertani, Proc. Natl. Acad. Sci. USA 65 (1970) 331-336]. A 1200-bp region of P2 DNA containing the int gene and attP, the prophage hybrid ends attL and attR, and one bacterial attachment site, the preferred site locI from E. coli strain C, have all been sequenced. An open reading frame coding for a polypeptide of 337 amino acids corresponds to the int gene. The gene has no obvious promoter sequence preceding it. The int gene transcript seems to continue past the attP site downstream from it, suggesting a possible explanation for the previously observed difference in integration and excision. A comparison of the four attachment sites reveals a common 'core' sequence of 27 bp: 5'-AAAAAATAAGCCCGTGTAAGGGAGATT-3'. The P2 nip1 mutation, which increases prophage excision [Calendar et al., Virology 47 (1972) 68-75], was found to lie within the int gene itself. The P2 saf variant, which has altered site preference [Six, Virology 29 (1966) 106-125], has a bp substitution within the core sequence. Three deletion/substitution mutants, vir22, vir94 and del3, also have altered core sequences.

Deoxycoformycin treatment for childhood T-cell acute lymphoblastic leukemia early in second remission: a Pediatric Oncology Group Study

2-Deoxycoformycin (DCF) was added to an intensive Pediatric Oncology Group protocol (#8303) for children with T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma in first relapse. Twenty-seven patients received one or more courses of DCF at 15 mg/m2/day as a 3-day continuous infusion immediately after achieving a second remission with a four-drug reinduction regimen. Renal and neuromuscular toxicities were frequent and occasionally severe despite the provision of a source of adenosine deaminase by means of a packed red cell transfusion 1 day following the infusion of DCF. Hepatic toxicity, manifested by transaminase elevations, accompanied 62% of the courses. The median duration of the second complete remission was 4 months (range 2-16+ months), with only two of the 27 patients still in remission at 13+ and 16+ months. Plasma concentrations of deoxyadenosine (dAdo) and the ratio of red cell deoxyadenosine triphosphate to adenosine triphosphate (dATP:ATP) were measured prior to the DCF infusion and on day 4. A dATP:ATP ratio of 1.0 or greater was seen in two patients with acute renal failure. There was no apparent correlation between toxicity or response and the plasma dAdo concentrations. DCF administered according to this dose and schedule was excessively toxic and did not appreciably prolong the duration of the second complete remission in children with T-cell lymphoblastic malignancies.

Anti-peptide antibodies detect oncogene-related proteins in urine

Antisera to a number of synthetic peptides predicted from nucleic acid sequences of oncogenes have been used to screen 483 urine samples of cancer patients, pregnant women, and normal controls for the presence of immunologically related proteins. Increased levels of oncogene-related proteins are found during neoplasia and pregnancy. The differential detection of these oncogene-related proteins indicates that panels of monoclonal antibodies may provide a convenient noninvasive means of detecting, classifying, and staging a wide variety of malignancies and may be useful in following fetal development during pregnancy.

Chronic allyl chloride poisoning. An epidemiology, clinical, toxicological and neuropathological study

It was previously reported that chronic exposure to allyl chloride resulted in liver and kidney damage. No neurotoxic effect of allyl chloride had been noticed until two outbreaks of polyneuropathy without liver and kidney dysfunction due to exposure to allyl chloride in China in the early 1970's. Epidemiological and clinical studies done within 1973-1982 revealed that the main risk of industrial exposure to allyl chloride is damage to the peripheral nervous system. Polyneuropathy is thought to be the main clinical manifestation of chronic allyl chloride poisoning. Electroneuromyography is essential and valuable for early diagnosis and biological monitoring. Toxicological and neuropathological studies in rabbits and mice have given the evidence of a pattern of central-peripheral distal axonopathy in peripheral nervous system which has further confirmed the neurotoxicity of allyl chloride found in man. Based on the above results, the maximum allowable concentration of allyl chloride and diagnostic criteria for chronic allyl chloride poisoning are proposed.

Detection of ganglioside GD2 in tumor tissues and sera of neuroblastoma patients

A murine monoclonal antibody (monoclonal antibody 126) produced against cultured human neuroblastoma cells (LAN-1) was found to be specifically directed to a disialoganglioside (GD2) antigen preferentially expressed on both cell lines and tissues derived from melanoma and neuroblastoma. In enzyme-linked immunosorbent assays, monoclonal antibody 126 failed to react with leukemic and lymphoblastoid cells as well as with a variety of carcinoma and sarcoma cell lines. Immunohistological analysis by the immunoperoxidase technique revealed strong reactivity of monoclonal antibody 126 with frozen and formaldehyde-fixed neuroblastoma and melanoma tissues. Tissues from patients with glioma or with small cell cancer of the lung showed faint staining, whereas those from individuals with sarcoma, lymphoma, and a variety of other neoplasms proved to be negative. Sera of neuroblastoma patients showed significantly elevated GD2 levels compared to normal children (p less than 0.001) and children with other tumors (p less than 0.001) as determined by a quantitative competitive enzyme-linked immunosorbent assay. Furthermore, the GD2 serum level of one neuroblastoma patient, when followed serially, was found to correlate with progression of disease, suggesting the potential usefulness of this assay for the diagnosis and monitoring of neuroblastoma.

Portal film quality: a multiple institutional study

The variation in quality of the several thousand portal films submitted to the Quality Assurance Review Center (QARC) has been substantial. To ascertain the nature and severity of this problem, a detailed study of "whole brain" portal films which were taken at 23 different radiotherapy departments for patients entered on three national leukemia studies was performed. Each film was analyzed in two ways: (a) independent subjective evaluation by four experienced radiotherapists and (b) measurement of objective parameters. Scores from 416 evaluations together with measured parameters were stored in a data base system for easy statistical manipulation. The dependence of perceived film quality on these objective parameters has been correlated and is the subject of this report.

Hodgkin's disease presenting in epitrochlear nodes

Two cases of Hodgkin's Disease (HD) presenting in epitrochlear nodes are described, and compared to four similar cases gleaned from the literature. The nodular sclerosis type of HD was present in 5 of the 6 patients. Of the four patients staged with laparotomy, two had infradiaphragmatic disease. A treatment approach using radiation alone for patients with disease limited to the epitroclear region is presented, and anatomical considerations of the treatment technique are given.

Specific toxicity of 2-chlorodeoxyadenosine toward resting and proliferating human lymphocytes

2-Chlorodeoxyadenosine (CdA), an adenosine-deaminase-resistant purine deoxynucleoside, is markedly toxic toward human T-lymphoblastoid cell lines in vitro and is an effective agent against L1210 leukemia in vivo. The present studies have examined the toxicity, and in some cases, metabolism, of CdA in (1) multiple established human cell lines of varying phenotype, (2) leukemia and lymphoma cells taken directly from patients, (3) normal bone marrow cells, and (4) normal peripheral blood lymphocytes. Nanomolar concentrations of CdA blocked the proliferation of lymphoblastoid cell lines with a high ratio of deoxycytidine kinase to deoxynucleotidase. The drug had virtually no effect on the growth of cell lines derived from solid tissues. The CdA inhibited the spontaneous uptake of tritiated thymidine by many T and non-T, non-B acute lymphoblastic leukemia cell specimens at concentrations less than or equal to 5 nM. The same concentrations did not impair either thymidine uptake or granulocyte-monocyte colony formation by normal bone marrow cells. In common with deoxyadenosine, but unlike several other agents affecting purine and purine metabolism, CdA was lethal to resting normal T lymphocytes and to slowly dividing malignant T cells. In both resting and proliferating lymphocytes, the CdA was phosphorylated by deoxycytidine kinase and entered a rapidly turning over nucleotide pool. Dividing lymphocytes also incorporated abundant CdA into DNA. The selective toxicity of CdA toward both dividing and resting lymphocytes may render the drug useful as an immunosuppressive or antileukemic agent.

In-vitro measurement of static pressure distribution in synovial joints--Part II: Retropatellar surface

This second part of a two-part paper is concerned with the measurement of static pressure distribution on the retropatellar surface. The study has been performed in a loading apparatus designed to simulate individually the lines of action and the magnitudes of the tensions in the components of the quadriceps femoris muscle group. Results have been obtained using 24 specimens in the knee flexion range 0 to 130 deg and employing a net quadriceps tension of 734 N. Particular emphasis has been placed on the evaluation of the sensitivity of the results to variations in the characteristics of the simulated quadriceps tension. The pressure distribution results have been interpreted in terms of variation of the normal force and the average contact stress on the retropatellar surface as a function of flexion angle. It has been shown that the "pulley" model of the patella consistently overestimates the actual patellofemoral joint reaction force throughout the range of flexion. Clinical implications of the results, in terms of etiology of degeneration of patellar cartilage, have been discussed.

Age-related changes in hepatic triacylglycerol content and phosphatidate phosphohydrolase activities in fasting male and female rats

Hepatic microsomal phosphatidate phosphohydrolase (PPH) showed minor fluctuations with age in male and female rats. In males, hepatic cytosolic PPH rose to a peak at day 58 and then declined. In female rats, the activities of this enzyme were much lower than those of the male to day 35, but then increased fivefold by day 50 to values approximating those of males, and thereafter gradually declined. The hepatic triacylglycerol (TG) content of male rats was fairly constant, but in females the values rose to a peak on day 50 and then declined in parallel with the cytosolic PPH activity, but remained substantially higher than values for male rats. A significant correlation between cytosolic PPH and hepatic TG was obtained. The microsomal PPH did not correlate with hepatic TG. These results suggest that in the rat cytosolic PPH may play a role in modulating age-related changes in hepatic TG metabolism, and that it is functionally more important than the microsomal enzyme in this species.

Modulation by phenobarbital of lipolytic activity in postheparin plasma and tissues of the rat

Male rats injected with phenobarbital at a dose of 100 mg/kg for 5 days manifested increased postheparin lipolytic activity of fasting plasma. Inhibition studies with protamine sulphate, 1 M NaCl, and sodium dodecyl sulphate revealed that the activities of both lipoprotein lipase and hepatic triacylglycerol lipase were increased in the postheparin plasma of the drug-treated rats. Adipose tissue lipoprotein lipase activity was also increased in the phenobarbital-treated rats. The triacylglycerol lipase activity elutable by heparin from liver slices and the residual activity of liver microsomes increased significantly in the drug-treated rats. Lipoprotein lipase of cardiac muscle and red skeletal muscle was unaltered by phenobarbital treatment. The increased postheparin lipolytic activity of fasting phenobarbital-treated rats seems to be accountable through increased lipoprotein lipase activity of adipose tissue and increased triacylglycerol lipase activity of liver, both of which may contribute to the lowered fasting concentrations of serum triacylglycerol mediated by the drug, as previously reported.