The use of antikeratin antiserum as a diagnostic tool: thymoma versus lymphoma

Indirect immunofluorescence staining in two thymomas, one case of thymic hyperplasia, 10 malignant lymphomas and three seminomas was done with an antibody prepared against keratins from human epidermis. Staining was observed only in the epithelial cells of the thymomas and thymic hyperplasia and correlated well with electron microscopic studies. Immunofluorescence staining of thymic tumors with antikeratin antibody provides a simple, specific, and sensitive method for distinguishing thymoma from lymphoma and seminoma. The method may also prove to be useful in other instances in the distinction between epithelial and nonepithelial tumors.

Acute effects of the pattern of fat ingestion on plasma high density lipoprotein components in man

Since Apoprotein A-I (apo A-I) is partially synthesized in the intestine and is secreted into plasma via chylomicrons, we have tested the effects of the daily distribution of fat intake on the concentration and composition of plasma high density lipoprotein (HDL). Ten normal subjects ingested 136 g fat either as a single load (SL) at 0 h or in 6 divided doses from 0 to 10 h (DL). Serial blood samples were obtained over a 24-h period. Studies were performed 7 days apart using a double crossover design and paired comparisons. HDL apo A-I increased during DL (+11% at 9 h, P < 0.01) but was not significantly altered after SL. The HDL Apo A-II concentration did not change. HDL cholesterol decreased significantly (-4 to -7%) during postprandial lipaemia in both phases of the study. Apo A-I and A-II were detected in lipoproteins of d < 1.006 during alimentary lipaemia but not in fasting plasma. These results indicate that HDL apo A-I increases when fat intake is distributed throughout the day (DL), perhaps due to intestinal production of particles with a higher protein/lipid ratio during DL than after a large bolus of oral lipid (SL). Alimentary lipaemia is associated with acute alterations in HDL components including a transient reduction in HDL cholesterol and an increase in the apo A-I/A-II ratio during DL.

Cerebellar retraction: significance and sequelae

Does cerebellar retraction during operations in the posterior fossa contribute to increased morbidity and mortality, and if so, what are the critical factors involved? In order to answer these questions, graded retractor pressures of 10, 20, and 30 mm Hg were applied for one hour to the cerebellar hemispheres of dogs in the sitting position. It was noted that the amount of mechanical pressure and the difference between systemic perfusion pressure and retractor pressure were important determinants of the outcome. The mechanism of damage from retractor pressure is discussed.

Ganglioneuroblastoma and fetal hydantoin-alcohol syndromes

A ganglioneuroblastoma developed in a 35-month-old boy with both the fetal hydantoin and fetal alcohol syndromes. Our case, plus two recent reports in the literature, would very likely establish the relationship between fetal hydantoin syndrome and the development of neural crest tumors. Infants exposed in utero to hydantoins should be closely observed for the development of these tumors.

"Stress" polycythaemia and peripheral facial palsy complications of severe hypertension

An 11-month-old boy had an episode of generalized convulsions followed by a right peripheral facial palsy, which resolved gradually within 3 weeks. Three months later he had another similar episode of convulsions followed by a left peripheral facial palsy. On both occasions it was found that he had polycythaemia. A careful physical examination discovered that the child had severe hypertension. Extensive laboratory investigations did not reveal a cause for his hypertension. Haematologic investigations showed that the polycythaemia was due to a contracted plasma volume as a result of the hypertension. The peripheral facial palsy most probably was due to a blood clot in the facial canal, below the origin of the nerve to m. stapedius, as audiograms were normal and lacrimation preserved. Control of the hypertension resulted in resolution of the facial palsy within 4 weeks and normal haematocrit readings within 6 weeks. It should be stressed that every patient with peripheral facial palsy should be examined for hypertension.

Warfarin Versus Warfarin and Dipyridamole on the Incidence of Arterial Throms Embolism in Prosthetic Heart Valve Patients

The effect of Warfarin (W) was compared with a combination of Warfarin and Dipyridamole (W+D) on the incidence of arterial thrombo-embolism in patients with prosthetic heart valves in a prospective randomised study. Sixty-four and 53 patients were allocated to W and W+D. The two groups were comparable as regards age, sex, arrhythmias and site and type of valves. The dose of W was determined by regular monitoring of prothrombin ratio 0.9 - 3) and that of D by monitoring serum D levels to between 2 and 4 μmol/l. The mean period of follow-up was 26.98 months (range 1 to 36) for W and 22.02 months (range 1 to 36) for W+D. Six patients in W and 1 in W+D developed arterial thrombo-embolic episodes giving an incidence of 0.0035 per patient month for W and 0.0009 per patient month for W+D. An actuarial analysis of the yearly incidence of thrombo-embolism confirmed the superiority of W+D over W. Of the 6 failures in W, 5 were in sinus rhythm and 1 in atrial fibrillation and all had cerebral embolic episodes. The failure in W+D was a patient in atrial fibrillation who died suddenly 6 weeks after surgery and the post-mortem showed clots on both mitral and aortic prostheses.

Effect of cross-clamp time, temperature, and cardioplegic agents on myocardial function after induced arrest

To evaluate the importance of time, temperature, and cardioplegia on the ability of the canine myocardium to maintain functional and ultrastructural integrity following induced arrest, we studied 220 dogs by varying myocardial temperature (34 degrees, 24 degrees, and 11 degrees C.), arrest time (0 to 120 minutes), and cardioplegic agents. Change in left ventricular function (LVF) was defined as the arithmetic difference in the center of mass between prearrest and postarrest LVF curves and was expressed as percent recovery of left ventricular stroke work. Left ventricular biopsies were obtained for semiquantitative electron microscopic analysis. After 90 minutes of cross-clamping, only hearts protected with combined hypothermia (H) and potassium-induced cardioplegia (K) significantly recovered prearrest function (24 degrees C.--80 percent, 11 degrees C.--99 percent). Hypothermia (H) alone for 90 minutes was less protective (24 degrees C.--49 percent, 11 degrees C.--59 percent). H preserved 84 percent of function after 60 minutes and 91 percent after 45 minutes. Normothermic arrest resulted in only 39 percent return of function at 45 minutes but could be extended with potassium-induced cardioplegia(K) to 78 percent at 60 minutes and 54 percent at 90 minutes. The addition of procaine plus HK improved protection over HK alone (95 percent versus 80 percent) but by itself was not effective. Neither hydrocortisone nor pretreatment with glucose-insulin-potassium, branched chain amino acids, or propranolol increased the protective effect of HK plus procaine. Inadequately protected groups (normothermia or H without K) showed more myocytic and capillary endothelial damage than the HK groups. No technique of myocardial protection studied completely preserved LVF, but the combination of HK plus procaine resulted in maximal recovery of LVF following cross-clamping for up to 120 minutes.

Genito-femoral neuralgia

A 46-year-old male with bilateral genito-femoral neuralgia is presented. The patient complained of groin and testicular pain, the onset following asynchronous bilateral inguinal herniorrhaphy. Relief was effected by genito-femoral nerve resections. The operative approach is discussed. The differentiation between this syndrome and ilio-inguinal nerve entrapment is tabulated.

Reversible cerebellocerebral disorder in primary hemochromatosis

Reversible cerebellar dysfunction is described in a patient with primary hemochromatosis. The electroencephalographic abnormalities initially recorded became normal after repeated phlebotomies. Both cerebellar dysfunction and electroencephalographic changes were present without clinical signs of hepatic failure, but may be related to the altered hepatic function tests.

The cortisol response during heart-lung bypass

The response patterns of plasma cortisol and plasma free cortisol have been studied in 20 consecutive patients undergoing cardiac surgery involving the use of heart-lung bypass. Sixteen consecutive patients undergoing closed mitral valvotomy have been used as controls. Total plasma cortisol levels fell at the onset of extracorporeal circulation (ECC) and did not rise significantly throughout the period of ECC. The peak cortisol level in the bypass patients occurred at 24 hours postoperatively with elevated levels still present at 48 hours. This pattern was significantly different from the control patients (P less than 0.001) who exhibited the typical cortisol stress response pattern. Synthetic ACTH stimulation of the adrenal cortex during heart-lung bypass produced a positive response (i.e., a rise in plasma cortisol greater than 7.5 mug/100 ml) in all six patients studied while the six mitral valvotomy patients had no response to synthetic ACTH administration during operation (P less than 0.01). Plasma free cortisol estimations indicate that a rapid and significant rise in % free cortisol occurred at the onset of ECC, but that despite the rise in percentage free, the overall plasma free cortisol concentration (i.e., total plasma cortisol X % free) was significantly lower during ECC in the bypass patients when compared with control (P less than 0.01). Twenty-four hours postoperatively these concentrations were significantly higher in the bypass patients (P less than 0.001).

Hepatocellular carcinomas in acatalasemic mice treated with nafenopin, a hypolipidemic peroxisome proliferator

The effects of long-term administration of nafenopin, a potent hypolipidemic drug with marked hepatomegalic and peroxisome-proliferative properties, were studied in wild-type (Csa strain) and acatalasemic (Csb strain) mice. Nafenopin was administered in the diet at a concentration of 0.1% during the first 12 months and then at 0.05% until the termination of the experiment at 20 months. By 56 weeks, 100% mortality occurred in both male and female wild-type mice, whereas the mortality rate in acatalasemic mice was approximately 50%. Between 18 and 20 months of the experiment, 9 of 9 male and 12 of 12 female acatalasemic mice that survived chronic nafenopin treatment developed hepatocellular carcinomas, some of which metastasized to the lungs. None of the 15 male and 15 female acatalasemic controls developed liver cancers. Numerous peroxisomes were seen in the lung metastases of these hepatocellular carcinomas on electron microscopic examination; in contrast the number of peroxisomes in primary liver tumor cells varied considerably. The hepatocarcinogenicity of nafenopin strongly suggests the need for long-term studies with other hypolipidemic drugs that cause hepatomegaly and peroxisome proliferation to clarify the role, if any, of peroxisome proliferation in liver carcinogenesis.

Postanesthetic necrotic defect

An unusual defect was noted in a 10-year-old girl near the usual site of administration for an inferior nerve block. It was interpreted to be the result of a local anesthetic having been administered 2 months previously.

Malignant mediastinal chemodectoma

A 20-year-old man with a posterior mediastinal mass and erosion of the rib proved to have a malignant chemodectoma. The case is of interest because of the rare location and malignant fatal course.

Effect of tweens on the production of ergot alkaloids by Aspergillus fumigatus

Tween 80, which caused increased biomass formation, also produced the highest increase in the uptake rate of all components of the medium. The fatty acid components of the respective Tweens, i.e. palmitic acid (Tween 40), stearic acid (Tween 60), and oleic acid (Tween 80), have no effect either on alkaloid production or on substrate uptake. The fatty acid composition was different in the cell membrane of the culture supplemented with Tween 60 and facilitated the transport of metabolites into the cells.

Silent anomalies of the urinary tract and congenital heart disease

Postangiocardiographic screening of infants and children with congenital heart disease for silent anomalies of the urinary tract yielded an incidence of 7.7 percent in 260 so studied. The incidence was 29 percent in 21 babies who came to autopsy and had been studied at catheterization but without this screening. Patients with atrial septal defect had the highest incidence of urinary tract anomalies, while those with ventricular septal defect and tetralogy had an average incidence. Some of the lesions discovered were potentially significant even though silent. They were found with sufficient frequency to warrant routine use of this screening technique at cardiac catheterization.

Ocular changes in epidermolysis bullosa letalis

Ocular changes in a rare case of epidermolysis bullosa letalis included edema of the trabecular meshwork, ciliary body, lens, optic nerve, and formation of edema cysts in the iris. The retinal was completely detached and focally necrotic. Foci of necrosis and detachment of the retinal pigment epithelium were also observed with occasional breach in the Bruch's membrane. The choroid showed focal edema and congestion.

Comparison of the hemodynamic effects of exercise and isoproterenol infusion in patients with pulmonary valvar stenosis

In children with congenital cardiac anomalies, isoproterenol has been used to simulate exercise. To determine if these states are comparable, 28 children with pulmonary valvar stenosis were studied by cardiac catheterization at rest, during supine submaximal exercise, and during isoproterenol infusion. Similar heart rates were obtained during exercise (142/min) and isoproterenol infusion (139/min). Cardiac index, right ventricular systolic pressure and oxygen consumption were measured during each physiologic state. The change in pulmonary valve area from rest was calculated. At similar heart rates, cardiac index was significantly greater with exercise than with isoproterenol and right ventricular systolic pressure was similar in the two states. Thus, the calculated pulmonary valve area was significantly smaller with the pharmacologically induced stress. The study indicates that several of the hemodynamic effects of isoproterenol are not comparable to those produced by exercise in patients with pulmonary valvar stenosis.

Human skeletal muscle glycogen branching enzyme activities with exercise and training

Sixteen healthy male subjects classified as sedentary (8) or active (8), exercised to exhaustion on a bicycle ergometer at a load requiring 70% of their maximal aerobic capacity. Biopsy samples of the vastus lateralis muscle were taken at rest and at the time of fatigue. A 12 week training program increased skeletal muscle glycogen content and branching enzyme activities twofold. The exhaustive submaximal exercise reduced the glycogen levels of the trained group to values similar to the fatigue levels of the non-trained subjects. Skeletal muscle glycogen branching enzyme activities decreased with submaximal exercise to fatigue in all groups. Maximal exercise to fatigue resulted in small increases in the activities of the enzyme. The results of the present study and a previous study (Taylor et al. 1972. Can. J. Physiol. Pharmacol. 50, 411–415) indicate that the activities of the glycogen synthesizing enzymes are highly correlated with the skeletal muscle resting glycogen concentration and the relative fitness of the subjects.

Rat blood and muscle lactate after prolonged exercise

The effects of reserpine upon skeletal muscle and blood lactate levels have been studied in exercised and control rats. The exercise program consisted of 12 weeks of running on a motor-driven treadmill at 26.8 m/min for 1 h per day, 5 days per week. Animals received reserpine doses of 2.5, 5.0, and 12.5 mg/kg (i.p.) 24 h prior to sacrifice. Skeletal muscle and blood lactate levels were measured from animals sacrificed at rest or immediately after a fatiguing run. Tissue lactate levels were elevated only in those animals receiving 2.5 mg/kg of reserpine and exhaustive exercise. Blood lactate levels were unaffected by the drug and by the run to exhaustion. The results indicate that elevated muscle lactate levels are not the sole cause of muscular fatigue.

Exercise hemodynamics of pulmonary valvular stenosis. Study of 64 children

Sixty-four children with pulmonary stenosis were studied by cardiac catheterization both at rest and on exercise. Whereas milder degrees of stenosis were associated with normal right ventricular function, more severe stenosis was associated with fixed stroke index and elevated RVEDP, and suboptimal response of cardiac index. These changes result from altered right ventricular compliance. In several the compliance abnormality was related to myocardial hypertrophy, whereas in four patients it was most likely caused by myocardial fibrosis.

Human skeletal muscle phosphorylase activities with exercise and training

Fifteen healthy male subjects classified as sedentary (7) or active (8), exercised to exhaustion on a bicycle ergometer at a work load requiring 70% of their maximal aerobic capacity. Biopsy samples of the vastus lateral is muscle were taken at rest, at the time of fatigue, and after a 10 min recovery. Training increased [Formula: see text], [Formula: see text], work time to fatigue, skeletal muscle glycogen levels, and phosphorylase a activity (P < 0.01). An exhaustive submaximal exercise reduced the glycogen levels of the trained group to values similar to the fatigue levels of the nontrained subjects: the higher the initial glycogen levels, the longer the subjects were able to exercise before the onset of fatigue. Skeletal muscle phosphorylase a activities decreased with exercise to fatigue in all groups whereas phosphorylase b activities were maintained. Training had no effect on resting phosphorylase b activity.

Assessment of cyclobenzaprine in the treatment of spasticity

The efficacy of cyclobenzaprine 60 mg/day in the treatment of spasticity was assessed in a double-blind crossover trial of two weeks' duration in 15 patients suffering from cerebral or spinal spasticity. Independent clinical and electromyographic methods were used. The effects of cyclobenzaprine did not differ significantly from those of placebo. The administration of a higher dosage, 150 mg/day, to one patient revealed a dose-related response, but the degree of improvement was clinically small. Apart from a skin rash there were no significant untoward effects of therapy.

Human skeletal muscle glycogen synthetase activities with exercise and training

A 5 month training program increased skeletal muscle glycogen synthetase activities of both the 'I' and 'D' forms in human subjects. The level of activity of the enzyme appears to be directly related to the physical fitness level of the subjects tested.

Action of L- -methyldopa-hydrazine on the blood pressure of patients receiving levodopa

The blood pressure and pulse rate have been compared in a 'double blind, cross over' study involving twenty patients with idiopathic Parkinsonism receiving maximum tolerated dosage of levodopa with and without an extracerebral decarboxylase inhibitor, L-alpha-methyldopahydrazine. The supine and erect systolic pressures were significantly higher and the erect pulse rate significantly lower during administration of L-alpha-methyldopahydrazine. The implications of these observations are discussed.