Malignant mesothelioma in two pairs of siblings: is there a hereditary predisposing factor?

Two pairs of siblings with malignant pleural mesothelioma are reported. One sister and brother experienced slight household asbestos exposure during childhood. Two identical-twin brothers were occupationally exposed to asbestos for only 8 years. The occurrence of this rare neoplasm in 2 pairs of siblings indicates that a hereditary predisposing factor may exist.

Reconstruction of large anterior full-thickness defect in the chest wall after resection of chondrosarcoma

Radical removal of a chondrosarcoma resulted in a very large full-thickness defect of the anterior chest wall, including the body of the sternum and adjacent parts of the ribs on both sides. The defect was closed with a double layer of Marlex mesh supported by metal bars bridging the gaps between the ends of resected ribs. This prosthesis was covered with bilateral latissimus dorsi muscle flaps and a split-thickness skin graft. The result, from both the functional and the cosmetic points of view, was excellent. The method permits closure of very large chest wall defects, enabling extensive radical removal of malignant tumours to prevent local recurrence.

Advisability of concomitant immediate surgery for perforation and underlying disease of the esophagus

Since 1979 our policy for management of esophageal perforation has included correction of underlying esophageal disorder as part of the initial treatment in selected cases. A series of 23 patients is presented, of whom 3 were managed conservatively and 20 surgically. The overall mortality rate was 8.7%. Concomitant operation of underlying esophageal disease and perforation was done in eight cases within 12 hours of the perforation. These operations included emergency resection and esophagogastrostomy in five patients (4 with stenosis and 1 with cancer). A Heller myotomy was done in addition to suture repair in two patients with achalasia, and a Belsey Mark IV hernia repair was added to the esophageal suture closure in a patient with gastroesophageal reflux and hiatal hernia. A postoperative fistula healed spontaneously in one of the eight patients, and the early postoperative course was uncomplicated in the other seven. Simultaneous correction of underlying esophageal disease in patients with iatrogenic perforation of the esophagus seems to be safe when perforation is diagnosed at an early stage. Such a radical approach is clearly beneficial.

Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases

This multicentre trial was undertaken to confirm previous results indicating that long-term treatment with oral acetylcysteine reduces the exacerbation rate in patients with chronic bronchitis. Two hundred and eighty-five patients, smokers or ex-smokers, with chronic bronchitis started a pre-trial placebo-period of 1 month. After this run-in period 259 patients were included in the trial and randomized into two parallel groups. The patients were treated in a double-blind way either with acetylcysteine 200 mg b.i.d. or placebo b.i.d. for 6 months. The trial was completed by 98 patients in the acetylcysteine group and by 105 patients in the placebo group. Initially, there were no significant differences between the groups. Twice weekly, the patients filled in a diary card concerning symptoms. The number of exacerbations was assessed from these cards and at visits 2, 4 and 6 months after institution of therapy. The exacerbation rate was significantly lower in the acetylcysteine group in which 40% of the patients remained free from exacerbations compared to 19% in the placebo group. Sick-leave due to acute exacerbation was significantly less common in the acetylcysteine group. The drug was well tolerated.

A new design of double-barrelled microelectrodes for intracellular pH-measurement in vivo

Intracellular pH (pHi) is one important regulator of cellular function. Most determinations of pHi in vivo have been performed by using indirect methods, e.g. CO2/HCO3 or DMO techniques, since no suitable direct method for reliable in vivo measurements have been available. In the present study a new type of double-barrelled microelectrode for simultaneous in vivo measurements of pHi and membrane potential (Em) is presented. The electrode was constructed on the basis of a combined recessed- and pencil-tip design. The tip diameter of the double-barrelled microelectrode was about 1.5 microns. The response of the pH channel was 55-60 mV/pH unit and the response time was between 30 s and 1 min. In vivo measurements of pHi and Em of rabbit skeletal muscle fibers are presented. A mean pHi of 7.00 (in 8 animals) at a membrane potential of -90.3 mV (arterial pH: 7.30, arterial PCO2: 6.39 kPa) was obtained. The new design of pH microelectrode offers some advantages over previously described microelectrodes and is well suited for in vivo measurements.

Non-uniformity induced artifacts in single-photon emission computed tomography

Changes of gamma camera uniformity due to choice of flood source configuration and camera head orientation, and influence of these changes on the reconstructed image, have been analysed using phantom measurements. The transfer of defects in the projection data to the reconstructed image has also been investigated using computer simulations. The results indicate that the use of gamma cameras for emission computed tomography will impose higher demands on gamma camera uniformity than conventional scintigraphy.

Cerebrospinal fluid circulation: evaluation by single-photon and positron emission tomography

Gamma camera cisternography after intrathecal administration of 111In-DTPA is a widely used and well established technique for studies of cerebrospinal fluid (CSF) circulation. The radiation dose from 111In, however, is a limiting factor that sometimes seriously affects the image quality and, hence, correct interpretation. This investigation was designed to assess the value of tomographic techniques for studies of CSF flow. Single-photon emission computed tomography (SPECT) was performed on 15 patients by means of the Karolinska Hospital rotating gamma camera system after injection of 111In-DTPA or 99mTc-DTPA. The combination of SPECT and 99mTc-DTPA proved to be a valuable technique. It permits a clear evaluation of the location of the isotope intracranially and its precise relation to the ventricles. Positron emission tomography (PET) applied after intrathecal administration of 68Ga-EDTA demonstrates that small amounts of radioactivity can be registered and that PET is a promising technique for the evaluation of CSF dynamics.

Single photon tomographic imaging of a standard heart phantom with 201T1: a gamma camera based system

A standard heart phantom (University of Iowa design), including discrete myocardial walls, a central blood pool, and a 24-cc transmural "cold" defect, was studied with both planar and transverse tomographic imaging. The heart phantom was filled with 201T1 and placed within a cylindrical tank containing water and 201T1 to simulate nonmyocardial background activity from the thorax. The tomographic imaging system used was a commercially available, rotating, large field-of-view gamma camera. Image reconstruction from 64 sampling angles was performed in a nuclear medicine minicomputer system. The percentage activity in the region of the defect (actual activity of 0) contrasted to the normal wall was compared between planar and 1.25-cm transaxial tomographic slices. Defect activity fell to between 65% and 85% of that of the opposing normal wall in planar images, whereas it fell to between 26% and 49% of that of the normal wall in the tomographic images. In most cases, tomographic defect activity was half or less than that in the planar image. The geographic extent of the defect was seen in an appropriate number of tomographic slices; i.e., the geographic 3.2-cm defect length was predominantly seen in three 1.25-cm transverse slices. We conclude that camera-based tomographic systems show promise for improved 201T1 myocardial defect detection and quantitation over conventional planar images.

Differentiation of pyriform sinus cancer from supraglottic laryngeal cancer by computed tomography

Nine pyriform sinus tumors and 16 supraglottic laryngeal lesions were studied by computed tomography. The pyriform sinus tumors had a much higher incidence of thyroid cartilage invasion (five of nine patients) and involved the posterolateral margins of the cartilage. Only two of 16 supraglottic tumors reached the thyroid cartilage, involving the midline or more inferior margins. The supraglottic tumors grew in a circumferential pattern, and when the pre-epiglottic space was involved, extension was bilateral. Lesions of the pyriform sinus more frequently showed unilateral involvement. Lymph node metastases were seen in an approximately equal proportion of patients in the two groups, and they correlated more with the size of the primary tumor than with its site of origin. Posteroinferior invasion of the space between the thyroid and cricoid cartilage was seen only with pyriform sinus lesions.

Differentiated treatment of intrathoracic oesophageal perforations

A series of 44 consecutive patients with oesophageal perforation treated during the ten-year period 1969-1978 has been reviewed. Thirty perforations were caused by oesophagoscopy using a rigid instrument, often combined with dilation and/or biopsy, 4 were caused by a fibreoptic instrument and 10 were spontaneous ruptures. A benign stricture was the most commonly associated lesion in the oesophagus. Six patients with an iatrogenic perforation were treated conservatively without mortality. These patients were characterized by mild symptoms, early recognition, minor leakage from the oesophagus and no communication to the pleural cavity. Fourteen patients were treated with closed thoracic drainage. The overall mortality among these patients was 70%, but for those with a spontaneous rupture it was 100%. Twenty-four patients were treated surgically with a mortality of 20%. Individualized treatment is recommended.

S100-glia regulation of GABA transport across the nerve cell membrane

A technique has been devised to isolate and prepare fresh nerve cell plasma membranes in order to study the transport of biologically active substances across the membrane and in the two opposite directions. The membrane is placed tightly over a 30-micrometer diameter hole in a thin glass plate forming a partition between two compartments of a micro-chamber made from silicon rubber. The plasma membrane is usually placed with the outer surface facing the upper compartment. We have studied the transport of labeled GABA across the plasma membrane of Deiters' nerve cells and the effect of the brain-specific protein S-100 in its calcium form on this process. 100 nl samples were separated by thin layer chromatography and each sample analyzed by an instrument especially made for low level 3H- and 14C-measurements. The S-100, Ca2+ protein significantly increased the GABA transport across the nerve cell membrane by maximally 25% and against a gradient. The kinetics of the transport process, and inhibition by 2-4 diaminobutyric acid, furthermore supported the conclusion that the S-100, Ca2+-stimulated GABA transport was an active process. When a thin layer of the nerve cell's S-100-synthesizing glia was placed in contact with the plasma membrane - as in the vivo situation - the stimulation of GABA transport was abrogated. The S-100, Ca2+ protein, if absorbed on the nerve cell membrane, stimulates GABA transport across the membrane. This phenomenon seems to be regulated by the glia which cover all parts of the plasma membrane except the post-synaptic areas.

Husfeldt hernia repair: indications and results. A follow-up study

Ninety-seven consecutive patients with hiatal hernia were operated upon with a modified Husfeldt hernia repair during a ten-year period. Thirty-two of the patients had severe reflux complications, such as ulcerative oesophagitis, oesophageal stricture and shortened oesophagus. Ninety patients were carefully followed up postoperatively. The mean duration of follow-up was 5 years. Analysis of the postoperative results in relation to the type of hernia showed no difference between sliding and combined hernia. Recurrence of hernia, unsatisfactory clinical results and gastro-oesophageal reflux were recorded more often in patients with severe reflux complications. The main cause of unsatisfactory results in these patients was found to be a shortened oesophagus. The method proved to be a reliable procedure for surgical treatment of not only uncomplicated hernias, but also cases complicated by oesophageal stricture if the stricture was not associated with shortened oesophagus. It is considered that a shortened oesophagus is a contra-indication for employment of the Husfeldt method.

Outcome of Listeria monocytogenes infection in compromised and non-compromised adults; a comparative study of seventy-two cases

The mortality in listeric meningitis and septicaemia, the two main clinical manifestations of the infection, is generally considered to be high. However, co-existing disorders rather than the listeric infection itself seem to determine the outcome. In the present study of 72 listeric infections among non-pregnant adults, 28 patients without co-existing disease had a fatality rate of 10.7% as compared to 57.9% among 19 immunocompromised individuals. Finally, in a third group of listeric patients, including alcoholics and people with heart disease or diabetes mellitus, the fatality rate was 24.0%.

Correlations between clinical and postmortem findings in listeriosis

Clinical data were correlated with postmortem findings in 14 cases of fatal listeriosis in adults and 23 cases of listeriosis during pregnancy and the neonatal period. Most children born with congenital listeriosis showed the typical morphological picture of granulomatosis infantiseptica. Occasionally no pathological changes were demonstrable. In adult patients the morphological lesions were those of non-specific purulent meningoencephalitis or septicemia. Sometimes encephalitis with abscesses in the brain was found.

Epidemiology of listeriosis in Sweden 1958--1974

In 1958--1974 altogether 110 cases of listeriosis were diagnosed in Sweden by culture. 64 cases were seen in children and adults. Of these, 52 had manifestations of meningoencephalitis and 10 of septicemia. Another 46 cases were seen in pregnant women and/or their neonates. Pregnancy ended in abortions in 8 cases and in stillborns in 3. Out of 37 neonates born alive, 22 had "early disease", mostly granulomatosis infantiseptica, and 8 had "late disease" with meningoencephalitis. The reported frequency of listeriosis in humans showed no correlation with that in animals. With the exception of pregnant women the incidence and mortality showed no difference with sex. Serotypes 1 and 4b prevailed and were equally common. The serotype did not vary with the clinical diagnosis or the outcome. There was no seasonal variation. Cases of all serotypes were uniformly distributed over the country in proportion to the density of its population. Occupational contact with animals was less common. Only in a few cases was there reason to suspect infection from animals. Co-existing disorders predisposed for the disease and often determined its outcome. Neonates with early onset of disease were infected by their mothers, while neonates with late onset of disease were infected from other and often nosocomial sources.