Laparoscopic transillumination for the location of anterior abdominal wall blood vessels

OBJECTIVE

To determine the efficacy of transillumination for locating abdominal wall vessels prior to trocar placement during laparoscopy.

DESIGN

Prospective clinical descriptive study.

SETTING

Normal human volunteers in an academic research environment.

PATIENTS

Forty-seven white and 21 black women of various weights undergoing laparoscopy for clinical indications unrelated to this study.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The location and number of abdominal wall vessels visible by transillumination were recorded for each patient.

RESULTS

In women of normal weight, a single vessel could be seen approximately 5 cm from the midline in > 90% of the patients, and second vessel approximately 8 cm from the midline could also be seen in 51%. The more medial vessels did not correlate with the course of the inferior epigastric vessels seen laparoscopically. The ability to see vessels was decreased significantly by the patients' weight but not by skin color.

CONCLUSIONS

Superficial abdominal wall vessels may be located by transillumination in the majority of women of normal weight regardless of skin color, but is of less value in overweight and obese women. However, the deep (inferior) epigastric vessels cannot be effectively located by transillumination, and thus other techniques should be used to minimize the risk of injury to these vessels.

Cocaine downregulates beta-adrenergic receptors in pregnant sheep myometrium

Cocaine abuse is associated with premature labor. Although cocaine is known to competitively inhibit beta-adrenergic receptor binding, cocaine's effect on receptor downregulation is uncertain. This study was designed to determine the in vitro effect of cocaine on downregulation of beta-adrenergic receptors in pregnant myometrium. Pregnant sheep myometrium was incubated with either cocaine, isoproterenol, or a cocaine metabolite, benzoylecgonine. Membrane fractions were assayed for beta-adrenergic receptors using (125I)-cyanopindolol and the beta 2-adrenergic antagonist ICI 118,551. We found that cocaine (10(-6) to 10(-4) mol/L), but not benzoylecgonine, downregulated both beta 1- and beta 2-adrenergic receptors, but did not further augment receptor downregulation by isoproterenol. The 46% decrease in beta-adrenergic receptors seen after exposure to cocaine was similar to the 53% decrease seen after isoproterenol. We hypothesize downregulation of beta-adrenergic receptors by cocaine may play a role in the association of cocaine abuse with premature labor.

[Hereditary gingival fibromatosis: a case report]

Hereditary gingival fibromatosis is an uncommon congenital anomaly of undetermined etiology, the condition is manifested as a dense, diffuse, smooth or nodular overgrowth of the gingival tissue, usually begins with the eruption of the permanent incisors. However, it may happen as early as the eruption of the deciduous teeth. The case, a 30 years old woman with normal stature, visited our dental clinic because of "overgrown gum" which greatly affected mastication and appearance. A review of her past medical history revealed no relevant diseases. Oral examination showed gross fibrous enlargement of gingival without inflammation or swelling. Her father, two sisters and one daughter also suffered from this disease. Microscopically, there is a obvious increase in the amount of connective tissue that is relatively avascular and consists of densely arranged collagen bundles and numerous fibroblasts. The surface epithelium is thickened and acanthotic with elongated rete pegs. Gingivectomy with flap operation were performed to correct the gingival overgrowth. After periodontal treatment, two fixed partial dentures were constructed to replace the missing right upper and lower first molars. One year after operation, no obvious recurrence was noted clinically.

[Postoperative evaluation in mandibular prognathism treated by bilateral sagittal split osteotomy]

The present study was undertaken to evaluate the postoperative relapse from the period of unwiring to 1 year postoperatively and its correlation to the amount of mandibular setback and change in vertical dimension after mandibular bilateral sagittal split osteotomy. Twenty-seven patients were evaluated cephalometrically by the time preoperatively, 6 weeks, 6 months and 1 year postoperatively. It was found that 1) the average amount of mandibular setback at pogonion point, 6 weeks postoperatively, is 7.6mm backward and 1.9mm downward, 2) the average amount of horizontal relapse at pogonion point, 6 months and 1 year postoperatively, are 1.9mm and 2.3mm respectively. 86% of the horizontal relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 3) the average amount of vertical relapse at pogonion point, 6 months and 1 year postoperatively, are 0.9mm and 1.1mm upward. 82% of the vertical relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 4) the amount of 1 year postoperatively horizontal relapse is significantly correlated both with the amount of horizontal mandibular set back and vertical downward change (r = 0.58, 0.67, p < 0.001), whereas the amount of vertical relapse is with the vertical downward change only, but horizontal setback isn't.

Reliability of environmental and occupational exposure data provided by surrogate respondents in a case-control study of Parkinson's disease

This study used data provided by 40 non-demented Parkinson's disease patients and 101 community controls, and by their 110 spouses and 31 adult children to assess the reliability of surrogate-provided rural environmental and occupational exposure information on the index subjects. The level of overall raw agreement between the index subjects and the spouse or adult child surrogates varied from 50.0 to 100.0% for the case-surrogate group and from 80.6 to 96.0% for the control-surrogate group. We did not detect significant differences in overall raw agreement between the case-surrogate and control-surrogate groups or between the spouse-surrogate and adult child-surrogate groups, for any of the variables studied. Considering all index subjects and their surrogates, the level of overall raw agreement was 80.3% for well water consumption, 82.3% for farm living, 85.8% for agricultural work, 87.1% for use of pesticides, 87.9% for field crop farming and 91.9% for use of fertilizers. However, the kappa estimates were lower, varying from 0.48 (SE = 0.20) for fertilizer use to 0.66 (SE = 0.11) for crop farming. The level of specific agreement was 52.2% for fertilizer use, 64.0% for pesticide use, 71.4% for agricultural work, 73.9% for crop farming, 80.9% for farm living, and 83.6% for well water consumption. The overall findings of this study support the use, if necessary, of spouses and adult children of index subjects as surrogate respondents in case-control studies of rural environment and occupational exposures and Parkinson's disease and, possibly, other neurologic diseases. Specific agreement seems to be a better index of reliability than overall agreement in studies where exposure is rare.

Childhood and adolescent passive smoking and the risk of female lung cancer

BACKGROUND

Few studies have reported the relationship between passive smoking (PS) in early life and the risk of lung cancer. This study was done to evaluate the risk of female lung cancer from PS, especially that during childhood and adolescence.

METHODS

Using household exposure to tobacco smoke as an estimate of PS, a 1:1 paired case-control study was conducted in Harbin, China. We interviewed 114 female primary lung cancer cases, aged 30-69 years, and their hospital-based controls. The controls were non-cancer patients, selected from the same hospital as the cases, and matched on age (+/- 5 years), residential area and smoking status over their lifetime. There were 59 pairs who ever smoked and 55 pairs who never smoked. Information on PS was collected by residence for each of the following periods: 0-6, 7-14, 15-22, 23-30 and 31-69 years.

RESULTS

Household PS significantly increases the risk of female lung cancer for those exposed at ages 22 or younger, who have ever smoked. The risk was also increased for those non-smoking pairs when exposed under the age of 15 years. Exposure to maternal smoking at ages 14 or younger increased the risk by about 170% (odds ratio, OR 2.7, 95% confidence interval [CI]: 1.49-4.88), but not to paternal smoking (OR 1.40, 95%CI: 0.92-2.50). The risk was highest for those exposed under the age of seven (OR 3.46, 95%CI: 1.80-6.65) and was also significant at ages 7-14 (OR 3.08, 95% CI: 1.62-5.57) and 15-22 (OR 3.10, 95%CI: 1.52-6.31) years. Under the age of 23 years, the OR increased with amount of PS (P < 0.001). Of note, the OR in all five exposure periods for non-smoking pairs were similar to those for all 114 pairs studied.

CONCLUSIONS

Household PS, particularly that during childhood, increases the risk of female lung cancer. The assessment of PS should be done by different periods of exposure.

[Complete revascularization of coronary artery]

25 cases of complete revascularization for coronary artery disease by sequential aorto-coronary saphenous bypass operation were performed from April, 1990 to July, 1993. All the patients suffered from three vessels diseases. Left ventricular ejection fraction ranged from 22-60%. Left ventricular end diastolic pressure ranged from 1.3-4.0 kPa. They received grafts from 2-5, 3.6 grafts for a patient in an average. There were no perioperative myocardial infarction and operative death. And they recovered smoothly postoperatively. Angina has been remarkably improved. The paper briefly discussed the technique of this type of the operation and the advantages of the sequential graft bypass operation.

[Preparation and identification of monoclonal antibodies against Echinococcus granulosus hydatid cyst fluid antigen]

McAbs were prepared by fusing SP2/0 cells with spleen cells of BALB/c mice immunized with hydatid cyst fluid (HCF) antigen. Antibodies in hybrid culture supernatant were detected by ELISA, and positive hybrids were cloned by technique of limiting dilutions. Numbers of chromosomes of five hybridoma cell lines (1D1, 1D8, 2D6, 4B10, 4F4) were demonstrated in the range of 99-108. The immunoglobulin class/subclass of McAb 4F4 was IgM and the others belonged to IgG1. IHA, ELISA and I-ELISA were used for identifying titer and specificity of five McAbs. The titers of two McAbs (1D1, 1D8) reached 1:10(6)-10(7) in IHA and ELISA. Two of these McAbs (1D1, 4F4) with other parasitic antigens revealed cross-reactions. This indicated that the McAbs 1D1 and 4F4 were against common antigen determiners of different parasitic antigens and the McAbs 1D8, 2D6, 4B10 against specific antigen determiners of HCF.

[Analysis of risk factors for female lung adenocarcinoma in haerbin: indoor air pollution]

An investigation including a matched case-control study and measurement of indoor air pollution, of risk factors for female lung adenocarcinoma in Haerbin showed that high coal consumption index (HCCI OR = 10.59), indoor smog pollution in winter (OR = 15.19) and low ceiling height of the living room (OR = 12.49) were main risk factors for the cancer. It was further confirmed by the measurement that the mean daily measured concentrations of TSP and Bap in inhabitants' bedroom in winter were 4.4 and 26.7 times respectively as high as those of outdoor air concentrations. No significant association with cigarette smoking and indoor passive smoking was found.

Radionuclide detection of duodenal ulcer perforation

An elderly obese male with a lengthy history of melanotic stools was admitted and was shown to have a posterior duodenal ulcer by endoscopy. He became obtunded and developed infected ascites. Because of his obesity, ascites, and inability to cooperate, the GI radiologist felt that a Gastrografin upper GI series would not be helpful. We therefore gave the patient 99mTc-labeled sulfur colloid and tap water through his nasogastric tube. We were able to clearly image a site of perforation at the duodenal bulb communicating with the lesser sac.

Differentiation of angiotensin-converting enzyme (ACE) inhibitors by their selective inhibition of ACE in physiologically important target organs

Seven ACE inhibitors were studied for possible differences in distribution to aorta, brain, heart, lung, and kidney after administration of single oral doses to spontaneously hypertensive rats (SHR). Doses, normalized for differences in inhibitory potency and molecular weight, were expected to deliver equivalent levels of ACE-inhibitory activity to the circulation, and this was confirmed by preliminary dose-response studies. The relative potencies of the active moieties of the seven drugs and the normalized oral doses used were: SQ 29,852 (1.0), 100 mg/kg; captopril (3.5), 30 mg/kg; enalapril (12), 20 mg/kg; fosinopril (13), 25 mg/kg; zofenopril (20), 10 mg/kg; lisinopril (24), 10 mg/kg; and ramipril (51), 5 mg/kg. In these ex vivo studies, ACE activities were determined fluorometrically in SHR sera and in uncentrifuged homogenates of the solid tissues at various times after oral dosing with the ACE inhibitors. As expected, the normalized oral doses of the seven inhibitors had equivalent effects on serum ACE. In lung, where ACE has a vascular endothelial localization, and in aorta, where ACE inhibition correlates with antihypertensive action, ramipril, lisinopril, and zofenopril were distinguished by the magnitude and duration (three to four days) of their effects. In the brain, where ACE may affect central regulation of blood pressure and participate in the degradation of certain neuropeptides, ramipril and enalapril had no effect; captopril and zofenopril had modest, short-lasting effects, and fosinopril, lisinopril, and SQ 29,852 had delayed but long-lasting inhibitory actions. In the kidney, where ACE inhibition may have positive or negative effects on renal function, ramipril and fosinopril could be distinguished by their weak actions, perhaps associated with biliary routes of excretion. In the heart, where ACE inhibitors may prevent ischemic damage to the myocardium, single oral doses of captopril, fosinopril, and particularly zofenopril produced striking and long-lasting inhibition, whereas equivalent doses of ramipril and enalapril produced barely detectable inhibition.

Comparisons in vitro, ex vivo, and in vivo of the actions of seven structurally diverse inhibitors of angiotensin converting enzyme (ACE)

1. Seven drugs (captopril, zofenopril, enalapril, ramipril, lisinopril, fosinopril, and SQ 29,852) were compared in vitro in homogenates of aorta, brain, heart, lung, and kidney and in sera of spontaneously hypertensive rats (SHR) both with respect to potencies of their active moieties as inhibitors of angiotensin-converting enzyme (ACE), and, where applicable, rates of hydrolysis of their prodrug ester functions. 2. In ex vivo dose-response and time-course studies, the inhibitory effects of the seven drugs on tissue ACEs and their relative distributions to SHR tissues were compared following oral administration. 3. The relative potencies of the inhibitory moieties of the drugs (in parentheses) and the normalized 'equiactive' oral doses employed for time-course studies were: SQ 29,852 (1.0), 100 mg kg-1; captopril (3.5), 30 mg kg-1; enalapril (12), 20 mg kg-1; fosinopril (13), 25 mg kg-1; zofenopril (20), 10 mg kg-1; lisinopril (24), 10 mg kg-1; and ramipril (51), 5 mg kg-1. 4. Following oral administration of the drugs to SHR, the degree and duration of ACE inhibition in aorta and lung correlated with the antihypertensive actions, with ramipril, lisinopril, and zofenopril producing effects of the greatest magnitude and duration. 5. Ramipril and enalapril did not inhibit brain ACE ex vivo; captopril and zofenopril had modest but short-lasting effects; and fosinopril, lisinopril, and SQ 29,852 had long-lasting inhibitory actions, which, with the latter two, were delayed in onset. 6. All of the drugs produced significant inhibition of kidney ACE, with ramipril and fosinopril having somewhat weaker effects, perhaps due to biliary routes of excretion. 7. Captopril, fosinopril, and particularly zofenopril inhibited cardiac ACE ex vivo with degrees and durations that were marked compared with those of the other drugs; preliminary studies with isolated hearts suggest a possible relationship between inhibition of cardiac ACE and preservation of cardiac function subsequent to ischaemia.

Isoenzymes of phenol oxidase in adult female Schistosoma japonicum

Isoelectric focusing was used to study the phenol oxidase isozymes in adult female worms of Schistosoma japonicum. More than one form of phenol oxidase has been demonstrated in extracts of female worms when incubated with 3,4-dihydroxyphenylalanine (DOPA), catechol or cresol as substrates. DOPA is the best substrate among all of them. The 5-6 bands of phenol oxidase exhibit pI values in the range of 6.0-7.5, the major band is at pI 6.0.

Rat brain enkephalinase: characterization of the active site using mercaptopropanoyl amino acid inhibitors, and comparison with angiotensin-converting enzyme

Over fifty mercaptopropanoyl amino acids and related derivatives were synthesized to define the steric, electronic and stereochemical requirements for binding to the active site of enkephalinase (ENKASE), and also for their ability to inhibit angiotensin-converting enzyme (ACE). In this way the character of ENKASE and ACE active sites were compared.

Purification and characterization of enkephalinase, angiotensin converting enzyme, and a third peptidyldipeptidase from rat brain

Three distinct peptidyldipeptidases (exopeptidases releasing carboxyl terminal dipeptide residues) can be solubilized from nerve terminal membrane fractions from whole rat brain or striatum, and separated by ion exchange chromatography. Brain angiotensin-converting enzyme (PDP-1) cleaves Hip-His-Leu, but not 80 nM [3H-Tyr1, Leu5]-enkephalin, and is markedly inhibited by several specific inhibitors such as captopril, teprotide, and MK-422. Enkephalinase (PDP-2) cleaves 80 nM [3H-Tyr1, Leu5]-enkephalin, but not Hip-His-Leu; it is not inhibited by any of the standard competitive inhibitors of angiotensin-converting enzyme (all analogs of carboxyl-terminal peptide sequences Phe-Ala-Pro or Ala-Pro), but is strongly inhibited by captopril analogs such as thiorphan (Phe-Gly analog). A third peptidyldipeptidase (PDP-3) cleaves Hip-His-Leu, but not 80 nM [3H-Tyr1, Leu5]-enkephalin; it is inhibited by dipeptide analog inhibitors such as captopril and thiorphan, but not by longer peptides such as teprotide or tripeptide analog inhibitors such as MK-422. Both PDP-2 (enkephalinase) and PDP-3 are apparently present in nerve terminal membranes predominantly as inactive proenzyme precursors, which elute from DEAE-cellulose at high salt concentration, and are activated very slowly by a process involving one or more trypsin-like enzymes. Rechromatography of activated PDP-2 and PDP-3 achieves a nearly complete separation of the two enzymes, both markedly purified, since each is much less acidic than its proenzyme precursor. Purified enkephalinase does not appear to have any significant endopeptidase activity. It cleaves Hip-Phe-Arg 200 times more effectively than Hip-Phe-Arg-NH2, and appears to be quite selective for cleaving the terminal dipeptide residue, Phe-Arg, from bradykinin, with no release of the second dipeptide and no cleavage of the Gly4-Phe5 interior peptide bond.

A simplified method for purification of the creatine kinase isoenzyme of human brain (BB)

A greatly simplified procedure has been developed for purification in high yields of creatine kinase isoenzyme BB from human brain. The procedure consists of fractional precipitation with ethanol, adsorption chromatography on hydroxylapatite, and fractional precipitation with ammonium sulfate. The essentially homogeneous enzyme obtained may be used as the antigen for radioimmunoassay of blood isoenzyme MB of creatine kinase, which specifically increases following myocardial infarction.