Observation of the serum uric acid in essential hypertension

In order to observe the relationship of hyperuricemia and essential hypertension, we studied serum uric acid in 139 patients with essential hypertension visiting the Department of Internal Medicine, Pusan National University Hospital, between May 1982 and July 1983, and analyzed its values in terms of various clinical and laboratory parameters.

The mean concentration of serum uric acid and incidence of hyperuricemia in essential hypertension were 6.60 ± 1.96 mg%, 57.9% and those of the normal control group were 3.87 ± 1.30 mg%, 17.8%, respectively with significantly higher values in the hypertension group. The mean concentration of serum uric acid and the incidence of hyperuricemia were significantly correlated with the levels of diastolic blood pressure, mean arterial pressure, BUN, and serum creatinine. Significant correlation between the mean concentration of serum uric acid and the extent of target organ damage and abnormal urine findings were observed.

A cement impactor for uniform cement penetration in the upper tibia

A cement impactor achieved adequate and uniform cement penetration consistently on the upper tibial surface. The penetration obtained, from 2.5 to 5.5 mm in all areas, is within the range of penetration found desirable by previous studies. Unlike most other methods, this technique is simple and achieves good penetration in peripheral areas, which have been shown to be the earliest and most frequent sites of radiolucency at the bone-cement interface.

Synthesis and antileukemic activity of 2-(2-methylthio-2-aminovinyl)-1-methylquinolinium iodides

Reaction of 2-bis(2-methylthio)vinyl-1-methylquinolinium iodide with several heterocyclic aliphatic amines at 30-70 degrees resulted in replacement of one methylthio group to give the title compounds. Reaction with pyrrolidine gave an unidentified product lacking sulfur. Antileukemic screening against P-388 lymphocytic leukemia showed positive activity only with the 6-methyl-morpholino derivative, whereas the 6-unsubstituted morpholino derivative was inactive. This result is in contrast to previous testing results with the 2-bis(2-methylthio)vinyl compounds where both 6-substituted and 6-unsubstituted derivatives showed activity.

Cyanide encephalopathy following therapy with sodium nitroprusside: report of a case

Bilateral necrosis of the globus pallidus was observed in a 43-year-old man who had received treatment for malignant hypertension with sodium nitroprusside. Cyanide released from sodium nitroprusside may have caused the pallidal lesions in the presence of deranged liver function and episodes of hypoxia.

Ultrastructure of lipoma

Eleven benign lipogenic tumors comprising ten ordinary lipomas and one fibroblastic lipoma were studied by light and electron microscopy. The former, which contained only a few inconspicuous septa, were composed of univacuolar mature adipocytes. No young forms of adipocytic differentiation were seen reflecting the slow growth of the ordinary lipomas. Small spindle cells accompanying capillaries located in the triangular confluence of the adipocytes are thought to be potential precursors of adipocytes. By contrast, the fibroblastic lipoma contained many younger forms which closely resembled those seen during maturation of normal adipose tissue. These younger forms are located in and about prominent trabeculae which therefore are considered to constitute active growth centers.

Computer controlled hyperthermia unit for cancer therapy

A versatile hyperthermia control system, based on a microcomputer, provides automated temperature regulation (1 channel) and monitoring (3 channels) and control of microwave output (both on/off and power level), and displays temperature (degree C) and microwave output (watts) graphically in real time; all data are stored on floppy diskette.

Chiral recognition by nucleosides and nucleotides: resolution of helicenes by high-performance liquid chromatography

Chiral recognition by nucleosides and nucleotides coated on silica gel was studied by high-performance liquid chromatography. Helicenes, which are chiral polyaromatic hydrocarbons, were used as probes. Stereoselectivity was detected when the nucleobase was a purine (adenosine 3', 5'-monophosphate, an guanosine), but was not detected with the pyrimidine derivative uridine. For a given nucleobase (adenine), all changes in the ribose moiety affected the resolution factors, which ranged between 1.03 and 1.074. These results might be relevant to the enantioselectivity of carcinogenic metabolites of polyaromatic hydrocarbons.

Radiation tolerance of the cervical spinal cord

A total of 109 patients were studied after receiving radiation therapy that included a dose to the spinal cord. In addition to irradiation of the primary site, 59 patients received radiation to the lower neck. Transverse myelopathy developed in three patients; all three had been treated with fields to the lower neck. The dose to the spinal cord at the site of junctional fields was thought to be considerably higher because of the beam divergence from multiple fields employed. The authors stress that prolonged fractionation of treatment, fixation of the head during treatment, precise dosimetry, and close surveillance of the patient are important factors in avoiding radiation myelitis. The authors also stress the importance of controlling divergence of multiple beams by employing appropriate shields.

Irradiation in the treatment of Hodgkin disease: a follow-up report

From 1971 through 1976, 167 patients with Hodgkin disease received radiation therapy. In 132, staging was determined upon laparotomy; the others had clinical staging. Most patients with stage I or II disease received either mantle or para-aortic-iliac irradiation, while the others received more extensive irradiation with or without chemotherapy. Overall five-year actuarial survival rate was 87%; Stage I, 97%; Stage II, 85%; and Stage III, 82%. Fifty-nine of the 167 patients had relapse of disease, and most relapses were seen in Stage II, located in the nodal sites on the opposite side of the diaphragm. Overall five-year relapse-free survival was 58%; Stage I, 94%; Stage II, 43%; and Stage III, 59%. Survival after the first relapse was 69%. Based on their results, the authors feel that Stage I disease of supradiaphragmatic presentation can be treated effectively with mantle field irradiation alone. In treating Stage II disease, mantle field irradiation alone was not optimal, and the authors recommend subtotal nodal irradiation.

Doridosine, 1-methylisoguanosine, from Anisodoris nobilis; structure, pharmacological properties and synthesis

The new N-methylnucleoside named doridosine, isolated from the shell-less marine dorid nudibranch Anisodoris nobilis, has been identified as 1-methylisoguanosine (1) by its spectral properties and by synthesis via methylation of isoguanosine. Doridosine has been shown to be identical to the nucleoside isolated from the Australian sponge Tedania digitata by Quinn, Gregson, Cook and Bartlett. They have also proved their product to be 1-methylisoguanosine. Doridosine was shown to cause prolonged reduced arterial pressure and reduced heart rate in the rat. The action is qualitatively similar to that of adenosine but of much greater duration, possibly because doridosine is resistant to attack by adenosine deaminase.

A clinical trial with cefoperazone in pneumonia and pyelonephritis

15 cases of pneumonia and 15 cases of pyelonephritis were included in a clinical trial of parenteral cefoperazone. The organisms isolated from patients with bacterial pneumonia were: Staphylococcus aureus (6), Klebsiella pneumoniae (5), Diplococcus pneumoniae (3), Pseudomonas species (2), and 6 others. Amongst those with pyelonephritis, Escherichia coli (12), Enterobacter (1), and 3 other pathogens, were isolated. All were sensitive to cefoperazone. The efficacy of cefoperazone in patients with pneumonia was: good in 11 (73%), fair in 3, and poor in 1. In pyelonephritis, 12 (80%) responded well and in the other 3 response was fair. There were no significant side effects or hypersensitivity reactions.

Ultrastructural "fingerprint" in cryoprecipitate and glomerular deposits: a case report of systemic lupus erythematosus

A 20 year old woman had lupus nephritis and cryoglobulinemia. The cryoglobulins isolated from the serum and a renal biopsy specimen were studied by means of immunofluorescence, immunochemistry, and electron microscopy. Ultrastructural "fingerprint" structures were observed both in the cryoprecipitate and in the glomerular deposits, as were IgG, IgM, and IgA. These observations furnish morphologic evidence for the glomerular deposition of cryoglobulins in lupus nephritis.

Computer controlled hyperthermia unit for cancer therapy

Hyperthermia is the artificial elevation of tissue temperature above 41 degrees C with therapeutic intent. Most of the currently used hyperthermia units lack feedback temperature control mechanisms, and, therefore, are not optimal for clinical trials. To solve this problem, we have developed a control system based on a microcomputer. The computer measures the tumor and normal tissue temperature using fine thermocouple sensors and regulates the output of the microwave generator to achieve and maintain the prescribed tumor temperature under specified conditions. Safety procedures are incorporated to avoid heating the tumor or normal tissue beyond predetermined limits.

Management of malignant salivary gland tumors

A total of 54 patients with major salivary gland tumor were treated with radiation therapy at the University of Michigan from 1955 to 1975, inclusive. Fifteen had total resection and radiation, 16 had subtotal resection and radiation, and 23 were inoperable and received radiation only. Local control rate was different between these groups, 86.7%, 75%, 21.7% respectively, as was survival rate at 5 years, 78.4%, 59.8%, 29.9%. In patients with facial nerve palsy, with combined surgery and radiation, 65.3% local control and 49.7% 5-year survival was obtained. Regional neck node metastasis was noted in 25.5% and distant metastasis in 24.1%. Local tumor control was found to be a very important factor in survival: 70.2% survival in patients with local control and 28.7% without. The authors conclude that a combined radical surgery and postoperative radiation would improve the prognosis of these patients with major salivary gland tumors.

Doridosine: a new hypotensive N-methylpurine riboside from the nudibranch Anisodoris nobilis

A new N-methylpurine riboside (doridosine), probably N1-Methylisoguanosine, was isolated from the digestive glands of a nudibranch. Doridosine produces prolonged hypotension and bradycardia in anesthetized rats, decreases the rate and the amplitude of contraction of guinea pig atria in vitro, and causes the heart rate in anesthetized mice to be reduced by 50 percent for many hours after which the animals recover completely.

Thyroid function following neck irradiation for malignant lymphoma

Thyroid function tests for T3 resin (T3-r), serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) were measured in 70 consecutive patients who had previously undergone lymphangiography and neck irradiation for malignant lymphoma. All were in remission and clinically euthyroid. The abnormalities found were: 23 (33%) patients hypothyroid by TSH, 14 (20%) with subnormal T4, and 21 (30%) with subnormal T3-r values. None of the patients were biochemically hyperthyroid. The prevalence and magnitude of abnormalities were highest during the third year after irradiation, thereafter decreasing with time.

Quantitative analysis of developing epiglottal taste buds in sheep

Epiglottal taste buds of the sheep increase in number during development, and continue to increase until the epiglottis has reached its adult size. However, since the increase in taste bud numbers is paralleled by increase in the surface area of the epiglottis, the density of taste buds decreases progressively in the fetus and newborn. After birth the density remains relatively constant. From examination of the morphological stages of epiglottal taste bud development, we conclude that taste buds are originally produced by de novo formation, but that further increase in numbers is effected by division of existing, developing taste buds. Because of the large number of taste buds, and the maintenance of their density on the epiglottis, it is concluded that they have an important functional role in upper airway protective reflexes.

Regression of Hodgkin disease in the mediastinum: a mathematical model

Twenty-seven patients with mediastinal Hodgkin disease were teated either by radiation therapy or chemotherapy. The rates of tumor regression were measured and were fitted into a three-parameter Gompertzian model. Tumor regression was more pronounced and prompt in patients treated with radiotherapy. The Gompertzian model matched the radiation therapy data closely in the first 90 days after initiation of therapy in cases of approximately equal tumor size.

A comparative cephalometric study of Class II, Division 1 nonextraction and extraction cases

1. Cephalometric tracings of thirty Class II, Division 1 cases without extraction and twenty-five Class II, Division 1 cases with extraction were evaluated and statistically compared by means of the overbite depth indicator (ODI) and the anteroposterior dysplasia indicator (APDI). 2. The mean ODI in the nonextraction group, in particular, was significantly higher than that of the extraction group. 3. Three clinical examples were presented to demonstrate the values of ODI and APDI as adjuncts to cephalometric differential diagnosis. 4. With respect to the vertical component it may be concluded that the lower the ODI value from the normal mean a case presents, the greater the incidence of an extraction procedure as a compromise for the poor skeletal pattern. 5. With respect to the horizontal component the initial APDI reading indicates the severity of skeletal discrepancy. When the posttreatment APDI reading falls below the normal mean, a relapse is probable: the lower the figure a case possesses, the greater the chance of relapse. In such incidences an extraction procedure must be provided to ensure the stability of occlusion.

Deflation of a Sengstaken tube balloon facilitating catheterization of the celiac artery

Selective catheterization of the celiac axis may be difficult when the lumen of the artery is compromised. The presence of an inflated compression balloon in the stomach may narrow the artery, presumably by placing tension on the median arcuate ligament of the diaphragm. Deflation of the gastric balloon can facilitate catheterization by relieving the extrinsic pressure on the artery.

Treatment of testicular tumors

A total of 145 consecutive primary testicular tumors were treated with radiation therapy at the University of Michigan Hospital from 1955 through 1974. In patients with seminoma, the 5-year survival rate was 98% for Stage I and 88% for Stage II regardless of whether retroperitoneal lymph node dissection was done. The 5-year survival rate for embryonal carcinoma was 63% for Stage I and 66% for Stage II. For teratocarcinoma it was 100% for Stage I and 54% for Stage II. Adjuvant chemotherapy appeared to be beneficial for patients with Stage II teratocarcinoma but made no difference in patients with embryonal carcinoma.

Accessory blood supply to the liver from the dorsal pancreatic artery: an unusual anatomic variant

A case of an accessory hepatic artery from the dorsal pancreatic artery is illustrated. A discussion of anatomic variations and embryology of the arterial blood supply to the liver from the celiac axis and aberrant blood supply from other vessels is presented with a consideration of the surgical and diagnostic significance of anatomic variance.

Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis

1. Cephalograms of 102 children with normal occlusion (Group 1) and 874 children with various malocclusions were analyzed to determine which measurements would produce the highest correlation against the displacement of the molar relationships. 2. Molar displacement was measured directly on the study casts, and an average of the measurements of the right and the left sides was obtained. 3. The malocclusion sample was divided into groups according to molar displacement: 214 neutroclusion cases (Group 2), 624 distoclusion cases (Group 3), and 36 mesioclusion cases (Group 4). 4. The mean value of the anteroposterior dysplasia indicator (APDI) in the normal group was 81.4 degrees, with a standard deviation of 3.79. 5. The APDI reading was obtained by tabulating the facial angle plus or minus the A-B plane angle and plus or minus the palatal plane angle. 6. Among the measurements tested, the APDI was found to show the highest correlation against the molar displacement, with a correlation value of 0.643. 7. The four variable that produced the highest correlation coefficient value--that is, the ANB angle (-0.495), the A-B pland angle (0.566), the "Wits" appraisal (-0.639), and the APDI (0.643)--were subjected to a study of their frequency distribution patterns. High percentage of overlapping of the two extreme groups (distoclusion and mesioclusion groups) were found in the above variables, with the exception of the APDI. 8. A discussion of the differential diagnostic value of the APDI was presented, together with illustrations and various clinical examples.

Enzymatic oxidation of disulfides and thiolsulfinates by both rabbit liver microsomes and a reconstituted system with purified cytochrome P-450

Both rabbit liver microsomes and reconstituted system with purified cytochrome P-450 and cofactors enzymatically oxidized o-dithiane (1, 2-dithiane), 3-methyl-o-dithiane, thiane and 2-methylthiane to the corresponding mono-oxygenated products; sulfides or disulfides were oxidized to the corresponding sulfoxides or thiosulfinates, while thiosulfinate was oxidized to thiolsulfonate. The reconstituted systems required oxygen and NADPH and were not affected by the catalase which decomposes H2O2, or by 1,4-diazabicyclo-[2,2,2]octane (DABCO), which is a good quencher of singlet oxygen. The differences in the binding of substrates such as sulfides and disulfides with the enzyme system are discussed in connection with differences in the spectra of the substrates in the reconstituted system with pure cytochrome P-450. A correlation was found between the rates of oxidation of the substrates and the rates of oxidation of NADPH.

Brunnian adenoma (inverted papilloma) of the urinary bladder: report of a case

An additional case of a benign polypoid tumor of the urinary bladder is reported, the first one observed at autopsy and the first in which photographic documentation of the gross appearance is presented. The lesion was first described as an adenomatoid polyp in 1927. We consider the subsequent (1963) designation of inverted papilloma misleading. Because its histologic morphology bears a striking resemblance to Brunn's nests and because the term papilloma of the urinary bladder connotes potential malignant change, we propose the designation brunnian adenoma. All cases previously reported have been benign.

Intracranial ependymomas

Clinically significant spinal implants develop in intracranial ependymomas. Spinal subarachnoid implants developed in 11 of 32 patients who received local irradiation at the University of Michigan between 1955 and 1972 for intracranial ependymoma. Seven of these patients received spinal axis irradiation for neurological disturbances resulting from the implants, and implants were found in the other 4 patients postmortem. Ten patients had infratentorial tumors, and one had a supratentorial tumor; nine tumors were poorly differentiated, two were well differentiated. The authors conclude that spinal irradiation is required if the tumor is poorly differentiated, or located in the infratentorial fossa.

Radiation necrosis of the scalp: a complication of cranial irradiation and methotrexate

A case of childhood leukemia with a severe skin reaction following a course of medium-dose cranial irradiation and intrathecal methotrexate is presented. Necrosis of the scalp of partial to full thickness resulted. The authors believe potentiation of the radiation reaction by methotrexate was the probable cause.

A clinical histologic, and immunologic study of a case of metastatic malignant melanoma undergoing spontaneous remission

A patient with biopsy-proven dermal recurrent malignant melanoma who refused therapy, and who was observed to undergo clinical regression during the period of November 1972 through June 1974 was studied to define the histologic features of spontaneous remission, and to evaluate the immune response as measured by in vitro assays of lymphocyte cytotoxicity and serum effects during the course of regression. Biopsy of regressed areas showed the following histologic features: 1) absence of malignant melanoma cells in basal layers of epidermis with relative increase in basal layer clear cells; 2) dermal inflammatory reaction with lymphocytic infiltrate, melanophages, and degenerate malignant melanocytes; and 3) dermal reactive vascular proliferation and interstitial edema progressing to reparative dermal fibrosis. Using a microcytotoxicity assay with two established allogeneic melanoma cell cultures as target cells, a statistically significant (p less than 0.01) increase in lymphocyte cytotoxicity values was observed over the clinical time course of regression. No significant serum cytotoxic or serum blocking effects were detectable. These findings are consistent with an immunologic basis for the spontaneous remission of the dermal melanoma metastases present in this patient.

Synthesis and biological activity of 10-thia-10-deaza analogs of folic acid, pteroic acid, and related compounds

The 10-thia analogs of pteroic acid, folic acid, their esters, and their 4-amino analogs were synthesized through a reaction sequence involving, as a key step, the condensation of 2-amino-3-cyano-5-chloromethylpyrazine with appropriately substituted thiols. The abilities of the products to inhibit the growth of methotrexate (MTX)-sensitive and MTX-resistant microorganisms were investigated as were their abilities to inhibit dihydrofolic acid reductase and thymidylic acid synthetase. Several compounds had high activity.

Tetrodotoxin: Occurrence in atelopid frogs of Costa Rica

The potent neurotoxin tetrodotoxin, which has previously been found in puffer fish of the order Tetraordontiformes, a goby (Gobius criniger), and the California newt (Taricha torosa), has now been identified in the skins of frogs of the genus Atelopus from Costa Rica.

Triage abilities of nurse practitioner vs pediatrician

The ability of ediatric nurse practitioners (PNPs) to perform triage functions for ill children in a busy pediatric outpatient service was compared to that of a group of pediatricians. One hundred thirteen children were seen separately on arrival by a PNP and by a pediatrician. The PNPs' evaluations agreed with the pediatricians' 84% of the time. Only two significant differences were shown: PNPs were more diligent in recording patient problems, while pediatricians were better able to anticipate the need for roentgenograms and laboratory studies. The results indicate that valuable physician time may be conserved by using the PNP to perform triage in large pediatric outpatient services.