Penetrating trauma of the internal carotid artery at the base of the skull

A 42-year-old female sustained a partial transection of the internal carotid artery at the base of the skull from a stab wound of the external ear. The clinical presentation and technical aspects of the surgical treatment are presented. The lesion could not be repaired and was successfully treated by ligation. The various techniques of operative exposure of challenging and unusual high carotid injuries which can be employed to eliminate the risk of cerebral embolism, false aneurysm formation, or carotid artery thrombosis associated with conservative management are reviewed.

Immediate breast reconstruction with tissue expanders

Primary breast reconstruction with expander devices provides a safe, simple, and rapid method that is most cost-effective and should usually be the method of choice in these cases.

Chemonucleation and changes observed on lumbar MR scan: preliminary report

This study examines the relation between the postchemonucleation clinical outcome and changes observed on the lumbar MR scan. Eight of 12 chemonucleated disks showed clinical improvement at the last follow-up, while the other four showed no improvement. In the cases that showed improvement there was a decrease in one or both dimensions of the defect in the thecal sac. Seven of eight showed an increase in the peridisk signal. Where there was no clinical improvement there were fewer decreases in the size of the defect, and three of four showed no increase in the peridisk signal.

Lineage analysis in the vertebrate nervous system by retrovirus-mediated gene transfer

We describe a cell-lineage marking system applicable to the vertebrate nervous system. The basis of the technique is gene transfer using the retroviral vector system. We used Escherichia coli beta-galactosidase as a marker gene and demonstrate a high level of expression of this marker from the viral long terminal repeat promoter, with simultaneous expression of the Tn5 neo gene from the simian virus 40 early promoter. This expression has allowed us to detect individual infected cells histochemically. We applied this marking technique to the study of lineage relationships in the developing vertebrate nervous system, both in vivo and in culture. In the rat retina, we injected virus in vivo and histochemically identified clones of marked neural cells. In addition, we used this virus to infect cultures of rat cerebral cortex and have analyzed the clonal relationships of morphologically different neural cell types. The host range of the marking system extends to avian as well as mammalian species. Thus, this system should have broad applicability as a means of gene transfer and expression in the nervous system.

Arterial lesions and blood lipids in rhesus monkeys fed human diets

The results of three consecutive experiments are reported in which atherosclerotic lesions of adult male rhesus monkeys produced by a ration relatively rich in calories, cholesterol, and saturated fats and resembling the "average American" table-prepared fare were compared with the atherosclerotic lesions in similar monkeys fed a low-fat, low-cholesterol, and low-calorie, so-called "prudent" table-prepared ration. Each experiment lasted 2 years. The frequency and severity of gross and microscopic aortic atheromatous disease and microscopic coronary artery disease were compared. In addition, the qualitative features of the lesions, several types of analyses of blood lipids, and the reactions of aortic cells to in vivo deposited interstitial aortic deposits of lipoprotein fractions prepared from these animals are described. In general, the animals fed the average American ration had serum cholesterols that were consistently higher (383 +/- 35 mg%) than animals fed the prudent ration (199 +/- 13 mg%). The contrasts in lesion involvement varied from about 6:1 in severity for both aortic and coronary lesions to approximately 3:1 or 4:1 in frequency. The aortic gross surface area involvement at autopsy was 46% for monkeys fed the average American ration compared to 7% for the prudent diet group. In lesions of animals fed the average American ration much of the lipid was extracellular and both cell proliferation and fiber protein deposition were prominent. The small lesions in the animals fed the prudent ration were much more likely to be composed mostly of "foam cell" intimal thickenings. The lesions seen in the animals fed the average American ration resemble those seen in autopsies of many young Americans whose lesions have been studied recently and who demonstrate raised lesions in their coronary arteries and aortas in the third decade.

A small DNA molecule containing covalently-linked ribonucleotides originates from the large intergenic region of the cauliflower mosaic virus genome

We have detected a small DNA molecule (sa-DNA), 725 nucleotides long, in cauliflower mosaic virus (CaMV)-infected, but not non-infected, turnip leaves. Alkali and RNase A treatments shortened sa-DNA by 100 nucleotides and we conclude that it contains covalently-linked ribonucleotides. This DNA co-purified with cellular polyadenylated RNA. It is complementary to the beta-strand of CaMV DNA and of opposite polarity to RNAs transcribed from the alpha-strand. Hybridisation studies suggest that sa-DNA originates from the large intergenic region (IR1) of the CaMV genome. A small double-stranded DNA with three single-stranded components, which co-purifies with cellular DNA, appears to be related to sa-DNA but lacks detectable ribonucleotides.

Biochemical and pharmacological studies on the opiate receptors from human placenta

The effect of different enzymatic treatments on the specific binding of 3H-Etorphine to the membrane bound opiate receptors from human placenta was studied. Phospholipase A2 inhibited etorphine binding, suggesting either that phospholipids are essential for ligand binding or that products of the phospholipase A2 reaction, either lysophospholipids or fatty acids, disrupt the membrane integrity because of their detergent like properties. Trypsin and alpha-chymotrypsin had no effect, suggesting that the receptors binding site was not accessible to these proteolytic enzymes. We also find that the placental villus upon in vitro stimulation with potassium releases acetylcholine. The inhibitory effect of morphine on acetylcholine release was investigated.

Amyloid P-component in human glomerular basement membrane. Abnormal patterns of immunofluorescent staining in glomerular disease

Serum amyloid P-component (SAP) is a normal plasma protein and is a constituent of normal human glomerular basement membrane. Immunofluorescence with anti-SAP antibody produced characteristic linear staining along the glomerular basement membrane in normal kidney. Distinctive abnormal staining patterns were seen in renal biopsy specimens from patients with diabetes, membranous glomerulonephritis, mesangiocapillary nephritis, systemic vasculitis, Goodpasture's syndrome.

Bronchial disease in ulcerative colitis

Ten patients with ulcerative colitis, all of whom were non-smokers, presented with a productive cough. In six, the chest radiography was normal and cough was the only symptom; three of these patients had a minor obstructive ventilatory defect on testing. Four patients complained of exertional dyspnoea and had both an abnormal chest radiograph with bilateral pulmonary shadows and a mixed obstructive and restrictive ventilatory defect. Bronchial epithelial biopsies from four patients (two with and two without pulmonary shadows) revealed basal reserve cell hyperplasia, basement membrane thickening, and submucosal inflammation, changes more usually associated with cigarette smoking. Inhaled beclomethasone diproprionate relieved cough in seven patients. The occurrence of airway epithelial disease in association with ulcerative colitis raises the possibility of a systemic mechanism affecting both bronchial and colonic epithelium. It does not seem likely that sulphasalazine was the cause of the pulmonary syndrome in these subjects.

Intussusception in older children

In a retrospective series of 37 cases of intussusception in children over 2 years of age, it was found that a subacute or chronic presentation was more common than in infancy, that few of them had rectal bleeding, and only a minority had a palpable intussusception. Diagnosis was often difficult but was helped by plain abdominal x-rays. Although the majority of children underwent surgery, with a 22% incidence of lead points, it is concluded that attempted hydrostatic reduction in these older children is not contraindicated, provided x-rays do not show small bowel obstruction.

Treatment of mesangiocapillary glomerulonephritis in children with combined immunosuppression and anticoagulation

10 children with mesangiocapillary (membranoproliferative) glomerulonephritis with features associated with a poor prognosis (either crescentic nephritis or a decline in renal function occurring after the initial presentation) were treated with a combination of immunosuppression and anticoagulation using corticosteroids, azathioprine, and heparin followed by warfarin and dipyridamole. Children were followed up for between 2 and 5 years, and at the end of this period 2 had died and 2 had entered the dialysis/transplant programme, but 6 were well (5 with glomerular filtration rates greater than 65 ml/min per 1 x 73 m2). We suggest that these results are sufficiently promising to encourage further trials of this form of treatment.

Prolonged brainstem transmission time in autism

Brainstem auditory evoked potentials (BAEPs) to clicks presented monaurally were gathered for 16 institutionalized children with a prior diagnosis of autism and with no hearing loss as tested by standard audiometry. Twenty age-matched normal children served as controls. Brainstem transmission time, defined as BAEP interpeak I-V latency, was prolonged significantly on the average in the autistic sample on both left and right sides. Individually, BAEPs for 9 of the 16 autistic children (or 56%) on whom some electrophysiological data were gathered were classified as abnormal when compared to the norms established in the control group. The most common BAEP abnormality was a prolonged interpeak III-V latency on the left side.

Prental diagnosis and subsequent team approach to the management of omphalocele

The diagnosis of omphalocele can now be made in the prenatal period with the use of ultrasound and the intraamniotic injection of radiopaque contrast material. By diagnosing omphalocele prior to birth a combined obstetric, neonatal and pediatric surgical approach can lead to a successful outcome of pregnancy and subsequent development of a normal infant.