'Chyloma': a persistent post-traumatic collection in the left supraclavicular region

A patient with traumatic disruption of the thoracic duct resulting in a chylothorax and a 'chyloma' in the left supraclavicular region is described. Supradiaphragmatic ligation of the thoracic duct was necessary for treatment of the chyloma.

Tissue distribution and excretion of tri-(2-ethylhexyl)trimellitate in rats

The disposition kinetics of tri-(2-ethylhexyl)trimellitate (TEHTM), a new plasticizer for polyvinyl chloride (PVC) plastic, was studied in rats following intravenous administration of [14C-carbonyl]tri-(2-ethylhexyl)trimellitate using an oil in water emulsion as the vehicle. The distribution half-life, elimination half-life, and clearance values estimated from the plasma concentration of radioactivity data obtained following iv administration of 10.5 mg/kg of TEHTM (59.9 muCi/kg), were 46.2 min, 5.34 d, and 40.5 ml/kg X h, respectively. Following iv dosage of 15.6 mg/kg of TEHTM (28.0 muCi/kg), significant accumulation of radioactivity was found in the liver, lungs, and spleen, with liver accounting for 72% of the administered dosage at 24 h. Excretion of TEHTM and its biotransformation products was slow, with 21.3% of the administered radioactivity found in the feces and 2.8% in the urine during the 14-d collection period. Biliary excretion seems to be the major route of elimination of TEHTM. The pharmacokinetic data gathered in the present investigation are compared to di-(2-ethylhexyl)phthalate (DEHP), a widely used plasticizer for PVC.

Assessment of the safety of chemicals administered intravenously in the neonatal rat

A 3-day-old neonatal rat model for the safety assessment of various drugs, chemicals, and nutrients administered intravenously is described. This model was used to assess the safety of di(2-ethylhexyl) phthalate (DEHP), cyclohexanone, and a 3:1 mixture of medium and long-chain triglyceride emulsions following subchronic administration using the intravenous route. The administration of DEHP at dosage of 164.8 mg/kg for 18 consecutive days resulted in a small but statistically significant increase in liver weight and SGOT activity. However, no conclusive histopathological alternations could be discerned between livers from DEHP and normal saline (control) animals. No effects were observed among neonates treated with cyclohexanone at dosages up to 25 mg/kg for 18 consecutive days. Because of technical difficulties emanating from high dosage volumes, the administration of lipid emulsion mixture lasted 9 consecutive days only. Except for transient ataxia and sedation, no adverse effects were observed among neonates that received 3:1 medium- and long-chain triglyceride emulsion for 9 consecutive days beginning on day 3 postpartum. No adverse effects were observed among neonates receiving the lipid emulsions for 7 consecutive days beginning on day 12 postpartum.

Ethylene oxide sensitivity in hemodialysis patients

Sera from 138 patients who had experienced hypersensitivity-type reactions while on hemodialysis (reactors) were examined retrospectively by the radioallergosorbent test (RAST) for specific IgE antibody to ethylene oxide (ETO). Seventy-eight hemodialysis patients without a history of reaction were also evaluated as controls. Elevated serum RAST values (greater than 2.0) were more common in reactors (63%) than in controls (11%, p less than 0.001). In a second study, RAST assays were performed using human serum albumin conjugated to ETO (HSA-ETO) as antigen and also using a concentrate of fluid used to rinse ETO-sterilized dialyzers ("dialyzer extract") as antigen. The RAST ratios obtained with HSA-ETO were similar to those obtained using the dialyzer extract (rank order correlation coefficient = 0.829, p less than 0.001). In a third study, RAST inhibition was demonstrated both by HSA-ETO and dialyzer extract. Our results, extending previously published reports, suggest that hypersensitivity to ETO might play an important role in hemodialysis-associated hypersensitivity-type reactions.

Patella alta and the adolescent growth spurt

The presence of patella alta has been linked to recurrent dislocation of the patella and the patello-femoral stress syndrome. It is not known whether patella alta is an inherited or acquired trait. To investigate the relationship of patella during the adolescent growth spurt, serial orthoroentgenograms (growth study films) were retrospectively analyzed in 19 patients. Two were found in whom proximal patella migration could be correlated (r = 0.85) with femoral growth rate. This was significant at the p = 0.01 level. Girls had a higher correlation of patella height to growth rate than boys. In certain cases, patella alta is an acquired rather than inherited condition; this supports the theory that overgrowth during the growth spurt can lead to patella alta in some individuals.

Assessment of potential toxic effects of treated Hemofil injection in rats and mice and on the systemic hemodynamics in dogs

The toxic effects of treated Hemofil (T-AHF) injection were evaluated by acute and subchronic intravenous administration to rats, mice, and dogs. Acute iv administration of T-AHF to rats and mice at dosages of 1320 units (U) of Factor VIII/kg did not produce toxic signs. Both species were found to have an LD50 greater than 1320 U. Seven-day iv administration to rats of T-AHF at dosages of 20, 40, and 60 U/kg and 3-mo administration (3 times/wk for 13 wk) of T-AHF at dosages of 100 and 200 U/kg did not produce any signs of toxicity. There were no treatment-related effects on body weights, hematology, clinical chemistry, urinalysis, ocular tissues, or histopathology. Intravenous administration to dogs at 0.5, 1.0, and 5.0 ml/min . kg (28 U/ml, 100 U/kg at each rate) produced no significant adverse effects on mean arterial pressure, cardiac output, or heart rate. No adverse changes in pulmonary function, as reflected by arterial blood-gas profiles, were observed. It is concluded that animals tolerated well T-AHF administered at dosages and rates similar to or greater than dosages used clinically. The results obtained from these studies establish a reasonable margin of safety and support the acceptability of the T-AHF for clinical use.

The effects on beagles of long-term administration of 20% Travamulsion fat emulsion

The tolerance of 20% Travamulsion intravenous fat emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using male beagle dogs. Physiologic (0.9%) saline, USP, was used as the control, and 10% Travamulsion Intravenous fat emulsion (Travenol Laboratories) as the reference article. The 20 and 10% emulsions were administered intravenously to each of eight animals for 91 days at 20 and 40 ml/kg/day, respectively. These dosages were administered over 4 hr and they correspond to approximately 4 g of lipid as soybean oil per kilogram of body weight. The saline was administered to eight animals at 40 ml/kg/day. On day 92, one-half of the animals in each group were necropsied. The remaining dogs were observed and necropsied on day 122. Toxicity was assessed on animal survival; changes in body weight, urinalysis, and hematologic, and serum biochemical analyses; ophthalmologic examination; gross pathology; and histopathology. The results obtained for the 20% Travamulsion fat emulsion correlated well with those for the 10% Travamulsion fat emulsion. The emulsions were well tolerated and all animals survived and gained weight. The 20% Travamulsion fat emulsion administered provided about 45% of the total caloric requirement of the dog, which is equal to an often used clinical dose. However, caloric administration in the form of lipid emulsion in relation to total energy required was performed at three to six times the indicated clinical rate. In addition to demonstrating that it is safe for prolonged administration, the 20% Travamulsion fat emulsion offers an advantage over the 10% Travamulsion fat emulsion in providing the same amount of calories because it produces lower serum levels of phospholipid, cholesterol, and triglyceride, and the volume of emulsion required is reduced.

Comparison of the elimination and metabolism of 10% Travamulsion and 10% Intralipid lipid emulsion in the dog

A study was performed comparing the elimination kinetics of two soybean oil/egg phosphatide lipid emulsions (10% Travamulsion vs 10% Intralipid) from the vascular compartment of the dog. Elimination kinetics were evaluated after bolus injection and after continuous infusion studies. Evaluation of triglyceride and free fatty acid data indicates the emulsions are similar metabolic substrates. Phospholipid and cholesterol data indicate a possible difference in remnant particle removal. At the higher lipid dosages, remnant particles from Travamulsion injection were removed at a faster rate than those from Intralipid.

The effects of intravenous administration of 10% travamulsion fat emulsion to beagle dogs for 91 consecutive days

The tolerance of 10% Travamulsion Intravenous Fat Emulsion (Travenol Laboratories, Inc., Deerfield, IL) was studied using beagle dogs. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% Fat Emulsion (Vitrum, Sweden) as the reference article. The emulsions were administered intravenously to each of 10 animals for 91 days at a dosage of 40 ml (approximately 4 g)/kg of body weight/day. The saline was administered to 10 animals at 40 ml/kg/day. On day 92, 7 of the 10 animals in each group were necropsied. The remainder were observed and necropsied at approximately day 160. Toxicity was assessed on the basis of animal survival; changes in body weight, hematology, and serum chemistry; gross pathology; and histopathology. The results obtained for the Travenol emulsion correlated well with those for the Vitrum emulsion. The emulsions were well tolerated and they did not produce any major clinical signs of toxicity. All animals survived and gained weight. The Travenol emulsion administered provided about 45% of the total caloric requirement of the dog which is equal to an often used clinical dose. However, the emulsion was infused at six times the indicated clinical rate. Thus, in addition to demonstrating the similarity of Travenol and Vitrum emulsions, the results of this study indicate that the Travenol emulsion is safe for prolonged administration.

Nonlinear kinetic analysis of the elimination of lipid emulsion administered intravenously to dogs

A model based on a Michaelis-Menten nonlinear kinetic approach was used to analyze the kinetics of elimination of an intravenously infused lipid emulsion in the dog. The emulsion was administered at doses of 0.3, 3, or 6 g of lipid/kg of body weight. The model was applicable to all data regardless of the kinetic order of the elimination process operating. This can be either zero (linear), mixed, or first order (exponential). Furthermore, it was also found that parameters derived with the model can be used to predict the kinetics of elimination at different dosages. However, it was also shown that elimination parameters for a single bolus dose of lipid emulsion cannot be used to predict the manner in which a continuously infused dose will be eliminated.

The Angelchik antireflux prosthesis. Effects on the lower esophageal sphincter of primates

It has been shown that the ACAP causes significant increases in the LES pressure of supine primates which are maximal when properly placed at the EGJ. This effect appears to be due to posterior padding of the EGJ in supine animals and can be reproduced by dowel rods or Maloney dilators. Further studies to evaluate the contribution of this effect to the prevention of acid reflux are underway.

Effects of intravenous administration of Travenol 10% lipid emulsion to miniature swine for 28 consecutive days

The potential toxicity of Travenol 10% lipid emulsion was studied using miniature swine. Physiological (0.9%) saline, USP, was used as the control, and Intralipid 10% fat emulsion as the reference article. The emulsions were administered intravenously at dosages of 40 milliliters (approximately 4 grams of lipid) and 60 milliliters (approximately 6 grams of lipid) per kilogram of body weight per day to eight animals (four males and four females) in each treatment group on each of 28 consecutive days. The saline was administered to eight animals at 60 milliliters per kilogram per day. On day 29, one half of the male and female animals in each group were necropsied. The remaining pigs were observed and necropsied on either day 56 or 57. Toxicity was assessed on the basis of animal survival; changes in body weight, urinalyses, and hematological, and serum biochemical analyses; ophthalmological examination; gross pathology; and histopathology. The results obtained for the Travenol emulsion correlated well with those for the Intralipid emulsion. The emulsions were well tolerated, and they did not produce any major clinical signs of toxicity. All Travenol emulsion-treated animals survived. In addition to demonstrating the similarity of Travenol and Intralipid emulsions, the results of this study indicate that the Travenol emulsion demonstrated an adequate margin of safety for prolonged administration. Travenol emulsion was well tolerated by miniature swine infused at about one and one-half (40 milliliters per kilogram per day) and two (60 milliliters per kilogram per day) times the proposed clinical dose, and at three and two times the anticipated clinical rate, respectively.

Micromethod for lipid-chromatographic determination of cholesterol in lipemic sera

A micromethod involving "high-performance" lipid chromatography was developed for determining cholesterol in sera obtained from animals that has been infused with high doses of lipid emulsions. Only 50 micro L of serum is required, and there is no interference from turbidity, bilirubin, fat-soluble vitamins, and sterols. Correlation with the commonly used Abell-Kendall method was good at cholesterol concentrations as great as 10.0 g/L (r = 0.998). The assay is ideal for determinations on samples from pediatric and hyperlipidemic patients. It is particularly useful for monitoring patients on lipid-emulsion therapy and for toxicological studies with small animals.

Micromethod for lipid-chromatographic determination of cholesterol in lipemic sera

A micromethod involving "high-performance" lipid chromatography was developed for determining cholesterol in sera obtained from animals that has been infused with high doses of lipid emulsions. Only 50 micro L of serum is required, and there is no interference from turbidity, bilirubin, fat-soluble vitamins, and sterols. Correlation with the commonly used Abell-Kendall method was good at cholesterol concentrations as great as 10.0 g/L (r = 0.998). The assay is ideal for determinations on samples from pediatric and hyperlipidemic patients. It is particularly useful for monitoring patients on lipid-emulsion therapy and for toxicological studies with small animals.

Effect of cavosurface treatment on marginal leakage in class V composite resin restorations

Under the experimental conditions used in this in vitro study, the following conclusions may be drawn: 1. Etching of the enamel walls in butt and beveled preparations significantly reduces incisal marginal leakage. 2. The application of a low-viscosity bonding resin to the etched enamel walls of preparations prior to the insertion of the composite resin is not necessary to obtain minimal incisal leakage at the composite resin/etched enamel interface. 3. Cavosurface configuration has no significant effect on incisal marginal leakage. 4. Cavosurface configuration and the restorative techniques used in this study affect the degree of gingival microleakage to some extent but do not eliminate it.