Primary retroperitoneal sarcomas

A retrospective analysis of 20 adult patients with primary retroperitoneal sarcomas demonstrated that most patients presented with pain and a palpable abdominal mass. Liposarcomas and leiomyosarcomas were the most common tumors. Seven of the 20 patients (35 percent) had complete tumor excision. Operative morbidity was 18 percent with no mortality. After complete resection, the 5 year survival rate was 43 percent. Thirteen patients underwent partial excision of tumor, with an operative morbidity rate of 29 percent and a mortality rate of 15 percent. No patient in our series lived more than 2 years after only partial excision. Anatomic restrictions to wide resection and local recurrence were the most important factors determining survival. Aggressive, complete surgical resection in treating primary retroperitoneal sarcomas is strongly recommended.

Embryonic heart rates before the seventh week of pregnancy

Previous studies of normal human embryonic heart rates showed an increase in the rates between the 7th and 9th gestational weeks; the rates gradually declined thereafter until the 15th week. The present study added new information about embryonic heart rates before the seventh week. The heart rates are slower than those reported to occur after the seventh week. These observations are connected with morphologic and physiologic changes during this period of embryonic life.

A totally implantable venous access system for long-term chemotherapy in children

A totally implantable venous access system consisting of a subcutaneously placed stainless steel portal with a silicone diaphragm attached to a Silastic elastomer central venous catheter was inserted in 39 children with poor venous access. The devices were utilized for blood drawing and the administration of antineoplastic drugs, parenteral nutritional fluids, antibiotics, and blood products. Cumulative duration of access was 6,724 days (range 5-491, median 172 days). Major complications necessitating removal of the device included catheter sepsis or pocket abscess (7%), catheter clot not responsive to enzyme declotting (5%), and catheter occlusion by too tight a ligature (2%). The system provided easy venous access and permitted full physical activity.

Acute cholecystitis associated with hepatic arterial infusion of floxuridine

In a 1 year period, 13 patients underwent pump implantation for liver metastasis from a primary colorectal tumor. The gallbladders were not removed at the time of pump implantation in the initial six patients. In these patients, chemotherapy consisted of floxuridine given every 2 weeks followed by a 2 week rest period and cisplatin over 1 hour by way of the side portal on day 8 of the cycle. The treatment was repeated every 28 days. All patients whose gallbladders were not removed at the time of pump implantation required reoperation for acute or chronic acalculous cholecystitis from 1 to 9 months (mean 5.4 months) after pump implantation. At operation, all patients were found to have various degrees of inflammation and fibrosis. In one patient, significant sclerosing cholangitis was documented that involved the entire intrahepatic ductal system and hepatic duct bifurcation. Cholecystectomy and operative cholangiography are recommended in all patients who undergo pump implantation for metastatic disease to the liver.

Syndrome of camptodactyly, ankyloses, facial anomalies, and pulmonary hypoplasia (Pena-Shokeir syndrome): obstetric and ultrasound aspects

Two siblings with Pena-Shokeir syndrome are described. This syndrome consists of polyhydramnios, intrauterine growth retardation, short umbilical cord, perinatal death, facial abnormalities, limb abnormalities including arthrogryposis, and lethal pulmonary hypoplasia. The mode of inheritance is most likely autosomal recessive. Prenatal diagnosis was made in the second pregnancy with ultrasound performed at 26 weeks' gestation. The roles of fetal akinesia and fetal apnea in the production of the various manifestations of the syndrome are detailed, and the possibility of early prenatal diagnosis is considered.

Varying rates of alcohol metabolism in relation to detoxification medication

Fifteen patients admitted for alcohol dependency had serial blood alcohol levels drawn. The rate of metabolism was calculated a number of different ways and this was compared to the amount of Librium required for the initial period of withdrawal. It was found that the alcoholics' average metabolism was 26.6 mg%/hour. Although there was a tendency for those with high initial blood alcohol levels to have faster metabolisms, there was not a significant correlation between the two features. There was correlation between the amount of Librium used in the initial period of detoxification and the initial blood alcohol concentration.

Reliability of rapid clinical staging of all night sleep EEG

The recording of all night sleep EEGs on a portable cassette recorder, and the rapid visual staging of the sleep records at 20 times real time, represent innovations in sleep research methodology. The reliability of sleep stager percentages obtained in this way is examined in this article. In the first of two studies, all night sleep records for six individuals were each staged twice by each of two qualified electroencephalographers. Inter-rater and intra-rater reliability assessed by intraclass correlation methods was modest, requiring the averaging of results from two judges to reach acceptable levels. Following consistency training, the two electroencephalographers staged all night sleep records for six additional subjects. Acceptable reliability was achieved in measurement of stages 2, 3, 4 and REM, although difficulty in reliably distinguishing stage 1 from the awake stage persisted. On the basis of these results, rapidly paced visual interpretation of sleep records at 20 times real time is recommended as a feasible way of meeting demands imposed by innovations in the technology of recording sleep EEGs.

Targeting therapeutic plasma levels of nortriptyline from test dose plasma concentrations

Computer programs, based on first order pharmacokinetic equations, were developed to predict steady state plasma levels and required daily maintenance doses of nortriptyline from plasma concentrations 24 hours after a test dose. These predictions are compared to clinical findings for geriatric and nongeriatric patients with a variety of accompanying medical disorders and concurrent medications.

Renal toxicity of mitomycin-C

The clinical spectrum and the pathological findings of renal toxicity in four patients treated with mitomycin-C are described. Our experience and evidence in the literature indicates that the renal impairment appears to be total-dose-related, with most patients developing renal symptoms after receiving at least 60 mg of mitomycin-C. The renal morphologic changes reveal a glomerular and vascular process similar to that seen in a number of clinical situations associated with the hematologic findings of microangiopathic hemolytic anemia. In patients with malignant disease, it may be that the use of mitomycin-C either alone or in combination with other drugs causes endothelial vascular damage with resultant activation of the coagulation system. There is evidence that early detection of the renal impairment and withdrawal of mitomycin-C might halt further progression of renal failure.

PPNG conjunctivitis

The treatment regimen for penicillin sensitive gonococcal conjunctivitis in an adult normally includes parenteral penicillin, frequent ocular irrigation, and topical ophthalmic gentamicin or tetracycline ointment. However, if a conjunctivitis is caused by a beta-lactamase producing microbe such as PPNG, then different antibiotics are required: e.g., spectinomycin or cefoxitin parenterally and topical chloramphenicol. Also, whereas urethritis is frequently treated with singular injections of penicillin or spectinomycin HCI (Trobicin), cases of PPNG ocular infections require a much longer course of treatment often involving seven days of intramuscular or intravenous antibiotics.

Quantitative relationships between structure and pharmacokinetic parameters using molecular connectivity chi indices I: Substituted 2-sulfapyridines

Quantitative relationships between the structure and pharmacokinetic parameters of several compounds have been derived using the molecular connectivity approach. The correlation coefficients of equations obtained using the Chi indices (chi) as predictor parameters were compared favorably with those obtained by the linear free energy approach, where physicochemical parameters have been used as predictor variables. High correlation coefficients (r) for the first-order elimination rate constant (r = 0.86), total body clearance (r = 0.89), and protein binding association constant (r = 0.78) for substituted 2-sulfapyridines were obtained. However, including the pKa (indicative of electronic effects) of the compounds within the equation as a predictor variable caused an increase in the correlation coefficients.

Mania in Cushing's syndrome: case report

A case is described of recurrent mania without depressive episodes in a patient subsequently diagnosed as having an ACTH-producing basophil adenoma. The difficulties involved in the clinical and laboratory diagnosis of Cushing's syndrome, and the ramifications of neuroendocrinopathies' ability to mimic symptoms of functional psychosis, are discussed.

The association of Fanconi's anemia and squamous cell carcinoma

Fanconi's anemia is a rare autosomal recessive disorder which manifests itself in early childhood, presenting as pancytopenia, pigmentation changes, skeletal deformities, small statures and chromosomal aberrations. Most patients ultimately die from sepsis as a result of their hematologic abnormalities, however, some patients live long enough to develop malignancies such as leukemia, hepatocellular carcinomas and squamous cell carcinoma. The association of Fanconi's anemia and squamous cell carcinoma is examined with a report of a patient with Fanconi's anemia and squamous cell carcinoma of the pyriform sinus and hypopharynx.

Epidemic viral keratoconjunctivitis diagnosis and management

The author reports an epidemic of adeno- and enteroviral eye infections at an overseas military complex in the third quarter of 1981. A similar epidemic was reported by the Center for Disease Control, Atlanta, GA to also have occurred in Florida, Latin America, and North Carolina at approximately the same time. The differential diagnosis between epidemic keratoconjunctivitis, pharyngoconjunctival fever, acute hemorrhage conjunctivitis and Chlamydial infections is described. Epidemiology and management of these widely seen ocular infections are also discussed.

Amitriptyline versus placebo in postherpetic neuralgia

To study the effects of amitriptyline in treating postherpetic neuralgia, 24 patients were randomly assigned to either drug or placebo in a double-blind crossover study. We found good to excellent pain relief in 16 of 24 patients (p less than or equal to 0.001). We did not find an antidepressant effect in most patients (p greater than 0.05). The median dose of amitriptyline was 75 mg. The median blood level was 65 ng per milliliter, and of nortriptyline 30 ng per milliliter. Good responses were maintained in 12 of 22 patients. Amitriptyline is useful in treating postherpetic neuralgia and may not act as an antidepressant.

The value of computed tomography in the diagnosis and management of pediatric mediastinal abnormalities

The utility of computed tomography (CT) in evaluation of mediastinal abnormalities was assessed in 23 pediatric patients. By comparison with standard chest radiography, CT provided additional diagnostic information in 82% of the patients. In 65%, the CT findings contributed to a change in clinical management. CT was most useful in documenting a benign process (near-water-density mass or a normal vascular or soft-tissue structure) and in demonstrating the full extent of a malignant tumor.

Diffuse juvenile polyposis of the colon: a premalignant condition?

Juvenile polyps are a common cause of rectal bleeding in the pediatric age group. These polyps are usually solitary, but occasionally polyposis can be identified by barium-enema or colonoscopy examinations. The benign nature of a single polyp or even scattered polyposis in childhood has been supported by several authors. A case of diffuse juvenile polyposis of the colon with associated adenomatous polyps of the colon in a 17-year-old who presented with iron deficiency anemia and rectal prolapse is discussed. This combination of diffuse juvenile polyposis and adenomatous polyps is an uncommon entity which is left to represent a premalignant lesion that warrants appropriate therapy. A review of the literature concerning the cause, diagnosis, and treatment of juvenile polyps is also discussed.

ECG changes in pure impramine overdose as function of plasma level

ECG changes occur with therapeutic doses of tricyclic antidepressants and cardiovascular conduction alteration is the lethal effect in overdoses on these drugs.

These ECG changes depend on the plasma level and metabolism of the particular antidepressant. Information about the relative toxicity and metabolism characteristics can be obtained by studying overdoses if the attempt simply involves one tricyclic and no other drug ingestion. Such a case report involving a known quantity of imipramine is presented.

The early toxic signs leading to cardiac arrest and the recovery from coma are discussed. The ECG along with corresponding plasma levels of imipramine and its metabolite desmethylimipramine are given as a function of time after ingestion. The relative toxicity of these metabolites and the use of anticholinesterase in the acute management is considered.

Masked "myxedema madness"

Hypothyroidism can present a wide range of psychiatric manifestations, including personality disturbance, neurotic traits and psychotic features. Psychiatric treatment techniques without recognition and correction of the endocrine root of the mental disturbance will result in a failure of treatment. However, severe hypothyroidism can exist with a poverty of classical signs and symptoms such that both internist and psychiatrist may easily overlook endocrine dysfunction as a possible etiology of the mental disorder. A case of long-standing paranoid illness whose etiology was severe myxedema with such a poverty of signs and symptoms is presented. Failure to recognize the endocrinopathy may not only produce recovery difficulties but also psychiatric and endocrine repercussions if psychotropic medications are given in such masked cases. These problems are considered with particular reference to lithium, and screening criteria to avoid this problem are discussed.

Quality control in the simultaneous assay of anticonvulsants using an automated gas chromatographic system with a nitrogen detector

An automated gas-liquid chromatographic technique for the routine determination of phenobarbitone, primidone and phenytoin using a nitrogen-detector is described. The high selectivity of the detector for nitrogen-containing compounds allows a direct extraction procedure and the use of a phenytoin analogue as an internal standard obviates the need for accurate aliquot measurement after extraction. The anticonvulsants are chromatographed as methyl derivatives produced by on-column methylation with trimethylphenyl ammonium hydroxide following automatic liquid injection. Quality control data from an internal quality control scheme is presented and the performance of the laboratory in an inter-laboratory control scheme is reported and discussed.

Effect of histones and nonhistone chromosomal proteins on the transcription of histone genes from HeLaS3 cell DNA

To elucidate the manner in which histones and nonhistone chromosomal proteins interact to render histone genes transcribable in HeLa S3 cells, we have examined transcription of histone mRNA sequences from DNA, as well as from several DNA-chromosomal protein complexes. Histone mRNA sequences were assayed by hybridization to a 3H-labeled single-stranded DNA complementary to histone mRNAs. Our results indicate that DNA is an effective template for transcription of histone mRNA sequences and that histones by themselves inhibit transcription from DNA, including transcription of histone genes, in a dose-dependent, nonspecific manner. When complexed with DNA alone, nonhistone chromosomal proteins do not affect the transcription of histone mRNA sequences. However, when associated with DNA in the presence of histones, nonhistone chromosomal proteins are capable of selectively rendering histone genes transcribable. These results suggest a possible role for nonhistone chromosomal proteins in mediating the interactions of histones with DNA to render histone genes transcribable.