Pneumosinus dilatans multiplex, mental retardation, and facial deformity

Pneumosinus dilatans is a term used to describe enlargement of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis, or mucous-membrane thickening. To date, many cases have been reported that involved frontal, ethmoid, sphenoid, and maxillary sinus. However, no case has been reported that involved all paranasal sinuses. Our case involved mastoid air cells as well as all paranasal sinuses. It is named pneumosinus dilatans multiplex by us. This is the first case to be reported in English literature that has this syndromic condition of pneumosinus dilatans multiplex, mental retardation, and facial deformity.

Intraosseous hemangioma of the orbit

Intraosseous hemangiomas of the orbit are very rare tumors. A case of cavernous hemangioma of the superolateral orbital rim is presented. A 45-year-old woman had a 1-year history of progressive swelling in the left lateral brow area. A computed tomography scan showed a well-marginated osteolytic lesion on the frontal bone near the frontozygomatic suture. The lesion was thought to be fibrous dysplasia, and the patient underwent tumor excision. The histological diagnosis was cavernous hemangioma. Cavernous spaces were filled with blood between the bony trabeculae. The spaces were lined by benign flattened endothelium. Intraosseous hemangioma should be suspected when a patient presents with an enlarging mass fixed to bone around the orbit.

Overexpression of the transforming growth factor-beta-inducible gene betaig-h3 in anterior polar cataracts

PURPOSE

In anterior polar cataracts and the fibrosis that can occur after cataract surgery, lens epithelial cells synthesize abundant extracellular matrix molecules and transdifferentiate into myofibroblast-like cells. Transforming growth factor (TGF)-beta has been implicated as a key player in these cataractous changes. The purpose of this study was to determine whether the TGF-beta-inducible gene h3 (betaig-h3) is expressed in lens epithelial cells from patients with anterior polar cataracts and to test whether betaig-h3 is induced by TGF-beta in cultured lens epithelial cells.

METHODS

Lens epithelial cells attached to the anterior capsules of human cataractous lenses and noncataractous lenses were examined for the expression of betaig-h3 mRNA and protein using reverse transcription-polymerase chain reaction and immunohistochemical analyses. The effect of TGF-beta on betaig-h3 gene expression was also tested in human lens epithelial B-3 cells using Northern and Western blot analyses.

RESULTS

betaig-h3 mRNA was not detected in lens epithelial cells from patients with clear lenses or patients with nuclear cataracts. Significant expression of mRNA for betaig-h3 was observed in lens epithelial cells from patients with anterior polar cataracts. Immunohistochemical analysis using anti-betaig-h3 antiserum indicated that betaig-h3 protein was present within the subcapsular plaques of anterior polar cataracts. Treatment of human lens epithelial B-3 cells with TGF-beta1 led to an increase in betaig-h3 mRNA and the secretion of betaig-h3 protein into the culture medium.

CONCLUSIONS

betaig-h3 may serve as a marker for anterior polar cataracts in addition to previously known proteins, fibronectin, type I collagen, and alpha-smooth muscle actin. The functions of this protein in lens pathology need to be further investigated.

Nodular fasciitis presenting as a parotid tumour after face lifting

Nodular fasciitis, a benign, pseudosarcomatous proliferative lesion of the soft tissue, is frequently misinterpreted as a sarcoma, both clinically and microscopically. Lesions associated with the parotid gland have been very rarely reported. We report a case of nodular fasciitis mimicking a parotid tumour after a facelift. We performed histological and immunohistochemical study and CT scan for it is difficult to make a differential diagnosis. We confirmed the final diagnosis as intraparotid nodular fasciitis. Superficial parotidectomy was performed because of initial pathological misdiagnosis reported as a dermatofibroma. The subsequent diagnosis was confirmed to be nodular fasciitis on the basis of immunohistochemical study. There was no recurrence after follow-up to 18 months. Proper diagnosis of nodular fasciitis in the parotid region and early recognition of its benign nature are necessary to differentiate it from other various benign and malignant tumours of the parotid gland.

Cutaneous sinus tract from remaining tooth fragment of edentulous maxilla

Cutaneous sinus tract of dental origin usually arises from chronic dental infections. These tracts usually appear as suppurative lesions of the chin or neck. Because many patients with this lesion do not have any complaints of oral symptoms, these lesions are often diagnosed incorrectly and overlooked, and are also treated ineffectively. A case of an unusual presentation of a chronic suppurative granuloma on nasolabial fold, which originated from the remaining tooth fragment of edentulous maxilla, is reported. Treatment with removal of the tooth fragment as well as the sinus tract resulted in complete healing of the lesion. This report emphasizes the importance of awareness of the possible dental origin of facial sinuses, despite their unusual location.

Interface between titanium miniplate/screw and human calvaria

This study demonstrates interfacial changes of titanium miniplate/screw with normal calvaria and nonvascularized calvarial bone graft ensued from craniectomy in a 53-year-old female. In 18 months after operation, a right parietal bone containing an L-shaped miniplate with screws, 5 mm long and 2 mm in external diameter, was harvested, fixed, and embedded in methylmetacrylate. Fifteen micrometer thick sections were made by an EXAKT cutting-grinding system (Exakt Company, Hamburg, Germany), and reviewed under the bright field light microscope. The mean of the bone-contacting surface ratio (BCSR) in six screwed bone was 64.1%; 69.3% in normal bone, and 60.4% in grafted bone. The trabecular bone areas in 10 x 5 mm (50 mm2) rectangular area of diploe surrounding the screws was 43.02 mm2; 45.25 mm2 in normal calvaria; and 41.82 mm2 in grafted bone. The mean Ca/P peak-height ratio of the plated and screwed calvaria was 1.47 in a 9 mm wide zone around each screw; 1.37 in normal calvaria; and 1.51 in grafted calvaria. We concede that the effect of direct contact of titanium with screws onto the bone is as much as an osseous integration (osseointegration).

Histomorphometry of parietal bones versus age and race

Surgeons are used to obtaining bone grafts of calvaria, which are abundant and available. The outer table of the parietal bone can be split, usually at the level of the diploic interstice, with an osteotome. Inadvertently violating the inner table and the dura leads some surgeons to avoid using the outer table in the elderly. Sullivan and Smith measured the thickness of the outer tables, diploe, and inner table of 37 cadavers (average age, 59 years) and found each layer to be well preserved distinctly. However, they suggested that calvaria become brittle in patients older than 50 years of age. The current authors hypothesized that diploic composition is not changed, even in the elderly. The thickest part of the parietal bone of 49 Koreans and 30 whites were acquired, and undecalcified slides were made. Via light microscopy, using the National Institutes of Health image, the following measurements were made: the thickness of the parietal bone (PT), outer table (OT), diploe (DT), and inner table (IT); trabecular bone volume percent (TBV); trabecular thickness (TT); and trabecular separation (TS). There was no significant difference in the thickness of the OT, DT, and IT of the PT, TBV, TT, and TS among different ages. The PTs of women were thicker than men's. The PTs of whites were significantly thicker than Koreans'. This study disclosed that the DT is not different among varying age groups and is not sclerosed in the persons older than 80 years, and the OT of these individuals is not brittle. Thus, surgeons do not need to hesitate when taking the OT of the PT in older patients. However, the selection of the site is attentive to PT. The thickest posteromedial part of the PT is favorable and safe as a donor.

Brachycephaly and external pressure

Browsing through some literatures, I happened to find out some records on the rite of imitation of the child's head to brachycephaly. In 1976, two skulls showing extraordinary forms were excavated out of an ancient tomb at Yean village of Daedong township in Kimhae County in Kyungnam Province, the Republic of Korea. The deformation in Yean village is judged to be an intentional frontal flattening. The frontal bone of deformed individuals is remarkably flattened by a primary deforming force. The parietal bone expands laterally and superoposteriorly as a major compensatory growth. The lambdoid or occipital flattening induced by the counterforce is light and unstable. In the facial skeleton, the maxilla shifts downward as a minor compensatory growth. These findings might be substantially correspondent to the custom in the southern area of Korea in the 4th century A.D. paragraphed by Han chuan of Wei-dynasty record, History of the Three Kingdoms. It described that the people gave a pressure onto the child's forehead with stones in order to mold it for preference. Flatheaded meant "free" among the Chinook and Salish tribes of American Indians. Babies of slaves were denied the year-long beauty treatment--a board tied to the infants' padded skull--that permanently flattened the foreheads of tribal members. Referring to these records, I presume that brachycephaly can be induced by direct extrinsic pressure at least until the soft infant's head gets hard.

Endotoxemia augments neurogenic plasma exudation in guinea pig lungs

BACKGROUND

Lipopolysaccharide (LPS) is closely associated with the development of infection-induced deleterious pulmonary reactions. In this study, we investigated the enhancement effects of LPS on tachykinin-mediated plasma exudation in the lungs of guinea pigs. The role of oxidants was also explored.

METHODS

Intravenous LPS (100 mu kg-1) or its vehicle was administered 0 to 3 hours prior to bilateral electrical or sham stimulation of the cervical vagus nerves in animals anesthetized with urethane and artificially ventilated. Plasma exudation into the lungs was assessed by measurement of extravasated 125I-albumin which had been intravenously administered before stimulation.

RESULTS

The plasma exudation in the lungs increased after bilateral cervical vagal stimulation. LPS alone did not induce significant plasma exudation. The vagally-mediated plasma exudation was enhanced by LPS with the peak effect 1 hour after LPS administration. LPS also enhanced exogenous substance P (10(-8) mol kg-1, i.v.)-induced plasma exudation. The vagally-induced plasma exudation was abolished by a specific neurokinin-1 (NK-1) receptor antagonist, L-732,138. The LPS-induced enhancement response was also attenuated by L-732,138. The vagally-induced plasma exudation was not affected by superoxide dismutase (SOD, 5000 U kg-1, i.p.) pretreatment. However, SOD significantly inhibited the LPS-enhanced neurogenic plasma leakage. The LPS-induced enhancement was not completely abolished by either L-732,138 or SOD pretreatment alone, but by a combination of both.

CONCLUSION

LPS augments neurogenic plasma exudation partly through NK-1 receptors to increase vascular permeability and partly via the generation of oxidative metabolites. Tachykinins released from nerve endings may contribute to endotoxin-related pulmonary inflammatory responses.

Purification and embryotropic roles of tissue inhibitor of metalloproteinase-1 in development of "HanWoo" (Bos taurus coreanae) oocytes co-cultured with bovine oviduct epithelial cells

This study was conducted to purify a tissue inhibitor of metalloproteinase (TIMP)-1 in a serum-free medium conditioned with bovine oviduct epithelial cells (BOEC) and to evaluate its effect on development of "HanWoo" (Bos taurus coreanae) embryos to the blastocyst stage. In the first study using SDS-PAGE electrophoresis, the presence of 32 kDa proteins, which contains TIMP-1, was detected in the medium conditioned with BOEC, and TIMP-1 was then purified from the medium by gel filtration and HPLC techniques. When examined TIMP-1 secretion, fluorescent foci indicating the secretion of TIMP-1 were found after stained BOEC with fluorescein isothiocyanate. In the next experiment, two-cell embryos derived from in vitro-fertilization were cultured in a serum-free medium, to which 0, 1.25, 2.5 or 5 microg/ml of purified TIMP-1 was supplemented. More (P<0.05) embryos developed to the morula and blastocyst stages after the addition of 2.5 microg/ml to culture medium than after no addition. In conclusion, our data indicate that BOEC secrete TIMP-1 and this glycoprotein promotes the prehatched development of "HanWoo" embryos derived from in vitro-fertilization.

Barbarin as a new tyrosinase inhibitor from Barbarea orthocerus

A tyrosinase inhibitor was isolated from the whole plant of Barbarea orthocerus Led. (Brassicaceae) by activity-guided fractionation, and identified as (R)-5-phenyl-2-oxazolidinethione (barbarin) by structural analysis followed by comparison with reported spectral data. The compound exhibited significant inhibitory effects on mushroom and murine tyrosinases at more than 1.6 x 10(-5) M. Barbarin exhibited IC50 values of 4.2 x 10(-5) M on mushroom tyrosinase and of 4.8 x 10(-5) M on murine tyrosinase. Kojic acid as a positive control exhibited IC50 values of 3.4 x 10(-5) M and 6.0 x 10(-5) M on mushroom and murine tyrosinases, respectively. Therefore, barbarin exhibited a similar level of inhibitory potency with kojic acid used as a positive control. In a kinetic study with various concentrations of L-dopa as the substrate, barbarin was identified as an uncompetitive inhibitor and kojic acid as a mixed inhibitor of both mushroom and murine tyrosinases. Barbarin exhibited KEIS values of 3.3 x 10(-5) M and 3.6 x 10(-5) M on mushroom and murine tyrosinases, respectively. Kojic acid exhibited KEIS and KEI values of 2.4 x 10(-5) M and 2.2 x 10(-5) M on mushroom tyrosinase and those of 8.9 x 10(-5) M and 7.2 x 10(-5) M on murine tyrosinase, respectively.

Tenosynovial giant cell tumor of finger, localized type: a case report

The authors report a typical case of tenosynovial giant cell tumor of the right middle finger of a 31-year-old man. Histologically, this tumor is characterized by a discrete proliferation of rounded synovial-like cells accompanied by a variable number of multinucleated giant cells, inflammatory cells, and xanthoma cells. Clinicopathologically, this tumor is a benign lesion that nonetheless possesses a capacity for local recurrence. Local excision with a small cuff of normal tissue is the treatment of choice in this tumor.

Reduction of zygomatic arch fracture using a towel clip

The authors describe a simple technique for reducing zygomatic arch fractures with a towel clip. The orbital rim and zygomatic arch are outlined with a marking pen. The exact fracture site is then marked by palpation. The depressed fracture site is held with a towel clip and pulled outward gently. A clicking noise may be heard. The clip is then released. The contour of the zygomatic arch is compared with the other side. Using this technique the authors reduced 11 fractured zygomatic arches (arch only, displaced medially) in 11 patients and the results were satisfactory in all patients. The towel clip method is one procedure to reduce zygomatic arch fracture.

The thickness of the skull in Korean adults

New instrumentation and techniques for skeletal fixation have been developed in response to concerns regarding variability of the skull base and the calvaria. The fear of intracranial penetration has limited the use of internal or external fixation to the skull base and the calvaria. Despite potential clinical usefulness, limited anthropometric data have been reported on the skull base and the calvaria. The purpose of this study was to measure the average thickness of various points of the skull base and the calvaria of Korean adults. Fifty-one Korean adult skull bases and calvaria, which were cut 2 cm above the supraorbital margin anteriorly and 2 cm above the inion posteriorly, were measured in this study. Thickness of 13 clinically important points were measured with a Teclock GM-21 Calipergauge (Teclock Co., Tokyo, Japan). The mean thickness of the two opposite sides were compared using paired t-tests. They did not differ significantly from the others except for three points. Frontal bone A (located 1 cm above the supraorbital margin and 1.5 cm lateral to the midline) was 6.35 +/- 2.88 mm, frontal bone B (located at the midpoint of the frontal midpoint and the frontoparietal suture on the cut edge) was 5.24 +/- 1.50 mm, frontal bone C (located at the midpoint of the vertex and frontal bone B) was 6.63 +/- 1.77 mm, the pterion was 3.19 +/- 0.85 mm, the midpoint of the squamous temporal was 1.96 +/- 0.65 mm, parietal bone A (located 1.5 cm below the middle meningeal groove) was 3.99 +/- 1.11 mm; parietal bones B and C (divided at the distances between the frontoparietal suture and the occipital midpoint with a ratio of 1:3 and 2:3 respectively on the cut edge) were 4.71 +/- 1.06 mm and 5.35 +/- 0.91 mm respectively, occipital bone A (located 1.5 cm posterolateral from the foramen magnum) was 2.31 +/- 1.00 mm, occipital bone B (located 1.5 cm lateral to the midline and 0.5 cm above the inion) was 5.41 +/- 1.50 mm, occipital bone C (located occipital to the midpoint and 2 cm above the inion) was 8.2 +/- 1.67 mm, the orbital roof was 1.37 +/- 1.08 mm, and the orbital lateral wall was 2.25 +/- 1.06 mm. The data give practical information for determining the position and depth for safe and effective internal or external fixation during craniofacial procedures.

Alteration of the NAD+/NADH ratio in CHO cells by stable transfection with human cytosolic glycerol-3-phosphate dehydrogenase: resistance to oxidative stress

The intracellular level of the NAD+/NADH ratio plays a vital role in sustaining and coordinating the catabolic reaction of the cell, and reflects the redox state of cytosol. Antioxidants play a role to protect cytosol and membrane from free radicals. This role of antioxidants involves sustaining cell viability and the procedure is thought to be regulated by the equilibrium of the redox state of the cell. However, there is very little known about how the NAD+/NADH level is set and changed. To alter the ratio, human NAD-dependent glycerol-3-phosphate dehydrogenase (cGPDH) cDNA was transfected stably in CHO dhfr- cells. When compared to parental CHO cells, cGPDH activities of the transfected cells were increased 8-12 fold, but the NAD+/NADH ratio was decreased. Specific growth rate of the transfected cells was similar to or slight lower than that of wild type CHO cells. Cell viability of the stable transformants against H2O2 was increased without change of either catalase or glutathione peroxidase activity. However, the increase of cell viability was correlated with the decrease of NAD+/NADH ratio in transfectants. From these results, it is suggested that the overexpression of cGPDH changes the NAD+/NADH ratio toward a decrease, and by this change in the redox state the cell confers more resistance against H2O2.

Impact of nicotine on bone healing

A limited number of experimental animal studies and in vitro data confirm that nicotine impairs bone healing, diminishes osteoblast function, causes autogenous bone graft morbidity, and decreases graft biomechanical properties. Therefore, our long-term goal is to develop an effective therapy to reverse the adverse impact of nicotine from tobacco products. However, before accomplishing this goal, we had to develop an animal model. Our hypotheses were nicotine administration preceding and following autogenous bone grafting adversely affected autograft incorporation and depressed donor site healing in a characterized animal wound model. Hypothesis testing was accomplished in bilateral, 4-mm diameter parietal bone defects prepared in 60 Long-Evans rats (male, 35-day-old). A 4-mm diameter disk of donor bone was removed from the left parietal bone and placed in the contralateral defect. The donor site served as a spontaneously healing bone wound. The rats were partitioned equally among three doses of nicotine administered orally in the drinking water (12.5, 25, and 50 mg/L). For each dose, the duration and sequence of nicotine treatment followed four courses, including no nicotine and designated combinations of nicotine administration and abatement prior to and following osseous surgery. Experimental sites were recovered on 14 and 28 days postsurgery, responses quantitated, and data analyzed by analysis of variance and post hoc statistics (p < or = 0.05). We developed a convenient and effective osseous model, and the results validated our hypothesis that nicotine negatively impacts on bone healing.

Attachment of the deep temporal fascia to the zygomatic arch: an anatomic study

It is generally acknowledged that the superficial layer of the deep temporal fascia attaches to the lateral surface and its deep layer along the medial surface of the zygomatic arch. However, Ramírez asserts that the superficial and the deep layer of the deep temporal fascia fuse consistently approximately 1 cm above the upper ridge of the arch and attach to the outer surface of the arch, blending with the superficial fascia of the masseter muscle. In this study the authors clarify the precise anatomic relations between the fascia and the zygomatic arch. Coronal sections crossing the midpoint between the zygomaticotemporal suture and the tubercle of zygoma were observed grossly and histologically in 32 hemifaces from 16 Korean adult cadavers. This study demonstrates that the superficial and the deep layers of the deep temporal fascial fuse and insert onto the superior margin of the arch in 18 dissections (56%) and insert onto the superolateral surface in 14 dissections (44%). The contacting surface of the fused deep temporal fascia to the periosteum of the zygomatic arch is less than 2 mm. The following route is safer and is recommended for reaching the zygomatic arch region: Just above the split of the deep temporal fascia, a dissection is carried through the deep temporal fasica, continuing downward to the superior margin of the arch along the undersurface of the fascia. At this spot the periosteum of the arch is dissected.

Impact of nicotine on bone healing

A limited number of experimental animal studies and in vitro data confirm that nicotine impairs bone healing, diminishes osteoblast function, causes autogenous bone graft morbidity, and decreases graft biomechanical properties. Therefore, our long-term goal is to develop an effective therapy to reverse the adverse impact of nicotine from tobacco products. However, before accomplishing this goal, we had to develop an animal model. Our hypotheses were nicotine administration preceding and following autogenous bone grafting adversely affected autograft incorporation and depressed donor site healing in a characterized animal wound model. Hypothesis testing was accomplished in bilateral, 4-mm diameter parietal bone defects prepared in 60 Long-Evans rats (male, 35-day-old). A 4-mm diameter disk of donor bone was removed from the left parietal bone and placed in the contralateral defect. The donor site served as a spontaneously healing bone wound. The rats were partitioned equally among three doses of nicotine administered orally in the drinking water (12.5, 25, and 50 mg/L). For each dose, the duration and sequence of nicotine treatment followed four courses, including no nicotine and designated combinations of nicotine administration and abatement prior to and following osseous surgery. Experimental sites were recovered on 14 and 28 days postsurgery, responses quantitated, and data analyzed by analysis of variance and post hoc statistics (p < or = 0.05). We developed a convenient and effective osseous model, and the results validated our hypothesis that nicotine negatively impacts on bone healing.

Bone morphogenetic proteins: an update on basic biology and clinical relevance

The regeneration of bone is a remarkable, complex physiological process, and BMPs are a formidable clinical tool to promote its regeneration. By defining roles played by BMPs in developmental biology and bone regeneration, significant progress has been made to identify cell-signaling molecules and their regulators. For example, the regulators of BMPs that include noggin, chordin, cerberus, dan, and gremlin may be harnessed as therapies to offset calcification encountered after total hip arthroplasties. Furthermore, exploiting BMPs and Smads may generate new therapeutic options for bone repair. Another compelling clinical consideration is the trans-acting factor osteoblast-specific factor-2, which can promote osteoblast differentiation. Moreover, the affiliation of osteoblast-specific factor-2 with heritable disorders merits exploration. A recognized daunting challenge includes a carrier/delivery system for the powerful morphogenetic therapeutic tools, as well as osteoprogenitor cells and intracellular transduction and transcriptional factors. In addition, the long-term effects of administering superphysiological doses of rhBMPs to patients must be assessed systematically. A new generation carrier/delivery system may be the answer to offset dosing liabilities as well as to provide residence for exogenous, BMP-receptive osteoprogenitor cells (111,112). The areas highlighted in this review offer fertile territory for thought and research to develop rational clinical treatments to promote bone regeneration and to understand some of the biological roles of BMPs.

Surgical anatomy of the orbit of Korean adults

When operating in and around the orbit, the key to a successful result is precise anatomical localization. However, there is no precise study about the localization of vital orbital structures from reliable periorbital bony anatomy of the Korean adult. This study was constructed to give pertinent anatomical measurements to which the plastic and maxillofacial surgeon may refer. The 82 orbits obtained from 41 skulls of adult Koreans were measured with Vernier calipers and Marshac calipers. Superiorly, the supraorbital fissure was 40.0 +/- 2.5 mm from the supraorbital notch. Medially, the posterior ethmoidal foramen was 31.7 +/- 3.0 mm from the anterior lacrimal crest. Inferiorly, the infraorbital fissure where the infraorbital groove started was 26.4 +/- 2.6 mm from the infraorbital foramen. Laterally, the supraorbital fissure was 34.3 +/- 2.7 mm from the frontozygomatic suture. These distances are suggested as appropriate safe distances from each periorbital bony landmark. Dissection beyond that distance should be done with great caution.

An anatomical study of the junction of the orbital septum and the levator aponeurosis in Orientals

The anatomical relationships of the orbital septum and levator aponeurosis has been studied in 40 eyelids subjected to blepharoplasty and corrective ptosis surgery by dissection in 10 cadavers and in histological sections. The orbital septum originates from the arcus marginalis of the frontal bone and consists of two layers. The whitish outer (superficial) layer, containing vertically running vessels, descends just inside the orbicularis oculi muscle to interdigitate with the levator aponeurosis with loose connective tissue, then disperses inferiorly. The inner (deep) layer follows the superficial one initially, then reflects at the levator aponeurosis and continues posteriorly with the levator sheath. We reconfirmed Whitnall's original description that the levator sheath thickens to form the superior transverse ligament runs continuously inferiorly anterior to the levator aponeurosis and forms the inner layer of the orbital septum. This detailed anatomical analysis should assist in performing upper eyelid surgery such as the Oriental double fold operation or levator resection.

Lipopolysaccharide enhances neurogenic plasma exudation in guinea-pig airways

1. Lipopolysaccharide (LPS) is implicated in many pulmonary and airway inflammatory diseases. Tachykinins released from nerve endings increase vascular permeability. In this study, we have assessed the enhancement by LPS of tachykinin-mediated plasma exudation in guinea-pig airways, and examined the role of oxidants as well as leukocyte adherence. 2. LPS (100 microg kg(-1), i.v.) was administered 0-3 h before bilateral electrical stimulation of the cervical vagus nerves in animals anaesthetized with urethane and ventilated. Vagal stimulation increased vascular permeability in the airways. LPS enhanced the vagally-mediated plasma exudation with the peak effect at 1 h after LPS administration. LPS alone induced no significant plasma exudation. LPS also enhanced exogenous substance P (10(-8) mol kg(-1), i.v.)-induced plasma exudation. 3. The NK-1 receptor antagonist L-732,138 abolished vagally-induced plasma exudation and significantly inhibited the enhancement by LPS. Pretreatment with superoxide dismutase (SOD, 5000 U kg(-1), i.p.) did not affect the vagally-induced plasma exudation, but inhibited the LPS-enhanced neurogenic plasma leakage. The LPS-enhanced vagally-induced plasma exudation was not completely inhibited by either L-732,138 or SOD pretreatment alone, but was blocked by the combination of both pretreatments. 4. Neutrophil depletion by cyclophosphamide alone did not influence vagally-induced plasma exudation, but significantly inhibited the LPS-enhanced response. 5. In conclusion, we have demonstrated LPS enhanced neurogenic plasma exudation by augmenting the response to tachykinins, partly through NK-1 receptors, to directly increase vascular permeability or to enhance leukocyte adhesion-mediated endothelial cell injury. Tachykinins released from nerve endings may contribute to endotoxin-related airway inflammatory responses.

Appendiceal CT in 140 cases. Diagnostic criteria for acute and necrotizing appendicitis

Computed tomography (CT) was performed in 140 patients with suspected acute appendicitis. Thin collimation (5 mm), intravenous contrast enhancement, 1-second scan times, and supplementary cecal air insufflation were emphasized. CT accuracy was 98% overall (137/140), and 99% in the 124 cases with early surgery. Necrotizing appendicitis was diagnosed by CT with 86% accuracy and 90% positive predictive value.

Distribution of hairs and sweat glands on the bodies of Korean adults: a morphometric study

A morphometric study was made of the number of sweat glands and hairs per square centimeter of skin on different body regions of Korean adults. For this purpose, samples of skin from 30 body regions were obtained by punch biopsy from 74 cadavers of Korean adults. Serial transverse sections that extended through the papillary layer of the dermis were prepared in each case and subjected to routine histological staining. Sections of skin were examined under low magnification and the sweat ducts and hair follicles in each section were counted and recorded in terms of the number per square centimeter of skin. Arithmetic means and standard deviations for each region were also obtained for comparison of the densities of distribution. The soles (male) and the palms (female) were the regions of most densely distributed sweat glands while the mammary area in both sexes was the region of lowest density. Hairs were distributed most densely in the buccal region in males and on the mental (chin) region in females. The region of lowest density of hairs was the dorsum of the middle phalanx of the fingers in both sexes. Seven regions of the body exhibited significant sexual dimorphism in terms of the density of sweat glands while only four regions showed significant sexual dimorphism in terms of the density of hairs. Hairs appeared to be more densely distributed in the buccal regions of females than of males. However, the density of hairs in the dermis was not always proportional to the density of visible hairs.

Effect of endogenous nitric oxide on tumour necrosis factor-alpha-induced leukosequestration and IL-8 release in guinea-pigs airways in vivo

1. Tumour necrosis factor-alpha (TNF-alpha) is implicated in the pathogenesis of many pulmonary and airway diseases. TNF-alpha stimulation may release interleukin-8 (IL-8) in airways mediated via an increase in intracellular oxidant stress. In the present study, we have assessed leukosequestration and IL-8 release in the airways in response to intratracheal administration of human recombinant TNF-alpha, and examined the modulatory role of endogenous NO by pretreatment with a NO synthase inhibitor N(omega)-nitro-L-arginine methyl ester (L-NAME). 2. TNF-alpha (10(2)-10(-4) u) was administered intratracheally in male guinea-pigs which were anaesthetized with urethane and were ventilated artificially. TNF-alpha induced a time- and dose-related increase in neutrophil numbers and a concomitant increase in human IL-8 equivalent level retrieved from bronchoalveolar lavage (BAL) with the peak effect at 10(3) u at 6 h of TNF-alpha injection (late phase). Intratracheal administration of recombinant human (rh)IL-8 (0.025, 0.25, 2.5 ng) producing a similar range of human IL-8 equivalent levels in BAL as measured in our results induced neutrophil recovery in BAL fluid to a similar extent. Administration of anti-IL-8 antibody prevented the late phase of neutrophil recruitment induced by TNF-alpha or rhIL-8. 3. Pretreatment with L-NAME significantly enhanced the TNF-alpha (10(3) u)-induced neutrophil recruitment and human IL-8 equivalents production at 6 h, but not at 1 h of TNF-alpha administration (early phase). L-Arginine reversed the responses to L-NAME. Pretreatment with 0.2% DMSO (i.v.) significantly inhibited TNF-alpha-induced neutrophil recruitment and human IL-8 equivalents release both in the early and late phase of the responses. Pretreatment with DMSO also inhibited the enhancement effect of L-NAME on the late phase of TNF-alpha-induced responses. DMSO failed to modify exogenous rhIL-8-induced neutrophil recruitment. Neither L-NAME nor DMSO alone induced any significant change in neutrophil numbers or human IL-8 equivalent level in BAL fluid. 4. Neutrophil depletion by cyclophosphamide pretreatment failed to modify TNF-alpha-induced human IL-8 equivalent release. 5. The expression of beta 2-integrin, CD11b/CD18 on neutrophils was increased only in the late but not early phase of TNF-alpha stimulation. L-NAME failed to modify these responses. 6. In conclusion, we demonstrated that NO may be an important endogenous inhibitor of TNF-alpha-induced leukocyte chemotaxis via inhibition of IL-8 production. Thus, the production of NO in airway inflammatory diseases may play a negative feedback role in self-limiting the magnitude of inflammatory responses.

A thickness map of iliac bone of Korean adults

The iliac bone is one of the most common donor sites for bone graft. Despite such potential and clinical usefulness, the anthropometric data on the iliac bone are lacking. The purpose of this study is to construct a thickness map that provides the mean iliac bone thickness of its various points and their differences. We studied 58 hip bones (from 23 males and 35 females) from Korean adults. We measured the iliac bone thickness at 26 points, which were positioned at regular intervals on each given iliac bone, using a Techlock GM 21 caliper gauge. The mean thickness of each measuring point of the male and the female, and of the right and the left, was compared with each other through paired t-test; the measurements did not differ significantly. From the anteriorposterior perspective, the region between anterior superior iliac spine (ASIS) and iliac tubercle was relatively thick. However, it became progressively thinner before it reached the sacroiliac articulation. It became thicker again toward the posterior superior iliac spine (PSIS), the thickest area. From the superoinferior perspective of superior iliac crest and inferior acetabulum, the thickness became inferiorly thinner in the anterior part between ASIS and iliac tuberosity. However, in the posterior part between the sacroiliac joint and PSIS, there was no significant difference of thickness. We hope that our thickness map can serve as a practical guide to the choice of an ideal site of the iliac bone for bone graft to obtain desired thickness.

Thickness map of parietal bone in Korean adults

The parietal bone remains the most common donor site for a bone graft in treating facial bone fractures, especially those involving orbital walls. Despite this potential clinical usefulness, anthropometric data on the parietal bone is lacking. Only one Korean and a few foreign studies report on its thickness, measured at two and three points of each of two parietal bones in a given subject, respectively. These studies, however, fall short of offering enough information for locating the optimal harvest point of the parietal bone for bone grafting. This study was thus aimed at constructing a thickness map that provides the mean parietal bone thickness at various points and determines the difference between them. Eighty-eight parietal bones were obtained from 44 Korean adult skulls for this study. Parietal bone thickness was measured at 15 points, spaced at regular intervals on each parietal bone of a given skull, using a Techlock GM 21 caliper gauge. The mean bone thickness at each of the 15 points of the bone and at the corresponding points of the opposite parietal bone was obtained in all skulls studied. The mean thickness at each point of measurement on two opposite parietal bones was compared using the paired Student's t test. Mean thickness did not differ significantly. The thickness in the same bone varied widely depending on the points of measurement. The thickest part, the posteromedial region of the parietal bone near the lambda, was 6.67 +/- 1.41 mm (mean +/- standard deviation [SD]) thick, and it became thinner toward the diagonal (anterolateral) direction, to the thinnest part, 4.73 +/- 1.19 mm (mean +/- SD) thick, near the pterion. It is hoped that our thickness map can serve as a practical guide for choosing an ideal site on the parietal bone for a bone graft of desired thickness.

Intracellular distribution of selenium and the growth of mammary cells in culture

Retention of Se in CMT-13 cells increased with an increase in the concentration of selenite in the incubation medium, the duration of exposure, and the density of the culture. The enhanced toxicity of selenite coincided with a proportional increase in Se in both the cytoplasm and nucleus. About 90% of the accumulated Se was isolated with cytoplasmic macromolecules. Increased nuclear Se retention correlated with increased cytoplasmic Se retention. Greater quantities of cytosolic Se-containing proteins (74, 55, 41, 34, and 28 kDa) and a nuclear Se-containing protein (56 kDa) were detected as the quantity of Se within CMT-13 cells increased. These findings suggest that cellular retention and distribution of Se are determinants of the degree of cellular growth inhibition caused by this trace element.

Discrepancy of recovery times related to potency between atracurium and mivacurium simultaneously administered in isolated forearms

Recovery from potent non-depolarising muscle relaxants is slower than from the less potent agents. However, recovery from mivacurium, which is more potent than atracurium, is faster than from atracurium following systemic administration. In an attempt to confirm this discrepancy we compared recovery times following simultaneous administration of equipotent doses of atracurium and mivacurium into the isolated forearms of human volunteers (n = 10). This method enabled us to study the interaction of muscle relaxants with receptors at the neuromuscular junction separated from the effects of plasma drug concentration. In these experiments, the recovery times from maximum block to 50% recovery of control twitch height were significantly longer with mivacurium than with atracurium (mean 25.2(SD 4.7) versus 22.6(3.1) min, p < 0.01). We found that the evidence that mivacurium has a slower recovery than the less potent atracurium may be true using the bilateral, isolated forearm technique and that the discrepancy might be due to a difference in the pharmacokinetic variables of the two drugs.

Neuromuscular and hemodynamic effects of mivacurium and succinylcholine in adult patients during nitrous oxide-propofol-fentanyl anesthesia

The neuromuscular and hem+odynamic effects of mivacurium 0.15 mg/kg and succinylcholine 1 mg/kg were compared in 26 adult patients (ASA I and II) during nitrous oxide-oxygen-propofol-fentanyl anesthesia. Neuromuscular block was monitored by recording the compound electromyogram of the hypothenar muscle resulting from supramaximal train-of-four stimuli applied to the ulnar nerve. Time to onset of over 95% block and duration to 25% recovery of control twitch after injection of mivacurium were significantly longer than for succinylcholine (201 +/- 37.6 vs 54 +/- 5.2 sec and 13.0 +/- 2.2 vs 8.4 +/- 2.1 min; mean +/- SD). Onset of mivacurium with priming technique was shortened (125 +/- 20.7 sec), but was also slower than that of succinylcholine. Although the recovery index during spontaneous recovery was significantly longer for mivacurium than for succinylcholine (6.9 +/- 1.3 vs 5.1 +/- 0.9 min), antagonism with neostigmine at 25% recovery of twitch height sufficiently facilitated the recovery index of mivacurium (4.5 +/- 1.0 min) to a level similar to that of succinylcholine with no statistical difference. The hemodynamic effects of mivacurium were few as compared to those of succinylcholine. In conclusion, mivacurium is considered to have additional advantages for short procedures when succinylcholine is undesirable.

Complete congenital duplication with incomplete separation of a lower extremity

A case of a boy with complete duplication of the lower extremity and separation below the lower leg was described. Although x-ray examination revealed no femur, operation revealed a cartilage expected to become the femur in the future. A classification of duplication and separation of the lower extremity is proposed. The method and course of treatment in the present case were described in detail, including the application of tissue expanders on the deformity of the knee joint accompanied by a shortening of the sciatic nerve.

Transplantation of long-term cryopreserved allocutaneous tissue by skin graft or microsurgical anastomosis: experimental studies in the rat

A step-wise method of freezing cutaneous soft tissue containing vessels to -196 degrees C for permanent preservation was developed. The methods of embryo cryopreservation were modified for soft-tissue preservation. Cutaneous tissue obtained from the abdominal wall of a Lewis rat was preserved for more than 3 weeks by this method and was then transplanted to a Brown Norway rat with the largest difference in major histocompatibility complex. Rejection reaction against the epidermal layer was markedly delayed, followed by a decrease in antigenicity of the dermis, with survival of the majority of the tissue for more than 6 months. A concept of artificial skin was formed based on these experimental results. A skin flap from the abdominal wall with a vascular pedicle consisting of the femoral artery and vein was similarly preserved and transplanted by vascular anastomosis. This transplant was made viable over a long period through the additional use of an immunosuppressant. Replantation of a rat hindleg also was successfully accomplished by using a skin flap from the abdominal wall with a vascular pedicle consisting of the femoral artery and vein, which had been cryopreserved for more than 3 weeks. These results with 65 pieces in five different treatment groups indicate the reliability of this method of preservation in maintaining the tissue in a state adequate for transfer without loss of viability over a long period. The applicability of this method of allograft preservation to the field of free-tissue transfer combined with microsurgical technique may introduce a new concept to the field of reconstructive surgery in the future. According to the results of the present experiment, the great potential for clinical application is described for the deepithelialized cryopreserved allocutaneous flap transfer.

Identification and characterization of a coronavirus packaging signal

Previously, a mouse hepatitis virus (MHV) genomic sequence necessary for defective interfering (DI) RNA packaging into MHV particles (packaging signal) was mapped to within a region of 1,480 nucleotides in the MHV polymerase gene by comparison of two DI RNAs. One of these, DIssF, is 3.6 kb in size and exhibits efficient packaging, whereas the other, DIssE, which is 2.3 kb, does not. For more precise mapping, a series of mutant DIssF RNAs with deletions within this 1,480-nucleotide region were constructed. After transfection of in vitro-synthesized mutant DI RNA in MHV-infected cells, the virus product was passaged several times. The efficiency of DI RNA packaging into MHV virions was then estimated by viral homologous interference activity and by analysis of intracellular virus-specific RNAs and virion RNA. The results indicated that an area of 190 nucleotides was necessary for packaging. A computer-generated secondary structural analysis of the A59 and JHM strains of MHV demonstrated that within this 190-nucleotide region a stable stem-loop of 69 nucleotides was common between the two viruses. A DIssE-derived DI DNA which had these 69 nucleotides inserted into the DIssE sequence demonstrated efficient DI RNA packaging. Site-directed mutagenic analysis showed that of these 69 nucleotides, the minimum sequence of the packaging signal was 61 nucleotides and that destruction of the secondary structure abolished packaging ability. These studies demonstrated that an MHV packaging signal was present within the 61 nucleotides, which are located on MHV genomic RNA 1,381 to 1,441 nucleotides upstream of the 3' end of gene 1.

Culture of endothelial cells from baboon and human glomeruli

Whereas mesangial and epithelial cells from glomeruli are commonly grown in vitro, there has been a failure to isolate and propagate human glomerular capillary endothelial cells. This study defines the conditions for the reproducible isolation and growth of homogeneous monolayers of primate (baboon and human) glomerular capillary endothelial cells. Using selective media and growth factors, the following criteria were identified to optimize the isolation and proliferation of glomerular endothelial cells: (1) collagenase treatment of isolated glomeruli; (2) requirement for 20% serum, endothelial cell growth factor and heparin; (3) requirement of fibronectin as surface matrix; and (4) isolation from donors less than 60 years old, as premature senescence was directly proportional to the age of the human kidney donor. Under these conditions, primary cultures with an endothelial cell composition greater than 70% were reproducibly obtained. Homogeneous endothelial monolayers were developed from 20 of 23 human kidneys, and maintained for 5 to 10 passages, depending on the age of the kidney donor. Purification to homogeneity was achieved by patch cloning or by fluorescence-activated cell sorting. Glomerular capillary endothelial cells exhibited a cobblestone morphology at confluence, expressed factor VIII-related antigen, angiotensin converting enzyme activity, and endocytosed acetylated low-density lipoproteins. Electron microscopy revealed the presence of intracellular Weibel-Palade bodies and caveolae and microvillous projections on the luminal surface. Glomerular cells also stained positive for Ulex europaeus, a lectin characteristic of human endothelial cells. In addition, preliminary results indicate that human glomerular endothelial cells increase intracellular cyGMP in response to alpha-human 5 to 28 atrial natriuretic peptide and intracellular free calcium in response to thrombin.

Primary amino acid sequence of alpha-trichosanthin and molecular models for abrin A-chain and alpha-trichosanthin

Ricin A-chain, abrin A-chain, and alpha-trichosanthin are members of a larger group of proteins called ribosome-inactivating proteins. These proteins all function to catalytically inactivate eukaryotic 60 S ribosomal subunits leading to rapid shutdown of protein synthesis. They are homologous in sequence and are probably evolutionarily related. We have determined the complete primary amino acid sequence of alpha-trichosanthin and have found it to be homologous, as expected, to that of abrin A-chain and ricin A-chain. A crystal structure for ricin, which includes ricin A-chain and ricin B-chain, has been determined from x-ray diffraction data. Based on the sequence homologies of these proteins, we fit the primary sequences of abrin A-chain and alpha-trichosanthin to the backbone structure for ricin A-chain and have generated energy-minimized molecular models for them. These models should prove useful in studying the structural-functional relationships of these proteins in particular and of the class in general.

Dynamic Electrical and Electromechanical Properties of Carbon-Black Loaded Rubber

1. Low-frequency resistance can be dominated by contacts. It was found that silver paint contacts were roughly equivalent to metal contacts bonded during vulcanization. 2. Three electrical regimes are clearly evident, determined by loading: dielectric, percolation, and conducting. 3. Resistance and dielectric constant dispersion for loading above 30 phr agree with Kawamoto's model. 4. Each carbon-black loading results in a distinctive dispersion signature. 5. Dynamic conductivity can be used to delineate persistent and transient carbon-black-structure changes versus composition, DSA, frequency, and potentially other parameters (temperature, stress waveform, etc.). 6. The remaining conductive network during stress is represented by gmin; Δg is determined by network fracture and reformation; gmin−gα is proportional to the amount of remaining transient structure; g0−gα is proportional to the total transient structure; normalized conductivity Z is the remaining-to-total transient-structure ratio. 7. The Δgm=0.525(g0−gα) relation indicates that maximum reformation occurs when approximately half the transient structure is broken down and confirms the correlation between conductivity parameters and transient carbon-black structure.

Renal function of baboons (Papio hamadryas) with a remnant kidney, and impact of different protein diets

To assess progression of renal disease and the effects of protein intake in a species phylogenically close to man, 10 young adult baboons (Papio hamadryas) were subjected to 20 to 30% infarction of the left kidney and, two months later, to right nephrectomy. They were then randomized to a synthetic diet containing either 8% or 25% protein. Hemodynamic and metabolic measurements were obtained in awake animals every four months. Baseline mean blood pressure, inulin clearance, protein and urea nitrogen excretion in intact animals on 15% protein averaged 75.5 +/- 3.5 (SE) mm Hg, 42.9 +/- 2.7 ml/min, 52 +/- 4.3 mg/24 hr, and 3.8 +/- 0.4 g/24 hr, respectively. At 12 months, values in the same baboons with a remnant kidney on 8% versus 25% protein averaged 100.6 versus 96.7 mm Hg, 29.2 versus 54.9 ml/min (P less than 0.01), 111 versus 108 mg/24 hr, and 3.4 versus 11.0 g/24 hr (P less than 0.001), respectively. Electron microscopic examination of renal biopsies obtained eight months after nephrectomy was normal but for slightly increased mesangial matrix in three animals. Thus, blood pressure increased (P less than 0.01), proteinuria doubled (P less than 0.01) and adaptations in GFR developed within four months of renal mass reduction, without significant changes occurring between four and 12 months. The adaptations in GFR were markedly attenuated by low protein intake. Further follow-up is necessary to assess progression of renal disease and the impact of different protein diets.

Coronary blood flow and thallium 201 uptake in rejecting rat heart transplantations

The effects of rejection on coronary flow (CAF) in heart allografts are unclear, although previous evidence with cardiac imaging agents indicates impaired flow during advanced rejection. The purpose of this study was to measure CAF in heterotopically placed heart grafts. Lewis rats (LEW) received grafts from either syngeneic Lewis rats (LEW/LEW group) or allogeneic ACI rats (ACI/LEW group). CAF was measured in both the transplanted and native hearts with radiolabeled microspheres. Rejection was measured histologically (grades 0 [absent] to 4+ [severe]). In addition systemic blood pressure and cardiac outputs of the native hearts were determined with microspheres. Different animals were studied during relatively early (4 days) and late (6 days) rejection. Among the 4-day animals a cyclosporine-treated group was included (ACI/LEW CyA). In 6-day rats CAF in allografts was lower (0.56 +/- .06 ml/gm/min) compared with syngeneic grafts (1.72 +/- 0.4 ml/gm/min) (p less than 0.05). The CAF in the native hearts did not differ significantly but was higher than in the grafts in both groups. Heart rates were reduced in allografts (p less than 0.05). It is interesting that arterial pressure and cardiac output were significantly lower in animals bearing allogeneic than syngeneic grafts. In rats studied at 4 days graft CAF was lower than in the native heart in both the LEW/LEW and ACI/LEW groups, but there was no significant difference in behavior between groups. The same was true for a cyclosporine-treated group. Graft heart rates were similar in all 4-day rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Glomerular filtration rate and blood pressure monitoring in awake baboons

Minimally invasive techniques were used to collect urine with an external catheter together with automated intermittent monitoring of arterial blood pressure in awake male baboons. Using endogenous creatinine, 24-hour creatinine clearances were measured for 2 to 3 consecutive days in four intact and in four uninephrectomized baboons. Despite large differences in urinary volume and sodium excretion, reproducibility of 24-hour creatinine clearances was within 15% in 15 of 19 studies obtained from 6 of 8 animals. Arterial blood pressure was monitored intermittently at 30 to 60 minute intervals over 24 hours with a Dinamap monitor and recorder. Mean blood pressure averaged 71 +/- 4.4 to 89 +/- 5.5 mm Hg in different animals. Blood pressure tended to be lower at night than during the day. In separate studies using 15 to 60 minute urine collection periods, inulin clearance was compared in awake and in anesthetized animals with endogenous or exogenous creatinine clearance measured simultaneously. The clearance of creatinine systematically exceeded the clearance of inulin, even in intact animals with a normal serum creatinine. The creatinine-to-inulin clearance ratio averaged 1.16 +/- 0.03 at a serum concentration of 0.7 to 0.8 mg/dl; 1.27 +/- 0.03 at a serum creatinine of 1.0 to 1.1 mg/dl and 1.56 +/- 0.04 at a serum creatinine greater than 10 mg/dl. All values exceed unity significantly (p less than 0.001). Thus, renal function, including inulin clearance, can be measured in awake baboons. Duplicate or triplicate 24-hour urine collections are needed to assess the reliability of creatinine excretion. However, creatinine clearance overestimates glomerular filtration rate, as it does in humans.

Calcium regulation in vascular smooth muscle contractility

The contractile activity of vascular smooth muscle is regulated by control over the cytoplasmic calcium concentration. The intracellular calcium receptor is calmodulin, which, through stimulation of myosin light chain kinase, can activate 2 different contractile states. The calcium is supplied from the sarcoplasmic reticulum and the extracellular space; a minor component is supplied from the inner surface of the plasmalemma. The main intracellular messenger responsible for the transduction of receptor occupation and calcium release from the sarcoplasmic reticulum is IP3 and, to a lesser extent, calcium itself. The superficial location of the sarcoplasmic reticulum in vascular smooth muscle makes it the logical area for control of calcium entry due to calcium leak or through either or both types of calcium channel. The sarcoplasmic reticulum, therefore, acts as a "superficial calcium buffer barrier" and is probably the major system controlling free cytoplasmic calcium concentration in vascular smooth muscle.

Renal effects of atrial natriuretic factor in primate

Baboons (Papio hamadryas) were infused intravenously with a nonhypotensive dose (0.1 microgram X min-1 X kg-1) of synthetic human atriopeptin III (ANF) for 60 min. Throughout the infusion in intact animals, ANF significantly increased glomerular filtration rate (GFR) (clearance of inulin) (P less than 0.001), and, to a lesser extent, total renal plasma flow (RPF) [clearance of p-aminohippurate (PAH)] (P less than 0.02) and filtration fraction (P less than 0.02). Concomitant increases in urinary flow rate and in the excretion of osmoles, sodium, chloride, potassium, phosphorus, and calcium were highly significant (less than 0.001 for all). To minimize the hemodynamic impact of ANF on GFR, the same dose of ANF was infused into the same animals 8 wk after uninephrectomy. Base-line single-kidney GFR was then 50% increased. With ANF infusion RPF increased significantly (P less than 0.02), as in intact baboons, but ANF then had only marginally significant effects on GFR (P = 0.06) and insignificant effects on filtration fraction (P = 0.17). Nevertheless, the changes in urinary flow rate and solute excretion rates were highly significant (P less than 0.001 to less than 0.007). In both groups, all changes developed rapidly, were sustained during the infusion of ANF, and were readily reversible within 15 to 30 min of cessation of ANF infusion. The data dissociate in uninephrectomized primate the effects of ANF on water and solute excretion from those on GFR and filtration fraction. Both in intact and in uninephrectomized baboons, the changes in water and solute excretion were associated with small but significant changes in RPF.

Endotoxemic acute renal failure in awake rats

The sequence of changes in renal function in endotoxemic acute renal failure (ARF) and the role of hypotension and systemic hemodynamics were evaluated in awake female Sprague-Dawley rats given an intravenous bolus of Escherichia coli endotoxin (20-40 mg/kg). After endotoxin ARF was abrupt in onset as glomerular filtration rate (GFR) fell promptly and progressively by 53% within 3.5 h, whereas renal blood flow decreased by 42% and renal vascular resistance nearly doubled. Systemic hemodynamics remained stable, including mean arterial blood pressure, cardiac output, and total peripheral resistance. Early endotoxemic ARF was associated with oliguria and sodium retention, a finding consistent with intact tubular function. Three and one-half hours after endotoxin, however, fractional water and sodium excretion were significantly increased. Ultrastructural studies then demonstrated sequestration of phagocytic leukocytes and intracellular edema in the peritubular capillaries with normal glomeruli. The decrease in GFR was spontaneously reversible within 7-9 days. Extracellular fluid volume expansion with saline either before or 24 h after administration of endotoxin failed to prevent the decrease in GFR or to normalize renal function. The data suggest that endotoxin has direct renal effects. The endothelial cells may be the primary target of endotoxin in the kidney.