Characterization of sarcoplasmic reticulum in skinned heart muscle cultures

The plasma membranes of rat heart muscle, grown in cell culture, were made permeable with saponin in a Ca-free solution. The cells were then supplied with a medium resembling the cytosol, and the adenosine triphosphate (ATP)-dependent Ca2+ sequestration was measured in the presence of oxalate. The nonmitochondrial component accounts for about 50% of the total Ca2+ uptake. The nonmitochondrial accumulation of Ca2+ within myocardial cells was found to be reversible by addition of the Ca2+ ionophore A23187. On the other hand, the Ca2+ antagonist D-600 (50 microM) had almost no effect on Ca2+ accumulation. Caffeine reduced Ca2+ accumulation in the skinned cardiomyocytes in a concentration-dependent manner. In addition, the anticalmodulin drug trifluoperazine (TFP) reduced Ca2+ accumulation in the skinned cells. Because of the analogy between nonmitochondrial ATP-dependent Ca2+ accumulation and the sarcoplasmic reticulum (SR) function with regard to the influence of various agents, it is assumed that we actually measure Ca2+ accumulation in the SR. The rate of Ca2+ accumulation into the SR measured during the development of the cardiomyocytes in culture shows an almost linear increase as a function of culture age. Amiodarone, a potent antiarrhythmic agent, and its metabolite, desethylamiodarone, inhibited Ca2+ accumulation into SR, which may explain their therapeutic effect.

Characterization of ascites present at cesarean section

Ascites has been reported at cesarean section delivery in pregnancies complicated by preeclampsia. The frequency and composition of peritoneal fluid collections in pregnancy have not previously been described. This descriptive study evaluated presence, composition, and characteristics of ascites present in 41 women undergoing cesarean delivery for a variety of indications. Twenty-six women had sufficient quantities of peritoneal fluid to be collected immediately after opening the parietal peritoneum. The protein content of the fluid was analyzed. The presence of fluid was not related to labor preceding delivery. All preeclamptic women in this study had fluid obtainable at cesarean section. Large volume ascites was noted in five preeclamptic women whose fluid had low total protein content, consistent with a transudate. Intrahepatic portal hypertension is one possible explanation of the large volume and low protein ascites in some preeclamptic patients. Ultrasonic measurements in preeclamptic patients and normotensive pregnant women showed uniform portal vein diameters and Doppler-derived portal vein flow velocities in all patients. The physiology of peritoneal fluid production in complicated and normal pregnancy remains unexplained.

Haemophilus influenzae: an important cause of maternal and neonatal infections

Although Haemophilus influenzae is recognized as a major pathogen of infants, its role in maternal and neonatal infections is not as well appreciated. We analyzed the records of all mothers and neonates infected with H influenzae over a 10-year period. Twenty-eight mother/neonate sets were identified in which at least one had documented infection with H influenzae. Of the 18 mothers with documented infection, 13 had chorioamnionitis, endometritis, or both, and two of these mothers were bacteremic with H influenzae. Of the 23 infected neonates, 15 presented with early sepsis and/or pneumonia and nine had conjunctivitis. During the period of the study, only group B streptococci and Escherichia coli were more common as causes of early neonatal bacteremia. Under the conditions of this retrospective study, maternal infection predicted neonatal infection. However, prospective studies in which asymptomatic patients are cultured will be required to determine how well maternal colonization/infection with H influenzae predicts neonatal infection.

Perceptions of parental competence while facing the death of a spouse

Healthy parents' perceptions of their competence to meet children's needs during the terminal illness of the other parent were measured on five major domains of parent-child relationships and parental functioning central to children's healthy development. Significant declines from pre-illness competence were perceived, of which the greatest were in emotional sensitivity and responsiveness, and ability to set limits and impose discipline. Implications for the development of preventive intervention strategies are discussed.

Sleepiness and REM sleep recurrence: the effects of stage 2 and REM sleep awakenings

Determinants of daytime sleepiness include sleep length, sleep continuity, and circadian factors. Sleep stage composition has not been seen as influencing subsequent daytime functioning; however, earlier studies did not focus explicitly on sleepiness. The present experiment studied the effects of selective sleep-stage restriction on an objective measure of sleep tendency, and explored the relationship between sleepiness and subsequent REM recurrence during REM deprivation. Daytime sleep latency was measured by a modified Multiple Sleep Latency Test prior to and following two nights of awakenings from either REM or Stage 2 sleep in 16 normal young adults. Sleep latency following these awakenings was also measured. REM sleep and Stage 2 awakenings produced comparable levels of sleepiness, both during the Awakening Nights and subsequent daytime Multiple Sleep Latency Testing. Pooling the groups, daytime and nocturnal sleepiness measures were correlated within individuals. In the REM-Awakening Group, Pre-Awakening daytime sleepiness was associated with the tendency for REM sleep to recur following experimental awakenings. Comparable levels of sleepiness may result from nonspecific processes such as sleep curtailment and fragmentation, or alternatively from separate REM and Stage 2 mechanisms. The relationship between REM sleep and sleepiness is discussed in the context of both state and trait models.

Cocaine and pregnancy--a lethal combination

There are many pharmacologic agents that have an effect on pregnancy outcome. Evidence is rapidly being accumulated that cocaine use in the pregnant patient is detrimental to both fetal and maternal well-being. This paper is a review of current data to make the health care provider aware of the impact that cocaine use can have on the pregnancy.

Evaluation of a continuous combined low-dose regimen of estrogen-progestin for treatment of the menopausal patient

Menopause constitutes a sizable proportion of the adult women's life, and it is reasonable to consider that most women will benefit from hormone-replacement therapy. Also, it is important to realize that cardiovascular disease is a major cause of morbidity and death in the menopausal patient. Two regimens of hormone-replacement therapy were evaluated in postmenopausal women with 0.625 mg of conjugated equine estrogen with either 2.5 or 5 mg of medroxyprogesterone acetate taken continuously for 52 weeks in 92 patients. The data demonstrated an improvement in menopausal symptoms, a beneficial effect in lipoprotein profiles, the establishment of an atrophic endometrium, and a marked decrease in vaginal bleeding after 13 weeks and a further decrease after 26 weeks. Ideally this regimen will offer better patient compliance and, if the favorable lipoprotein profiles offer protection to the cardiovascular system, the overall health of the American woman will be markedly affected.

Hormonal therapy in the patient with surgical menopause

Removal of both ovaries in the premenopausal patient is performed infrequently, but when it is, attention must be paid to hormone replacement. The benefits of hormone replacement include protection from osteoporosis, elimination of vasomotor symptoms, improvement in general well-being, and some decrease in the risk of cardiovascular disease. Some evidence suggests that the addition of androgen therapy to estrogen replacement in the premenopausal woman can also be beneficial. Administration of hormonal therapy to certain premenopausal patients who have had a bilateral oophorectomy is controversial. These include patients who are disease-free after surgery for endometrial carcinoma and patients who are post-therapy for breast carcinoma. The most common question is whether a progestin should be given to the patient receiving estrogen therapy after a hysterectomy. Prevention of endometrial carcinoma is unnecessary in this patient, but the effects of the progestin on the breast and the cardiovascular system should be considered.

Plasma levels of fibronectin and prostacyclin metabolite in peripartum preeclamptic women

Plasma fibronectin and prostacyclin levels have been reported to vary in preeclamptic women when compared with pregnant control women. Elevation of fibronectin and deficiency of prostacyclin have been postulated to be due to endothelial cell disruption or dysfunction. Eighteen preeclamptic women and 19 normal pregnant controls were evaluated for plasma levels of fibronectin and the prostacyclin metabolite 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). 6-keto-PGF1 alpha and fibronectin plasma levels in patients were significantly different from control patients, with preeclamptic patients exceeding control subjects. Five patients had serial samples of 6-keto-PGF1 alpha prior to, during, and after intravenous magnesium sulfate therapy and no consistent effect was noted. No correlation existed between fibronectin and 6-keto-PGF1 alpha levels or between either compound and platelet count or liver function tests. Despite an overall elevation of fibronectin in preeclamptic patients, two patients with the hemolysis, elevated liver tests, and low platelet count syndrome showed low normal fibronectin levels coinciding with thrombocytopenia, hemolysis, and liver dysfunction. The magnitude of fibronectin elevation may therefore not predict the severity of preeclampsia. The significance of these findings is discussed.

Malignant soft-tissue tumors of the anterior abdominal wall

Malignant soft-tissue tumors of the abdominal wall consist of desmoid tumors and nondesmoid soft-tissue sarcomas. These neoplasms tend to invade adjacent musculoaponeurotic and bony structures. Transperitoneal organ invasion can also occur with devastating sequelae, especially after an incomplete excision. Extirpation with the full-thickness of the abdominal wall is required except for small, superficial lesions. A wide-margin resection, including any adherent viscus, segments of adjacent ribs, and iliac or pubic crest, offers the best assurance of local control. Adjunctive radiotherapy can be given when the margin of resection is unavoidably limited, but an effective radiation dose can be difficult to administer, due to the sensitivity of underlying intestines. Metastases develop frequently with high-grade sarcomas; adjuvant chemotherapy may be tried in these patients, but its value remains unproven.

Developmental aspects of linguistic and mnestic abilities in normal children

The Peabody Picture Vocabulary Test-Revised (PPVT-R), Boston Naming Test (BNT), Paired Associate Learning of the Wechsler Memory Scale (PAL), and verbal fluency tests were administered to 241 normal children aged 6-12 years. Normative data were compiled for the BNT, PAL, and verbal fluency tests. A Principal Components Factor Analysis with Varimax Rotation was conducted to determine whether the tests evaluated similar or differential functions. Three factors emerged, accounting for 67.7% of the variance: Factor 1 contained loadings from two semantic fluency measures (animals and food), Factor 2 contained the PPVT-R and the BNT, and Factor 3 contained two measures from the PAL (easy and hard associations). In children, the BNT relates more to word knowledge than to retrieval or fluency, and verbal memory appears to be relatively independent of these linguistic functions.

Distractibility in schizophrenia: state and trait aspects

This report compared the selective attention of 19 schizophrenic in-patients, 10 recently discharged schizophrenic out-patients, 21 schizophrenic out-patients in stable clinical remission, 33 first-degree relatives of schizophrenics from 15 families, 25 students who scored deviantly on questionnaire measures of magical ideation, perceptual aberrations, and physical anhedonia, and 20 normal controls. Results indicated that distractors only disrupted the performance of schizophrenic in-patients, suggesting that differential deficits in selective attention are a marker of episodes of schizophrenia. A propensity to interject phonemes from the distracting message was found not only in patients in or just emerging from a psychotic episode, but also in the remaining vulnerable but non-psychotic groups, suggesting that intrusion errors might be a mediating vulnerability marker. The findings suggest both state and possibly trait aspects to distractibility in schizophrenia.

The development of scales to measure the experience of self-participation in sleep

Recent literature suggests that how the self is represented is a cardinal aspect of the dream experience. A review of studies of phasic-tonic distinctions within rapid eye movement (REM) sleep revealed that increasing self-participation marked awakenings from phasic intervals. Five scales specifically designed to measure absorption in dreaming were compared with three scales previously shown to discriminate phasic from tonic awakenings within REM sleep. Eight reports per night (two stage REM, six stage 2) were collected from each of 20 subjects on 4 baseline nights. Awakenings were controlled for time into the REMP and time of night, correcting the methodological flaws of previous studies in this area. Scales developed to measure self-participation were able to discriminate phasic from tonic awakenings better than those already in the literature. Results are discussed in terms of the psychometric properties of the individual scales.

Fever of unknown origin

The evaluation of an FUO is a significant test of all a physician's clinical skills. The ultimate goal of the physician is to reach a diagnosis and to cure the patient in the best possible situation. Despite such pressure both externally and self-imposed, a physician needs to meticulously follow the patient and logically pursue the available diagnostic tests. To "shotgun" the process, except in the most urgent situation, is to ultimately create more frustration, confusion, and despair among the physician and his patient.

Malpractice--the syndrome of the 80s

The current malpractice situation exists for the following reasons: 1) society's belief that all wrongs must have a reason and that the wrong must be put right, 2) the pervasive lottery mentality, 3) the inability of many individuals to accept responsibility for themselves or their actions, and 4) an increasing incidence of true medical negligence. The physician who gives careful detail to practice style, who constantly attempts to upgrade his skills and knowledge, and who prepares himself when involved in the inevitable legal quagmire will survive during this difficult time to practice the healing arts.

Oxygen saturation in the supine hypotensive syndrome

This study used recently available, continuous noninvasive monitoring techniques to evaluate positional variations in pulse, blood pressure, and maternal oxygen saturation in 42 women undergoing fetal nonstress testing in the third trimester. Ten nonpregnant women were similarly evaluated with the automatic sphymomanometer and pulse oximeter. Six of 42 pregnant women (14.3%) developed the supine hypotensive syndrome (defined as a mean blood pressure decrease of 15 mmHg and a sustained increase in pulse of 20 beats per minute) when in the supine position. Nine of them (21.4%) met at least one of the criteria, but the majority (27 of 42, 64.3%) met neither criterion. None of the ten nonpregnant subjects had hypotension or tachycardia, although nine demonstrated blood pressure elevation after assuming the supine position. Significant oxygen desaturation did not occur in any patient, although three of six hypotensive patients had a transient 3-5% desaturation after supine rest. This study confirms that a significant percentage of patients in the third trimester are affected to some degree by supine hypotension. However, significant oxygen desaturation does not appear to occur.

Factor VIII: von Willebrand factor patterns in the plasma of patients with pre-eclampsia

Elevation of the factor VIII protein to coagulant ratio previously has been reported to predict the severity of pre-eclampsia. Abnormal levels and patterns of factor VIII: von Willebrand factor (VIII/vWF) have been reported in thrombotic thrombocytopenia purpura (TTP). Severe pre-eclampsia shares many features with this syndrome. Nine primigravid patients with pre-eclampsia were evaluated by assays for factor VIII/vWF protein and coagulant activity and were compared to nine normal primigravid (controls). The patients and controls were indistinguishable by factor VIII antigen/coagulant activity ratios. Pre-eclamptic patients also had unremarkable factor VIII patterns on crossed immunoelectrophoresis. The evaluation of factor VIII/vWF multimeric patterns showed four patients with abnormal patterns in the pre-eclamptic patients and three abnormal patterns in the controls. These patterns were not analogous to the factor VIII abnormalities found in TTP.