The antischistosomal activity of substituted indoles

5-Bromoindole carboxylic acid and substituted indoles were administered parenterally to hamsters infected with an Egyptian strain of S. mansoni, to assess their antischistosomal activity. 5-Bromoindole showed a significant hepatic shift in 59 percent of treated hamsters. The results suggest that modification of the indole nucleus may produce a series of antischistosomal agents.

The Syed-Neblett interstitial template in locally advanced gynecological malignancies

Twenty-eight patients with locally advanced malignancies of the cervix and vagina were treated with a combination of external radiation therapy and afterloading Syed-Neblett iridium template. There were 22 patients with squamous cell cancer and two patients with adenocarcinomas of the cervix. Four patients with squamous cell cancer of the vagina were treated with this method. Only patients with locally advanced disease (cervical lesion greater than 4 cm in diameter) and poor vaginal anatomy were selected for this modality of therapy. In our series the incidence of distant failures of 39% seems to confirm the significance of local volume of disease as a prognostic indicator; despite a local control rate of 59%, only 33% of our patients are alive from 25-51 months. Complications occurred in 12 patients (42%). Six patients (22%) developed severe rectal stricture or rectovaginal fistula necessitating diverting sigmoid colostomy; five patients (18%) developed hemorrhagic proctitis with diarrhea and tenesmus; one patient developed vaginal vault necrosis. Complications occurred 7 to 24 months following therapy. Six of the 12 patients developing complications are dead of disease. On the basis of this study and because of the low cure rate and high incidence of complications, the value of the Syed-Neblett template in locally advanced gynecologic malignancies should be reconsidered.

Correlation of computed tomography with surgical diagnosis in lumbar disc disease

The lumbar spines of one hundred patients with suspected lumbar disc herniations were analysed with computed tomography. The results are compared with the patients' surgical diagnosis and with myelography. CT scanning is with few exceptions the diagnostic procedure of choice in investigating lumbar disc disease.

Massive cerebellar infarction: "conservative" management

Eleven patients with large cerebellar infarctions were admitted recently to our service. Eight of them showed evidence of hydrocephalus on the CT scan examination. Five were treated with controlled external ventricular drainage and six were managed conservatively. One death, most likely due to progressive brainstem infarction, occurred. The outcome was favorable in the other patients. It is suggested that prompt treatment of the acute obstructive hydrocephalus may obviate the need for posterior fossa decompression in patients with massive cerebellar infarction.

Acute spinal cord injury in the rat: comparison of three experimental techniques

Three techniques to produce experimental spinal cord injuries in the rat are compared; 1) the weight dropping method, 2) the aneurysm clip compression method and 3) the extradural balloon compression method. In principle, different forces were used in technique one, while a constant force for different durations is maintained in techniques two and three. The relationship between these different types of injuries and subsequent clinical recovery was assessed quantitatively by the inclined plane method of Rivlin and Tator. The weight dropping technique was found unreliable for experimental spinal cord injury in the rat while the aneurysm clip compression technique resulted in consistent cord injuries with respect to subsequent clinical recovery. The extradural balloon compression method invariably resulted in complete recovery after three and five minutes but no recovery after seven minutes of 0.1 cc air inflated balloon compression of the cord indicating a steep dose--response curve. However, using a 0.2 cc air inflated balloon, no recovery was noted after one minute compression. The major factor in the pathogenesis of spinal cord injury produced by the weight dropping technique is believed to be mechanical, while both mechanical and vascular factors seem to operate in the clip and balloon compression techniques.

Emergency room thoracotomy for penetrating cardiac injuries

The results of emergency room thoracotomy (ERT) and cardiorrhaphy for 91 patients with penetrating cardiac injuries admitted in extremis to Lincoln Medical and Mental Health Center from 1963 to 1981 are reviewed to determine criteria for selection of patients for this procedure. Four groups were defined based on the severity of the effects of their injuries. The survival rates were 32.1 and 33.3%, respectively, for Group I ('fatal') and Group II ('agonal') patients. There were no survivors in Group IV ('D.O.A.') patients for whom ERT is a fruitless procedure. Survival in Group III ('profound shock') patients was only 40%, which might have been improved if ERT had been performed without delay. We conclude that ERT is essential for patients with 'fatal' and 'agonal' wounds and advise prompt ERT for patients in 'profound shock' who do not respond immediately to rapid volume infusion.

Hypertension in the rural population of Bangladesh--a preliminary survey

A total of 5,026 persons constituting 75% of the total population of a village of Bangladesh were screened for elevated blood pressure. Three hundred thirty seven (6.7%) showed diastolic blood pressure of 90 mm Hg or above. Those with diastolic blood pressure of 95 or above constituted 2% of the population. 74% of the hypertensives were asymptomatic while 86.3% of the cases were undetected and therefore remained untreated. Our findings indicate the need for early detection and control of elevated blood pressure to prevent complications. It is recommended that a large scale community survey programme may be undertaken for detection and early treatment of hypertension which helps prevention of total complications.

Sexual abuse of young children

For an 18-month period, all sexual abuse cases were referred to a project social worker. From her initial interview and the medical records, data were analyzed for 113 children who were 12 years of age or younger. It was found that half were five years or younger and three-fourths of the cases were female children. Reasons were discussed as to why females are more likely to be identified as sexually abused cases. A higher than average rate of gonorrhea was found among the pediatric group studied. While only 44 per cent of abusers were relatives of the abused, almost all (93%) were known to the family. If a relative were the alleged abuser, there was a high probability that it was a father, stepfather, or uncle.

Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases

Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.

Timing of surgery for intracerebral hematomas due to aneurysm rupture

✓ Intracerebral hematomas (ICH) from aneurysm rupture are not rare and can now be diagnosed easily and accurately by computerized tomography. The authors have collected 132 such cases from 11 medical centers. Of these patients, 38% died prior to discharge from the hospital. Seventy-eight percent of cases were admitted to the neurosurgical services on Day 0 or 1 after rupture of the aneurysm; of these patients, 15% died without surgery, 28% had surgery and died postoperatively, and 57% were operated on and survived. Mortality rates were increased in patients who were hypertensive, had poor neurological grades, showed evidence of brain herniation, or had larger clots. If the patient lived beyond the first few days and did not have brain herniation, the timing of surgery was not of great consequence, although there was a tendency toward lower morbidity in earlier surgery. This was true despite the fact that earlier operations were carried out on an initially sicker group of patients. Ischemic deterioration attributed to vasospasm occurred in 26% of cases; even when deaths at the acute stage were excluded, it was no more common in patients with early than in those with late surgery. Morbidity and mortality rates were prohibitively high in operations consisting solely of evacuation of ICH without clipping of the aneurysm. Parietal hematomas were particularly dangerous, while those in the temporal lobe were associated with the best outcome. Since it is impossible to predict survival with a high degree of reliability, even when the prognostic indicators are known, the authors recommend that patients with a significant ICH have it removed as soon as possible and that their ruptured aneurysm be clipped at the same time.

Dual role of the liver in regulating circulating polymeric IgA in man: studies on patients with liver disease

The human liver probably removes circulating polymeric IgA by two routes: (1) secretory component-mediated endocytic transport of polymeric IgA from portal tract blood vessels into bile across biliary epithelial cells and (2) uptake with possible catabolism by hepatocytes and/or sinusoidal phagocytic cells by uncharacterized receptor(s). Failure of either clearance mechanism due to liver disease results in elevated serum polymeric IgA levels. In patients with cholestasis, the raised serum polymeric IgA concentration is due to reflux of biliary secretory immunoglobulin into the blood.

Antigen shared by human hemopoietic precursor cells and T and B lineage cells

In this study, we investigated antigens present at the surface of acute myeloblastic leukemia (AML) cells by using the monoclonal antibody (MAb) approach. The MAb AGF43 reacted with acute myeloid and lymphoid leukemia cells and chronic lymphocytic leukemia cells and was unreactive against chronic myeloid leukemia cells. A large proportion of AML blasts showing minimal or no differentiation (AML-M1) were intensely labeled by AGF43 in contrast to a smaller percentage of blasts showing partial differentiation (AML-M2 and acute myelomonocytic leukemia). The AGF43 antigen is expressed by bone marrow lymphoid (TdT+) and myeloid (CFU-GM) progenitor cells, 95% of B cells and 65% of T cells in the blood and absent from monocytes. Only 17% of normal myeloblasts were weakly stained by AGF43. Sections of tonsil and spleen were used to confirm that, unlike antibodies to MHC class II antigens, AGF43 stained a majority of T cells and macrophages were unreactive. In conclusion, the MAb AGF43 identifies a new precursor cell antigen. The distribution of this antigen during normal myelopoiesis and on AML cells support the suggestion that acute myeloid leukemias originate in pluripotent or closely related myeloid stem cells.

Analytical study of burns in Kashmir

Kashmir Valley is part of Jammu and Kashmir State. It is surrounded on all sides by the Pirpanchal range of mountains, and as a result of this position it is cold in the valley for about three-quarters of the year. The population of the Kashmir Valley is 31 30 090 and that of the Srinagar district is 7 21 078. The people of the valley use a 'Kangri' which is a portable unguarded heater to keep themselves warm. Burns being common in the area it prompted the undertaking of an analytical study of 100 burn cases admitted to the Medical College Hospital, Srinagar, Kashmir. The pattern of cases referred to or admitted directly in our hospital reflect the percentage of burn injuries sustained in Kashmir Valley since it is the only provincial hospital of its kind in the Valley having facilities for the undertaking of plastic surgery.

Studies on the uterine inhibitory actions of diphenylhydantoins

Diphenylhydantoin and diphenyl-thio-hydantoin inhibited the spontaneous motility of rat uterus in a dose-dependent manner. On molar basis diphenyl-thio-hydantoin was found to be 2.7 times as potent as diphenylhydantoin. The stimulant effects of acetylcholine, oxytocin, adenosine triphosphate, prostaglandins I2 and E2 were reduced by both hydantoins. Furthermore, hydantoins potentiated the inhibitory effects of sympathomimetic amines, theophylline, nitroglycerin and dibutyryl cyclic adenosine monophosphate. The uterine inhibitory actions of adrenaline, isoprenaline and phenylephrine were antagonized by propranolol but not by phentolamine. However, adrenergic blocking agents were ineffective against hydantoins indicating that their effects were not mediated through adrenergic receptors. Ouabain and sodium fluoride caused stimulation of uterine motility. Pre-treatment with ouabain did not block the inhibitory effect of hydantoins, while, sodium fluoride antagonized the inhibitory effects of hydantoins. Furthermore, even increasing the diphenylhydantoin concentration 10 times did not produce any relaxation in the presence of sodium fluoride. The results are discussed in relation to the effect of hydantoins on sodium pump and on membrane permeability.

The influence of radiation therapy quality control on survival, response and sites of relapse in oat cell carcinoma of the lung: preliminary report of a Southwest Oncology Group study

Two hundred and ninety-eight patients with limited (confined to chest and supraclavicular area, encompassable by a single radiation portal) small cell carcinoma of the lung were entered on Southwest Oncology Group Protocol 7628. Patients were treated with multi-agent chemotherapy and radiation therapy with or without BCG. Radiation therapy quality control analysis, including dosimetric reconstruction and port film review was introduced after the protocol was activated and was retrospectively applied. Patients who were considered major protocol variations had statistically worse survival (40 weeks versus 60 weeks; P = .002), a lesser improvement in response rate after induction chemotherapy (27 versus 48%; P = .05) and a higher chest failure rate (77 versus 55%; P = .047) than evaluable patients. Five patients relapsed in the brain, all associated with chest failure. Quality control is essential in cooperative group studies.

Role of protein content in CSF ascites following ventriculoperitoneal shunting. Case report

The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of the condition is discussed.

Patterns of Shigella infection in families in rural Bangladesh

To assess the mode of transmission of Shigella infection in rural Bangladesh, questionnaire and culture surveys were conducted in baris (neighborhoods) where persons with diarrhea associated with Shigella infection and index controls with non-Shigella diarrhea lived. Nineteen percent of persons in Shigella baris and 7% of persons in control baris were infected during the survey periods (P less than 0.001). The prevalence of Shigella infection was highest for children 1-9 years of age and for females than 39 years and was not related to socioeconomic status, family size or household crowding. Use of surface water for drinking was not a risk factor for Shigella infection; in fact, use of river water was more frequent in control baris. Both household and bari contacts of Shigella index cases frequently excreted different serotypes from that excreted by the person with the index case. In Shigella baris, families with infection were significantly more likely than uninfected families to have a history of an overnight stay away from home by a family member during the previous week. These observations suggest there were multiple introductions of Shigella into some families and that the epidemiology of Shigella infection for families in rural Bangladesh differs from that observed for families living in more industrialized countries.

Effects of neuroleptics on platelet monoamine oxidase activity

Platelet MAO activity in schizophrenics was significantly decreased, by about 15%, after 3 weeks of treatment with haloperidol. Treatment with thioridazine or butaperazine also tended to decrease platelet MAO activity. The neuroleptic-induced decrease began to appear within a few days of treatment and did not show tolerance over 1-2 months of treatment with haloperidol. Platelet MAO activity of schizophrenic patients measured during drug-free base-line was not significantly different from that of normal controls, but MAO activity of schizophrenics was significantly lower than normals after 3 weeks of treatment with neuroleptics. The extent of decrease in platelet MAO activity correlated negatively with base-line prolactin and its increase after 24 hr. With PEA as substrate, the decrease in activity correlated positively with steady state plasma haloperidol.

Migrant mu+ delta+ and static mu+ delta- B lymphocyte subsets

Immunoglobulin isotype expression in isolated lymph node (LN), spleen and blood lymphocyte suspensions was assessed in rats. The proportion of mu+ delta- B cells in spleen (34%) was approximately twice that in blood and LN. Immunohistological examination of spleens showed the cells of the marginal zones to be predominantly mu+ delta-. On the other hand, mu+ delta+ B cells were mainly confined to the follicles in both spleen and LN. These follicles had a minor mu+ delta- component. The migratory properties of B cells with these two phenotypes were assessed by depleting lymphocytes migrating through the white pulp of rat spleen. This was achieved by placing a 32P-impregnated beta-emitting polythene strip over one half of the spleen. Examination of the nonirradiated half of the spleen, LN and peripheral blood after 12 days irradiation showed selective loss of delta + B cells. The mu + delta- cells of the splenic marginal zone were numerically unaltered. There was also a substantial residual mu + delta- B cell presence in the small lymphocyte compartment of follicles of LN and spleen in depleted animals. In addition, the blood selectively retained a mu + delta- B cell component. This was not derived from the spleen, as mu + delta- blood B cell numbers were sustained even where both halves of the spleen were irradiated. It is concluded that: (a) the major static B cell component of spleen and LN is mu + delta-, (b) that most if not all delta + B cells repeatedly migrate through the spleen and (c) there is a blood-born mu + delta- component which is resistant to depletion by splenic irradiation.,