Skin flap neovascularization by means of a vasodilator

The viability of vascularized flaps depends mainly on good microsurgical technique, although several factors can affect the final outcome. There are few studies of neovascularization at the recipient site and its significant role in late vascular occlusion. In this study, the rat abdominal skin flap based on circulation through the epigastric vessels was used, to study a drug with vasodilator effects (isoxsuprine) and its relation to flap neovascularization. By ligating the epigastric artery from one to five days after raising the flap, good results in flap viability were statistically significant when isoxsuprine was used. At two, three, and four day arterial occlusion after flap elevation, faster and more neovascularization occurred with isoxsuprine, when compared to control groups. The study strongly suggest that isoxsuprine hastens neovascularization time in the rat model.

Effect of fasting on amino acid metabolism by lactating mammary gland: studies in women and rats

Concentrations of free amino acids were measured in human milk and arterial blood from lactating women after an overnight fast or after a controlled breakfast. The concentrations of many free amino acids in milk (except L-tyrosine, L-aspartate, L-asparagine, L-glutamate and L-glutamine) were lower after an overnight fast than after breakfast. Similarly, the arterial concentrations of amino acids were lower except for L-asparagine, L-alanine, L-tyrosine and L-phenylalanine. Net uptake of amino acids by the mammary gland of the lactating rat was significantly lower after starvation for 6 or 24 h than in the fed state because the arteriovenous differences of amino acids and the blood flow were significantly lowered. Starvation produced a significant decrease of 2-amino-[1-14C]isobutyric acid uptake by isolated acini from lactating rat. These results show that short-term starvation decreases the amino acid supply and transport in mammary gland as well as the free amino acid concentration in milk.

The next generation of managed mental health care

The rise in mental health claims and the tremendous expansion of psychiatric facilities and services have put payers and providers alike on the defensive. Payers cut benefits, while providers rush to justify even clearly needed care. The venturesome in both camps will be intrigued by General Telephone of California's comprehensive, managed mental health care program, combining the PPO concept with provider risk and strong case management, as described by the authors, Vice Presidents of Preferred Health Care, Ltd.

A simple method for the correction of enophthalmos

Autogenous rib cartilage grafts are used to correct enophthalmos. The grafts are introduced through two small tunnels into the posterior quadrant of the orbit. The procedure leaves almost no scar and final results are satisfactory.

Intestinal glucose and galactose transport in the cultured gilthead bream (Sparus aurata)

1. Electrical parameters and transepithelial glucose and galactose transport were determined in vitro across anterior and posterior intestine of the culture fish Sparus aurata. 2. Electrical potential difference (PD) and short-circuit current (Isc) were serosa-positive in anterior intestine, while they were serosa-negative or near zero in posterior intestine. 3. Tissue conductance (Gt) was higher in posterior than in anterior intestine. In both parts it was decreased when the Na ion was omitted in mucosal and serosal reservoirs. 4. Addition of glucose or galactose to the mucosal side of intestine caused an increase in PD and Isc in posterior intestine but did not significantly change PD and Isc in anterior intestine. 5. Isotopic flux of glucose and galactose measurements in short-circuit conditions showed a net active glucose and galactose absorption in posterior intestine, while in anterior intestine active transport of glucose or galactose was not observed. 6. The net transport of glucose and galactose in posterior intestine was decreased to zero in the absence of Na in mucosal and serosal reservoirs or in the presence of ouabain (1 mM) in serosal solution.

Effect of theophylline on ion transport in the lizard colon

1. The effect of theophylline on ion transport was examined using an in vitro short-circuited preparation of lizard colon. 2. Theophylline increased short circuit current (Isc) and transmural potential difference (PD). This increase caused by theophylline was accompanied by a small increase in transmural conductance (Gt). 3. Theophylline did not inhibit the absorption of Na+ but reversed Cl- absorption to secretion. This latter effect was due to an increase of the serosal-to-mucosal flux of Cl-. 4. Ion substitution experiments revealed that the effect of theophylline was Na+- and HCO3(-)-dependent and that these ions were required in the bathing solution. 5. These results with lizard colon are compared with those reported for mammalian colon and the mechanism of theophylline-induced Cl- secretion in these epithelia is discussed.

Intersubunit transfer of fatty acyl groups during fatty acid reduction

Fatty acid reduction in Photobacterium phosphoreum is catalyzed in a coupled reaction by two enzymes: acyl-protein synthetase, which activates fatty acids (+ATP), and a reductase, which reduces activated fatty acids (+NADPH) to aldehyde. Although the synthetase and reductase can be acylated with fatty acid (+ATP) and acyl-CoA, respectively, evidence for acyl transfer between these proteins has not yet been obtained. Experimental conditions have now been developed to increase significantly (5-30-fold) the level of protein acylation so that 0.4-0.8 mol of fatty acyl groups are incorporated per mole of the synthetase or reductase subunit. The acylated reductase polypeptide migrated faster on sodium dodecyl sulfate-polyacrylamide gel electrophoresis than the unlabeled polypeptide, with a direct 1 to 1 correspondence between the moles of acyl group incorporated and the moles of polypeptide migrating at this new position. The presence of 2-mercaptoethanol or NADPH, but not NADP, substantially decreased labeling of the reductase enzyme, and kinetic studies demonstrated that the rate of covalent incorporation of the acyl group was 3-5 times slower than its subsequent reduction with NADPH to aldehyde. When mixtures of the synthetase and reductase polypeptides were incubated with [3H] tetradecanoic acid (+ATP) or [3H]tetradecanoyl-CoA, both polypeptides were acylated to high levels, with the labeling again being decreased by 2-mercaptoethanol or NADPH. These results have demonstrated that acylation of the reductase represents an intermediate and rate-limiting step in fatty acid reduction. Moreover, the activated acyl groups are transferred in a reversible reaction between the synthetase and reductase proteins in the enzyme mechanism.

Prothrombin Perija: a new congenital dysprothrombinemia in an Indian family

A Western Venezuelan indigenous Yukpa(Irapa) family with moderate bleeding and discrepancy in the prothrombin values by biological and immunological methods is described. The propositus presented biological activity of 2% by the methods in one-stage including Staphylocoagulase and Echis carinatus. Electrophoretic migration of the prothrombin in plasma was normal, while the serum only showed one precipitation arc instead of the three of normal serum. The propositus appeared to be homozygous for the abnormal prothrombin which we have denominated Prothrombin Perijá.

Mycobacterium tuberculosis infection in the acquired immunodeficiency syndrome. A review of 14 patients

The clinical findings in 13 drug abusers and one homosexual man with tuberculosis and the acquired immunodeficiency syndrome (AIDS) from New York City are described. Tuberculosis preceded the diagnosis of AIDS in nine of the 14 patients by a mean of 7 months and occurred within the same month in the remaining five. The presence of thrush, generalised lymphadenopathy, lymphopenia, cutaneous anergy and chest radiographs showing hilar adenopathy and/or lower lobe infiltrates was common among the patients in whom tuberculosis preceded AIDS. Eight of our patients had extra-pulmonary tuberculosis, six had disseminated tuberculosis and five had tuberculous lymphadenitis. Cultures of tissue biopsies may be positive for Mycobacterium tuberculosis despite the absence of acid fast bacilli or granulomas on microscopic examination. Tuberculosis generally responded to chemotherapy, but the majority of patients died from opportunist infections.

The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT

The clinical and laboratory diagnosis of acute acalculous cholecystitis is difficult, and the reliability of various diagnostic imaging techniques has not been established. The results of several imaging procedures performed over a 6-year period on 56 patients with clinically suspected acute acalculous cholecystitis were evaluated retrospectively. Sonography and CT were both highly sensitive (92% and 100%, respectively) and specific (96% and 100%, respectively). Hepatobiliary scintigraphy was compromised by frequent false-positives; the result was a specificity of only 38%. Percutaneous bile aspiration was insufficiently sensitive (33%) for diagnosis. Sonography was as sensitive as hepatobiliary scintigraphy and was more specific in establishing the diagnosis. Because sonography is relatively inexpensive and can be performed at the bedside, it should be regarded as a satisfactory screening procedure. However, CT is a good alternative in an easily transported patient when other intraabdominal disease is suspected.

Epidermoid carcinoma of the colon. Description of a lesion located in the hepatic flexure

A case of epidermoid carcinoma of the colon is described--the 25th such case reported in the literature. The pathogenesis, natural history, and treatment of the disease are reviewed.

Two-year prospective study in Colombia of Norplant implants

A clinical trial of levonorgestrel-releasing Norplant implants used for contraception was undertaken in two cities in Colombia. Through two years in which 389 women had accumulated 594 years of use, there were no pregnancies. In a comparison group of copper intrauterine device acceptors, the one-year pregnancy rate was 1.1 per 100. Menstrual disturbances associated with progestin-only administration were the principal side-effects, and the major reason for cessation of use. Continuation among users of the implants was at the same or at a higher rate than observed among users of the intrauterine device. Advantages and disadvantages of alternate sites for implant placement are discussed.

A histological assessment of the initial healing response adjacent to porous-surfaced, titanium alloy dental implants in dogs

We report here the results of a histological assessment of the initial healing response following implantation into the dog mandible of a porous-surfaced, titanium alloy endosseous dental implant. Two implants were placed in edentulous areas on each side of the mandible of each dog and covered with a full-thickness mucoperiosteal flap. The implant sites on one side of the mandible were allowed to head for four weeks, while those on the other side were allowed to head for eight weeks before the animals were killed. Histological specimens were obtained and assessed both qualitatively and by computer-assisted morphometry. All but one of the 24 implants were well-tolerated and healed with a variable ingrowth of bone into the porous-surface geometry. The histomorphometric measurements revealed that bone ingrowth had reached a plateau by four weeks of initial healing.

Acute rupture of the diaphragm in blunt trauma: analysis of 60 patients

During a 9-year period, 60 patients with acutely ruptured diaphragms following blunt trauma were treated in our institution. Diaphragmatic injury was detected within 24 hours of hospital admission in all but two patients. The diagnosis was suggested by upright chest X-ray in 40% of the patients. Diaphragmatic tears were discovered at laparotomy for hemoperitoneum in the remaining patients. At initial evaluation hypotension was present in 67% of the patients, and respiratory distress was evident in 52%. In contrast to traditional teaching, there was a 30% incidence of right hemidiaphragmatic disruption. One patient experienced bilateral diaphragmatic rupture, and two had isolated tears of the pericardial diaphragm. Intra-abdominal organs were herniated through the diaphragmatic defect in only 32% of the patients. There was a 90% incidence of associated intra-abdominal injuries. The diaphragmatic tear was repaired via the abdomen in 53 patients, through a thoracoabdominal incision in five patients, and through the chest in only two cases. All defects were closed primarily. Twelve patients also required thoracotomy for resuscitation and/or correction of intrathoracic injury. Atelectasis was the most frequent postoperative complication, occurring in 65% of the patients. The mortality was 26.7% and was related to associated injuries in all cases.

The concentrations of xanthine and hypoxanthine in cerebrospinal fluid as therapeutic guides in hydrocephalus

Xanthine, hypoxanthine, and total oxypurine levels were determined in the cerebrospinal fluid of 18 hydrocephalic patients and 8 healthy controls by high-performance liquid chromatography (HPLC). Eight of the hydrocephalic patients were self-compensated and 10 had shunts implanted during the course of the study. The mean xanthine, hypoxanthine, and total oxypurine levels in the normal children were 5.20, 5.94 and 11.29 mumol/l, respectively. In self-compensated hydrocephalics these levels were respectively 6.06, 6.50 and 12.57 mumol/l. In noncompensated hydrocephalics, they were 11.40, 10.79 and 22.19 mumol/l. The differences between the latter group and the first two are statistically significant (P less than 0.001). Fifteen days after implantation of shunts in the noncompensated hydrocephalics, the mean xanthine levels had fallen to 4.61 mumol/l, the mean hypoxanthine levels to 5.03 mumol/l, and the mean total oxypurine levels to 9.64 mumol/l. The change is statistically significant (P less than 0.001). In light of these findings we propose that xanthine, hypoxanthine, and total oxypurine levels be used in cases of hydrocephalus as guides for therapeutic action and to monitor progress.

Basal prolactin and the behaviour of the gonadotrophins, testosterone, androstenedione, estradiol, and the sex-hormone-binding globulin during stimulation with clomiphene in subjects with spermatogenic disorders

To clarify the significance of clomiphene test in spermatogenic disorders, it was performed on three groups of subjects: 10 with normozoospermia, 29 with oligozoospermia, and 11 with azoospermia. Two basal blood samples were drawn five days apart; prolactin, FSH, LH, estradiol, testosterone, androstenedione and sex-hormone-binding globulin were determined. 100 mg of clomiphene per day were administered for eleven consecutive days; another sample was drawn on the eleventh day and all the basal parameters, except prolactin, were determined. It may be concluded from the results: a) All the parameters studied increased significantly after clomiphene; and b) Testosterone levels obtained after clomiphene, as well as the increases in this hormone during the test and the ratio delta T/delta LH, were significantly lower in the oligozoospermic group. This finding suggests a decrease in the testicular androgenic function of this group.

Acquired immunodeficiency syndrome (AIDS) in an economically disadvantaged population

Forty patients with acquired immunodeficiency syndrome (AIDS), 70% of whom were intravenous drug abusers (IVDAs), were seen over a 20-month period (July 1, 1981, through Feb 28, 1983). Most of the patients came from two inner-city sections of New York City and from nearby correctional facilities. Eighty-five percent of the patients were black or Hispanic; only 15% were white. Unique features of AIDS in this mostly heterosexual population were the high incidence of opportunistic infections (90% of the patients), the low incidence of Kaposi's sarcoma (10%), and the high mortality rate (34% died during initial hospitalization, 74% after one year of follow-up). Tuberculosis occurred in 10% of cases, preceding other opportunistic infections by four to 24 months. We found that AIDS was a common disease among inpatient IVDAs, and in one of the participating hospitals, its incidence was similar to that of infective endocarditis. Acquired immunodeficiency syndrome should be considered as the underlying illness in all IVDAs with oral thrush, shortness of breath, pneumonia, or extra-pulmonary tuberculosis.

CT evaluation of thoracic infections after major trauma

Thirty-seven septic patients with major multisystem trauma were evaluated by computed tomography (CT) to identify possible thoracic sources of infection. CT was 72% accurate in the diagnosis of empyema and 95% accurate in the diagnosis of lung abscess. While CT proved useful in demonstrating these sites of thoracic infections in septic trauma victims, the presence of concurrent thoracic pathology, particularly loculated hemothorax or hemopneumothorax and traumatic lung cysts with hemorrhage or surrounding parenchymal consolidation, introduced sources of diagnostic error. CT also proved helpful in guiding appropriate revisions of malpositioned and occluded thoracostomy tubes.

Analysis of 3-indolylacetic acid and abscisic acid by high-performance liquid chromatography and gas-liquid chromatography

A method of analysis of 3-indolylacetic acid (IAA) and abscisic acid (ABA), allowing the simultaneous extraction of both regulators from plant material, has been developed. The method involves extraction with methanol, isolation of the acid fraction, diazomethane methylation, separation of the hormones through reverse-phase preparative high-performance liquid chromatography, and quantification of both compounds by gas-liquid chromatography. The recovery percentage at each step was monitored with radioactive compounds added at the beginning of the process. The final recovery was 70% for IAA and 96% for ABA. The method was applied to the analysis of the IAA and ABA content of stems of hazel (Corylus avellana L.).

Operative technique for repair of tracheoinnominate artery fistula

Tracheoinnominate artery fistula is a relatively rare but highly lethal complication for long-term tracheostomy patients that occurs with an estimated incidence of 1 out of every 150 tracheostomies performed. Appropriate operative technique during tracheostomy and meticulous postoperative care usually prevent this devastating lesion. When tracheoinnominate fistula is suspected, immediate evaluation under general anesthesia in the operating suite, followed by prompt thoracotomy and repair, is essential for the survival of these patients.

Fatty acyl-AMP as an intermediate in fatty acid reduction to aldehyde in luminescent bacteria

The acyl protein synthetase component (50K) of the fatty acid reductase complex from the luminescent system of Photobacterium phosphoreum has been found to catalyze the activation of fatty acid via formation of an enzyme bound acyl-AMP (carboxyphosphate mixed anhydride) immediately prior to the acylation of the enzyme. PPi-ATP exchange and nucleotide binding experiments are dependent on fatty acid and indicate that the fatty acyl-AMP is directly formed and that an adenylated enzyme intermediate is not part of the mechanism. The formation of acyl-AMP from fatty acid and ATP is reversible with a standard free energy of -2 kcal/mol, and is dependent on Mg2+. The fatty acyl-AMP intermediate has been isolated and shown to be part of the pathway of fatty acid reduction. The 34K component of the complex, which strongly stimulates the acylation of the 50K protein by fatty acyl-AMP or fatty acid and ATP, is not required for the formation of acyl-AMP showing that it differentially affects the fatty acid activation and acylation steps catalyzed by the 50K protein.