Lateral canthoplasty to change the eye slant

A technique is described to modify eyelid slanting and correct excessive scleral show. The anatomic relations of the canthal ligament with the fibrous supporting structures of the eyelid are discussed. The procedure is indicated in aesthetic surgery, in congenital anomalies, and in sequelae of trauma.

In vitro acylation of the transferrin receptor

In vitro fatty acylation of the transferrin receptor with [3H]tetradecanoate or [3H]tetradecanoyl-CoA has been demonstrated for isolated sheep reticulocyte plasma membranes. Although less than 5% of the receptor was labeled in vitro, the acylated protein could be readily observed after sodium dodecyl sulfate-gel electrophoresis. The acylated transferrin receptor in the reticulocyte membrane was specifically precipitated with a monoclonal antibody and was absent from mature red cell membranes. Incorporation of fatty acid was dependent on ATP, and fatty acid was 5-10 times less effective as an acyl donor than the acyl-CoA derivative, pointing out the strong potential of this reagent for in vitro acylation of membrane proteins. During in vitro maturation of reticulocytes, the receptor is released in vesicles into the incubation medium. Using reticulocytes labeled with [3H]tetradecanoate, it can be shown that the 3H-labeled receptor is transferred from the cells to the vesicles without loss of acyl groups, suggesting that the vesiculation process does not involve deacylation.

Leukapheresis in a patient with Sézary syndrome

A patient with Sézary syndrome refractory to cytotoxic agents underwent leukapheresis on the Aminco continuous flow centrifuge. Five procedures were performed over a 15-day period. A total of 6.9 X 10(9) cells were removed. The patient's skin lesions and lymphadenopathy regressed. Repeated removal of the buffy coat by leukapheresis has not resulted in thrombocytopenia. It is concluded that cytapheresis may be effective in this clinical condition even when the peripheral leukocyte count is normal.

Empyema occurring in the multiply traumatized patient

During an 11-month period 31 cases of nosocomial empyema were identified in 29 of 741 multiply traumatized patients who remained in our unit for more than 3 days. Nosocomial empyema was defined as purulent culture-positive material drained from the pleural space after five days' hospitalization. All patients had fever and leukocytosis. Possible risk factors included previous aspiration in five patients but none developing pneumonia, prior respiratory tract infection in nine but none with the same pathogen as their empyema, prior antibiotic use in over 50% of the patients, and severe head or chest injury in two thirds of the patients. Thirty-eight pathogens were recovered: S. aureus, 14; beta-streptococci, three; Pseudomonas, six; Klebsiella, two; Enterobacter, two; E. coli, two; other Gram-negative bacilli, six; and anaerobes, three. Fourteen infections were polymicrobic and bacteremia occurred in 42% of the patients. Of these 29 patients, 27 had chest tubes inserted for fluid in the pleural cavity before development of empyema; nine for hemo- or pneumothorax secondary to chest trauma, 11 for pneumothorax while on ventilators, and seven for unexplained sterile pleural effusion. If empyema complicated a prior hemothorax it was usually caused by Staphylococcus aureus and occurred about 10 days after draining blood from the pleural cavity. If empyema was a complication of pneumothorax or serothorax it was usually due to Gram-negative organisms colonizing the upper respiratory tract and occurred within 4 days of draining the fluid. Sixteen per cent of all patients who had chest tubes placed for fluid in their pleural cavity subsequently developed empyema.(ABSTRACT TRUNCATED AT 250 WORDS)

Generation of fatty acids by an acyl esterase in the bioluminescent system of Photobacterium phosphoreum

The fatty acid reductase complex from Photobacterium phosphoreum has been discovered to have a long chain ester hydrolase activity associated with the 34K protein component of the complex. This protein has been resolved from the other components (50K and 58K) of the fatty acid reductase complex with a purity of greater than 95% and found to catalyze the transfer of acyl groups from acyl-CoA primarily to thiol acceptors with a low level of transfer to glycerol and water. Addition of the 50K protein of the complex caused a dramatic change in specificity increasing the transfer to oxygen acceptors. The acyl-CoA hydrolase activity increased almost 10-fold, and hence free fatty acids can be generated by the 34K protein when it is present in the fatty acid reductase complex. Hydrolysis of acyl-S-mercaptoethanol and acyl-1-glycerol and the ATP-dependent reduction of the released fatty acids to aldehyde for the luminescent reaction were also demonstrated for the reconstituted fatty acid reductase complex, raising the possibility that the immediate source of fatty acids for this reaction in vivo could be the membrane lipids and/or the fatty acid synthetase system.

Right ventricular outflow obstruction secondary to right-sided tamponade following myocardial trauma

A case of isolated tamponade of the right side of the heart, seen as an abrupt change in the cardiac silhouette and as right ventricular outflow obstruction following myocardial trauma, is presented, along with a review of the English-language literature on delayed postoperative tamponade and loculated pericardial effusion. The importance of a low, fixed cardiac output and nonspecific physical findings in suggesting the clinical diagnosis is emphasized. The absence of many of the classic signs and symptoms of pericardial tamponade is noted, as is the possibility of unusual changes in the appearance or function of the heart in the presence of a loculated effusion. Finally, the differential diagnosis and the results of a variety of diagnostic techniques are discussed.

DNA/protein ratio as an index of oestrogen receptor content in human breast cancer

The nuclear DNA/cytoplasmic protein ratio was related to the oestradiol receptor content in both cytoplasmic (ERc) and nuclear (ERn) fractions in 165 cases of breast cancer. The patients under study were divided into groups according to whether their biopsies contained functional (ERc/ERn = +/+), abnormal (+/0) or non-detectable receptor (0/0). The mean microgram DNA/mg protein ratio was significantly decreased in both the abnormal and receptor-negative groups, with means of 30.4 and 30.2 respectively, when compared to the mean of 52.8 for the receptor-positive group. When the DNA/protein ratio for each patient was related to age, a discriminant line which clearly differentiated the ER +/+ group from the other two groups was obtained. It may be concluded that an increased DNA/protein ratio is related to the presence of ERn. Furthermore, since the DNA content per cell is higher in ER-negative tumours, an increase in cellularity must exist in ER-positive tumours.

Role of the ovary in the regulation of sex hormone binding globulin and its contribution to peripheral levels of androstenedione

In order to assess the role of the ovary in the regulation of the levels of the sex-hormone-binding-globulin (SHBG) and its contribution to peripheral levels of androstenedione, three subject groups were studied: 10 normally menstruating women, 8 postmenopausic women, and 8 postmenopausic ovariectomized women. A basal venous blood sample was drawn between 8:00 to 9:00 h from all subjects in the latter two groups. The blood samples were drawn from the normally menstruating women on days 7, 14, 21 and 28 of their cycles. The following determinations were made in each sample: oestradiol, progesterone, testosterone, androstenedione SHBG, FSH and LH. It was concluded that: 1) SHBG does not vary during the menstrual cycle, nor there are significant differences between postmenopausic and castrated women, and 2) androstenedione levels in castrated women are significantly different from both postmenopausic and normally menstruating women.

Purification of the acyl coenzyme A reductase component from a complex responsible for the reduction of fatty acids in bioluminescent bacteria. Properties and acyltransferase activity

The acyl-CoA reductase component of the fatty acid reductase complex responsible for synthesis of long chain aldehydes for the bioluminescent reaction in bacteria has been purified to homogeneity. The enzyme copurified as part of the complex through the initial steps and was then resolved and further purified to give a single band on sodium dodecyl sulfate-gel electrophoresis of molecular weight 58,000. The molecular weight of the native enzyme was 2 x 10(5), indicating it was an oligomeric enzyme containing identical subunits. The acyl-CoA reductase had a high specificity for NADPH with a Km value of 5 microM at optimal concentrations of tetradecanoyl-CoA (5-10 microM). The purified enzyme was discovered to have a high, intrinsic acyltransferase activity forming thioesters with a number of different thiol compounds (mercaptoethanol, dithiothreitol, 2-mercaptoethyl ether). The rates of the acyltransferase and acyl-CoA reductase reactions were similar to the rate of turnover of the fatty acid reductase complex suggesting that fatty acid reduction and not activation controls the rate of conversion of fatty acids to aldehydes.

Traumatic rupture of the pericardium

Patients with traumatic rupture of the pericardium rarely survive to reach a hospital. Ten cases from the Maryland Institute for Emergency Medical Services Systems and 132 previously published cases are reviewed. Patients were usually men who were victims of violent thoracic trauma. The median age was 40 years. Half of the patients had left pleuropericardial tears; tears of the diaphragmatic pericardium, right pleuropericardium, and superior mediastinal pericardium were less frequent. Associated injuries of the heart or left hemidiaphragm were common. Pericardial rupture was usually discovered during surgical exploration for other indications, but physical or radiographic signs were occasionally present. Repair is indicated for most pericardial tears to prevent herniation of the heart or abdominal viscera.

Molecular and cellular radiobiology of heavy ions

Quantitative studies at the BEVALAC have demonstrated some of the physical and radiobiological factors that promise to make accelerated heavy ions important for the therapy of cancer. The measured physical dose-biological effect relationships allow the safe and effective delivery of therapeutic schedules of heavy ions. Among the charged particle beams available, carbon, neon and helium ions in the "extended Bragg peak mode" have optimal physical and biological effectiveness for delivery of therapy to deep seated tumors. The depth-dose profiles of these beams protect intervening and adjacent tissues as well as tissues beyond the range of the particles. For the treatment of hypoxic tumors, silicon and argon beams are being considered because they significantly depress the radiobiological oxygen effect in the region of the extended Bragg ionization peak. The depth-effectiveness of the argon beam is somewhat limited, however, because of primary particle fragmentation. Silicon beams have a depth-dose profile which is intermediate between that of neon and argon, and are candidates to become the particle of choice for maximizing high LET particle effects. Heavy accelerated ions depress enzymatic repair mechanisms, decrease variations of radiosensitivity during the cell division cycle, cause greater than expected delays in cell division, and decrease the protective effects of neighboring cells in organized systems. Near the Bragg peak, enhancement of heavy particle effects are observed in split dose schedules. Late and carcinogenic effects are being studied. With the newly developed Repair-Misrepair theory we can quantitatively model most observations.

The value of technetium99m pyrophosphate scanning in the diagnosis of myocardial contusion

Twelve patients who sustained significant blunt chest trauma and had abnormal electrocardiographic changes unrelated to hypotension, hypoxia, or pre-existing myocardial disease were studied prospectively during a one-year period. The patients were divided into two groups on the basis of serum creatine phosphokinase (CPK)/MB isoenzyme concentrations: Group A (six patients) had normal CPK/MB isoenzymes (less than 8 IU), and Group B (six patients) had elevated CPK/MB isoenzymes (greater than 8 IU). All patients underwent cardiac scanning with technetium99m pyrophosphate. All studies were interpreted as normal. These data suggest that technetium99m pyrophosphate scanning is not a reliable adjunctive test to confirm myocardial contusion in patients with significant blunt trauma of the chest. However, the diagnosis of myocardial contusion in such patients can be established by the presence of abnormal electrocardiographic changes associated with an elevation of the serum CPK/MB isoenzyme concentration.

Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage

The accuracy of initial physical examination and peritoneal lavage in detecting intra-abdominal injury was assessed in 221 consecutive blunt trauma victims. Of the patients, 121 had negative peritoneal lavages, with one false result, and 100 had positive peritoneal lavages, including six false results and two injuries not requiring surgical correction. Hemoperitoneum occurred in 32 of 71 patients with a depressed sensorium and in 29 of 54 patients with thoracic injury. Twenty-eight of 120 patients with absent bowel tones and 20 of 100 patients with abdominal guarding or rigidity had negative peritoneal lavages. Among the 150 conscious, responsive patients there was a high incidence of false-positive and false-negative abdominal findings on physical examination. Hemoperitoneum was detected in four clinically negative patients. Significant error accompanies the initial abdominal examination and clinical assessment in the blunt trauma victim. In contract, open diagnostic peritoneal lavage is a sensitive and highly accurate test for blunt intraperitoneal injury. We believe peritoneal lavage is the single best test for intra-abdominal injury and should be performed in th majority of patients with such injuries.

Peritoneal lavage in children and adolescents with blunt abdominal trauma

The major cause of death in children is trauma. Although prompt recognition of blunt abdominal injury is essential, physical examination is an inexact means of establishing the diagnosis. One hundred thirty-five blunt trauma victims under 16 years of age underwent open diagnostic peritoneal lavage over a three-year period. The overall accuracy rate of peritoneal lavage was 95.5 per cent, which included true-negatives (65.9%), false-positives (4.5%), and true-positives (29.6%). These were no false-negative results. Of 40 patients with intra-abdominal injuries, five (12.5%) did not require surgical correction. Open diagnostic peritoneal lavage is the single best test for detecting serious intra-abdominal injury following blunt trauma in children and adolescents.

Glucose and lactate kinetics and interrelations in an antarctic bird (emperor penguin)

The isotope single-injection method was used to investigate the glucose and lactate kinetics and the interrelationships between the glucose and lactate pools in fasting emperor penguins. In these remarkably fast-resistant birds, mean lactate concentration, replacement rate, pool, space, and transit time were 1.5 mmol.1-1,53 mumol.min-1.kg-1, 900 mumol.kg-1, 60% of body mass, and 17 min, respectively. Mean glucose concentration, replacement rate, pool, space, and transit time were 20 mmol.1-1, 23 mumol.min-1.kg-1, 4,300 mumol.kg-1, 24% of body mass, and 196 min, respectively. Maximum conversions of lactate into glucose and of glucose into lactate were 29 +/- 2.9% and 75.5 +/- 4.2%, respectively, which indicates that lactate is an effective gluconeogenic precursor and a major fate of glucose metabolism in fasting penguins. The lactate replacement rate and incorporation into glucose were related to the plasma lactate concentration, which suggests that the rate of formation of glucose from lactate is dependent on the availability of lactate. The glucose replacement rate and reduction into lactate were related with the plasma glucose concentration, suggesting that the rate of lactate formation from glucose is dependent on the plasma glucose concentration. These data suggest that in the fasting emperor penguin glucose and lactate availability is capable of regulating the rate at which these substrates are utilized and interconverted. To our knowledge, this is the first evidence for such regulatory capacities in birds.