Natriuretic factors and lithium clearance in patients with the syndrome of inappropriate antidiuretic hormone (SIADH)

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.

[Aneurysm of the abdominal aorta and leg amputation. A chance coincidence or a pathogenetic correlation?]

A retrospective analysis of 545 patients, operated on between 1970 and 1987 for a closed or ruptured infrarenal aneurysm of the abdominal aorta (AAA), revealed an incidence of 5.1% of unilateral leg amputations among them (20 above, 8 below the knee) during the Second World War. Patients in both groups (with or without amputation) had one or more arteriosclerotic risk factors, their frequency rising with increasing age. There were differences between the two groups in the frequency of certain morphological characteristics in the area of the bifurcation and the terminal aorta affecting the haemodynamics of these regions. Stenosis or occlusion of the ipsilateral iliac arteries may be a possible pathogenetic factor. A prospective study will be required to decide whether the coincidence between leg amputation and AAA is pathogenetic or accidental.

Appearance of specific proteins in the apical plasma membrane of cultured renal collecting duct principal cell epithelium after chronic administration of aldosterone and arginine vasopressin

Principal cell epithelium of renal collecting duct from neonatal rabbit kidney was cultured in the presence of aldosterone (1 x 10(-6) M) and arginine vasopressin (AVP; 1 x 10(-6) M) for 10 days to investigate, by immunohistochemical methods using specific monoclonal antibodies, whether the hormones influence the expression and insertion of plasma membrane proteins. The experiments demonstrated that aldosterone alone or aldosterone plus AVP significantly increased the number of epithelial cells reacting at the luminal and lateral plasma membrane with the antibodies CD 2 and 3, specific for renal collecting duct, as we have shown in the kidney. In cultures treated with aldosterone and aldosterone plus AVP, nearly all epithelial cells were labelled by the antibodies, while controls or AVP treatment showed 41% and 24% unreactive cells, respectively. These findings were complemented with electrophysiological experiments, in which epithelia pretreated by aldosterone or aldosterone plus AVP showed significantly hyperpolarized transepithelial voltage (Vte) and higher resistance (Rte) than controls or AVP-treated specimens. The experiments demonstrated that chronic administration of aldosterone or of aldosterone plus AVP to increase Na+-transport was paralleled by the appearance of collecting-duct-specific proteins in the epithelium. Consequently, this result indicates that aldosterone influences the functional maturity of the cultured epithelium.

Ionic conductances of cultured principal cell epithelium of renal collecting duct

The ionic conductive properties were studied of epithelia of collecting duct principal cells which had been grown in primary tissue culture from renal cortex/capsule explants. When pretreated with aldosterone (10(-6) mol/l) and bathed on either surface with isotonic HCO3(-)-free Ringer's solution, the transepithelial voltage, Vte, varied between -21 and -72 mV (apical surface negative) while the transepithelial resistance, Rte, ranged from 0.4 to 1.5 k omega cm2. By 10:1 step-changes in Na+ concentration the apical cell membrane was shown to have a high conductivity for sodium, inhibitable by amiloride, 10(-6) mol/l. However, contrary to observations in natural collecting duct under control conditions, amiloride never reversed the polarity of Vte even at 10(-4) mol/l. Both the apical and the basolateral cell membranes were conductive for potassium and both conductivities were inhibitable by Ba2+ (5 mmol/l). 10:1 reduction of apical Cl- concentration strongly hyperpolarized Vte with a monophasic time course suggesting the presence of a paracellular shunt conductance for Cl-. In addition there may be a small Cl- conductance present in the apical cell membrane since apical application of the chloride channel blocker 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPAB) at 10(-7) mol/l produced a minute but significant hyperpolarization. On the other hand, 10:1 reduction of basolateral Cl- concentration caused a biphasic change in Vte (initial depolarization, followed by repolarization) which indicates the presence of a large Cl- conductance in the basolateral cell membrane. The latter was not inhibitable by 10(-7) mol/l NPPAB. Higher concentrations of this and of an other Cl-channel blocker produced non-specific effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of diuretics, hormonal derangements, and clinical setting of hyponatremia in medical patients

Because hyponatremia is frequently associated with preceding diuretic treatment and unrestricted fluid intake--conditions which have not been addressed sufficiently in published literature--we studied the pathophysiology and the clinical setting of such hyponatremia in a large group of internal medicine patients. We observed: a) Of an initial 310 patients with chemical hyponatremia only 204 (64%) had an associated plasma hypoosmolality. Since a normal plasma osmolality excludes a disturbance of water metabolism only the 204 patients with hypoosmolar hyponatremia were included in the study. This data shows that plasma osmolality is an essential measurement in any evaluation of hyponatremia. b) In 204 consecutive patients with hypoosmolar hyponatremia the electrolyte disturbance was related to advanced congestive cardiac failure in 25%, decompensated liver cirrhosis in 18%, volume contraction in 28%, syndrome of inappropriate antidiuretic hormone secretion in 19% and renal insufficiency in 4%. c) Plasma vasopressin was measurable in 90% of the 204 patients. It is known that radioimmunoassays to measure vasopressin fail to reliably detect low concentrations of circulating vasopressin (less than 0.5 pg/ml). It may therefore be stated that hypoosmolar hyponatremia was generally characterized by a failure of antidiuretic hormone suppression. d) Mean daily fluid intake of hyponatremic patients was 2.35 +/- 0.15 l. In the presence of stimulated vasopressin this large a fluid intake is bound to worsen the severity of hyponatremia. e) Of 204 patients 126 were treated with diuretics at the time of study. In these patients hyponatremia worsened during such treatments and was associated with evidence of prerenal azotemia. However there were no significant differences between diuretic-treated and -untreated patients with respect to plasma vasopressin stimulation and amount of fluid intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural and functional variations in capillary systems within the brain

The major hypothesis of this study is that there are differences among brain areas in capillary bed structure and function. Three general differences between circumventricular organ and non-CVO capillary beds were found. First, the PS products for AIB were about 300 times greater in CVO capillaries than in non-CVO (blood-brain barrier) capillaries. Second, the frequency of endothelial cell fenestrations was much greater in CVO capillaries than in non-CVO capillaries and the fenestrae may be structural modifications of endothelial cells that permit ready passage of solutes such as AIB. Third, the frequency of mitochondria was greater in BBB capillaries than in CVO capillaries; this high metabolic potential of BBB capillaries may be associated, in part, with "carrier-mediated" transport of various solutes between plasma and cerebral interstitial fluid. Capillary bed differences among all (i.e., both CVO and non-CVO) brain structures were also observed. Among these differences are: rate of blood flow, mean transit time of albumin, capillary volume and surface area, perfused microvessel blood volume, apparent percentage of perfused capillaries, PS products for AIB, and frequency within the endothelium of vesicular profiles.

Herpes simplex virus type 2 latency in the footpad of mice: effect of acycloguanosine on the recovery of virus

Herpes simplex virus type 2 has been reactivated from the latent state in the footpad and dorsal root ganglia of acycloguanosine-treated BALB/c mice. Virus was also recovered from the footpad tissue but not from the ganglia of denervated, latently infected mice. Treatment in vitro of explanted footpad cultures with acycloguanosine or phosphonoacetic acid did not affect the rate of virus reactivation. In all the isolates examined the virus was found to be acycloguanosine-sensitive. Recovery of virus from footpad tissue of mice after a long period of acycloguanosine treatment supports the theory that virus had been truly latent in the footpad and not in a state of persistent infection.

[Correlation between roentgen morphometrically obtained data and cortical thickness indicative of anchorage strength of screws in human cadaver vertebral bodies]

Through the morphometric and histomorphometric examinations on the vertebral of the corpses, a functional connection between roentgenmorphometric plain facts (in transverse- and sagittal diameter of the vertebral body) and the cortical thickness can be established. The stress of the vertebral body through a screw can already preoperatively be assessed by roentgenmorphometric examinations that the cortical thickness plays an important dimension in the anchorage tightening of the screws on the vertebral body. By use of this knowledge the guarantee of operation on vertebral body is raised.

Methylation of cytosolic proteins may be a possible biochemical pathway of early aldosterone action in cultured renal collecting duct cells

The common model of aldosterone-dependent sodium transport is that the hormone increases sodium transport during the "early" and "late" response phases by inducing specific proteins (AIPs). However, in actual biochemical studies, AIPs were mostly detected 6-24 h after aldosterone application. Regarding the physiological early response phase, this implies temporal dissociation of the physiological and biochemical events. The discrepancy raises the question as to whether other biochemical events, such as protein modifications, may be involved in addition to the novo protein synthesis. Labelling of cultured renal collecting duct epithelia for 1-5 h with a radioactive methylgroup donor, S-adenosyl methionine (SAM), following tissue fractionation, resulted in progressive methylations of specific cytosolic proteins. Aldosterone-dependent methylations increased consistently with time, and accounted for a 60% increase in total cytosolic protein content as compared to controls after 5 h labelling. The different methylated proteins showed a molecular weight of 220, 97 and 75 kd and comprised groups of proteins with an isoelectric point of 5.1-5.7 and 6.0-7.5. Methylation of identical proteins was obtained by incubation of the epithelia with unlabelled SAM instead of aldosterone. SAM-induced as well as aldosterone-induced methylation of proteins with an isoelectric point of 6.0-7.5 could be inhibited by the methylation inhibitor S-adenosylhomocysteine. The results indicate that aldosterone may influence the SAM cycle in cultured collecting-duct epithelia during increase of the Na+-transport.

Optimising hospital revenues

Today's hospital materials manager must search for new ways to reduce expenses and/or increase revenues. In this article the author examines a method of rate optimization for charge paying patients; whereby, departments serving these patients are identified, their impact both measured and optimized.

Expression of the alpha-subunit of Na/K-ATPase in renal collecting duct epithelium during development

Aldosterone enhances synthesis and enzyme activity of Na/K-ATPase and has been found to stimulate sodium reabsorption by the renal cortical collecting duct. Moreover, chronic exposure to aldosterone is associated with a remarkable morphological-functional adaptation. This is seen as a magnification in basolateral membrane area of principal cells. In the present paper we investigated the acquistion of Na/K-ATPase alpha-subunit in renal tissue and examined whether aldosterone initiates functional and adaptive changes in cultured collecting duct cells similar to those observed in vivo. Using a monoclonal antibody, immunofluorescence microscopy demonstrated the acquisition of the alpha-subunit of Na/K-ATPase in the developing cortical collecting ducts of the kidney of neonatal rabbits. The mature collecting ducts in the medulla and papilla of the developing kidney were strongly labelled at the basolateral side, while in the cortical portion of the fetal collecting duct adjacent to the embryonic ampullae the immunolabel was found at the apical and the basolateral aspect of the epithelium. However, the embryonic collecting duct ampullae in the outer cortex did not show any reaction with the antibody. In the collecting duct cells cultured for 24 hours the alpha-subunit of Na/K-ATPase was found to be distributed at both the apical and basolateral aspect of the epithelium. After two to 16 days, the immunolabel was strictly found distributed at the basolateral side. Culturing collecting duct cells in the presence of aldosterone (10(-6) M), the hormone modulated the cellular shape of epithelia after five days by infolding the lateral plasma membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

High-conductance K+ channel in apical membranes of principal cells cultured from rabbit renal cortical collecting duct anlagen

Using the patch clamp technique, one type of K+ channel was identified in the apical cell membrane of cultured principal cells of rabbit renal collecting ducts in the cell-attached or excised-patch configuration. The channel was highly selective for K+ over Na+ (typically 30-70-fold) and had a conductance of 180, SD +/- 39 pS (n = 6), referred to a situation of 140 mmolar K+-Ringer solution present on either surface of the patch membrane. Channel activity was completely blocked by Ba2+ (5 mmol/l) and partially inhibited by Na+. The latter was evidenced by a deviation from Goldman rectification at high cytoplasm-positive membrane potentials, which was observed when Na+ competed with K+ for channel entrance from the cytoplasmic surface. Channel open probability depended strongly on membrane voltage and cytoplasmic Ca2+ concentration. Open-close kinetics exhibited double exponential behaviour, with a strong voltage dependence of the slow open time constant. Infrequently also a substate conductance level was identified. The voltage and calcium dependence suggest that the channel plays a role in adjusting K+ secretion to Na+ absorption in the fine regulation of cation excretion in renal collecting ducts.

Intramuscular vitamin E repletion in children with chronic cholestasis

Progressive spinocerebellar degeneration was identified in six children with chronic cholestatic liver disease and attributed to severe vitamin E deficiency. In addition to areflexia, ataxia, dysmetria, and diminished vibratory and position sense, three patients had pigmentary retinopathy. Abnormalities were present on electromyography, nerve conduction studies, and electroretinography. Because the vitamin E deficiency was not corrected by oral administration of massive doses of vitamin E, vitamin E was administered by the intramuscular route. With doses of 50 to 100 mg of vitamin E every three to seven days, over a 32-month interval (range, 15 to 44 months), vitamin E deficiency and abnormal red blood cell peroxide hemolysis were corrected. Other than discomfort and occasional edema at the site of injection, there were no side effects of parenteral vitamin E therapy. In several other studies intramuscular vitamin E therapy has produced significant neurologic improvement in patients with similar characteristics. In this study clinical progression of spinocerebellar degeneration was arrested but improvement could not be demonstrated despite adequate vitamin E replacement.

Complex physiological and biochemical action of aldosterone in toad urinary bladder and mammalian renal collecting duct cells

Since the discovery of the steroid hormone aldosterone nearly 35 years ago, our knowledge on the cellular actions of aldosterone is still incomplete. Most of the present physiological and biochemical knowledge about the antinatriuretic action was revealed by investigations on amphibian tight epithelia, in particular the toad urinary bladder. Less biochemical information was obtained from mammalian tissue such as microdissected renal tubules and cultured cells. In our opinion, it is questionable whether de novo synthesis of cell proteins-induced by aldosterone-can explain all of the hormonal effects to increase the Na+ transport. In the present paper we try to analyze the wide and contradictory field of biochemical data about the action of aldosterone on the increase in Na+ transport in renal cells in an attempt to incorporate this information into an extended working hypothesis. We suggest distinguishing principally between an early and a late biochemical response phase. We speculate that aldosterone may act by a two-step mechanism: the early and late aldosterone-induced proteins.

Differentiation properties of renal collecting duct cells in culture

In the present study, we were particularly interested in distinguishing specific patterns of structural and functional proteins in the collecting duct system of neonatal and adult kidneys and in cultured renal collecting duct epithelia in order to ascertain the degree of differentiation in the cultures. We studied the distribution of specific renal collecting duct cell markers using morphological, immunohistochemical and biochemical procedures. Cultured renal collecting duct epithelium undergoes maturation in vitro. Examples of morphological differentiation include the appearance of cilia and microvilli at the apical cell pole, and a basement membrane at the basal aspect of the epithelium. Tight junctions with five to seven strands separate the wide intercellular spaces from the apical cell surface. Physiological maturation from a 'leaky' to a 'tight' epithelium is evident from the acquisition of the alpha-subunit of Na/K-ATPase and the development of a high transepithelial potential difference and resistance. Biochemical differentiation is revealed by the expression of specific proteins. The simple-epithelium cytokeratins, PKK1 and PKK2, which are typical intracellular-matrix proteins of mature collecting duct epithelium, maintain the same distribution in cell culture as in neonatal and adult kidneys. An indicator of maturation in vitro is the expression of the collecting duct-specific proteins, PCD2 and PCD3. Newly developed monoclonal antibodies against these antigens reacted similarly with cultured cells and cells of the mature collecting duct system, but they did not label the embryonic ampullae in the cortex of neonatal rabbit kidneys. In contrast, a third collecting duct-specific protein, PCD1, is not expressed by the cultured cells, which indicates the retention of an embryonic characteristic in vitro. Embryonic collecting duct ampullae of the neonatal kidney in situ contain laminin during their development. Laminin is, however, absent in cultured collecting duct epithelium. Biochemical stimulation of the adenylate cyclase system by arginine vasopressin resulted in a twofold stimulation of the enzyme activity. This degree of stimulation is similar to that found in maturing kidneys of neonatal rabbits and indicates another embryonic feature of the cultures.

Influenza vaccine and pneumonia mortality in a nursing home population

The effectiveness of immunization against influenza in elderly persons is uncertain. A retrospective cohort study in a New York City nursing home examined the occurrence of pneumonia and its related mortality over three consecutive influenza seasons (Nov 1 through April 30, 1979 to 1980, 1980 to 1981, and 1981 to 1982). Nearly one half of approximately 450 residents (mean age, 84 years) accepted immunization each year. The vaccinated and unvaccinated groups were similar. The attack rate of pneumonia did not differ significantly between the vaccinated and unvaccinated groups in any of the three influenza seasons. When influenza was occurring in the community (1979 to 1980 and 1980 to 1981), however, the risk of death from pneumonia in the unvaccinated group was three-fold higher than in the vaccinated group (60% vs 18% and 73% vs 25%, respectively). In a year when influenza was specifically sought and not found in the facility (1981 to 1982), however, vaccination did not affect pneumonia-related mortality. This study also suggests that estimates of mortality due to pneumonia should include deaths that occur up to 60 days after onset of pneumonia; shorter follow-up may overestimate the protective effect of vaccination.

Man-made vitreous fibers: an overview of studies on their biologic effects

Clinical and roentgenologic studies have not shown that workers in the MMVF industry have demonstrable pulmonary changes attributable to MMVF exposures. Large scale international experimental studies have demonstrated that MMVF cause neither lung cancer, mesothelioma nor lung fibrosis when inhaled by rats. Other studies have confirmed this and extended these findings also to monkeys and hamsters. Epidemiologic studies on a total of over 40,000 workers in the MMVF industry have failed to demonstrate that exposure to MMVF is associated with a significantly increased risk of death from lung cancer or nonmalignant respiratory disease.

Electrical properties of renal collecting duct principal cell epithelium in tissue culture

Whereas collecting duct epithelium in vivo is composed of principal and intercalated cells, we grew a pure principal cell epithelium using a new technique involving tissue culture. These principal cells were derived from collecting duct anlagen of newborn rabbits. We investigated the electrical properties of such epithelia in a newly designed lucite double-chamber with an inner opening of 0.08 cm2. Our observations were: mean transepithelial resistance Rte was 0.83 +/- 0.2 k omega cm2 at 37 degrees C and after preincubation in aldosterone; mean transepithelial potential difference Vte was low and variable under standard conditions and at room temperature but increased to -59.5 +/- 4.4 mV (sign referring to polarity of apical surface) after preincubation in 10(-6) mol/l aldosterone and at 37 degrees C; 10(-6) mol/l amiloride added to the apical perfusion fluid largely abolished this Vte while increasing Rte by 120%; experiments with 5 X 10(-3) mol/l BaCl2 in the apical perfusion fluid failed to change Rte and Vte significantly. This principal cell epithelium therefore has characteristics of a "tight" epithelium with active sodium transport; however, its electrical properties differ from those of the isolated perfused collecting duct segment.

Alkaline inorganic pyrophosphatase and starch synthesis in amyloplasts

The aim of this work was to see if amyloplasts contained inorganic pyrophosphatase. Alkaline pyrophosphatase activity, largely dependant upon MgCl2 but not affected by 100 μM ammonium molybdate or 60-100 mM KCl, was demonstrated in exracts of developing and mature clubs of the spadix of Arum maculatum L. and of suspension cultures of Glycine max L., but not in extracts of the developing bulb of Allium cepa L. The maximum catalytic activity of alkaline pyrophosphatase in the above tissues showed a positive correlation with starch synthesis, and in the first two tissues was shown to exceed the activity of ADPglucose pyrophosphorylase. Of the alkaline pyrophosphatase activity in lysates of protoplasts of suspension cultures of Glycine max, 57% was latent. Density-gradient centrifugation of these lysates showed a close correlation between the distribution of alkaline pyrophosphatase and the plastid marker, nitrite reductase. It is suggested that much, if not all, of the alkaline pyrophosphatase in suspension cultures of Glycine max is located in the plastids.

The hepatocyte and type IIA and IIB hyperlipoproteinemia. A morphometric study

We obtained liver biopsies in 4 patients with type IIA and 7 patients with type IIB hyperlipoproteinemia, and also in 7 healthy controls. A morphometric analysis of liver tissue was carried out by light and electron microscopy. Structural alterations of the hepatocyte and its organelles in type IIA and IIB hyperlipoproteinemia seem to fall into different categories: smaller nuclei, enlarged peroxisomes and altered mitochondria are found in both types of hyperlipoproteinemia, while an increase in the volume of hepatocytes is found only in type IIA. The enlargement of liver peroxisomes in untreated hyperlipoproteinemia is noteworthy, since it has been considered as a marker of the liver toxicity of lipid-lowering drugs.

The prevalence of retinopathy is similar in diabetes mellitus secondary to chronic pancreatitis with or without pancreatectomy and in idiopathic diabetes mellitus

In a retrospective study, we compared the prevalence of retinopathy in two groups of 88 diabetic patients (84 men, 4 women) with either diabetes mellitus secondary to chronic pancreatitis (CP-DM group) or idiopathic diabetes mellitus (I-DM group). The patients of these two groups were pair-matched according to age (48.7 +/- 1.1 versus 48.8 +/- 1.0 yr in CP-DM and I-DM groups, respectively; mean +/- SEM), sex, duration of diabetes (7.96 +/- 0.56 versus 8.08 +/- 0.8 yr) and therapy (80 on insulin and 8 on oral hypoglycemic agents in each group). Retinopathy was assessed by bilateral ophthalmoscopic examination of the fundus after pupillary dilation in all 176 patients and by fluorescein angiography in 47 patients with CP-DM and 35 patients with I-DM. Forty-one percent of patients in the CP-DM group and 45.5% of patients in the I-DM group had diabetic retinopathy (P greater than 0.5). In each group, patients with retinopathy were older than patients without retinopathy (51.6 +/- 1.3 versus 46.7 +/- 1.8 yr in the CP-DM group, P less than 0.01, and 52.1 +/- 1.5 versus 46.0 +/- 1.2 yr in the ID-M group, P less than 0.01). They had diabetes of longer duration (10.9 +/- 1.0 versus 5.9 +/- 0.6 yr in the CP-DM group, P less than 0.001, and 10.5 +/- 1.0 versus 6.0 +/- 0.6 yr in the ID-M group, P less than 0.001). The prevalence of retinopathy increased parallel to the duration of diabetes in a similar way in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Biologic activity of hydroxylamine: a review

Although hydroxylamine, as such, is a product of normal cellular metabolism it is also a potent mutagen in vitro. However, in spite of this potential, it has not been shown to possess carcinogenic capabilities. Indeed, this chemical has demonstrated carcinostatic activity against certain tumors in animals. In addition, hydroxylamine has been shown to inactivate or inhibit a number of cellular enzymes and some viruses in vitro. It is also a skin irritant and sensitizer. It causes dermatitis and it is corrosive to the eyes. Acute and chronic exposures to hydroxylamine have caused methemoglobinemia and sulfhemoglobinemia.

Phosphorus trichloride toxicity. Preliminary report

A railroad accident in Somerville, Massachusetts, led to spillage of phosphorus trichloride liquid. Attempted clean-up with water led to the liberation of phosphorus trichloride, phosphoric acid, hydrochloric acid, and phosphorus oxides. Seventeen people exposed to this mixture were studied. Patients experienced eye irritation, lacrimination, nausea, vomiting, and dyspnea. Six patients had transient elevation of lactic dehydrogenase. Although all patients had normal chest roentgenographic findings, pulmonary function tests showed statistically significant decreases in vital capacity (p = 0.02), maximal breathing capacity (p = 0.02), forced expiratory volume in one second (p = 0.02), and maximal expiratory flow rate at 25 percent of vital capacity (p = 0.05) in those closest to the accident site. Further, patients exposed for less than one and a half hours had significantly greater maximal expiratory flow rates at 25 percent of vital capacity when compared with patients who had been exposed longer (p = 0.02). In seven patients, repeated pulmonary function tests one month later showed improvement, suggesting strongly that the acute effects may have been due to phosphorus trichloride toxicity.

Biologic activity of epsilon-caprolactam

In general, this literature review indicates that epsilon-caprolactam has a relatively low toxicity to humans. This low-degree of toxicity is attributable in part to its rapid elimination as demonstrated by experimental studies on animals. Human studies are mostly those based on workers in Russian factories. Although reporting physicians attributed such symptoms as general weakness, irritability, headaches, and insomnia, and such diagnoses as neurosis, neurasthenia, rapid mood shifts as well as others to excessive caprolactam exposures, the widely recognized Russian national scourge of alcoholism, particularly among working populations was not considered as a possible factor. Some of the reports recognized the complicating existence of multiple exposures in the factories such as excessively high temperatures and humidity, high noise levels, and other chemicals - including mixtures of diphenyl and diphenyl oxide, cyclohexane, benzene, and others, but most reports gave scant or no consideration to them.

Scrotal and penile lymphedema: surgical considerations and management

From 1971 to 1981, 6 patients with scrotal and penile lymphedema were treated with total excision of the scrotal and penile skin. Split thickness skin grafts were used to cover the penis and form a neoscrotum. Of the patients 2 men had primary idiopathic lymphedema, while 4 had secondary lymphedema resulting from foreign body injections or trauma with subsequent chronic infection. Surgical considerations using split thickness skin grafts versus posterior lateral scrotal skin flaps are compared.

Serologic responses and systemic reactions in adults after vaccination with monovalent A/USSR/77 and trivalent A/USSR/77, A/Texas/77, B/Hong Kong/72 influenza vaccines

Four hundred twenty-six volunteers aged 16 to 83 years were given experimental doses of inactivated monovalent [A/USSR/77 (H1N1)] and trivalent [A/USSR/77 (H1N1), A/Texas/77 (H3N2), B/Hong Kong/72] influenza vaccines as part of a double-blinded, placebo-controlled, national collaborative study. Local reactions at inoculation sites occurred in less than 6.6% of volunteers. Systemic reactions, generally consisting of low-grade fever, myalgia, or headache, lasting less than 24 hr, did not occur more frequently in vaccinees than in placebo recipients. Vaccines containing lower doses of the A/Texas/77 (H3N2) hemagglutinin (8-10 micrograms) and B/Hong Kong/72 hemagglutinin (6-9 micrograms) produced hemagglutinin-inhibiting (HAI) antibody responses equivalent to those produced by higher doses (15-28 and 19-28 micrograms, respectively) in all age groups. Single injections of vaccines containing lower doses of A/USSR/77 (H1N1) hemagglutinin (4-7 micrograms) induced titers of HAI antibody of greater than 1:40 in 93% of volunteers greater than or equal to 26 years of age but in only 58% of volunteers less than 26 years of age. In this latter group, two injections containing higher doses (10-19 micrograms) induced better antibody responses. Vaccines containing approximately 6-15 micrograms of hemagglutinin of each antigen can be expected to be well tolerated and to induce good HAI antibody responses in a one- or two-dose regimen, depending on the age group.

Man-made vitreous fibers: present status of research on health effects

Concerns engendered by inappropriate extrapolation from rat intracavitary cancer experiments stimulated the initiation of new retrospective and prospective epidemiologic studies of man-made vitreous fibers (MMVF). The results of these new studies have confirmed those of previous investigations that MMVF exposure had not caused an increased risk to develop lung cancer or nonmalignant respiratory disease. In contrast to the high pathogenic potential of MMVF (thin long fibers) when injected into the body cavities of rats, the pulmonary reaction of rodents inhaling such fibers has been that of a nuisance-type dust. The results of new experimental inhalation studies have not yet been published. In vitro studies have demonstrated cytotoxicity of thin long MMVF. Although there is a parallelism between the in vitro cytotoxicity results of MMVF and those of the in vivo intracavitary carcinogenesis studies with the same fibers, it is difficult to attach significance to this parallelism insofar as man is concerned because the rat intracavitary carcinogenesis results have no relevance to man.

Gluteal myoplasty for sphincter replacement: principles, results and prospects

The treatment of anal incontinence following anorectal malformations and their treatment can be done even if the colic pull-down has been carried out of the levatori ani muscle sling. The use of the gluteus maximus encircling the neorectum with a contractile muscular ring provides an active control of continence, and reverses the anorectal angulation. The rationale of the myoplasty has been pointed out and our first resulted analyzed. The use of voluntary contraction limits the scope of an operation whose effects can be lost during sleep. But the voluntary daytime control makes it possible for the patient to take part in school, occupational or sportive activities.

[Evaluation and treatment of hyponatremia (author's transl)]

In all patients with hyponatremia, an etiologic diagnosis must be made. A diagnostic classification of hyponatremic states is proposed, which is based on extracellular fluid volume status. A spot urinary sodium concentration will be helpful in confirming the diagnosis. Treatment should concentrate on correction of etiologic factors and fluid restriction after any extracellular fluid volume depletion is treated. A regimen of rapid correction of hyponatremia is outlined for serious, symptomatic cases. It consists of diuretic induced diuresis, accompanied by hypertonic sodium replacement of urinary losses. Finally, the usefulness of demeclocycline hydrochloride is characterized.