Endotoxemia in obstructive jaundice. Observations on cause and clinical significance

Perioperative endotoxemia was detected in 24 of 40 patients who underwent operation for obstructive jaundice (bilirubin level greater than 5.8 mg/dl). Endotoxemia was associated with an increased admission serum bilirubin level (p less than 0.05) and white blood cell count (p less than 0.05) and a decreased hematocrit value (p less than 0.05), but there was no significant association with other established preoperative risk factors. Patients with preoperative endotoxemia had a decreased immunoglobulin M anti-J5 endotoxin titer (p less than 0.05) and a decreased serum bile acid concentration (p less than 0.05). Preoperative endotoxemia was associated with reduced creatinine clearance before and after operation (p less than 0.05). There was no association between endotoxemia and clinical sepsis, gram-negative infection, or small-bowel colonization. Patients who died had increased preoperative serum fibrin degradation products (p less than 0.05).

Effectiveness of citizen volunteers functioning as counselors for high-risk young male offenders

This research evaluated a counseling program utilizing citizen volunteers in 1:1 relationships with young male offenders placed on probation for 12 mo. 100 high-risk offenders were randomly assigned to either citizen counseling with regular probation or to regular probation only. A random sample of 50 low-risk offenders assigned to regular probation served as a comparison group. Low-risk offenders were superior to the high-risk groups on measures of behavior, personality functioning, and social competence. Citizen-counseled high-risk offenders, compared to other high-risk offenders, committed fewer and less serious criminal offenses, were employed more regularly, made better educational progress, and appeared to be somewhat less rebellious, less impulsive, and more responsible as measured on the California Psychological Inventory at the end of probation. The implications and unique features of the programming, which may limit the generality of the findings to other settings, were discussed. Potentially limiting conditions included the stringent selection and matching procedures, the high caliber of the volunteers, the severe demands imposed on the time (weekly meetings over about 10 mo.) and talents (crisis counseling, tutoring, advocacy, friendship, and resource brokerage) of the unpaid citizen volunteers, and the availability of vital community resources, such as vocational and educational opportunities.

Effect of immunization with Escherichia coli J5 on graft-versus-host disease induced by minor histocompatibility antigens in mice

We have used a cell-wall-deficient mutant of Escherichia coli (E coli J5) to study the effect of active and passive immunization against bacterial endotoxin (ET) in a murine model of acute graft-versus-host disease (GVHD) induced by minor histocompatibility antigens. C57BL/B6 (H-2b) mice were irradiated and grafted with 1 X 10(7) anti-Thy-1.2 and complement-treated bone marrow cells and 5 X 10(7) spleen cells from LP/J (H-2b) donors. Groups of mice were immunized against J5--either actively immunized with killed J5 cells or pure J5 lipopolysaccharide or passively immunized with rabbit anti-J5 antiserum (R alpha J5). Controls included irradiation controls, negative controls (conventional mice grafted with depleted bone marrow only), positive controls (conventional mice grafted with bone marrow and spleen cells), and mice passively immunized with normal rabbit serum (NRS). Positive control mice developed GVHD and all died by day +77. Active immunization partially protected against the rapid weight loss due to GVHD (P less than 0.05) but mice had an earlier onset of GVHD (P less than 0.05) and a shortened survival after onset (P less than 0.05). Median survival time (MST) and overall survival were unchanged. Passive immunization with R alpha J5 delayed death (P less than 0.01), increased MST (P = 0.01), increased overall survival (P less than 0.01), and protected against weight loss (P = 0.01). NRS had no beneficial effect.

Detection of intracavitary masses on gated scans: a phantom study

A series of 1.5, 2.0 and 3.0 cm diameter paraffin balls were placed on a 3 cm tether within a simulated left ventricular balloon phantom to determine the maximal balloon volume that permitted identification of the lesion. When images were recorded with the phantom stationary, the lesions could be detected at 100, 280 and 360 ml volumes, respectively. When the phantom was set in motion with a fixed 80 ml stroke volume, the lesions were detected at 120, 320 and 360 ml, respectively. These findings suggest that gating does not decrease lesion detection even when the lesion is freely mobile, and a 1.5 cm lesion would be difficult to detect in an enlarged ventricle, but 2 and 3 cm lesions could be detected even in the presence of moderate ventricular enlargement.

Biodistribution of tantalum-178: a short-lived radiopharmaceutical for blood pool imaging

178Ta is a short lived radionuclide (half life = 9.3 min), which results in favorable radiation exposure compared to 99mTc (half life 6 h). The energy spectrum of 178Ta consists of imageable photons in the 55-65 keV (61.2%) and 93 keV (33.7%) range but also 6% of disintegrations result in photons with energies greater than 500 keV. These high energy photons cause septal penetration in low energy collimators so that resolution is degraded. However, a medium energy collimator prevents the septal penetration of these higher energy photons. Serial blood samples obtained from dog and rabbit models indicate that 178Ta is retained in the blood pool for at least 20-30 min after intravenous injection. The 178Ta appears to be associated with the protein fraction of the plasma and not primarily with the red blood cell fraction as determined by centrifugation and column chromatography. Gated equilibrium blood pool images using 178Ta were comparable in quality to images using the 99mTc labelled red blood cell technique. Therefore, 178Ta may allow comparable equilibrium gated blood pool imaging with much more favorable radiation dosimetry. Thus, serial studies over prolonged periods of observation may be obtained.

Cardiac response to daily activities and exercise in normal subjects assessed by an ambulatory ventricular function monitor

The cardiac response to a variety of daily activities was assessed in 18 healthy adult subjects (mean age 31 years, range 21 to 39) with an ambulatory ventricular function monitor (VEST), which records serial beat-to-beat radionuclide and electrocardiographic data. The VEST was positioned and calibrated using data recorded during a multigated blood pool scan. It was worn for an average of 3.0 +/- 1.1 hours, while the subjects performed the following activities: sitting quietly (baseline); standing in place; walking; climbing stairs; bicycle or treadmill exercise; eating; sitting in a room at 4 degrees C for 20 minutes; and urinating. To calculate ejection fraction (EF), relative end-diastolic counts, relative cardiac output and heart rate, the beat-to-beat data were averaged over 15 to 30 seconds. Compared with baseline, standing increased EF by 0.03 +/- 0.04 and decreased end-diastolic volume by 10.9 +/- 4.7%. Walking and climbing stairs increased EF by 0.10 +/- 0.05 and 0.18 +/- 0.09, respectively, and increased end-diastolic volume by 7.8 +/- 5.3% and 12.8 +/- 4.3% (p less than 0.001). Eating increased EF by 0.02 +/- 0.03 and decreased end-diastolic volume by 11.3 +/- 6.1% (p less than 0.001). Cold stimuli and urinating decreased EF by 0.05 +/- 0.04 and 0.03 +/- 0.04, respectively (p less than 0.001 and less than 0.05). Serial left ventricular function monitoring during graded bicycle and treadmill exercise revealed a rapid increase in EF in the early stages of exercise, with no further change in the late stages. Heart rate and systolic blood pressure increased progressively with each successive stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of endotoxin on graft-versus-host disease after bone marrow transplantation across major histocompatibility barriers in mice

Much clinical and experimental data suggest that infection and graft-versus-host disease (GVHD) are intimately associated, and that bacterial endotoxin (ET), a potent immunostimulant, influences the severity of GVHD. We have used a cell-wall-deficient mutant of Escherichia coli (E coli J5) to study the effect of active and passive immunization against ET in a murine model of GVHD induced by major histocompatibility antigens. CBA/Ca (H-2k) mice were irradiated and grafted with 1 X 10(7) bone marrow cells from C57BL/B6 (H-2b) donors. Groups of mice were immunized against J5: either actively immunized with killed J5 cells or pure J5 lipopolysaccharide, or passively immunized with rabbit anti-J5 antiserum (R alpha J5). Controls included irradiation controls, negative controls (syngeneic graft), positive controls (conventional mice receiving allogeneic graft), mice immunized with normal rabbit serum, Freund's adjuvant (FA), or human serum albumin (HSA) in FA. Active immunization with J5 exacerbated the effects of GVHD as indicated by increased weight loss (P = 0.002) and earlier death (P = 0.043). In contrast, immunization with HSA protected against weight loss (P = 0.028), and improved survival (P = 0.008). Passive immunization with J5 had no effect. These observations support the hypothesis that ET influences the pathogenesis of GVHD, and provide a useful model for studying the effects of ET in a well-defined immunological system.

Measurement of both left ventricular function and regional myocardial perfusion with 133Xe in dogs

A technique to measure left ventricular (LV) function and myocardial perfusion was validated in 12 dogs. 133Xe in saline was injected into the left atrium (LA) or LV and two data sets were obtained using gamma camera imaging: 1) A first pass gated scan for LV function; followed by 2) Sequential images for regional myocardial perfusion. LV ejection fraction and wall motion measurements from the 133Xe blood pool images were compared to ejection fraction (r = 0.88, P less than 0.01) and wall motion (r = 0.83, P less than 0.01) data from 99mTc labeled blood pool scans. The perfusion measurements obtained with the 133Xe method were compared to microsphere data (r = 0.79, P less than 0.01). Measurements after LV 133Xe injection were similar to data following LA injection. Thus, quantitative assessment of global LV function, regional wall motion and myocardial perfusion is possible with LA or LV 133Xe injection and gamma camera imaging.

Antibody titres to a rough-mutant strain of Escherichia coli in patients undergoing allogeneic bone-marrow transplantation. Evidence of a protective effect against graft-versus-host disease

Much clinical and experimental evidence suggests that infection and graft-versus-host disease (GvHD) are commonly associated as complications of bone-marrow transplantation (BMT). A likely basis for this association is the gram-negative faecal flora,the origin of many septicaemias and a source of bacterial endotoxin, which has potent immunostimulatory effects. A rough-mutant strain, Escherichia coli J5, has only core determinants in its endotoxin,and antibodies to E coli J5 protect animals and human beings from the consequences of septic shock. Naturally occurring antibodies to E coli J5 ("anti-endotoxin") were assayed in serum from patients undergoing BMT, healthy controls, and patients with obstructive jaundice. BMT recipients had significantly lower titres than the other two groups. Furthermore, the titre of IgM class anti-J5 antibody was significantly associated with protection from GvHD.

Multigated blood-pool tomography: new method for the assessment of left ventricular function

A technique for the semiautomatic calculation of left ventricular volumes from multigated blood-pool tomograms (MGBPT) was tested in a series of 12 patients undergoing contrast ventriculography within 48 hr of gated tomography. The parameters necessary for the calculation of volume were developed in a chest phantom study performed with a series of 99mTc-filled balloons representing the right and left ventricles. The images were analyzed for volume using a percentage of peak count-threshold of the left ventricular balloon. This technique resulted in a correlation of r = 0.99 of the calculated to the true phantom volumes (y = 0.87x + 27.4, p less than 0.01, s.e.e. = 7.87 ml). The patient studies were recorded at 16 frames/cardiac cycle at each of 60 angles over a 360 degree rotation. Reconstructed data were presented in an endless loop cine format producing a set of sequential "beating tomographic slices" in the transverse, apical four-chamber, short-axis, and long-axis oblique views. Measurements of end systolic volume (y = 0.79x + 30, r = 0.93, p less than 0.001, s.e.e. = 24 ml), end-diastolic volume (y = 0.63x + 60, r = 0.94, p less than 0.0001, s.e.e. = 20 ml) and ejection fraction (y = 0.88x - 0.02, r = 0.92, p less than 0.001, s.e.e. = 0.08) determined from the semiautomated volume method correlated well with those determined by left ventricular contrast angiography. A qualitative comparison of MGBPT, planar imaging, and left ventricular angiography in 12 patients revealed that the visual assessment of wall motion using the 16-frame tomographic slices had significant advantages over planar and single plane angiographic data in the identification of inferior, basal, and septal wall motion abnormalities as well as the extent of involvement by aneurysm formation. A quantitative comparison of wall motion in the long-axis oblique view of the MGBPT to the RAO 30 degree ventriculogram (y = 0.74x + 8.7, r = 0.82, p less than 0.0001, s.e.e. = 14%) confirmed the qualitative similarity of these two views. We conclude that MGBPT is promising as a method for accurately measuring left ventricular volumes and assessing regional wall motion.

Idiopathic periodic hypothermia and bizarre behaviour in the presence of occult syringomyelia

Overt psychological, neurological and haematological abnormalities were present in a 35 year old Jamaican female diagnosed as having idiopathic periodic hypothermia. Although symptoms and signs were ameliorated by warming, no long term satisfactory therapeutic measure was identified. Despite extensive clinical and subsequently histological investigation no cause for the hypothermia was found although she had clinically unsuspected cervical syringomyelia.

A World War II uranium hexafluoride inhalation event with pulmonary implications for today

Two individuals were exposed to massive quantities of airborne uranium hexafluoride (UF6) and its hydrolysis products following a World War II equipment rupture. An excretion pattern for uranium exhibited by these patients is, in light of current knowledge, anomalous. The possible role of pulmonary edema is discussed. Examination of these individuals 38 years later showed no physical changes believed to be related to their uranium exposure and no deposition of uranium could be detected.

Construct validity of the MacAndrew Scale: secondary psychopathic and dysthymic-neurotic character orientations among adolescent male misdemeanor offenders

The empirical validity of the MacAndrew Scale was investigated in 200 adolescent males convicted of misdemeanor offenses who were classified according to their pattern of alcohol intoxication. Classification results were comparable to those from studies of adult men--true positive = 80%, false negative = 20%, true negative = 81% and false positive = 19%. An empirical cluster analysis of factor scores from the California Psychological Inventory yielded 14 personality types. About 56% of these cases resembled two character orientations (Emotional Extraversion or Emotional Introversion) that were hypothesized by MacAndrew to mediate addiction-proneness among males. However, 38.7% of these subjects were not alcohol misusers. The hypothesis that Emotional Introverts tend to be classified as false negatives was not supported--true positive = 79% and false negative = 21%. Although MacAndrew's formulation of two character orientations has heuristic value, the present study found alcohol misuse among adolescents with other personality characteristics. Studies of nonoffender adolescent males were recommended to clarify the MacAndrew Scale's sensitivity to the character orientation Emotional Introvert. Consistent with earlier research, the present study found no evidence of high levels of emotional tension in the form of anxiety or depression among adolescent alcohol misusers.

The concurrent and construct validity of the MacAndrew Alcoholism Scale among at-risk adolescent males

Investigated the empirical validity of the MacAndrew Alcoholism Scale as a measure of alcohol abuse and a bipolar personality dimension, hypothesized by MacAndrew (1979) to mediate addiction-proneness among males, in a sample of N = 160 adolescent male offenders, who were classified according to pattern of alcohol intoxication. Classification accuracy was comparable to studies of adult males, e.g., 75% correct, but only 53.1% correct for marijuana use. There were significant personality differences (as measured by the California Psychological Inventory) between true positives and false negatives. As predicted, the true positive group resembled the Emotional Extraversion (Secondary Psychopathy) character orientation. Contrary to predictions, the false negative group did not resemble the Emotional Introversion (Dysthymic or Neurotic) character orientation, although they were more inhibited, less angry, and less inclined to antisocial acts than were true positives. Some observed differences in reported uses of alcohol were unexpected, e.g., true positives were more inclined to drink when they were coping with feelings of inadequacy, dysphoric affect, or interpersonal problems. Some limitations of the test when used with young males were discussed.

The role of fibrinolysis in the therapy of peripheral vascular disease

In vivo thrombolytic studies in stumptailed monkeys indicated that pentoxifylline potentiates thrombolysis induced by urokinase activated human plasmin. Pentoxifylline as well as prostaglandin E1 released plasminogen activators and activated the fibrinolysin system. From this point of view pentoxifylline and prostaglandin E1 synergized with each other. Pentoxifylline potentiated the thrombolytic effect of prostaglandin E1 in vivo.

College shoplifters: rebuttal of Beck and McIntyre

Prior findings by Beck and McIntyre about the relationship between shoplifting and pathology or maladjustment among college students were tested with 78 full-time college students, convicted of first-offense shoplifting. Contrary to the earlier study, there was little evidence that pathology or maladjustment were significant contributing factors. There were no meaningful personality differences on the California Psychological Inventory between regular and occasional shoplifters or a sample of 30 undergraduates who denied ever shoplifting. The personality test data, offense records, and the diverse motives found among regular shoplifters indicated these college students were not delinquent, criminal personalities, psychopaths, and had no psychopathic tendencies. They steal for a variety of reasons, including the acquisition of personally attractive goods while saving money for other purposes.

An ambulatory ventricular function monitor: validation and preliminary clinical results

A device for the continuous measurement of left ventricular (LV) function was tested in a series of 34 subjects. The instrument consisted of 2 arrays of radiation sensitive cadmium telluride detectors held in place over the region of the left ventricle and lung by a vest-like garment (hence the name VEST). The VEST electronic instrumentation included analog-to-digital converters, a battery pack, microprocessor and gating device, which were worn in a back pack. Data generated by the VEST, including the digitized average electrocardiogram, RR interval, counts/13 ms in each radiation detector, and time since commencement of data recording, were recorded on a cassette tape recorder every 2 minutes for subsequent analysis. At the conclusion of conventional multigated blood pool imaging, the VEST was positioned and worn by the subjects while supine, standing in place and walking. The correlation of ejection fraction calculated independently from the VEST and scintillation camera data was greater than 0.95. The inter-record reproducibility of the ejection fraction measured by the VEST in sedentary subjects was less than 3%.

Prophylactic anticoagulation as a possible cause of inguinal lymphocyst after radical vulvectomy and inguinal lymphadenectomy

From 1957 to 1982, 115 patients underwent radical vulvectomy and bilateral inguinal lymphadenectomy for invasive squamous carcinoma of the vulva. From 1957 to 1971, 57 patients received perioperative prophylactic sodium warfarin (Coumadin) as prophylaxis against pulmonary embolism. From 1971 to 1976, 27 consecutive patients received dextran-40 as prophylaxis for pulmonary embolism and to improve the microcirculation to the inguinal skin flaps. Because of the report that dextran-40 is a cause of acute renal failure, this study was terminated and the subsequent 19 patients were treated with mini-dose heparin because of the reported benefit as prophylaxis against thromboembolic disease. During the 25-year period, 12 patients received no prophylactic anticoagulants. Mini-dose heparin resulted in a significant morbidity not previously reported in patients undergoing inguinal lymphadenectomy: 43% (8/19) of the mini-dose heparin patients, 7% (2/27) of the dextran-40 patients, 0% (0/57) of the sodium warfarin patients, and none of the 12 patients not receiving perioperative prophylaxis developed inguinal lymphocysts (P less than .001). There was no significant difference in the prevention of pulmonary embolism between the mini-dose heparin (0/19), dextran-40 (0/27), and no treatment groups (0/12) as compared to the 5% (3/57) incidence in the sodium warfarin patients (.10 less than P less than .50). The significant relationship between prophylactic heparin and the subsequent development of inguinal lymphocysts and the need to reassess its role in prevention of pulmonary embolism in patients undergoing lymphadenectomy is discussed.

Lymphedema after groin dissection

Groin dissection was performed in 67 patients, of whom 40 had superficial groin dissection and 27 had ilioinguinal dissection. The incidence of overall lymphedema of a mild to moderate degree was 21 percent. Lymphedema was observed more frequently (26 percent) in patients with primary lesions in the leg when compared with those with lower trunk lesions (6 percent, p less than 0.001), and in those who did not follow a prophylactic regime of leg elevation and use of a fitted elastic stocking (45.8 percent) when compared with those who adhered to the regime (7 percent, p less than 0.004). Sex, age, wound problems, histologic status of lymph nodes, and the duration of follow-up did not significantly affect the occurrence of lymphedema.

A variable angle slant-hole collimator

A variable-angle slant-hole (VASH) collimator was constructed to show the feasibility of using multiple sliding plates to achieve a range of collimator channel inclinations. One hundred and sixty tungsten plates, 0.125 mm thick and 14 cm square, were photoetched to produce 3025 1.5-mm2 holes in each plate, separated by 0.8-mm septa. Along with the collimator holes, registration holes and positioning grooves were also etched. The plates were placed in a holder and stacked to form a collimator 2.0 cm high. The holder permitted the plates to be "sheared" to achieve viewing angles from 0 to 40 degrees from the vertical. Resolution and sensitivity were determined both across and along the shear directions. Resolution of a thin Tc-99m source, 1.24 mm diam and 7 cm long, located 5 cm from the collimator face in air, was 1.1 cm FWHM at 0 degree shear and remained unchanged with increasing slant. The resolution was similar both across and along the shear plane. Sensitivity was determined with a point source placed 7 cm from the collimator face. At 0 degree slant the sensitivity was 169 cps/MBq (6.24 csp/mu Ci). A general all purpose (GAP) collimator had a FWHM of 1 cm for the line source in air at 5 cm, and a sensitivity of 205 cps/MBq (7.58 cps/mu Ci) for the point source at 7 cm. The data suggest that a variable-angle slant-hole collimator can be constructed of laminated plates.

The U.S. Uranium Registry tissue program

The U.S. Uranium Registry tissue program was established in December 1980. It is patterned after the U.S. Transuranium Registry program. Both are funded by DOE. The objectives of the program are to: (1) detect the presence and distribution of uranium, if any, in human tissue in occupationally exposed workers, (2) compare bioassay and in vivo measurements for exposed individuals with the results of analysis of tissue obtained at autopsy, (3) seek evidence of histopathological changes related to any uranium deposition found, (4) conduct analyses of whole bodies, when available, to obtain more precise data on the uranium burdens, if any, in the body and organs, and especially the distribution in parts of the body, such as most of the skeleton, that are not usually accessible for sampling. The program will include (1) participants who have been permissibly exposed, (2) participants who were exposed at a time when current limits did not exist and (3) reference individuals without exposure. The program will develop data that will assist in evaluating (1) the accuracy of current in vivo measurement techniques, (2) the propriety of existing regulations and (3) the adequacy of current protection programs. Enrollment in the program is voluntary.

Effects of enkephalins on perfusion pressure in isolated hindlimb preparations

A series of studies were conducted to determine the effects of leucine-(leu-) enkephalin and methionine-(met-) enkephalin on perfusion pressure. These experiments utilized isolated perfused femoral arterial preparations in pentobarbital-anesthetized cats. The enkephalins were administered intraarterially into the femoral artery and changes in perfusion pressure recorded. Leu-enkephalin in doses of 1 microgram to 320 micrograms produced significant dose-dependent decreases in perfusion pressure (4.0 +/- 1.3% with 1 microgram to 19.1 +/- 2.1% with 320 microgram). Similar declines in perfusion pressure (5.2 +/- 2.4% with 1 microgram to 21.7 +/- 4.1% with 320 micrograms) were observed following the administration of met-enkephalin. Pretreatment with naloxone (3 mg/kg) antagonized the effects of both enkephalins. Diphenhydramine (2 mg/kg) effectively antagonized the leu-enkephalin elicited decline in perfusion pressure but blocked the effects of met-enkephalin only at lower agonist doses. Propranolol treatment (4 mg/kg) did not alter the pressure responses to either enkephalin. The results of the study show that intraarterially administered enkephalins exert a vasodilatory effect on vasculature in skeletal muscle which may be direct, indirect or both. The differential antagonism of the effects of the two enkephalins suggest that the two opioids act through different receptors or multiple receptors.