Use of lasers for closure of cutaneous wounds: experience with Nd:YAG, argon and CO2 lasers

The concept of tissue fusion by laser has been recently established. In this study, we have examined the skin welding by laser and tested the efficacy of four different lasers for this application. The results attest to the feasibility of the procedure and suggest that laser welding may represent an alternative for closure of cutaneous wounds.

Kinin generation in the gingival inflammatory response to topically applied bacterial lipopolysaccharides

A water-soluble lipopolysaccharide from Salmonella enteritidis and a phenol-soluble lipopolysaccharide from Leptotrichia buccalis were applied topically to the healthy marginal gingivae of beagle dogs. Saline was applied to contralateral areas as an internal control. Increases in vascular permeability were monitored by measurement of gingival fluid, and the collected gingival fluid samples were assayed for kininogenase and kinin activities. Both lipopolysaccharides induced an inflammatory response, as indicated by increased gingival fluid flow. Kininogenase-kinin activities paralleled the increases in gingival fluid flow, with the highest values being associated with peak increases in gingival fluid. The results indicate that both lipopolysaccharides, although different in lipid solubility, penetrate healthy sulcular epithelium and initiate an inflammatory response which is mediated in part by the kallikrein-kinin system. Interrelationships between this system and other inflammatory mediators suggest that kinin generation not only plays a role in the early phases of acute gingival inflammation, but may also contribute to the activation of other mediators appearing later in the response and in chronic inflammatory lesions.

Management of chronic wounds in the elderly

The elderly patient with a chronic wound displays many characteristics peculiar to the age group that must be considered by the treating physician. This article describes a variety of specific age-related influences on wound healing, and incorporates several illustrative case reports.

Management of wounds in the diabetic foot

Current management of wounds in the diabetic foot is detailed. A thorough initial clinical examination and non-invasive tests can give baseline values and provide valuable information about limb and foot circulation. The approach detailed involves limited amputation and preservation of as much of the weight-bearing surface as possible.

Partial purification and characterization of mouse peritoneal exudative macrophage elastase

Mouse peritoneal exudate macrophage elastase can be significantly purified with 60% recovery of the starting activity by affinity chromatography against SDS-treated alpha-elastin covalently linked to agarose beads. The enzyme has an apparent Mr of 26 500 based on SDS-acrylamide gel electrophoresis. Molecular sieving chromatography on Sephadex gel gives a Mr for macrophage elastase of 21 000--28 000. The enzyme is not inhibited by chloromethyl ketone inactivators specific for pancreatic and leukocyte elastase nor by phenylmethylsulfonyl fluoride. Macrophage elastase also does not bind to tritiated diisopropylphosphorofluoridate. The enzyme is inhibited by EDTA and thus appears to be a metallo-protease. Macrophage elastase is resistant to human alpha 1-proteinase inhibitor and to human and mouse alpha 2-macroglobulin. In view of its lack of susceptibility to these endogenous serum proteinase inhibitors, macrophage elastase may play an important role in physiological and pathological remodeling of connective tissues.

Computerized tomographic assessment of the traumatized dorsolumbar spine before and after Harrington instrumentation

Nine patients, treated with Harrington instrumentation for dorsolumbar fracture dislocations were studied pre- and postoperatively with computerized tomography (CT). In all 9 cases the preoperative CT scan showed the bony intrusion upon the spinal canal. Postoperative CT scans were of good quality despite minimal scatter artifact from the rods and demonstrated the integrity of the spinal canal and the reduction of the dislocation. CT scan is a useful tool for diagnosing the severity of dorsolumbar spine fractures and judging the results of the various forms of therapy.

Primary lymphomas of the gastrointestinal tract

An institutional experience with primary gastrointestinal lymphoma (PGL) is reviewed. Included are 46 cases involving the stomach, 11 involving the small bowel, and two, the large bowel. The clinical, pathologic, and therapeutic aspects of PGL are discussed.

Receptor-mediated binding and internalization of leukocyte elastase by alveolar macrophages in vitro

Radioiodinated leukocyte elastase was found to bind rapidly and specifically to alveolar macrophages in vitro. In contrast to the binding of pancreatic and bacterial proteases, leukocyte elastase binding did not require the presence of alpha 2 macroglobulin. The binding was inhibited by an excess of unlabeled enzyme and was saturable by increasing elastase concentrations. Leukocyte elastase binding thus met criteria for receptor-mediated binding, with and estimated association constant of 4.97 x 10(5) M-1 and an estimated total of 640 x 10(6) binding sites/cell. It differed from the previously described binding of lysosomal glycosidases to macrophages in that it was insensitive to trypsin pretreatment, did not require calcium ions, and was not inhibited by yeast mannan. High-resolution autoradiography indicated that the cell-associated radiolabeled leukocyte elastase was rapidly incorporated into phagolysosomes. Macrophage binding may have a role in clearance of leukocyte elastase from tissue sites where alpha 2 macroglobulin is absent or present in low concentration. Thus, enzyme uptake by alveolar macrophages may be an important factor in the amelioration of lung tissue injury by extracellular leukocyte elastase.

Carcinoma of the ampulla of Vater

Adenocarcinoma of the ampulla of Vater represents about 10% of periampullary neoplasms. This tumor is slow-growing, often amenable to radical surgical resection, and associated with a better prognosis than the other neoplasms which arise in the periampullary area. Correct identification of ampullary carcinoma may be difficult but is essential because of its better prognosis. A review of 31 patients with adenocarcinoma of the ampulla of Vater treated at our institution reveals that the classical history of fluctuating jaundice and the well known findings of a palpable gallbladder and occult blood in the stool may not be present. The treatment of choice for ampullary carcinoma in the absence of hepatic or distant metastases is pancreaticoduodenectomy. Our operative mortality for pancreaticoduodenectomy is 16%, and the five-year survival rate is 32%. The role of palliative procedures, the operative complications, and the survival rates are discussed.

Plasma thyroxine concentrations in grazing sheep in several areas of Australia

Plasma thyroxine concentrations were measured by radioimmunoassay in plasma samples from 691 lactating ewes in 26 areas of New South Wales, Queensland, Western Australia and Tasmania. Sheep sampled in New South Wales and Tasmania had significantly lower plasma thyroxine values (4.0 and 4.3 microgram/100 ml respectively) than those sampled in Queensland and Western Australia (5.4 and 5.3 microgram/100 ml respectively). However, sheep in some districts in southern Queensland also had low plasma thyroxine values. The areas where sheep had low plasma thyroxine values correlate well with areas where goitre has been previously reported, both in man and in domestic animals. This suggests that measurement of plasma thyroxine is probably a valid empirical method of assessing the relative iodine deficiency of grazing sheep and further that sheep grazing substantial areas of New South Wales, Tasmania and to a lesser extent Queensland may have thyroid dysfunction of varying degrees of severity. These findings could have implications for animal production in these areas.

Elastase release from human alveolar macrophages: comparison between smokers and nonsmokers

Alveolar macrophages from smokers, in contrast to those of non-smokers, release elastase into serum-free culture medium. Since enzymes that digest elastin produce pulmonary emphysema in experimental animals, release of elastase by alveolar macrophages from smokers suggests that these cells are important in the pathogenesis of emphysema of smokers.

Phagocytosis of latex beads by a human gingival epithelial-like cell line in tissue culture

Phatocytosis by a human gingival epithelial-like cell line in tissue culture was studied using latex beads as a marker. Electron microscopic and chemical analyses revealed that the cells ingested the beads in a quantitative and reproducible manner. This phagocytosis system is potentially useful for studying the effects of dental plaque on cell metabolism.

Isolation of toxic metabolites of Phomopsis leptostromiformis responsible for lupinosis

Two metabolites of P. leptostromiformis (phomopsins A and B) have been isolated as a crystalline mixture from a culture of the fungus on lupin seed. The mixture has been shown to be capable of inducing lupinosis in sheep and in young rats. Key steps in the isolation were the transfer of the phomopsins from crude aqueous solution to tetrahydrofuran and chromatography on macroreticular polystyrene resin. The bioassays used in monitoring fractions were based on inhibition of cell cultures and the mitosis-arresting effect of the metabolites on liver cells in vivo.

Exocytosis of polymorphonuclear leukocyte lysosomal contents induced by dental plaque

Rabbit polymorphonuclear leukocytes were incubated with a sonically treated suspension of pooled dental plaque to determine if the plaque would induce release of lysosomal enzymes from the polymorphonuclear leukocytes. Cells incubated with plaque at 37 degrees C released significantly greater amounts of the lysosomal enzymes, beta-glucuronidase and lysozyme, than did cells incubated with plaque at 0 degrees C or without plaque at 37 degrees C. This response was both dose and time dependent. Release of the cytoplasmic enzyme lactate dehydrogenase was minimal, and there were no significant differences in lactate dehydrogenase release between cells at 0 and 37 degrees C, or without plaque. These results indicate that dental plaque can induce the selective release of lysosomal enzymes, which could be involved in the periodontal injury produced by dental plaque.

Pachyonychia congenita (Jadassohn-Lewandowski syndrome: case report

We report an illustrative case of pachyonychia congenita, with a description of the presenting complaints, the associated physical findings, the rationale for surgical treatment, and the technical aspects of the surgical treatment.

Development of mercury hypersensitivity among dental students

With regard to the principal purpose of this investigation, it is apparent that exposure to mercury during the preparation of silver amalgam definitely presents an additional occupational hazard as an allergen in the dentist. The fact that the dental students who were the volunteers in this study received only a small fraction of the exposure to mercury that the practicing dentist receives does emphasize the potential of this allergen in actual dental practice. Recent publicity concerning the toxioogenicity of mercury has led to a call for improved mercury hygiene in the dental operatory. The allergenic potential of mercury, as reported in this paper, accentuates the need for such an improvement.

Primary tumors of the small bowel

Primary tumors of the small bowel are uncommon, representing less than 6 per cent of all gastrointestinal tumors and less than 2 per cent of all malignant gastrointestinal tumors. This report concerns a twenty-five year survey of our clinical records from 1946 to 1971 which revealed 140 primary small bowel tumors, excluding periampullary tumors. Fifty-two of the neoplasms (37 per cent) were benign; eighty-eight (63 per cent) were malignant and included twenty-eight adenocarcinomas (31.8 per cent), twenty-four lymphosarcomas (27.3 per cent), nineteen carcinoids (21.6 per cent), and ten leiomyosarcomas (11.4 per cent). The average age at the time of diagnosis was 56.9 years for patients with benign tumors and 55.9 years for those with malignant tumors. The illusive and obscure nature of small bowel tumors is illustrated by the fact that 63.3 per cent of patients with benign lesions and 47.6 per cent of those with malignant lesions had symptoms for more than six months before the diagnosis was made. Bleeding was the most common present complaint in patients with benign neoplasms (52.9 per cent) whereas patients with malignant lesions more often had symptoms of obstruction (50.6 per cent). Most of the benign lesions were located proximally in the small bowel (duodenum, 34.6 per cent; ileum, 11.5 per cent), and most of the malignant lesions were located distally (duodenum, 17.0 per cent; ileum, 61.4 per cent). Treatment of patients with malignant lesions was radical excision whenever possible. Adjunctive radiation therapy was used for those with lymphoma. A second benign or malignant tumor occurred in 42.9 per cent of the patients with primary small bowel tumors. The average period of survival after diagnosis of a malignant small bowel tumor was 5.03 years: for patients with adenocarcinoma, 3.6 years; lymphosarcoma, 1.3 years; carcinoid, 6.8 years; and leiomyosarcoma, 8.3 years.

Population genetics of euphydryas butterflies. I Genetic variation and the neutrality hypothesis

Twenty-one populations of the checkerspot butterfly, Euphydryas editha, and ten populations of Euphydryas chalcedona were sampled for genetic variation at eight polymorphic enzyme loci. Both species possessed loci that were highly variable from population to population and loci that were virtually identical across all populations sampled. Our data indicate that the neutrality hypothesis is untenable for the loci studied, and therefore selection is indicated as the major factor responsible for producing these patterns. Thorough ecological work allowed gene flow to be ruled out (in almost all instances) as a factor maintaining similar gene frequencies across populations. The Lewontin-Krakauer test indicated magnitudes of heterogeneity among standardized variances of gene frequencies inconsistent with the neutrality hypothesis. The question of whether or not to correct this statistic for sample size is discussed. Observed equitability of gene frequencies of multiple allelic loci was found to be greater than that predicted under the neutrality hypothesis. Genetic differentiation persisting through two generations was found between the one pair of populations known to exchange significant numbers of individuals per generation. Two matrices of genetic distance between populations, based on the eight loci sampled, were found to be significantly correlated with a matrix of environmental distance, based on measures of fourteen environmental parameters. Correlations between gene frequencies and environmental parameters, results of multiple regression analysis, and results of principle component analysis showed strong patterns of association and of "explained" variation. The correlation analyses suggest which factors might be further investigated as proximate selective agents.

An analysis of twenty years' experience with operations for carcinoma of the stomach

We analyzed the records of 242 consecutive patients with adenocarcinoma of the stomach operated on for cure. We correlated survival with several factors, including the type of primary lesion, the operation performed, operative mortality, state of regional lymph nodes, margins of the resected specimens, and duration of preoperative symptoms. Overall survival at 5 years was only 18.6% and at 10 years was 7.1%. Patients with small malignant gastric ulcers, however, enjoyed increased survival at 5 years (53.8%) and at 10 years (15.0%). Overall operative mortality was 7.1%, but was 0% for patients with small malignant gastric ulcers. Even with large or high-lying lesions, radical operation can be accomplished with acceptable mortality and definite chance for cure. Thirteen of 45 five-year survivors had positive lymph nodes, and 7 of the 45 had positive margins of resection. Longer symptomatic preoperative periods, correlated positively with increased survival. Thirty patients with preoperative symptomatic periods exceeding 24 months had a 30.0% 5-year survival. Perhaps some of these lesions underwent malignant change in areas of symptomatic benign disease. We advocate early operation for gastric ulcers which do not heal promptly and stay healed.

Urinary sediments in sheep feeding on oestrogenic clover. II.* Site of origin and preliminary analysis of spontaneously occurring sediments in wethers receiving fresh or dried Dinninup subterranean clover

Unilateral ureteric catheters were established in two Merino wethers, which were then fed on fresh subterranean clover (Trifolium subterraneum cv. Dinninup). Sediments appeared simultaneously in ureteric and urethral urines of each animal c. 3½ days after commencement of feeding, and persisted for 48 hr, when the catheters became irreparably blocked. Urine was collected from two wethers (without ureteric catheters) receiving dried Dinninup subterranean clover. Sediments appeared after 36–48 hr and persisted for 16 days while the animals received dried clover. Oestrogenicity of the fresh and dried clovers was established from histological changes produced in accessory sexual glands of the sheep. Chemical analysis of all sediments revealed a common major component, consisting of methanol-insoluble crystalline plates. These contained .calcium and on hydrolysis yielded an uncharacterized organic acid and at least one other organic component. The findings are considered in relation to previous reports and to possible functions of sediments and oestrogenic effects in the aetiology of urinary obstruction. ____________________ *Part I, Aust. J. Agric. Res., 21: 933 (1970).

Effect of E. coli endotoxin on mitochondrial form and function: inability to complete succinate-induced condensed-to-orthodox conformational change

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