[A comparison of ankle fixation between two kinds of low-temperature plastic anterior ankle foot orthoses]

The low-temperature ankle foot orthosis (AFO) was designed in the anterior leaf type, called anterior AFO, to meet the need of indoor barefoot walking. It could be easily molded and remolded to fit the foot, as well as to adjust the position of the foot and ankle. Two kinds of low-temperature plastic anterior ankle foot orthoses, anterior encased and anterior direct molding ankle foot orthoses, were compared to analyze the effectiveness of ankle fixation in plantar flexion and inversion. Force was applied to each of the anterior AFOs at the anterior-middle and anterior-lateral sides to simulate the movement of ankle plantar flexion and inversion. At the same time, the deformation in plantar flexion and inversion of both anterior AFOs were recorded to analyze the relationship between force and the deformed angle. The results showed that plantar flexion deformed angles of the anterior direct molding AFO were 2.6 times more flexible than anterior encased AFO. The ankle inversion deformed angles of the anterior direct molding AFO were 3 times more flexible than the anterior encased AFO in inversion. These results support our belief that anterior encased AFO is more effective in controlling ankle plantar flexion and inversion than anterior direct molding AFO, especially for severe spastic hemiplegia in gait correction.

[Comparison of various patterns of chopstick use and functional performance]

Three hundred and ninety-seven normal adult subjects were tested in order to investigate the prevalences of various patterns of chopstick-use. Manipulation speed was also compared. According to the movement of the fingers, finger positions and contact areas, we can divide the various chopstick-use patterns into 3 basic patterns with 13 variations. Prevalences of the 3 basic patterns were palmar prehension (68.5%), lateral prehension (14.2%), and dynamic palmar prehension (17.3%). There was a statistically significant difference in manipulation speed among the 3 basic patterns. The influence of sex and age on manipulation speed was also analyzed for each of the 3 basic chopstick-use patterns. The results of this study will serve as a reference for occupational therapists in the evaluation and training for eating activities.

[Investigation of activity of daily living performance in patients with Duchenne muscular dystrophy]

The purpose of this study was to reach a better understanding the deficits of activity of daily living (ADL) skills in patients with Duchenne muscular dystrophy (DMD), and their influencing factors. Our samples consisted of 35 male DMD patients, aged 3-24 years. The Barthel index was used to assess daily living abilities. Besides ten different motor abilities, muscle strengths of both upper and lower extremities and joint contractures were also included in each patient's evaluation. The results of degree of severity in ADL performance showed that 21.1% of patients were classified as totally dependent, 48.5% were severely dependent, 12.1% moderately dependent, 9.1% mildly dependent and 9.1% totally independent. Among the ADL skills, the bathing needed most assistance whereas feeding required the least. Two of the sixteen factors influencing ADL performance was calculated to be significant after stepwise multiple regression analysis. They were hip contracture and static sitting balance. In conclusion, we find that DMD patients are highly dependent in carrying out ADL tasks. Therefore, it is very important to avoid contracture, to increase static sitting balance and to use appropriate devices to improve their daily living abilities. Finally, the Barthel index proved acceptable in evaluating Taiwanese children over six years of age.

Synthesis and cytotoxicity of 1,6,7,8-substituted 2-(4'-substituted phenyl)-4-quinolones and related compounds: identification as antimitotic agents interacting with tubulin

A series of 1,6,7,8-substituted 2-(4'-substituted phenyl)-4-quinolones and related compounds have been synthesized and evaluated as cytotoxic compounds and as antimitotic agents interacting with tubulin. The 2-phenyl-4-quinolones (22-30) with substituents (e.g. F, Cl, and OCH3) at C-6, C-7, and C-8 show, in general, potent cytotoxicity against human lung carcinoma (A-549), ileocecal carcinoma (HCT-8), melanoma (RPMI-7951), and epidermoid carcinoma of the nasopharynx (KB) and two murine leukemia lines (P-388 and L1210). Introduction of alkyl groups at N-1 or C-4 oxygen led to inactive compounds (35-43 and 50). In addition, compounds 24, 26, and 27 were evaluated in the National Cancer Institute's 60 human tumor cell line in vitro screen. These compounds demonstrated the most marked effects in the screen on two colon carcinoma cell lines (COLO-205 and KM-20L2) and on a central nervous system tumor cell line (SF-539) with compound 26 the most potent of the three agents. Compounds 24, 26, and 27 were potent inhibitors of tubulin polymerization, with activity nearly comparable to that of the potent antimitotic natural products colchicine, podophyllotoxin, and combretastatin A-4. The three agents also inhibited the binding of radiolabeled colchicine to tubulin, but this inhibition was less potent than that obtained with the natural products.

Open heart surgery in a patient with an implanted pacemaker: case report

When a patient has a pacemaker and requires operation, surgeons have to consider some possible intraoperative pacemaker complications induced by electrocautery. Electrocautery is commonly used during surgery to achieve hemostasis. However, this very effective tool may introduce innumerable problems in the paced patient, including irreversible damage to the pulse generator, pacemaker reprogramming, induction of a rise in the capture threshold, and ventricular fibrillation. Although electrocautery may be avoided in some surgical procedures, open heart surgery cannot be performed without it. One case is presented to illustrate how to achieve hemostasis while decreasing electric interference and how to protect the permanent pacemaker while avoiding those possible complications during the defibrillation. The purpose of this article is to call attention to potential problems induced by electrocautery and in an effect to facilitate the perioperative management of the paced patient undergoing open heart surgery.

Effect of moisture content on the microbial activity in JP-5 fuel oil

The water solubility of JP-5 fuel oil was found to be proportional to the reciprocal of absolute temperature from 0 degree C to 60 degrees C. Water in the fuel oil would become condensed once the temperature was shifted from a high temperature to low temperature. During the storage, condensed water was precipitated in the bottom of the tank. Both the static and the dynamic dehumidification processes with molecular sieve could reduce the moisture content of fuel oil to less than 5 ppm. However, pre-dried fuel oil had a mildly hydroscopic phenomenon at relatively high humidity condition. The spores of contaminated microbes could survive in the fuel oil with 5 to 80 ppm of moisture content. High moisture content of fuel oil was not favorable to the spore survival. Penicillium sp. could survive in the fuel oil longer than Cladosporium resinae.

Successful surgical correction of acute ascending aortic dissection: a case report

The prognosis of patients with acute aortic dissection is extremely poor, especially when involving the ascending aorta. It has long been recognized as a catastrophic cardiovascular event. Acute dissections involving an ascending aorta have approximately a 90 percent acute mortality rate if left untreated or treated medically. Therefore, nearly all patients with acute ascending aortic dissection should be surgically treated immediately after a diagnosis has been established. A 60-year-old man having an acute ascending aortic dissection was successfully operated on with a resection of the dissecting aorta which was replaced with a Dacron graft. The postoperative course was complicated with a respiratory insufficiency and a disruption of the sternal wound. A 4 years follow-up confirmed the patient was in good condition. This is the first successfully operated case of acute ascending aortic dissection at our hospital.

Evidence of direct activation of adenosine A1 receptor by 5'-adenosine monophosphate in isolated guinea pig atrial myocytes

The electrophysiological effect of 5'-adenosine monophosphate (AMP) was examined in isolated atrial myocytes of guinea pig. Membrane potential and ionic currents were measured by the tight-seal, whole-cell patch-clamp technique. AMP caused the shortening of atrial action potential in a dose-dependent manner. In voltage-clamp experiments, AMP (3-10 microM) caused the activation of IKACh as well as the decrease in basal ICa. Prolongation of action potential duration caused by isoproterenol (20 nM) was antagonized by AMP (10 microM). Isoproterenol (20 nM) occasionally caused the sustained rhythmic activity and the subsequent application of AMP (10 microM) terminated it. AOPCP (10 microM), which inhibits 5'-nucleotidase and hence prevents breakdown of AMP, did not significantly attenuate the effect of AMP on shortening action potential. However, the application of adenosine deaminase (1 U/ml), which deaminates adenosine to inosine, partially reversed the shortening of action potential caused by AMP (10 microM). These results indicate that (1) AMP could activate IKACh and decrease basal ICa simultaneously, and antagonize the isoproterenol-stimulated action potential prolongation; and (2) the observed electrophysiological effect of AMP in whole-cell preparation is attributed to AMP per se as well as its degradative product, adenosine.

Inconsistent effectiveness of myocardial preservation among cardiac chambers during hypothermic cardioplegia

The purpose of this study was to examine the selective and differential natures of ischemic injuries among three cardiac chambers (right atrium, right ventricle, and left ventricle) from the viewpoint of ultrastructural morphometric study. Twenty consecutive adult patients undergoing cardiac operations were studied. The duration of aortic crossclamp time varied from 36 to 142 minutes (mean 83.4 +/- 36.4 minutes). Two serial specimens (preischemic and ischemic) were obtained from the right atrium, the right ventricle, and the left ventricle, respectively. A total of 120 biopsy specimens was obtained from these 20 patients. The average mitochondrial surface area of the left ventricle was 0.308 +/- 0.062 micron 2 in the preischemic stage and 0.352 +/- 0.083 microns 2 in the ischemic stage. This represented a 14.3% increase in mitochondrial surface area after ischemic injury (p less than 0.01). The mitochondrial surface area of the right ventricle showed an average increase of 43.7%, from 0.252 +/- 0.036 micron 2 in the preischemic stage to 0.362 +/- 0.087 micron 2 in the ischemic stage (p less than 0.0005). With respect to the mitochondrial surface area of the right atrium, there was an increase of 88.0%, from 0.217 +/- 0.044 micron 2 in the preischemic stage to 0.408 +/- 0.084 micron 2 (p less than 0.0005). The difference of mitochondrial swelling among three chambers was statistically significant (right atrium versus right ventricle versus left ventricle, p less than 0.0005). Moreover, the differences of mitochondrial swelling between any two chambers were also highly significant (right atrium versus right ventricle, p less than 0.0005; right ventricle versus left ventricle, p less than 0.01; right atrium versus left ventricle, p less than 0.0005). In conclusion, our findings suggest that from the viewpoint of ultrastructural morphometric study myocardial injury after an average of 83 minutes of ischemic arrest is poorer in the right chambers of the heart than in the left ventricle, with the right atrium having the poorest preservation.

In vivo study of fluoride chewing gum for the remineralization of human root lesions

The purpose of this study was to study the efficacy of a fluoride-containing chewing gum (0.1 mg F/stick chewed 5 x/day) in the remineralization of artificial caries lesions in abraded root surfaces compared to sorbitol-containing chewing gum and a no gum control group in vivo. Root specimens were cut from human root surfaces and polished. The specimens were demineralized in a buffered lactate solution with low concentration of fluoride in order to preserve an intact surface layer. Six healthy subjects wore mandibular Hawley-type appliances containing up to fourteen slabs for each of one control and two experimental periods. The experimental protocol included chewing five pieces of gums per day and brushing with fluoride-free dentifrice for each 21 days period. All three regimens were analyzed for fluoride uptake and microradiography. The results indicate that fluoride-containing chewing gum has a highly significant fluoride uptake and remineralization compared to sorbitol gum and control regimens, suggesting that fluoride chewing gum may provide another vehicle for fluoride delivery.

The results of transplant livers from selected non-heart-beating cadaver donors

The clinical experience following transplantation of livers obtained from non-heart-beating cadaver donors (NHBD) with the use of core cooling method is presented here. Six livers procured from such cadavers were transplanted into 6 recipients with hepatoma involving right and left lobes but without distant metastases. The first liver subjected to 75 minutes of warm ischemia had insufficient function after transplantation. The recipient died of graft failure 54 days later. The other 5 livers with 32 to 45 minutes of warm ischemia had a good or excellent immediate function. These 5 recipients died of tumor recurrence, acute rejection or septicemia 131 to 261 days after transplantation. The utilization of selected NHBD is suggested by our practice as a possible approach to help alleviate the acute organ shortage in the areas where heart-beating cadaver donors of brain death are not available.

Alcohol and aldehyde dehydrogenase genotypes and alcoholism in Chinese men

The liver enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which are responsible for the oxidative metabolism of ethanol, are polymorphic in humans. An allele encoding an inactive form of the mitochondrial ALDH2 is known to reduce the likelihood of alcoholism in Japanese. We hypothesized that the polymorphisms of both ALDH and ADH modify the predisposition to development of alcoholism. Therefore, we determined the genotypes of the ADH2, ADH3, and ALDH2 loci of alcoholic and nonalcoholic Chinese men living in Taiwan, using leukocyte DNA amplified by the PCR and allele-specific oligonucleotides. The alcoholics had significantly lower frequencies of the ADH2*2, ADH3*1, and ALDH2*2 alleles than did the nonalcoholics, suggesting that genetic variation in both ADH and ALDH, by modulating the rate of metabolism of ethanol and acetaldehyde, influences drinking behavior and the risk of developing alcoholism.

[Permanent pacemaker with implantation in a young child with congenital complete atrioventricular block: a case report]

Congenital atrioventricular block is a congenital disorder of the cardiac conducting system. Pacemaker implantation is the treatment of choice for patients with congenital A-V block if prior medical treatment fails. The criteria for pacemaker implantation in infants and children are (1) frequent syncope (2) heart failure (3) ventricular rate below 55 beats/min (4) ventricular arrhythmia (5) QRS widening in the ECG (6) moderate to severe exercise intolerance. Our experience with a 15-month-old male child is herein presented. The patient suffered from frequent attacks of upper respiratory tract infection, bradycardia and complete A-V block as found on electrocardiograms. At 15 months old, he was admitted again due to respiratory tract infection and several attacks of syncope. Stokes-Adams syndrome was noted several times despite medical treatment. Following implantation of a VVI mode epicardiac pacemaker, the patient's condition, including resistance to heart failure and respiration, were improved dramatically. He was followed up regularly for 4 years, his heart beat remaining stable.

Meniscectomy operation as a surgical treatment for internal derangement of the temporomandibular joint in our department

This paper describes the surgical treatment of six patients with internal derangement of the temporomandibular joint (nine joints). Meniscectomy was performed on all the patients, because severely advanced cases in which the articular disk could not be preserved or replaced were chosen. Our surgical technique and the results of short-term follow up are presented. Indications of meniscectomy and the criteria for postoperative evaluation are also described. The postoperative outcomes were assessed as "good" for seven joints in five patients and as "acceptable" for two joints in one patient.

[The relationship between early motor stage and hand function recovery six months after stroke]

The prognosis of hemiplegic hand function may reflect intrinsic recovery. Applying the variables of initial neurological loss in the hemiplegic upper extremity to predict the prognosis of hand function will enable therapists to establish the ultimate goals of rehabilitation and to select the appropriate treatment programs. Pinch and grip strength tests, Frenchay arm function test and the nine-hole peg test were used to determine the relationship between the initial Brunnstrom motor stage of the hemiplegic upper extremity and the prognosis of hand function after six months. Forty stroke patients were divided into three groups. Group I was subjects with a motor stage below the Brunnstrom motor stage III in both proximal and distal parts of the hemiplegic upper extremity. Group II was subjects with motor stage below Brunnstrom motor stage III in the proximal part and above stage III in the distal part or vice versa. Group III was subjects with a motor stage above Brunnstrom motor stage III both in the proximal and the distal parts. The results of this study indicated that the prognosis of the Brunnstrom motor stage of the hemiplegic upper extremity generally improved about one or two stages. According to the results of the grip and pinch strength tests, the Frenchay arm function test or the nine-hole peg test, group I patients could hardly use their affected hand functionally. The grip strength and the pinch strength deficits of group I were 93.8% and 91.4% respectively. The grip strength and the pinch strength deficits of group II were 72.1% and 68.5% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Uneven myocardial hypothermia among cardiac chambers during hypothermic myocardial preservation

During the development of methods to protect the heart from ischaemic injury, attention has been focused on protection of the left ventricle. In an attempt to assess right heart preservation. 55 consecutive patients undergoing open heart surgery were studied. Mean aortic cross-clamp time was 59.3 +/- 29.4 min. Temperature probes were inserted into the right atrium (RA), right ventricle (RV), and left ventricle (LV). During cardioplegia, the mean myocardial temperatures of RA, RV and LV were 19.1 degrees +/- 4.1 degrees C, 12.7 degrees +/- 4.8 degrees C and 7.3 degrees +/- 3.4 degrees C, respectively. Of the LV temperature measurements, 67.2% were 10 degrees C or lower. By contrast, 94.1% of RA measurements and 58.5% of RV measurements were above 10 degrees C. The inhomogeneity of chamber temperatures was observed irrespective of the patient's disease or age and whether the atrium or right ventricle were open or not. Hearts with mitral regurgitation (MR), in contrast to mitral stenosis and stenoinsufficiency, had higher LV temperatures, similar to those in the RV. We conclude that there is uneven hypothermia among the three cardiac chambers during hypothermic cardioplegic arrest, regardless of disease states except MR and regardless of age and procedure performed.

[Lymphoepithelial cyst of the upper neck: report of a case]

A case of lymphoepithelial cyst of the upper neck is presented. The patient was a 77-year-old woman. After her lesion was extirpated under clinical diagnosis of salivary gland tumor, identified as lymphoepithelial cyst (so-called branchial cyst). Histopathologically salivary gland was observed in the cyst wall composed of lymphoid tissue and was demonstrated highly active amylase-enzyme (S type) in the cyst fluid. These findings are convicted that our case originates ductal epithelium entrapped in cervical lymph node (inclusion theory of Bhaskar).

The superiority of blood over electrolyte cardioplegia in prevention of supraventricular arrhythmias and conduction disturbances following open heart surgery

A total of 111 patients underwent open heart surgery during which myocardial preservation was provided by systemic hypothermia, topical cardiac cooling and cardioplegic solution (blood cardioplegia or electrolyte cardioplegia). The purpose of this study was to determine if the use of the different types of cardioplegia correlated with the occurrence of postoperative supraventricular arrhythmias and conduction disturbances. These patients were retrospectively divided into two groups according to the difference in the infused cardioplegic solutions. The group receiving blood cardioplegia (BCP) comprised 69 patients and the group receiving electrolyte cardioplegia (ECP) had 42 patients. There were a longer ischemic time and bypass time in the BCP group as compared with those of the ECP group (68.4 +/- 36.1 minutes v.s. 50.7 +/- 37.0 minutes, p less than 0.01; 93.7 +/- 48.9 minutes v.s. 65.5 +/- 39.1 minutes, p less than 0.005). However, the result shows a significantly lower incidence of supraventricular arrhythmias and conduction disturbances in the BCP group (5.8%) as compared with the ECP group (21.4%; p = 0.013). There was no significant difference in incidence of supraventricular arrhythmias and conduction disturbances between the two groups when the ischemic time was less than 60 minutes (6.7% v.s. 17.2%, p greater than 0.05). On the other hand, there was a significant difference between the two groups when the ischemic time was a significant difference between the two groups when the ischemic time was longer than 60 minutes (5.1% v.s. 30.8%, p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Adenoidcystic carcinoma of the palate in pregnancy: report of a case]

The Patient was a 28-year-old woman with 8th month of her pregnancy. She had noted a swelling of her palate (6-region) about 3 years before. Incisional biopsy was done in 8th month of her pregnancy and histological diagnosis was confirmed; adenoidcystic carcinoma. After normal health baby was born with cesarean section in 34 weeks, partial maxillectomy was performed. She is now free of the disease. The baby is now 1-year-old and enjoying the good health.

A simple and rapid method for obliteration of patent ductus arteriosus in the small infant

There was a 45-day old small baby with 2,650 g of body weight undergoing surgical operation of patent ductus arteriosus because of congestive heart failure and severe pulmonary hypertension. A simple and rapid method as proposed by Traugott et al for obliteration the ductus with two ligaclips (Ethicon LC300) is presented.

CSF neurochemical study of tardive dyskinesia

Twenty-three inpatients who met DSM-III criteria for schizophrenia were selected for cerebrospinal fluid (CSF) neurochemical study of tardive dyskinesia (TD). Ten inpatients had tardive dyskinesia, and the remaining 13 patients without TD served as controls. There were no intergroup differences in sex, age, duration of neuroleptic treatment, or in total amount of neuroleptics received between the TD and the control groups. Cerebrospinal fluid was collected by lumbar puncture, and concentrations of homovanillic acid (HVA), MHPG, 5-hydroxyindoleacetic acid (5-HIAA), and acetylcholinesterase (AChE) activity were measured. The concentrations of MHPG (TD 11.56 +/- 3.48 ng/ml versus control 14.20 +/- 3.86 ng/ml), 5-HIAA (45.27 +/- 9.77 ng/ml versus 40.34 +/- 13.77 ng/ml), and HVA (38.26 +/- 18.31 ng/ml versus 31.40 +/- 7.83 ng/ml), and the activity of AChE (TD 7.95 +/- 5.21 mmol/g.hr versus control 12.89 +/- 8.04 mmol/g.hr) showed no significant differences between the two groups, but the ratios of HVA/AChE (t = 2.21, p = 0.05), 5-HIAA/AChE (t = 2.62, p = 0.02), MHPG/HVA (t = -2.16, p = 0.04), and MHPG/5-HIAA (t = -2.48, p = 0.02) were statistically different. The results indicated that TD might involve an imbalance of dopamine-acetylcholine, noradrenalin-dopamine, noradrenalin-serotonin, and serotonin-acetylcholine.

Specificity of alkaline elastase Bacillus on the oxidized insulin A- and B-chains

The substrate specificity of alkaline elastase Bacillus from alkalophilic Bacillus sp. Ya-B was investigated using oxidized insulin A- and B-chains. Under time-limited cleavage, the initial cleavage site of the enzyme on the oxidized insulin A-chain and B-chain was at the leucine13-tyrosine14 bond and the leucine15-tyrosine16 bond, respectively. When the cleavage was completed, three major cleavage sites and three minor cleavage sites on the A-chain, and five major cleavage sites and four minor cleavage sites on the B-chain were found. However, most of the peptides produced after complete hydrolysis of the A- or B-chain by the enzyme were composed of four to six amino acid residues. The results suggest that this enzyme cleaves the oxidized insulin A- and B-chains in a block-cutting manner.

The specificity of the dexamethasone suppression test in endogenous depressive patients

The purpose of this study was to evaluate the specificity of the dexamethasone suppression test (DST) for endogenous depression. Between July 1983 and June 1985 we collected 51 cases of endogenous depression (including 16 bipolar disorder, depressed, and 35 major depression with melancholia), 36 cases of schizophrenia (including 14 with depression and 22 without depression), 19 cases of borderline disorder with depression, 16 cases of dysthymic disorder, and 20 normal volunteers. The sensitivity of the DST in the endogenous depression group was 62.7%, which was significantly higher than that of the schizophrenic group (36.1%), the borderline disorder with depression group (31.6%), and the control group (11.1%) (including dysthymic disorder patients and normal volunteers) (X2 = 24.48, df = 3, p less than 0.001). However, the specificity of the DST was 63.9%, 68.4%, and 88.9% when the endogenous depression group was compared with the other three groups, respectively. To differentiate endogenous depression from other mental disorders (e.g., schizophrenia, borderline disorder), such critical variables as patient history and clinical symptoms may be more valuable. Many factors that were reported to be related with DST were discussed.

Differentiation between eclampsia and cerebrovascular disorders by brain CT scan in pregnant patients with convulsive seizures

Six pregnant women with convulsions between 25 to 40 weeks of gestation were experienced. Among them, 4 patients were diagnosed as having intracranial hemorrhage and two as simple eclampsia. With the aid of brain CT scan, one case of arteriovenous malformation was detected and treated surgically with good prognosis for both the mother and the fetus. Two patients were diagnosed to have cerebral hemorrhage with subsequent penetration into the lateral ventricles and were treated conservatively. Their fetuses were delivered alive by cesarean section, but the mothers expired. The other patient with cerebral hemorrhage was treated surgically, and both the mother and the fetus survived. One of the simple eclampsia patients was noted to have a growth retarded fetus at 32 weeks of pregnancy with subsequent intra-uterine death, but the mother recovered after conservative treatment. Another patient at 40 weeks of pregnancy was also treated conservatively and both the fetus and the mother survived. Brain CT scan findings differed between these two eclampsia patients; local brain edema for the second patient and generalized brain edema for the first patient. Thus more active application of brain CT scan is recommended in managing pregnant patients with convulsions.

Determination by ultrafiltration of the fraction of unbound estradiol and its variation in peritoneal fluid during the menstrual cycle

An ultrafiltration method employing a Centrifree filter for determining the unbound fraction of estradiol was studied. Centrifugation was performed under conditions similar to those in vivo. Good correlation was recognized between this method and the equilibrium dialysis. This method was employed to determine the unbound fraction of estradiol in the serum and the peritoneal fluid of 26 infertility patients classified according to their menstrual dates. The total estradiol and progesterone contents in the peritoneal fluid were high after ovulation. There was no significant difference in the percentage of unbound estradiol in the serum among various groups. In the peritoneal fluid, however, the percentage of unbound estradiol for the day 12-14 patients was 4.5 +/- 0.2% in contrast with 3.8 +/- 0.4% for the day 15-18 group (p less than 0.05) and 3.5 +/- 0.1% (p less than 0.05) for the day 19-28 group. Moreover, the fraction (4.5%) of unbound estradiol in the peritoneal fluid of a patient with luteinized unruptured follicle (LUF) syndrome was comparable with that of patients in the follicular phase. The difference between the percentage of unbound estradiol in the peritoneal fluid before and after ovulation is considered to be due to the transudation of follicular estradiol in the follicular phase and the exudation of estradiol from the corpus luteum into the peritoneal cavity in the luteal phase.

Liquid and solid two-phase radioimmunoassay--simultaneous measurement of levels of triiodothyronine and thyroxine of human serum in a single specimen

The principle of the liquid and solid two-phase radioimmunoassay and its application to measuring the concentrations of triiodothyronine and thyroxine of human serum in a single sample at the same time are described in this paper. Rabbit anti-triiodothyronine antiserum was immobilized on the inner surface of a plastic tube as solid-phase radioimmunoassay system of testing triiodothyronine and donkey anti-rabbit gamma globulin antiserum was used to separate immunocomplex in liquid-phase radioimmunoassay system of thyroxine reaction. In both systems, radioiodine-125-labelled antigens were used as tracer. Through simple calculation, we can get the results of serum concentrations of triiodothyronine and thyroxine in a single sample. Compared with classical single-component radioimmunoassay of triiodothyronine and thyroxine and by methodological appraisal of two-phase radioimmunoassay itself, this method has the advantages of very high efficiency, reliability and also has the same specificity and precision.

Comparison of the effectiveness of myocardial preservation in right atrium and left ventricle

Ten patients underwent cardiac operations during which myocardial preservation was provided by systemic hypothermia, topical cardiac cooling, and cold blood cardioplegia. The duration of ischemia ranged from 45 to 142 minutes (mean, 84.2 +/- 36.2 minutes). Two serial specimens (preischemic and ischemic) were obtained from the right atrium and the left ventricle, respectively; thus, a total of 40 biopsy specimens was obtained from these 10 patients. A combination of grading of ischemic injury and stereological morphometric measurement of mitochondria was performed to assess the effectiveness of myocardial preservation. Our findings from the mitochondrial score studies (grading of ischemic injury) were as follows. In the right atrium, the average mitochondrial score rose from 0.337 +/- 0.235 in the preischemic stage to 1.969 +/- 0.492 in the ischemic stage. In contrast, the average mitochondrial score for the left ventricle was only elevated from 0.380 +/- 0.161 to 1.353 +/- 0.396. The difference between preischemia of the right atrium and left ventricle is not statistically significant, but the difference between ischemia of these chambers is significant (p less than 0.01). Our stereological morphometric studies revealed that in the left ventricle, the average mitochondrial surface area was 0.316 +/- 0.046 micron 2 in the preischemic stage and 0.347 +/- 0.073 micron 2 in the ischemic stage, a 9.8% increase in mitochondrial size (not significant). In contrast, the mitochondrial surface area of the right atrium showed a mean increase of 65.8%, from 0.231 +/- 0.038 micron 2 in the preischemic stage to 0.383 +/- 0.057 micron 2 in the ischemic stage (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of blood cardioplegia to electrolyte cardioplegia on the effectiveness of preservation of right atrial myocardium: mitochondrial morphometric study

The right atrium differs from the left ventricle in two respects during cardioplegic arrest: a higher proportion of noncoronary collateral flow is delivered to the right atrium, and the atrium is frequently excluded from topical ice cooling because of its higher position relative to the left ventricle. These factors result in early rewarming of atrial myocardium. To the best of our knowledge, the surgical literature contains no reports on whether blood cardioplegia can provide better atrial myocardial preservation than electrolyte cardioplegia. Twenty consecutive patients who underwent cardiac operations were randomly selected to receive blood cardioplegia (Group 1) or electrolyte cardioplegia (Group 2). Hypothermia was achieved by systemic cooling and continuous topical cooling with ice slush. Stereological morphometric study of mitochondria was performed on 40 biopsy specimens taken from the right atrium prior to aortic cross-clamping (preischemia) and at the end of ischemia. In Group 1, total aortic cross-clamp time was 72.8 +/- 32.5 minutes. The mean mitochondrial surface area before ischemia was 0.224 +/- 0.032 mu 2 and after ischemia, 0.336 +/- 0.032 mu 2, a 50.0% increase in mitochondrial size. In Group 2, total aortic cross-clamp time was 69.7 +/- 30.9 minutes. The mean mitochondrial surface area before ischemia was 0.205 +/- 0.025 mu 2 and after ischemia, 0.439 +/- 0.111 mu 2, an average increase in mitochondrial size of 114.2%. There was no significant difference between the two groups in mitochondrial size before ischemia. However, after ischemia the mean mitochondrial surface areas were significantly different (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunoperoxidase staining studies on C-cells in fresh human thyroid]

It has been well demonstrated that C-cells are the source of the hypocalcemic polypeptide hormone calcitonin (CT), and that they are the origin of medullary thyroid carcinoma. However, our knowledge of the morphology of normal human C-cells is still primitive. The purpose of this study is to present a detailed report concerning the morphology, distribution and population of C-cells in fresh normal thyroid glands using the high specificity immunoperoxidase staining method. In addition, the carcinoembryonic antigen (CEA) activity in the C-cells and the solid cell nest are studied. Fifteen fresh thyroid glands with no abnormal histological or laboratory findings were examined for C-cells by Sternberger's PAP method, and five thyroid glands obtained at autopsy 6 approximately 8 hours after death with no evidence of thyroid or parathyroid disease were examined as the control group. The CEA activity in the C-cells was examined by the anti-CEA and anti-CT double staining method. The C-cells were detected in all 15 fresh glands examined. They were oval, spindle or polygonal in shape, and at the interfollicular or parafollicular position. Except for one gland which contained very rare C-cells, no C-cells were detected in the control autopsy glands. C-cells were most numerous at the junction of the upper and middle third of the lateral lobe, and in these areas the C-cell population ranged from 47 to 111 per section. Morphologically, the C-cells appeared not only singly but in groups in a parafollicular position as clusters or enclosing the follicular epithelium in the form of lamina. Solid cell nests were easily distinguished from follicular epithelium by a routine H-E staining examination. None of these areas revealed a positive reaction with anti-CT, although scattered C-cells were seen occasionally in the neighboring area. CEA activity in the C-cells was evident from the brown color by a DAB reaction product, while the CT was indicated by the violet color using a 4-chloro-naphthol reaction product. These two colors were identified in the same cells simultaneously. From these results, it is concluded: The autopsy thyroids obtained a few hours after death were not suitable for C-cell examination by the immunoperoxidase staining method. The most numerous C-cells were distributed at the junction of the upper and middle third rather than the middle third of the lateral lobe, and the population in these areas averaged from 47 to 111 per section, or about 3 times as many as reported before.(ABSTRACT TRUNCATED AT 400 WORDS)

Direct communication of the right pulmonary artery with the left atrium in an infant

An 8-month-old Japanese girl with cyanosis and evidence of a round shadow connected with the right cardiac border on the chest X-ray film was diagnosed as a case of direct communication of the right pulmonary artery with the left atrium (RPA-LA communication) following cardiac catheterization and angiocardiography. She had a history of transient congestive heart failure in the early neonatal period. A secundum atrial septal defect and a two-lobed right lung were also present. The patient became asymptomatic after a successful ligation of the anomalous connecting vessel.

Hemodynamic performance of the Ionescu-Shiley valve prosthesis

The hemodynamic performance of the Ionescu-Shiley bovine heterograft valve has been evaluated by intraoperative measurement of transvalvular gradients and cardiac outputs. Effective orifice areas (EOAs) were calculated and the data compared to those obtained by other investigators for other prostheses. In the aortic position, each valve, from 19 to 31 mm external diameter, produced a pressure gradient; mean EOA increased with increasing valve size, so that small (19 to 23 mm) valves were moderately stenotic and larger valves were only mildly stenotic. The presence of a mitral prosthesis produced larger transaortic valve gradients, probably as a result of aortic outflow obstruction by the mitral prosthesis. The Ionescu valve appears to be hemodynamically superior to other biological valves in the aortic position and comparable to most mechanical prostheses, although the data for comparison are scant. Each mitral valve produced a pressure gradient and, on the average, larger (29 mm) valves performed no better than smaller (25 mm). Mean EOAs for each valve size (25 to 29 mm) were adequate to provide satisfactory hemodynamics comparable to other available prosthetic valves. Mild obstruction of the left ventricular outflow by the prosthetic struts was seen to be related to the distance between ventricular septum and the struts. Most currently available prostheses seem to provide similar hemodynamics in the mitral position, and considerations such as thrombogenicity and durability may be relatively more important in the choice of a mitral valve substitute than in the choice of an aortic valve substitute.

beta-Blockade therapy for supraventricular tachyarrhythmias after coronary surgery: a propranolol withdrawal syndrome?

A high incidence of cardiac arrhythmias and hypertension has been noted after coronary artery bypass surgery in patients previously treated with oral propranolol. Forty-two patients undergoing coronary bypass surgery had propranolol withdrawal 10 hours before surgery and were randomized into a group treated with propranolol immediately postoperatively, and a nontreatment group. Patients treated with prophylactic propranolol had a significantly lower incidence of postoperative supraventricular arrhythmias compared to patints who received no prophylaxis. All the arrhythmias responded rapidly to 1 mg of intravenous propranolol therapy, whether it was used as a primary treatment or as a supplement to prophylactic propranolol. The findings suggest that (1) there is a high incidence of supraventricular arrhythmias and sinus tachycardia after coronary artery bypass which might reflect an abrupt propranolol withdrawal, and (2) that perioperative prophylactic or supplementary propranolol therapy will successfully prevent or treat most of these arrhythmias.

Arterial hypoxemia in patients with anterior and posterior nasal packings

Previous clinical reports indicate that nasal packing is frequently associated with arterial hypoxemia. Anesthesia and surgery in hypoxemic patients can be hazardous, especially when it is associated with acute blood loss. Nine patients with severe epistaxis, who failed to respond to anterior and posterior nasal packing, were anesthetized for emergency internal maxillary artery ligation. Arterial blood-gas and pH changes during the procedure were evaluated. The results indicate some degree of arterial hypoxemia and high alveolar/arterial PO2 difference without significant change in PaCO2 and pH in most of the patients observed. Arterial PO2 was within normal range 24 hours after operation. The anesthetic management is described and the various causes of such arterial hypoxemia are reviewed. It is important to recognize the presence of arterial hypoxemia and treat accordingly during surgery for such patients.