CT appearance of diffuse mesenteric edema

The extent of pathologic processes involving the mesentery is frequently difficult to assess by clinical examination and standard radiography. Contrast studies of the gastrointestinal tract only identify the effect of these processes on adjacent opacified bowel loops and frequently underestimate the extent of mesenteric pathology. Computed tomography has previously been used to characterize various mesenteric abnormalities, most often secondary to malignant or inflammatory disease. We report the characteristic CT appearance of diffuse mesenteric edema in 14 patients. Eleven patients had documented hypoalbuminemia, two patients superior mesenteric vein thrombosis, and one patient cirrhosis. The CT findings that allowed confident diagnosis of this entity include increase in density of the mesenteric fat, poor definition of segmental mesenteric vessels, relative sparing of the retroperitoneal fat, and association with subcutaneous edema.

Bacterial arthritis in the elderly

The clinical and microbiological features of bacterial arthritis in 21 elderly patients presenting to hospitals in an English health district over the decade 1973-1982 are reviewed. Differences from bacterial arthritis in younger patients include the high prevalence (71%) of underlying joint disease, infections more commonly affecting the hip (38%), absence of constitutional features of toxaemia and delay in diagnosis. Outcome in elderly patients is markedly worse, with an appreciable mortality attributable to the condition.

Computed tomography of omental pathology

Computed tomographic scans were reviewed in 46 patients with documented omental pathology to analyze the radiographic characteristics of benign and malignant disease. The normal omentum is identified on CT of the abdomen as a homogeneous fat density anterior to the transverse colon. Four distinct patterns of omental pathology were identified: (a) omental caking, (b) finely infiltrated fat with a "smudged" appearance, (c) cystic masses, and (d) discrete nodules. The smudged pattern of omental pathology was identified most frequently; it was present in 20 to 39 patients with malignant disease and in five of seven patients with inflammatory disease. Omental caking was present in 17 of 46 patients but was only identified in malignant disease. Computed tomography provides the most reliable radiographic technique to routinely evaluate omental pathology. A thorough understanding of the variable appearance of omental disease is important in identifying omental pathology.

Dermatomyositis associated with idiopathic thrombocytopenia

A case of dermatomyositis is described with the simultaneous appearance of clinical and laboratory features of myositis, skin involvement and idiopathic thrombocytopenia with associated anti-platelet antibodies.

Reversibility of acute renal failure in elderly patients with the nephrotic syndrome

Acute renal failure may occur in the nephrotic syndrome due to minor glomerular changes, especially in the elderly. We describe five cases and review the literature. Previous renal damage due to ischaemia and drugs may be important in pathogenesis. We stress the importance of active management of these cases, as the renal lesions are reversible and recovery can be expected.

Simultaneous turnover of normal and dysfunctional C1 inhibitor as a probe of in vivo activation of C1 and contact activatable proteases

Simultaneous turnover of normal and dysfunctional C1-inhibitor (C1-INH) was carried out in 10 normal subjects and 13 patients with rheumatoid arthritis as a measure of the in vivo activation of C1 and the contact activatable enzymes. In the first series of experiments, dysfunctional protein We was used in simultaneous turnover studies in five normal subjects and nine patients. The fractional catabolic rate of the dysfunctional C1-INH, We, (FCR(d)) was unchanged in both groups but the fractional catabolic rate of the normal C1-INH (FCR(n)) was faster in the patients compared to the controls, in particular patients with vasculitis. The enzyme-dependent catabolism defined as FCR(n-d) X concentration of C1-INH X plasma volume, was raised in the patient group, and correlated with disease activity score (r = 0.83, P less than 0.05). Neither FCR(n) nor FCR(d) was dependent on C1-INH concentration. The latter was higher in the patients (206 mg/l compared with 155 mg/l) indicating a very high synthetic rate in the patients (280.81 micrograms/kg/h compared with 179.77 micrograms/kg). In the second series of turnovers in six patients and five normal subjects, another dysfunctional C1-INH, at, was used. The FCR of C1-INH was slower than C1-INH (We) (1.88%/h compared with 2.7%/h). Enzyme-dependent catabolism of C1-INH in these patients were raised and also correlated with disease activity score (r = 0.82, P less than 0.05).

Vanishing lung tumor

The case of a patient with a lung mass that disappeared after therapy with furosemide and digoxin is presented.

A double-blind controlled trial of bovine brain gangliosides in amyotrophic lateral sclerosis

We conducted a double-blind controlled study of the effect of brain gangliosides in amyotrophic lateral sclerosis. Nineteen patients received intramuscular gangliosides (40 mg/d) for 6 months, and 21 received placebo. The deterioration rates for approximately 120 clinical and electrophysiologic parameters of neuromuscular function were analyzed, but no statistically significant beneficial effect of the drug was demonstrated. However, the large coefficient of variation for each item indicated that a sample size of several hundred patients would have been necessary to exclude the possibility that the drug produced a 25% slowing of progression of the disease.

Production of prostaglandins and thromboxane by isolated cells from intracranial tumours

Tumour cell-rich platelet-free preparations were isolated from 21 fresh samples of human intracranial tumours using enzymic digestion, followed by discontinuous density gradient centrifugation on Percoll and (14 preparations) adherence on plastic. Of the disaggregated cells 79.8 to 97.7% (mean 86.2%) were tumour cells, and mean cell viability was 82.6%. All the tumours produced prostaglandin (PG), E2, F2 alpha, 6 oxo F1 alpha and Thromboxane B2 during 16 hours of incubation but the amount varied widely. Highest production of PGE2 and TXB2 per 10(5) cells was by the eight meningiomas in which the prostanoid profile closely resembled that of circulating monocytes.

Ultrasonic characteristics of frozen liver

The recent development of new ultrasound probes has made real-time intraoperative monitoring of cryosurgery, and thermocouple placement a possibility. It is shown that frozen tissue and thermocouple needles have acoustic characteristics that enable them to be easily visualized by ultrasound examination. Further in vivo animal studies are needed to examine temperature characteristics of visualized cryolesions, to develop scanning techniques, and to correlate ultrasonic findings with histologic changes in tissue.

Capillary gas chromatographic determination of naphthalene in bran and wheat germ products

A method is described for determining naphthalene in bran and wheat germ products. The method involves distilling the naphthalene from a water-cereal mixture and then extracting the distillate with hexane. A 10 microL aliquot of the hexane extract is injected into a gas chromatograph equipped with a capillary column. Dodecan-1-ol is used as the internal standard. Mean recoveries, standard deviations (SD), and coefficients of variation (CV) for samples of unprocessed bran, unprocessed wheat germ, bran flakes breakfast cereal, and sultana bran breakfast cereal, spiked with naphthalene at various levels, were 1.0 ppm spike, mean 0.98, SD 0.09, CV 9.5%; 2.5 ppm spike, mean 2.37, SD 0.22, CV 9.4%; 5.0 ppm spike, mean 4.86, SD 0.19, CV 4.0%; 10 ppm spike, mean 9.25, SD 0.38, CV 4.1%. The mean recoveries exceeded 90% in each case. The detection limit for the method was about 0.5 ppm.

The effect of relative hypoxemia on the pattern of breathing movements in fetal lambs

To determine whether there is a causal relationship between transient, modest hypoxemia and fetal breathing movements (FBM), we first raised fetal descending aortic PO2 (PaO2) from 17.3 +/- 0.8 (SE) to 24.9 +/- 1.8 mm Hg by administering 50% O2 in N2 to a plastic bag over the ewe's head for 26.5 +/- 3.8 min, then changed to 21% O2 in N2. Fetal PaO2 returned to control levels over the next 5 min. In 4 of 20 experiments on 11 fetal lambs (121-142 days gestation), FBM were absent when the change in maternal inspired O2 concentration was made, and did not occur in the following 5 min. In 16 trials, FBM were present for 2.0-24.1 min prior to the change to 21% O2. In 4 of these, FBM ceased within 2.1 +/- 0.7 min of the change, i.e., before PaO2 had fallen to control levels. In the remaining 12, FBM continued for 4.7-15.9 (mean = 8.6 +/- 1.0) min after the change to 21% O2, and the amplitude of FBM increased significantly (P less than 0.01) from 5.4 +/- 0.7 to 9.5 +/- 1.4 mm Hg over the first 4 min. Thereafter amplitude declined to the end of the breathing episodes. It is concluded that transient, modest reductions in vascular PO2 during episodes of FBM are a stimulus for FBM. However, it appears that transient hypoxemia cannot stimulate FBM from apnea.

A coordinating center in a clinical trial: the Hypertension Detection and Followup Program

Multicenter clinical trials are often larger and more complex than other methods of clinical inquiry. They tend to involve a number of research or clinical centers and several formal committees. In many of these trials a coordinating center is one of the participating organizational units. This article describes one such coordinating center, that of the Hypertension Detection and Follow-up Program (HDFP). In 1971 the HDFP Coordinating Center was established to assist in planning and implementing this National Heart, Lung, and Blood Institute (NHLBI)-sponsored, multicenter, community-based, randomized, controlled clinical trial. The HDFP Coordinating Center is a large, intricate organization comprised of personnel who perform a wide variety of functions. From 1972 to 1979 it supervised the adherence to a common protocol among the cooperating centers and reported the Program's progress to the various monitoring and review committees, the Steering Committee, and the NHLBI Program Office. The Program screened approximately 159,000 persons ages 30 to 69 years, identifying and following 10,940 hypertensive participants. It has been the responsibility of this Coordinating Center to institute, coordinate, and monitor the data-gathering activities of the study as a whole and to process, store, and analyze the large, multifaceted set of data that were collected.

CT appearance of the normal inferior pulmonary ligament

The inferior pulmonary ligament, a double layer of pleura that tethers the lower lobe of the lung to the mediastinum, is rarely appreciated on plain radiographs but may be involved in pathologic processes. A linear structure on axial computed tomographic (CT) images of the lung bases corresponds to the inferior pulmonary ligament on cadaver sections. Review of 100 CT studies identified at least one inferior pulmonary ligament in 42%. Its presence and configuration did not correlate with patient age or gender. The anatomy and CT appearance of the ligament are discussed.

Heterogeneity of very-low-density lipoprotein remnants bound and taken up by liver of starved rat in vivo

Very-low-density lipoprotein (VLDL), labelled in vivo with [9,10-3H]oleate, was taken up rapidly by liver after injection in vivo. Initially, radioactive lipoprotein remnants in the VLDL density range were present in liver as a bound extracellular pool that could be released by perfusion with polyphosphate or heparin. The bound remnant showed a decrease in mean diameter and an increased proportion of cholesteryl ester as a function of time after injection. When VLDL of different mean diameters was injected, it was found that: (1) total uptake by liver was independent of diameter; (2) small VLDL was not taken up more rapidly than large VLDL; and (3) Large VLDL lost no more triacylglycerol before binding than did small VLDL and larger species of mean diameter greater than 40 nm were bound. It is concluded that there is no unique VLDL remnant taken up by liver in vivo. When livers were perfused after binding radioactive VLDL in vivo, the lipoprotein was metabolized, with the production of water-soluble products, and this metabolism was inhibited by chloroquine.

cGMP stimulates active K+ uptake in rat submandibular slices

The 8-bromo derivative of cGMP was found to stimulate the ouabain-sensitive uptake of K+ and to reduce the net release of K+ induced by acetylcholine in rat submandibular gland slices incubated in vitro.

Interlobar pleural plaque mimicking a lung nodule in a patient with asbestos exposure

Computed tomography (CT) is generally superior to plain chest radiographs in differentiating pleural and pulmonary parenchymal lesions. We report a patient with asbestos exposure who had a rare interlobar pleural plaque involving the major fissure. In this patient CT suggested the presence of a lung nodule but the lateral chest radiograph indicated the correct diagnosis.

Effect of chronic reserpine administration on K+ and amylase release from the rat parotid gland

After chronic administration of reserpine, slices of the rat parotid gland incubated in vitro were found to release significantly more K+ and significantly less amylase than similar slices from untreated control animals. The extent of K+ release in the gland slices of the drug-treated animals shows no dependency on external Na+ or Ca++ and is probably enhanced because of a decreased activation of K+ uptake by the Na+-K+ pump. This effect may also involve a defective generation of cyclic GMP, which was found to enhance K+ uptake and, thus, to inhibit K+ release in control slices. The inhibition of amylase release observed after treatment with reserpine most likely results from a deficient level or utilization of the energy or nucleotide sources required for enzyme secretion, because a similar inhibition was observed in control slices after incubation in the absence of the purines inosine and adenine. These results indicate that chronic reserpine administration impairs the stimulus-secretion coupling mechanism in the rat parotid gland and results in abnormal responses from both alpha and beta adrenergic receptors.

Endocytosis of very low density lipoprotein remnants by liver of fasted rats

Radioactive lipoproteins in the very low density lipoprotein (VLDL) density range were taken up by rat liver in vivo. The radioactivity became associated with an intracellular particle of d = 1.11 that did not correspond to lysosomes, endoplasmic reticulum, or plasma membrane as determined by marker enzyme distribution. Radioactive VLDL remnants could be released from these particles by passage through a hydraulic press, hypotonic shock, or sonication. The release of radioactivity from the particles by one of these methods became more complete with increasing time after injection. The injection of colchicine inhibited the breakdown of the VLDL triglyceride and cholesterol ester and caused an accumulation of radioactive material in the d = 1.11 particles. In contrast, injected chloroquine inhibited breakdown of VLDL triglyceride and cholesterol ester and caused an accumulation in lysosomes. We have concluded VLDL remnants are metabolized in liver by an endocytosis-lysosomal digestion pathway and that the d = 1.11 particles are endocytic vesicles. The existence of a releasable pool of VLDL within endocytic vesicles makes it possible to examine the internalized remnant.

A validation of the Defence Mechanism Inventory

The Defence Mechanism Inventory (Gleser & Ihilevich, 1969) was validated by examining the 16PF profiles of each group of defenders. These were found to correspond closely to profiles hypothesized on the basis of Freudian theory, and thus suggest that the test may be valid. The ipsative scoring system was thought to limit the clinical usefulness of the five scales and to hinder statistical analyses, and the development of a rating form of the questionnaire was recommended.

A computer-assisted surgical pathology system

SURPATH is a comprehensive, integrated computer-assisted system for service, research, and management in surgical pathology that has been in use at New England Medical Center (NEMC) since July 1, 1978. Functions of the system include: maintenance of patient-name and diagnostic files; generation, editing, and printing of preliminary and final specimen reports; SNOMED coding and indexing of diagnoses; retrieval and video display or printing of data on individual cases or groups of cases; billing and generation of billing reports; and, calculation of intervals between accession and signout of specimens. Use of the system has greatly facilitated the production of surgical pathology reports; increased the spread with which inquiries about individual specimens can be answered; provided rapid, accurate searches of the diagnostic files; improved timeliness, accuracy, and completeness of billing resulting in increased departmental revenue; reduced intervals between accession and reporting; and, improved the morale of the professional and support staffs.