Aphidicolin-inducible common fragile-site expression: results from a population survey of twins

Common chromosomal fragile sites appear to be ubiquitous in humans and other mammals, and, although the molecular basis and function of these sites remain an enigma, it has been speculated that they may be a cytogenetic expression of gene activity. A population survey of 28 twin pairs was conducted to assess the heritability of common fragile-site expression. Our data yielded a heritability estimate of .88 for total site expression, suggesting that these sites may result from some common process that is under relatively stringent genetic control. An analysis of the expression of individual autosomal sites revealed that expression on both homologues in the same cell occurred more frequently than expected.

Intracranial infection after missile injuries to the brain: report of 30 cases from the Lebanese conflict

This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988. The follow-up period ranged from 1 month to 7 years (mean, 2.5 years). Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis. Infection developed 4 days to 7 years after the initial debridement. The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%). Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared. There was a 76% correlation between the organisms cultured from the dehiscent scalp wound and the brain. Twenty-three patients had intracranial retention of bone. Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis. At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure. The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present. Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostaglandins in the kidney, urinary bladder and gills of the rainbow trout and European eel adapted to fresh water and seawater

Prostaglandins in kidney, gills, and urinary bladder of freshwater-adapted and seawater-adapted rainbow trout, Oncorhynchus mykiss (= Salmo gairdneri), and European eel, Anguilla anguilla, were determined by solid-phase extraction of tissue homogenates and high-pressure liquid chromatography. Prostaglandins E2, E1, F1 alpha, F2 alpha, and D2 and the more stable metabolite of prostacyclin, 6-keto F1 alpha, occurred in these osmoregulatory tissues. In gill filaments and kidneys of both eel and trout, prostaglandins D2 and 6-keto F1 alpha were major prostaglandins. Concentrations of these prostaglandins were significantly lower in the eel after seawater adaptation, but not in the trout. The urinary bladder of the trout contained the highest levels of prostaglandins; bladders of seawater-adapted trout contained prostaglandin D2 at 6.7 ng/mg wet tissue, the highest level of any prostaglandin determined in the present studies. Prostaglandin D2 was not detected in bladders of freshwater-adapted trout.

The chromatin structure of Saccharomyces cerevisiae autonomously replicating sequences changes during the cell division cycle

The chromatin structures of two well-characterized autonomously replicating sequence (ARS) elements were examined at their chromosomal sites during the cell division cycle in Saccharomyces cerevisiae. The H4 ARS is located near one of the duplicate nonallelic histone H4 genes, while ARS1 is present near the TRP1 gene. Cells blocked in G1 either by alpha-factor arrest or by nitrogen starvation had two DNase I-hypersensitive sites of about equal intensity in the ARS element. This pattern of DNase I-hypersensitive sites was altered in synchronous cultures allowed to proceed into S phase. In addition to a general increase in DNase I sensitivity around the core consensus sequence, the DNase I-hypersensitive site closest to the core consensus became more nuclease sensitive than the distal site. This change in chromatin structure was restricted to the ARS region and depended on replication since cdc7 cells blocked near the time of replication initiation did not undergo the transition. Subsequent release of arrested cdc7 cells restored entry into S phase and was accompanied by the characteristic change in ARS chromatin structure.

Sinusitis and headache

Nasal endoscopic examination and CT views of the sinuses were obtained in patients with symptoms of headache and sinusitis who had failed to respond to conservative medical therapy. Endoscopic sinus surgery has challenged traditional concepts of sinus disease management. The site of obstruction rather than the extent of the disease is the major concern. Removal of pressure points with reestablishment of a competent airway, and revision of sinus passageways to facilitate mucociliary drainage and ventilation of the obstructed cavity can benefit patients with chronic headaches.

Missile injuries to the brain treated by simple wound closure: results of a protocol during the Lebanese conflict

This is a prospective study of the treatment of penetrating missile injuries to the brain without intracranial surgery carried out at the American University of Beirut Medical Center between 1981 and 1988. Of 600 patients treated for missile injuries to the head, 32 satisfied the study criteria. There were 27 shrapnel and 5 bullet injuries. The mean patient age was 23 years (range, 3-51 years). Twenty patients had intracranial indriven bone fragments. Six patients had exposed brain tissue. The mean follow-up was 3.5 years (range, 1-7.5 years). The superficial entry wound was debrided and closed without drainage in the Emergency Room within a mean of 3 hours (range, 0.5-6 hours), and the patient received methicillin for 14 days. All patients survived and had no or improved neurological deficits. No leakage of the cerebrospinal fluid, infection, or seizures occurred in 31 patients. One patient with indriven bone fragments had leakage of the cerebrospinal fluid and developed seizures and a brain abscess 20 days after the injury. The management of penetrating missile injuries to the brain without intracranial surgery in a select patient population is a reasonable option. This treatment becomes important for a surgeon facing large numbers of casualties, or when operative personnel or resources are limited or unavailable.

Minimization of indomethacin-induced reduction in renal function by misoprostol

A prospective, randomized, open-label, triple crossover comparison of the effects of indomethacin, misoprostol, or the combination, on renal function was performed to assess the ability of an oral prostaglandin E analogue, misoprostol, to minimize indomethacin-induced decline in renal function in middle-aged women. Twelve healthy women (mean age: 60.5 +/- 1.6 yr) with normal renal function (serum creatinine: 81 +/- 9 umol/L) were studied; six women were normotensive, and six women were hypertensive with their blood pressure controlled with 50-mg hydrochlorothiazide daily. All patients were placed on a 2-g sodium daily diet for 2 weeks before initiation of the study. The subjects were prospectively randomized to receive each of three 4-day treatments of indomethacin (25 mg q 6hr), misoprostol (200 mcg q 6hr), or the combination of drugs with a 4-day washout between each treatment period. Measurements of GFR (urine accumulation of 99mTc-DTPA) and RPF (serum disappearance 131I-Hippuran), and urine collections for electrolytes were obtained before the first treatment period and on the fourth day of each treatment period. Three of the six hypertensive patients and three of the six normotensive patients had a decrease (greater than 10%) in GFR associated with indomethacin therapy. When misoprostol was given with the indomethacin, four of these six patients did not experience a decline in GFR (baseline GFR for six patients: 75.4 +/- 6.6 mL/min/1.73m2, GFR after indomethacin: 57.8 +/- 9.5 mL/min/1.73m2, GFR with combination of indomethacin and misoprostol: 69.7 +/- 3.5 mL/min/1.73m2. RPF was not consistently altered by subacute/chronic dosing of indomethacin, misoprostol, or the combination of the drugs. The authors conclude that misoprostol ameliorates indomethacin-induced renal dysfunction in salt-restricted and diuretic-treated middle-aged women with normal serum creatinine.

Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. A randomized, controlled trial

OBJECTIVES

To compare the efficacy and frequency of adverse experiences of misoprostol and sucralfate in the prevention of gastric ulcers in patients receiving nonsteroidal anti-inflammatory drug (NSAID) therapy.

DESIGN

A prospective, randomized, single-blind, multicenter trial.

PATIENTS

Patients with osteoarthritis receiving treatment with ibuprofen, piroxicam, or naproxen and experiencing abdominal pain were eligible.

INTERVENTIONS

Patients who were expected to receive at least 3 months of NSAID therapy and who did not have a gastric ulcer at the time of the initial screening endoscopy were randomized to receive misoprostol, 200 micrograms four times a day, or sucralfate, 1 g four times a day. A gastric ulcer was defined as a lesion of the gastric mucosa 0.3 cm or greater in diameter. Patients were followed clinically, and repeat endoscopies were performed after 4, 8, and 12 weeks.

MAIN MEASUREMENT

The development of a gastric ulcer, which was regarded as a prophylaxis failure.

RESULTS

Two hundred fifty-three patients were evaluable for efficacy analysis. A gastric ulcer developed in 2 of the 122 (1.6%, 95% CI, 0.3% to 6.4%) patients on misoprostol, compared with 21 of 131 patients on sucralfate (16%, CI, 10.4% to 23.7%). The difference in ulcer rates was 14.4% (CI, 10.4% to 19.5%; P less than 0.001).

CONCLUSION

In patients receiving chronic NSAID therapy for osteoarthritis, treatment with misoprostol for 3 months was associated with a significantly lower frequency of gastric ulcer formation, compared with treatment with sucralfate (P less than 0.001).

Manganese peroxidase gene transcription in Phanerochaete chrysosporium: activation by manganese

The expression of manganese peroxidase in nitrogen-limited cultures of Phanerochaete chrysosporium is dependent on Mn, and initial work suggested that Mn regulates transcription of the mnp gene. In this study, using Northern (RNA) blot analysis of kinetic, dose-response, and inhibitor experiments, we demonstrate unequivocally that Mn regulates mnp gene transcription. The amount of mnp mRNA in cells of 4-day-old nitrogen-limited cultures is a direct function of the concentration of Mn in the culture medium up to a maximum of 180 microM. Addition of Mn to nitrogen-limited Mn-deficient secondary metabolic (4-, 5-, and 6-day-old) cultures results in the appearance of mnp mRNA within 40 min. The appearance of this message is completely inhibited by the RNA synthesis inhibitor dactinomycin but not by the protein synthesis inhibitor cycloheximide. Furthermore, the amount of mnp mRNA produced is a direct function of the concentration of added Mn. In contrast, addition of Mn to low-nitrogen Mn-deficient 2- or 3-day-old cultures does not result in the appearance of mnp mRNA. Manganese peroxidase protein is detected by specific immunoprecipitation of the in vitro translation products of poly(A) RNA isolated from Mn-supplemented (but not from Mn-deficient) cells. All of these results demonstrate that Mn, the substrate for the enzyme, regulates mnp gene transcription via a growth-stage-specific and concentration-dependent mechanism.

The literature and perspectives on muscle relaxants for rapid sequence induction

Since the advent of surgical anesthesia, one of the single greatest challenges to providers and researchers has been to develop, test, and promote drugs and techniques to facilitate rapid intubation and security of the airway to diminish risk of regurgitation and gastric aspiration. This article provides a comprehensive, historical perspective of such efforts, including the efficacy of various techniques and muscle relaxant drugs that have been used to further the ideal situation in which airway control would obviate the all-too-common morbidity statistics of gastric aspiration. Special emphasis is given to the review of succinylcholine and vecuronium relative to their roles in rapid sequence induction.

Protein and antigen profiles of prevalent serovars of Leptospira interrogans

Whole-cell and detergent-soluble proteins, enriched for outer membrane antigens, of the Leptospira interrogans serovars present in commercially available pentavalent vaccines (hardjo, pomona, icterohaemorrhagiae, grippotyphosa, and canicola) were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting (immunoblotting). Protein and antigenic profiles of these serovars, representing several serogroups, were compared with similar profiles of the most common North American bovine pathogen, serovar hardjo type hardjo bovis. The reference strain of serovar balcanica and a hardjoprajitno bovine field isolate (serovar hardjo) were also assayed. Coomassie blue-stained gels revealed extensive protein similarities, and Western blots demonstrated antigenic relatedness throughout the low- and high-molecular-weight regions. Possible quantitative differences in protein expression among the strains were noted, as were similarities in the protein profiles of type hardjo bovis and the balcanica reference strain. A cocktail composed of these homologous antigens may serve as an efficacious subunit vaccine for leptospirosis.

A molecular genetic approach to the identification of isochromosomes of chromosome 21

The largest class of de novo chromosomal rearrangements in Down syndrome are rea(21q21q). Classically, these rearrangements have been termed Robertsonian translocations, implying an attachment of two different chromosome 21 homologues. Additionally, a Robertsonian translocation between two chromosomes 21 cannot be distinguished from an isochromosome composed of genetically identical arms by cytogenetic analyses. Therefore, we have used molecular techniques to differentiate between true Robertsonian translocations and isochromosomes. Samples were obtained from 12 probands, ascertained for de novo rearrangements between homologous chromosomes 21 [11 rea(21q21q) and 1 rea (21;21)(q22;q22)], their parents (n = 24) and available siblings (n = 7). The parental origins of the de novo rearrangements were assigned using molecular and cytogenetic analyses. Although not statistically significant, there was a two-fold increase in the number of paternally derived de novo rearrangements (n = 8) as compared with maternally derived rearrangements (n = 4). To distinguish between rob(21q21q) and i(21q), we used restriction fragment length polymorphisms (RFLPs) spanning the length of chromosome 21. Using all informative and partially informative RFLPs, we used the method of maximum likelihood to assign the most likely rearrangement definition (i or rob) and parental origin in each family. The maximum likelihood estimates indicated that all rearrangements tested (n = 8) were isochromosomes. C-banding revealed two centromeres in three cases indicating that a U-type exchange occurred between sister chromatids in these rearrangements. Our results suggest that the majority of de novo rea(21q21q) are isochromosomes derived from a single parental chromosome 21.

Characterization of a gene encoding a manganese peroxidase from Phanerochaete chrysosporium

The complete nucleotide (nt) sequence of a gene (mnp-1) encoding manganese peroxidase isozyme 1 (MnP-1) (pI = 4.9) from Phanerochaete chrysosporium has been determined. The sequence of 2539 bp includes 526 bp of 5'-flanking sequence and 368 bp 3' to the poly(A) site. Comparison of cDNA and genomic sequences indicates six introns varying in size from 57-72 bp. Intron splice-junction sequences all adhere to the GT---AG rule. The positions of the introns show little similarity to the intron positions in the closely related lignin peroxidase-encoding genes. The 5' upstream region of the mnp-1 gene contains a TATAA element and three inverted CCAAT elements (ATTGG) at nt positions -81, -181, -195, and -304, respectively, relative to the start codon. In addition, the mnp-1 gene contains three putative heat-shock (HS) elements similar to the consensus C--GAA--TTC--G sequence, and two consensus metal response elements located within 500 bp upstream from the start codon. Furthermore, Northern-blot analysis demonstrates that mnp gene transcription is regulated by HS.

Manganese regulates expression of manganese peroxidase by Phanerochaete chrysosporium

The appearance of manganese peroxidase (MnP) activity in nitrogen-limited cultures of Phanerochaete chrysosporium is dependent on the presence of manganese. Cultures grown in the absence of Mn developed normally and produced normal levels of the secondary metabolite veratryl alcohol but produced no MnP activity. Immunoblot analysis indicated that appearance of MnP protein in the extracellular medium was also dependent on the presence of Mn. Intracellular MnP protein was detectable only in cells grown in the presence of Mn. MnP mRNA was detected by Northern (RNA) blot analysis only in cells grown in the presence of Mn. If Mn was added to 4-day-old nitrogen-limited Mn-deficient cultures, extracellular MnP activity appeared after 6 h and reached a maximum after 18 h. Both actinomycin D and cycloheximide inhibited the induction of MnP activity by Mn. These results indicate that Mn, the substrate of the enzyme, is involved in the transcriptional regulation of the MnP gene.

Autonomic and histopathological effects of percutaneous trigeminal ganglion compression in the rabbit

The histopathological and autonomic effects of percutaneous trigeminal ganglion compression for trigeminal neuralgia were studied in New Zealand White rabbits. Drops in mean arterial blood pressure of 38% and in heart rate of 30% were observed during compression (p less than 0.0001). Corneal reflex, pinprick sensation, and mastication strength were intact in 13 of 14 rabbits after compression. These findings resembled the effects of percutaneous compression in humans and suggested that the New Zealand White rabbit is a useful model for the study of percutaneous compression. Trigeminal sensory roots and ganglia from 14 rabbits killed at intervals from 1 to 84 days after percutaneous compression were sectioned and stained using immunoperoxidase for neurofilaments, hematoxylin and eosin, luxol fast blue, and cresyl echt violet. Focal axonal damage and demyelination were present 7 days after compression. No difference could be detected in the perikaryonal distribution of neurofilaments between compressed and control trigeminal ganglia. Focal demyelination and Schwann cell proliferation preceding remyelination were present in the trigeminal sensory root at 84 days. Differential injury of axons compared to trigeminal ganglion cell bodies suggests that axonal regeneration is possible and may contribute to the recovery of motor and sensory function in patients after percutaneous compression.

DNA and protein analyses of tick-derived isolates of Borrelia burgdorferi from California

Nine isolates of Borrelia burgdorferi from ixodid ticks collected in northern California were characterized. Restriction endonuclease analysis, pulsed-field gel electrophoresis, and Western blot (immunoblot) analysis were used in this study. Four isolates were very similar to each other. The others shared some similarities but were classified as having unique genotypes. A strain from an Ixodes neotomae tick displayed the greatest genetic and antigenic diversity when compared to the isolates collected from Ixodes pacificus ticks. A computerized library based on DNA banding patterns of the isolates by restriction enzyme analysis is also reported. This library was created by using a scanning laser densitometer.

Prenatal detection of non-cardiac rhabdomyosarcoma

The most prevalent soft tissue tumour in children is rhabdomyosarcoma. These tumours may develop within or outside of muscle anywhere in the body and at any age. We report what is apparently the earliest case of non-cardiac rhabdomyosarcoma detected prenatally.

Percutaneous trigeminal ganglion compression for trigeminal neuralgia. Experience in 22 patients and review of the literature

Between 1983 and 1988, a percutaneous trigeminal ganglion compression (PTGC) procedure for trigeminal neuralgia was performed on 22 patients. All patients were initially relieved of their pain. There were three recurrences (14%); two of these patients underwent a second PTGC procedure and one a partial trigeminal nerve root section. Follow-up examination 3 to 53 months after the procedure showed that all patients were free of pain. Morbidity included persistent minor hypesthesia in five patients, persistent minor dysesthesias in three, persistent minor weakness in three, aseptic meningitis in one, transient sixth nerve palsy in one, and transient otalgia in three. None of the patients had either anesthesia dolorosa or an absent corneal reflex.

Characterization of a cDNA encoding a manganese peroxidase, from the lignin-degrading basidiomycete Phanerochaete chrysosporium

A cDNA clone of a manganese peroxidase (MnP) from Phanerochaete chrysosporium was isolated and characterized. The cDNA contains 1314 nucleotides excluding the poly(A) tail and the coding region has 68% G + C content. The deduced mature MnP protein contains 357 amino acids and is preceded by a 21-amino acid leader sequence. The experimentally determined N-terminal sequence of the purified MnP-1 protein, pI = 4.9, corresponds to the deduced N-terminal sequence of the gene. The Mr of the mature MnP-1 deduced from the cDNA is 37,439, which is approximately 81.4% of the experimentally determined molecular weight. The difference is due to glycosylation and a single potential N-glycosylation site with the general sequence Asn-X-Thr/Ser is present in the deduced MnP-1 sequence. Consistent with the peroxidase mechanism of MnP, the proximal histidine, the distal histidine, and the distal arginine are all conserved and regions flanking these residues display homology with other peroxidases. Northern blot analysis indicates that MnP expression is controlled by nutrient nitrogen at the level of transcription. Southern blot hybridization analysis suggests that MnP-1 is a member of a family of MnP genes.

Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report

We reviewed 13 cases of unstable cervical spine treated by stabilization with posterior Roy-Camille plates and fusion. The patients were treated between 1985-1988. Six patients had acute traumatic episodes, three patients had posttraumatic instabilities, one patient had laminectomy for cervical spondylotic myelopathy, and three patients had metastatic bone disease. All had successful fusion in approximately 3 months without complications. The indications and techniques of posterior Roy-Camille plating are outlined.

Trigeminal depressor response during percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia

Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia was performed 23 times on 21 patients. Significant abrupt drops in heart rate and blood pressure (P less than 0.0002) occurred when the needle entered the foramen ovale or upon balloon advancement or inflation. In 16 of 23 (70%) procedures, the heart rate fell abruptly to 60 or less, by a mean of 38%. Mean arterial blood pressure decreased transiently by 31% during 12 of 23 (55%) procedures. Our findings of transient bradycardia and hypotension upon mechanical stimulation or compression of the mandibular nerve or trigeminal ganglion show for the first time the presence of a trigeminal depressor response in humans. We recommend that heart rate and arterial blood pressure be monitored continuously during percutaneous microcompression of the trigeminal ganglion. Intravenous atropine should be available for immediate use, and an external pacemaker should be fitted preoperatively.

Use of phorbol-12,13-dibutyrate as a mitogen in the cytogenetic analysis of tumors with low mitotic indexes

Solid tumors, particularly those involving the colon, breast, and lung, are the most common tumors in humans. However, many technical difficulties exist in obtaining analyzable chromosomes from these tumors, including the inability to stimulate cell division. Phorbol-12,13-dibutyrate (PDBu) is a tumor promoter that activates a variety of cellular responses, including proliferation. Using flow cytometry, we have demonstrated that PDBu acts as a mitogen in primary cultures of colon tumor cells. Based on these results, we developed a short-term culture technique that greatly improves the yield of analyzable metaphases from colon tumors. Stimulated cultures consistently contained at least ten times more metaphases than unstimulated cultures, and chromosome morphology was improved. By modifying this technique with the addition of the calcium ionophore A23187, we have successfully obtained analyzable chromosomes from the peripheral blood of normal individuals, chronic lymphocytic leukemia patients, and a nodular small cell lymphoma patient. These results demonstrate that mitogenic stimulation by PDBu is a valuable technique in the cytogenetic analysis of colon tumors. By using PDBu alone or in combination with other agents, this technique may also be applicable to many other tumors that are difficult to karyotype because of an inability to obtain mitoses.

Glomerular bypass shunts in the kidney of the Atlantic hagfish, Myxine glutinosa

The vascular pathways associated with the glomerulus of the Atlantic hagfish, Myxine glutinosa have been studied by scanning electron microscopy of corroded resin casts of the vasculature. Although the overall pattern of the renal vasculature did not differ from earlier reports, a previously unreported vascular pathway which arose from the renal artery and bypassed the glomerular capillaries in 28% of glomeruli was clearly demonstrated. Glomerular bypass shunts either ran to join the loose capillary network around Bowman's capsule and thereby drain into the network of vessels associated with the mesonephric duct (ureter), or ran directly into the ureteral system of vessels and subsequently into the posterior cardinal veins. Glomerular bypass shunts which theoretically permit renal arterial blood to bypass the process of filtration may play a role in the regulation of body fluid volume.

Pyriformis syndrome in a 10-year-old boy as a complication of operation with the patient in the sitting position

We present a case of sciatic neuropathy due to the pyriformis syndrome after operation in the sitting position. Neither sciatic nerve injury nor the pyriformis syndrome has been reported after operation in the sitting position, although a low incidence of common peroneal nerve injury has been reported as a complication of operation on patients who are in the sitting position. The clinical findings of sciatic neuropathy, external rotation of the ipsilateral foot in the position of comfort, and a therapeutic response to local anesthetic injection into the pyriformis muscle are diagnostic of the syndrome. Nerve conduction studies should be performed to aid in the differentiation between a common peroneal and sciatic neuropathy. The syndrome may occur because of extreme flexion of the hips and prolonged pressure while in the sitting position, leading to pyriformis muscle trauma, resultant spasm, and sciatic compression. The prognosis is for complete recovery after symptomatic treatment with nonsteroidal antiinflammatory medication and physical therapy.

Cervical stabilization by plate and bone fusion

Anterior stabilization with combined plate and bone fusion was performed after neural decompression on ten patients for spondylotic cervical myelopathy, and for radiculopathy or trauma in three patients. Medial corpectomy was performed at one to four levels. Iliac crest or fibular bone grafts were secured by plates anchored to the graft and adjacent vertebral bodies. All patients were placed in Minerva braces postoperatively. There was successful fusion in all cases, and no graft dislodgement or kyphosis. Early initiation of rehabilitation was achieved. Morbidity occurred in patients with severe spondylotic cervical myelopathy. This include respiratory depression requiring reintubation in 2/13 procedures, dysphagia (2/13) from loosening of the screws or prominent hardware and graft, and screw loosening (2/13). Neurological improvement was present in 85% (11/13) of patients. There was no deterioration of neurological function in any case. We conclude from this early follow-up that anterior bone fusion with supplemental plates provides effective stabilization for the unstable cervical spine. Greater morbidity risk exists in patients with severe spondylotic cervical myelopathy and spastic quadriparesis who required multilevel medial corpectomies and fusion.

Chromosome analysis of 30 cases of non-Hodgkin's lymphoma

Karyotype analysis is now a routine procedure in the clinical evaluation of leukaemia because of its value in diagnosis and prognosis. This is not yet so for lymphoma because the relative paucity of data available has prevented an evaluation of its usefulness. We therefore karyotyped 30 unselected cases of non-Hodgkin's lymphoma and six controls with reactive hyperplasia. All cases were karyotyped 'blind' to diagnosis; all were classified by immunohistopathology and 29 were analysed before treatment. This is one of the four largest cytogenetic studies to be reported of untreated, immunotyped patients with non-Hodgkin's lymphoma. Chromosome abnormalities were observed in 29/30 tumour samples. The only rearrangement observed more than once was the 14;18 translocation. The combined results of this study and others indicate that while there are no unique associations between histological sub-types and chromosome rearrangements in untreated non-Hodgkin's lymphoma patients, some partial specificity does exist.

Hyperbaric oxygen in the treatment of elevated intracranial pressure after head injury

This study is the first to evaluate the effect of hyperbaric oxygen (HBO) on elevated intracranial pressure (ICP) after severe head injury during documented controlled ventilation, hypocapnea, and minute-by-minute ICP data collection. We studied the effect of HBO at 2 atmospheres absolute (ATA) with 100% O2, on ICP in 2 patients, aged 5 and 21 years. Each patient had diffuse cerebral swelling after blunt trauma and after a gun shot wound, respectively. Both required controlled hyperventilation, osmotic diuretics and ICP monitoring. ICP, mean arterial blood pressure, pulse and atmospheric pressure were recorded at 1-min intervals during 1-hour treatments and for 15 min before and after HBO therapy. Controlled hyperventilation was continued during HBO therapy and PCO; was measured at intervals. Each patient underwent 4 treatments. Data was divided into 5 phases, all at 100% O2; (1) prior to therapy; (2) during pressurization from 1 to 2 ATA; (3) at 2 ATA; (4) during depressurization from 2 to 1 ATA, and (5) after HBO therapy. During pressurization the mean ICP dropped from 13 to 8 Torr, rising to 14 Torr during HBO therapy at 2 ATA, and to 16 Torr during depressurization to 1 atmosphere, then returning to 12 Torr after HBO therapy. We conclude from this preliminary work that HBO may lower ICP in head-injured patients with diffuse cerebral swelling during the first 15 min, or pressurization phase, of therapy. However, rebound elevations in ICP may occur during or after treatment. No lasting effects of treatment were seen after concluding therapy. The effect of HBO on elevated ICP has not yet been clarified, but deserves further careful study in those patients with severe enough injury to require ICP monitoring.

Glomerular ultrastructure of the trout, Salmo gairdneri: effects of angiotensin II and adaptation to seawater

The effect of angiotensin infusion on the glomerular ultrastructure of freshwater- and seawater-adapted rainbow trout. Salmo gairdneri, has been examined by scanning and transmission electron microscopy. Adaptation of trout to seawater resulted in epithelial podocyte flattening, primary process broadening and apparent loss of foot processes in almost all glomeruli, features which were uncommon in freshwater-adapted trout. Similar changes were induced by infusion of freshwater-adapted animals with angiotensin, suggesting that the renin-angiotensin system plays a role in the modification of glomerular epithelial ultrastructure. Adaptation of trout to seawater also reduced glomerular diameter, but infusion of freshwater-adapted animals with angiotensin did not mirror this effect. Infusion of angiotensin into seawater-adapted animals increased the overall thickness of glomerular basement membrane by increasing the lamina rara interna and lamina densa. This did not occur when freshwater-adapted fish were either infused with angiotensin or adapted to seawater. These findings suggest that other humoral systems are involved in the control of glomerular diameter and basement membrane thickness as part of an integrated response to increased environmental salinity.

Cytogenetic and molecular genetic studies of a patient with atypical lymphoid hyperplasia

We have karyotyped cells from a lymph node of a patient with atypical lymphoid hyperplasia. Among other clonal chromosomal abnormalities, a t(2;19) translocation was observed with breakpoints at 2p11.2 and 19q13. The genes for transforming growth factor alpha and beta have been mapped to 2p11-p13 and 19q13, respectively, but Southern blot analysis did not reveal any alteration in the structure of these genes. Similarly, the kappa immunoglobulin gene, which maps to 2p11-p12 was not rearranged. In addition, Southern blot analysis using immunoglobulin and T-cell receptor genes as probes, did not demonstrate any clonality of either B or T cells. We propose that this patient represents an early, polyclonal stage of atypical hyperplasia. The chromosome changes observed may have been one of the etiologic factors causing this disorder.

Single nephron function of the lesser spotted dogfish, Scyliorhinus canicula, and the effects of adrenaline

Function of the kidney and the nephron in the lesser spotted dogfish, Scyliorhinus canicula, was investigated by clearance, renal tubular micropuncture and ferrocyanide infusion techniques. 70% of the glomerular filtrate was reabsorbed within the renal tubule, producing slightly hypotonic urine. Glomeruli were: perfused and filtering (F); arterially perfused but not filtering (NF); or non-arterially perfused and hence not filtering (NP). Adrenaline reduced the proportion of filtering glomeruli from 94% to 70%. Despite this reduction, a marked overall glomerular diuresis occurred. Single nephron glomerular filtration rates (SNGFRs) ranged from 1.5 to 26 nl min-1 with a mean rate of 9.5 nl min-1 during control periods. Adrenaline elevated SNGFR to a mean value of 22.9 nl min-1 (range 2.4-64.6 nl min-1). Tubular fluid/plasma inulin concentration ratios (TF/Pin) indicated reabsorption of around 74% of the glomerular filtrate by the proximal segments. Comparison of TF/P and urine/plasma inulin concentrations (U/Pin) strongly suggests tubular secretion of water beyond the point of puncture. Adrenaline infusion appears to increase both proximal water reabsorption and distal tubular secretion.

Morbidity in the forearm flap donor arm

A retrospective study was carried out of the morbidity in the donor limb following use of the radial forearm flap in 27 patients. Of the 13 patients whose flaps contained bone, 4 sustained fractures of the radius. This was associated with a 50% loss of power of grip and pinch, and limitation of other movements, particularly pronation and supination. In the other patients little or no loss of power or range of movement was seen. No patient had cold intolerance; a few had areas of sensory loss, related to the radial nerve. Of the 12 patients whose radial arteries were reconstructed, 7 remained patient; no patient had any clinical features of ischaemia. These findings and their implications are discussed.

Prostaglandin regulation of colonic blood flow in rabbit colitis

Human and experimental colitis are associated with release of both vasoconstrictor and vasodilator eicosanoids. To determine the pattern of colonic blood flow in vivo and the role of prostaglandins and thromboxanes, immune complex-mediated colitis and delayed hypersensitivity-mediated colitis were induced in rabbits. Organ blood flow was determined in conscious animals by radiolabeled microspheres before and after cyclooxygenase or thromboxane synthetase inhibition. Colonic blood flow was twofold higher in colitis than in control animals. Thromboxane synthetase inhibition with dazoxiben caused a slight further increase of colon perfusion in animals with colitis, but thromboxane receptor blockade had no effect. Prostaglandin inhibition with indomethacin and ibuprofen did not affect blood flow in controls, but in animals with colitis these drugs markedly reduced colonic blood flow to the level of control animals. The data demonstrate that vasodilatory prostaglandins enhance colonic blood flow in acute colon inflammation.

Recurrent sinus pericranii in a 14-year-old boy

A case of symptomatic and recurrent sinus pericranii in a 14-year-old boy is presented. A blood-filled cyst was diagnosed after head trauma. The sinus pericranii was surgically removed. One year later the patient presented with blurred vision, headaches, and recurrence at a different site in the skull.

Functioning parathyroid lipoadenoma. Report of a case diagnosed by intraoperative touch preparations

Lipoadenoma of the parathyroid gland is an unusual cause of primary hyperparathyroidism. Inasmuch as they may grossly resemble lipoma more than parathyroid adenoma, these tumors may be missed by surgeons and surgical pathologists alike. In this case, the diagnosis was made during surgery utilizing touch preparations because frozen sections were technically difficult to perform due to the fat content of the tumor. Examination of multiple sections disclosed a neoplastic proliferation of parathyroid cells, thus supporting the premise that this entity represented an adenoma rather than a hamartoma.

Common Components of Industrial Metal-Working Fluids as Sources of Carbon for Bacterial Growth

Water-based metal-working fluids used in large-scale industrial operations consist of many components, but in the most commonly used formulations only three classes of components are present in high enough concentrations that they could, in principle, provide enough carbon to support the high bacterial densities (10 9 CFU/ml) often observed in contaminated factory fluids. These components are petroleum oil (1 to 5%), petroleum sulfonates (0.1 to 0.5%), and fatty acids (less than 0.1%, mainly linoleic and oleic acids supplied as tall oils). We isolated pure strains of predominating bacteria from contaminated reservoirs of two metal-working systems and randomly selected 12 strains which we tested in liquid culture for growth with each of the metal-working fluid components as the sole source of carbon. Of the 12 strains, 7 reached high density (10 9 CFU/ml from an initial inoculum of less than 2 × 10 3 ) in 24 h, and 1 strain did the same in 48 h with 0.05% oleic or linoleic acid as the carbon source. These same strains also grew on 1% naphthenic petroleum oil but required up to 72 h to reach densities near 10 8 CFU/ml. One strain grew slightly and the others not at all on the petroleum sulfonates. The four remaining strains did not grow on any of the components, even though they were among the predominating bacteria in the contaminated system. Of the seven strains that grew best on the fatty acids and on the naphthenic petroleum oil, five were tentatively identified as Acinetobacter species and two were identified as Pseudomonas species. Four of the bacteria that did not grow were tentatively identified as species of Pseudomonas , and one could not be identified.

Effects of thioglucoses on sensitivity to insulin hypoglycemic convulsions

Based on the effects of gold thioglucose (GTG), we have previously proposed a regulatory center in brain which adjusts the convulsive response to insulin hypoglycemia. The sensitivity to insulin hypoglycemic convulsions is decreased 24 hr and increased 1 week after a single i.p. injection of GTG. The differences are in the brain's convulsive response to equal hypoglycemia, as the blood glucose response to insulin is unchanged. The generalized convulsive threshold, reflected in the sensitivity to nonmetabolic pentylenetetrazol (Metrazol) convulsions, is not altered. Despite its systemic administration, GTG causes lesions focused in the ventromedial hypothalamus. In the present study, this regulatory center was explored further by the ability of two thioglucoses to substitute for GTG. beta-D-Thioglucose had no effect. 5-Thioglucose simulated the early (24 hr) action of GTG but had no effect at 1 week. However, unlike GTG, 5-thioglucose did not cause the ventromedial hypothalamus lesion. The early (24 hr) and late (1 week) components are thus dissociated. The early effect on insulin hypoglycemic convulsions does not require a ventromedial hypothalamus lesion. Structure-activity relationships and relationships to glucoregulatory systems are discussed.

Insulin-stimulated sodium transport in toad urinary bladder

Mammalian and teleost insulins increase active sodium transport by the toad urinary bladder at subnanomolar concentrations. This stimulation is evident within 15 min and persists for hours. Porcine proinsulin and a cross-linked derivative of bovine insulin are less effective than porcine insulin in stimulating the short-circuit current (SCC), indicating the specificity appropriate for activation of sodium transport through an insulin receptor. The initial stimulation by insulin of the SCC is not blocked by pretreatment with actinomycin D, puromycin, cycloheximide, or tunicamycin. However, in the presence of any one of these inhibitors the sustained increase in SCC is blocked and the rise is short-lived, lasting only 45 to 90 min. In amphotericin-treated bladders, the addition of insulin did not further stimulate SCC.