The relationship of systemic hemodynamics and oxygen consumption to early allograft failure after liver transplantation

The early postoperative hemodynamic data of 88 patients who underwent primary liver transplantation between July 1989 and October 1990 at the University Health Center of Pittsburgh were analyzed to establish the relationship of systemic hemodynamics and oxygen consumption to perioperative allograft function. The 15 patients whose allografts failed within the 1st month following transplantation were designated as group 1, while 73 patients who retained adequate graft function constituted group 2. Although the cardiac index and oxygen delivery did not differ significantly between the groups, group 1 consistently demonstrated a lower mean arterial pressure, oxygen consumption, arteriovenous oxygen content difference, and arterial ketone body ratio. The etiology of reduced oxygen consumption in group 1 patients is speculative, but the data support the notion that oxygen consumption is a useful, predictive indicator for liver allograft function after transplantation.

Adult respiratory distress syndrome secondary to end-stage liver disease-successful outcome following liver transplantation

The adult respiratory distress syndrome (ARDS) complicating liver failure carries a 100% mortality. Two cases of ARDS that resolved following liver transplantation have been reported, one associated with acute allograft rejection, and the second due to sepsis. There is, however, a great reluctance to transplant these very-high-risk patients. We report the first series of patients with ARDS secondary to liver failure who successfully underwent OLTX. No patient had sepsis or pneumonia. Posttransplant mechanical ventilation was required for a median of 14 days (range 6-37 days). All patients in this series are alive and well, with a follow-up of 6-15 months. This demonstrates that ARDS associated with liver failure, an otherwise uniformly lethal complication, can respond dramatically to OLTX.

Prenatal sonographic findings of trisomy 18: review of 47 cases

Prenatal sonographic findings were reviewed in 47 consecutive fetuses with trisomy 18. One or more abnormalities, excluding choroid plexus cysts, were found in 39 fetuses (83%), including 21 of 29 (72%) fetuses examined between 14 and 24 weeks and all 18 (100%) fetuses examined after 24 weeks. Abnormalities most frequently detected before 24 weeks included cystic hygromas, nuchal thickening, and meningomyelocele. Intrauterine growth retardation, cardiac defects, and an enlarged cisterna magna were detected more frequently after 24 weeks than before 24 weeks (P < 0.05). Intrauterine growth retardation was the single most common abnormality, detected in 51% of all fetuses and 89% of fetuses examined after 24 weeks. Choroid plexus cysts were identified in 25% (12 of 47) of fetuses, including 11 of 29 (38%) fetuses seen before 24 weeks. Additional abnormalities were identified in 10 of 12 (83%) fetuses with choroid plexus cysts; one of the two remaining fetuses showed clenched hands and a cardiac anomaly at autopsy, and the other showed unusually large, multiple choroid plexus cysts. Awareness of the type of anomalies and the usual menstrual age of diagnosis in fetuses with trisomy 18 should improve patient counseling and prenatal detection of fetuses considered at risk for this disorder.

Prenatal diagnosis of tetraploidy: a case report

We report on the second trimester prenatal diagnosis of an apparently nonmosaic tetraploid fetus, 92,XXYY. Indications for cytogenetic studies of the fetus included abnormal ultrasound findings and abnormal maternal serum levels of alpha-fetoprotein (AFP)/estriol. Chromosome analysis of amniocytes documented tetraploidy, a finding confirmed by flow cytometry of several fetal tissues. Autopsy findings in the fetus are compared with those of other cases of tetraploidy. To our knowledge this is the first reported prenatal diagnosis of a tetraploid fetus. Additionally, it illustrates the value of flow cytometric analysis of products of conception in which polyploidy is suspected.

Paranasal echogenic mass: sonographic sign of bilateral complete cleft lip and palate before 20 menstrual weeks

A paranasal echogenic mass identified at ultrasound performed during the second trimester was the initial and primary clue to the presence of bilateral complete cleft lip and palate in four fetuses. Referral had been for dating purposes in three cases and because of high maternal serum alpha-fetoprotein level in one. Genetic amniocentesis revealed deletion of the 15th chromosome in one case. The clefts were small and difficult to visualize; the finding of the echogenic mass (representing a premaxillary protrusion) therefore added confidence to the diagnosis.

Applications of voxel shifting in magnetic resonance imaging

Due to the nature of three-dimensional Fourier transform (3-DFT) data acquisition in magnetic resonance imaging (MRI), the spatial relation between a resolved volume element (a voxel) and the object can be manipulated easily. Those manipulations have practical consequences in terms of registering slice positions with respect to features of interest in producing oblique reformatted images where volume resolution is preserved, and in generating reformatted images that project the viewing plane onto a surface through the object that has an arbitrary shape.

A vasopressin metabolite increases attentional selectivity

Two behavioral paradigms were used to assess the effect of a vasopressin metabolite, AVP4-9, on selectivity of attention. The effects observed in a multiple-cue task indicated that AVP4-9 treatment increased the extent to which attention was controlled by the dominant cues in the environment. When these stimuli predicted reward, the peptide treatment facilitated learning, but when these cues were nonpredictive, the treatment hindered learning. In a redundant learning paradigm, administration of the lower dose of AVP4-9 (1 microgram/kg) prevented animals from learning about an added, equally predictive (i.e., redundant) set of cues, suggesting that this treatment caused selective attending to the originally presented stimuli, whose relationship with reward had already been learned. The results of these two studies provide converging evidence that AVP4-9 treatment increases the selectivity of attention, with preferential processing of dominant information. Parallels with the putative attentional effects of increased arousal are discussed.

Accessible magnetic resonance imaging

The cost of magnetic resonance imaging (MRI) is driven by magnetic field strength. Misperceptions as to the impact of field strength on performance have led to systems that are more expensive than they need to be. Careful analysis of all the factors that affect diagnostic quality lead to the conclusion that field strength per se is not a strong determinant of system performance. Freed from the constraints imposed by high-field operation, it is possible to exploit a varied set of opportunities afforded by low-field operation. In addition to lower costs and easier siting, we can take advantage of shortened T1 times, higher contrast, reduced sensitivity to motion, and reduced radiofrequency power deposition. These conceptual advantages can be made to coalesce onto practical imaging systems. We describe a low-cost MRI system that utilizes a permanent magnet of open design. Careful optimization of receiving antennas and acquisition sequences permit performance levels consistent with those needed for an effective diagnostic unit. Ancillary advantages include easy access to the patient, reduced claustrophobia, quiet and comfortable operation, and absence of a missile effect. The system can be sited in 350 sq ft and consumes a modest amount of electricity. MRI equipment of this kind can widen the population base than can access this powerful and beneficial diagnostic modality.

Increasing empathy among medical students

The objective of the research was to evaluate the short- and long-term effectiveness of teaching medical students interviewing skills. Methods of teaching communication skills included a workshop for clinical instructors, as an indirect approach, a workshop for medical students, as a direct approach, and a combination of both. Results demonstrated that in order to stimulate medical students to use supporting-interview skills, they themselves should participate in an interpersonal skills workshop. Being taught these skills by teachers who have participated in the workshop does not have the same positive effect.

Preliminary characterization of a group of actinophages of the thermophilic actinomycete genus Saccharomonospora

The comparison of the Saccharomonospora phages phi SaC1, phi SaG1, phi SaV1, phi SaV2, phi SaV3, and Tm1 demonstrated that they all belong to a single group of closely related actinophages: they were similar with regard to host range, virion mophology (B1 type), genome length (43-45 kb), and GC content of their genomes (63, 3% G + C). Furthermore, DNA-DNA hybridization showed that the phage genomes had a high degree of homology to each other. The phages are, therefore, proposed as representatives of a new bacteriophage species in the sense of the ICTV.

Circuit for the electromanipulation of plant protoplasts

An electric circuit for plant protoplast manipulation is described. The circuit used readily available materials and was designed for use in teaching. This integrated circuit can be placed in a single small box with controls for the aligning voltage, the aligning frequency, the pulse voltage, and the pulse timing. The circuit can be supplied by any suitable source of dc power and can be easily altered for individual requirements. The circuit, as presented here, can be assembled for less than $250.

Control of the development of iron-efficiency reactions in potato as a response to iron deficiency is located in the roots

Roots of potato plants (Solanum tuberosum cv Bintje) growing on low Fe nutrient solution developed the characteristic Fe efficiency reactions, such as high ferric reductase activity, proton extrusion and increased root hair formation. Roots from a tuber with sprout removed, when grown on Fe-free nutrient solution, also expressed these reactions; transfer to iron-containing medium resulted in their complete disappearance within 10 days. Roots growing on 2% sucrose in sterile Murashige-Skoog medium increased their ferric reductase activity upon withholding Fe and formed transfer cells. It is concluded that potato roots themselves control the development of Fe-efficiency reactions, and that the shoot may exert a modulating influence on their expression.