Changes in fatty acids in phospholipids of the bronchoalveolar fluid in bacterial pneumonia and in adult respiratory distress syndrome

Fatty acids of the phospholipid fraction of bronchoalveolar lavage fluid from patients with bacterial pneumonia or with the adult respiratory distress syndrome were chromatographed and the patterns compared with those for a control group. In the control group, palmitic acid (16:0) was the predominant fatty acid, accounting for 58.0% (SD 8.25%) of the total fatty acid, a proportion significantly higher (p less than 0.001) than in the distress-syndrome group (42.1%, SD 4.88%) or the acute pneumonia group (32.1%, SD 1.73%). There was a greater proportion of oleic acid (18:1) in the disease groups; thus the ratio of palmitic to oleic acid was useful in distinguishing these three groups. No patient with a palmitic/oleic acid ratio greater than 2.45 had evidence of parenchymal inflammation. Of those with a ratio less than 1.3, 89% had acute bacterial pneumonia.

Changes in fatty acids in phospholipids of the bronchoalveolar fluid in bacterial pneumonia and in adult respiratory distress syndrome

Fatty acids of the phospholipid fraction of bronchoalveolar lavage fluid from patients with bacterial pneumonia or with the adult respiratory distress syndrome were chromatographed and the patterns compared with those for a control group. In the control group, palmitic acid (16:0) was the predominant fatty acid, accounting for 58.0% (SD 8.25%) of the total fatty acid, a proportion significantly higher (p less than 0.001) than in the distress-syndrome group (42.1%, SD 4.88%) or the acute pneumonia group (32.1%, SD 1.73%). There was a greater proportion of oleic acid (18:1) in the disease groups; thus the ratio of palmitic to oleic acid was useful in distinguishing these three groups. No patient with a palmitic/oleic acid ratio greater than 2.45 had evidence of parenchymal inflammation. Of those with a ratio less than 1.3, 89% had acute bacterial pneumonia.

Tooth transplantation with the periodontium intact: a histometric analysis

A method was devised, from a pilot study, for transplanting a root-treated tooth with an intact periodontium into a newly prepared socket to assess whether the prognosis for transplantation procedures could be improved. Five male vervet monkeys were used for the definitive study. The mandibular central incisors were extracted from each monkey and the sockets were allowed to heal for 5 weeks. Thereafter a window of gingiva overlying each of these healed receptor sites was removed and the sockets were prepared with tapered burs. The distal root of the mandibular second molar was used as the transplant tooth and the distal root of the first molar as the control tooth. The transplant tooth was removed, together with surrounding alveolar bone which was then trimmed to a thickness of approximately 1 mm. The control tooth was extracted with root forceps. After transplantation, the teeth were splinted to the adjacent incisors for 3 weeks. After 8 weeks the healing process was examined histologically, both qualitatively and quantitatively. Replacement resorption (ankylosis) was not observed. Student's t test for paired samples revealed that the incidence of secondary cementum formation was significantly greater on the control teeth. The minimization of trauma may be the reason ankylosis did not occur.

Portacaval shunt in patients with familial hypercholesterolemia

Portacaval shunt was performed in ten patients with homozygous and two with heterozygous familial hypercholesterolemia (FH). Total serum cholesterol was lowered by 20% to 55.4% during follow-up periods of 14 months to almost 9 years, with commensurate decreases in LDL cholesterol. The effect on HDL cholesterol and triglyceride levels was variable. Tendinocutaneous xanthomas diminished or disappeared. Growth and development in children proceeded or accelerated. There was no detectable emotional or intellectual deterioration. Hepatic failure did not occur, although blood ammonia concentrations and serum alkaline phosphatase levels increased relative to preoperative values. Cardiac symptoms were often improved, but evidence of reversal of cardiovascular lesions was inconclusive. Three patients with pre-existing heart disease died of cardiac complications after 4 months, 18 1/2 months, and 30 months. Portacaval shunt has been effective therapy for patients with FH who were refractory or intolerant to medical treatment; it should be performed before the development of irreversible cardiovascular damage.

[Appendicitis in children]

In 218 children of less than 16 years old appendectomy was performed. Presence of appendicitis was confirmed histologically in 199 cases. The ratio boys to girls was two to one. In one third the appendix had perforated. Administration of a combined Ampicillin-Metronidazole antimicrobial therapy, started during surgery, proved to be very efficacious in avoiding infectious complications. In this group the complication rate remained below 3%.

T- and B-cell responses in patients with malignant pleural effusions

Lymphocytes of lymphocyte-rich pleural effusions and venous blood from 16 cancer patients, 7 patients with benign pleural effusions and blood from 23 normal blood donors, were examined for cytological features, rosette-forming capacity, immunofluorescent staining, and PHA-stimulated DNA synthesis. Total protein and immunoglobulin levels were also determined. Metastatic effusions revealed approximately 40% higher content of immunoglobulins G, A and M (P less than 0.002) as well as of total protein (P less than 0.005) than non-metastatic pleural effusions. However, the serum of the non-cancer patients contained approximately 50% higher level of Ig than in cancer patients (P less than 0.001). Whilst there was no significant difference in the relative T- or B-cell contents of pleural effusions between cancer and non-cancer patients (P greater than 0.05) spontaneous proliferation of lymphocytes was significantly increased (P greater than 0.01), which led to a lower PHA-stimulated transformation index in pleural effusions from cancer patients than in all other lymphocyte sources examined (P less than 0.001).

[Abnormal left-ventricular contraction and filling in patients receiving adriamycin for solid tumours (author's transl)]

Various ventricular functions, as obtained by echocardiography (M-mode), were measured on 14 patients with solid tumours receiving adriamycin (mean total dosage 330 +/- 188 mg/m2 body surface area), the results being compared with those on 14 normal subjects of similar ages. There were statistically highly significant differences between the two groups. In those receiving the drug there was (1) a decrease in the percentage shortening fraction and (2) a reduction in the maximal velocity of endocardial circumferential fibre shortening, as expression of reduced contractility. The abnormal filling was characterized by a marked decrease in maximal velocity of endocardial fibre stretch, diminution of diameter increase during the rapid filling phase, and a shortened duration of the rapid filling phase. There was no electrocardiographic or radiological evidence of myocardial damage. The findings suggest that it will be possible by serial echocardiography to recognize a higher tolerance to the drug in some individuals and, at the same time, reveal abnormal contractility and filling due to adriamycin before irreversible heart failure has occurred.