Midazolam, diazepam, and placebo as intravenous sedatives for dental surgery

This study was a comparison of the sedative and amnestic properties of midazolam and diazepam when administered for relief of patient discomfort during dental surgery. It was a double-blind placebo-controlled group study, which entailed the analysis of 60 patients randomly assigned to the three groups: midazolam, diazepam, and placebo. There were 20 patients in each group. Midazolam patients showed superior performance in the parameters of sedation and amnesia when compared to patients who were administered diazepam. Both groups showed better results than the placebo group, which had the best results with the Digit Symbol Substitution Test and the Trieger Test.

Adult-onset minimal change nephrotic syndrome: a long-term follow-up

A series of 89 adult-onset nephrotic patients with minimal changes on renal biopsy was analyzed to compare the rate of response to corticosteroids and cytotoxic agents and the stability of remission or frequency of relapses at different ages. Severe hypertension and diminished renal function were more common in patients aged over 60 years, who formed 22.5% of the group. Seventy-five patients were given a first course of prednisolone in an initial dose of 60 mg/24 hr. After an eight week course of tapering doses of corticosteroids, only 45 of the 75 patients were in complete remission, 55 patients after 16 weeks and eventually 58 lost their proteinuria. The respective estimates of remission were 60%, 76% and 81%. Subsequently, of the 58 treated patients who responded, 24% never relapsed. Fifty-six percent of the patients relapsed on a single occasion or infrequently, and only 21% were frequent relapsers. Cyclophosphamide was used in 36 patients, in two as initial treatment, in 11 because of corticosteroid resistance, and in the remainder because of relapses. The time-course of loss of proteinuria was similar to that following treatment with corticosteroids, 25 (69%) losing proteinuria within 16 weeks. Only four patients failed to lose their nephrotic syndrome. Two of them had presented in acute renal failure and all four were over 60 years of age. The stability of remission after cyclophosphamide was better than that reported for children, only 13 of 36 showing relapses and 66% being in remission at five years, after which no further relapses were seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Development of a competitive enzyme-linked immunosorbent assay for detecting cytomegalovirus antibody

A competitive enzyme-linked immunosorbent assay (ELISA) for detecting cytomegalovirus (CMV) antibody was developed. The competitive ELISA was five times more sensitive than the complement fixation test (CFT) and twice as sensitive as indirect ELISA. Testing of paired sera from cardiac transplant patients taken before and after transplantation showed good correlation between results of competitive and indirect ELISA and CFT. The competitive ELISA was more successful than CFT or indirect ELISA in detecting passively acquired antibody, but detection of CMV antibody by competitive ELISA immediately after primary CMV infection was unreliable, possibly because of the high affinity of the monoclonal antibody chosen for the horseradish peroxidase conjugate. However, competitive ELISA may well prove to be more suitable than indirect ELISA for detecting CMV antibody in blood donations.

Long-term outcome for children with minimal-change nephrotic syndrome

A retrospective study was undertaken to assess the outcome of a cohort of 183 unselected children who presented with the nephrotic syndrome between 1963 and 1969. All subjects showed minimal glomerular changes in biopsy samples and were given conventional steroid therapy. Information was available on 152 children, now aged 14-32 years. Activity persisted longer in patients presenting at an early age. The outcome for most of the children was favourable. Only 10 patients (5.5%), all of whom presented with initial symptoms before their 6th birthday, continued to have steroid-responsive relapses in adult life. There were 11 deaths, of which 7 (4% of the series) were from avoidable complications of the disorder.

Why do patients with lupus nephritis die?

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"--that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts--almost all with inactive lupus--but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n = 14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died. Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n = 13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

Structure of the SAD mutation and the location of control sites at silent mating type genes in Saccharomyces cerevisiae

The SAD mutation, an extra mating type cassette, has been shown to arise from an unequal mitotic crossover between the MAT and HMR loci, resulting in the formation of a hybrid cassette and a duplication of the MAT-HMR interval. The SAD cassette contains the "a" information and left-hand flanking regions from the parental HMRa cassette and the right-hand flanking sequences of the parental MAT cassette. This arrangement of flanking sequences causes a leaky but reproducible mating phenotype correlated with a low-level expression of the cassette as measured by RNA blotting. This weak expression is attributed to the loss of one flanking control site normally present at the silent HM storage loci.

Oral sensorimotor therapy in the developmentally disabled: a multiple baseline study

The efficacy of a program of sensorimotor facilitation procedures to improve oral motor function and feeding behaviors in students with severe developmental delay was explored. Four severely handicapped students were administered the oral habilitation program using a multiple baseline across-subjects design with staggered introduction of the treatment. Graphic analysis and the split middle method of trend estimation revealed that one subject evidenced an increase in weight and improved oral motor evaluation as a result of the intervention. Two other subjects displayed partial improvement. The correlates of treatment effectiveness are briefly discussed and the need for continued investigation is emphasized.

Idiopathic mesangiocapillary glomerulonephritis. Comparison of types I and II in children and adults and long-term prognosis

Of 104 patients with idiopathic mesangiocapillary glomerulonephritis studied for at least two years, 69 patients had type I disease and 35 had type II. Forty-five patients were children, and 59 were adults. Type II mesangiocapillary glomerulonephritis was more common in children than in adults, but no other clinical feature distinguished the two types at onset. Complement studies revealed that patients with type II had lower serum C3 concentrations and more frequently showed C3-splitting activity (C3 nephritic factor) in the serum. Children had hypertension or a lowered glomerular filtration rate less frequently at onset than did adults, but children had a higher incidence of a hematuric onset; C3 nephritic factor was also more frequent in the children. During a follow-up period of two to 21 years (mean eight years), only seven patients (five with type I and two with type II) showed clinical remission, whereas 38 percent of patients with type I and 49 percent of patients with type II died or required dialysis; a further 23 percent of patients with type I and 16 percent of patients with type II had continuing disease and reduced glomerular filtration rate. Only the presence and persistence of a nephrotic syndrome in type I predicted renal failure. In both types, the presence of sclerosis or crescents in the initial renal biopsy specimen was associated with a poorer prognosis, but no other feature was of major prognostic value.

The long-term outcome of idiopathic membranous nephropathy

Thirty-five consecutive patients with renal biopsy appearances of idiopathic membranous nephropathy, who were initially studied between 1960 and 1969, were reevaluated in 1979 to determine (a) the long-term outcome of idiopathic membranous nephropathy, and (b) whether any clinical or biopsy features at onset would permit prediction of long-term outcome. After fifteen years, actuarial analysis showed that approximately half the patients would be in remission; the rest dead or on dialysis/transplantation programs. Entry into renal failure, in those who ran this course, started at three years after diagnosis and continued steadily for at least another ten years. Likewise, remission was seen as early as one year from onset, but patients were still going into remission after thirteen years of proteinuria. No feature in the glomeruli predicted outcome, but interstitial and vascular changes were seen more frequently in those whose disease persisted or worsened. No onset feature predicted a poor outcome reliably, but younger patients did better than older, and all three children with initial macroscopic hematuria went into remission.

Surface membrane glycoproteins of cultured human pancreatic cancer cells

The cell-surface glycoproteins and proteins of four human pancreatic cell lines (MIA PaCa-2, PANC-1, HS766T, and CAPAN-1) were separately tritiated using galactose oxidase/NaB(3H)4 and iodinated using lactoperoxidase/125I. Gel electrophoresis showed that the cell lines had very different surface components. All four cell lines were tested for cell-surface antigens that cross-reacted with antisera raised against carcinoembryonic antigen and against the membrane fractions of MIA Pa Ca-2 and CAPAN-1 cells. CAPAN-1 cells reacted most strongly with all three antisera. Seventeen cell-surface proteins can be detected when CAPAN-1 cells are labeled using lactoperoxidase. The labeled membranes were solubilized in detergent and subjected to affinity chromatography on Sepharose-conjugated lectins. The bound proteins were eluted and analyzed on gel electrophoresis . All 17 proteins capable of being labeled by lactoperoxidase bound to at least one lectin column, indicating they are all glycoproteins.

Effects of sodium butyrate and dimethylsulfoxide on biochemical properties of human colon cancer cells

Sodium butyrate and dimethylsulfoxide (DMSO) have marked effects on the growth, morphology, and biochemistry of two human colonic adenocarcinoma cell lines in culture. Doubling times were increased between 18% and 660% while cell viability was unaffected. Both cell lines formed colonies in soft agar in the absence of butyrate of DMSO, but no colonies were observed in the presence of these agents. However, no differences in in vivo tumorigenicities, when cells were implanted in athymic mice, were seen following treatment. Gross morphological alterations including cell enlargement, process formation, and cellular flattening occurred during culture in butyrate or DMSO. Acrylamide gel electrophoresis in sodium dodecyl sulfate revealed no change in membrane protein constituents, but autoradiographic analysis of membrane glycoproteins demonstrated differences between treated and untreated cells. Ganglioside compositions were altered, and a sialyltransferase required for the synthesis of GM3 ganglioside was elevated by butyrate. Although cytoplasmic aminooligopeptidase remained unaffected by butyrate or DMSO, brush border-associated activity was enhanced by butyrate. Alkaline phosphatase also rose dramiatically during culture in butyrate but was not enhanced by DMSO.

Transposable mating type genes in Saccharomyces cerevisiae

A functional copy of the alpha mating type gene of Saccharomyces cerevisiae has been cloned by transformation in yeast. Using the Southern Blotting procedure it has been shown that three distinct genetic loci implicated in mating type interconversion (HML, HMR and MAT) contain sequences homologous to the clone fragment. The restriction fragment associated with each locus exhibits a characteristic size which can be correlated with the mating type allele present at that locus. The characteristic size difference between the a and alpha genetic elements made it possible to demonstrate that the homothallic interconversion of mating types in this yeast occurs by DNA rearrangement as proposed in the 'cassette hypothesis'.

The respiratory depressive effects of intravenous buprenorphine in patients in an intensive care unit

Buprenorphine hydrochloride, a new, potent, long-acting synthetic opiate analgesic, with partial agonist-antagonist activity, was administered intravenously to two groups of patients in an intensive care unit. Arterial blood was drawn for blood gas analysis before (control) and at regular intervals after drug administration, to determine the effects of intravenous buprenorphine on respiration in critically ill patients, each acting as his or her own control. Intravenous buprenorphine 0,4 mg (group I -- 10 patients) caused a significant reduction in mean respiration rate and an increase in mean PaCO2, but did not alter heart rate, PaO2 or base excess values. Intravenous buprenorphine 0,2 mg (group II -- 10 patients) was associated with a less significant reduction in the rate of breathing and elevation of PaCO2. Both 0,4 mg and 0,2 mg buprenorphine produced effective relief of pain, sedation, and reduction in restlessness, and allayed anxiety. Our results suggest that intravenous buprenorphine 0,2 mg can be safely recommended for the prolonged relief of postoperative pain in adults.

Periumbilical perforating pseudoxanthoma elasticum

Periumbilical pseudoxanthoma elasticum (PXE) with transepidermal elimination of altered elastica presented a distinctive clinical pattern in six middle-aged, multiparous women. Other sites usually affected in PXE were spared. The possible genetic predisposition to PXE of these patients found its expression in the periumbilical skin, a site exposed to the trauma of multiple pregnancies. The extruded elastica had tinctorial properties that were characteristic of PXE. The clinical picture in our cases differs from clasic PXE. A peculiar acquired cutaneous PXE is not excluded.