Thin needle cholangiography: experience with 50 patients

Thin needle cholangiography (TNC) was performed in 50 patients with obstructive jaundice or jaundice of obscure origin. The purpose of this study was to assess the diagnostic accuracy and safety of this procedure. TNC was performed by the technique described by Redeker et al. using the Chiba needle (JAMA 231:386, 1975). Obstructed ducts were successfully demonstrated in 100% of cases (29/29). Non-obstructed ducts were opacified in 12/21 (57%). Overall success was 82% (41/50). Two septic complications occurred. It is concluded that 1) TNC is a highly reliable, easy to perform and safe procedure in the evaluation of the jaundiced patient; 2) Accurate demonstration of the biliary anatomy by TNC provided important information which often in (10/50 = 20%) led to a change in diagnosis, avoidance of unnecessary procedures, and shortening of hospitalization; 3) Failure to visualize patients with non-dilated biliary ducts occurred with advanced chronic liver disease or fatty liver.

Gray-scale ultrasonography and thin-needle cholangiography. Evaluation in the jaundiced patient

Gray-scale ultrasonography (GSU) and thin-needle cholangiography (TNC) were performed in 35 consecutive patients with unexplained jaundice. The status of the biliary tree was correctly assessed by GSU in 33 of 35 cases (94%); in two patients technical difficulty prevented definitive assessment. Neither false-positive nor false-negative results were encountered. There were no discrepancies between the results of GSU and TNC. We conclude that GSU provides a safe, highly reliable method of assessing the jaundiced patient and should be the preferred initial procedure in the diagnostic evaluation of patients with jaundice when the major differential lies between the medical and surgical types. If GSU does not demonstrate a dilated biliary system, TNC is unnecessary, and other diagnostic studies should be undertaken.

A study of the critical bacterial inoculum to cause a stimulus to wound healing

Results of previous work have shown that wounds infected with gram-negative bacteria may be stronger than uninfected wounds. The inoculum in these studies was about 2 X 10(7) organisms. Laparotomy wounds were swabbed with inocula of from 10(2) to 10(9) organisms, Escherichia coli. Only with inocula of 10(6) or greater were all parts of all wounds infected by gross inspection. All wounds inoculated with 10(7) organisms, or more, were significantly stronger than the wounds of the control group on the 14th day. A smaller inoculum--10(3) to 10(6)--also resulted in stronger wounds, but not consistently so.

Quantitation of local acidosis and hypoxia produced by infection

Increased strength of healing incisions infected with E coli was demonstrated in this experiment. Efforts to measure respiratory gas tensions and pH in these incisions were unsuccessful. Therefore, these moieties were measured in normal and infected wound fluid contained in implanted wire cylinders. The wound fluid from infected cylinders was consistently more acidotic and had a lower pO2 and a higher pCO2 than fluid from unifected wound cylinders.

Transcriptional control of T4 coliphage-specific genes 30, 42, 43, rIIA, rIIB, and e

Escherichia coli B/r (suo) was infected, at 30 degrees C, with T4Dam+, T4DamB24-amN82 (I-, 44-, DNA-negative phenotype), and T4DamN134amBL292 (33-, 55-, maturation-defective phenotype). A genetic ('transformation') assay was used to monitor transcription of genes 30 (polynucleotide ligase), 42 (deoxycytidylate hydroxymethylase), 43 (DNA polymerase), rIIA, rIIB, and e (endolysin). The principal results are: (I) All of the genes studied were transcribed exlusively from the so-called l-strand of phage DNA. (2) DNA synthesis and the maturation-defective proteins were required to turn-off transcription of genes 42, rIIA, tIIB, and 43. Experiments performed with chloramphenicol suggested that all phage-specific proteins required to turn-off transcription of these genes were not present until 6 to 8 min post infection (p.i.). (3) During a normal developmental programme, gene 30 was transcribed throughout the eclipse. DNA-negative and maturation-defective conditions had no obvious effect on transcription of this gene. (4) During a normal lytic event, two discrete waves of gene e transcription were observed. The late wave was dependent upon DNA-synthesis and presence of functional maturation-defective proteins. The early wave was unaffected by DNA-negative or maturation-defective conditions. Experiments with chloramphenicol indicated that, if any virus-specific proteins are involved with regulation of early e transcription, such proteins are present by 3 min p.i. The data are interpreted to mean that early gene transcription is regulated by a minimum of two mechanisms. One of these mechanisms is fully operational by the 3rd min and, among the genes studied, controlled early e transcription. A second mechanism becomes operational between 6 and 8 min p.i. and controls transcription of genes 42, 43, rIIA, and rIIB.

Corynebacterium aquaticum septicemia. Characterization of the microorganisms

An 85-year-old woman with the diagnosis of diabetic ketoacidosis developed septicemia during hospitalization. Cultures of the patient's blood revealed the presence of Gram-variable coccobacilli, later identified as Corynebacterium aquaticum. The microorganisms grew aerobically on blood agar plates after incubation overnight. The colonies were convex, non-hemolytic and slightly yellow-pigmented. No growth was observed on MacConkey and endo agar plates. The organisms were catalase-positive, oxidase-negative, motile, and oxidized glucose and mannitol. The morphologic and biochemical properties of Corynebacterium aquaticum should be considered for separation from related organisms such as Listeria monocytogenes, Corynebacterium species and oxidative Gram-negative rods that do not grow on MacConkey medium (Flavobacterium spp.).

Compartive behavioral effects of dibutyryl cyclic AMP and prostaglandin E1 in mice

Three behavioral tests, spontaneous locomotor activity (SLMA), exploratory behavior (EB) and rotarod performance (RP), a measure of neuromuscular coordination, were used to stuey the interaction of PGE1 (1 mg/kg i.p., 10 min. pretreatment) with DBcAMP (25 mg/kg i.p., 25 min. pretreatment) in mice. A dose-response relationship of PGE1 (0.01-5.0 mg/kg) to SLMA was determined, with a significant decrease in SLMA produced by a dose of 0.1 mg/kg. decreases in SLMA were produced by PGE1 (79%), DBcAMP (41%) and DBcAMP-PGE1 combination (71%). Similar decreases in EB were observed. Although no significant difference between controls and DBcAMP was observed in RP, 52% of mice tested were RP failures following PGE1 and a 100% failure rate was induced by the combination. Mice were treated with a second injection of DBcAMP or PGE1 or the combination 24 hr following the first injection. Behavioral activity of these mice was observed 25 min (DBcAMP) or 10 min (PGE1) after the second dose was administered. A second injection of DBcAMP failed to decrease SLMA and EB from controls; moreover, SLMA began to return towards control levels as early as 2 hr between injections. The second injection of PGE1 or DBcAMP+PGE1 produced the same behavior as that produced by the first injection. On the basis of these results, the relationship of cyclic nucleotides and PGs to behavioral activity is discussed.

A computer-assisted instruction course in the diagnosis and treatment of respiratory diseases

A computer-assisted simulation of the 'chart method' of teaching has been developed and was used to provide instruction in clinical decision-making in the diagonosis and treatment of pulmonary diseases. The course requires a student to reach and to defend a diagonisis and to provide appropriate treatment for each of 10 simulated cases. Evaluation of performance and immediate feedback and correction of errors of commission and ommission are an integral part of the course. The course provides a model for development of additional programs in other subject areas.

Comparative effects of adenosine and adenine and guanine nucleotides on drug biotransformation in rats

The effect of various nucleotides and adenosine on the hepatic biotransformation of hexobarbital sodium (HB) and p-chloro-N-methylaniline (PCMA) was determined in male rats. Intraperitoneal administration of dibutyryl cyclic adenosine 3',5'-monophosphate (DBcAMP), alone and in combination with theophylline, and the cyclic adenosine 3',5'-monophosphate (cAMP)-theophylline combination prolonged HB sleeping time by more than 70%. cAMP or dibutyryl cyclic guanosine 3',5'-monophosphate (DBcGMP), alone or in combination with theophylline, failed to significantly alter the duration of HB-induced hypnosis. Plasma levels of HB upon awakening suggested that the increase in sleeping time was apparently not due to an altered sensitivity of the brain to the barbiturate. The effect appears to be related to an impairment of HB metabolism since only those compounds that inhibited HB oxidation when added to liver slices prolonged hypnosis. In addition, 5'-AMP, adenosine, and cyclic guanosine 3',5'-monophosphate (cGMP) failed to alter HB biotransformation by liver slices. A similar pattern of impairment of metabolism by liver slices was observed when PCMA was used as the substrate. The inhibitory effect of DBcAMP was not altered by concurrent addition of either cGMP or DBcGMP. No impairment in the rate of microsomal PCMA biotransformation resulted from addition of adenosine or any of the nucleotides used in this study.

The objective and timing of drug disposition studies, appendix IV. Phenylbutazone formulations: in vitro dissolution and in vivo performance

Human plasma level studies were conducted on various phenylbutazone formulations. The resultant data indicated that the nature of the formulation had a marked influence on the rate of phenylbutazone absorption. An in vitro dissolution rate apparatus was employed in an attempt to predict potential absorption of phenylbutazone from a given formulation. Based upon the in vitro-in vivo correlation, a new phenylbutazone tablet product was developed which produced a complete and more rapid absorption of the drug.

Cardiobacterium homonis endocarditis. Characterization of the unusual organisms and review of the literature

A case of subacute bacterial endocarditis in which Cardiobacterium hominis was isolated from the blood of a 55-year old woman who had rheumatic heart disease is reported. A survey of the literature revealed very few reports in which this organism has been implicated in human lesions. The colonies grew after 48 hours of incubation in a candle jar. They were small, convex, nonhemolytic, and oxidase-positive. The indole reaction was positive, the catalase and nitrate reactions were negative, and acid reaction was obtained from the following carbohydrates: glucose, maltose, mannitol, sucrose, and sorbitol. The morphologic and biochemical properties served to distinguish these organisms from similar bacteria implicated in human disease, such as Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Streptobacillus moniliformis, and HB-1.

The objective and timing of drug disposition studies, appendix I. Species differences in the tissue distribution of metazimid, an imidazolone derivative

A marked species difference has been observed in the tissue distribution of metazimid in the rat vs the dog after repeated doses. Differences in toxicity between these species are consistent with tissue levels but not plasma levels. No species differences in patterns of drug metabolism could be found in association with the marked difference in tissue cumulation.

Thrombocyte and Megathrombocyte Kinetics during Thrombocytosis Induced by Acute and Chronic Blood Loss and by Iron Deficiency Diet

The mechanism of blood loss-induced thrombopoiesis was studied by measuring thrombocyte and megathrombocyte (young platelet) kinetics in guinea pigs made thrombocytotic by acute or chronic blood loss. The effect of an Fe-deficient diet was also examined. Acute and chronic blood loss raised the platelet count 1.2- and 1.4-fold, respectively Simultaneous replacement of Fe loss raised the platelet count 2.1- and 2.5-fold in acute and chronic blood loss, respectively. Paradoxically, an Fe-deficient diet also raised the platelet count 1.4-fold. Megathrombocyte number increased 1.4-fold more than the increase in platelet count for both acute and chronic blood loss. Simultaneous replacement of Fe produced an increase in megathrombocyte number which was 1.8- and 1.6-fold greater than the increase in platelet count for acute and chronic blood loss, respectively. Animals on an Fe-deficient diet did not raise their megathrombocyte number above their rise in platelet count. Thus, Fe is required for megathrombocyte production. A two-compartment system is postulated for the effect of Fe on thrombocytosis. (1) Fe inhibits the rise in platelet count above steady-state levels. (2) Fe is also required for maximum platelet production above steady-state levels via the production of megathrombocytes.The increment in megathrombocyte production following acute or chronic blood loss could account for one-quarter of thrombocyte production if one megathrombocyte gives rise to one thrombocyte. Alternatively, one megathrombocyte could give rise to four thrombocytes in the peripheral circulation. It is suggested that this latter mechanism may be important physiologically.