Renal failure in the respiratory intensive care unit

The development of renal failure during respiratory failure is of grave prognostic significance. In 686 patients with respiratory failure, 74 developed renal failure; these had a mortality of 80%. The leading predisposing factors are: 1) gastrointestinal bleeding with hypovolemic shock; 2) sepsis with shock; 3) drug induced nephrotoxicity; and 4) hypotension. With antacid gastric neutralization, judicious use of nephrotoxic antibiotics, the incidence of renal failure can be reduced. Once renal failure occurs, early dialysis may increase the chances of recovery in these critically ill patients.

Case report. The iron rim sign

A chronic cystic cerebral hematoma occurred in the frontal lobe and mimicked both clinically and radiographically a frontal sinus mucocele. A rim seen on multidirectional tomography and unenhanced computed tomography was presumed to be composed to calcium. However, electron microscopic analysis revealed the rim to be composed almost entirely of iron from hemosiderin breakdown products. This is the first such report of an "iron rim" that we could find in the literature.

The monitoring role of plasma CEA alone and in association with other tumor markers in colorectal and mammary carcinoma

During the past decade, evidence has accumulated to show that most, if not all, human tumors produce a variety of different factors which, if they pass into the blood and/or urine, may serve as tumor index substances (tumor markers).7 Tumor markers may either be: 1) tumor-derived--i.e., produced by the tumor itself, or 2) tumor-associated--i.e., produced by other tissues in response to the presence of the tumor and its local or distant effects on that tissue. Examples of this latter category include the changes in urinary hydroxyproline output in patients with bone metastases or the altered levels of serum acute phase proteins in neoplasia in general.7 Tumor-derived markers may be produced by either the tumor cell population itself, e.g., CEA, alpha-fetoprotein (AFP), and other oncofetal antigens, inappropriate hormones such as ACTH etc., or by their supporting framework (stroma), e.g., the osteolysins of human breast cancer.3

Machakos project studies. Agents affecting health of mother and child in a rural area of Kenya. V. Pertussis sentypes in Kenyan children 1974--1975

Cultures of Bordetella pertussis were isolated by pernasal swabs from Kenyan children in whom whooping-cough was suspected. Serotyping of 94 of these isolates was undertaken by four laboratories in Europe, and there was very close agreement in their typing results. Each laboratory found that the incidence of type 1, 3 was the lowest of the three types, and that there were approximately equal numbers of types 1, 2, 3 and 1, 2. No new serotype was found. This distribution of serotypes was found in all age-groups; and it is in marked contrast with that currently seen in vaccinated communities, where type 1, 3 predominates. The implications of these findings for vaccination against whooping-cough in East Africa are discussed.

Diagnostic usefulness of plasma carcinoembryonic antigen levels in acute and chronic liver disease

Raised plasma carcinoembryonic antigen (CEA) levels were found in over 90% of 71 patients with chronic liver disease and 50% of 16 patients with acute liver damage. Levels increasing chronicity and clinical severity of disease. In individual patients, the plasma CEA level fluctuated with the clinical condition. Persistently normal levels were never found in patients with chronic liver disease in poor clinical condition. A very high level suggests a bad prognosis. If CEA is considered together with SGPT, a discriminant function can be calculated, separating patients with acute liver damage and those with an acute exacerbation of chronic active hepatitis, with a high degree of certainty. In acute damage, peak CEA levels occur later than the time of maximum liver necrosis, suggesting that the rise is not owing to release of CEA from damaged cells. There is no significant difference in CEA level between patients with and without spontaneous or surgical portosystemic shunts, suggesting that high levels are not attributable to bypass of the liver. The timing of the rise in CEA in acute liver damage suggests that raised levels may be associated with regeneration. The tendency for higher levels to occur in those patients with greater disturbances of liver function suggests altered metabolism or excretion of CEA.

Computed tomography of systemic lupus erythematosus

Computed tomographic (CT) findings in 14 patients with systemic lupus erythematosus are correlated with clinical symptomatology. Microinfarction (manifested by perisuical atrophy) large infarcts, and hematomas are the major abnormalities demonstrated by CT. The neuropathology of these changes is discussed.

Classification and management of mycotic aneurysms

After a review of 14 patients with extracranial mycotic aneurysms, a classification of mycotic aneurysms has been proposed based upon the pre-existing pathologic condition of the artery and on the pathogenesis. Ten aneurysms resulted from an infection due to intravascular sources and four, due to extravascular sources. Ten patients in this series were treated surgically, and of these, eight were cured. All four patients who did not undergo a surgical procedure died. Early diagnosis, appropriate antibiotic therapy and prompt surgical intervention are recommended in the management of these aneurysms. Excision or exclusion of aneurysms is preferred. If necessary, the circulation to the distal part of the extremity can be restored by vascular reconstruction using an autogenous bypass graft, preferably through a noninfected field.

Sustained-release hormonal preparations XV: release of progesterone from cholesterol pellets in vivo

Progesterone-sterol pellets were made that porvided a zero-order release of progesterone for 80 days. 4-(14)C-Progesterone was used to measure the release in vitro and in vivo. The dissolution rate in vitro (distilled water as the desorbing medium) for progesterone-cholesterol (59:41 w/w) and the progesterone-beta-sitosterol (47:53 w/w) pellets was 72 microng/100 mm2/24 hr. The average in vivo absorption from subcutaneously implanted pellets in rabbits was 2 +/- 0.1 microng/ml of plasma/cm2 of surface area. Of this amount, 20-25% was progesterone; the remainder was progesterone metabolites and conjugates. Zero-order release (plasma levels) was obtained for approximately 80 days or until about 70% of the available progesterone was exhausted. During this time, the level of excreted radioactivity in urine continuously decreased, indicating that monitoring only this parameter would lead to erroneous conclusions. A long-term effect and increased effectiveness were obtained with a 5-20-mg progesterone equivalent dose, using gel prepared from 2% methylcellulose as the suspending medium.

Demonstration of purulent bacterial intracranial infections by computed tomography

Computed tomography is shown to be an important modality in both diagnosis and management of cerebral infections. Representative findings from CT scans of patients with purulent bacterial infection of the meninges, cerebrum, ventricles, and adjacent structures are presented. Material is taken from 2,645 CT scans done in a 1 year period at the Hospital of the University of Pennsylvania. It is hoped that the use of CT will lead to a decrease of morbidity and mortality in entities such as brain abscess and subdural empyema.

Antibodies to spermatozoa. VII humoral and cellular aspects of sperm inmunity and infertility

The occurrence of sperm antibody in serum and cervical mucus of women from intertile couples in the serum of their male partners, as well as cellular immunity to sperm, has been studied by agglutination and immobilization techniques. For a total of about 260 couples, the tests on serum showed that 18% of the women and 8% of the men were positive by the Kibrick technique and that 15% of the women and 4% of the men were positive by the F-D technique. The women who were positive in their cervical mucus were 8% of the group by the K-agg (Kibrick agglutination) technique, 2% by the MIS-agg. (Microscale agglutination) technique, and 40% by the MIS-imm. (Microscale immobilization) tecnique. In considering all three techniques. 42% of a group of 132 women were positive. Cellular immunity to sperm, by the Migration Inhibition method, was positive in 18% and zero per cent of infertile and fertile women, respectively.

Serum enzyme levels in alcoholism and drug dependency

Serum gamma glutamyl transpeptidase (GGTP), isocitrate dehydrogenase (ICD), ornithine carbamoyl transferase (OCT), alanine aminotransferase (AlT), aspartate aminotransferase (AsT), and alkaline phosphatase (ALP) activities were assayed in 67 alcoholics and 40 drug dependent patients. Bilirubin, total protein, albumin, and globulin were also measured. GGTP elevation was observed in 48% of alcoholics and in 50% of drug dependents. The incidences of elevated levels of other enzymes were: ICD 39 and 38-7%; OCT 23-7 and 36-1%; AlT 30 and 33%; AsT 24-2 and 21-7%; ALP 10-4 and 5% respectively. Measurement of GGTP is thus more useful as a screening test for involvement of the liver in alcoholics and drug dependent patients than that of the other enzymes.

Assessment of a new enzyme reaction rate analyser, the Vitatron AKES

We have assessed the function of the Vitatron AKES (Automatic Kinetic Enzyme System) in terms of three enzymes, alpha-hydroxybutyrate dehydrogenase, alanine transaminase and asparate transaminase, and have compared the results with our existing techniques. Overall a good precision and correlation with routine laboratory methods was found. The machine is entirely automatic in operation and is economical in its use of sample and reagents.

Role of serial plasma C.E.A. assays in detection of recurrent and metastatic colorectal carcinomas

Serial estimations of plasma carcinoembryonic antigen (C.E.A.) levels have been carried out in 220 patients with colorectal carcinomas who had potentially and apparently curative surgery. In a two-year follow-up period 53 patients developed recurrences or metastases. In 36 of these patients sustained rises in plasma C.E.A. titres occurred synchronously with or between three and 18 months before the clinical detection of recurrences or metastases. The use of serial plasma C.E.A. assays is therefore recommended as an additional diagnostic aid for the earlier detection of recurrent or metastatic colorectal carcinomas.