Treatment of severe aplastic anaemia with anti-thymocyte globulin

Ten patients (9 adults, 1 child) with severe aplastic anaemia (SAA) were treated with anti-thymocyte globulin (ATG). All patients developed serum sickness. No long-term adverse sequelae attributable to ATG were noted. Fifty percent of patients are alive at 1 year post-ATG. One patient received an allogeneic bone marrow transplant because of failure to respond to ATG. One long-term survivor is severely thrombocytopenic and requires support, and one patient has mild thrombocytopenia requiring oxymetholone therapy.

The effect of vitamin E on mammary dysplasia: a double-blind study

Alpha-tocopherol (vitamin E) has been used to treat patients with benign breast disease. To evaluate the efficacy of this treatment, a randomized, double-blind placebo-controlled study was performed on 128 women with confirmed mammary dysplasia. Patients were treated with placebo or 150, 300, or 600 IU of d, 1 alpha-tocopherol per day for two months; breast examinations, sonography, and thermography were performed in the midluteal phase of the menstrual cycle before and after treatment. No significant objective effects to treatment were noted in any of the parameters monitored. In addition, serum concentrations of estradiol, progesterone, dehydroepiandrosterone sulfate, and testosterone were measured before and after treatment. There were no significant effects on concentrations of these hormones. From this study, d, 1 alpha-tocopherol does not seem to be beneficial in the treatment of patients with mammary dysplasia.

Relationship between intracellular oxygenation and neuromuscular conduction during hypoxic hypoxia

Previous studies have shown that high-altitude hypoxic hypoxia is associated with reduced ventilatory capacity that may be related to skeletal muscle weakness. In the present investigation, ascent to high altitude (4,000 m) was simulated experimentally by exposure of male rats (Sprague-Dawley, 250-350 g), anesthetized with thiopental sodium (25 mg/kg, i.p.), to a breathing gas mixture of 12% oxygen diluted in 88% nitrogen (FiO2 = 0.12). Determinations of oxygen saturation on microsamples (250 ul) of arterial and central venous blood were made spectrophotometrically. Neuromuscular conduction latency was measured following electrostimulation of the sciatic nerve (1-5 V, 0.5 msec duration, 1-40 Hz) and recording of the electromyogram from the gastrocnemius muscle. Experimental hypoxia (FiO2 = 0.12) produced a highly significant increase in conduction latency from a control value (mean +/- SEM) of 3.06 +/- 0.16 msec to 4.02 +/- 0.31 msec (n = 10, P less than 0.001). Conduction latency increased with decreasing arterial oxygen saturation from a control value of 92.9% +/- 0.18% to 83.2% +/- 0.76% (P less than 0.001) in the absence of statistically significant changes in central venous oxygen saturation, central venous pressure, arterial and central venous pH, and heart rate. A significant decrement in the mean arterial blood pressure from a control value of 85 +/- 1.5 mm Hg to 69 +/- 1.5 mm Hg suggests that local ischemia may be a component of this model. These responses were accompanied by marked reduction in uptake of 3,3'-diaminobenzidine (DAB) by gastrocnemius muscle mitochondria, suggesting decreased intracellular activity of cytochrome oxidase. It was concluded that exposure of rodents to hypoxic gas mixtures may provide a suitable model for studying the mechanism of skeletal muscle weakness associated with ascent to high altitude and of other conditions wherein the supply of oxygen to tissues is limited.

Reliability of contact-thermogram reading services

Contact thermography has been advocated by some as a rapid, noninvasive diagnostic modality in evaluating patients at risk for breast cancer. In order to study the value of different criteria for interpreting thermograms, two sets of contact thermograms from 34 patients with benign breast disease were submitted to two different reading services. The results suggest that interrater agreement is enhanced when thermograms are classified as "normal" and "abnormal" rather than as class I-V.

The "critical" neonate with diaphragmatic hernia: a 21-year perspective

We have seen a modest improvement in the survival of a homogeneous group of critically ill newborns with congenital diaphragmatic hernia since 1979. Twenty-seven "critical" infants have been treated who developed respiratory distress shortly after birth, required urgent resuscitation, and could not be stabilized before operation. Two died with other anomalies that appeared incompatible with prolonged survival. Ten of the 27 lived. This survival contrasts with that of only two of 17 similarly affected babies treated from 1962 to 1978. In addition, there has been no operative mortality outside of this "critical" group since 1979; whereas six noncritical babies died between 1967 to 1978. Our current therapeutic plan includes the early establishment of a respiratory alkalosis and vasodilator therapy before or during transport. Postoperatively we have attempted to maintain the baby's arterial pH greater than 7.5, Pco2 less than 25 to 30 and the PO2 approximately 150 torr. The most effective ventilatory parameters have been a rate of 130, PEEP of 5 and an inspiratory:expiratory ratio of 1:1. Peak airway pressures are kept as low as possible. Pharmacologic and ventilator therapy are weaned slowly, and intensive support has been required for at least 48 hours in each baby. Retained secretions and atelectasis of the hypoplastic lung persisted for two to several weeks postoperatively. Two babies that are one year or older still appear to have severely hypoplastic lungs on chest x-ray. M-mode echocardiography has been used to measure ventricular ejection periods. The right ventricular systolic time interval correlates with the degree of pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Mapping from Space: The Metric Camera Experiment

The Spacelab metric camera experiment acquired stereoscopic high-resolution black-and-white and color infrared photographs of various regions of the world. In total, an area of about 11 million square kilometers was covered. Because of the delay in launching the shuttle until 28 November, illumination conditions were frequently poor over many candidate targets. However, unique high-quality images with a ground resolution of about 20 meters were obtained by increasing camera exposure time. Initial image analysis has shown that these images may be used for earth mapping at the scale 1:100,000.

The effects of a series of capsaicin analogues on nociception and body temperature in the rat

A series of capsaicin analogues have been synthesized in an attempt to try to separate the antinociceptive properties of capsaicin from its hypothermic effects. In capsaicin analogues with an unbranched alkyl side-chain of varying length, maximum antinociceptive and hypothermic activity was achieved with a chain length of 8-9 C atoms. Decreasing the chain length decreased both parameters equally. Substitution in the aromatic ring abolished activity. Several compounds related to homovanilloyl dodecylamide, an analogue of capsaicin in which the acylamide linkage is reversed, produced some antinociceptive activity without concomitant hypothermia, but the maximum antinociceptive effect achieved was very small. In the present series of capsaicin analogues good antinociception without hypothermia was not found.

The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. II. Endocrine correlates

In a randomized, double-blind, dose-response study, alpha-tocopherol significantly ameliorated symptoms in three of the four classes of the premenstrual syndrome (PMS). Alpha-tocopherol treatment had no significant effect on serum concentrations of testosterone, dehydroepiandrosterone sulfate (DHEA-S), estradiol, and progesterone. However, independent of treatment, a significant correlation emerged between temporal changes in one PMS category and changes in DHEA-S concentrations. These results suggest that improvement in PMS severity is not mediated through direct effects of alpha-tocopherol on serum steroids. Androgens, however, may play a role in some PMS symptomatology.

Ventriculoperitoneal shunt infection masquerading as an acute surgical abdomen

Shunting of cerebrospinal fluid to the peritoneal cavity has brightened the outlook for children with hydrocephalus. Nine hundred sixty-nine primary ventriculoperitoneal shunts were inserted for hydrocephalus between 1970 and 1981. During this same period, 2205 shunt revisions were performed in 847 children, some of whose primary shunt had been inserted prior to 1970 or at other institutions. Nineteen patients with a ventriculoperitoneal shunt infection persented with abdominal pain, fever, and abdominal tenderness; each had acute peritonitis. Three underwent laparotomy with the preoperative diagnosis of appendicitis; however, only infected peritoneal fluid and nonobstructing adhesions were found. A fourth child underwent an unnecessary intestinal resection at another hospital and required prolonged nutritional support and treatment of severe postoperative complications. Fifteen children who presented with an "acute surgical abdomen" were managed with intravenous fluids, gastric decompression, antibiotics, and removal of the intraperitoneal shunt. External ventricular drainage was employed until the cerebrospinal fluid was sterile. The shunt was then internalized in the peritoneal cavity. The abdominal signs and symptoms improved after removing the peritoneal tubing in all children. This plan of therapy has eliminated unnecessary laparotomy in those who may require repeated procedures for control of hydrocephalus.

Serum unconjugated estriol concentrations before and after the oxytocin challenge test: an index of fetal well-being

Serum unconjugated estriol concentrations before and after the oxytocin challenge test (stress test) were measured in 54 high-risk, obstetric patients. Six of the stress test results were positive, and eight were equivocal. Eleven patients demonstrated decrements in estriol of greater than or equal to 25% after stress tests, and the infants of six of these patients demonstrated perinatal morbidity. Three patients exhibited positive stress test results but had estriol concentrations which were unaltered by the stress test; all were delivered vaginally of healthy infants shortly after the stress test. The coefficient of correlation between the stress test and perinatal outcome was 0.58 (P less than 0.001). When the estriol and stress test results were combined to predict outcome, a multiple correlation coefficient of 0.71 was obtained (P less than 0.001). This increment represents a significant (P less than 0.001) and substantial (18%) improvement in the prediction of perinatal outcome. These findings indicate that the measurement of changes in estriol with the stress test significantly improves one's ability to define the fetus at risk.

Use of 3,3',5,5'-tetramethylbenzidine (TMB) in the identification of erythroid colonies

Images

CPK-MB isoenzume determinations in blunt chest trauma

To identify the most sensitive screening test for cardiac contusions, a series of 35 patients with blunt chest trauma was evaluated with serial electrocardiograms (ECGs)- creatine phosphokinase isoenzymes, and serum enzymes (serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, and creatine phosphokinase). Twenty of the 35 patients had diagnoses of cardiac contusions by ECG. Three with contusions developed complications. Although isoenzyme elevation was present in most patients sustaining blunt chest trauma, no complications of the injury were seen in patients with elevated enzymes and normal ECGs. The ease of obtaining ECGs and their reliability in identifying patients who will have complications make it the best screening procedure for the diagnosis of cardiac contusions.

No news is bad news: patients' views about communication in hospital

One hundred patients on four general surgical wards in a large teaching hospital were interviewed about the information they had received about their illness and what they had been told about the investigations they had undergone. Fifty-five of them expressed some dissatisfaction and 14 were strongly dissatisfied. The way in which ward rounds were conducted was heavily criticised, but most patients did not object to the teaching of medical students at the bedside. Twenty-four patients would have liked more explanation about why investigations were performed, and 38 though that they had not been told enough about the results of their investigations. This lack of information led to anxiety and fear. The findings suggest that more effort is needed to improve communication between doctors and patients.

Tracheo-innominate artery erosion: Successful surgical management of a devastating complication

Successful management of a patient with tracheo-innominate artery erosion requires the rapid institution of specific resuscitative and operative measures. Ten patients seen at the Charity Hospital of Louisiana in New Orleans and 127 documented cases from the world literature were analyzed regarding predisposing factors, diagnostic features, resuscitative measures and operative treatment. Diagnoses associated with abnormal neck positioning were seen in 48% of patients with tracheo-innominate erosions. In 69% of 96 instances, the site of erosion was located at the cannula end and implicates excessive anterior pressure. Caution is recommended in those patients with abnormal neck positions, low placed tracheostomy stomas and individuals with asthenic habitus. Resuscitative measures were highly successful when the tracheal ballon was inflated or when the method of retrosternal finger pressure was used. All personnel providing care for patients with tracheostomies should be aware of the initial measure of ballon inflation. Operative measures which permanently interrupted the innominate artery in the area of possible future erosion were the most successful. Of the 22 cases in which the innominate artery was sacrificed, only one had evidence of cerebral ischemia. Timely institution of proper measures can result in salvage of an unexpected number of these otherwise dramatic fatalities.

Hepatitis-associated-antigen-positive hepatitis in a tuberculosis unit

An outbreak of hepatitis-associated-antigen-(HB Ag)-positive hepatitis in a hospital unit for the care of male patients with pulmonary tuberculosis is described. Sixty-four patients were studied of whom 37 were HB Ag positive. Hepatitis developed in at least 20 and was icteric in 11. The illness was mild, without fatality due to hepatitis and persistent jaundice did not occur. A carrier state developed in 15 of 24 HB Ag-positive patients followed up for more than six months and was unrelated to the presence or absence of initial hepatitis. Spread of HB Ag to domestic and medical staff occurred and following the discharge of the patients, household contacts became positive. Five, all wives of patients, developed jaundice. Faeces and sputum were HB Ag negative in seropositive cases. The origin of the outbreak remains undetected. The probability of non-parenteral transmission of HB Ag in this outbreak is discussed. Closure of the unit, isolation of HB Ag-positive cases with separate toilet and kitchen facilities, and discharge of patients when their respiratory condition allowed, resulted in prevention of further spread and eventually all patients were discharged from the unit.