Pelvic fibromatoses--a rare gynecological entity

A rare case of pelvic fibromatoses is reported. This condition is rarely encountered in gynecological practice but when encountered, creates a diagnostic and therapeutic challenge. The reported patient highlights the difficulties encountered in surgical excision (done twice) and illustrates the local aggressive growth behavior of this entity.

Systemic complications of acute pancreatitis

The multisystem involvement in acute pancreatitis (AP) is a reflection of the pancreatic gland's capacity to produce a number of potent vasoactive peptides, hormones, and enzymes. The various prognostic criteria are early evaluations of these metabolic derangements. The pathogenesis of hypocalcemia, long recognized as an indicator of severity of AP, is multifactorial. Imbalances of parathyroid hormone (PTH)-calcitonin, the interactions of glucagon, gastrin and other pancreatic hormones with PTH-calcitonin, the role of free fatty acids in binding serum calcium with albumin, and the translocation of calcium ion in muscles and liver, have been recently described but remain conflicting theories. Yet, the time-honored theory of calcium-soap formation enjoys wide acceptance. Hyperglycemia, hypoglycemia, and occasional ketoacidosis in acute pancreatitis have been studied thoroughly. The complex cause-and-effect relationship between hyperlipidemia with acute pancreatitis needs further study. The coagulation abnormalities seem to be initiated by activated trypsin, and their role in microvascular coagulation appears to form a unifying hypothesis for major organ dysfunction, but this requires further investigation. Adult respiratory distress syndrome may be the result of active enzymes that digest pulmonary surfactant and/or microvascular thrombosis. The depression of cardiac function and shock are suspected to be secondary to vasoactive peptides such as bradykinin, or myocardial depressant factor, whose structure has yet to be elucidated. The renin-angiotensin alterations and renal complications in acute pancreatitis have received scant attention in the literature. The onset of moderate visual disturbances, or even blindness, in a patient with acute pancreatitis as a result of retinal vessel thrombosis is fortunately uncommon. Rare but interesting are the manifestations such as subcutaneous fat necrosis, arthralgia, and pancreatic encephalopathy. Despite the extensive literature on the complexities of the pathogenesis of complications of acute pancreatitis, there have been very few advances in the prevention and management of specific complications. It is hoped that further work on modification of enzymatic disturbances induced in acute pancreatitis will result in its effective treatment and prevention of serious complications.

Overinflation of pneumatic antishock garments in the elderly

The hemodynamic effects of pneumatic antishock garment application in high-risk elderly patients were examined in 10 preoperative patients (mean age 66.5 +/- 6.4 years) with the pneumatic antishock garments uninflated, after 15 minutes of inflation to 50 mm Hg, and after 15 minutes of inflation to 75 mm Hg. After inflation, significant increases in right atrial pressure (89 percent), pulmonary capillary wedge pressure (34 percent), and mean pulmonary artery pressure (21 percent) were noted. Mean peripheral arterial pressure increased 11.2 percent. Depression of the cardiac index (18 percent), left ventricular stroke work (20 percent), and right ventricular stroke work (16.4 percent) with associated increases in total peripheral resistance (26 percent) and pulmonary vascular resistance (18 percent) occurred in 5 of 10 patients. Left ventricular function curves revealed a progressive decrease in ventricular function at 50 mm Hg and 75 mm Hg. We have concluded that the effect of the pneumatic antishock garment on myocardial function is variable and unpredictably dangerous in the elderly patient with diminished myocardial reserve. As no significant benefit was derived from inflation pressures greater than 50 mm Hg in these patients, the lowest combination of pressures producing the most efficacious results should be used.

Effect of administration and withdrawal of oral contraceptive pills on serum lipids and lipoproteins

We studied the effects of oral contraceptive pills (OCP) supplied by the Govt of India in its Family Welfare Campaign, on serum lipid levels of women. The OCP, containing 30 micrograms ethinyl estradiol and 1 mg of norethisterone acetate were administered to the women for six months continuously and serum lipid levels were estimated after three and six months of the treatment. There were no significant changes in serum cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), serum triglycerides and very low density lipoprotein (VLDL). In a simultaneous study we also measured serum lipid levels at 3 and 6 months after withdrawal of the pills in women who had been receiving OCP containing 50 micrograms of ethinyl estradiol and 0.5 mg of one of the progesterones for the past 1 1/2 to 2 years continuously. Only serum LDL level fell significantly (P less than 0.01) on 3 months withdrawal period. It is concluded that 6 months of usage of the OCP marketed by the Govt. of India does not affect the serum lipid profile.

Stimulation by serum of the Na+/H+ antiporter in quiescent pig kidney epithelial (LLC-PK1) cells and role of the antiporter in the reinitiation of DNA synthesis

LLC-PK1 cells can be brought into a classical quiescent state by depriving them of serum for 6 days. At this time, pulse-labeling with [3H]-thymidine shows that only 3% of the cells are synthesizing DNA, but the quiescent cells can be stimulated with serum to re-enter the cell cycle at a point early in G1. The rate of amiloride-sensitive 22Na+ uptake (as a measure of the Na+/H+ antiporter) is relatively low during quiescence; it rises 2- to 3-fold within 4 h after serum addition. This increase in antiporter activity appears to be required for the resumption of DNA synthesis in the absence of bicarbonate, because ethylisopropylamiloride (EIPA) blocks [3H]-thymidine incorporation when serum is added to cells in bicarbonate-free medium. In the presence of bicarbonate, however, EIPA has no effect on [3H]-thymidine incorporation, indicating that another (bicarbonate-dependent) transport system can substitute for the antiporter under these conditions.

Synthesis and metabolic disposition of 14C-centperazine in rats

The metabolic disposition of [2-14C]-centperazine (1; 3-ethyl-8-methyl-1,3,8-triazabicyclo[4.4.0]decan-2-one) following an injection of 5 mg/kg dose was studied in male albino rats. During the initial period of 45-60 min, a very rapid fall in blood level of radioactivity was noticed. Thereafter the rate of fall of blood radiocarbon went on decreasing but did not attain linearity even upto 24 h. The drug was found to be fairly distributed in all the tissues attaining highest concentration in most of them within 30 min. In 24 h, about 83.5% of the administered drug was eliminated from the body, of which 21.3% was recovered from the faeces and 61.1% from the urine. The 14CO2 accountes for only 1% of the total dose. The drug exhibited significant binding with all the tissues examined. The brain and muscle showed highest and lowest activity, respectively.

Clinical evaluation of steroid receptors in ovarian neoplasms

Estrogen and progesterone receptors were estimated in a total of 25 ovarian neoplasms. None of the benign tumors showed steroid receptors. In malignant tumors serous tumors were more often receptor positive than the mucinous. Receptor levels were correlated with the staging of the disease, menstrual status and the resectability of the tumor. The response to chemotherapeutic drugs was better in patients with low estrogen and progesterone receptors as compared to those with high levels. The latter group showed a definite response to progesterone treatment in vitro. These are the group of patients who may benefit by combination of hormones and chemotherapeutic drugs.

Inhibition of aspartic proteinases by peptides containing lysine and ornithine side-chain analogues of statine

The synthesis of two new analogues of statine are reported corresponding to analogues with the lysine side chain and the ornithine side chain. These analogues were designed on the basis of substrate specificity and molecular modeling of three-dimensional structures of the penicillopepsin: Iva-Val-Sta-OEt crystal structure. 4,8-Diamino-3-hydroxyoctanoic acid [LySta] and 4,7-diamino-3-hydroxyheptanoic acid [OrnSta] were synthesized respectively from Boc-Lys(Z)-al and Boc-Orn(Bzl,Z)-al by addition of lithio ethyl acetate to the aldehyde group. The [LySta] derivative was converted to the trichloroethoxycarbonyl derivative and separated into the corresponding 3S,4S and 3R,4R diastereomers. The [OrnSta] derivative was used as a mixture of 3-position diastereomers. These new amino acids were used to prepare the following inhibitors: Iva-Val-Val-[LySta]-OEt and Iva-Val-Val-[OrnSta]-OEt as well as the corresponding synthetic intermediates. Inhibition constants (Ki values) were measured for inhibition of porcine pepsin and penicillopepsin. Both compounds were potent inhibitors of penicillopepsin with Ki values 10-100 times smaller (2.1 and 1.1 nM, respectively) than the Ki of Iva-Val-Val-Sta-OEt (47 nM). In contrast both inhibitors are exceptionally weak inhibitors of porcine pepsin with Ki values greater than 1 microM. These results are correlated with the ability of the basic group in the new inhibitors to bind to aspartic acid-77 in penicillopepsin.

Ultrasound detection of antenatal meconium

A new method for antenatal diagnosis of the presence of meconium in the amniotic cavity is reported. Ultrasonographic placental grading is a routine procedure in the monitoring of high-risk pregnancy. During serial scans of 58 patients, it was noted that in 11 cases placental grading was impossible after a certain period. At delivery, thick meconium was noted in all these cases.

Effect of acute sublethal and chronic administration of DDT (chlorophenotane) on brain lipid metabolism of rhesus monkeys

Either a single oral dose of 1,1,1-trichloro-2,2-bis-(p-chlorophenyl) ethane (DDT), 150 mg/kg body weight or a long-term chronic dose of the pesticide, 10 mg/kg body weight daily for 100 days was administered to rhesus monkeys and the level of various lipid classes was studied in the brain. A significant decrease was observed in total lipid, unesterified cholesterol and phospholipid (PL) level. Individual PL fractions showed a generalized pattern of reduction, so also did the cholesterol (chol)/PL ratio. Sphingomyelin (SM) registered a significant increase, while no significant alteration was observed in the brain galactolipid and ganglioside level. Lipid lowering effect of DDT was more pronounced in the chronic group. Lipids associated with the myelin sheath were found to be more resistant to pesticide injury, while cholesterol and PL metabolism were more affected.

Isolation and characterization of a Na-H antiporter-deficient mutant of LLC-PK1 cells

LLC-PK1 is an established cell line derived from pig kidney epithelium; it differentiates in vitro to form a polarized epithelial sheet, capable of the vectorial transport of solutes and water. We have used a modification of the "proton-suicide" method of Pouyssegur et al. (Proc. Natl. Acad. Sci. USA. 81:4833-4837, 1984) to isolate a mutant of LLC-PK1 cells that is deficient in Na-H antiporter activity. The mutant grows normally at pH 7.0 and above in the presence and absence of bicarbonate; at pH 6.5, however, it requires bicarbonate for growth. Alkalinization of the cytoplasm by the Na-H antiporter thus appears to be essential for growth at acidic pH in the absence of bicarbonate. The antiporter is also essential for the formation of domes (a consequence of vectorial water transport) in the absence of bicarbonate.

Energy expenditure in chronic alcoholics with and without liver disease

Chronic alcoholism activates metabolic pathways, resulting in wasteful expenditure of energy (Pirola and Lieber, J Nutr 1975;105:1544-8). To study this hypothesis, we measured oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (MREE) utilizing indirect calorimetry in 8 chronic alcoholics with (group I) and 11 chronic alcoholics without (group II) clinical or biochemical evidence of alcoholic liver disease. Seven healthy volunteers served as controls. A statistically increased MREE was observed in group II subjects (p less than 0.05, MREE 999.7 +/- 111.4 kcal X day X m2) as compared to normals (MREE 842.3 +/- 42.1 kcal X day X m2) and group I subjects (MREE 813.4 +/- 101.4 kcal X day X m2). VO2 and VCO2 were also significantly higher (p less than 0.05) in group II than in group I and normals. The predicted resting energy expenditure as calculated by the Harris-Benedict equation was similar in both groups and normals. Theories to explain the increased MREE in group II subjects are presented.

Clinical zinc deficiency during long-term total enteral nutrition

Zinc deficiency during long-term total parenteral nutrition has been well reported in the literature. However, there is limited information available on zinc deficiency occurring during total enteral nutrition. Two cases of clinical zinc deficiency in patients on long-term enteral feedings are presented. Nutritional assessment of these two patients on admission revealed hypoalbuminemic malnutrition. Nutritional support in the form of nasogastric tube feedings were initiated in both patients due to altered mental status. The formula used was Ensure (Ross Labs, Columbus, OH), which provided greater than 150% of the RDA for zinc. However, four months and seven months after initiation of adequate nutritional support, both patients developed skin rashes around the groin and under the breasts and axilla. Serum zinc levels were depressed in both patients, to 42 and 54 mg/dL, respectively (normal for the authors' laboratory, 66 to 120 mg/dL). Supplementation with zinc sulfate 220 mg per day via nasogastric tube resulted in disappearance of the rash with return of serum zinc to normal levels. The authors suggest close observation of patients on long-term enteral nutrition for clinical manifestation of zinc deficiency, especially an unexplained skin rash. Further studies are needed to establish minimum daily zinc requirements in patients on long-term enteral feedings.

Factors influencing DRG 210 (hip fracture) reimbursement

The effect of prospective payment system (PPS) on reducing cost and quality of care is still unknown. Fifty-two patients (mean +/- SD, 82.0 +/- 6.5 years) with hip fracture classified as DRG 210 (hip and femur procedures except major joint, age greater than 69 years and/or complication and/or comorbidity), treated by compression nail were separated into four groups: Group I--no comorbidity, no complications; Group II--no comorbidity but had complications; Group III--with comorbidity but no complications; and Group IV--with both comorbidity and complications. Compared to length of stay (LOS) in Groups I, II and III (mean 26 days), Group IV had significantly increased LOS (mean, 61.5 days) and 81% of the 16 who were day outliers (L.O.S. greater than 40 days). Patients without comorbidity (I & II) even if they did develop complications were not financial losers. Those with comorbidity appear to be high-cost patients as they invariably end up with complications (78%), and reimbursement for Group IV was significantly less, resulting in net loss of this DRG. Our finding demonstrates the importance of preventing complications in patients with comorbidity. Present DRG reimbursement guidelines do not provide sufficient attention to LOS implications of both comorbidity and complications. Ideally, they should be considered as separate factors within the DRG category.

Causes of limb loss in civilian arterial injuries

Progress in the management of complex vascular injuries of the extremities has not eliminated the necessity for amputation. An analysis of 100 consecutive patients treated at the Lincoln Medical and Mental Health Center during 1974-1980 disclosed that five amputations followed 24 instances of blunt trauma, but only one minor amputation of toes was required in 76 patients after repair of arterial injuries associated with penetrating wounds. Extensive skeletal, muscular and skin loss at the sites of blunt trauma precluded salvage of two limbs. Physicians' failure to suspect arterial injury on admission in three patients with blunt trauma caused delay in the diagnosis and management of occlusive arterial injury that ultimately led to three amputations. In contrast, limited soft tissue damage accompanying penetrating wounds and high index of suspicion resulted in expeditious repair, accounting for the minimal risk of limb loss. Amputation may be obligatory in the presence of extensive skeletal and soft tissue destruction. However, limb loss due to delay in diagnosis is preventable. In every instance of blunt trauma to extremities, we advocate the same suspicion of vascular injuries as in penetrating trauma, with early liberal use of angiography whenever pulses are not absolutely normal, and prompt revascularization of ischemic limbs.

Delayed sternal closure as a safe adjunct to support biventricular failure after open heart surgery

Over a four-year period, 22 patients of 2495 undergoing open heart surgery sustained severe biventricular failure (BVF) and would not tolerate primary sternal closure. Reasons for BVF included intraoperative injury, perioperative infarction, global dysfunction, cardiopulmonary edema, and intractable arrhythmia. Mechanical assist devices were required in nine patients. Average cardiac index fell to 1.1 L/min/m2 with attempts to close the chest, then stabilized at 1.9 with the sternum open and only soft tissue closed. After 3 to 11 days, cardiac index rose to 2.5 when assist devices were removed, inotropic agents decreased, and the sternum closed. Three early deaths (5-12 days) were caused by progressive biventricular failure. Five later deaths (19-64 days) were associated with renal and respiratory failure, superinfection, and sepsis. All of these required tracheostomy. Survival of 14 patients was not related to early low cardiac output, preoperative status, timing of sternal closure, or age, but was associated with early recovery of respiratory function without need for tracheostomy, avoidance of renal failure, and satisfactory alimentation. Sternal infection occurred in three patients, resulting in one death. The hospital stay ranged from 12 to 230 days. There was one death resulting from respiratory failure 14 months postoperatively. Our findings show that delayed sternal closure lessens early cardiac instability during BVF, helps allow recovery, and does not produce long-term disability.

Comparison of bentiromide test and rice flour breath hydrogen test in the detection of exocrine pancreatic insufficiency

Bentiromide test (BT) has been recently approved in the United States for screening patients with chronic pancreatitis for exocrine insufficiency. A few reports have suggested that the rice flour breath hydrogen test (RFBHT)--i.e., breath hydrogen analysis after rice flour ingestion--may also be useful in diagnosing exocrine pancreatic insufficiency. We conducted this study to compare the diagnostic value of these two tests in chronic alcoholic (n = 14) and nutritional or tropical (n = 6) pancreatitis. False-positive results were not noted with either of these two tests in 12 healthy volunteers. BT was positive in 28.6% of patients with chronic alcoholic pancreatitis and in 16.7% of patients with tropical pancreatitis. In comparison, RFBHT was almost twice as sensitive as BT in detecting insufficiency in patients with alcoholic pancreatitis (50 vs. 28.6%) and four times as sensitive in patients with tropical pancreatitis (66.7 vs. 16.7%). Only one patient in our study had a positive BT but a negative RFBHT. We recommend RFBHT as a simple, safe, and inexpensive test in screening patients for exocrine pancreatic insufficiency.

Increased risk of colorectal cancer following breast cancer

Identification of population groups at increased risk for colorectal cancer is important for deriving maximum benefit from screening procedures. A retrospective analysis of 7605 patients with cancer treated between 1958 to 1982 revealed that the colorectum was the site of metachronous primary in 38 patients (15 males and 23 females). The risk factor of developing the metachronous multiple primary cancer was determined by comparing the observed number of second primary malignancy with the expected number based on person years of observation, age, sex, and site specific incidence rates. Incidence of metachronous colonic cancer was twice the expected number and was the highest following a primary in the breast. This increased risk (2.0) is of equal magnitude as noted following primary colon cancer (1.7). Advanced metachronous colonic lesions were seen more often following breast cancer than following colon cancer. Since carcinoma of the breast is the leading cancer in women, it is urged that the follow-up management of such patients include the same aggressive screening program as that recommended for those with colorectal cancer.

Simplified prognostic criteria in acute pancreatitis

Simplified prognostic criteria (SPC) have been developed for evaluating patients with acute pancreatitis. The criteria based on easily measured biologic and clinical variables were evaluated on all 76 patients with acute pancreatitis treated over a 2-year period. Results were compared with Ranson's early objective sings. All the SPC within 48 h of admission correlated significantly (p less than 0.001) with increased incidence of complications. Of the 11 early objective signs only four--fall in hematocrit, serum calcium, PO2, and fluid sequestrations--were associated with significantly increased complications. The incidence of complications, 48%, seen in patients with one or more SPC was comparable to the 50% seen in patients with three or more Ranson's early objective signs. The results suggest that SPC is a simple, easily applicable gauge that gives valuable assessment of the severity of acute pancreatitis.

The metabolic cost of breathing in critical surgical patients

Twenty ventilator-dependent patients, 14 male and six female, age 47.9 +/- 14, status post polytrauma (14), emergency surgery (three), and coronary artery bypass (three) were evaluated to compare measured energy expenditure (MEE) between the intermittent mandatory ventilation mode (IMV) and assist mode ventilation (AMV) utilizing indirect calorimetry. The MEE was then compared to the predicted basal energy expenditure (PEE) utilizing the Harris-Benedict equation (HBE) and appropriate correction factors dependent on disease and injury status (mean 1.65 +/- 0.24). The mean oxygen consumption (VO2) (IMV) was 347.5 +/- 54.6 ml/min; (VO2) (AMV) was 307.1 +/- 51.4 ml/min (p less than 0.001). The mean MEE (IMV) was 2,380 +/- 369 kcal/day; MEE (AMV) was 2,128 +/- 342 kcal/day (p less than 0.05). The mean predicted energy expenditure (PEE) was 2,731 +/- 416 kcal/day. The IMV mode required 11.6% more pulmonary work when compared to AMV (VO2 IMV - VO2 AMV). The PEE overestimated caloric needs in ventilator-dependent patients by 12.8% on IMV and 22.1% on AMV. The MEE (IMV) required 10.7% more energy than MEE (AMV). Assist mode ventilation resulted in decreased work of breathing and decreased energy expenditure, and the (HBE) inaccurately predicted caloric needs in ventilator dependent patients.

Assessment of nutritional and metabolic status of paraplegics

Nutritional and metabolic assessment using anthropometric, biochemical, immunological, and indirect calorimetric techniques was performed on 17 healthy paraplegic males with a mean age of 44.2 +/- 14.6 years and mean duration of injury of 17.8 +/- 12.3 years. Significant differences in energy expenditure were observed; only 29.4 percent were normometabolic [measured resting energy expenditure: (MREE) 90-110 percent of predicted resting energy expenditure (PREE)], 35.3 percent were hypermetabolic (MREE greater than 110 percent of PREE) and 35.3 percent were hypometabolic (MREE less than 90 percent of PREE). Obesity (weight greater than 110 percent ideal body weight) was maximum in hypometabolic patients (83.3 percent) due to the imbalance between caloric intake and energy expenditure (p less than 0.05). None of the patients had normal values for all four objective measurements of nutritional assessment (albumin, transferrin, total lymphocyte count, and cutaneous hypersensitivity). Mild malnutrition was evidenced in 47 percent of patients; 53 percent of patients demonstrated some index of moderate malnutrition. We conclude that nutritional therapy based on measurements of energy expenditure instead of predictive equations will benefit these patients. A larger long-term study is needed to determine the ideal predictive measurements of nutritional assessment with their optimal cutoff values applicable to the spinal cord-injured patient.

Toilet facilities in a large Indian teaching hospital

While assessing the total medical care provided by any large hospital in a community, hardly any stress is laid on the sanitary facilities which the hospital provides and which form such an integral part of every hospital patient. We studied the toilet facilities of M.L.B. Medical College, Jhansi. They seem to be adequate for the ambulant patient but are insufficient for the bedridden and for those who have weak legs. The findings are discussed.

Studies on the mechanism of action of local anesthetics on proton translocating ATPase from Mycobacterium phlei

We have measured the inhibitory potencies of local anesthetics (procaine, lidocaine, tetracaine and dibucaine) on ATP-mediated H+-translocation, Ca2+-transport and ATPase activity in membrane vesicles from Mycobacterium phlei. Procaine and lidocaine up to 1 mM concentration did not inhibit ATP-dependent H+-translocation, Ca2+-transport and ATPase activity. However, tetracaine and dibucaine at 0.2 mM concentration caused dissipation of the proton gradient, measured by the reversal of the quenching of fluorescence of quinacrine, and inhibition of active Ca2+-transport. Tetracaine (1 mM) inhibited membrane-bound ATPase activity without affecting solubilized F1-ATPase activity. Studies show that these local anesthetics do not prevent the inactivation of F0-F1 ATPase by dicyclohexylcarbodiimide (DCCD). Binding of [14C]DCCD to F0-proteolipid component remained unchanged in the presence of tetracaine indicating that DCCD and tetracaine do not share common binding sites on the F0-proteolipid sector. The inhibition of H+-translocation and membrane-bound ATPase activity by tetracaine was substantially additive in the presence of vanadate.

Systemic organ assessment using computerized profiles

Clinical monitoring of isolated parameters may lead to erroneous conclusions or conflicting speculations about the patient's general physiological status. Data derived from two or three primary parameters may provide a better understanding of the patient's overall status. Four automated profiles have been designed to aid in the management of critically ill patients. Data obtained from simple blood and urinary tests are used to compute parameters for various physiologic, renal, respiratory, and metabolic functions. The derived data are plotted in hard-copy form. A sequential series of each profile assists the physician in making intelligent and rapid therapeutic decisions and in evaluating the effectiveness of this therapy.

Physiologic profile monitoring in burned patients

Physiologic profile monitoring was performed on 18 elderly patients (mean age, 71.3 +/- 11.7 years) with major burns (mean, 49% +/- 17% BSA) on days 1 to 4. Nine had associated inhalation injury. Ten patients survived more than 10 days. Degree of myocardial dysfunction in response to burn injury is unpredictable. Sixteen of the total 18 patients needed inotropic support. Cardiac output is probably a more accurate means of assessing efficacy of resuscitation than hourly urine output. Maintenance of cardiac index at higher than normal levels is a physiologic necessity. Failure of cardiac index to remain high after 3 days predicted nonsurvival in this group of patients. In presence of combined cutaneous and inhalation burn injury fluid requirement is unpredictable, and the optimum resuscitation in these patients merits further definition. Physiologic profile monitoring in these older patients is a very useful guide to the precise management of fluid resuscitation, early detection, and treatment of ventricle dysfunction, and results in improved survival.

A study of disseminated intravascular coagulopathy in hepatic coma complicating acute viral hepatitis

Thirty cases of viral hepatitis with and without coma and 15 normal healthy age and sex matched controls were studied for disseminated intravascular coagulopathy (DIC). Cases of viral hepatitis with coma showed strong evidence of DIC in the form of increased plasma FDP (240 +/- 190.64 dilution), diminished fibrinogen half life (48.1 +/- 15.3 hours) and increased fractional catabolic rate (46.13 +/- 14.7% per day) with normal Euglobulin clot lysis time and reduced fibrinogen (147.33 +/- 43.5%) and platelet count (1.27 +/- 0.324 lakhs/cm.). The possible role of heparin in the reversal of coagulation abnormalities have been discussed.

Purification and functional properties of the DCCD-reactive proteolipid subunit of the H+-translocating ATPase from Mycobacterium phlei

Interaction of N,N'-dicyclohexylcarbodiimide (DCCD) with ATPase of Mycobacterium phlei membranes results in inactivation of ATPase activity. The rate of inactivation of ATPase was pseudo-first order for the initial 30-65% inactivation over a concentration range of 5-50 microM DCCD. The second-order rate constant of the DCCD-ATPase interaction was k = 8.5 X 10(5) M-1 X min(-1). The correlation between the initial binding of [14C]DCCD and 100% inactivation of ATPase activity shows 1.57 nmol DCCD bound per mg membrane protein. The proteolipid subunit of the F0F1-ATPase complex in membranes of M. phlei with which DCCD covalently reacts to inhibit ATPase was isolated by labeling with [14C]DCCD. The proteolipid was purified from the membrane in free and DCCD-modified form by extraction with chloroform/methanol and subsequent chromatography on Sephadex LH-20. The polypeptide was homogeneous on SDS-acrylamide gel electrophoresis and has an apparent molecular weight of 8000. The purified proteolipid contains phosphatidylinositol (67%), phosphatidylethanolamine (18%) and cardiolipin (8%). Amino acid analysis indicates that glycine, alanine and leucine were present in elevated amounts, resulting in a polarity of 27%. Cysteine and tryptophan were lacking. Butanol-extracted proteolipid mediated the translocation of protons across the bilayer, in K+-loaded reconstituted liposomes, in response to a membrane potential difference induced by valinomycin. The proton translocation was inhibited by DCCD, as measured by the quenching of fluorescence of 9-aminoacridine. Studies show that vanadate inhibits the proton gradient driven by ATP hydrolysis in membrane vesicles of M. phlei by interacting with the proteolipid subunit sector of the F0F1-ATPase complex.

An improved cathepsin-D substrate and assay procedure

Ten analogs of the peptide A-Phe(NO2)-Phe-Val-Leu-B were synthesized and tested as substrates for cathepsin D and pepsin. The best substrate found for cathepsin D, Phe-Ala-Ala-Phe(NO2)-Phe-Val-Leu-OM4P (kcat = 2.9 s-1; Km = 7.1 microM), has the largest kcat/Km value (408 mM-1 s-1) reported to date for this enzyme. The effect of peptide structure on solubility and kinetic parameters is discussed. The peptide provides a useful new substrate for continuous assay of cathepsin D.

Interaction of lanthanide cations and uranyl ion with the calcium/proton antiport system in Mycobacterium phlei

Uranyl ions (UO2+(2)) and lanthanide cations (La3+, Nd3+, Sm3+, Eu3+, Tb3+ and Dy3+) at 100-200 microM concentration inhibited active transport of Ca2+, mediated by respiratory linked substrates as well as by ATP hydrolysis, without affecting respiration and membrane-bound ATPase activity, in inside-out membrane vesicles of Mycobacterium phlei. The extent of inhibition in the uptake of Ca2+, mediated by ATP hydrolysis, increased with increase in ionic radii of these cations. Lanthanide cations did not dissipate the formation of a proton gradient, as measured by determining the effect either on the uptake of [14C]methylamine or energy-linked quenching of the fluorescence of 9-aminoacridine. However, uranyl ion (UO2+(2+)) caused reversal of the energy-linked quenching of 9-aminoacridine. UO2+(2)) concentration yielding 50% of Vmax (S0.5) was approx. 15 microM. Kinetic studies revealed that inhibition in the uptake of Ca2+ was competitive with UO2+(2) while non-competitive with rare-earth metals. It is proposed that inhibition in the uptake of Ca2+ by uranyl ion occurs as a result of UO2+(2) transport into the interior of vesicles in exchange for protons, while lanthanide cations are not being transported but affect the binding of Ca2+ to the membrane, presumably to the Ca2+/H+ antiporter.

Norethindrone in serum after use of an oral contraceptive containing norethindrone acetate

The availability of norethindrone (NET) in serum was studied in 8 women after daily administration of a combination oral contraceptive pill (MinovlarR) containing 1 mg norethindrone acetate (NETA) and 50 micrograms ethinyl estradiol (EE2) from day 5 to day 25 of the menstrual cycle. The pill was taken daily at 9:30 a.m. after a light breakfast and blood samples were collected at 3 hr on alternate days and at 24 hr on other days after ingestion of the pill. On day 12 or day 15 of the first treatment cycle, serial blood samples were also collected at 1/2, 1, 2, 4, 6, 8 and 24 hr after taking the pill. Serum NET levels were estimated by the radioimmunoassay (RIA) technique. The plot of serum NET concentration versus time (0-24 hr) profile showed a rapid absorption of steroid and a peak NET concentration (18.3 +/- 4.8 ng/ml) reached at 2 hr after ingestion of the pill. By linear regression analysis of data (y = 0.27 + 0.12x; r = 0.95), it was observed that the serum NET level was initially about 1 ng/ml. Thereafter, it increased by 0.12 ng/ml per day up to 3.5 ng/ml by the end of 21 days' treatment with oral pills. The serum NET concentration decay slope fitted a two-compartment open model with an initial rapid decay (half-life of 1.2 +/- 0.1 hr) followed by a slower beta-phase with a half-life of 8.5 +/- 1.5 hr. The study revealed that there was an accumulation of norethindrone in plasma during the treatment period and this suggests the possibility of exploring a reduction in the dose of this preparation so as to achieve the optimum NET concentration for contraception, and thereby avoiding unwanted steroid accumulation in the plasma of women.

Penetrating injuries of the neck: criteria for exploration

One hundred thirty-six patients with penetrating injuries of the neck over a 4-year period were studied prospectively. Seventy-two patients (52.9%) had no major physical signs on admission, 56 were observed without complications, and 16 had a negative exploration. Injuries below the level of the cricoid cartilage were associated with a very high mortality (12.12%). We recommend a policy of selective conservatism in the management of penetrating neck injuries.