Superior mesenteric artery syndrome after resection of an arteriovenous malformation in the cervical cord

Any disease process decreasing the angle between the superior mesenteric artery and the abdominal aorta can result in the external compression of the duodenum and subsequent intestinal obstruction. This unusual type of intestinal obstruction known as superior mesenteric artery syndrome is a well-recognized clinical entity. It is diagnosed radiologically by an abrupt, vertical cutoff of barium flow in the third portion of the duodenum. The management is primarily medical but occasionally surgical correction is required. Herein, the diagnosis of superior mesenteric artery syndrome was made in an incomplete quadriplegic woman who had recently undergone surgical resection of an arteriovenous malformation in the cervical cord. This case was managed successfully with gastrointestinal decompression, proper positioning in the side-lying position, and adequate nutrition.

Role of immediate versus delayed nephrectomy for failed renal transplants

The role of timing of transplant nephrectomy after renal transplantation has not been well defined. This report compares the morbidity, mortality, and hospitalization costs of 37 patients undergoing transplant nephrectomy within 14 days after graft failure and return to dialysis, with 31 patients undergoing delayed transplant nephrectomy (less than 14 days after graft failure and return to dialysis). This analysis revealed that there were no significant (P greater than .05) differences in patient morbidity and mortality between these groups. There was, however, a substantial increase (P less than .05) in the cost of hospitalization in the delayed nephrectomy group. For this reason, we recommend early nephrectomy after renal transplant failure in order to minimize the cost of health care for these patients undergoing failed cadaver donor transplant nephrectomy.

Electrodiagnostic characteristics of acute carpal tunnel syndrome

Carpal tunnel syndrome (CTS) exemplifies a cumulative trauma disorder which may occur in industrial settings. Occasionally, industrial workers develop CTS acutely over the course of a few days to a few weeks. We recently performed electrodiagnostic studies on 22 workers at a midwestern automobile manufacturing plant who developed symptoms compatible with CTS. All tests were within eight weeks of symptom onset; 70% were within four weeks. The acute syndrome was manifested by a conduction block of sensory, motor, or both fiber types beneath the carpal ligament. All patients received sensory studies; nine had motor studies as well. Sensory nerve latencies were not prolonged in proportion to the symptoms, which were short in comparison to the low amplitude sensory nerve action potential evoked proximal to the carpal ligament. Sensory nerve action potential amplitude at midpalm averaged 200% of the value obtained proximally. Because of short distance and residual latency, comparison of motor latencies proximal and distal to the carpal ligament was less helpful than the difference in amplitude of the evoked potentials. Amplitude of the distal response increased an average of 32%. Prompt identification of acute CTS was followed by a recommendation for job change which, along with conservative therapy, led to resolution of symptoms in 77% of patients. The diagnosis of acute CTS leading to avoidance of inciting activities is beneficial in the industrial setting.

Dysphagia in acute stroke

A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke. The site of the present lesion and of any previous stroke was determined clinically and was confirmed by computed tomography of the brain or necropsy in 40 cases. Of 41 patients who had dysphagia on admission, 37 had had a stroke in one cerebral hemisphere. Only seven patients showed evidence of lesions in both hemispheres. Nineteen of 22 patients who survived a stroke in a hemisphere regained their ability to swallow within 14 days. Dysphagia in patients who had had a stroke in a cerebral hemisphere was associated in this study with a higher incidence of chest infections, dehydration, and death.

Evidence for a direct action of exogenous insulin on the pancreatic islets of diabetic mice: II. Prolonged insulin therapy before islet isolation and perifusion

24 week old diabetic mice of the C57Bl/Ks (db/db) strain were treated with subcutaneous injections of Ultratard M.C. insulin at a dose of 40 mU/animal rising to 100 mU/animal after 12 weeks. The mean plasma insulin value was 146 +/- 20 microU/ml (n = 6). During this time, the mean body weight of the animals rose significantly (p less than 0.05) and the mean blood glucose concentration fell significantly (p less than 0.005) until a value 2-3 times normal was reached, the insulin dose was then adjusted empirically to maintain hyperglycaemia at this level. Pancreatic islets from these animals, untreated diabetic mice and normal (+/+) mice were isolated by collagenase digest and perifused with a modified Krebs-Ringer medium containing either 3 mmol/L or 15 mmol/L glucose. During glucose challenge, normal islets demonstrated the usual biphasic insulin response, but high glucose levels elicited no response from islets of untreated diabetic mice. Previous treatment of diabetic mice with insulin led to a restoration of the first phase of glucose mediated insulin secretion on perifusion and a significant increase (p less than 0.05) in the second phase. Such an improvement in beta-cell function in the face of prevailing hyperglycaemia, even allowing for the possible mediating effect of a 30% fall in blood glucose, was taken as further evidence for a direct action of exogenous insulin on the islets of diabetic mice.

Efficacy of transdermal scopolamine against seasickness: a 3-day study at sea

Transdermal scopolamine has been reported to provide protection against motion sickness, both while sailing at sea (7-8 h) and under experimental conditions. In this study, we tested the efficacy of transdermal scopolamine and evaluated its side effects during a 72-h cruise at sea. We tested 38 male volunteers, 20-25 years old, who were located on a 3000-ton vessel. The presence of seasickness, defined by Graybiel's diagnostic criteria, was used to calculate percent protection. When sickness was considered as malaise II or more, the drug provided 74, 73, and 39% protection during the three sailing days, respectively. There were no significant differences in the magnitude of the side effects reported by experimental and placebo groups. We conclude that transdermal scopolamine's efficacy against seasickness during a 3-day cruise was not associated with significant side effects and, therefore, we find the drug suitable for long-term use by sailing crews.

The purification of mouse monoclonal antibodies from ascitic fluid

A method is described for the purification of monoclonal antibody from mouse ascitic fluid. The fluid is clarified and the lipid removed using silicon dioxide powder, before the immunoglobulin is precipitated using polyethylene glycol. The method provides IgM antibody in high yield and good purity. In the case of IgG antibodies the purity is 30-40% after PEG precipitation and the yield is high. The enriched IgG is adequate for many purposes and is suitable for further purification on an ion exchange column.

Transdermal scopolamine: human performance and side effects

The effect of transdermal scopolamine on performance was tested on 23 naval volunteers. Performance was evaluated by using a battery of professional (naval-related) and cognitive tests. For all tests performed there were no significant differences between the scores obtained in placebo and transdermal scopolamine conditions. These results were in close agreement with subjective estimations of performance. Transdermal scopolamine significantly reduced salivary flow, whereas mood state, visual acuity, and eye accommodation for near vision were not affected. We conclude that transdermal scopolamine administration is not accompanied by decrement in performance abilities and can safely be used by naval crews.

The role of the sympathetic nervous system in the regulation of ultradian rhythms in urine excretions

The effects of alpha and beta adrenoreceptors blockade and surgical kidney denervation on ultradian rhythmicity in urine excretion were investigated in four dogs. Pharmacological treatments and surgical denervation of the kidneys suppressed the ultradian rhythmicity in urine flow but did not completely eliminate the ultradian rhythms in urinary osmolality and in electrolyte concentrations. These findings suggest that the autonomic nervous system plays a major role in the regulation of the ultradian rhythms in water excretion in dogs. The partial persistence of ultradian rhythms in urine osmolality and electrolyte concentrations after autonomic denervation supports the assertion that the ultradian rhythms in solute concentrations are regulated by different mechanisms to those of water excretion, suggesting the possible involvement of a multioscillatory system.

The modulating effects of flurbiprofen on adriamycin plus vincristine or vindesine in the treatment of advanced breast cancer

To assess the modulating effects of a non-steroidal anti-inflammatory drug on chemotherapeutic agents, 183 patients with advanced breast cancer have been treated in a randomised study with flurbiprofen or placebo and adriamycin plus a vinca alkaloid. To assess the efficacy of the new vinca alkaloid, vindesine, in breast cancer, patients were further randomised to receive vindesine or vincristine. The overall response rate in evaluable patients was 57%, and the median duration of response in the different treatment groups varied from 6 to 10 months. Response rates and toxicity in vindesine- and vincristine-treated patients were similar, although with vindesine neurotoxicity was slightly lower. Flurbiprofen did not improve the response rate or reduce the toxicity of adriamycin plus vinca alkaloid.

Effect of transdermal scopolamine on salivation

The effect of transdermal scopolamine on salivary flow and composition was analyzed in 21 healthy volunteers. The flow rate of whole saliva was significantly lowered by transdermal scopolamine. Significant positive correlations were found between the placebo rate of flow and both the quantity and percentage decreases in response to transdermal scopolamine. The magnesium concentration was significantly increased during transdermal scopolamine administration, whereas the sodium, potassium, and calcium concentrations were not consistently altered. Accordingly, the magnesium secretion rate was unaltered, whereas sodium, potassium, and calcium secretion rates were significantly lowered by transdermal scopolamine administration.

Intraportal autotransplantation of cryopreserved porcine islets of Langerhans

Mechanically prepared isolated islets of Langerhans were cryopreserved in liquid nitrogen for a period of 4 days. Intraportal autotransplantation studies were performed on two groups of six pigs rendered diabetic by total pancreatectomy (group 2) or by partial pancreatectomy combined with streptozotocin (group 4) and compared with two control groups (groups 1 and 3, respectively). The pigs were assessed for survival, weight gain, glycosuria, polyuria, systemic blood sugar and insulin, and, in selected pigs, intravenous glucose tolerance tests. Results showed that partial pancreatectomy with streptozotocin was the better tolerated experimental diabetes. Variable control of hyperglycemia was obtained over an experimental period of 3 months. Random blood glucose returned to normal in one of six pigs in the totally pancreatectomized group and three of six pigs in the partial pancreatectomy and streptozotocin group. Despite these normal circulating glucose levels, imperfect glucose homeostasis was achieved as shown by the response to glucose tolerance testing. These results report blood glucose control after cryopreserved islet autotransplants in diabetic pigs but further study is still necessary to achieve consistency.

Hereditary hemorrhagic telangiectasia and factor VIII inhibitor

A patient with hereditary hemorrhagic telangiectasia manifested recurrent gastrointestinal bleeding aggravated by an acquired factor VIII inhibitor. Immunosuppressive therapy with cyclophosphamide and prednisone successfully corrected the coagulation defect.

Evidence for a direct action of exogenous insulin on the pancreatic islets of diabetic mice: islet response to insulin pre-incubation

Pancreatic islets were isolated by collagenase digest from normal (+/+) and severely diabetic (db/db) mice of the C57BL/Ks strain. Batches of islets from the diabetic mice were incubated for 1 h at 37 degrees C in Krebs-Ringer medium containing glucose (3 mmol/l), with or without mouse insulin (50 mU/l), before perifusion. When compared with untreated islets from the same digest, pre-incubation of islets from diabetic mice with insulin elicited a restoration of the biphasic insulin response to a glucose challenge which was indistinguishable from the response of the untreated, control islets from non-diabetic mice. Untreated diabetic islets showed no insulin response to glucose challenge, insulin values being very significantly lower than those of either non-diabetic or treated diabetic mouse islets (p = less than 0.005). The restoration of secretion in treated islets of diabetic mice was shown not to be an artefact. These observations provide evidence for a direct, as yet undefined, action of insulin on the beta cell of the diabetic mouse.

Sexual conflict and eating disorders in 27 males

Twenty-seven anorectic and bulimic males and 142 anorectic and bulimic females treated on an eating disorders unit were compared. Significantly more male patients reported experiencing sexual isolation, sexual inactivity, and conflicted homosexuality.

Metabolic response to refined carbohydrates in idiopathic urolithiasis

The dietary habits of 139 stone patients and 20 control subjects were assessed to investigate the differential features, if any, of the eating pattern between the two groups. There was no significant difference between stone formers and controls, although the data for animal protein was inadequate for statistical analysis. In a separate study, 39 idiopathic calcium stone formers and 18 control subjects were studied by measuring the blood glucose, plasma insulin and glucagon levels following oral glucose. The insulin response was abnormal in 70% of the patients. Increased urinary risk factors for calcium oxalate oversaturation were significantly associated with patients who exhibited an abnormal insulin response.

Cis-diamminedichloroplatinum(II) nephrotoxicity and its relationship to renal gamma-glutamyl transpeptidase and glutathione

To investigate the mechanism of cis-diamminedichloroplatinum(II) (cisplatin) nephrotoxicity, male Sprague-Dawley rats were given one injection of cisplatin (6 mg/kg i.v.). Urinary levels of amino acids and gamma-glutamyl transpeptidase were monitored for 8 days; kidney homogenate content of gamma-glutamyl transpeptidase was followed for 50 hr, and that of selenium-dependent glutathione peroxidase and total glutathione was followed for 4 hr. Peak urinary levels of amino acids and gamma-glutamyl transpeptidase occurred 4.5 hr after the i.v. dose. Glutamine, glycine, and ethanolamine were all elevated greater than 20 times that of the control at 4.5 hr and were still significantly elevated at 50 hr. Total renal glutathione content increased 51 +/- 17% (S.D.) of control values 20 min after cisplatin was given, before returning to base-line levels. No depletion of either renal glutathione or glutathione peroxidase was detected over the time interval studied. These results demonstrate an earlier physiological impairment than has hitherto been shown. Furthermore, depletion of glutathione and glutathione peroxidase does not occur in the rat kidney following therapeutic doses of cisplatin, in contrast to the changes observed in cardiac tissue following doxorubicin treatment.

Phase I trial of PCNU

In a phase I trial, 28 patients with advanced solid tumors were given PCNU daily for 5 days by iv infusion over 20 minutes at 6-week intervals. The total dose for each course ranged from 25 to 150 mg/m2 in six escalation steps. Myelosuppression was dose-limiting, with a platelet count depression regularly observed at doses of greater than or equal to 82.5 mg/m2. Leukopenia occurred only at higher doses. Nausea was uncommon, and vomiting did not occur. There were no adverse drug-related effects on renal or hepatic function. No antitumor activity was observed. A dose range of 100-125 mg/m2 iv for each 5-day course (20-25 mg/m2/day) is recommended for phase II studies.

Conflicting treatment models for the inpatient management of borderline patients

The authors contrast two paradigms for long-term treatment of borderline patients: 1) modified psychoanalytic psychotherapy, which attempts to bring about structural intrapsychic change, and 2) psychotherapy that strives only to improve adaptation. They demonstrate the divergent uses of the psychiatric hospital for these two treatments and the potential for regression and hospital failure when conceptual conflict arises between inpatient and outpatient clinicians or when the hospital mixes aspects of these often antithetical treatment models.

Subzero preservation of mechanically prepared porcine islets of Langerhans: response to a glucose challenge in vitro

Islets of Langerhans, prepared by a new mechanical process and avoiding enzymatic digestion were frozen to -196 degrees C. Two rates of freezing were compared, instantaneous directly into liquid nitrogen and slow freezing at 1 degree C min-1. Post-thaw survival was greater after slow freezing. Three concentrations of dimethyl sulfoxide (DMSO) were compared. The 10% v/v concentration was found to give greater success than 20 or 30%. Contaminating exocrine tissue was found not to survive the freezing process.

Ultradian rhythms in renal excretion in dogs

Urine flow, osmolality, concentrations of sodium and potassium were measured every 10 min for 24 hours in 6 female dogs, whose sleep-wake stages were monitored electrographically. Experiments were conducted under hydration and progressive dehydration conditions. Visual examination and spectral analysis revealed significant diurnal ultradian rhythms of about 200 min/cycle in urine flow, which were out of phase with similar rhythms in osmolality in different hydratory conditions. Diurnal rhythms with similar characteristics were found in urinary potassium only in the hydration condition. Sodium excretions did not show consistent rhythmic patterns. No consistent rhythms were found in nocturnal urine parameters in different hydratory conditions. The variations in renal activities were related to the dogs' diurnal ultradian sleep-wake cycle, urine volume increased and osmolality decreased during diurnal waking episodes, and conversely volume decreased and osmolality increased during the diurnal sleep episodes.

Adjuvant aminoglutethimide therapy for postmenopausal patients with primary breast cancer: progress report

A group of 122 postmenopausal patients with histologically proven node-positive primary breast cancer have been randomized to receive aminoglutethimide-hydrocortisone or placebo aminoglutethimide-placebo hydrocortisone for 2 years. Median follow-up is 17 months. In general, treatment was well tolerated, but 15 patients required a reduction in the dose of aminoglutethimide, and of these four patients were unable to continue therapy due to side effects. Primary staging, incidence of extensive node involvement, and estrogen receptor were similar in the treatment and control arms. Dehydroepiandrosterone sulfate (DHA-S) and estrone were measured in a subgroup of patients, and significant suppression of DHA-S levels throughout the duration of the treatment period as seen in patients receiving the active drug. No significant suppression of either DHA-S or estrone levels was seen in the controls. Patients were monitored for metastases by serial liver function tests, carcinoembryonic antigen, and chest X-rays, and of 26 relapsing patients only three patients were not detected by this screen. We conclude that adjuvant aminoglutethimide is moderately well tolerated. It is capable of suppressing DHA-S throughout 2 years of treatment. A further 280 patients will be entered into the study to assess the survival benefit for those taking aminoglutethimide-hydrocortisone.

Clinical trial of multiple endocrine therapy for metastatic and locally advanced breast cancer with tamoxifen-aminoglutethimide-danazol compared to tamoxifen used alone

Multiple-endocrine therapy with combinations of various types of treatment has not been evaluated properly in spite of the success of individual types of hormone treatment. This paper reports the early results of a randomized controlled clinical trial comparing tamoxifen (10 mg 2 times/day)-amino-glutethimide (250 mg 3 times/day)-danazol (100 mg 3 times/day)-hydrocortisone (20 mg 2 times/day) (TAD) with tamoxifen (10 mg 2 times/day). Analysis of the first 107 assessable patients indicates objective response (criteria of the International Union Against Cancer) in 33% of patients receiving tamoxifen versus 50% of patients receiving TAD. Duration of response to TAD is identical to duration of response to tamoxifen alone. TAD is well tolerated, and toxicity, although greater than or tamoxifen, is acceptable.

Method of addition of cellulose to experimental diets and its effect on rat growth and protein utilization

The growth response of rats to experimental diets limiting in protein was used to evaluate two modes of addition of fiber. The first mode (trial A) used the more conventional approach of substituting cellulose for starch. The second mode (trial B) proceeded by total diet dilution, by which cellulose was added to a cellulose-free stock diet. Rats fed both types of diets compensated for the energy dilution and their digestible energy intake did not change markedly. However, both protein intake and growth increased with rising dietary cellulose levels in trial A and the protein efficiency ratio (PER) decreased. These did not change in trial B, except at the highest cellulose level, where growth and PER tended to decrease. Not only did the total diet digestibility and gross energy digestibility diminish upon the addition of cellulose to the diet, but the apparent protein digestibility also decreased in response to increasing dietary cellulose. We concluded that, in the design of experiments using high-fiber diets, careful consideration should be given to the effect which the method of dietary fiber addition has on the effective concentration of nutrients in the non-fiber portion of the diet and to the effect which variations in the parameter might have on nutrient utilization or biological responses to them. Our results indicate that, under conditions where protein is in limiting amounts in the low-fiber diets, total diet dilution is the more appropriate mode of dietary fiber addition. This conclusion may apply to other nutrients as well, but that remains to be proved.

Phase I and pharmacological studies of pentamethylmelamine administered by 24-hour intravenous infusion

A Phase I study of pentamethylmelamine (PMM) was conducted, administering the drug as a 24-hr i.v. infusion once weekly for 3 weeks. Doses ranged from 80 to 3000 mg/sq m/week. Twenty-six evaluable patients received a total of 30 courses of PMM. The median performance status of the patients was 60% (range, 40 to 90%), and the median age was 58 years (range, 43 to 72 years). The highest tolerated dose was 2000 mb/sq m/week. Nausea and vomiting were the dose-limiting toxicities; myelosuppression was neither consistent nor severe. One objective response lasting 10 months was noted in a patient with renal cancer. Pharmacokinetic studies using [ring-14C]PMM demonstrated a postinfusion half-life of 14C of approximately 12 hr, with the majority of the radiolabel excreted in the urine. PMM was introduced as a parenteral form of hexamethylmelamine. The present schedule does not permit administration of PMM in a dose greater than the tolerated dose of hexamethylmelamine and does not appear to offer an advantage over the p.o. use of the parent compound.

Phase I evaluation of succinylated Acinetobacter glutaminase-asparaginase in adults

Succinylated Acinetobacter glutaminase-asparaginase (SAGA) has broader antitumor activity than Escherichia coli L-asparaginase in experimental systems; moreover, drug resistance does not develop in tumor cell lines initially sensitive to this enzyme. We have investigated the pharmacology and toxicology of SAGA after both single-dose and serial daily dose injections in 20 adult patients. Glutaminase activity in plasma after i.v. injection of single doses did not follow simple first-order kinetics (half-life during the initial 24 hr was 21 +/- 9 hr. A linear relation was observed between increasing doses of SAGA and resultant levels of plasma enzyme activity and blood glutamate. Assay of whole blood which had been deproteinized immediately following phlebotomy showed that single doses of SAGA lowered glutamine only transiently to nondetectable levels; serial daily doses were required to achieve and maintain continuous glutamine depletion. Reversible depression of the central nervous system, ranging from encephalopathy to coma, occurred in a dose-related manner and was dose limiting. Other prominent reactions included respiratory alkalosis, hyperglycemia, nausea, and vomiting. Transient antitumor effects were noted in two patients with solid tumors and in two patients with leukemia. SAGA causes considerable neurotoxicity in adults which requires close patient monitoring. Phase II studies in leukemic patients are in progress.

Sleep apneic episodes as indications for adenotonsillectomy

Fourteen children with adenoid and tonsillar hyperplasia were studied for one night in the sleep laboratory. Six of the children had at least 40 apneic episodes per night, mostly central or obstructive. The largest number of episodes was found in rapid eye movement sleep. Mixed episodes were the longest and central episodes the shortest. Adenotonsillectomy was performed on children with at least 40 episodes and on children with predominantly obstructive episodes. In two of these children, preoperative and postoperative recordings were taken, revealing a reduction in the total number of apneic episodes and a complete disappearance of obstructive episodes. These results suggest that polysomnographic recordings can provide useful information regarding the necessity of adenotonsillectomy.

Extraction and analytic procedures for cytosine arabinoside and 1-beta-D-arabinofuranosyluracil and their 5'-mono-, di-, and tri-phosphates

A qualitative and quantitative comparison of perchloric acid (PCA) and trichloroacetic acid (TCA) extraction procedures of biologic material containing cytosine arabinoside (Ara-C) and 1-beta-D-arabinofuranosyluracil (Ara-U) and their biologic 5'-phosphate derivatives revealed definite superiority of the PCA procedure over the TCA procedure. High-pressure liquid chromatography provides rapid and accurate quantitative and qualitative separation of both Ara-C and Ara-U and their 5'-mono-, di-, and tri-phosphates (mu Bondapak NH2 column), or their 5'-mono-, di-, and tri-phosphates without nucleosides (ABX Permaphase columns).

Separation of 5'-mono-, di- and triphosphates of 1-beta-D-arabinofuranosylcytosine and of 1-beta-D-arabinofuranosyluracil by thin-layer and high pressure liquid chromatography

The separation of all the 5'-mono-, di- and triphosphates of ara-C and ara-U by thin-layer (TLC) and high pressure liquid chromatography (HPLC) is described. Whereas for the TLC two different systems are necessary, HPLC allows a rapid separation of all the nucleotides with high resolution, reproducibility, and sensitivity within 15 minutes. An example of an HPLC separation of ara-C and ara-U nucleotides derived from a biological sample is presented.

Human placental transfer of glucagon

1. The permeability of human chorion laeve in vitro to 125I-labelled glucagon was investigated. The problem caused by degradation of 125I-labelled glucagon in the preparation and a means to prevent this are described.

2. The human chorion laeve was found to be impermeable to iodinated glucagon.