Acute surgical abdominal disease in chronic schizophrenic patients: a unique clinical problem

From our experience with chronic schizophrenic patients treated for acute intra-abdominal surgical disease, we present seven examples of this unique clinical condition. In all seven cases the decision to operate was preceded by considerable delay, owing to misleading medical history, patient behavior, and the lack of definitive signs of peritonitis. The intra-operative findings were unexpected, and in all cases the disease had reached an advanced stage. As chronic schizophrenic patients have a distorted perception of pain and seldom demonstrate a clinical picture commensurate with the disease, we advocate that a higher index of suspicion be assigned to these patients than to the average acutely ill patient.

Treatment of fistulas of the biliary tract by endoscopic insertion of endoprostheses

Five patients with fistulas of the biliary tract are reported; three had fistulas caused by operative injury and two, by accidental blunt abdominal trauma. All patients were treated successfully by endoscopic transpapillary insertion of biliary endoprostheses. The endoprostheses were removed after four to 17 weeks in all patients, and no evidence of biliary leakage was revealed by repeat cholangiograms and other clinical follow-up study. This effective, simple and safe method allows the fistula to heal and is a good alternative to surgical treatment.

The danger of high compliance balloons for esophageal dilatation in achalasia

High compliance balloons, commonly used for pneumatic dilatation of achalasia patients, theoretically subject the widened esophageal wall, proximal to the narrow zone, to increased pressure, and subsequently to a higher risk of perforation. The new type of inelastic cylindrically shaped balloons, such as the Gruntzig-type and Rigiflex Achalasia Dilator, seems to be safer, since it increases esophageal wall tension in the stenotic zone only. The purpose of this study was to present a pathophysiological consideration of this assumption, together with two cases which support it.

The persistence of neutralizing antibodies after revaccination against smallpox

Persistence of neutralizing antibodies after revaccination against smallpox was studied. Single serum samples from 140 revaccinated donors were tested for neutralizing antibodies using the plaque reduction assay. The donors, aged 21-49 years at sampling, had been vaccinated in infancy and revaccinated at 8 and 18 years; they formed seven groups of 20 men each, revaccinated about 3, 5, 10, 15, 20, 25, and 30 years before sampling. The differences in mean titer among groups were insignificant (P greater than .01). The titer significantly decreased during the first 3 years after the revaccination but remained stable for at least 30 years thereafter (geometric mean titer, 10.5; 95% confidence interval, 6.8-16.4). The results suggest that there is probably no need for routine revaccinations beyond the primary and two revaccinations; nevertheless, persons at high risk should be revaccinated regardless of their vaccination status.

Experimental model of acute appendicitis in the rabbit with determination of leucine amino peptidase (LAP) and acid phosphatase (acid-P) activities in portal blood samples

The activities of leucine amino peptidase (LAP) and acid phosphatase (Acid-P), conceivable markers of acute appendicitis, were determined in the portal blood of rabbits with acute appendicitis. An experimental model of acute appendicitis was established using No.-O silk ties to block the base of the appendix. The clinical and histopathological picture of acute appendicitis was seen after 12 hr in all the rabbits in the model group (9/9) and in none of the control group. Catheterization of the superior mesenteric vein was performed in rabbits with acute appendicitis, and portal blood samples were taken at 0, 6, and 12 hr for assay of LAP and Acid-P activities. No statistically significant difference between the experimental group and the control group, in the activities of LAP and Acid-P, was found at any time interval. The experimental model of acute appendicitis in the rabbit which is described here is simple and carries a high rate of success. This is probably the first report of using continuous catheterization and repeated sampling of portal blood, for the measurement of enzyme activities, in an experimental model of acute appendicitis. It was concluded that serum LAP and Acid-P activities cannot be used as markers for acute appendicitis.

Correlation between cutaneous reaction in vaccinees immunized against smallpox and antibody titer determined by plaque neutralization test and ELISA

The correlation between skin reaction, exhibited by vaccinees immunized against smallpox, and antibody titer determined by plaque neutralization and ELISA, was evaluated. Twenty eight out of 35 young adults (vaccinated at infancy and at the age of 8 years), who were injected with vaccinia virus, displayed a major skin reaction a week later. An increase of four-folds and more, in antibody titer against vaccinia virus, is generally considered positive immunization take-up against smallpox. According to this criterion, only 17 of the vaccinees were found positive by plaque neutralization, while 25 by the indirect micro-ELISA. Thus, there were eight vaccinees who were considered immunized by the ELISA, (seven of them also according to the skin reaction), but not by the plaque neutralization test.

[Papillary cystic neoplasm of the pancreas]

Papillary cystic neoplasm of the pancreas, usually found in the tail, is a relatively benign tumor that occurs predominantly in young women. We report a 17-year-old girl admitted for investigation of an abdominal mass found on routine examination. At operation a 12 cm solid mass was found originating from the tail of the pancreas. Distal pancreatectomy was performed and histopathological examination revealed a solid papillary cystic tumor.

[Repair of large abdominal wall defects with expanded polytetrafluoroethylene]

Most abdominal wall defects can be repaired by primary closure. However, when the defect is so large that there is tension on closure, use of prosthetic material is indicated. Expanded polytetrafluoroethylene has the advantages of low rates of infection, foreign body reaction and adhesion formation, making it the material of choice for repair of large abdominal wall defects.

Effects of systemic administration of indomethacin on ovulation, luteinization, and steroidogenesis in the rabbit ovary

Indomethacin blocks ovulation in human chorionic gonadotropin-stimulated rabbits. Experiments were done with an in vitro ovarian perfusion system to investigate whether indomethacin affects luteinization and steroidogenesis. Indomethacin (10 mg/kg) was administered in combination with human chorionic gonadotropin (100 IU) via a marginal ear vein, and a second dose of indomethacin was given 8 hours later. Control animals received vehicle in place of indomethacin. Laparotomy was performed 24 hours after the initial treatment. The presence of unruptured follicles and corpora lutea was recorded and the ovaries were perfused in vitro for 3 hours. Progesterone, prostaglandin F2 alpha, prostaglandin E2, and 6-keto-prostaglandin F1 alpha were measured in samples obtained at 0, 30, 60, 120, and 180 minutes from the circulating perfusion medium entering and exiting the ovary. At the end of the perfusion all ovaries (12 treated and 10 controls) were fixed for histologic analysis. Ovulation occurred in all control ovaries but in none of the indomethacin-treated ovaries. The mean number of unruptured follicles per ovary in the treated group was not significantly different from the number of corpora lutea plus unruptured follicles per ovary in the controls. Cells in both groups were qualitatively similar in ultrastructure; abundant lipid droplets, smooth endoplasmic reticulum, and mitochondria were seen. Secretion rates of progesterone and prostaglandin did not differ between the two groups during the 3-hour perfusion period. These results suggest that transformation of granulosa cells into fully functional luteal cells can occur in the absence of follicular rupture.

Acetylcholinesterase and nonspecific cholinesterase activities in rat liver: subcellular localization, molecular forms, and some extraction properties

Subcellular distribution and some extraction properties of acetylcholinesterase (AchE) (EC 3.1.1.7) and nonspecific cholinesterase (ChE) (EC 3.1.1.8) were studied in rat liver employing subcellular fractionation techniques. All purified subcellular fractions were enriched in total cholinesterase activity over the homogenate. Plasma membrane and Golgi fractions showed a significant enrichment in AchE activity, while ChE activity was enriched in both rough and smooth endoplasmic reticulum. Subcellular fractions were subjected to conditions that selectively release proteins having varying degrees of association to membranes. High-pH treatment (known to release peripheral and soluble proteins) extracted ChE activity, but more than 90% of AchE activity remained associated to the pellet. Solubility properties and molecular forms of AchE and ChE in this tissue were studied by extraction in high-salt medium with and without Triton X-100, followed by velocity sedimentation centrifugation. Most of AchE activity (88%) (41% G4 and 59% G2 + G1) was detergent soluble; 42% of ChE activity (detected only as G2 + G1) was high-salt soluble, whereas remaining ChE activity was detergent soluble. These results indicate not only a different subcellular location for both enzymes, but also point to a differential association to membranes. AchE behaves as an integral membrane protein and ChE behaves as a peripheral or a luminal soluble protein.

Transfection of EK-3, a subline of NIH 3T3, with the oncogene Ha-ras does not abolish its anchorage dependence

EK-3 cells, previously isolated by us from cultures of NIH 3T3, require both ras and myc oncogenes for efficient transformation, while their parent cells are readily transformed by ras alone. We transfected the EK-3 cells with the v-Ha-ras oncogene and obtained several sublines which integrated this gene and transcribed it successfully. The ras-NIH 3T3 formed foci of multilayered cells that were piling up in culture, while the ras-EK-3 cells remained contact inhibited. Furthermore, when the growth of the cells in soft agar was examined, a clear difference was observed. Cells of the ras-NIH 3T3 clonal lines showed high efficiency of growth (10%), while the ras-EK-3 cells exhibited low efficiency (0.2%). The latter being quite similar to that of the non-transfected NIH 3T3 and EK-3 cells (0.05%). The results presented now, showing that ras-EK-3 cells are more anchorage dependent than the ras-NIH 3T3 cells, clearly indicate that differences, previously shown to exist between EK-3 and NIH 3T3 cells, persist in their daughter cell lines derived following transfection with the Ha-ras oncogene.

Injuries due to deliberate violence in areas of Argentina. II. Lesions. Copenhagen Study Group

As part of a transcultural investigation of violent behavior in Argentina and Denmark, the lesions from accidents involving deliberate violence registered in the emergency wards of Hospital Fernandez and Hospital Pinero in Capital Federal Buenos Aires over a period of 13 and 17 months, respectively, were studied. Among the 281 victims entering the two emergency wards blunt violence without use of instruments was most often reported to be the violation method. Frequently indicated violation instruments against the male victims were batons (18.7%), sharp instruments (17.7%), and firearms (17.7%), the corresponding figures for female victims being 9.6%, 8.4% and 4.8%. The use of firearms and batons was considerably more pronounced in Argentina than in Denmark, particularly against male victims. A total of 373 primary and secondary diagnoses were reported from the patients, the most frequent diagnoses being contusions and open wounds in the head/neck region. Forty-three percent of the diagnoses were related to the head/neck region, being the most frequently injured region and the trunk the second most frequently injured region (30%). The degree of predominance of lesions in the head/neck region was much less than in the Danish material. Injuries of internal organs of the trunk were considerably more frequent in Argentina than in Denmark. Eighty-five percent of the victims had moderate or less serious lesions when assessed on the basis of the scores in the Abbreviated Injury Scale (AIS), (score less than or equal to 2). The AIS scores of the lesions in female victims were on average only slightly higher than those recorded in the Danish study, while 16.1% of the male Argentinian victims had lesions scored greater than or equal to 3 compared to 1.8% in male Danish victims. The need for treatment and hospitalization was more pronounced than in the Danish study. It may be concluded that the frequency of serious cases of deliberate violence probably would decrease if more restrictive rules for the possessing of firearms were enacted and enforced.

Injuries due to deliberate violence in areas of Argentina. I. The extent of violence. Copenhagen Study Group

As part of a transcultural investigation of violent behaviour in Argentina and Denmark an analysis was made of the incidents involving deliberate violence as registered in the emergency wards of Hospital Fernandez and Hospital Pinero in Capital Federal Buenos Aires over a period of 13 and 17 months, respectively. In the two emergency wards a total of 281 victims of deliberate violence were observed corresponding to a rate of approximately 0.2/1000 per year in a mainly middle income area of the metropolis Buenos Aires, the catchment region of Hospital Fernandez, and 0.6/1000 per year in a mainly low income area of Buenos Aires, the catchment region of Hospital Pinero. Men aged 20-24 years and 40-49 years were found to be the most frequent victims of deliberate violence, 13% and 11%, respectively. Elderly women greater than or equal to 60 years of age were rarely found to be victims of deliberate violence (2%). Skilled and unskilled male workers were over-represented as victims of violence. Sixty-four percent of the victims were men and 29% women, 6% were boys and 0.7% girls less than or equal to 14 years of age. Twenty-one percent of the male victims and 5% of the female victims were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for only 7% of the male victims, while 55% of male victims and 34% of female victims had been injured in the street, most often by non-acquainted men. Fifty-eight percent of the female victims had been subject to deliberate violence at home, in the majority of the cases beaten by their spouse. Twelve percent of the male victims and 8% of the female victims were estimated to be under the influence of drugs. The incidence of deliberate violence seems to be lower in Argentina than in Denmark. However, serious lesions appear to be considerably more frequent in male Argentinian victims compared to male Danish victims, maybe because the practice of seeking medical assistance is different in the two countries. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors. Influence of alcohol does not appear to play a role that is comparable to the situation observed in Denmark. A considerably larger percentage of victims in Argentina than in Denmark had been injured in the street.

[Swallowed toothbrush: an indication for immediate endoscopy]

Foreign body ingestion is a common problem encountered in the emergency room. A swallowed toothbrush poses a special problem as it never passes through the GI tract spontaneously. Early endoscopy and removal is recommended. We report a 16-year-old girl who accidentally swallowed a toothbrush which was extracted via endoscopy without complications.

Persistence of remnants of hormonally active tubal trophoblast 3 months following linear salpingostomy in the face of undetectable serum beta human chorionic gonadotropin

Viable remnants of trophoblastic tissue were found 3 months following linear salpingostomy for ectopic pregnancy despite the disappearance of serum beta human chorionic gonadotropin.

Primary blast injury after a bomb explosion in a civilian bus

A 6-kg explosive charge detonated under a seat in the center of a crowded city bus in Jerusalem, killing three passengers immediately. Of the 55 survivors, all of whom were transferred to two major medical centers, 29 were hospitalized. Among those admitted, a high rate of primary blast injuries was found, including perforated ear drums (76%), blast lung (38%), and abdominal blast injuries (14%). Two of the latter patients suffered bowel perforations, which were diagnosed with considerable delay. Eight patients (31%) had sustained life-threatening trauma, consisting of a combination of primary, secondary, and tertiary blast injuries. The overall mortality rate was 10.3%. The large number of primary blast injuries, including the unexpected finding of bowel perforations, is explained by the high amplitude of the air pressure wave (3.8-5.2 atm) and its relatively long duration (2-3 msec) resulting from the detonation of the high-energy explosive charge in the small, enclosed space of the bus. Besides the usual wounds sustained by victims of an explosion that occurs in a confined space, the possibility of primary blast injury to the abdomen and to the lungs should be taken into account by the treating surgeon.

Elevated virulence of Newcastle disease virus strains following serial passages in kidney cells in vitro

Serial passage of two lentogenic Newcastle disease virus (NDV) strains in kidney cell lines increased virulence and changed viral biological properties. In two cell lines (BHK and MDBK), elevation in virulence was demonstrated by plaque formation under an overlay with no additives, decrease in mean death times, elevated intracerebral pathogenicity index, and cytopathic effect in chicken embryo fibroblasts. Some other markers not directly correlated to virulence, such as heat inactivation of hemagglutinin and neuraminidase, were not influenced by passage in kidney cells. In addition, all strains were slow eluters. This observation emphasizes the importance of preventing the virus from reaching the viscera.

Successful treatment of a prolactin-producing pituitary macroadenoma with intravaginal bromocriptine mesylate: a novel approach to intolerance of oral therapy

A 37-year-old woman with a symptomatic 18-mm prolactin-secreting pituitary adenoma could not be managed with oral bromocriptine mesylate because of unacceptable gastrointestinal side effects. However, when given the medication intravaginally, the patient was successfully treated as assessed by evident tumor shrinkage and diminished secretory activity. Serum bromocriptine levels were approximately six to eight times higher than those reported after oral administration. The vaginal route may help reduce some of the adverse effects of bromocriptine mesylate experienced during oral administration and may possibly allow lowering of the overall effective dose by avoiding first liver passage.

Eat for health: a nutrition and cancer control supermarket intervention

The growing evidence linking dietary patterns to the incidence and prevention of chronic disease has prompted a number of prominent health and scientific agencies to publish dietary guidelines for the public. Some dietary guidelines address specific diseases, such as cancer or heart disease; others focus on overall health promotion. This situation has created a demand for nutrition education and information programs for the public. Increasingly, supermarkets are seen as potential sites for effective consumer education. Eat for Health is a joint research study by the National Cancer Institute (NCI) and Giant Food Inc., a regional supermarket chain in the Washington-Baltimore area. The study's goal was to test the feasibility of supermarkets as a site for consumer nutrition education. Eat for Health's educational focus was diet and cancer control issues in the context of dietary patterns that promote health. Particular attention was paid to reduction of fat intake and increases in consumption of dietary fiber from grains, vegetables, and fruits. Analysis of program results is currently underway; data should be available in early 1990.