Successful pregnancy in a patient with a double inlet left ventricle treated with a septation procedure

Because of improved medical and surgical care, women with univentricular hearts may live to enter the reproductive years and become pregnant. Pregnancy in a woman with a history of a univentricular heart treated successfully with a septation repair can follow a favorable course if she is acyanotic without functional or cardiovascular compromise.

The development of small cell lung cancer in the contralateral lung of a patient surviving 8 years after the original diagnosis of small cell lung cancer

The development of non-small cell lung cancer in patients successfully treated for small cell lung cancer has been previously described. Many of these non-small cell tumors appear to be second primary lung tumors. However, the development of second primary small cell lung cancers has not been clearly delineated. In this report, a patient with limited stage small cell lung cancer who had a complete response to chemotherapy plus chest radiotherapy and remained cancer-free for 8 years is described. Small cell lung cancer developed in this patient's contralateral lung with no evidence of recurrence at the original primary site. Clinical evidence suggests that a second primary small cell lung cancer developed in this patient.

Calcium currents, charge movement and dihydropyridine binding in fast- and slow-twitch muscles of rat and rabbit

1. The Vaseline-gap technique was used to record slow calcium currents and asymmetric charge movement in single fibres of fast-twitch muscles (extensor digitorum longus (e.d.l.) and sternomastoid) and slow-twitch muscles (soleus) from rat and rabbit, at a holding potential of -90 mV. 2. The slow calcium current in soleus fibres was about one-third of the size of the current in e.d.l. fibres, but was very similar otherwise. In both e.d.l. and soleus fibres, the dihydropyridine (DHP), nifedipine, suppressed the calcium current entirely. 3. In these normally polarized fibres, nifedipine suppressed only part (qns) of the asymmetric charge movement. The proportion of qns suppressed by various concentrations of nifedipine was linearly related to the associated reduction of the calcium current. Half-maximal suppression of both parameters was obtained with about 0.5 microM-nifedipine. The calcium current and the qns component of the charge movement also were suppressed over the same time course by nifedipine. Another DHP calcium antagonist, (+)PN200/110, was indistinguishable from nifedipine in its effects of suppressing calcium currents and qns. 4. In all muscle types, the total amount of qns in each fibre was linearly related to the size of the calcium current (in the absence of DHP). On average, qns was 3.3 times larger in e.d.l. fibres than in soleus fibres. 5. In contrast to the other dihydropyridines, (-)bay K8644, a calcium channel agonist, did not suppress any asymmetric charge movement. 6. The potential dependence of the slow calcium current implied a minimum gating charge of about five or six electronic charges. The movement of qns occurred over a more negative potential range than the change in calcium conductance. 7. Experiments on the binding of (+)PN200/110 indicated that e.d.l. muscles had between about 2 and 3 times more specific DHP binding sites than did soleus muscle. 8. These results point to a close relationship between slow calcium channels, the qns component of the charge movement and DHP binding sites, in both fast- and slow-twitch mammalian muscle. qns appears to be part of the gating current of the T-system calcium channels.

Immunolymphoscintigraphy of pulmonary and mediastinal lymph nodes in dogs: a new approach to lung cancer imaging

Despite improved resolution with new imaging techniques, surgical confirmation of mediastinal lymph node status is often required for reliable staging of patients with non-small cell lung cancer. Recent scintigraphic studies suggest that s.c. administration of radiolabeled antibodies can be more efficient than the i.v. route for targeting regional lymph nodes in animals and humans. To determine if this approach could be applied to the lymphatics of the lung, we injected both specific and irrelevant radiolabeled monoclonal antibodies via a flexible fiberoptic bronchoscope through the mucosa of lobar bronchi in normal dogs. The injected antibodies were expected to drain by way of local lymphatic vessels toward the central lymph nodes, in effect following the same pathway as do cells metastasizing to these nodes during early regional tumor dissemination. To accomplish this, anesthetized dogs were intubated and then coinjected with the two labeled antibodies [600 microCi/100 micrograms (total)] through a fiberoptic bronchoscope. The animals were serially imaged and then autopsied 14-36 h after injection. Individual hilar and carinal nodes contained over 1% of the injected 131I-labeled specific antibody dose and the average selectivity was 2.5:1 with respect to a coinjected irrelevant IgG. Distant organs (mesenteric lymph node, liver, spleen, bone marrow, and lung parenchyma other than the injection site) contained much less radioactivity, and those sites accumulated a greater fraction of the non-specific labeled antibody. The ratio of iodine-131 to iodine-125 counts between hilar/carinal lymph nodes and abdominal lymph nodes ranged from 15:1 to 100:1. These initial studies indicate efficient delivery of antibody to a subset of the regional nodes via pulmonary lymphatics. They suggest the feasibility of this technique which may be of use in the detection and perhaps therapy of human lung cancer metastases in regional lymph nodes.

Outpatient treatment of patients with substance abuse and coexisting psychiatric disorders

Thirty-two patients with coexisting substance abuse and other psychiatric disorders were treated in a unique outpatient pilot program that used techniques drawn from both psychiatric and substance abuse treatment. Eleven patients remained in treatment for 3 or more months, and seven completed a year or more of treatment. Severity of associated psychiatric illness did not affect retention in treatment. Drug-abusing patients and those with personality disorders dropped out quickly; patients with a history of reliable outpatient treatment involvement tended to remain in treatment. Treatment retention was associated with reduced hospital utilization. The authors suggest guidelines for management of patients with coexisting substance abuse and other psychiatric disorders.

Intracranial neoplasms in children

The outlook for children with intracranial neoplasms is not uniformly bleak. Fully half of these children have nonmalignant tumors. Treatment for patients with inoperable lesions remains unsatisfactory but may significantly prolong useful function. Knowledge of the wide variety of signs and symptoms produced by brain tumors in children, along with the increased availability of computed tomography, usually enables the physician to make the diagnosis quickly and refer the patient for treatment.

Patients with small-cell lung cancer treated with combination chemotherapy with or without irradiation. Data on potential cures, chronic toxicities, and late relapses after a five- to eleven-year follow-up

We assessed the outcome in 252 patients with small-cell lung cancer 5 to 11 years after treatment with combination chemotherapy, with or without chest and cranial irradiation, in National Cancer Institute therapeutic trials from 1973 through 1978. Twenty-eight patients (11%) survived free of cancer for 30 months or more. Fourteen patients remain alive without evidence of cancer beyond 5 years (range, 6.4 to 11.3 years), and 7 patients have returned to a lifestyle similar to that before diagnosis. The other 14 patients who were cancer-free at 30 months have developed cancer or died; 6 patients had a relapse, 4 developed or died from non-small-cell lung cancer, and 4 died of unrelated causes. A few patients with small-cell lung cancer (5.6%) may be cured. Thirty-month, cancer-free survival is insufficient to show a cure. Although late toxicities are troublesome, they do not outweigh the benefits of prolonged survival and potential for cure with modern aggressive therapy in small-cell lung cancer.

Ender nailing for peritrochanteric fractures of the femur. An analysis of indications, factors related to mechanical failure, and postoperative results

Of 100 patients with a peritrochanteric fracture of the femur treated by the Ender technique, we reviewed the cases of seventy-nine after an average follow-up of 11.4 months in order to clarify the indications for the procedure and investigate variables that may affect the results. The variables that correlated with the failure rate appeared to be the quality of the reduction, the number of nails used, the experience of the surgeon with the technique, and the degree of fracture instability. Nail placement in terms of medial-lateral and anterior-posterior positioning within the femoral head, however, did not appear to correlate. The Ender technique seems to be reasonably effective both for the treatment of stable intertrochanteric fractures and, if a good reduction and four or more nails are used, for the treatment of four-part unstable fractures. We do not recommend the technique for fractures with a subtrochanteric component unless mobilization of the patient can be delayed.

Voice-onset time as a clue to the nature of Broca speech errors

Blumstein, Cooper, Goodglass, Statlender, and Gottleib (Brain and Language, 9, 153-170 (1980] attempt to determine by an examination of the VOTs of aphasic speakers whether Broca's aphasics make phonemic substitutions in addition to their well-known phonetic errors. There are a number of problems with this study, mostly due to an apparent failure to fully appreciate the fact that VOT is a cover term for several acoustic features. It is suggested that VOT measurement in any given position in a word cannot solve this problem and that future studies should include glottographic observations as well as VOT measurements made in all positions in the word.

Quality review of outpatient psychopharmacological practice with APA Task Force criteria

The authors conducted quality review of outpatient psychopharmacological practice in 180 cases with the screening criteria of the APA Task Force on Psychopharmacological Criteria Development and a subset of 12 criteria involving higher-risk practices. Excessive duration of drug treatment was the most common questionable practice, and no relationship was found between frequency of questionable practices and patients' sex, age, social class, or Global Assessment Scale score. An educational exercise based on the audit resulted in a nonsignificant decrease in the higher-risk practices.

Late sequelae of allergic bronchopulmonary aspergillosis

Seven patients with late sequelae of allergic bronchopulmonary aspergillosis (ABPA) are described. All seven had significant chronic symptoms from asthma. At the time of diagnosis of ABPA all patients had marked irreversible pulmonary function abnormalities; symptoms of chronic bronchitis were present in all. Pulmonary fibrosis was present in six of seven patients. Three patients have died from irreversible lung disease with terminal cardiac failure. Despite the difficulty in establishing an early diagnosis of ABPA, its importance must be emphasized in order to attempt to prevent progression of the disease to severe irreversible and potentially fatal end-stage lung disease.

Emergency room patients in concurrent therapy: a neglected clinical phenomenon

The authors found that more than one-third of emergency room patients were participating in concurrent psychiatric treatment. Exploration of the relationship between patient and therapist proved to be a valuable tool in formulating consultation and in ensuring continuity of care.

The ototoxic potential of propylene glycol in guinea pigs

Propylene glycol, previously indicated to be ototoxic and to produce "deafness," was studied in the middle ear space of guinea pigs. Ninety percent propylene glycol produced conductive middle ear problems, but there was no loss of hair cells above that found in normal untreated animals. Ten percent propylene glycol produced no negative effects in the middle ear or elsewhere. Topical ear drops containing high concentrations of propylene glycol are contraindicated in cases with perforation of the tympanic membrane.