Computed tomography of bronchial carcinoid

Computed tomography was used to evaluate three patients with endobronchial tumors. In each case the mass showed enhancement following intravenous contrast medium administration. Each patient underwent surgical resection, and pathology showed carcinoid tumor in each case.

Absence of a relationship of size of primary colon carcinoma with metastasis and survival

This retrospective study analysed the relationship of tumor size to regional and systemic metastasis and to survival according to stage of disease. Colon cancers (391 cases) that were treated surgically at M. D. Anderson Hospital from 1955 to 1975 were reviewed. Staging of disease was based on the Astler-Coller modification of Dukes' staging classification. The mean diameters (cm +/- s.e.m.) of Dukes' B1, B2, C2 and D tumors were 4.47 +/- 0.34 (n = 46), 6.61 +/- 0.29 (n = 147), 5.39 +/- 0.23 (n = 71) and 5.78 +/- 0.24 (n = 120), respectively. The mean diameter of Dukes' B2 tumors was significantly greater than C2 (P less than 0.001) and D (P less than 0.05) tumors. Within stage B and C, size of the primary tumor showed no relationship to five year adjusted survival. Our findings suggest that colon carcinoma metastasis and survival are independent of tumor size. Because tumor burden does not account for distant disease, specific tumor cell phenotypes and biological processes are probably more important in determining metastatic disease.

Pneumothorax during positive-pressure mechanical ventilation

The hemodynamic and respiratory effects of unilateral pneumothorax were studied during positive-pressure mechanical ventilation in five sheep. The sheep were anesthetized, intubated, and placed on mechanical ventilation with positive end-expiratory pressure (5 cm H2O). After baseline studies, including chest roentgenograms, were taken, increments of air were injected into the right pleural cavity. Measurements were repeated at pneumothoraces of 500, 1,000, and 1,500 ml. There was a steady fall in cardiac output (p less than 0.02) at pneumothoraces of 1,000 and 1,500 ml. The decrease in cardiac stroke volume paralleled that of cardiac output. Heart rate rose (p less than 0.05) at a pneumothorax of 1,500 ml. There appeared to be a linear relationship between the percent increase in pneumothorax as estimated by roentgenogram and the percent fall in cardiac output (r = 0.991). There was a steady rise in mean pulmonary arterial, pulmonary arterial capillary wedge, superior vena caval, and inferior vena caval pressures, although the changes in inferior vena caval pressure were not statistically different from baseline. Peak airway pressure increased from baseline at pneumothoraces of 1,000 and 1,500 ml. Both right and left end-expiratory intrapleural pressures increased and were statistically different (p less than 0.01) from baseline. However, there was a substantially greater rise in right intrapleural pressure than left. Arterial oxygen tension remained physiological throughout the study. This study indicates that cardiac output decreases as the amount of pneumothorax increases in sheep during mechanical ventilation. This study also demonstrates that, during positive-pressure mechanical ventilation, a relatively benign-appearing pneumothorax by chest roentgenogram may be associated with a significantly depressed cardiac output. In addition, arterial oxygen tension may not be useful in predicting the onset of pneumothorax during mechanical ventilation.

MR imaging of the mediastinum: a retrospective comparison with computed tomography

Magnetic resonance (MR) imaging of the mediastinum was performed with a 0.12 T resistive magnet and compared with the results of CT. On T1 weighted images with partial saturation technique, soft tissue masses, lymphadenopathy, lipomatosis, and vascular anatomy were comparable with MR and CT imaging in 19 of 30 patients (63.3%). In the remaining 11 patients only slight differences between the two modalities were observed. Our experience suggests that MR imaging at low field strength is equivalent to CT in the morphologic assessment of the mediastinum without the need for administration of intravenous contrast medium or exposure to ionizing radiation.

First report of intramyocardial pH in man: I. Methodology and initial results

Continuous in vivo measurements of intramyocardial pH (MpH) have not been previously obtained in man. To achieve this goal, we developed in our laboratory a new, steel-jacketed, glass electrode, and circumvented temperature-related problems by recording the output in millivolts along with the adjacent myocardial temperature. A computer program was devised to calculate MpH in accordance with the Nernst equation. The need in this system for a remote, subcutaneous, reference electrode prompted two sets of experiments. The first set of experiments demonstrated in vitro that the adverse effect of varying the temperature of the reference electrode on the calibration of the pH electrode could be avoided if the reference electrode was placed in a potassium chloride (KCl) solution outside the body and connected to the subcutaneous tissues with a salt bridge. The second set of experiments, which were conducted in vivo in dogs, demonstrated that MpH measurements made with the reference electrode in the limb were not affected by ischemic electrocardiographic changes. This system was then used successfully in 10 patients undergoing coronary artery bypass surgery. Reliable, reproducible, and uniform changes were observed. Baseline MpH prior to revascularization was 6.81 +/- 0.07. Myocardial protection with cold K+ cardioplegia resulted in a significant rise in MpH to 7.45 +/- 0.06. Throughout the period of cross-clamping, MpH remained high. After revascularization and discontinuation of cardiopulmonary bypass, MpH stabilized at 6.93 +/- 0.04.(ABSTRACT TRUNCATED AT 250 WORDS)

Human peritoneal macrophage cytotoxicity mediated by cytophilic IgG

Cells of the human mononuclear phagocyte system have recently been shown to possess cytophilic IgG molecules that promote phagocytosis of staphylococci bearing cell-wall protein A. In the present study, the possible mediation of a cytotoxic response to 51Cr-labeled sheep erythrocytes coated with protein A by cytophilic antibodies on human peritoneal macrophages was evaluated. The target cells were readily lysed by peritoneal macrophages. Cytotoxicity was blocked by pretreatment of macrophages with soluble protein or with anti-Fc F(ab')2 fragments. In contrast, cytotoxicity was not affected by cytochalasin B; this finding suggests that cytolysis is an extracellular event. Perturbation of cytophilic IgG with particle-bound protein A elicited a chemiluminescent response from peritoneal macrophages; however, experiments with scavengers of reactive oxygen species indicated that toxic oxygen radicals may not be required for cytotoxicity. The results indicate that cytophilic antibody-mediated cytotoxicity may contribute to cellular injury as well as host-defense aspects of the inflammatory process.

Increases in HDL-cholesterol and the HDL/LDL cholesterol ratio during prolonged endurance exercise

The influence of prolonged, low-intensity exercise (45% VO2max) until exhaustion on plasma lipid levels, in particular high-density lipoprotein cholesterol (HDL-C), and the time sequence associated with changes in these blood constituents was investigated in 10 trained subjects. The exercise consisted of walking on a motor-driven treadmill until exhaustion. Blood samples were drawn before, at 30 and 60 minutes after the beginning of exercise, at each hour thereafter until exhaustion, immediately before exhaustion, and after a 30-minute recovery period. At exhaustion the total cholesterol concentration was significantly elevated by 3% and rose another 3% during the recovery period. The HDL-C level was significantly elevated within two hours after the start of exercise and by exhaustion (about 4.5 hours of exercise) had risen to 52.5 +/- 2.3 mg X dL-1, which represented a 10.8% increase above the pre-exercise concentration (47.4 +/- 1.8 mg X dL-1). The HDL/LDL cholesterol ratio followed a pattern similar to that described for HDL-C. Plasma free fatty acids (FFA) also increased linearly during the exercise period but were not significantly correlated with HDL-C during exercise (r = 0.14). These results suggest that prolonged, low-intensity exercise can acutely improve the lipid profile of humans.

Transplantation of T-lymphocyte-depleted bone marrow between HLA-mismatched individuals

Four patients with acute leukemia received transplants from HLA-mismatched, related donors. Marrow cells that had been depleted of T lymphocytes using a monoclonal anti-T-lymphocyte antibody and rabbit complement were used. In vitro studies showed that 80-97% of the mature T lymphocytes were removed using this procedure. Infusion of the treated marrow was accomplished without complications, and engraftment occurred in each case. Graft-versus-host disease occurred in 3 of the 4 patients. These results show that additional manipulations of the marrow will be required to allow complete T lymphocyte removal from the marrow before the feasibility of this approach in HLA-mismatched patients can be determined.

Red cell cation transport: differences between black and white school children

Differences in red cell sodium content and sodium-lithium countertransport were studied in black and white children with a mean age of 12 years. For both boys and girls red cell sodium content was higher in blacks and countertransport lower (P less than 0.05). For both ethnic groups red cell sodium was lower in girls than boys and a consistent positive relationship was noted between body mass index and countertransport. Despite the lower red cell Na-Li countertransport values in black compared to white children, a significant positive correlation with systolic blood pressure was found independent of adiposity. In contrast, no correlation was evident between Na-Li countertransport and blood pressure in the white children. If red cell cation transport is confirmed as a marker for hypertension, study of racial differences may help explain the twofold higher prevalence of this disease among blacks.

Display station anthropometrics: preferred height and angle settings of CRT and keyboard

This study investigates display station physical adjustments preferred by a sample of visual display terminal operators. Participants in the study were selected to assure representation of extremely short and extremely tall persons, as well as persons of midrange physical stature. Individual operators were led through a step-by-step sequence to determine their preferred initial settings of seat height, keyboard height and slope angle, and CRT height and tilt angle. Each operator then performed a brief text input task, after which final preferred adjustments were measured.

Intermeasure correlation strongly suggest that “flat” (low slope angle) keyboards are inappropriate for short operators who select low seat heights. In addition, the keyboard angle adjustments preferred by most operators substantially exceed a current German ergonomic display station requirement.

A candidate reference method for uric acid in serum. II. Interlaboratory testing

We describe the interlaboratory testing of a candidate Reference Method (Part I) for uric acid in serum. The method is based on the ultrasound spectrophotometric quantitation of uric acid before and after incubation with uricase. A comprehensive investigation involving 12 laboratories was organized to document the transferability, intra- and interlaboratory precision, and general reliability of the candidate Reference Method. The interlaboratory CV with this method was about 2 to 6% for uric acid concentrations ranging from 0.12 to 0.60 mmol/L. The results detailed here demonstrate that the method can be successfully duplicated among different laboratories.

A candidate reference method for uric acid in serum. II. Interlaboratory testing

We describe the interlaboratory testing of a candidate Reference Method (Part I) for uric acid in serum. The method is based on the ultrasound spectrophotometric quantitation of uric acid before and after incubation with uricase. A comprehensive investigation involving 12 laboratories was organized to document the transferability, intra- and interlaboratory precision, and general reliability of the candidate Reference Method. The interlaboratory CV with this method was about 2 to 6% for uric acid concentrations ranging from 0.12 to 0.60 mmol/L. The results detailed here demonstrate that the method can be successfully duplicated among different laboratories.

Dietary sodium, erythrocyte sodium concentration, sodium-stimulated lithium efflux and blood pressure

1. There was a significant positive relationship between sodium-stimulated lithium efflux and systolic blood pressure (r = 0.512) in erythrocytes of black school children. Weight was also positively and significantly correlated with blood pressure. Although erythrocyte sodium concentration did not bear any significant relationship with blood pressure, it did bear significant inverse relationship with urinary sodium excretion. 2. High-school students were randomly assigned to either the experimental or the control group. In the former a reduction of about 70% in salt intake was achieved. After 24 days, the erythrocyte sodium concentration was significantly reduced in the experimental group. A non-significant decline in systolic blood pressure was observed in the experimental group; no change was detectable in the control group for either erythrocyte sodium concentration or systolic blood pressure.

Improved mortality among U.S. Blacks, 1968-1978: the role of antiracist struggle

A marked improvement in health status for black adults took place over the last decade in the United States. Life expectancy for black men increased 4.6 years between 1968 and 1978, while for black women the increase was 5.7 years. Death rates for the age group 35-74 decreased approximately 25 percent for blacks over the same period. The largest contribution to this improvement was made by cardiovascular diseases (coronary heart disease and stroke). Although similar improvement was observed in the white population, on both a percentage and absolute basis the change was greater for blacks. For the first time in the U.S., important progress was made in the effort to narrow the gap in mortality rates between black and white adults. Hypertension detection and control appears to have played the key role in this positive public health trend. The community-based demand for greater access to medical care, which emerged from the social struggle of the 1960s, also can be accorded a major social role. The current policies of the Reagan Administration pose a serious threat to these antiracist programs, as well as to the effort to close the gap in black-white mortality.

Racism, society, and disease: an exploration of the social and biological mechanisms of differential mortality

Racial differentials in mortality provide important insight into the nature of mass disease in capitalist society. Not only are the differentials sizable in magnitude, they are consistent for multiple causes of death and appear to evolve in response to social development. The relationships among social factors and the biological and physical agents of disease can be identified through racial contrasts and a pattern of causation which applies to both the minority and majority populations described. Furthermore, the impact of exploitation as the primary disease-mediating factor under capitalist social relations can be estimated. This paper attempts to combine an analysis of bio-medical mechanisms with Marxist social theory in a comprehensive framework for the study of the social origins of racial differentials.

Human T-cell lymphoma with suppressor effects on the mixed lymphocyte reaction (MLR). I. Morphological and cytogenetic analysis

The aggressive clinical course and the distinctive histologic, cytochemical, and cytogenetic features of an adult non-Sézary T-cell lymphoma with suppressor activity have been investigated. Morphological and ultrastructural analysis of neoplastic cells from peripheral blood and involved lymph nodes revealed cells with convoluted nuclei, prominent cytoplasmic azurophilic granules, well developed Golgi apparatus, short strands of endoplasmic reticulum, and moderate numbers of ribosomes and mitochondria. Cytochemical reactions showed acid phosphatase (ACP) positivity in virtually all of the neoplastic cells; and a substantial percentage of the cells, the tartrate-resistant acid phosphatase (T-ACP) isoenzyme was observed. Granular naphthyl acetate esterase (A-EST) reactivity was not present. The histological and cytochemical features of these neoplastic suppressor cells were compared with those recently described for the suppressor T-cell fraction isolated from normal peripheral blood T-cell by Fc gamma-rosette formation. The aneuploid clone had 47 chromosomes with multiple complex abnormalities, including a 14q + chromosome formed by the tandem translocation of two no. 14 chromosomes and translocations involving the long arms of no. 2 and no. 9 at band 9q34. These latter changes are particularly common in T-cell disorders. The extensive analysis of this histologic, cytochemical, and cytogenetic features of this adult T-cell suppressor lymphoma should help to clarify the criteria for distinguishing among the subsets of T-cell neoplasms with definable immunologic function.

The treatment of haemorrhoids by rubber band ligation at St Mark's hospital

Two hundred and ninety-five patients with symptomatic haemorrhoids were treated by rubber band ligation as out-patients at St Mark's Hospital, London, between April 1972 and December 1975. Follow-up was possible in 260 patients of whom two-thirds were satisfied with the outcome: 69 patients had residual symptoms for which no treatment had been sought. Nineteen patients eventually required a haemorrhoidectomy.

Modulation of the two promoters of the galactose operon of Escherichia coli

The gal operon of Escherichia coli is controlled by two independent promotors--one is activated and the other inhibited by cyclic AMP and cyclic AMP receptor protein. The two promotors are modulated, however, by the same operator locus and receptor protein.

A succesful repair of a recto-urethral fistula: a case report

A case report of a method of repair of a recto-urethral fistula is described. A combined synchronous abdominoperineal approach was used with the patient in the lithotomy-Trendelenburg position. The greater omentum was mobilized and interposed between the repaired rectum and the prostatic urethra. A review of the literature is presented.

The seeded growth of calcium phosphates on dentin and predentin

The in vitro mineralization of predentin (PD) and of the organic component of dentin (OD) has been studied in a supersaturated solution of calcium phosphate at 37 C and pH=7.4 at total calcium and phosphate concentrations close to those in vivo. The mineralization of OD can be divided into at least three periods based upon the morphology and the specific surface area of the mineral phase formed. Dissolution of the newly precipitated mineral on OD revealed a stoichiometry close to that for octacalcium phosphate. In contrast, PD was ineffective as a crystal nucleator. The mineralization of the inorganic component of dentin (ID) and whole dentin (D) has also been examined.

Chronic synovitis with early cartilage destruction in sickle cell disease

Two patients with sickle cell disease presented with joint pain and early x-ray evidence of articular cartilage loss. Both later developed increasingly destructive arthritis with chronic synovitis identified in synovial biopsies. One patient developed demonstrable aseptic necrosis. Destructive arthropathy is much less common than the frequent transient effusions in sickle cell disease.

The natural history of recurrent herpes simplex labialis: implications for antiviral therapy

We performed daily examination of 80 patients with recurrent herpes simplex labialis to define the course of the disease and to identify quantitative and objective measurements for use in monitoring the efficacy of antiviral chemotherapy. Pain, lesion size, mean virus titers from lesion swabs (10(5) plaque-forming units [PFU]) and frequency of virus-positive lesions (89 per cent) were maximal during the first 24 hours and decreased thereafter. Lesion punch-biopsy virus titers increased from a mean of less than 10(1) PFU in the prodromal and erythema stages to a mean of 10(4.7) in the vesicle stage. MEasurements potentially useful in monitoring antiviral efficacy include: time to loss of crust, time to complete healing, intensity and duration of lesion pain, area defined by lesion virus titer and duration of lesion virus excretion, and maximum lesion virus titer after the first visit. Early application of topical antiviral therapy should theoretically be able to alter the course of this disease.

The effects of prostaglandin E1, bradykinin and histamine on canine synovial vascular permeability

1 The relative effects of prostaglandin E1, bradykinin and histamine on canine synovial vascular permeability were investigated by a method based on the measurement of the amounts of radiolabelled dextran (molecular weight 20,000) leaking from the circulation into the synovial cavity. 2 Bradykinin, prostaglandin E1 and histamine in that order of potency all increased synovial vascular permeability. Threshold concentrations were 0.3 micrometer, 3 micrometer and 30 micrometer respectively. 3 The effects of infusion of prostaglandin E1 combined with either bradykinin or histamine were greater than mere summation.

Metabolism of (14C) cefaclor, a cephalosporin antibiotic, in three species of laboratory animals

The metabolic fate of the orally effective cephalosporin antibiotic cefaclor (Lilly 99638) has been studied in rats, mice, and dogs. Cefaclor is efficiently absorbed from the gastrointestinal tract as the intact antibiotic. In rats and mice, cefaclor, for the most part, escapes metabolism in the body and is eliminated unchanged as unaltered antibiotic, primarily by renal excretion. In dogs, however, cefaclor is more labile to metabolism and only a portion of the administered antibiotic is eliminated unchanged via the kidney.

Aorto-coronary graft for dissected coronary artery

A 46-year-old woman while undergoing selective coronary cine angiogram dissected her coronary artery. She was managed by heparin therapy followed by urgent aorto-coronary artery saphenous vein graft with no consequences.

Congenital fistula between an aberrant systemic artery and a pulmonary vein without sequestration. A report of three cases

Three children had an arteriovenous fistula between an aberrant vessel from the descending aorta and a normal pulmonary vein in the posterior basal segment of a lung. The affected lung was otherwise normally developed. Only a few similar cases could be found in the literature.

Masochism: a clinical and theoretical overview

This paper will review some of the theoretical and clinical features of masochism from an eclectic point of view. The topic of masochism has been taken up by authors of many perspectives because it addresses one of the anomalous, absurd, difficult-to-explain aspects of behavior for which no psychological system has an easy answer. Therefore, a wide-ranging literature on the topic of masochism is available. However, few previous reviewers have attempted to draw from a variety of disciplines and theoretical frameworks. In this review the historical development of the term and some of the psychoanalytic conceptualizations will be presented first. Since previous reviews of masochism from a strictly psychoanalytic perspective are adequate (Brenner, 1959; Eisenbud, 1967; Fenichel, 1945; Loewenstein, 1957; Panken, 1967), our discussions of masochism will be developed employing more extensively the interpersonal, social, learning theory, and biological perspectives.

A fixed-ankle, below-the-knee orthosis for the management of genu recurvation in spastic cerebral palsy

A fixed-ankle, below-the-knee molded plastic splint designed to maintain the ankle in 5 degrees of dorsiflexion and correct any foot deformity was used on eighteen extremities of twelve children with spastic cerebral palsy and genu recurvatum. After an average follow-up of twenty-six months, the genu recurvatum was well controlled and gait was improved.

Stimulation and inhibition with LH and other hormones of female mammalian meiosis in vitro

Utilizing some known physiological preovulatory hormone levels and specific cytological end-points, experiments were carried out with two different media to obtain a clearer understanding of meiotic maturation in vitro of ewe, cow, monkey and human oocytes. In the first series of experiments, it was shown that, in McCoy's medium, ovine LH, prostaglandin E1 and ovine prolactin increased the percentage of divisions of ewe oocytes, without cAMP as a demonstrable intermediate. Monkey oocytes incubated in McCoy's medium with fetal calf serum were stimulated by ovine LH, prostaglandin E2 or cAMP. Human oocytes were stimulated to divide in Diploid medium by ovine LH, oestradiol-17 beta with LH added later, or prostaglandin E1. Diploid medium containing added sheep serum markedly inhibited the meiotic activity of ewe oocytes when ovine LH, HCG, cAMP, prostaglandin E1 and E2 of prolactin were added. This effect was studied by separating the contained fetal calf and sheep sera. It was noted that when LH, HCG, or prostaglandins E1 and E2 were added to a system utilizing fetal calf serum, only spontaneous resumption of meiosis occurred: stimulated and spontaneous activity were reduced when cAMP or prolactin were added. The inhibition of ewe oocyte maturation in Diploid medium with sheep serum and additives was also seen with cow oocytes incubated in Diploid medium containing fetal calf serum and LH, HCG, cAMP or prostaglandin E1 and E2. Cow oocytes incubated in McCoy's medium with equivalent fetal calf serum and added LH were sharply inhibited but spontaneous maturation persisted in the presence of added HCG, cAMP or bovine prolactin.