Prostaglandins and the management of congenital heart disease

Either continued patency or closure of the ductus arteriosus is needed to improve survival of infants with certain kinds of congenital heart disease. In many of these infants, the use of prostaglandin (PGE1) or a prostaglandin synthetase inhibitor (indomethacin) permits clinical stabilization in preparation for surgery or makes surgery unnecessary. Although these forms of therapy carry some risk, the risk does not outweigh that of the untreated congenital defects.

Pharmacist-coordinated pneumonia and influenza vaccination program

High-risk candidates in an ambulatory-care center were identified and immunized against pneumococcal pneumonia and influenza in a program coordinated by a pharmacist. Patients determined to be at increased risk for pneumococcal pneumonia were notified by letter of the vaccination program and encouraged to participate. Participants were then screened by their health-care providers to determine whether they were candidates for the vaccination. Those who received the pneumococcal pneumonia vaccine were later urged to be immunized against influenza virus. Of 1593 patients selected as possible vaccine candidates, 474 received the pneumococcal vaccine and 397 received the influenza vaccine. No confirmed cases of pneumococcal pneumonia and only one case of flu-like syndrome developed among the immunized patients. Income from the program exceeded its cost, excluding the salaries of the center's employees. Substantial savings were projected from reduced future treatment costs. The pharmacist had initiated and coordinated a successful effort to increase vaccine use and decrease morbidity.

Carcinoma of the tonsillar region: results of external irradiation

A retrospective analysis is made of 104 patients treated with photon megavoltage radiotherapy for squamous cell carcinoma of the tonsillar region during the period 1965--1975. Moderately differentiated squamous cell carcinoma was the most common histological grade. Fifty-three per cent of the cases presented with cervical lymphadenopathy with three cases of bilateral involvement. The three year local control rate was 100% for Stage I, 74% Stage II, 49% Stage III, and 33% Stage IV. Two Stage III cases and one Stage IV case developed subsequent contralateral neck disease. No patient with either T1N0 or T2N0 tumor failed in the ipsilateral or contralateral neck despite the fact that 42% of the T1N0 cases and 37% of the T2N0 cases were treated with unilateral portals. The prognostic significance of the T and N stages, treatment techniques, as well as dose response relationships are analyzed and the literature is reviewed.

Effect of hydralazine on aortic rupture induced by B-aminopropionitrile in turkeys

The effects of hydralazine on aortic rupture, hemodynamics and aortic ultrastructure were studied in turkeys fed B-aminopropionitrile (BAPN). A mortality rate of 24% due to hemopericardium and internal hemorrhage in turkeys fed only BAPN increased to 91% when turkeys were fed both BAPN and hydralazine, despite a significant reduction in blood pressure after both drugs. Death rates among turkeys fed BAPN and hydralazine were lowered by adding either dietary propranolol (53%), which lowered blood pressure and dP/dt max, or reserpine (67%), which reduced blood pressure and increased dP/dt max. Striking ultrastructural alterations of collagenous and elastic fibers of the aortic media, which were additive to the effects of BAPN alone, were induced by BAPN and hydralazine. This study demonstrates that a 6-week feeding of high levels of BAPN and hydralazine, which accumulates in vessel walls, can produce vascular injury and increase mortality from hemorrhage in lathyritic turkeys.

Crystalline inclusions in erythrocytes parasitized with Babesia equi following treatment of ponies with imidocarb

Four splenectomized Welsh ponies were infected with Babesia equi. Two ponies were treated with imidocarb dipropionate, and two were not treated. By light microscopic examination, 1% to 2% of the parasitized erythrocytes of treated ponies contained crystalline inclusions. The crystals were rectangular, diamond, or burr shaped. They occupied most of the erythrocytic cytoplasm, and, as a result, the remainder of the pale staining cytoplasm was inconspicuous in Wright-Giemsa-stained blood smears. The size and shape of intraerythrocytic inclusions varied when examined by electron microscopy, but in most instances they were either adhered to or were located close to the parasite. The sides of crystals were either smooth or serrated, and corners were either sharp or notched. Fractures or faults were common in large crystals. Parasitized erythrocytes of nontreated ponies and nonparasitized erythrocytes of treated ponies did not contain crystals. Four hemoglobulin types were identified in five noninfected, nontreated Welsh ponies from the same herd.

The interaction of amine local anaesthetics with muscarinic receptors

1 Amine local anaesthetics inhibited the binding of (-)-[3H]-quinuclidinyl benzilate ((-)-[3H]-QNB) to muscarinic receptors in crude synaptosomal preparations from guinea-pig brain. The order of potency was SKF 525A greater than tetracaine greater than procaine congruent to quinidine greater than procainamide greater than bupivacaine greater than lignocaine greater than prilocaine. 2 The concentration of tetracaine or prilocaine causing 50% inhibition of the receptor-specific binding of [3H]-QNB varied linearly with the concentration of [3H]-QNB present for the range of concentrations of prilocaine used and at lower concentrations of tetracaine, thus providing evidence for a competitive interaction. The affinity constant for tetracaine was 2.6 +/- 0.2 x 10(5) M-1 and that for prilocaine 2.6 +/- 0.8 x 10(3) M-1. At higher concentrations of tetracaine the interaction appears to diverge from simple competitive kinetics. 3 The log dose-response curve for the contractile response of longitudinal muscle strips from guinea-pig intestine to carbachol was shifted in a parallel fashion by low concentrations of tetracaine, but flattened by higher doses. A similar effect was observed for both lignocaine and prilocaine. The affinity constants for tetracaine and prilocaine calculated from the parallel shifts, 1 x 10(5) M-1 and 4 x 10(3) M-1, respectively, were in reasonable accord with the binding data. 4 The curve for the inhibition of [3H]-QNB binding by carbachol was not significantly altered, either in position or shape, in the presence of 1 mM prilocaine. Thus there is no evidence that prilocaine, which increases the affinity of nicotinic acetylcholine receptors for agonists, has any similar effect on agonist binding to muscarinic receptors.

Prenatal ethanol exposure in mice: teratogenic effects

C57BL/6J mice were fed a liquid diet in which 17, 25, or 30% of the calories were derived from ethanol from the fifth through the tenth day of gestation. Control mice were fed lab chow or pair-fed identical diets, except that sucrose substituted isocalorically for ethanol. At term the fetuses were removed and, following fixation, examined by microdissection. The incidence of fetal resorptions and congenital malformations increased in a dose-related manner. Anomalies included skeletal, neurological, urogenital, and cardiovascular systems. These data indicate that in mice, an alcohol diet which is adequate in vitamins and protein results in increased fetal wastage and birth defects.

Carcinoma of the prostate: local control with external beam radiation therapy

Local clinical control of the primary disease was evaluated in 209 patients with stage C adenocarcinoma of the prostate treated with definitive external beam radiation therapy and followed for a minimum of 2 years. Of these patients 92 per cent required no further prostatic operations for obstruction. Prostatectomy before therapy did not necessarily prevent later prostatic obstruction from occurring. Of 129 patients who had only a needle biopsy before irradiation 90 per cent had improvement of the obstructive and/or irritative symptoms as tumor regression occurred with therapy and these patients did not require a later prostatic operation for obstruction. Stricture formation occurred in 8 per cent of the patients and was not influenced by the type of preirradiation prostatic operation done. If transurethral resection was reuqired after irradiation it was technically more difficult but the morbidity was acceptable. The incidence of hematuria and incontinence was far less than that reported in non-irradiated patients with this disease. Most tumors exhibited a down-grading effect after irradiation. There were no deaths attributable to the treatment. Over-all, 83 per cent of the 209 patients had no urinary complaints after completion of therapy. From a urological viewpoint, good clinical local control is achieved in the patient with stage C adenocarcinoma of the prostate treated with external beam radiation therapy.

Radiation therapy for localized prostate cancer

Since 1965, 401 patients with prostate cancer have received intensive local pelvic radiation therapy at the Virginia Mason Medical Center. Two hundred seventy-seven of these patients were treated from 1965 through 1975, comprising the study group. Two hundred twenty-one of this series were in the Stage C category. The 36 Stage B cancers were either medically nonoperable, or advanced extent, or had high-grade histopathology. Ten patients each were in diffuse Stage A or Stage D groups, the latter receiving local palliative intensive treatment to the prostate area. The mean age of the patients was 67.6 years. The five year survival of the Stage C group was 57.7%. There was no apparent influence on the survival of irradiated Stage C patients who received estrogen therapy. Current treatment techniques employ 10 megavolt photon beam with whole pelvic nodal fields and bilateral arc rotational boost fields. The incidence of reactions and complications is presented.

Multiple hemoglobin alpha-chains in the sika deer (Cervus nippon)

Investigation of the hemoglobin alpha-chains of an Asiatic deer, the sika (Cervus nippon), was prompted by the heterogenity of alpha-chain gene loci in the Virginia white-tailed deer (Odocoileus virginianus). Although electrophoresis of hemoglobin chains from 10 sika revealed only a single alpha-chain band, peptide mapping demonstrated variations in the alpha-TPIII and alpha-TPIV peptides. Substitutions at positions 15, 20, and 22 produced a minimum of five alpha-chains; two possible additional chains could noy be proven because of inseparability of the whole alpha-chains. The most common chain contains Asp-15, Lys-20 and Pro-22 but in other chains glycine is present at position 15, Asx at position 20, and either serine or Asx at position 22. The probable explanation for the large number of alpha-chains is gene duplication which may have been produced by breedings between subspecies from different geographical areas. Comparison with the alpha-chain structure of the white-tailed deer suggests that the sika may have evolved from the lineage which produced the white tailed-deer after the alpha-chain genes of the latter species had duplicated. In addition, these data provide further examples of the unusual variability of this portion of the alpha-chain.

Radiation oncology: cancer of the prostate

The role of palliative radiation treatment of prostate cancer is well recognized. Appreciation of the value of definitive radiation therapy in management of locally advanced prostate cancer is increasing. Optimal management requires careful patient selection with multidiscipline evaluation to provide accurate grading and staging, availability of adequate facilities, and careful planning the treatment. Definitive radiation therapy may be used as primary treatment, or in management of endocrine treatment failure, and in postoperative residual or recurrent cancers. Similar techniques may be employed in the management of locally symptomatic Stage D cancer. Definitive radiation therapy is useful management of some Stage B and many Stage C locally advanced and nonresectable cancers of the prostate.

An evaluation of procedures used in staging carcinoma of the cervix

A review of 227 cases of invasive carcinoma of the cervix was undertaken to determine the efficacy of procedures using in the staging of this disease. All patients had a pretreatment chest radiography and intravenous pyelogram. 96.5% had pretreatment cystoscopy, 98.6% had pretreatment proctoscopy, and 92% had a pretreatment barium enema. These patients were retrospectively staged on the findings of physical examination only. Each additional procedure was then evaluated by comparison with the initial staging. Cystoscopy and chest film findings each would have changed the clinical stage in fewer than 1% of cases, barium enema in 1.4%, and proctoscopy in 2.2%. No patient had a positive barium enema without a positive proctoscopy, while two patients had positive proctoscopies with negative barium enemas. The overall yield of positive findings by pretreatment intravenous pyelography was 7.3%. Lymphangiography, although inconsistently done, yielded positive findings in all stages. Chest radiographs, intravenous pyelography, proctoscopy, and lymphangiography are recommended as part of the pretreatment workup of patients with carcinoma of the cervix. Routine barium enema is no longer recommended, and cystoscopy is only recommended in patients with clinical stage IIB disease or greater.