Ventricular tachyarrhythmias during cesarean section after ritodrine therapy: interaction with anesthetics

This case illustrates that patients receiving ritodrine for preterm labor may risk interactions between the residual betamimetic effects of ritodrine and the effects of anesthetics during cesarean section. Such interactions may result in serious cardiovascular complications even after cessation of an infusion of ritodrine. Preoperative assessment should focus on cardiovascular status and serum potassium level. Delaying induction of anesthesia should be considered whenever possible. Careful fluid administration and cautious use of titrated doses of ephedrine are advised. After delivery of the infant, there should be no contraindication to the use of an alpha-adrenergic vasopressor such as phenylephrine to treat hypotensive patients with tachycardia.

Frontal sinus mucopyocele in cystic fibrosis

This report summarizes the treatment of two patients with cystic fibrosis and frontal sinus mucopyocele. The first patient, an 18-year-old boy, had a 1-year history of a proptosis of the left eye. The second patient, a 28-year-old woman, had a 3-month history of intermittent diplopia. In both cases, the frontal sinus mucocele was diagnosed by computed tomographic scans; both were successfully treated with an osteoplastic flap and fat obliteration of the frontal sinus. When a patient with cystic fibrosis presents with a history of unilateral proptosis, diplopia, or frontal headaches, a paranasal sinus mucocele should be suspected.

Hemodynamics of protamine administration. Comparison of right atrial, left atrial, and aortic injections

Protamine administration for heparin reversal after cardiopulmonary bypass on occasion is associated with mild to severe hemodynamic deterioration. The route of administration may modify these reactions. A prospective randomized study was done in 68 patients undergoing isolated coronary artery bypass grafting. The route of protamine administration was randomized in a balanced fashion between right atrium, left atrium, and aorta. The preoperative and operative characteristics of the three groups were similar. Hemodynamic measurements were recorded before cannulation, after removal of the venous drainage catheter, and 1 minute, 5 minutes, and 10 minutes after protamine administration. Hypotension occurred in 11 patients with no significant difference among the three groups. The hypotension was immediate in three patients in whom route of administration was the aorta. The overall hemodynamic changes observed for the three treatment groups were not significantly different. An analysis for type II error indicated that it was unlikely that an important difference had been missed. We conclude that the route of administration does not affect the hemodynamic changes associated with protamine administration. We did not observe a case of severe hemodynamic deterioration, so that we cannot assess the effect of route of administration on the severity of an anaphylactic reaction.

Envelope proteins of human T cell leukemia virus type I: characterization by antisera to synthetic peptides and identification of a natural epitope

Three peptides corresponding to selected regions of the env gene products of human T cell leukemia virus type I were synthesized by solid-phase Merrifield techniques. The sequence of peptide designated SP-65 was identical to the predicted C-terminal 12 residues of the transmembrane protein p21env, and peptide SP-74 was inferred from a region shown to be highly conserved among mammalian retroviruses. The third peptide, SP-70, was derived from a C-terminal region of the surface glycoprotein gp46. Antibodies to each peptide were raised in rabbits and were used to identify and further characterize the proteins coded by the env gene. Despite being present at very low levels in purified viral preparations, these proteins were chromatographed by reverse-phase high pressure liquid chromatography and were located by Western blot analysis of the column fractions. Anti-SP-70 recognized the surface glycoprotein (gp46) and also its C-terminal cleavage fragment (gp16). Anti-SP-65 and anti-SP-74 both reacted with the hydrophobic transmembrane protein (p21) and provided evidence that this protein does not undergo apparent C-terminal processing during viral maturation, unlike the trans-membrane protein of murine leukemia virus. As expected, anti-SP-74 also reacted with homologous proteins from other Type C and Type D viruses, confirming that peptide SP-74 corresponds to a broadly conserved region of retroviral transmembrane proteins. SP-70, which is predicted to be quite near the C terminus of the major surface glycoprotein, was also reactive with sera of HTLV-I-positive patients, indicating that this peptide corresponds to, or is part of, a native epitope recognized by the natural host.

Envelope proteins of human T cell leukemia virus type I: characterization by antisera to synthetic peptides and identification of a natural epitope

Three peptides corresponding to selected regions of the env gene products of human T cell leukemia virus type I were synthesized by solid-phase Merrifield techniques. The sequence of peptide designated SP-65 was identical to the predicted C-terminal 12 residues of the transmembrane protein p21env, and peptide SP-74 was inferred from a region shown to be highly conserved among mammalian retroviruses. The third peptide, SP-70, was derived from a C-terminal region of the surface glycoprotein gp46. Antibodies to each peptide were raised in rabbits and were used to identify and further characterize the proteins coded by the env gene. Despite being present at very low levels in purified viral preparations, these proteins were chromatographed by reverse-phase high pressure liquid chromatography and were located by Western blot analysis of the column fractions. Anti-SP-70 recognized the surface glycoprotein (gp46) and also its C-terminal cleavage fragment (gp16). Anti-SP-65 and anti-SP-74 both reacted with the hydrophobic transmembrane protein (p21) and provided evidence that this protein does not undergo apparent C-terminal processing during viral maturation, unlike the trans-membrane protein of murine leukemia virus. As expected, anti-SP-74 also reacted with homologous proteins from other Type C and Type D viruses, confirming that peptide SP-74 corresponds to a broadly conserved region of retroviral transmembrane proteins. SP-70, which is predicted to be quite near the C terminus of the major surface glycoprotein, was also reactive with sera of HTLV-I-positive patients, indicating that this peptide corresponds to, or is part of, a native epitope recognized by the natural host.

Comparison of T-antigen expression in normal, premalignant, and malignant human colonic tissue using lectin and antibody immunohistochemistry

The Thomsen-Friedenreich antigen has been implicated as a cancer-associated antigen in some human organs including the colon. Most previous studies of Thomsen-Friedenreich antigen expression in the colon used peanut agglutinin (PNA) to identify the immunodeterminant in tissues. However, evidence from other organs suggests that anti-T antibodies have specificities which differ from those of peanut lectin. To elucidate the nature of the T-immunodeterminant in colonic mucosa, we compared staining by PNA to that of a polyclonal (PAb) and monoclonal (MAb) anti-T antibody. PNA demonstrated the best sensitivity (91%) in cancer tissues but the lowest specificity (68%) in normal mucosa. Staining with MAb was only 76% sensitive but 100% specific. Sensitivity and specificity of PAb were intermediate between PNA and MAb. MAb stained fewer adenomatous polyps than either PNA or PAb, but staining appeared to correlate with premalignant features of the polyps. PNA-binding sites were more prevalent than either PAb or MAb in hyperplastic polyps. Cell cytoplasm was stained by both antibodies more often than by PNA. The majority of fetal colonic specimens stained with all three reagents suggesting that Thomsen-Friedenreich antigen may be an oncodevelopmental antigen in human colon. Differences in staining patterns in some tissues may be due to different antigenic specificities among PNA, PAb, and MAb.

Effects of halothane on the intramyocardial pressure of the canine left ventricle

In the intact canine heart a gradient of systolic intramyocardial pressure from a minimum at the epicardial region to a maximum at the endocardial region is well established. No information is, however, available regarding the effects of various anaesthetic agents on this gradient. In the present study the effects of halothane on intramyocardial pressure recorded from subendocardial and subepicardial layers of the canine left ventricular free wall were assessed. Experiments were performed on seven anaesthetised mongrel dogs ventilated with 100% oxygen. Intramyocardial pressure was recorded simultaneously from the inner and outer regions of the myocardium using two Mikro-tip pressure transducers. Halothane concentration in the inspired gas varied from 0% to 2%. In the pentobarbital anaesthetised dog halothane does not significantly change the heart rate. With increasing concentrations of halothane in inspired gas systolic intramyocardial pressure at both endocardium and epicardium decreased significantly from control values. As the halothane concentration increased, the normal differential between systolic left ventricular pressure and endocardial intramyocardial pressure was abolished. The intramyocardial pressure gradient from endocardium to epicardium, however, persisted during systole. During diastole the pressure gradient was reversed, becoming maximum in the epicardial region and minimum in the endocardial region in both control and halothane treated animals. Over the range of 0-2% halothane concentration there was no significant effect on the diastolic intramyocardial pressure gradient. These results suggest that halothane affects the myocardial tissue pressure non-uniformly across the left ventricular free wall and therefore influence sth e transmural distribution of coronary blood flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Halothane effects on subendocardial oxygen supply-demand balance: estimation from intramyocardial tissue pressure and left ventricular pressure

We evaluated the effect of halothane on the balance of subendocardial oxygen supply and demand in six dogs by estimating the endocardial viability ratio (EVR) based on the pressure generated within the subendocardium (ENDO-IMP). Concurrently, the conventional EVR based on left ventricular pressure (LVP) was estimated and compared with the EVR based on ENDO-IMP. The subendocardial oxygen supply-demand ratio based on ENDO-IMP (IMP-EVR) was significantly less than EVR based on LVP (LVP-EVR) (0.87 +/- 0.03 vs 1.07 +/- 0.06, P less than 0.05) during the control period. With 0.5% halothane administration, IMP-EVR improved significantly (1.04 +/- 0.07, P less than 0.05) while LVP-EVR remained unchanged (1.08 +/- 0.09). No further changes in EVR (either IMP-EVR or LVP-EVR) were observed with increasing halothane concentrations up to 2%. The relationship between the two indices was weak (r2 = 0.44, P less than 0.001) but statistically significant. Because an estimate of EVR based on direct measurement of subendocardial tissue pressure (IMP-EVR) would reflect more accurately the oxygen supply-demand balance of this region than the LVP-EVR, our results suggest that the oxygen balance of the subendocardium improves with halothane administration. The use of LVP-EVR as a hemodynamic index of subendocardial oxygen balance during halothane anesthesia, therefore, is questionable.

A qualitative agar gel immunoprecipitin (IP) test for detection of fecal occult human hemoglobin

A versatile, qualitative, agarose gel immunoprecipitation (IP) test for the detection of fecal occult hemoglobin (Hb) was developed to provide a more accurate method for the detection of occult blood in stool. This test allowed detection of 0.2 mg human hemoglobin/g of stool after a 2-h incubation. In addition, a specimen application device which can accommodate a variety of specimens was developed for this test. A study of 252 clinical stool specimens revealed a close correlation in the results obtained at three separate laboratories. The IP test identified blood in 11 out of 24 specimens collected from patients with colorectal carcinoma as compared to 4 of 24 specimens positive with a guaiac-based Hemoccult II test. The simplicity of immunoprecipitation coupled with the high sensitivity and specificity of this technique suggests that this new test would be a very useful and effective means with which to screen for occult blood in stool.

Protamine induced arterial hypoxaemia: the relationship to hypoxic pulmonary vasoconstriction

Protamine administration may induce arterial hypoxaemia in dogs and humans. However, the responsible mechanism has not been established. Protamine, as it is a pulmonary vasoactive substance, may interfere with normal hypoxic pulmonary vasoconstriction (HPV) and cause arterial hypoxaemia. This possibility was tested in dogs utilizing a one lung hypoxic model. One lung hypoxic ventilation decreased pulmonary blood flow in the hypoxic lung from 1022 +/- 96 ml X min-1 (mean +/- SEM) to 846 +/- 39 ml X min-1 (p less than 0.05) while increasing blood flow from 833 +/- 85 ml X min-1 to 1109 +/- 101 ml X min-1 (p less than 0.05) in the normoxic lung, resulting in 24 per cent effective diversion of blood flow. Protamine infusion, after heparinization, markedly elevated pulmonary vascular resistance in both lungs but preferentially in the normoxic lung (102 +/- 27 per cent increase in normoxic lung, 60 +/- 6.4 per cent increase in hypoxic lung) and significantly reversed the pulmonary blood flow shift induced by one lung hypoxic ventilation (effective diversion of blood flow was reduced to four per cent). Concurrently, arterial PO2 further decreased. Our results demonstrate that protamine interferes with effectiveness of pre-existing HPV and suggest that this mechanism, at least in part, may be responsible for arterial hypoxaemia observed after protamine infusion. The marked generalized pulmonary vasoconstriction with protamine appears to be the direct force that interferes with pre-existing auto-regulatory HPV. In addition to the well known haemodynamic effects of protamine, protamine infusion may also cause arterial hypoxaemia in those patients in whom HPV plays a significant role in maintaining arterial oxygenation.

Galactosyltransferase variant in pleural effusion

In measuring total galactosyltransferase activity in the pleural effusions from patients with benign or malignant diseases, we found no significant difference between the two groups (p greater than 0.05). However, a small amount of a galactosyltransferase variant, GT(l), could be separated from other galactosyltransferase enzymes in malignant pleural effusions by anion-exchange chromatography (DEAE-cellulose) with a buffer of low ionic strength. Other galactosyltransferases were eluted from the column with buffer of higher ionic strength. Using a mini-column method, we detected GT(l) enzyme in 19 of 26 specimens fro cancer patients, as compared with eight of 25 specimens from patients with benign disorders. The appearance of GT(l) enzyme in pleural effusion may be a tumor-associated phenomenon.

Galactosyltransferase variant in pleural effusion

In measuring total galactosyltransferase activity in the pleural effusions from patients with benign or malignant diseases, we found no significant difference between the two groups (p greater than 0.05). However, a small amount of a galactosyltransferase variant, GT(l), could be separated from other galactosyltransferase enzymes in malignant pleural effusions by anion-exchange chromatography (DEAE-cellulose) with a buffer of low ionic strength. Other galactosyltransferases were eluted from the column with buffer of higher ionic strength. Using a mini-column method, we detected GT(l) enzyme in 19 of 26 specimens fro cancer patients, as compared with eight of 25 specimens from patients with benign disorders. The appearance of GT(l) enzyme in pleural effusion may be a tumor-associated phenomenon.

Changes in peripheral vascular and cardiac sympathetic activity before and after coronary artery bypass surgery: interrelationships with hemodynamic alterations

The plasma catecholamine levels obtained simultaneously from radial artery (A), pulmonary artery (MV), brachial vein (PV), and coronary sinus (CS) were measured concurrent with hemodynamic determinations during coronary artery bypass graft (CABG) operations. Arterial catecholamine levels decreased after induction of anesthesia and increased after sternotomy; changes in veno-arterial norepinephrine (NE) differences ([PV-A]ne, [MV-A]ne, and [CS-A]ne) were of the same magnitude and direction, suggesting that NE release from various organs was of the same extent. After operation, arterial NE increased further, but the veno-arterial NE differences were in striking contrast; [PV-A]ne became markedly positive, whereas [CS-A]ne became markedly negative, indicating that NE release from extremity peripheral vasculature increased markedly while cardiac NE release decreased. These differential changes in regional sympathetic activity appear to be related to postoperative hypertension (HT) and low cardiac output (CO). There were close relationships of changes in [MV-A]ne to mean arterial pressure (r = 0.78, p less than 0.001) and systemic vascular resistance (r = 0.62, p less than 0.010, suggesting that the sympathetic nervous system plays an important role in CABG perioperative hemodynamic alterations.

Pulmonary shunting during leukoagglutinin-induced noncardiac pulmonary edema

Noncardiogenic pulmonary edema occurred in an anesthetized patient during an otherwise uneventful laparotomy. Following transfusion of an individual unit of whole blood, routine intraoperative monitoring detected sudden major pulmonary shunting (increased alveolar-arterial oxygen gradient) and an increased physiological alveolar dead space (increased arterial-alveolar carbon dioxide gradient). The noncardiac pulmonary edema probably resulted from the presence of a leukoagglutinin against the patient's granulocytes in the donor's plasma. This antibody had no apparent specificity for known HLA, neutrophil, or blood group antigens. The acute respiratory failure was transient, resolving in 72 hours with respiratory support. The presence of otherwise unexplained noncardiogenic pulmonary edema during or soon after a blood transfusion should suggest the possible diagnosis of a leukoagglutinin reaction.

Noninvasive determination of core temperature during anesthesia

A noninvasive, zero heat flux method of determining core (intracardiac blood) temperature was studied in ten anesthetized patients having whole body hyperthermia for the treatment of cancer. True intracardiac blood temperature was determined by a calibrated pulmonary artery thermistor. Accuracy, precision, and responsivity for the noninvasive system were comparable to conventional esophageal thermometry in reflecting intracardiac blood temperatures. This method of contact thermometry is convenient and independent of environmental influence, and it rapidly reflects the small changes in arterial blood temperature which evoke vasomotor responses.

Immunochemical characteristics of human anti-T antibodies

A specific and sensitive radioimmunoassay was developed to investigate the immunochemical properties of serum anti-T antibodies. Evidence was presented that the radioimmunoassay can measure non-agglutinating as well as agglutinating anti-T antibodies, while the hemagglutination method can detect only the latter type. Although the hemagglutination method failed to detect anti-T agglutinins in cord sera, the radioimmunoassay results demonstrated the presence of non-agglutinating antibodies. Presence of 1% polyethylene glycol potentiated some of the originally nonagglutinating antibodies to produce a hemagglutination reaction. Immunochemical characteristics associated with the human anti-T antibodies are discussed.