Continuous Transcutaneous Gas Monitoring in Adults on Regular Dialysis Treatment

We tested a transcutaneous (tc) oxygen (O2) and carbon dioxide (COz) sensor in 15 normal adults and in 20 patients on regular dialysis treatment (RDT). We compared the tc gas values (ptcO2, PtcCO2) with the gas tension values in arterial blood samples (PaO2, PaCO2), in normal adults and in RDT-patients at the end of a 30-min test and six times during RDT. During the test, PtcO2 correlated with PaO2 both in normal adults (r 0.72p<0.01) and in RDT patients (r 0.41 p<0.05). PtcCO2 correlated with PaCO2 (r 0.59 in normal adults and r 0.76 in RDT). During 14 acetate dialyses the changes were expressed as %Δ from time 0. %Δ PaO2 was – 12.7 at 60 min, + 4.8 at 240 min; %Δ PtcO2 – 6.0 at 60 min, + 9.7 at 240 min; %Δ PaCO2 – 17.7 at 240 min, – 1.8 1 h later; %Δ PtcCO2 was – 15.8 at 240 min, – 3.2 1 h later. Both in normal adults and in RDT, patients there was a good relationship between PtcCO2 and PaCO2 values. In normal adults the absolute PtcO2 values were always lower than PaO2 (– 14.4± 10 mmHg); in RDT-patients this difference was more pronounced (– 27.6± 15.1) and is probably attributable to the lower Hb levels (6.7± 1.1 vs 12.4± 1.2). During RDT the pattern was the same between tc and gas tension values. The tc-sensor seems to be useful in continuous monitoring, especially in acetate dialysis and/or in patients suspected of developing hypoxemia, but it cannot replace direct blood gas measurements in arterial blood samples.

A dynamic nostril splint in the surgery of the nasal tip: technical innovation

Some types of surgery performed on the tip of the nose, such as secondary rhinoplasty on cleft lip and palate (CLP) patients, may have an uncertain end-result due to the difficulty in maintaining the surgically created status constant over time. This is precisely the reason behind the multiple proposals and surgical techniques presented by various authors through the years, in order to produce a long lasting, valid, surgical result. The problem has been approached by implementing varied and creative methods and still remains partially unsolved. Experience has shown that the application of a dynamic nasal splint has contributed efficiently to maintaining the surgical results by opposing healing contraction.

Continuous transcutaneous gas monitoring in adults on regular dialysis treatment

We tested a transcutaneous (tc) oxygen (O2) and carbon dioxide (CO2) sensor in 15 normal adults and in 20 patients on regular dialysis treatment (RDT). We compared the tc gas values (ptcO2, PtcCO2) with the gas tension values in arterial blood samples (PaO2, PaCO2), in normal adults and in RDT-patients at the end of a 30-min test and six times during RDT. During the test, PtcO2 correlated with PaO2 both in normal adults (r 0.72 p less than 0.01) and in RDT patients (r 0.41 p less than 0.05). PtcCO2 correlated with PaCO2 (r 0.59 in normal adults and r 0.76 in RDT). During 14 acetate dialyses the changes were expressed as % delta from time 0. % delta PaO2 was -12.7 at 60 min, + 4.8 at 240 min; % delta PtcO2 -6.0 at 60 min, + 9.7 at 240 min; % delta PaO2 -17.7 at 240 min, -1.8 1 h later; % delta PtcCO2 was -15.8 at 240 min, -3.2 1 h later. Both in normal adults and in RDT, patients there was a good relationship between PtcCO2 and PaCO2 values. In normal adults the absolute PtcO2 values were always lower than PaO2 (-14.4 +/- 10 mmHg); in RDT-patients this difference was more pronounced (-27.6 +/- 15.1) and is probably attributable to the lower Hb levels (6.7 +/- 1.1 vs 12.4 +/- 1.2). During RDT the pattern was the same between tc and gas tension values.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-base balance during biofiltration

Five patients were shifted from acetate dialysis (AD) to biofiltration (BF); their pre-dialytic acid-base balance (ABB) was re-examined for six months before the start of BF. Samples for ABB were drawn at 0', 30', 60', 120' and 180' during three AD and 1, 2 and 3 hours after them (period A). The same procedure was then repeated two months (period B) and 12 months (period C) after the start of BF. From analysis of the data it is concluded that the correction of AD-acidosis is very rapid during the early two months of BF, but the post-BF ABB may be too alkalotic, with risks if respiratory alkalosis is superimposed. After one year of BF, there were fewer pCO2 falls and pH variations; no more post-BF alkalotic rebounds were observed.

Nucleic acid cytometry of homosexual-associated lymphoproliferative disease

Twenty-six reactive lymph nodes and 5 malignant lymphomas from homosexual males were studied by acridine orange flow cytometry (AO-FCM) for determination of ploidy, proliferation, and RNA characteristics. Two reactive lymph nodes showed ploidy abnormalities as compared with none of 27 reactive lymph nodes from nonhomosexual patients. The homosexual-associated (HA) lymphadenopathy had a higher mean proliferative activity (11.2% versus 5.6%) and higher ribonucleic acid (RNA) content (1.11 versus 0.96) than non-HA counterparts. The proliferative activity of HA lymphadenopathy was also higher than follicular small cleaved cell lymphoma, and not dissimilar to that of follicular large cell lymphoma. These findings indicate that HA-reactive lymphadenopathy is a hyperproliferative state associated with high cellular RNA content and rare DNA-abnormal stemlines. One HA lymphoma had an abnormal stemline by AO-FCM, compared with 9 of 15 (63%) non-HA high grade lymphomas. This lymphoma also demonstrated an abnormal karyotype (47,XY, +12, t[8;22]) by classic cytogenetic studies. The mean proliferative activity and RNA content of HA lymphomas was higher than non-HA counterparts (37% versus 22.5% and 2.48 versus 1.73, respectively). The proliferation and RNA features of HA lymphoma were on higher planes than non-HA lesions histologically comparable. Thus, in addition to differences in clinical presentation, histologic subtype, stage distribution, and therapeutic response, HA lymphomas have DNA/RNA characteristics different from those of counterparts in the general population.

Active specific immunotherapy of Dukes B2 and C colorectal carcinoma: comparison of two doses of the vaccine

The ability of active specific immunotherapy to enhance immune responses to autologous tumor-associated antigens (TAA) and to prolong the disease-free interval was evaluated in patients with Dukes B2 and C colorectal carcinoma who had undergone potentially curative resections. Patients were sensitized in the early postoperative period with irradiated autologous adenocarcinoma cells mixed with bacillus Calmette-Guérin (BCG) to yield either a low-dose vaccine (3 X 10(6) tumor cells) or a high-dose vaccine (1 X 10(7) tumor cells). Six of seven patients who received the low-dose vaccine developed delayed-type hypersensitivity (DTH) responses to autologous tumor cells upon completion of the vaccination, whereas all four patients receiving high-dose vaccine displayed a positive DTH response. However, DTH responses to autologous TAA waned within 3 months in all patients receiving the low-dose vaccine; DTH responses persisted for 3 months in three of the four high-dose vaccine patients. In vitro lymphoproliferative responses to TAA correlated with DTH responses to autologous tumor cells. Active specific immunotherapy appeared to induce specific immune responses either in vitro or in vivo to autologous TAA because it did not induce responses to autologous mucosa cells. There were no complications caused by BCG or tumor cells. This series demonstrates that active specific immunotherapy is a nontoxic treatment that augments immunity to autologous TAA.

Human cryptosporidiosis: spectrum of disease. Report of six cases and review of the literature

Although once regarded exclusively as an animal parasite, Cryptosporidium has emerged during the last decade as a cause of diarrhea in humans. Of the 43 cases of human cryptosporidiosis reported, 27 patients in whom either humoral or cell-mediated immune defects were present had chronic protracted diarrhea that was almost invariably unresponsive to therapy and culminated in death. In contrast, 16 patients with intact immune systems had either self-limited disease or were asymptomatic. Animal exposure was almost exclusively recorded in the latter group. During the last six months at University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, gastrointestinal (GI) tract cryptosporidiosis developed in six homosexual men with acquired immune deficiency syndrome (AIDS). The diagnosis of cryptosporidiosis was established histologically in five patients. In four, cryptosporidial oocysts were detected in the stool. In addition to extensive GI tract cryptosporidiosis, two patients had biliary tract involvement. Multiple chemotherapeutic agents failed to control the disease, and five patients eventually died. Cryptosporidiosis should be considered in the differential diagnosis of diarrhea, in animal handlers or in the severely compromised patient, especially one with AIDS, who has chronic protracted diarrhea.

Preoperative chemotherapy for Wilms tumor

Preoperative chemotherapy was administered to 19 children with Wilms tumor judged clinically to be unresectable at M. D. Anderson Hospital between January 1, 1962, and September 1, 1980. After 2 to 4 doses of vincristine, marked reduction in tumor size occurred in 16 patients. After chemotherapy 16 tumors could be resected completely, another required irradiation to reduce the tumor, and only 2 tumors could not be excised. Pathologically the most dramatic changes occurred in the undifferentiated interstitial stroma, followed next by changes in the nodular blastema. Differentiated elements were apparently not affected. No serious complications were attributed to the preoperative drug treatment. This experience suggests that in selected instances preoperative chemotherapy can affectively facilitate the therapy of Wilms tumor.