'To make a difference'. The Lincoln Collective

The Lincoln Collective was born in 1970 as a grassroots effort of health and community workers to start the kind of nonhierarchical community-oriented program described in this article. The idea of two residents who were already at Lincoln Hospital, the notion was given official approval because of the influx of young, American-trained physicians and nurses it would bring. But, as the experiment was advertised by word of mouth to members of the Student Health Organization, the Medical Committee for Human Rights, and other health workers involved in antiwar activities, the hospital, administration got more than it bargained for.

Ceramide: a novel cell signaling mechanism for vasodilation

Ceramide is a lipid second messenger generated by membrane hydrolysis of sphingomyelin by sphingomyelinase, but a role for this novel signaling pathway in vascular smooth muscle has not been elucidated. Based upon observations of cytokine-induced increases in sphingomyelinase activity, we hypothesized that ceramide plays a cell signaling role in vasodilation. Here, we demonstrate that ceramide is present at significant basal levels in cultured vascular smooth muscle cells and that these levels may be increased using exogenous sphingomyelinase. We also report that both exogenously added ceramide and sphingomyelinase cause dose-dependent relaxation in phenylephrine-contracted endothelium-denuded rat thoractic aortic rings. We conclude that the ceramide signaling pathway represents a novel signal transduction mechanism for vasodilation.

Gardner's syndrome: a case report

Gardner's syndrome (GS) is a dysplasia characterized by neoformations of the intestine, soft tissue, and osseous tissue. Because extra-intestinal manifestations, in particular osteomas, appear promptly even in infants affected with the syndrome and because of the possibility of malignant degeneration, the presence of osteomas necessitates regular surveillance to promptly diagnose the development of an intestinal polyposis typical of GS. This study describes a case of GS diagnosed merely upon suspicion of the existence of the syndrome in a patient who came to our Emergency Department. The study also emphasizes the importance not only of carrying our regular surveillance investigations to ascertain the presence of GS (colonoscopy), but also studying the relatives of any patient with GS, in light of the fact that this particular dysplasia is transmitted genetically.

Cough fracture of the ribs

A case of multiple rib fractures induced by a paroxysm of coughing in an elderly women is presented. The cough mechanism and theories of the mechanism of injury are reviewed, as well as the complications and treatment of the injury. The disorder may be underdiagnosed and should be considered in any patient with an acute onset of chest pain following coughing or sneezing.

Within-day physiologic variation of leukocyte types in healthy subjects as assayed by two automated leukocyte differential analyzers

The physiologic within-day (700-2200 h) variation of leukocyte-type concentrations in blood as determined for 21 healthy young adults is reported. All blood specimens were obtained in duplicate such that the within-batch analytic variation, as well as the pertinent biologic sources of variation, was able to be determined. All specimens were analyzed on each of two automated leukocyte differential systems: Hemalog-D Differential System and the Hematrak-240 Analyzer. On the basis of a comparison of the performances of the two analyzers, it was decided to report the neutrophil and the lymphocyte values as measured on both systems, the monocyte values as measured on teh Hematrak only, and the eosinophil and basophil values as measured on the Hemalog-D only. The intrasubject within-day physiologic variations for the cell on the Hemalog-D and Hematrak, respectively, in terms of coefficient of variation wee as follows: neutrophils 19.4% and 19.6%; lymphocytes, 13.8% and 17.5%. For monocytes, as measured on the Hematrak, it was 13.4%. For eosinophils and basophils, as measured on the Hemalog-D, it was 27.2% and 8.3%, respectively. There was a consistent group-specific diurnal variance that amounted to more than 40% of the total within-day variance, both for lymphocytes and for eosinophils. The within-day physiologic variation of the cell type concentrations for eight of the volunteers was compared with that of the plasma cortisol concentrations, as determined on specimens derived from the same veni-puncture sessions. The decrease in plasma cortisol values was in most instances associated with decreases in eosinophils and increases in neutrophils. For total leukocytes and neutrophils, the mean concentration for smokers was significantly higher than that for nonsmokers.

[Metabolism of collagen in progressive scleroderma and dermatomyositis]

The biosynthesis of collagen was studied in skin of healthy subjects and patients with progressive sclerodermia and dermatomyositis. The incorporatione of radioactive precursors (14C-proline), the rate of so-called collage-like-protein in sera, and the excretion of hydroxyprolin in urine depended on the severity of the dermatomyositis in progressive sclerodermia.