.I 125536
.U
89315773
.S
Proc Natl Acad Sci U S A 8910; 86(14):5242-6
.M
Amino Acid Sequence; Animal; Argipressin/GE; Base Sequence; Cloning, Molecular/*; Comparative Study; DNA/*GE; DNA Polymerases; Fishes/*GE; Gene Amplification; Genes, Structural; Human; Molecular Sequence Data; Oxytocin/*AA/GE; Protein Precursors/*GE; Sequence Homology, Nucleic Acid; Support, Non-U.S. Gov't; Vasotocin/*GE.
.T
Vasotocin and isotocin precursors from the white sucker, Catostomus commersoni: cloning and sequence analysis of the cDNAs.
.P
JOURNAL ARTICLE.
.W
The nucleotide sequences of cloned cDNAs encoding the precursors for vasotocin and isotocin have been elucidated by analyzing a lambda gt11 library constructed from poly(A)+ RNA from the hypothalamic region of the teleost fish Catostomus commersoni. Screening of the library was carried out with synthetic oligonucleotide probes deduced from the amino acid sequences of the nonapeptides vasotocin and isotocin. The cDNA nucleotide sequences predict isotocin and vasotocin prohormone precursors each consisting of a signal peptide, a hormone moiety, and a neurophysin-like molecule. However, in comparison to their mammalian counterparts, both fish neurophysins are extended at their C termini by an approximately 30 amino acid sequence with a leucine-rich core segment. These extensions show striking similarities with the glycopeptide moiety (the so-called copeptin) present in mammalian vasopressin precursors, except that they lack the consensus sequence for N-glycosylation. These data suggest that mammalian copeptin is derived from the C terminus of an ancestral neurophysin.
.A
Heierhorst J; Morley SD; Figueroa J; Krentler C; Lederis K; Richter D.
.I 125537
.U
89315780
.S
Proc Natl Acad Sci U S A 8910; 86(14):5276-80
.M
Amino Acid Sequence; Animal; Base Sequence; Blotting, Northern; Cloning, Molecular; DNA/*GE/IP; Gene Amplification/*; Genes, Structural/*; Golgi Apparatus/*EN; Liver/*EN; Mannosidases/*GE; Molecular Sequence Data; Oligonucleotide Probes; Rats; RNA, Messenger/GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transcription, Genetic.
.T
Isolation of a rat liver Golgi mannosidase II clone by mixed oligonucleotide-primed amplification of cDNA.
.P
JOURNAL ARTICLE.
.W
A clone encoding Golgi mannosidase II (MII; GlcNAc-transferase I-dependent alpha 1,3(alpha 1,6) mannosidase), an enzyme involved in asparagine-linked oligosaccharide processing, was isolated from a rat liver lambda gt11 cDNA library by a method that employs a modification of the polymerase chain reaction. Specific oligonucleotide primers were designed from two regions of protein sequence and were combined in an amplification reaction with a single-stranded cDNA preparation derived from rat liver poly(A)+ RNA. Based upon mapping of the protein sequences 42 kDa apart on the MII polypeptide, the procedure was expected to generate an approximately 1150-base-pair amplification product representing a segment of the MII gene between the two primer regions. The size of the amplified product (1170 base pairs) was in close agreement with this predicted fragment size. The authenticity of the amplified fragment was confirmed by the agreement of the DNA sequence with additional protein sequence data. A 1474-base-pair clone was isolated from a cDNA library by plaque hybridization using the amplification fragment as a radiolabeled probe. The nucleotide sequence of this clone predicts a single continuous open reading frame and, based upon a polypeptide molecular mass of 117 kDa for the enzyme subunit, is consistent with the clone representing approximately 50% of the coding sequence of MII. Both the clone and the amplification product hybridized to a rat liver mRNA of approximately 8 kilobases, a message size approximately 4.7 kilobases larger than the size of the predicted open reading frame. This extensive non-coding information on the MII message is a feature common to two other Golgi processing enzymes, both of which contain most of the non-coding information on the 3' end of their messages. The function of these disproportionately large untranslated regions is not clear.
.A
Moremen KW.
.I 125538
.U
89315782
.S
Proc Natl Acad Sci U S A 8910; 86(14):5286-90
.M
Alanine/*; Amino Acid Sequence; Circular Dichroism; Kinetics; Peptides/*/CS; Protein Conformation/*; Structure-Activity Relationship; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Thermodynamics.
.T
Unusually stable helix formation in short alanine-based peptides.
.P
JOURNAL ARTICLE.
.W
Short, 16-residue, alanine-based peptides show stable alpha-helix formation in H2O. This result is surprising when contrasted with the classical view that regards the alpha-helix as a marginally stable structure in H2O and considers short helices unstable. The alanine-based peptides are solubilized by insertion of three or more residues of a single charge type, lysine (+) or glutamic acid (-). The results cannot be explained by helix stabilization resulting from concentration-dependent association or by the interaction of charged residues with the helix dipole. Our results are not predicted by the parameters for alanine and lysine that have been determined by the "host-guest" method: these parameters predict that a 16-residue peptide should not show measurable alpha-helix formation. Analysis of the role of the hydrophobic interaction in alpha-helix formation [Richards, F.M. & Richmond, T. (1978) in Molecular Interactions and Activity in Proteins, Ciba Foundation Symposium 60, ed. Wolstenholme, G.E. (Excepta Medica Amsterdam), pp. 23-25] does not show an unusually strong hydrophobic interaction in a helical block of alanine residues. The likely explanation for our results is, therefore, that individual alanine residues have a high helical potential. It is not yet known whether any other amino acids show this property, and the origin of this property is also unknown.
.A
Marqusee S; Robbins VH; Baldwin RL.
.I 125539
.U
89315783
.S
Proc Natl Acad Sci U S A 8910; 86(14):5291-5
.M
Amino Acid Sequence; Animal; Avian Leukosis Viruses/*GE; Base Sequence; Cloning, Molecular; Comparative Study; Erythroblastosis Virus, Avian/EN/*GE; Fibroblasts; Genes, Reiterated/*; Genes, Structural; Molecular Sequence Data; Oncogene Proteins, Viral/*GE; Oncogenes/*; Protein-Tyrosine Kinase/*GE; Rats; Restriction Mapping; Sequence Homology, Nucleic Acid; Support, U.S. Gov't, P.H.S..
.T
The v-sea oncogene of avian erythroblastosis retrovirus S13: another member of the protein-tyrosine kinase gene family.
.P
JOURNAL ARTICLE.
.W
The cloning and sequencing of the oncogene of the avian erythroblastosis virus S13 is described. The oncogene, termed v-sea, was found to be another member of the protein-tyrosine kinase gene family. The oncogene was fused in frame with the retrovirus S13 envelope gene, thus generating a fusion protein with a structure resembling that of a growth factor receptor. Sequence comparisons revealed that the v-sea gene was most closely related to the insulin receptor family of protein-tyrosine kinases, the greatest similarity being with the human MET oncogene.
.A
Smith DR; Vogt PK; Hayman MJ.
.I 125540
.U
89315784
.S
Proc Natl Acad Sci U S A 8910; 86(14):5296-300
.M
Animal; Antimetabolites/*PD; Glutathione/AI/*ME; Kinetics; Liver/DE/ME; Lung/DE/*ME/UL; Lymphocytes/DE/ME; Male; Methionine Sulfoximine/*AA/PD; Mice; Microscopy, Electron; Mitochondria/DE/*ME; Organoids/DE/*ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Glutathione metabolism in the lung: inhibition of its synthesis leads to lamellar body and mitochondrial defects.
.P
JOURNAL ARTICLE.
.W
Mice treated with buthionine sulfoximine, an inhibitor of glutathione synthesis, showed striking alterations of morphology of lung type 2 cell lamellar bodies (swelling and disintegration) and mitochondria (degeneration) and of lung capillary endothelial cells (mitochondrial swelling). These effects probably may be ascribed to glutathione deficiency; administration of glutathione monoester protects against them. Measurements of arteriovenous plasma glutathione levels across the lung indicate that the net uptake of glutathione by this organ is substantial. Thus, glutathione exported from the liver to the blood plasma is utilized by the lung which, like the liver, kidney, and lymphocytes (and unlike skeletal muscle), exhibits a high overall rate of glutathione turnover. Intraperitoneal injection of glutathione into buthionine sulfoximine-treated mice leads to very high levels of plasma glutathione without significant increase in the glutathione levels of liver, lung, and lymphocytes; on the other hand, administration of glutathione monoester leads to markedly increased tissue and mitochondrial levels of glutathione. Administration of glutathione monoester (in contrast to glutathione) to control mice also increases mitochondrial glutathione levels. The findings indicate that glutathione is required for mitochondrial integrity and that it probably also functions in the processing and storage of surfactant in lamellar bodies. The morphological changes observed after treatment with buthionine sulfoximine and their prevention by glutathione monoester as well as findings on glutathione metabolism indicate that this tripeptide plays an important role in the lung. The previously observed failure of buthionine sulfoximine-treated mice to gain weight is mainly due to glutathione deficiency in the intestinal mucosa.
.A
Martensson J; Jain A; Frayer W; Meister A.
.I 125541
.U
89315786
.S
Proc Natl Acad Sci U S A 8910; 86(14):5306-9
.M
Base Sequence; Cell Line; Chromosome Deletion; Gene Expression Regulation; Genes, Regulator/*; Genes, Structural/*; Globin/*GE; Human; Mutation; Plasmids; Promoter Regions (Genetics); Sequence Homology, Nucleic Acid; Transcription, Genetic/*; Transfection.
.T
Identification of a transcriptional silencer in the 5'-flanking region of the human epsilon-globin gene.
.P
JOURNAL ARTICLE.
.W
We have studied the 5'-flanking sequences required for the transcriptional regulation of human epsilon-globin gene expression. A series of deletion mutants of the human epsilon-globin gene 5'-flanking sequences were constructed and linked to the bacterial chloramphenicol acetyltransferase gene. Expression of these constructs was tested in HeLa cells and the human erythroleukemia K-562 cells. By measuring chloramphenicol acetyltransferase activities and mRNA levels we found that the sequence between -177 and -392 base pairs (bp) relative to the mRNA initiation site exerts a negative effect on epsilon-globin promoter activity. This effect is more pronounced in HeLa cells compared with K-562 cells. To further characterize the negative control region we cloned the DNA sequence between -177 and -392 bp either 5' or 3' of the epsilon-globin promoter and in either orientation. Our data indicate that this negative control region inhibits the epsilon-globin promoter activity in a position- and orientation-independent manner, thus suggesting that it is a silencer. In addition, the silencer also inhibits the expression from the Herpesvirus thymidine kinase promoter. Sequence comparison reveals that there are three short regions within the silencer that share extensive homology with those found in other negative control DNA elements. Our results therefore indicate that an upstream silencer element is present in the epsilon-globin gene and that it may play an important role in the control of epsilon-globin gene expression during development.
.A
Cao SX; Gutman PD; Dave HP; Schechter AN.
.I 125542
.U
89315787
.S
Proc Natl Acad Sci U S A 8910; 86(14):5310-4
.M
Amino Acid Sequence; Base Sequence; Carrier Proteins/*GE; Cloning, Molecular; Comparative Study; Gene Expression Regulation; Genes, Reiterated; Genes, Structural; Human; Molecular Sequence Data; Sequence Homology, Nucleic Acid; Support, Non-U.S. Gov't; Transcription, Genetic; Tretinoin/ME.
.T
A third human retinoic acid receptor, hRAR-gamma.
.P
JOURNAL ARTICLE.
.W
Retinoic acid receptors (RARs) are retinoic acid (RA)-inducible enhancer factors belonging to the superfamily of steroid/thyroid nuclear receptors. We have previously characterized two human RAR (hRAR-alpha and hRAR-beta) cDNAs and have recently cloned their murine cognates (mRAR-alpha and mRAR-beta) together with a third RAR (mRAR-gamma) whose RNA was detected predominantly in skin, a well-known target for RA. mRAR-gamma cDNA was used here to clone its human counterpart (hRAR-gamma) from a T47D breast cancer cell cDNA library. Using a transient transfection assay in HeLa cells and a reporter gene harboring a synthetic RA responsive element, we demonstrate that hRAR-gamma cDNA indeed encodes a RA-inducible transcriptional trans-activator. Interestingly, comparisons of the amino acid sequences of all six human and mouse RARs indicate that the interspecies conservation of a given member of the RAR subfamily (either alpha, beta, or gamma) is much higher than the conservation of all three receptors within a given species. These observations indicate that RAR-alpha, -beta, and -gamma may perform specific functions. We show also that hRAR-gamma RNA is the predominant RAR RNA species in human skin, which suggests that hRAR-gamma mediates some of the retinoid effects in this tissue.
.A
Krust A; Kastner P; Petkovich M; Zelent A; Chambon P.
.I 125543
.U
89315788
.S
Proc Natl Acad Sci U S A 8910; 86(14):5315-9
.M
Animal; Base Sequence; Cell Line; DNA/IP/*RE; DNA Damage/*; DNA Polymerases; Enhancer Elements (Genetics); Genes/*RE; Genes, Regulator; Molecular Sequence Data; Nucleotide Mapping/*; Plasmids; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Ultraviolet Rays/*.
.T
Genomic footprinting in mammalian cells with ultraviolet light.
.P
JOURNAL ARTICLE.
.W
A simple and accurate genomic primer extension method has been developed to detect ultraviolet footprinting patterns of regulatory protein-DNA interactions in mammalian genomic DNA. The technique can also detect footprinting or sequencing patterns introduced into genomic DNA by other methods. Purified genomic DNA, containing either damaged bases or strand breaks introduced by footprinting or sequencing reactions, is first cut with a convenient restriction enzyme to reduce its molecular weight. A highly radioactive single-stranded DNA primer that is complementary to a region of genomic DNA whose sequence or footprint one wishes to examine is then mixed with 50 micrograms of restriction enzyme-cut genomic DNA. The primer is approximately 100 bases long and contains 85 radioactive phosphates, each of specific activity 3000 Ci/mmol (1 Ci = 37 GBq). A simple and fast method for preparing such primers is described. Following brief heat denaturation at 100 degrees C, the solution of genomic DNA and primer is cooled to 74 degrees C and a second solution containing Taq polymerase (Thermus aquaticus DNA polymerase) and the four deoxynucleotide triphosphates is added to initiate primer extension of genomic DNA. Taq polymerase extends genomic hybridized primer until its polymerization reaction is terminated either by a damaged base or strand break in genomic DNA or by the addition of dideoxynucleotide triphosphates in the polymerization reaction. The concurrent primer hybridization-extension reaction is terminated after 5 hr and unhybridized primer is digested away by mung bean nuclease. Primer-extended genomic DNA is then denatured and electrophoresed on a polyacrylamide sequencing gel, and radioactive primer extension products are revealed by autoradiography. By using this method we demonstrate that it is possible to footprint with ultraviolet light, in intact monkey cells, regulatory protein--DNA interactions along a single copy of a simian virus 40 viral genome integrated into the monkey genome.
.A
Becker MM; Wang Z; Grossmann G; Becherer KA.
.I 125544
.U
89315791
.S
Proc Natl Acad Sci U S A 8910; 86(14):5330-4
.M
Amino Acid Sequence; Base Sequence; Cloning, Molecular; Codon/GE; DNA/*GE; Human; Liver/EN; Macromolecular Systems; Molecular Sequence Data; Pyruvate Dehydrogenase Complex/*GE; Restriction Mapping; Support, U.S. Gov't, P.H.S..
.T
Characterization of cDNAs encoding human pyruvate dehydrogenase alpha subunit.
.P
JOURNAL ARTICLE.
.W
A cDNA clone (1423 base pairs) comprising the entire coding region of the precursor form of the alpha subunit of pyruvate dehydrogenase (E1 alpha) has been isolated from a human liver cDNA library in phage lambda gt11. The first 29 amino acids deduced from the open reading frame correspond to a typical mitochondrial targeting leader sequence. The remaining 361 amino acids, starting at the N terminus with phenylalanine, represent the mature mitochondrial E1 alpha peptide. The cDNA has 43 base pairs in the 5' untranslated region and 210 base pairs in the 3' untranslated region, including a polyadenylylation signal and a short poly(A) tract. The nucleotide sequence of human liver E1 alpha cDNA was confirmed by the nucleotide sequences of three overlapping fragments generated from human liver and fibroblast RNA by reverse transcription and DNA amplification by the polymerase chain reaction. This consensus nucleotide sequence of human liver E1 alpha cDNA resolves existing discrepancies among three previously reported human E1 alpha cDNAs and provides the unambiguous reference sequence needed for the characterization of genetic mutations in pyruvate dehydrogenase-deficient patients.
.A
Ho L; Wexler ID; Liu TC; Thekkumkara TJ; Patel MS.
.I 125545
.U
89315792
.S
Proc Natl Acad Sci U S A 8910; 86(14):5335-9
.M
Barley; Base Sequence; Molecular Sequence Data; Mosaic Viruses/GD/*GE; Mutation; Nucleic Acid Conformation; Plants/GE; RNA, Transfer/*GE; RNA, Viral/*GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Telomeric function of the tRNA-like structure of brome mosaic virus RNA.
.P
JOURNAL ARTICLE.
.W
Four mutant brome mosaic virus (BMV) RNA3 transcripts, bearing single or double base changes in the 3'-CCAOH terminus of the tRNA-like structure, previously characterized as being deficient in vitro with respect to aminoacylation and replication activities, have now been assayed in vivo for their ability to replicate (in the presence of transcripts of wild-type RNA1 and -2) in barley protoplasts and plants. In tests conducted with protoplasts, irrespective of the time post-infection, all four mutants were fully viable, and the relative levels of both plus and minus strand replication for each mutant were similar to that of the wild type. Inoculation of barley plants with these mutants resulted in phenotypic symptoms and viral yields that were similar to those from wild-type infections. Analysis of each mutant progeny RNA3 indicated that the altered sequence at the 3' terminus was restored to that of wild type. These observations indicate that there is a rapid turnover and correction of the 3' termini of BMV RNAs in vivo. Such correction is commensurate with the action of tRNA nucleotidyltransferase, but it differs from recombination processes that appear to be relatively infrequent for BMV RNA3. These results support the conclusion that the 3'-CCAOH termini of viral tRNA-like structures function analogously to telomeres of chromosomal DNA.
.A
Rao AL; Dreher TW; Marsh LE; Hall TC.
.I 125546
.U
89315795
.S
Proc Natl Acad Sci U S A 8910; 86(14):5351-5
.M
Hydrogen-Ion Concentration; Kinetics; Lipid Bilayers; Liposomes/*; Models, Theoretical; Nuclear Magnetic Resonance/MT; Phosphatidic Acids/*; Phosphatidylcholines/*; Phosphorus; Support, Non-U.S. Gov't.
.T
Mechanism of spontaneous vesiculation.
.P
JOURNAL ARTICLE.
.W
Both naturally occurring and synthetic phosphatidic acid (PtdOH) molecules show the phenomenon of spontaneous vesiculation on jump in pH value. This method involves a transient increase in pH of smectic PtdOH dispersions to values between 10 and 12. Such a pH increase induces spontaneous vesiculation with the formation of small unilamellar vesicles of diameter less than 50 nm as shown by 31P NMR. Both high-resolution and broad-line 31P NMR were used to study the mechanism of this process. When the pH of unsonicated PtdOH dispersions is raised to pH 10-12, lipid molecules on the outer monolayer of the bilayer become fully ionized. The second pK value of PtdOH in bilayers is 8.6 +/- 0.3, determined by 31P NMR. PtdOH molecules on the inner monolayer remain partially protonated. 31P NMR provides unambiguous evidence that the "pH-jump" treatment produces a pH gradient across the PtdOH bilayer. The orientation of the pH gradient is such that the pH in the external medium is 3-5 pH units higher than the internal pH. Associated with the pH gradient is a transverse packing asymmetry: partially protonated PtdOH molecules in the inner layer of the bilayer are more tightly packed than fully ionized molecules present in the outer layer. The pH gradient generated by the pH jump is proposed as the energy source that drives the spontaneous formation of highly curved vesicles.
.A
Hauser H.
.I 125547
.U
89315796
.S
Proc Natl Acad Sci U S A 8910; 86(14):5356-60
.M
DNA/*UL; Mathematics; Microscopy/MT; Models, Molecular; Nucleic Acid Conformation; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Imaging of single uncoated DNA molecules by scanning tunneling microscopy.
.P
JOURNAL ARTICLE.
.W
Scanning tunneling microscope images of DNA molecules absorbed onto highly oriented pyrolytic graphite have been obtained. Three methods of deposition and sample preparation have been utilized. In the first method, a highly concentrated solution of DNA is sonicated, and a drop is deposited on freshly cleaved graphite. Under these conditions, the molecules tend to align in a parallel fashion, forming liquid-crystalline phases. In the second method, a solution of DNA is deposited directly on the graphite surface without sonication. In this case, ammonium acetate, a volatile salt, is used to decrease the amount of the residual salt crystals left after drying. In the third method, a solution containing lysed phage particles and DNA is adsorbed onto a graphite surface. The molecules are seen either isolated or in small bundles. The values of height, periodicity, and thickness observed and the handedness of the molecules are consistent with those expected for DNA. In all cases, the molecules were identified by their characteristic periodic structure and because, at higher magnification, no graphite-like structure was detectable on the surface of the molecules. Often the DNA molecules appear to adsorb in areas of the graphite that have many steps and defects. A mechanism that explains the magnitude of the tunneling currents measured in DNA is proposed. This mechanism, in turn, suggests a general method by which large insulating molecules can be rendered conductive.
.A
Keller D; Bustamante C; Keller RW.
.I 125548
.U
89315798
.S
Proc Natl Acad Sci U S A 8910; 86(14):5366-70
.M
Actins/ME; Adenosine Triphosphatase/ME; Animal; Macromolecular Systems; Mathematics; Muscles/*PH; Myosin/*ME; Peptide Fragments/AN; Rabbits; Spectrometry, Fluorescence; Stress, Mechanical; Support, Non-U.S. Gov't.
.T
Effect of negative mechanical stress on the orientation of myosin cross-bridges in muscle fibers.
.P
JOURNAL ARTICLE.
.W
The effect of positive and negative stress on myosin cross-bridge orientation in glycerinated muscle fibers was investigated by using fluorescence polarization spectroscopy of the emission from the covalent label tetramethyl-rhodamine-5-(and -6)-iodoacetamide (IATR) specifically modifying sulfhydryl one (SH1) on the myosin heavy chain. Positive tension was applied by stretching the fiber in rigor. Negative tension was applied in two steps by using a protocol introduced by Goldman et al. [Goldman, Y. E., McCray, J. A. & Vallette, D. P. (1988) J. Physiol. (London) 398, 75P]: relaxing a fiber at resting length and stretching it until the relaxed tension is appreciable and then placing the fiber in rigor and releasing the tension onto the rigor cross-bridges. We found, as have others, that positive tension has no effect on the fluorescence polarization spectrum from the SH1-bound probe, indicating that the cross-bridge does not rotate under these conditions. Negative tension, however, causes a change in the fluorescence polarization spectrum that indicates a probe rotation. The changes in the polarization spectrum from negative stress are partially reversed by the subsequent application of positive stress. It appears that negative tension strains the cross-bridge, or the cross-bridge domain containing SH1, and causes it to rotate.
.A
Burghardt TP; Ajtai K.
.I 125549
.U
89315800
.S
Proc Natl Acad Sci U S A 8910; 86(14):5380-4
.M
Animal; DNA/GE; Female; Intercellular Junctions/*PH; Kinetics; Membrane Potentials; Membrane Proteins/GE/*PH; Oocytes/PH; RNA, Messenger/GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Transcription, Genetic; Xenopus.
.T
Formation of hybrid cell-cell channels.
.P
JOURNAL ARTICLE.
.W
The oocyte cell-cell channel assay was used to demonstrate that connexin-43 is a cell-cell channel-forming protein as previously shown for connexin-32. Expression of connexin-32 in one and connexin-43 in the other oocyte of a pair results in the formation of junctional conductances at rates similar to those observed when only one or the other connexin is expressed in both oocytes of a pair. This suggests that hybrid cell-cell channels form in the oocyte system. Hybrid channels also form when a connexin-43 mRNA-injected oocyte is paired with a noninjected oocyte expressing endogenous connexin. The latter hybrids have properties apparently contributed by both types of hemichannels. Pure connexin-43 channels are not voltage gated, whereas pure oocyte channels are voltage dependent; hybrids of these channels rectify.
.A
Werner R; Levine E; Rabadan-Diehl C; Dahl G.
.I 125550
.U
89315801
.S
Proc Natl Acad Sci U S A 8910; 86(14):5385-9
.M
Animal; Carcinoma; Diffusion; Ear/BS; Male; Microcirculation/*ME; Microscopy, Fluorescence/MT; Photochemistry; Rabbits; Regional Blood Flow; Serum Albumin, Bovine/*ME; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Tumor Cells, Cultured/*ME.
.T
Direct measurement of interstitial convection and diffusion of albumin in normal and neoplastic tissues by fluorescence photobleaching.
.P
JOURNAL ARTICLE.
.W
Macromolecular transport through the interstitial space of a tissue occurs by convection and diffusion. The convective component of transport results from interstitial fluid flow. There have been no direct measurements of the magnitude or direction of interstitial fluid flow in tissues to date. Using fluorescence recovery after photobleaching, we have measured interstitial fluid velocities and the diffusion coefficient of bovine serum albumin in normal and neoplastic tissues grown in a thin, transparent window in the ear of a rabbit. A well-defined laser beam was focused on a region within the interstitium of the fluorescence-bathed tissue. A short pulse of laser irradiation extinguished the fluorescence emanating from this selected region. The recovery of fluorescence due to diffusion and convection within the medium was monitored and analyzed to yield values of the diffusion coefficient and the fluid velocity. The average fluid velocity was about 0.6 microns/s, and albumin diffusion coefficients were 5.8 +/- 1.3 x 10(-7) cm2/s and 6.3 +/- 1.9 x 10(-7) cm2/s in normal and neoplastic tissues, respectively. The interstitial fluid flow, in general, was directed into postcapillary venules. The results obtained in this study should provide the impetus for further investigation into the diffusion and convection in various tissues under normal and pathological conditions.
.A
Chary SR; Jain RK.
.I 125551
.U
89315811
.S
Proc Natl Acad Sci U S A 8910; 86(14):5434-8
.M
Adipose Tissue; Animal; Cell Differentiation/*; Cell Line; Fibroblasts; Gene Expression Regulation/*; Genes, Regulator/*; Genetic Vectors; Human; Liver; Melanoma; Moloney Sarcoma Virus/GE; Muscles/*CY; Neuroblastoma; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transfection.
.T
Activation of muscle-specific genes in pigment, nerve, fat, liver, and fibroblast cell lines by forced expression of MyoD.
.P
JOURNAL ARTICLE.
.W
MyoD is a master regulatory gene for myogenesis. Under the control of a retroviral long terminal repeat, MyoD was expressed in a variety of differentiated cell types by using either a DNA transfection vector or a retrovirus. Expression of muscle-specific proteins was observed in chicken, human, and rat primary fibroblasts and in differentiated melanoma, neuroblastoma, liver, and adipocyte lines. The ability of MyoD to activate muscle genes in a variety of differentiated cell lines suggests that no additional tissue-specific factors other than MyoD are needed to activate the downstream program for terminal muscle differentiation or that, if such factors exist, they are themselves activated by MyoD expression.
.A
Weintraub H; Tapscott SJ; Davis RL; Thayer MJ; Adam MA; Lassar AB; Miller AD.
.I 125552
.U
89315812
.S
Proc Natl Acad Sci U S A 8910; 86(14):5439-43
.M
Animal; Cell Line; Chromosome Deletion; Gene Expression Regulation/*; Genes, Regulator/*; Genes, Structural/*; Globin/*GE; Human; Mice; Plasmids; Restriction Mapping; RNA, Messenger/GE; Support, U.S. Gov't, P.H.S.; Transcription, Genetic.
.T
Molecular analysis of the human beta-globin locus activation region.
.P
JOURNAL ARTICLE.
.W
Recently, DNA sequences containing four erythroid-specific DNase I hypersensitive sites within 20 kilobases 5' of the human epsilon-globin gene have been identified as an important cis-acting regulatory element, the locus activation region (LAR). Subfragments of the LAR, containing either all or only the two 5' or two 3' hypersensitive sites were linked to the human beta-globin gene and analyzed for their effect on globin gene expression in stably transformed mouse erythroleukemia (MEL) cells. Constructs containing all four of the hypersensitive sites increase beta-globin mRNA levels 8- to 13-fold, while constructs with only the 5' or 3' sites increase globin expression to a lesser extent. No effect was seen when the constructs were assayed in 3T3 fibroblasts. All of the LAR derivatives form hypersensitive sites at the corresponding sequence position in MEL cells prior to and after induction of MEL cell differentiation. However, in 3T3 fibroblasts only the hypersensitive site corresponding to the previously described erythroid-specific -10.9 site was formed.
.A
Forrester WC; Novak U; Gelinas R; Groudine M.
.I 125553
.U
89315814
.S
Proc Natl Acad Sci U S A 8910; 86(14):5449-53
.M
Amino Acid Sequence; Animal; Antibodies; Base Sequence; Chick Embryo; Chickens; Cloning, Molecular; DNA/*GE; Immunoblotting; Molecular Sequence Data; Molecular Weight; Protein-Tyrosine Kinase/*GE; Sequence Homology, Nucleic Acid; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tyrosine/*AA/AN/IM.
.T
Identification of a developmentally regulated protein-tyrosine kinase by using anti-phosphotyrosine antibodies to screen a cDNA expression library.
.P
JOURNAL ARTICLE.
.W
To identify the protein-tyrosine kinases that are expressed during chicken embryonic development, a 10-day chicken embryo cDNA expression library was screened with anti-phosphotyrosine antibodies. Of the positive clones isolated, many encoded the same protein-tyrosine kinase, which we designate Cek1 (chicken embryo kinase 1). Its amino acid sequence suggests that the Cek1 protein is a transmembrane tyrosine kinase and presumably the receptor for an unknown ligand. Antibodies prepared to the cloned Cek1 kinase recognize, in immunoblotting experiments, two protein bands with apparent molecular weights of 100,000 and 110,000. The Cek1 protein was detected in many chicken embryonic tissues, but not in the corresponding adult tissues (with the exception of brain). The Cek1 kinase appears to be very closely related to two protein-tyrosine kinases whose partial sequences have been recently determined, human Flg and mouse Bek. Cloning using anti-phosphotyrosine antibodies has allowed us to detect, in addition to Cek1, several other protein-tyrosine kinases that are expressed during chicken embryonic development, some of which have not been previously identified.
.A
Pasquale EB; Singer SJ.
.I 125554
.U
89315815
.S
Proc Natl Acad Sci U S A 8910; 86(14):5454-8
.M
Alcohol Dehydrogenase/*GE; Amino Acid Sequence; Animal; Base Sequence; Comparative Study; DNA/*GE; Evolution/*; Gene Expression Regulation; Genes, Reiterated/*; Genes, Structural/*; Hominidae/*GE; Human; Liver/EN; Molecular Sequence Data; Papio/*GE; Primates/*GE; Restriction Mapping; Sequence Homology, Nucleic Acid; Support, Non-U.S. Gov't.
.T
Cloning and sequencing of cDNA encoding baboon liver alcohol dehydrogenase: evidence for a common ancestral lineage with the human alcohol dehydrogenase beta subunit and for class I ADH gene duplications predating primate radiation.
.P
JOURNAL ARTICLE.
.W
The baboon has at least five alcohol dehydrogenases (ADH; alcohol:NAD+ oxidoreductase, EC 1.1.1.1) and has distinct liver and kidney class I isozymes. A rat liver class I ADH partial cDNA was used to screen a baboon liver cDNA library. A cDNA clone was isolated and sequenced and found to contain the entire coding region for baboon liver ADH, 12 nucleotides of the 5' noncoding region, and 256 nucleotides of the 3' noncoding region. The amino acid sequence deduced from this cDNA most closely resembles that of human liver ADH beta subunit (ADH-beta): 363 of 374 residues were identical. This suggested that baboon liver class I ADH is of the same ancestral lineage as the human ADH-beta. In contrast to human liver, only a single ADH-beta transcript is observed in baboon liver. A comparison of human and baboon ADH 3' noncoding regions suggests that a single nucleotide change in a polyadenylylation signal consensus sequence may, in part, be responsible for the generation of ADH-beta transcripts with variable-length 3' ends in human liver. A nucleotide substitution rate of 0.5 x 10(-9) substitutions per site per year for primate class I ADH genes was deduced from the data, which suggests that the alpha-beta gamma separation of human ADH genes occurred about 60 million years ago, and that primate class I ADH gene duplications predated primate radiation.
.A
Trezise AE; Godfrey EA; Holmes RS; Beacham IR.
.I 125555
.U
89315816
.S
Proc Natl Acad Sci U S A 8910; 86(14):5459-63
.M
Animal; Chromosome Mapping; Comparative Study; Drosophila/GE; Evolution/*; Genes, Homeo Box/*; Human; Mice; Rats; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vertebrates/*GE.
.T
Two steps in the evolution of Antennapedia-class vertebrate homeobox genes.
.P
JOURNAL ARTICLE.
.W
Antennapedia-class vertebrate homeobox genes have been classified with regard to their chromosomal locations and nucleotide sequence similarities within the 183-base-pair homeobox domain. The results of these comparisons support the view that in mammals and most likely the vertebrates, four clusters of homeobox genes exist that were created by duplications of an entire primordial gene cluster. We present evidence that this primordial cluster arose by local gene duplications of homeoboxes that were present before the divergence of arthropods and chordates. Sequence analyses indicate that the expansion of the primordial gene cluster complex was accompanied by diversification, whereas conservation predominated after the duplications of entire homeobox gene clusters.
.A
Kappen C; Schughart K; Ruddle FH.
.I 125556
.U
89315817
.S
Proc Natl Acad Sci U S A 8910; 86(14):5464-8
.M
Animal; Chromosome Mapping; Crosses, Genetic/*; Drosophila/*GE; Evolution; Female; Male; Support, U.S. Gov't, P.H.S..
.T
Genetics of sexual isolation between two sibling species, Drosophila simulans and Drosophila mauritiana.
.P
JOURNAL ARTICLE.
.W
Drosophila simulans and Drosophila mauritiana are sibling species that show substantial sexual isolation in one of their two reciprocal hybridizations. Genetic analysis reveals that in females this isolation is caused by at least one recessive gene on each autosome, while the X chromosome has little or no effect. Our results, combined with those of previous studies, show that in Drosophila the genetics of sexual isolation differs from that of postzygotic reproductive isolation, which invariably involves large effects of the X chromosome.
.A
Coyne JA.
.I 125557
.U
89315818
.S
Proc Natl Acad Sci U S A 8910; 86(14):5469-72
.M
Animal; Cell Nucleus/AN; Diploidy/*; DNA/AN/GE; Flow Cytometry; Trypanosoma/*GE; Trypanosoma brucei brucei/GE; Trypanosoma congolense/GE.
.T
Evidence for diploidy in metacyclic forms of African trypanosomes.
.P
JOURNAL ARTICLE.
.W
The DNA contents of bloodstream form trypanosomes (life cycle stages circulating in the blood of the vertebrate host) of four African Trypanosoma species and of metacyclic forms (the life cycle stage that is injected into the vertebrate by the tsetse fly during its bite) of the same four species were measured by cytofluorometry of individual cells or nuclei. The results showed unambiguously that the metacyclic forms cannot be considered to be products of meiosis containing only half of the DNA of bloodstream forms, in contrast to what was previously reported for Trypanosoma brucei [Zampetti-Bosseler, F., Schweizer, J., Pays, E., Jenni, L. & Steinert, M. (1986) Proc. Natl. Acad. Sci. USA 83, 6063-6064] during an attempt to localize the gametes in the life cycle after experimental evidence of sexual gene exchange in this parasite was reported.
.A
Kooy RF; Hirumi H; Moloo SK; Nantulya VM; Dukes P; Van der Linden PM; Duijndam WA; Janse CJ; Overdulve JP.
.I 125558
.U
89315820
.S
Proc Natl Acad Sci U S A 8910; 86(14):5478-82
.M
Chromosome Deletion; Cloning, Molecular; Drug Resistance, Microbial; Genes, Bacterial; Genetic Vectors/*; Halobacterium/DE/*GE; Lovastatin/PD; Mutation; Restriction Mapping; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Transformation, Bacterial.
.T
Shuttle vectors for the archaebacterium Halobacterium volcanii.
.P
JOURNAL ARTICLE.
.W
Progress in archaebacterial molecular biology requires tools for genetic analysis. We describe vectors that can be selected and maintained in either Halobacterium volcanii or Escherichia coli. A genetic determinant for resistance to the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor mevinolin was isolated by "shotgun cloning" into a derivative of the endogenous H. volcanii plasmid pHV2, to form pWL2, which transforms sensitive H. volcanii to mevinolin resistance at high frequency. The resistance determinant, portions of pHV2, and an ampicillin- and tetracycline-resistance-conferring pBR322 derivative, pAT153, were ligated together to form the shuttle vectors pWL101 and pWL102. We describe conditions for the use of these vectors and provide preliminary definition of regions essential for drug resistance and for plasmid replication and maintenance.
.A
Lam WL; Doolittle WF.
.I 125559
.U
89315821
.S
Proc Natl Acad Sci U S A 8910; 86(14):5483-6
.M
Amino Acid Sequence; Animal; Base Sequence; Comparative Study; Drosophila/*GE; Evolution/*; Genes, Homeo Box/*; Molecular Sequence Data; Sequence Homology, Nucleic Acid; Species Specificity; Support, Non-U.S. Gov't.
.T
The homeotic gene spalt (sal) evolved during Drosophila speciation.
.P
JOURNAL ARTICLE.
.W
The region-specific homeotic gene spalt (sal) acts in two separate domains in the head and tail region of the Drosophila melanogaster embryo. Based on comparative morphology, sal is likely to be involved in the establishment of the head during the evolution of invertebrates and thus, it should be conserved. We have analyzed the conservation of the segmentation genes Kruppel (Kr) and even-skipped (eve) in parallel with sal coding sequences in several Drosophila species that are evolutionarily separated by up to 60 million years. To our surprise, sal sequences appear to be conserved in the Sophophora subgenus of the Drosophila genus but not in the Drosophila subgenus. On the other hand, the segmentation and other homeotic genes are conserved in the Drosophila subgroup as well. Our data suggest that sal encodes an accessory function that evolved relatively late during Drosophila speciation rather than playing a fundamental evolutionary role similar to that of other homeotic genes.
.A
Reuter D; Schuh R; Jackle H.
.I 125560
.U
89315822
.S
Proc Natl Acad Sci U S A 8910; 86(14):5487-91
.M
Animal; Animals, Newborn; Blotting, Northern; Blotting, Southern; DNA/GE; DNA, Neoplasm/GE; Evolution; Gene Amplification; Gene Expression Regulation/*; Human; Lymphoma/*GE/MI; Mice; Moloney Leukemia Virus/*GE; Proto-Oncogenes/*; Rats; Rats, Inbred F344; Restriction Mapping; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Activation of the Mlvi-1/mis1/pvt-1 locus in Moloney murine leukemia virus-induced T-cell lymphomas.
.P
JOURNAL ARTICLE.
.W
The Mlvi-1/mis-1/pvt-1 locus, located approximately 270 kilobase pairs 3' of the c-myc protooncogene, was originally discovered as a common region of provirus integration in Moloney murine leukemia virus-induced rat T-cell lymphomas. The same locus was shown subsequently to be coamplified with c-myc and to be involved in chromosomal translocations in a variety of human and animal neoplasms. Provirus integration in Mlvi-1 in Moloney murine leukemia virus-induced rat T-cell lymphomas activates the c-myc protooncogene. The studies reported here were aimed to determine whether, in addition to the activation of c-myc, provirus integration affected the expression of other neighboring genes. Provirus integration was shown to occur in three clusters separated by regions of uninterrupted DNA. The proviruses in all three clusters had integrated in a single-transcriptional orientation, and they appeared intact. Systematic hybridization of Mlvi-1 clones to rat, mouse, and human genomic DNA revealed three patches of evolutionarily conserved sequences. Two of them were mapped in regions targeted by the provirus, and the third was mapped immediately 5' to the provirus clusters. A probe derived from the conserved sequences 5' of the integrated proviruses detected a tumor-specific RNA transcript in tumors carrying a provirus in Mlvi-1 or in the neighboring Mlvi-4 and c-myc loci. The highest level of RNA transcript expression, however, was seen in a CD4+ CD8+ tumor cell line that was not carrying a provirus in this region. We conclude that provirus insertion in this region activates both c-myc and another gene that is located in the immediate vicinity of the integrated Mlvi-1 proviruses and may be developmentally regulated in T cells.
.A
Tsichlis PN; Shepherd BM; Bear SE.
.I 125561
.U
89315825
.S
Proc Natl Acad Sci U S A 8910; 86(14):5502-6
.M
Base Sequence; Chromosome Deletion; DNA, Neoplasm/GE; Exons; Eye Neoplasms/*GE; Genes/*; Human; Introns; Molecular Sequence Data; Promoter Regions (Genetics); Restriction Mapping; Retinoblastoma/*GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Transcription, Genetic.
.T
Structure of the human retinoblastoma gene.
.P
JOURNAL ARTICLE.
.W
Complete inactivation of the human retinoblastoma gene (RB) is believed to be an essential step in tumorigenesis of several different cancers. To provide a framework for understanding inactivation mechanisms, the structure of RB was delineated. The RB transcript is encoded in 27 exons dispersed over about 200 kilobases (kb) of genomic DNA. The length of individual exons ranges from 31 to 1889 base pairs (bp). The largest intron spans greater than 60 kb and the smallest one has only 80 bp. Deletion of exons 13-17 is frequently observed in various types of tumors, including retinoblastoma, breast cancer, and osteosarcoma, and the presence of a potential "hot spot" for recombination in the region is predicted. A putative "leucine-zipper" motif is exclusively encoded by exon 20. The detailed RB structure presented here should prove useful in defining potential functional domains of its encoded protein. Transcription of RB is initiated at multiple positions and the sequences surrounding the initiation sites have a high G + C content. A typical upstream TATA box is not present. Localization of the RB promoter region was accomplished by utilizing a heterologous expression system containing a bacterial chloramphenicol acetyltransferase gene. Deletion analysis revealed that a region as small as 70 bp is sufficient for RB promoter activity, similar to other previously characterized G + C-rich gene promoters. Several direct repeats and possible stem-and-loop structures are found in the promoter region. No enhancer element was detected within the 7.3 kb of upstream sequence studied. Several features of the RB promoter are reminiscent of the characteristics associated with many "housekeeping" genes, consistent with its ubiquitous expression pattern.
.A
Hong FD; Huang HJ; To H; Young LJ; Oro A; Bookstein R; Lee EY; Lee WH.
.I 125562
.U
89315827
.S
Proc Natl Acad Sci U S A 8910; 86(14):5512-6
.M
Animal; Cell Line; Cell Survival/RE; Cloning, Molecular/*; DNA Repair/*; DNA Replication/RE; Embryo; Genes/*; Genetic Complementation Test; Human; Mice; Plasmids; Restriction Mapping; Support, Non-U.S. Gov't; Transfection/*; Ultraviolet Rays; Xeroderma Pigmentosum/*GE.
.T
Molecular cloning of a mouse DNA repair gene that complements the defect of group-A xeroderma pigmentosum.
.P
JOURNAL ARTICLE.
.W
For isolation of the gene responsible for xeroderma pigmentosum (XP) complementation group A, plasmid pSV2gpt and genomic DNA from a mouse embryo were cotransfected into XP2OSSV cells, a group-A XP cell line. Two primary UV-resistant XP transfectants were isolated from about 1.6 X 10(5) pSV2gpt-transformed XP colonies. pSV2gpt and genomic DNA from the primary transfectants were again cotransfected into XP2OSSV cells and a secondary UV-resistant XP transfectant was obtained by screening about 4.8 X 10(5) pSV2gpt-transformed XP colonies. The secondary transfectant retained fewer mouse repetitive sequences. A mouse gene that complements the defect of XP2OSSV cells was cloned into an EMBL3 vector from the genome of a secondary transfectant. Transfections of the cloned DNA also conferred UV resistance on another group-A XP cell line but not on XP cell lines of group C, D, F, or G. Northern blot analysis of poly(A)+ RNA with a subfragment of cloned mouse DNA repair gene as the probe revealed that an approximately 1.0 kilobase mRNA was transcribed in the donor mouse embryo and secondary transfectant, and approximately 1.0- and approximately 1.3-kilobase mRNAs were transcribed in normal human cells, but none of these mRNAs was detected in three strains of group-A XP cells. These results suggest that the cloned DNA repair gene is specific for group-A XP and may be the mouse homologue of the group-A XP human gene.
.A
Tanaka K; Satokata I; Ogita Z; Uchida T; Okada Y.
.I 125563
.U
89315831
.S
Proc Natl Acad Sci U S A 8910; 86(14):5532-6
.M
Animal; Antibodies/*GE; Antibody Diversity; Antigen-Antibody Complex/*; Antigens/*; Base Sequence; Binding Sites; Cell Line; Computer Simulation; Enzyme-Linked Immunosorbent Assay; Gene Rearrangement/*; Models, Molecular; Molecular Sequence Data; Mutation; Phosphorylcholine/IM; Protein Conformation; Structure-Activity Relationship; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Significant structural and functional change of an antigen-binding site by a distant amino acid substitution: proposal of a structural mechanism.
.P
JOURNAL ARTICLE.
.W
To study the molecular basis for antibody diversity and the structural basis for antigen binding, we have characterized the loss of phosphocholine (P-Cho) binding both experimentally and computationally in U10, a somatic mutant of the antibody S107. Nucleotide sequencing of U10 shows a single base change in JH1, substituting Asp-101 with Ala, over 9 A distant from the P-Cho-binding pocket. Probing with antiidiotypic antibodies suggests local, not global, conformational changes. Computational results support a specific structural mechanism for the loss of P-Cho binding. The U10 mutation eliminates the charged interaction between Asp-101 and Arg-94, which allows the Arg-94 side chain to disrupt P-Cho binding sterically and electrostatically by folding into the P-Cho-binding site. These results specifically show the importance of the Arg-94 to Asp-101 side chain salt bridge in the heavy-chain CDR3 conformation and suggest that residues distant from the binding site play an important role in antibody diversity and inducible complementarity.
.A
Chien NC; Roberts VA; Giusti AM; Scharff MD; Getzoff ED.
.I 125564
.U
89315840
.S
Proc Natl Acad Sci U S A 8910; 86(14):5575-9
.M
Amino Acid Sequence; Animal; Blood Proteins/GE/*PH; Cloning, Molecular; Comparative Study; Complement 4/GE/*PH; DNA/GE; Hemolysis; Human; Mice; Molecular Sequence Data; Mutation; Oligonucleotide Probes; Plasmids; Sequence Homology, Nucleic Acid; Support, U.S. Gov't, P.H.S..
.T
Murine complement component C4 and sex-limited protein: identification of amino acid residues essential for C4 function.
.P
JOURNAL ARTICLE.
.W
Murine sex-limited protein (Slp) is an isotype of murine complement component C4 that shares 95% sequence identity with C4 as well as the intramolecular thioester necessary for C4 function but has no complement activity. Slp is nonfunctional at least in part because it is not cleaved by the activated form of complement protease C1s (C1s), which proteolytically activates C4 in the classical complement pathway. Slp is also distinct from C4 in that its expression in some mouse strains is under testosterone control. In the present studies, we used site-directed mutagenesis of C4 and expression of the mutant proteins in cultured cells to identify the amino acid substitutions in Slp that are responsible for resistance to C1s cleavage. We focused on sequence changes immediately downstream of the cleavage site in C4 because the arginine at that site is conserved in Slp, but the downstream sequences diverge substantially, with six differences in the first 7 residues followed by a 3-residue deletion in Slp. We found that a C4 mutant carrying only the 3-residue deletion is not cleaved by C1s and has essentially no hemolytic activity, whereas a mutant carrying only the six replacement changes is cleaved by C1s and has normal hemolytic activity. Both mutants have intact thioesters. A third mutant in which two acidic residues in the segment deleted in Slp were replaced by aliphatic residues is also cleaved by C1s, has an intact thioester group, and has normal hemolytic activity. These results indicate that the downstream mutations are responsible for the resistance of Slp to C1s cleavage and suggest that the length rather than the specific sequence of this segment is critical in determining susceptibility to the protease.
.A
Ogata RT; Cooper NR; Bradt BM; Mathias P; Picchi MA.
.I 125565
.U
89315842
.S
Proc Natl Acad Sci U S A 8910; 86(14):5585-9
.M
Breast Neoplasms; Carbon Isotopes; Cell Line; Clone Cells; Cycloheximide/*PD; Dactinomycin/*PD; Estradiol/*PD; Female; Glucose/*ME; Glutamates/ME; Glycolysis/DE; Human; Lactates/ME; Nuclear Magnetic Resonance/MT; Phospholipids/*ME; Phosphorus; Support, U.S. Gov't, P.H.S.; Tamoxifen/*PD; Tumor Cells, Cultured/DE/*ME.
.T
Early estrogen-induced metabolic changes and their inhibition by actinomycin D and cycloheximide in human breast cancer cells: 31P and 13C NMR studies.
.P
JOURNAL ARTICLE.
.W
Metabolic changes following estrogen stimulation and the inhibition of these changes in the presence of actinomycin D and cycloheximide were monitored continuously in perfused human breast cancer T47D clone 11 cells with 31P and 13C NMR techniques. The experiments were performed by estrogen rescue of tamoxifen-treated cells. Immediately after perfusion with estrogen-containing medium, a continuous enhancement in the rates of glucose consumption, lactate production by glycolysis, and glutamate synthesis by the Krebs cycle occurred with a persistent 2-fold increase at 4 hr. The content of phosphocholine had increased by 10% to 30% within the first hour of estrogen stimulation, but the content of the other observed phosphate metabolites as well as the pH remained unchanged. Pretreatment with either actinomycin D or cycloheximide, at concentrations known to inhibit mRNA and protein synthesis, respectively, and simultaneous treatment with estrogen and each inhibitor prevented the estrogen-induced changes in glucose metabolism. This suggested that the observed estrogen stimulation required synthesis of mRNA and protein. These inhibitors also modulated several metabolic activities that were not related to estrogen stimulation. The observed changes in the in vivo kinetics of glucose metabolism may provide a means for the early detection of the response of human breast cancer cells to estrogen versus tamoxifen treatment.
.A
Neeman M; Degani H.
.I 125566
.U
89315844
.S
Proc Natl Acad Sci U S A 8910; 86(14):5595-9
.M
Acquired Immunodeficiency Syndrome/*MI; Bone Marrow/PA; Human; HIV-1/*GE/IP; Megakaryocytes/*IM/UL; Microscopy, Electron; RNA, Viral/GE/*IP; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vacuoles/UL.
.T
Megakaryocytes of human immunodeficiency virus-infected individuals express viral RNA.
.P
JOURNAL ARTICLE.
.W
The pathogenesis of thrombocytopenia associated with human immunodeficiency virus (HIV) infection is not fully understood. Immune mechanisms provide a partial explanation but fail to account for a lack of compensatory megakaryocytosis, the rapid reversal after treatment with azidothymidine, and the ultrastructural aberrations seen in the megakaryocytes of patients with acquired immunodeficiency syndrome. Therefore, a direct effect of HIV on megakaryocytes was investigated. The bone marrow of HIV seropositive individuals was analyzed ultrastructurally, and the megakaryocytes of 10 thrombocytopenic patients were subjected to in situ hybridization with a HIV RNA probe. The structural aberrations in HIV megakaryocytes were distinct from those in HIV-negative immune thrombocytopenias, and the megakaryocytes of 10 of 10 patients examined by in situ hybridization unambiguously expressed viral RNA. Therefore, it is likely that direct infection of megakaryocytes with HIV-1 is one mechanism for the decrease in platelet production.
.A
Zucker-Franklin D; Cao YZ.
.I 125567
.U
89315845
.S
Proc Natl Acad Sci U S A 8910; 86(14):5600-4
.M
Animal; Blood Platelets/DE/*PH; Dogs; Human; In Vitro; Kinetics; Muscle Contraction/DE; Muscle, Smooth, Vascular/DE/*PH; Platelet Aggregation Inhibitors/*PD; Prostaglandin Endoperoxides, Synthetic/PD; Saphenous Vein/DE/PH; Stereoisomers; Structure-Activity Relationship; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Thromboxane A2/*AA/PD.
.T
Difluorothromboxane A2 and stereoisomers: stable derivatives of thromboxane A2 with differential effects on platelets and blood vessels.
.P
JOURNAL ARTICLE.
.W
The present study reports on the selective effects on human platelets and canine saphenous veins of four stable difluorinated analogues and thromboxane A2 (TXA2), in which the characteristic 2,6-dioxa[3.1.1]bicycloheptane structure of TXA2 has been retained. The four compounds differ in their stereochemistry of the 5,6 double bond and/or the 15-hydroxyl group. Only 10,10-difluoro-TXA2 (compound I) with the natural stereochemistry of TXA2 was an agonist in both platelets and canine saphenous veins (EC50 = 36 +/- 3.6 nM and 3.7 +/- 0.8 nM, respectively). (15R)-10,10-Difluoro-TXA2 (compound II), (5E)-10,10-difluoro-TXA2 (compound III), and (5E,15R)-10,10-difluoro-TXA2 (compound IV) were antagonists of platelet aggregation stimulated by compound I (Kd = 98 +/- 46 nM, 140 +/- 42 nM, and 1450 +/- 350 nM, respectively). However, compounds II, III, and IV stimulated contraction of canine saphenous veins (EC50 = 36 +/- 4.4 nM, 31 +/- 6.8 nM, and 321 +/- 50 nM, respectively). All four compounds could displace the TXA2/prostaglandin H2 antagonist 9,11-dimethylmethano-11,12-methano-16-(3- 125I-4-hydroxyphenyl)-13,14-dihydro-13-aza-15 alpha beta-omega-tetranor-TXA2 from its platelet receptor (Kd values = 100 +/- 30 nM, compound I; 280 +/- 60 nM, compound II; 230 +/- 70 nM, compound III; and 1410 +/- 1020 nM, compound IV). These results support the existence of two subtypes of TXA2/prostaglandin H2 receptors and emphasize the importance of the stereochemical requirements of these TXA2 analogues for interaction with these receptors. These stable fluorinated TXA2 analogues should prove useful tools for the further characterization of these and other TXA2/prostaglandin H2 receptors.
.A
Morinelli TA; Okwu AK; Mais DE; Halushka PV; John V; Chen CK; Fried J.
.I 125568
.U
89315846
.S
Proc Natl Acad Sci U S A 8910; 86(14):5605-9
.M
Adult; Comparative Study; DNA/IP/*RE; Erythema; Human; Pyrimidine Dimers/*AN; Skin/*RE; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Ultraviolet Rays/*.
.T
Wavelength dependence of pyrimidine dimer formation in DNA of human skin irradiated in situ with ultraviolet light.
.P
JOURNAL ARTICLE.
.W
The UV components of sunlight are believed to be a major cause of human skin cancer, and DNA is thought to be the principal molecular target. Alterations of the intensity and wavelength distribution of solar UV radiation reaching the surface of the earth, for example by depletion of stratospheric ozone, will change the effectiveness of solar radiation in damaging DNA in human skin. Evaluation of the magnitude of such effects requires knowledge of the altered sunlight spectrum and of the action spectrum for damaging DNA in human skin. We have determined an action spectrum for the frequency of pyrimidine dimer formation induced in the DNA of human skin per unit dose of UV incident on the skin surface. The peak of this action spectrum is near 300 nm and decreases rapidly at both longer and shorter wavelengths. The decrease in our action spectrum for wavelengths less than 300 nm is attributed to the absorption of the upper layers of the skin, an in situ effect that is inherently included in our measurements. Convolution of the dimer action spectrum with the solar spectra corresponding to a solar angle of 40 degrees under current levels of stratospheric ozone (0.32-cm O3 layer) and those for 50% ozone depletion (0.16-cm O3 layer), indicate about a 2.5-fold increase in dimer formation. If the action spectrum for DNA damage that results in skin cancer resembles that for dimer induction in skin, our results, combined with epidemiological data, suggest that a 50% decrease in stratospheric ozone would increase the incidence of nonmelanoma skin cancers among white males in Seattle, Washington, by 7.5- to 8-fold, to a higher incidence than is presently seen in the corresponding population of Albuquerque, New Mexico.
.A
Freeman SE; Hacham H; Gange RW; Maytum DJ; Sutherland JC; Sutherland BM.
.I 125569
.U
89315848
.S
Proc Natl Acad Sci U S A 8910; 86(14):5615-9
.M
Adenoviruses, Human/*GE; Animal; Blotting, Northern; Chimera; Genes, MHC Class I; Genes, Viral; Human; Mammary Cancer Virus/GE; Mice; Mice, Transgenic; Nucleic Acid Hybridization; Oncogene Proteins, Viral/*GE; Plasmids; Repetitive Sequences, Nucleic Acid; Stomach Neoplasms/*GE/MI/PA; Transcription, Genetic.
.T
Transgenic mouse model for human gastric carcinoma.
.P
JOURNAL ARTICLE.
.W
To understand the pathogenesis that may be induced by human adenovirus type 12 (Ad12), we have generated transgenic mice carrying the Ad12 early region 1 under control of the mouse mammary tumor virus long terminal repeat. Eleven of 11 male founder mice, but only 2 of 12 females, died between 3 to 4 mo of age. Death was associated with presence of tumors at or near the squamocolumnar junction of the stomach. Microscopically, these multifocal tumors appeared to arise from hyperplastic epithelium and showed features consistent with adenocarcinoma or adenosquamous carcinoma. High levels of expression of both the Ad12 E1A and E1B genes were seen in the tumor-bearing stomach. Various levels of expression were also detected in other tissues, although the stomach was the only organ with detectable pathology. These observations suggest an organ-specific action of the Ad12 early region 1 gene products. This transgenic mouse model provides an experimental system for studying the development of human carcinomas at sites of transition from squamous to columnar epithelium.
.A
Koike K; Hinrichs SH; Isselbacher KJ; Jay G.
.I 125570
.U
89315850
.S
Proc Natl Acad Sci U S A 8910; 86(14):5626-30
.M
Animal; Base Sequence; Cells, Cultured; Coronaviridae/*GE; Gastroenteritis Virus of Swine/*GE; Genes, Viral; Kinetics; Male; Molecular Sequence Data; Oligonucleotide Probes; Replicon/*; RNA, Messenger/BI/*GE; RNA, Viral/BI/*GE; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Swine; Testis/CY.
.T
Coronavirus subgenomic minus-strand RNAs and the potential for mRNA replicons.
.P
JOURNAL ARTICLE.
.W
The genome of the porcine transmissible gastroenteritis coronavirus is a plus-strand, polyadenylylated, infectious RNA molecule of approximately 20 kilobases. During virus replication, seven subgenomic mRNAs are generated by what is thought to be a leader-priming mechanism to form a 3'-coterminal nested set. By using radiolabeled, strand-specific, synthetic oligodeoxynucleotide probes in RNA blot hybridization analyses, we have found a minus-strand counterpart for the genome and for each subgenomic mRNA species in the cytoplasm of infected cells. Subgenomic minus strands were found to be components of double-stranded replicative forms and in numbers that surpass full-length antigenome. We propose that subgenomic mRNA replication, in addition to leader-primed transcription, is a significant mechanism of mRNA synthesis and that it functions to amplify mRNAs. It is a mechanism of amplification that has not been described for any other group of RNA viruses. Subgenomic replicons may also function in a manner similar to genomes of defective interfering viruses to lead to the establishment of persistent infections, a universal property of coronaviruses.
.A
Sethna PB; Hung SL; Brian DA.
.I 125571
.U
89315855
.S
Proc Natl Acad Sci U S A 8910; 86(14):5651-5
.M
Aging; Amino Acid Sequence; Animal; Base Sequence; Blotting, Northern; Brain/DE/*GD/ME; Cerebellar Diseases/CI/*ME; Cerebellum/*ME; Cloning, Molecular; Gene Expression Regulation/*; Genes, Structural/*; Harmaline/PD; Male; Methylazoxymethanol Acetate/TO; Mice; Mice, Mutant Strains; Molecular Sequence Data; Mutation/*; Nerve Tissue Proteins/*GE; Pyridines/PD; Rats; Rats, Inbred Strains; Reference Values; RNA, Messenger/GE; Transcription, Genetic/*/DE.
.T
Molecular cloning of a neuron-specific transcript and its regulation during normal and aberrant cerebellar development.
.P
JOURNAL ARTICLE.
.W
PEP-19 is a brain-specific polypeptide whose levels increase dramatically during the late maturation of the rodent nervous system. By using immunocytochemistry, PEP-19 is shown to be localized to several regions of the central nervous system, notably cerebellum, thalamus caudate putamen, and olfactory bulb. We have isolated a 0.5-kilobase cDNA clone that encodes the entire PEP-19 protein sequence, making this one of the smallest primary transcripts and translation products ever identified in eukaryotes. The cDNA was used to investigate the developmental expression of PEP-19 in rodent brain. PEP-19 mRNA rises from low levels at embryonic day 17 of gestation in the rat to a plateau value by day 18 postpartum. This mirrored the levels of the protein determined by radioimmunoassay. Since the rise coincided with the formation of synaptic contacts onto Purkinje cells (a major site of PEP-19 expression), the hypothesis was tested that the activity and/or presence of afferent input modulated PEP-19 expression. Parallel fiber innervation was disrupted either by killing granule cells with the cytostatic agent methylazoxymethanol or by examining PEP-19 levels in cerebellar granuloprival mutant mice (reeler and weaver). The influence of climbing fiber input was assessed by either eliminating them with 3-acetylpyridine or stimulating them with harmaline in both neonatal and mature rats. None of the above altered PEP-19 gene expression in cerebellum, leading us to propose that the signals triggering the PEP-19 gene do not emanate from granule cells or neurons in the olivary nucleus. However, preliminary evidence suggests that PEP-19 is under posttranscriptional regulation.
.A
Sangameswaran L; Hempstead J; Morgan JI.
.I 125572
.U
89315856
.S
Proc Natl Acad Sci U S A 8910; 86(14):5656-60
.M
Adenosine Triphosphate/*PH; Animal; Cerebral Cortex/PH; Dinitrophenols/PD; Electrophysiology; Fluorescent Dyes; Ganglia/PH; In Vitro; Rats; Squid; Support, U.S. Gov't, Non-P.H.S.; Synapses/DE/*PH; Synaptic Vesicles/DE/*PH; Synaptosomes/PH; Xanthenes.
.T
ATP-dependent directional movement of rat synaptic vesicles injected into the presynaptic terminal of squid giant synapse.
.P
JOURNAL ARTICLE.
.W
The question as to whether synaptic vesicles prepared from vertebrate brain can be transported to the active zones of the squid giant synapse was studied by using a combined optical and electrophysiological approach. In order to visualize the behavior of the vertebrate synaptic vesicles in situ, synaptic vesicles isolated from rat brain were labeled with a fluorescent dye (Texas red) and injected into the presynaptic terminal of the squid giant synapse. The pattern of fluorescence that would result from passive diffusion was determined by coinjection of an unconjugated fluorescent dye (fluorescein). The patterns obtained with fluorescent synaptic vesicles were strikingly different from that obtained by simple diffusion of fluorescein. Although the fluorescein diffused freely in both directions, the vesicles moved preferentially into the terminal--i.e., toward the release sites--at a rate of 0.5 microns/sec. The final distribution of the injected fluorescent synaptic vesicles displayed a discrete localization that suggested a distribution coincident with the active zones of the presynaptic terminal. Like fast axonal transport, but unlike fluorescein movements in the terminal, the vesicle movement was energy dependent, since the addition of 2,4-dinitrophenol blocked the redistribution of vesicles completely. In addition, reduction of extracellular calcium concentration reversibly blocked vesicular movement as well. In conclusion, mammalian synaptic vesicles retain the cytoplasmic surface components necessary for translocation, sorting, and targeting to the proper locations by the native machinery of the squid giant synapse.
.A
Llinas R; Sugimori M; Lin JW; Leopold PL; Brady ST.
.I 125573
.U
89315858
.S
Proc Natl Acad Sci U S A 8910; 86(14):5666-9
.M
Animal; Body Temperature/DE; Brain/DE/*PH; Circadian Rhythm/DE; Dinoprostone/PD/*PH; Male; Prostaglandin Antagonists/*PD; Rats; Rats, Inbred Strains; Reference Values; Sleep/DE/*PH; Sleep, REM/PH; Wakefulness/DE/*PH; Xanthenes/*PD.
.T
Evidence that brain prostaglandin E2 is involved in physiological sleep-wake regulation in rats.
.P
JOURNAL ARTICLE.
.W
We reported in previous studies that prostaglandin E2 (PGE2) has central effects of augmenting wakefulness and suppressing slow-wave sleep (SWS) and paradoxical sleep (PS) in rats. In the present study, we tested the effect of AH 6809, an antagonist of PGE2 receptors, on sleep-wake activities. AH 6809 in saline was infused continuously into the third ventricle of freely moving rats at a rate of 2.1, 6.3, and 21 pmol/min from 2300 to 0500 hr. During the infusion at 21 pmol/min, wakefulness decreased to 82%, and SWS and PS increased to 122% and 161%, of the respective baseline values. These changes can be explained by AH 6809 antagonizing the endogenous PGE2 that acts to augment wakefulness in the brain. This explanation is supported by the fact that the infusion of AH 6809 at 21 pmol/min inhibited the wakefulness-promoting effect of PGE2 infused at 10 pmol/min. Moreover, the PGE2-related mechanisms for regulating sleep-wake activities may be different from those producing hyperthermia, because AH 6809 at 21 pmol/min had no primary effect on brain temperature and did not antagonize the hyperthermia produced by the PGE2 infusion. A diurnal infusion (1200 to 1800 hr) of AH 6809 at 21 pmol/min produced similar effects on sleep-wake activities compared with the nocturnal infusion (2300 to 0500 hr), although the PS increase was not significant, suggesting that the PGE2-related mechanisms are acting all day long with or without a circadian rhythm. These findings strongly suggest that endogenous PGE2 in the brain is involved in the physiological mechanisms for regulating sleep-wake activities.
.A
Matsumura H; Honda K; Choi WS; Inoue S; Sakai T; Hayaishi O.
.I 125574
.U
89316038
.S
Phys Ther 8910; 69(8):633-9
.M
Adolescence; Bronchi/*; Child; Combined Modality Therapy; Cystic Fibrosis/*TH; Drainage/*MT; Exercise Test; Exercise Therapy/*; Human; Oximetry; Respiratory Function Tests; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Relative effects of bronchial drainage and exercise for in-hospital care of patients with cystic fibrosis.
.P
JOURNAL ARTICLE.
.W
Bronchial hygiene therapy is a standard part of the treatment of patients with cystic fibrosis (CF). Coughing alone promotes sputum expectoration and is probably the primary effective component of standard bronchial hygiene therapy. The purpose of this study was to determine whether substituting regular exercise, which also promotes coughing, for two of three daily bronchial hygiene treatments would affect the expected improvements in pulmonary function and exercise response in hospitalized patients with CF. Seventeen patients with CF hospitalized (means length of stay = 13.0 +/- 2.6 days) for an acute exacerbation of their pulmonary disease participated in the study. The patients were randomly assigned to either a group that participated in two cycle ergometer exercise sessions and one bronchial hygiene treatment session per day (EX Group [n = 9]) or a group that participated in three bronchial hygiene treatment sessions per day (PD Group [n = 8]). Pulmonary functions and responses to a progressive, incremental cycle ergometer exercise test were measured on admission and before discharge. Bronchial hygiene therapy consisted of postural drainage, in six positions, with chest percussion and vibration. Therapeutic exercise was of moderate intensity and was individually adjusted based on the patient's heart rate and arterial oxygen saturation response to the admission exercise test. Coughing was encouraged during and after all treatments. Pulmonary function and exercise response were significantly improved over the period of hospitalization in both groups; the improvements were the same in the two groups. These results indicate that, in some hospitalized patients with CF, exercise therapy may be substituted for at least part of the standard protocol of bronchial hygiene therapy.
.A
Cerny FJ.
.I 125575
.U
89316039
.S
Phys Ther 8910; 69(8):640-50
.M
Adult; Ankle Joint/*PH; Biomechanics; Dominance, Cerebral/*; Female; Gait/*; Human; Knee Joint/*PH; Male; Middle Age.
.T
Bilateral analysis of the knee and ankle during gait: an examination of the relationship between lateral dominance and symmetry.
.P
JOURNAL ARTICLE.
.W
This study examined the relationship between lower extremity dominance and kinematic symmetry during gait. Fourteen healthy volunteers without any observable gait deviations participated in the study. The subjects (8 male, 6 female) ranged in age from 19 to 56 years. Lower extremity lateral dominance was determined using an assessment method developed by Carol Coogler. Retroreflective spherical markers were placed bilaterally at points over the greater trochanter, the lateral joint line of the knee, the lateral malleolus, and the metatarsal break. A video-based data-acquisition instrument interfaced with a PDP 11/73 computer measured 12 kinematic variables while the subjects walked at self-selected speeds along a 10-m walkway. A multivariate analysis of variance with one repeated measure revealed significant differences between limbs, across subjects, for stance time and maximum knee extension. A within-subject analysis demonstrated significant differences for 10 variables; however, lateral dominance could not be related predictably to these variations. Our results indicate that symmetry cannot be generalized in view of intrasubject variability for these variables. [Valle DR, Gundersen LA, Barr AE, et al: Bilateral analysis of the knee and ankle during gait: An examination of the relationship between lateral dominance and symmetry.
.A
Gundersen LA; Valle DR; Barr AE; Danoff JV; Stanhope SJ; Snyder-Mackler L.
.I 125576
.U
89316041
.S
Phys Ther 8910; 69(8):656-62
.M
Adolescence; Biomechanics; Cerebral Palsy/*PP; Child; Contracture/PP; Female; Gait/*; Hemiplegia/PP; Human; Locomotion; Male; Muscle Contraction; Photogrammetry/MT.
.T
Toe-walking in children with cerebral palsy: contributions of contracture and excessive contraction of triceps surae muscle.
.P
JOURNAL ARTICLE.
.W
The study was designed to provide a quantitative analysis of toe-walking in children with cerebral palsy (CP). The total internal moment developed about the ankle joint during locomotion and the passive component of this internal moment were measured. The contributions of the active and passive components were expressed as the ratio (R) between the passive moment and the total internal moment. Measurements were compared for 13 children with CP and 5 healthy children. For the data analysis, the children with CP, exhibiting apparently similar toe-walking, were divided into two groups: 1) Group CPI and 2) Group CPII. Group CPI was characterized by a small ratio R value, which indicated the presence of excessive contractions of the triceps surae muscle during locomotion. In Group CPII, the ratio R value was abnormally high, which indicated that a contracture (ie, structural change of the muscle or the tendon) was entirely or at least partly responsible for toe-walking. Each group requires a different therapeutic strategy.
.A
Tardieu C; Lespargot A; Tabary C; Bret MD.
.I 125577
.U
89316042
.S
Phys Ther 8910; 69(8):663-70
.M
Adult; Biomechanics; Female; Gait/*; Heel/*PP; Human; Leg Length Inequality/*PP; Locomotion; Male; Middle Age; Support, Non-U.S. Gov't.
.T
Effect of heel lifts on ground reaction force patterns in subjects with structural leg-length discrepancies.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to determine the effect of heel lifts on ground reaction force patterns in subjects with structural leg-length discrepancies (LLDs). Eighteen subjects with LLDs ranging from 4.8 to 22.2 mm participated in this study. Subject age range was from 20 to 63 years. A force platform was used to obtain ground reaction force data for four conditions. Data were collected prior to fitting of the heel lift and after a three-week break-in period. Data were analyzed by use of a two-factor within-subject analysis of variance for repeated measures. Before heel-lift fitting, maximum lateral force was greater in the short leg than in the long leg. After heel-lift fitting, maximum vertical force was greater within both legs, and maximum medical force was greater in the long leg than in the short leg. The results suggest that although heel lifts are used to achieve pelvic levelness, the use of heel lifts also resulted in increased ground reaction forces, which may cause increased joint stresses within the lower extremities.
.A
Schuit D; Adrian M; Pidcoe P.
.I 125578
.U
89316044
.S
Phys Ther 8910; 69(8):679-89
.M
Human; Infrared Rays; Movement/*; Optics; Physical Medicine/*IS/MT; Robotics.
.T
Reliability and validity of the WATSMART three-dimensional optoelectric motion analysis system.
.P
JOURNAL ARTICLE.
.W
Reliability and validity of the WATSMART (Waterloo Spatial Motion Analysis Recording Technique) system was evaluated under static and dynamic conditions. In experiment 1, infrared light-emitting diodes (IREDs) were placed at the axis and along the arms of a clinical goniometer. Twelve angles in 5-degree increments were each recorded 10 times at each of three spatial locations. Reliability was assessed using intraclass correlation coefficients (ICCs) and analysis-of-variance procedures to determine within-trial variability. The ICCs for all spatial locations exceeded .99. The 95% confidence interval for each angle was less than 0.5 degree in all cases. Criterion-referenced instrument validity was assessed with regression analysis. Slopes of the regression of reconstructed angle on reference angle were close to unity for each spatial location. A systematic error, however, that increased as the goniometer was rotated 45 degrees away from the cameras was evident. In experiment 2, a robotic arm was fitted with four IREDs and made to repeat a defined movement trajectory 10 times at each of three spatial locations. The ICCs for portions of each trajectory ranged from .20 to .99. The results show that reliable and valid results can be obtained from this motion analysis system if adequate precautions are taken to reduce unwanted light reflections. Reliability and validity decreased somewhat as the object was rotated further away from the plane in which the cameras were mounted.
.A
Scholz JP.
.I 125579
.U
89316046
.S
Phys Ther 8910; 69(8):695-8; discussion 698-9
.M
Exercise Therapy/*MT; Human; Muscle Contraction; Poliomyelitis/PP/*RH; Syndrome.
.T
A rejoinder to "Exercise Programs for Patients with Post-Polio Syndrome: a case report"--a short communication [comment]
.P
COMMENT; JOURNAL ARTICLE.
.W
This communication is in response to the article by Michael T Gross and Charles P Schuch entitled "Exercise Programs for Patients with Post-Polio Syndrome: A Case Report" published in the January 1989 issue of Physical Therapy. The investigators examined the effects of a rigorous isokinetic training program on peak torque of the knee flexor and extensor muscles of a post-polio patient. The literature on post-polio syndrome, however, does not support the use of either conventional muscle strengthening regimens or rigorous isokinetic exercise programs in the management of post-polio syndrome. In addition, based on the observation that there was no appreciable increase in muscle strength in either the affected or the apparently unaffected leg, the investigators concluded that their rigorous exercise program was not deleterious. The lack of a normal training response, however, is consistent with bilateral muscle fatigue secondary to overuse rather than muscle weakness secondary to disuse. This result is consistent with the need for a balance between rest and low-intensity exercise, which will help to maintain or enhance function while slowing rather than hastening further deterioration. We hope that this rejoinder clarifies some of the misconceptions that may arise from the Gross and Schuch article and that physical therapists consider very carefully the rationale for any type of exercise program for post-polio patients.
.A
Dean E; Ross J; MacIntyre D.
.I 125580
.U
89316047
.S
Phys Ther 8910; 69(8):700-2
.M
Human; Physical Therapy/*MT; Reproducibility of Results; Statistics/*ST.
.T
Not really reliability? [letter; comment]
.P
COMMENT; LETTER.
.A
Stratford PW.
.I 125581
.U
89316048
.S
Phys Ther 8910; 69(8):702
.M
Education, Continuing/*; Human; Physical Therapy/ED/*OG; Societies; United States.
.T
Section educational opportunities [letter; comment]
.P
COMMENT; LETTER.
.A
Johnson GR.
.I 125582
.U
89316067
.S
Plast Reconstr Surg 8910; 84(2):189-202
.M
Cartilage/*TR; Female; Human; Male; Methods; Nasal Septum/BS/SU; Nose/BS/*SU; Nose Neoplasms/SU; Surgical Flaps/*.
.T
Nasal support and lining: the marriage of beauty and blood supply.
.P
JOURNAL ARTICLE.
.W
Assured of a robust blood supply by its narrow pedicle centered on the septal branch of the superior labial artery, the pivoting septal flap provides nasal support from the radix to the most distal nasal tip and from the tip to the columella base--plus a large bonus of lining tissues for the nasal vault and vestibules. Lining flaps from such intranasal tissues are thin, vascular, and flexible. They allow the use of primary cartilage grafts and the establishment of a subsurface architecture in the shape of a nose. When visualized through a conforming forehead flap, the normal landmarks and highlights are restored. In cases of total nasal amputation, a pivoting septal flap permits the fabrication of dorsal nasal support weeks before lining and cover flaps are assembled.
.A
Burget GC; Menick FJ.
.I 125583
.U
89316068
.S
Plast Reconstr Surg 8910; 84(2):204-12
.M
Adult; Audio-Visual Aids; Case Report; Female; Human; Medical Records; Middle Age; Photography; Rhinoplasty/ED/*MT.
.T
A graphic record of intraoperative maneuvers in rhinoplasty: the missing link for evaluating rhinoplasty results.
.P
JOURNAL ARTICLE.
.W
A pictorial system is introduced for documenting intraoperative maneuvers in rhinoplasty that can be used to advantage for relating the effect that different surgical techniques have on postoperative results and for describing to other surgeons the technical steps performed in the operation.
.A
Gunter JP.
.I 125584
.U
89316069
.S
Plast Reconstr Surg 8910; 84(2):213-6; discussion 217-8
.M
Child, Preschool; Human; Orbital Fractures/*PA/RA/SU; Skull Fractures/*PA; Tomography, X-Ray Computed.
.T
Orbital roof fractures in the pediatric population.
.P
JOURNAL ARTICLE.
.W
Twenty-three patients aged 3.3 +/- 1.6 years (mean +/- SD) presented between January of 1984 and September of 1987 with fronto-orbital trauma resulting in fractures of one (N = 20) or both (N = 3) orbital roofs. All patients had computed tomography (CT) with axial and coronal sections that revealed three fracture patterns of the orbital roof (nondisplaced, superiorly displaced, and inferiorly displaced fractures). Orbital dystopia was exhibited in 35 percent (N = 8) of the patients. Exophthalmos was noted in 61 percent (N = 14) of the patients. Only 30 percent of the patients (N = 7) sustained associated maxillofacial fractures. Eight percent of fractures exhibited orbital encephaloceles. All patients lacked frontal sinus pneumatization. The majority of children with orbital roof fractures do not exhibit concomitant facial fractures. CT utilizing both axial and coronal sections is valuable in defining the extent and pattern of the fracture as well as in identifying associated neurologic injuries. Large, displaced orbital roof fractures, which occurred in 3 of 13 patients with displaced fractures in our series, should undergo early reduction to avoid late development of encephalocele.
.A
Messinger A; Radkowski MA; Greenwald MJ; Pensler JM.
.I 125585
.U
89316070
.S
Plast Reconstr Surg 8910; 84(2):219-26
.M
Case Report; Child, Preschool; Diagnosis, Differential; Female; Hand Deformities, Congenital/PA; Human; Infant; Infant, Newborn; Male; Mandibulofacial Dysostosis/DI/PA; Palate, Soft/*AB/SU; Syndrome.
.T
A significant feature of Nager's syndrome: palatal agenesis.
.P
JOURNAL ARTICLE.
.W
Nager's syndrome, which has the facial features of Treacher Collins syndrome, preaxial upper limb defects, short stature, and frequently subnormal intelligence, is very rare. Five new cases have been collected. In four, there was virtually total absence of the soft palate. This has been described in two patients in the past. Differing methods of correcting this are presented.
.A
Jackson IT; Bauer B; Saleh J; Sullivan C; Argenta LC.
.I 125586
.U
89316073
.S
Plast Reconstr Surg 8910; 84(2):245-9
.M
Animal; Bone and Bones/BS/*SU; Hydroxyapatites/*; Implants, Artificial/*; Male; Nasal Bone/SU; Neovascularization/*; Rabbits; Support, Non-U.S. Gov't.
.T
The rate of vascularization of coralline hydroxyapatite.
.P
JOURNAL ARTICLE.
.W
Coralline hydroxyapatite (CHAP) is a porous, biocompatible bone-graft substitute manufactured by the Replamineform process. The use of this material in the experimental and clinical settings for maxillofacial onlay grafting has been recently described. This study was designed to quantitate the rate of vascularization of coralline hydroxyapatite when used in an onlay application to membranous bone in an animal model. Sixteen onlay grafts of coralline hydroxyapatite (0.5 X 0.5 X 1.0 cm Interpore 200) were placed in a subperiosteal location on the nasal dorsum of 2- to 3-kg male New Zealand white rabbits. The grafts and nasal bones were harvested en bloc at 1, 2, 3 and 4 weeks after onlay. Prior to harvest, injectable silicone visualizing agent (Microfil*) was injected by means of carotid artery cutdown. The decalcified specimens were examined on a digitizing pad to count the number of vessels appearing in the blocks of hydroxyapatite. Counting was summed and integrated by an Apple IIe microcomputer. A significant difference (p less than 0.05) was noted in both the number of vessels and the fraction of implants infiltrated by vessels between 1 and 4 weeks. The usefulness of these previously undescribed data may be in their extrapolation to onlay grafts of coralline hydroxyapatite in maxillofacial reconstruction in humans.
.A
Grenga TE; Zins JE; Bauer TW.
.I 125587
.U
89316074
.S
Plast Reconstr Surg 8910; 84(2):250-7
.M
Cleft Palate/SU; Facial Muscles/AH/BS/SU; Fistula/SU; Human; Mandibular Diseases/SU; Methods; Mouth/*SU; Osteitis/SU; Palatal Neoplasms/SU; Surgical Flaps/*.
.T
The buccinator musculomucosal flap: anatomic study and clinical application.
.P
JOURNAL ARTICLE.
.W
Since 1984, we have used the buccinator muscle mucosal flap for the treatment of mucosal defects after tumor resection, osteomyelitis of the mandible, closure of cleft palate fistulas, primary closure of very wide cleft palates, and lengthening of the soft palate. A study was made in the facial regions of 14 cadavers, and a comparison was made to descriptions found in the anatomic literature. It was confirmed in our dissections that the buccal artery, which reaches the posterior half of the muscle, is the major arterial pedicle of the buccinator and that it runs very close to the buccal nerve. Several veins originating from the lateral aspect of the muscle make the venous drainage of the buccinator even richer than its arterial supply. The abundant vascular supply from multiple interconnected pedicles supports the blood supply of the buccal mucosa. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication, and voiding the buccal cavity. The flap was utilized clinically in 38 patients: 24 to close primary cleft palates that required palate lengthening, 12 to close palatal fistulas, 1 to treat a mandibular osteitis, and 1 to repair the palate after tumor resection. We had three small fistulas as complications in our series owing to technical mistakes.
.A
Bozola AR; Gasques JA; Carriquiry CE; Cardoso de Oliveira M.
.I 125588
.U
89316075
.S
Plast Reconstr Surg 8910; 84(2):258-64; discussion 265-6
.M
Adult; Aged; Breast/BS/*PA/SU; Female; Human; Mastectomy, Subcutaneous/*AE; Methods; Middle Age; Necrosis; Nipples/BS/*PA; Skin/BS/PA.
.T
Conservative management in full-thickness nipple-areolar necrosis after subcutaneous mastectomy [see comments]
.P
JOURNAL ARTICLE.
.W
Nipple-areolar necrosis is a known and expected complication in a small percentage of patients undergoing subcutaneous mastectomy, especially with concomitant mastopexy or in smokers. Impending ischemia or congestion of the areola can often be ameliorated by simple maneuvers such as suture release. When full-thickness necrosis occurs, conservative management with essential debridement, dressings, and careful wound hygiene alone will often yield a surprisingly good result, requiring little or no revisional surgery.
.A
Woods JE; Meland NB.
.I 125589
.U
89316077
.S
Plast Reconstr Surg 8910; 84(2):273-9
.M
Adolescence; Adult; Child; Child, Preschool; Female; Hemangioma/SU; Human; Infant; Laser Surgery/*/IS/MT; Lymphangioma/SU; Male; Neoplasms, Vascular Tissue/*SU; Neurofibroma/SU; Postoperative Complications.
.T
Sapphire tip technology for YAG laser excisions in plastic surgery.
.P
JOURNAL ARTICLE.
.W
Thirty-two patients with a variety of vascular and nonvascular lesions have been resected over a 3-year period with the neodymium:YAG laser utilizing sapphire peripheral scalpel devices. These innovative peripheral devices concentrate the YAG laser energy to a small area at the end of the scalpel, providing precise incisions with excellent hemostasis. In addition, the tactile sensation of the scalpel contacting tissue is more comfortable and familiar than the "no touch" aspect of other lasers that are held away from the surface and depend on laser light transmission to approach the skin. Total excision with excellent hemostasis was achieved in 17 patients, while 15 patients had subtotal resection. The YAG laser with sapphire scalpels has allowed resection of very difficult and massive hemangiomas previously considered unresectable by standard techniques.
.A
Apfelberg DB; Maser MR; Lash H; White DN.
.I 125590
.U
89316078
.S
Plast Reconstr Surg 8910; 84(2):280-8; discussion 289
.M
Animal; Arteriovenous Anastomosis/*; Embolism/ET/PA/*PP; Groin; Microcirculation/PA/PP; Muscles/BS; Postoperative Complications/*; Rats; Rats, Inbred Strains; Video Recording.
.T
Direct in vivo observations of embolic events in the microcirculation distal to a small-vessel anastomosis.
.P
JOURNAL ARTICLE.
.W
This study was done to determine whether microemboli are produced by an arterial anastomosis. Direct in vivo observations were made in an isolated microcirculatory bed lying directly downstream from a newly made anastomosis. The tissue used was the isolated rat cremaster muscle, a new experimental model. The vessel anastomosed was the external iliac artery. Following anastomosis, microemboli were clearly observed in eight of eight animals during the first 30 minutes after clamp release. Embolic events were sometimes of impressive magnitude and in one case were associated with cessation of blood flow throughout the preparation. No microemboli were observed in eight of eight animals subjected only to dissection of the cremaster, nor were any observed in eight of eight animals in which the isolated cremaster was subjected only to 2 hours of clamp ischemia. These findings may be significant in explaining perturbations to blood flow following free-tissue transfer and instances of partial tissue necrosis following apparently successful arterial repair. These findings also identify an important factor (microemboli) to be considered in research on reperfusion injury.
.A
Acland RD; Anderson G; Siemionow M; McCabe S.
.I 125591
.U
89316079
.S
Plast Reconstr Surg 8910; 84(2):290-5
.M
Adult; Aged; Case Report; Extremities/SU; Female; Head and Neck Neoplasms/SU; Human; Male; Methods; Surgical Flaps/*.
.T
The "reduced" latissimus dorsi musculocutaneous flap.
.P
JOURNAL ARTICLE.
.W
This report introduces a new device among latissimus dorsi flaps: the "reduced" latissimus dorsi musculocutaneous flap. This flap consists of a proximal musculocutaneous unit and a distal, thin fasciocutaneous unit (the "reduced" portion). The former unit carries a reliable blood supply from the thoracodorsal artery and is able to cover deeper recipient defects, while the latter provides a well-contoured reconstruction of the defect. If needed, an extended portion and/or a thin cutaneous flap can be carried along with the flap according to the defect. In our clinic, we have so far used four pedicled and one free reduced latissimus dorsi musculocutaneous flap in the repair of a variety of defects. All flaps survived, and satisfactory contour of the recipient site was achieved in each case. These clinical experiences clarify that a reduced portion 10 cm in length can be safely carried, and it is suggested that survival of this flap does not depend on its width-to-length ratio.
.A
Hayashi A; Maruyama Y.
.I 125592
.U
89316080
.S
Plast Reconstr Surg 8910; 84(2):296-302
.M
Case Report; Decubitus Ulcer/SU; Human; Male; Methods; Middle Age; Reoperation; Surgical Flaps/*; Thigh.
.T
Multiple and repetitive uses of the extended hamstring V-Y myocutaneous flap.
.P
JOURNAL ARTICLE.
.W
An extended hamstring V-Y myocutaneous advancement flap is described that may be used to cover unusually large defects in the ischial region. Technical points that allow a large amount of flap advancement are discussed. Because of its large size, the flap can be raised and used on repeated occasions to repair defects from recurrent ischial pressure sores. Two patients are presented in whom the same flap was used repeatedly on multiple occasions, demonstrating the potential for preservation of future options in such patients when this flap is used.
.A
Kroll SS; Hamilton S.
.I 125593
.U
89316082
.S
Plast Reconstr Surg 8910; 84(2):314-22; discussion 323-4
.M
Animal; Capillaries/PH; Implants, Artificial/*; Male; Regional Blood Flow; Skin/*BS; Support, Non-U.S. Gov't; Surgical Flaps/*; Swine.
.T
Effect of capsulectomy on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin in the pig.
.P
JOURNAL ARTICLE.
.W
Skin flaps constructed on expanded skin usually include the underlying capsular tissue. It has been hypothesized that capsulectomy may jeopardize the viability of the expanded skin flap. The experiments reported herein were designed to test this hypothesis. Specifically, we studied the hemodynamics and viability of random-pattern skin flaps (8 X 20 cm) raised on delayed bipedicle flaps (group A) and on expanded skin pockets with capsulectomy at the time of flap elevation (group B) or with intact underlying capsular tissue (group C). Each group was randomly assigned to each flank in 16 pigs. Skin pockets were expanded by inflation of subcutaneous silicone tissue expanders with sterile saline (299 +/- 7 ml; X +/- SEM) over a period of 3 weeks. At the end of this period, the bipedicle flaps were constructed. Eight days later, random-pattern skin flaps were raised on bipedicle flaps and skin pockets. The length and area of skin flap viability, judged by the fluorescein dye test performed 1 day postoperatively, were not significantly different (p greater than 0.05) among groups A, B, and C (n = 31 to 32). There also were no significant differences (p greater than 0.05) in total skin capillary blood flow measured 1 day postoperatively (A = 2.6 +/- 0.4, B = 2.4 +/- 0.4, and C = 2.7 +/- 0.6 ml/min per flap; n = 15 to 16) and in skin viability assessed 7 days postoperatively (A = 74 +/- 2, B = 75 +/- 2, and C = 76 +/- 2 percent; n = 16) among delayed skin flaps and skin flaps raised on expanded skin pockets with or without capsulectomy. The results of this flap viability study were confirmed in 5 minipigs in a separate experiment. We conclude that capsulectomy did not have a detrimental effect on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin. Furthermore, we hypothesize that skin flaps raised on expanded skin are similar to delayed skin flaps in that the skin blood flow is optimally augmented; therefore, the capsular tissue does not add significant blood supply to the overlying skin.
.A
Morris SF; Pang CY; Mahoney J; Lofchy N; Kaddoura IL; Patterson R; Lista F.
.I 125594
.U
89316083
.S
Plast Reconstr Surg 8910; 84(2):325-37
.M
Adrenal Hyperplasia, Congenital/*SU; Child; Child, Preschool; Female; Follow-Up Studies; Genitalia/AB/*SU; Human; Infant; Surgery, Plastic/*MT.
.T
Reconstruction of the external genitalia in the adrenogenital syndrome by means of a personal one-stage procedure [see comments]
.P
JOURNAL ARTICLE.
.W
The techniques for correction of the external genitalia in the adrenogenital syndrome, as far as known by the author, are reviewed. The goals of repair and timing of surgery are discussed. The author's one-stage technique, first published in 1974, is described with intraoperative illustrations, and the results obtained in nine patients are discussed. The advantages of the technique are preservation of a clitoral glans with erogenous sensation based exclusively on the deep dorsal neurovascular bundle. The glans of the megaloclitoris is obliquely reduced in size at its base toward the ventral surface and by resection of up to two-thirds of the ventral segment. It is relocated at its anatomic female position. The labia minora and the introitus vaginae are reconstructed at the same stage with the skin of the megaloclitoris displaced in posterior direction after a cutback incision. Dispareunia is prevented by total excision of the corpora cavernosa, including the crura.
.A
Hinderer UT.
.I 125595
.U
89316084
.S
Plast Reconstr Surg 8910; 84(2):338-9
.M
Medical Records/*.
.T
Weighty records: medicine by bulk [editorial]
.P
EDITORIAL.
.A
Goldwyn RM.
.I 125596
.U
89316085
.S
Plast Reconstr Surg 8910; 84(2):340-1
.M
Ethics, Medical/*; Human; Malpractice/*; Surgery, Plastic/*.
.T
Have we really come this far?[editorial]
.P
EDITORIAL.
.A
Curtin JW.
.I 125597
.U
89316086
.S
Plast Reconstr Surg 8910; 84(2):342-6
.M
Adult; Case Report; Female; Head and Neck Neoplasms/SU; Human; Methods; Neoplasm Recurrence, Local/SU; Reoperation; Surgical Flaps/*; Trachea/*SU.
.T
Reconstruction of the mediastinal trachea with a tubed pectoralis major myocutaneous flap.
.P
JOURNAL ARTICLE.
.W
A young patient with a massive postirradiation recurrence of thyroid cancer invading the larynx and mediastinal trachea had been treated by resecting the larynx and trachea to within three rings of the carina. A mediastinal tracheostomy was avoided by using a tubed pectoralis major myocutaneous flap to replace the ablated trachea. The flap, transferred into the mediastinum subclavicularly, was connected to the tracheal stump and exteriorized as a cervical tracheostomy. This resulted in direct closure of the donor site and primary healing. Four years after the operation, the patient remains free of disease and is tolerating the neotrachea without difficulty or complications. The technique described is offered as an alternative to conventional mediastinal tracheostomy methods, which have acknowledged shortcomings.
.A
Fleischer A; Khafif R.
.I 125598
.U
89316087
.S
Plast Reconstr Surg 8910; 84(2):347-52
.M
Abdominal Wall/*AB/SU; Female; Human; Implants, Artificial/*; Infant; Methods.
.T
Abdominal wall expansion in congenital defects.
.P
JOURNAL ARTICLE.
.W
A method for expanding the skin, fascia, muscle, and peritoneal layers of the abdominal wall is described, and clinical application is demonstrated in two children with cloacal exstrophy and congenital absence of the lower half of the abdominal wall. This technique provides an innervated composite reconstruction of defects in excess of 50 percent of the abdominal surface and is recommended in large secondary defects where peritonealization has been achieved and in congenital defects that do not lend themselves to standard methods of closure. Cadaver dissection confirms that tissue expanders may be placed with preservation of innervation and blood supply to the abdominal wall.
.A
Byrd HS; Hobar PC.
.I 125599
.U
89316088
.S
Plast Reconstr Surg 8910; 84(2):353-5
.M
Botulinum Toxins/*TU; Case Report; Facial Asymmetry/ET/*TH; Facial Paralysis/*CO; Female; Human; Middle Age; Rhytidoplasty/AE.
.T
Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis.
.P
JOURNAL ARTICLE.
.W
Injury to the frontal or other facial nerve branches can result in an asymmetry that can be very distressful to both patient and surgeon. This is especially true following cosmetic procedures such as rhytidectomy. We propose a means to create temporary symmetry while awaiting the possible return of nerve function. Botulinum neurotoxin causes a muscle paralysis lasting for approximately 3 months, and it is well established as the preferred treatment for blepharospasm. A case is presented in which botulinum toxin type A was injected into the opposite functioning frontalis muscle of a patient with unilateral frontal nerve paralysis. The patient experienced satisfactory relief of the asymmetry caused by onesided forehead wrinkling and brow elevation. Botulinum toxin therapy should be considered for both temporary and permanent facial asymmetries due to facial nerve paralysis as well as spasm.
.A
Clark RP; Berris CE.
.I 125600
.U
89316090
.S
Plast Reconstr Surg 8910; 84(2):363-4
.M
Human; Nicaragua; Surgery, Plastic/*.
.T
Reconstructive surgery in Nicaragua [letter; comment]
.P
COMMENT; LETTER.
.A
Lineaweaver WC.
.I 125601
.U
89316091
.S
Plast Reconstr Surg 8910; 84(2):364
.M
Photography/*IS; Surgery, Operative/*.
.T
A pointer on pointers [letter]
.P
LETTER.
.A
Hoehn JG.
.I 125602
.U
89316092
.S
Plast Reconstr Surg 8910; 84(2):364
.M
Human; Methods; Pathology, Surgical/MT; Surgical Flaps/*.
.T
Measuring the area of a lesion or flap [letter] [see comments]
.P
LETTER.
.A
Furnas H.
.I 125603
.U
89316093
.S
Plast Reconstr Surg 8910; 84(2):364-6
.M
Arthritis, Rheumatoid/CI; Case Report; Face/*PA; Female; Human; Inflammation/CI/PA; Injections; Magnetic Resonance Imaging/*; Middle Age; Silicones/AD/*AE; Suction.
.T
Localization of injected silicone with MRI prior to removal by suction cannula [letter]
.P
LETTER.
.A
Bailey MH; Jackson IT; Baker HL; Allen GL.
.I 125604
.U
89316094
.S
Plast Reconstr Surg 8910; 84(2):366
.M
Human; Rhinoplasty/*MT.
.T
Nasion graft in rhinoplasty [letter; comment]
.P
COMMENT; LETTER.
.A
Bortnick E.
.I 125605
.U
89316095
.S
Plast Reconstr Surg 8910; 84(2):366-7
.M
Human; Microsurgery/*IS; Surgery, Plastic/*IS.
.T
Usefulness of the silicone microsurgical background [letter]
.P
LETTER.
.A
Isogai N; Kamiishi H.
.I 125606
.U
89316096
.S
Plast Reconstr Surg 8910; 84(2):367-9
.M
Human; Methods; Surgical Flaps/*.
.T
Extracorporeal tissue transfer [letter]
.P
LETTER.
.A
Govila A.
.I 125607
.U
89316097
.S
Plast Reconstr Surg 8910; 84(2):369-70
.M
Child, Preschool; Cleft Lip/PP/*SU; Hearing/*; Human; Infant; Methods; Speech Intelligibility/*.
.T
Improved hearing and improved speech [letter; comment]
.P
COMMENT; LETTER.
.A
Dellon AL.
.I 125608
.U
89316098
.S
Plast Reconstr Surg 8910; 84(2):370
.M
Ear, External/*AB/SU; Human; Models, Anatomic/*; Surgery, Plastic/*IS.
.T
Ear models [letter; comment]
.P
COMMENT; LETTER.
.A
Rueckert F.
.I 125609
.U
89316099
.S
Plast Reconstr Surg 8910; 84(2):370-2
.M
Adolescence; Case Report; Fibrous Dysplasia of Bone/SU; Human; Male; Mandibular Diseases/SU; Mandibular Prosthesis/*; Methylmethacrylates/*.
.T
Prefabricated methyl methacrylate implant for reconstruction of the hemimandible and temporomandibular joint complex [letter]
.P
LETTER.
.A
Govila A.
.I 125610
.U
89316100
.S
Plast Reconstr Surg 8910; 84(2):372
.M
Certification/*; Hand/*SU; Surgery, Plastic/*; United States.
.T
In support of the certificate of added qualifications in hand surgery [letter]
.P
LETTER.
.A
McCormack RM.
.I 125611
.U
89316101
.S
Plast Reconstr Surg 8910; 84(2):372
.M
Electrocoagulation/*IS; Human; Laser Surgery/IS; Smoke; Suction/IS; Surgery, Plastic/*; Surgical Equipment/*.
.T
Using the suction apparatus of the laser machine to get rid of smoke from electrocoagulation [letter]
.P
LETTER.
.A
Karaca AR.
.I 125612
.U
89316102
.S
Plast Reconstr Surg 8910; 84(2):372-3
.M
Cleft Lip/CO/*PA/SU; Extraoral Traction Appliances/*; Human; Malocclusion/CO/*TH; Maxilla/*PA; Orthodontic Appliances, Removable/*; Preoperative Care.
.T
Protruding premaxilla in the bilateral cleft lip patient [letter; comment]
.P
COMMENT; LETTER.
.A
Georgiade NG; Mason RM; Riefkohl RE; Georgiade GS; Barwick W.
.I 125613
.U
89316103
.S
Plast Reconstr Surg 8910; 84(2):373-4
.M
Biopsy/*; Disease Susceptibility; Human; Malignant Hyperthermia/*DI; Muscles/*PA.
.T
Muscle biopsy testing for malignant hyperthermia [letter; comment]
.P
COMMENT; LETTER.
.A
Allen G; Rosenberg H.
.I 125614
.U
89316105
.S
Plast Reconstr Surg 8910; 84(2):375
.M
Human; Postoperative Care/*; Pressure; Rhinoplasty/*.
.T
Postoperative nighttime nasal taping to decrease swelling [letter]
.P
LETTER.
.A
Hoefflin SM.
.I 125615
.U
89316106
.S
Plast Reconstr Surg 8910; 84(2):376
.M
Case Report; Choristoma/*CO; Cleft Lip/*CO; Cleft Palate/*CO; Female; Head and Neck Neoplasms/*CO; Human; Infant, Newborn; Thymus Gland/*.
.T
Bilateral ectopic thymus gland tissue associated with the cleft lip and palate [letter; comment]
.P
COMMENT; LETTER.
.A
Dado DV; Gonzalez-Crussi F.
.I 125616
.U
89316107
.S
Plast Reconstr Surg 8910; 84(2):376-7
.M
Abdomen/*SU; Animal; Equipment and Supplies; Rats/*; Research; Surgical Flaps/*.
.T
Protection of abdominal flaps from self-mutilation in the rat [letter]
.P
LETTER.
.A
Tark KC.
.I 125617
.U
89316109
.S
Prim Care 8910; 16(2):289-550
.M
Aged; Geriatrics/*; Human.
.T
Care of the aging patient.
.P
JOURNAL ARTICLE.
.I 125618
.U
89316287
.S
Radiology 8910; 172(2):313-4
.M
Human; Lung/RI; Pulmonary Embolism/*RI; Ventilation-Perfusion Ratio.
.T
Another look at pulmonary embolism [editorial]
.P
EDITORIAL.
.A
Alderson PO.
.I 125619
.U
89316288
.S
Radiology 8910; 172(2):315-7
.M
Human; Lymphatic Diseases/DI/RA/RI; Lymphatic System/*RI; Lymphedema/RA/RI; Lymphography/*.
.T
The lymphatic system: diagnostic imaging studies.
.P
JOURNAL ARTICLE.
.A
Weissleder R; Thrall JH.
.I 125620
.U
89316289
.S
Radiology 8910; 172(2):318-20
.M
Brain/PA; Brain Neoplasms/DI; Human; Nuclear Magnetic Resonance/*DU/MT; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
The power of the proton [editorial; comment]
.P
COMMENT; EDITORIAL.
.A
Weiner MW; Hetherington HP.
.I 125621
.U
89316291
.S
Radiology 8910; 172(2):327-30
.M
Adult; Aged; Aged, 80 and over; Angiography; Angioplasty, Transluminal/AE/*MT; Arterial Occlusive Diseases/RA/*TH; Chronic Disease; Female; Human; Leg/*BS; Male; Middle Age.
.T
Low-speed rotational angioplasty in chronic peripheral artery occlusions: experience in 83 patients. Work in progress.
.P
JOURNAL ARTICLE.
.W
Between December 1986 and October 1988, 83 patients with chronic peripheral artery occlusions were treated with a new technique. In 56 patients, the superficial femoral artery was completely occluded; in 21 patients, the popliteal artery; and in six patients, the iliac artery. The length of occlusion ranged from 5 to 35 cm (mean, 12.5 cm). The duration, estimated by history, was 5-48 months (mean, 16.5 months). In seven patients, durations of 6-36 months were documented angiographically. A flexible, blunt, motor-driven rotating catheter was introduced through an 8-F sheath, and rotational angioplasty was performed at low speed (up to 200 rpm). In 49 of 60 (82%) patients in whom this new technique was used as the primary intervention, the occlusions were successfully reopened. In 23 patients in whom conventional methods had failed more than 4 weeks earlier, the success rate for rotational angioplasty was 67% (12 of 18 patients); when the time interval was less than 4 weeks, only one of five patients was treated successfully. In none of the 83 patients did a perforation occur. This new technique can reopen chronic artery occlusions with a high degree of success and without the danger of vessel-wall perforation, even after failure of conventional techniques.
.A
Vallbracht C; Liermann DD; Prignitz I; Beinborn W; Roth FJ; Kollath J; Landgraf H; Kaltenbach M.
.I 125622
.U
89316293
.S
Radiology 8910; 172(2):337-9
.M
Adult; Aged; Bladder Neoplasms/CO; Embolization, Therapeutic/*/AE/MT; Female; Genital Neoplasms, Female/CO; Hemorrhage/ET/RA/*TH; Human; Iliac Artery/*/RA; Male; Middle Age; Pelvic Neoplasms/*CO; Prostatic Neoplasms/CO.
.T
Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms.
.P
JOURNAL ARTICLE.
.W
The control of the massive and often fatal hemorrhage from pelvic neoplasms is a major therapeutic problem. Transcatheter embolization of the internal iliac arteries was performed in 108 patients with uncontrollable hemorrhage due to pelvic neoplasms (urinary bladder in 50, uterus in 39, ovary in 16, and prostate in three). Complete control of the hemorrhage was achieved in 74 patients, partial control in 23, and no control in 11. Seventy patients experienced postembolization syndrome (nausea, vomiting, gluteal pain, and fever due to tissue necrosis), and three had transient acute tubular necrosis caused by the contrast medium. It is important for success that the embolization be bilateral and that the embolic agent used be a permanent one.
.A
Pisco JM; Martins JM; Correia MG.
.I 125623
.U
89316295
.S
Radiology 8910; 172(2):345-8
.M
Anticoagulants/*; Blood Coagulation/*DE; Contrast Media/*PD; Diatrizoate/PD; Diatrizoate Meglumine/PD; Human; Iohexol/PD; Iopamidol/PD; Ioxaglic Acid/PD; Support, Non-U.S. Gov't; Thrombin Time; Whole Blood Coagulation Time.
.T
Differing mechanisms of clotting inhibition by ionic and nonionic contrast agents.
.P
JOURNAL ARTICLE.
.W
The anticoagulant potency of ioxaglate has been shown to be approximately twice that of iopamidol and iohexol. Those findings were obtained with use of the thrombin time as a test and platelet-poor plasma as a thrombin substrate. The authors confirmed these findings with use of a whole-blood version of the same test. However, the thrombin time measures only the final stages of the clotting process. A measure of the entire intrinsic pathway would more nearly simulate the situation in the angiographic suite. When measured with such an assay, the anticoagulant potency of ioxaglate was equivalent to that of diatrizoate and was approximately four times that of iopamidol and iohexol. Because of this difference in potency, it seemed likely that the ionic agents were inhibiting the clotting cascade at a late stage as well as at an earlier stage. To investigate this possibility, whole blood-contrast agent mixtures were activated, incubated for several minutes, and then diluted with either citrated or heparinized whole blood. There was rapid clot formation when the unclotted iopamidol and iohexol mixtures were diluted with citrated whole blood but not when they were diluted with heparinized whole blood. The ionic mixtures did not clot in the presence of either anticoagulant. Thus, in unclottable mixtures nonionic agents still permitted the generation of procoagulants. These procoagulants are theoretically capable of causing clotting on reinjection.
.A
Ing JJ; Smith DC; Bull BS.
.I 125624
.U
89316296
.S
Radiology 8910; 172(2):349-50
.M
Heart/*AH; Human; Magnetic Resonance Imaging/*MT; Movement.
.T
Heart wall motion: improved method of spatial modulation of magnetization for MR imaging.
.P
JOURNAL ARTICLE.
.W
A previously reported method of using magnetic resonance (MR) imaging to study heart wall motion involves a pair of nonselective radio-frequency (RF) pulses, separated by a magnetic field gradient pulse, prior to imaging; this produces images with a regular pattern of stripes that move with the heart wall and that have a sinusoidal intensity profile. It is demonstrated in this study that the substitution of more RF pulses, with their relative amplitudes distributed according to the binomial sequence, results in sharper stripes. This permits the use of a two-dimensional grid of stripes for more detailed studies of heart wall motion and provides a unique method of analyzing regional ventricular myocardial strain.
.A
Axel L; Dougherty L.
.I 125625
.U
89316297
.S
Radiology 8910; 172(2):351-7
.M
Arteries/*AH/PA; Human; Magnetic Resonance Imaging/*MT; Veins/*AH/PA.
.T
Projection arteriography and venography: initial clinical results with MR.
.P
JOURNAL ARTICLE.
.W
Motion currently limits the applications of magnetic resonance (MR) angiography in certain regions of the body. To overcome this problem, a series of breath-hold, two-dimensional, flow-compensated gradient-echo images were acquired. These images were then processed by means of the maximum intensity projection algorithm to produce projection angiograms. The method was evaluated in 10 healthy subjects and in 12 patients and validated by comparing conventional angiograms, contrast material-enhanced computed tomographic scans, and duplex sonograms with MR projection arteriograms and venograms of the chest, abdomen, and pelvis. The aorta and pulmonary arteries and their branches were demonstrated, as was detailed anatomy of the hepatic and portal venous systems and inferior vena cava. Renal arteries and veins could be studied in both native and transplanted kidneys. The method permits determination of flow direction and differentiation of arteries and veins and is superior to three-dimensional acquisition techniques for imaging slow blood flow. Initial results suggest that the method may have clinical applications for a variety of vascular disorders.
.A
Edelman RR; Wentz KU; Mattle H; Zhao B; Liu C; Kim D; Laub G.
.I 125626
.U
89316298
.S
Radiology 8910; 172(2):359-62
.M
Adult; Aged; Aged, 80 and over; Aorta, Abdominal/PA/*SU; Blood Vessel Prosthesis/*; Female; Graft Survival; Human; Infection/*DI; Magnetic Resonance Imaging/*; Male; Middle Age; Postoperative Complications/*DI; Retroperitoneal Space; Support, Non-U.S. Gov't; Wound Healing.
.T
Incorporation versus infection of retroperitoneal aortic grafts: MR imaging features.
.P
JOURNAL ARTICLE.
.W
The magnetic resonance (MR) imaging characteristics of normal aortic graft healing were compared with those of perigraft infection in 57 patients after aortic graft implantation. Thirty-three patients without postoperative complications underwent MR imaging in a 0.35-T unit 1 week after graft implantation, and 13 of those patients were reexamined 2-3 months after graft implantation. Twenty-four patients with clinically suspected perigraft infection underwent MR imaging 6 weeks to 18 years after graft implantation. Early normal postoperative changes were characterized by a perigraft collar of low to medium signal intensity on T1-weighted images and of high intensity on T2-weighted images in all 33 cases, consistent with perigraft fluid collection. In 10 of 13 patients reexamined 2-3 months postoperatively, the MR images demonstrated a collar of tissue consistent with perigraft fibrosis. In cases of clinical suspicion of retroperitoneal graft infection, MR imaging showed eccentric fluid collections of low to medium signal intensity on T1-weighted images and high intensity on T2-weighted images at more than 3 months after surgery. The MR findings were diagnostic of retroperitoneal perigraft infection in 17 of 20 patients shown to be infected at surgery. Retroperitoneal infection was correctly excluded on the basis of MR findings in four patients. Thus, MR imaging is an accurate imaging method for the diagnosis of aortic graft infection. In the early postoperative phase, resolving perigraft fluid cannot be differentiated from perigraft infection.
.A
Auffermann W; Olofsson PA; Rabahie GN; Tavares NJ; Stoney RJ; Higgins CB.
.I 125627
.U
89316299
.S
Radiology 8910; 172(2):363-6
.M
Blood Flow Velocity; Fingers/*BS; Human; Magnetic Resonance Imaging/*MT; Regional Blood Flow; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Use of radio-frequency field gradients to image blood flow and perfusion in vivo.
.P
JOURNAL ARTICLE.
.W
A magnetic resonance imaging method based on the use of radio-frequency (RF) magnetic field gradients to detect molecular motion has been combined with GRASS (gradient-recalled acquisition in a steady state) imaging to detect arterial blood flow in vivo. The method has been used to selectively attenuate signals from flowing blood in the human finger. Attenuation of signals from arterial blood was greatly reduced when blood flow was decreased with the application of a tourniquet. This result demonstrated the sensitivity of the technique to the rate of blood flow. RF gradient coils can be used to generate very high RF gradients with submicrosecond rise times and minimal eddy currents. Therefore, this method may prove useful for imaging very slow, nonuniform flow through capillary beds and in the extravascular space.
.A
Karczmar GS; Tavares NJ; Moseley ME.
.I 125628
.U
89316300
.S
Radiology 8910; 172(2):367-71
.M
Adolescence; Adult; Child; Child, Preschool; Human; Infant; Infant, Newborn; Magnetic Resonance Imaging/*; Reference Values; Thymus Gland/*AH/PA; Thymus Hyperplasia/DI; Thymus Neoplasms/DI.
.T
Normal and abnormal thymus in childhood: MR imaging.
.P
JOURNAL ARTICLE.
.W
Magnetic resonance (MR) imaging studies of 47 children without thymic disease were compared with those of 14 children with proved thymic abnormalities (eg, lymphoma, leukemia, hyperplasia) to evaluate the spectrum of MR features of the normal and abnormal thymus and to determine the best indicators of thymic disease. In healthy children younger than 5 years of age, the thymus had a quadrilateral shape and biconvex lateral contours. Older children and adolescents had a triangular thymus with straight lateral margins. The thymus appeared homogeneous with a signal intensity slightly greater than that of muscle on T1-weighted images and close to that of fat on T2-weighted images. Qualitative evaluation of gross thymic morphology (size, shape, margins, and signal intensity) usually was sufficient for distinguishing between the normal and abnormal thymus. The abnormal thymus generally was enlarged, multilobular, or inhomogeneous because of the presence of cystic degeneration, hemorrhage, septations, fibrosis, or calcification on pathologic sections. In patients with lymphoma, the presence of associated lymphadenopathy also was helpful in distinguishing the normal from the abnormal thymus.
.A
Siegel MJ; Glazer HS; Wiener JI; Molina PL.
.I 125629
.U
89316301
.S
Radiology 8910; 172(2):373-5
.M
Bone Marrow/*AH/GD; Child; Child, Preschool; Female; Human; Infant; Magnetic Resonance Imaging/*; Male; Retrospective Studies; Sphenoid Bone/AH; Sphenoid Sinus/*AH/GD.
.T
Marrow conversion before pneumatization of the sphenoid sinus: assessment with MR imaging.
.P
JOURNAL ARTICLE.
.W
To evaluate the bone marrow change before pneumatization of the sphenoid sinuses in childhood, the authors retrospectively reviewed short repetition time/echo time midsagittal magnetic resonance images in 56 patients younger than 6 years. The signal intensity of the presphenoid bone marrow (anteromedial part of the sphenoid bone) was as low as that of muscle (grade 1) and remained the same as that of the basisphenoid and basiocicput in all infants (n = 6) younger than 6 months. Between 7 months and 2 years, most patients (24 of 27) exhibited fatty conversion of bone marrow limited to the presphenoid (grade 2). After 3 years of age, most patients demonstrated pneumatization (six of 12 at 3-4 years, eight of 11 at 5-6 years) in addition to the grade 2 findings (grade 3). The presphenoid exhibits signal intensity characteristics of fatty marrow before it is invaginated by the developing sphenoid sinus. Fatty change before pneumatization is a normal developmental process and should not be misinterpreted as a pathologic condition.
.A
Aoki S; Dillon WP; Barkovich AJ; Norman D.
.I 125630
.U
89316303
.S
Radiology 8910; 172(2):381-5
.M
Adolescence; Adult; Brain/*ME/PA; Child; Child, Preschool; Female; Human; Iron/*ME; Magnetic Resonance Imaging/*; Male; Reference Values.
.T
Normal deposition of brain iron in childhood and adolescence: MR imaging at 1.5 T.
.P
JOURNAL ARTICLE.
.W
Magnetic resonance (MR) images of the brain in 285 patients between the ages of 2 and 25 years were retrospectively studied to determine the appearance of brain iron accumulation. The globus pallidus, red nucleus, substantia nigra, and dentate nucleus were evaluated with long TR/TE (repetition time/echo time) spin-echo sequences and staged. All four regions in most patients were initially hyperintense compared with white matter (stage I) before becoming isointense (stage II) and subsequently hypointense (stage III). The globus pallidus was the first to reach stage III, the red nucleus and substantia nigra were next, and the dentate nucleus was last. In general, decreased signal intensity (stage III) was not seen in these regions in patients less than 10 years old; in most patients it was seen by age 25 years. The dentate nucleus decreased in signal intensity more slowly and inconsistently; only one-third of patients had reached stage III by age 25 years. The temporal sequence of normal iron deposition as detected with MR imaging is helpful not only in the diagnosis of known iron-deposition diseases but also in the detection of iron-related pathologic changes.
.A
Aoki S; Okada Y; Nishimura K; Barkovich AJ; Kjos BO; Brasch RC; Norman D.
.I 125631
.U
89316306
.S
Radiology 8910; 172(2):393-7
.M
Animal; Ferric Compounds/*DU; Image Enhancement/*MT; Liver Neoplasms, Experimental/*DI/SC; Magnetic Resonance Imaging/*MT; Magnetics; Mammary Neoplasms, Experimental; Neoplasm Transplantation; Rats; Support, Non-U.S. Gov't.
.T
Superparamagnetic iron oxide-enhanced MR imaging: pulse sequence optimization for detection of liver cancer.
.P
JOURNAL ARTICLE.
.W
The effects of magnetic resonance (MR) pulse sequences and timing parameters on tumor-liver contrast were studied in an animal model of metastatic liver cancer. Six spin-echo (SE), three inversion-recovery (IR), and four gradient-echo (GRE) sequences were evaluated at 0.6 T before and after injection of super-paramagnetic iron oxide. GRE techniques, irrespective of echo time and flip angle, showed the greatest change in signal intensity (enhancement) of the liver after administration of iron oxide. Single-acquisition GRE sequences (16 seconds) matched the contrast-to-noise ratio (C/N) performance of the most effective 6.4-minute SE sequences. Multiexcitation GRE sequences showed tumor-liver C/Ns per unit time that were significantly (P less than .05) higher than those achieved with SE and IR sequences. GRE sequences, which recruit intravoxel dephasing as an additional source of transverse relaxation enhancement (T2*), show a higher C/N per unit time and in this respect seem superior to SE and IR sequences for MR imaging with superparamagnetic iron oxide.
.A
Fretz CJ; Elizondo G; Weissleder R; Hahn PF; Stark DD; Ferrucci JT Jr.
.I 125632
.U
89316307
.S
Radiology 8910; 172(2):399-401
.M
Animal; Comparative Study; Dogs; In Vitro; Radiographic Image Enhancement/*; ROC Curve; Stomach Diseases/*RA; Stomach Neoplasms/RA; Stomach Ulcer/RA.
.T
Subtle gastric abnormalities in a canine model: detection with low-dose imaging with storage phosphors and its equivalence to conventional radiography.
.P
JOURNAL ARTICLE.
.W
The authors compared low-dose (32% of standard exposure) storage phosphor digital imaging (system resolution: 0.2-mm pixels, 10 bits) with isovoltage 75-kVp conventional radiography (standard exposure) in the detection of subtle simulated gastric abnormalities by using air contrast barium studies. Subtle simulated abnormalities (3-7-mm polyps, 4-15-mm ulcer craters, 4-11-mm-diameter edema, and 11-12-mm linear ulcers) were produced in resected canine stomachs. Receiver operating characteristic analysis of 1,800 observations by six readers indicated that the digital images with and without high-frequency edge enhancement were equivalent to conventional radiographs (mean receiver operating characteristic areas [+/- standard deviation]: 0.76 +/- 0.06, 0.78 +/- 0.04, and 0.77 +/- 0.04, respectively). The accuracy of the diagnosis was equivalent for all three modalities. The following mean accuracies of negative and positive responses, respectively, for unenhanced digital, edge-enhanced digital, and conventional images were determined: 0.71 +/- 0.05 and 0.41 +/- 0.07, 0.71 +/- 0.04 and 0.51 +/- 0.09, and 0.68 +/- 0.04 and 0.43 +/- 0.05. It was concluded that low-dose storage phosphor air-contrast barium studies were equivalent to conventional radiography in the detection of subtle gastric abnormalities.
.A
Shin JH; Oestmann J; Hall D; Cardenosa G; McCarthy KA; Mrose HE; Pile-Spellman E; Rubens JR; Greene RE.
.I 125633
.U
89316310
.S
Radiology 8910; 172(2):415-20
.M
Adolescence; Adrenal Cortex Diseases/CO/*DI/RA; Adrenal Glands/PA/RA; Adult; Child; Child, Preschool; Comparative Study; Cushing's Syndrome/*ET; Female; Human; Magnetic Resonance Imaging/*; Male; Tomography, X-Ray Computed/*.
.T
Cushing syndrome due to primary pigmented nodular adrenocortical disease: findings at CT and MR imaging.
.P
JOURNAL ARTICLE.
.W
Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of Cushing syndrome in infants, children, and young adults. It is characterized by non-adrenocorticotropic hormone-dependent hypersecretion of cortisol by multiple, pigmented nodules of hyperplastic adrenocortical cells. With a single exception, adrenal glands have been described as normal with computed tomography (CT) in all previous series. Eight patients had Cushing syndrome due to surgically proved PPNAD. Four of the eight patients had stigmas of Carney complex (lentigines, calcified Sertoli cell tumors of the testes, and cardiac and soft-tissue myxomas). CT and/or magnetic resonance (MR) imaging demonstrated unilateral or bilateral nodularity in five of six patients examined. Macronodules (greater than 10 mm) were seen in the two oldest patients. As the clinical presentation of Cushing syndrome in this group of patients may be atypical (severe osteoporosis or short stature), the detection of multiple, small adrenocortical nodules with CT or MR imaging supports, or may even suggest, the diagnosis of PPNAD.
.A
Doppman JL; Travis WD; Nieman L; Miller DL; Chrousos GP; Gomez MT; Cutler GB Jr; Loriaux DL; Norton JA.
.I 125634
.U
89316313
.S
Radiology 8910; 172(2):431-6
.M
Comparative Study; Human; Iodine Radioisotopes/DU; Iodohippuric Acid/DU; Kidney/*RI; Methods; Renal Circulation/*; Support, Non-U.S. Gov't.
.T
Two-compartment, two-sample technique for accurate estimation of effective renal plasma flow: theoretical development and comparison with other methods.
.P
JOURNAL ARTICLE.
.W
Discordance between effective renal plasma flow (ERPF) measurements from radionuclide techniques that use single versus multiple plasma samples was investigated. In particular, the authors determined whether effects of variations in distribution volume (Vd) of iodine-131 iodohippurate on measurement of ERPF could be ignored, an assumption implicit in the single-sample technique. The influence of Vd on ERPF was found to be significant, a factor indicating an important and previously unappreciated source of error in the single-sample technique. Therefore, a new two-compartment, two-plasma-sample technique was developed on the basis of the observations that while variations in Vd occur from patient to patient, the relationship between intravascular and extravascular components of Vd and the rate of iodohippurate exchange between the components are stable throughout a wide range of physiologic and pathologic conditions. The new technique was applied in a series of 30 studies in 19 patients. Results were compared with those achieved with the reference, single-sample, and slope-intercept techniques. The new two-compartment, two-sample technique yielded estimates of ERPF that more closely agreed with the reference multiple-sample method than either the single-sample or slope-intercept techniques.
.A
Lear JL; Feyerabend A; Gregory C.
.I 125635
.U
89316314
.S
Radiology 8910; 172(2):437-41
.M
Adolescence; Adult; Aged; Aged, 80 and over; Balloon Dilatation/*/MT; Female; Human; Male; Middle Age; Postoperative Complications/TH; Ureteral Obstruction/ET/RA/*TH; Urography.
.T
Dilation of benign ureteral strictures.
.P
JOURNAL ARTICLE.
.W
Balloon dilation of benign ureteral strictures was performed in 33 patients in a percutaneous antegrade (25 patients) or retrograde (eight patients) fashion followed by placement of a 7-10-F stent for 4-8 weeks. Dilation was possible in all patients. During the follow-up period of 1-40 months the overall success rate was 76%. The success rate in primary strictures at the ureteropelvic junction was 86%. Among 10 patients with postsurgical (pyeloplasty, ureteroenterostomy, and ureteroneocystostomy) anastomotic strictures, dilation was successful in 50%. Of six patients with postoperative strictures after calculus removal by ureterolithotomy or pyelolithotomy, four (67%) had good results. All patients with iatrogenic postureteroscopic strictures (five patients) or accidental ureteral ligation (two patients) had a normal pyelogram at follow-up. The success rate in acute strictures of less than 3 months duration was 88%; in strictures of more than 3 months duration the success rate was 67%. Cause, length, and duration of stricture are the prime determinants of success. Early intervention with balloon dilation is suggested.
.A
Beckmann CF; Roth RA; Bihrle W 3d.
.I 125636
.U
89316315
.S
Radiology 8910; 172(2):443-4
.M
Communication/*; Female; Human; Interprofessional Relations/*; Mammography/*; Prospective Studies; Radiology.
.T
Communication problems after mammographic screening [see comments]
.P
JOURNAL ARTICLE.
.W
The authors prospectively assessed the effectiveness of requests for immediate additional evaluation or biopsy made on the basis of the interpretation of abnormal findings on screening mammograms. In 1,125 screening mammograms obtained in asymptomatic women referred by physicians, the findings in 63 (6%) were interpreted as requiring additional imaging or biopsy. Written reports were sent, and in all cases the office of the referring physician was notified directly by phone. Physicians were periodically contacted if no follow-up had been performed to resolve the questioned abnormality. In the first 2.5 months, no action had been taken in 40 of 63 (63%) of the recommendations. After additional calls, this diminished to 10 of 63 (16%) at 3.5 months, but at 4.5 months four of 63 (6%) patients had not undergone the recommended additional studies. These results suggest the need for development of systems to ensure prompt action in patients with abnormal findings at mammographic screening.
.A
Robertson CL; Kopans DB.
.I 125637
.U
89316319
.S
Radiology 8910; 172(2):459-62
.M
Adolescence; Adult; Chest Pain/*ET/RA; Cocaine/*; Dyspnea/*ET/RA; Female; Human; Lung Diseases/ET/RA; Male; Mediastinal Emphysema/ET/RA; Middle Age; Smoking; Substance Abuse/*CO; Thoracic Radiography/*.
.T
Chest pain and dyspnea related to "crack" cocaine smoking: value of chest radiography.
.P
JOURNAL ARTICLE.
.W
The chest radiographs of 71 patients who had chest pain or shortness of breath following the smoking of highly potent "crack" cocaine were retrospectively evaluated. Nine patients had abnormal findings on radiographs as follows: atelectasis or localized parenchymal opacification in four, pneumomediastinum in two, pneumothorax in one, hemopneumothorax in one, and pulmonary edema in one. Radiographic detection of these abnormalities was important in the clinical management of these patients. This spectrum of findings is presented with a discussion of the pathophysiologic mechanisms responsible.
.A
Eurman DW; Potash HI; Eyler WR; Paganussi PJ; Beute GH.
.I 125638
.U
89316320
.S
Radiology 8910; 172(2):463-5
.M
Adult; Case Report; Cocaine/*; Female; Human; Lung/RA; Male; Pulmonary Edema/*ET/RA; Smoking; Substance Abuse/*CO.
.T
Pulmonary edema in cocaine smokers.
.P
JOURNAL ARTICLE.
.W
Cocaine smoking can cause a number of medical complications. Pneumomediastinum and pneumothorax due to barotrauma have been the most common radiographic abnormalities reported in the medical literature. The hospital records of five patients with pulmonary edema who smoked cocaine just before admission were reviewed. Except for cocaine abuse no other possible cause for the pulmonary edema was found. Although chest radiographic abnormalities in these patients are uncommon, these cases are reported to inform the radiologist of this possible complication of cocaine smoking. The presence of pulmonary edema in a young, otherwise healthy patient without predisposing risk factors should alert the radiologist to the possible diagnosis of cocaine abuse.
.A
Hoffman CK; Goodman PC.
.I 125639
.U
89316321
.S
Radiology 8910; 172(2):467-71
.M
Adult; Aged; Female; Human; Lung/RA; Lung Diseases/*RA; Male; Middle Age; Prospective Studies; Sarcoidosis/*RA; Tomography, X-Ray Computed/*.
.T
Pulmonary sarcoidosis: evaluation with high-resolution CT.
.P
JOURNAL ARTICLE.
.W
Forty-four patients with histologically confirmed sarcoidosis were prospectively studied with high-resolution computed tomography (CT). Nodules were seen in all cases. They were isolated in 19 cases and associated with other lesions in 25 cases. Other abnormalities were irregular interfaces (n = 18, 41%), linear network (n = 14, 32%), thickening of the pleural surface (n = 9, 20%), ground-glass opacities (n = 7, 16%), lung distortion (n = 11, 25%), traction bronchiectasis (n = 3, 7%), and network of air-filled cavities (n = 3, 7%). Predominant sites of lesions were the upper and middle zones (n = 30, 68%) and posterior zones (n = 13, 30%). Nodular abnormalities were noted at CT in six cases in which the pulmonary parenchyma appeared normal on radiographs. Lung distortion was noted at CT in eight cases without visible fibrosis on chest radiographs. The majority of patients with lung distortion (nine of 11, 82%) had disease of greater than a years duration. CT improved sensitivity for the detection of all types of lesions, mainly lung distortion. Low but significant correlations were found between visual score at CT and total lung capacity, vital capacity, forced expiratory volume in 1 second, and diffusing capacity.
.A
Brauner MW; Grenier P; Mompoint D; Lenoir S; de Cremoux H.
.I 125640
.U
89316323
.S
Radiology 8910; 172(2):477-80
.M
Adolescence; Adult; Bronchiolitis Obliterans/*RA; Bronchography; Child; Female; Human; Lung/RA; Lung Diseases/RA; Male; Prospective Studies; Syndrome; Tomography, X-Ray Computed/*.
.T
CT findings in Swyer-James syndrome.
.P
JOURNAL ARTICLE.
.W
Swyer-James syndrome (SJS) is usually diagnosed with plain chest radiographs obtained during inspiration/expiration. The authors studied patients with CT to assess its value in the evaluation of this syndrome. In patients with SJS, CT was useful in the determination of bronchial patency (all nine patients), lung parenchymal changes (subpleural infiltrates in six patients, atelectasis in two, and cavities in two), and the extent and degree of bronchiectasis (all nine patients). If CT is used for the evaluation of bronchiectasis, knowledge of the main findings associated with SJS (hyperlucent lung without anteroposterior gradient attenuation [n = 8], small lung [n = 6], and diminished central and peripheral pulmonary arteries [n = 9]) should facilitate the diagnosis of associated SJS. Expiration CT would support the diagnosis with demonstration of air trapping.
.A
Marti-Bonmati L; Ruiz Perales F; Catala F; Mata JM; Calonge E.
.I 125641
.U
89316324
.S
Radiology 8910; 172(2):481-5
.M
Adult; Aged; Aged, 80 and over; Female; Hip Joint/SU; Hip Prosthesis/*; Human; Knee Joint/SU; Knee Prosthesis/*; Lung/*RI; Male; Middle Age; Postoperative Complications/*; Prospective Studies; Pulmonary Artery/RA; Pulmonary Embolism/ET/*RI.
.T
Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients.
.P
JOURNAL ARTICLE.
.W
Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.
.A
Foley M; Maslack MM; Rothman RH; Casey MP; Lugano EM; Parry CE; Balderston RA; Booth RE Jr.
.I 125642
.U
89316326
.S
Radiology 8910; 172(2):495-502
.M
Adolescence; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Extremities; Female; Human; Lymphatic System/RA/*RI; Lymphedema/RI; Lymphography; Male; Methods; Middle Age; Support, Non-U.S. Gov't.
.T
Whole-body lymphangioscintigraphy: preferred method for initial assessment of the peripheral lymphatic system.
.P
JOURNAL ARTICLE.
.W
In 20 patients with congenital and acquired lymphedema in either upper or lower extremities and in four patients without extremity edema, human serum albumin labeled with technetium-99m was injected intradermally into a digital web space of the hand or foot. With a digital gamma camera that permitted a "sweep" of the torso, serial extremity and whole-body lymphagioscintigraphy (LAS) of the peripheral lymphatic system was performed. In 11 patients with acquired lymphedema, a well-defined obstructive pattern was seen, characterized by discrete peripheral lymphatic trunks, delayed or absent depiction of regional nodes, and delayed but extensive soft-tissue tracer extravasation. Five of nine patients with congenital lymphedema showed hypoplasia characterized by poorly defined lymphatic trunks, delayed depiction of regional nodes, and early and extensive extravasation of tracer. The other four patients showed aplasia, with absence of trunks, no depiction of nodes, and little or no tracer extravasation. LAS is technically simple to perform and requires no special training. Radiation exposure is minuscule, and the procedure is safe and without apparent side effects. For these reasons, whole-body LAS should be the preferred method for the initial assessment of congenital or acquired lymphedema.
.A
McNeill GC; Witte MH; Witte CL; Williams WH; Hall JN; Patton DD; Pond GD; Woolfenden JM.
.I 125643
.U
89316327
.S
Radiology 8910; 172(2):503-8
.M
Adenosine Triphosphate/ME; Adolescence; Adult; Child; Child, Preschool; Dystonia/ME; Glycerylphosphorylcholine/ME; Human; Leg/*; Middle Age; Muscles/ME; Muscular Dystrophy/ME; Neuromuscular Diseases/*ME; Nuclear Magnetic Resonance/*DU; Phosphates/ME; Phosphocreatine/ME; Poliomyelitis/CO/ME; Support, Non-U.S. Gov't; Werdnig-Hoffmann Disease/ME.
.T
Human leg neuromuscular diseases: P-31 MR spectroscopy.
.P
JOURNAL ARTICLE.
.W
Phosphorus-31 magnetic resonance (MR) spectra of leg muscles in patients with the neuromuscular diseases Duchenne dystrophy, myotonic dystrophy, postpoliomyelitis, Werdnig-Hoffmann disease, and pedal dystonia were recorded. Ratios of beta-adenosine triphosphate (ATP), inorganic phosphate (Pi), alpha-glycerophosphorylcholine (GPC), and phosphomonoesters to phosphocreatine (PCr) were calculated from peak integrals and compared with normal muscle ratios. In all diseases studied, beta-ATP/PCr and Pi/PCr values showed an increase from normal values. The extent of increase in beta-ATP/PCr was related to the clinical severity of the disease, suggesting that this could be a useful noninvasive means of monitoring effectiveness of therapy for neuromuscular disorders. In myotonic dystrophy and Werdnig-Hoffmann disease, GPC/PCr values increased greatly. The intracellular pH in Duchenne and postpoliomyelitis muscles was slightly elevated compared with that in normal muscles. Hydrogen-1 MR images of muscles showed fat infiltration in all patients, more in weaker muscles and less in stronger muscles.
.A
Barany M; Siegel IM; Venkatasubramanian PN; Mok E; Wilbur AC.
.I 125644
.U
89316329
.S
Radiology 8910; 172(2):513-4
.M
Adult; Athletic Injuries/DI; Case Report; Female; Human; Knee Injuries/*DI; Ligaments, Articular/IN/PA; Magnetic Resonance Imaging/*; Male; Middle Age; Tendon Injuries/*DI; Tibial Fractures/*DI.
.T
Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging.
.P
JOURNAL ARTICLE.
.W
Two sports-related knee injuries resulted in small fractures at the posteromedial corner of the tibial plateau. Magnetic resonance imaging demonstrated findings consistent with an avulsion injury at the semimembranosus insertion, as well as a similar pattern of internal derangement in both cases.
.A
Yao L; Lee JK.
.I 125645
.U
89316330
.S
Radiology 8910; 172(2):515-20
.M
Chronic Disease; Exudates and Transudates/AN; Human; Magnetic Resonance Imaging/*; Paranasal Sinus Diseases/*DI/ME/SU; Paranasal Sinuses/*SE; Proteins/AN; Spectrophotometry, Ultraviolet; Viscosity.
.T
Chronically obstructed sinonasal secretions: observations on T1 and T2 shortening.
.P
JOURNAL ARTICLE.
.W
Clinically assessed chronic proteinacious sinonasal secretions usually have long T1 and T2 relaxation times reflecting their high water content. However, in some cases variable combinations of short and long T1 and T2 relaxation times are found. To study the causes of these findings, the magnetic resonance (MR) images of 41 patients with surgically proved, chronically obstructed sinonasal secretions were studied. The relative signal intensities on both T1- and T2-weighted sequences of the sinus specimens were correlated with the gross viscosity of the specimens at surgery. Ten specimens were collected that were not contaminated with either blood or saline. UV spectrophotometric analysis of four of these samples excluded the presence of methemoglobin. Total protein content was determined in five samples, and in vitro T1 and T2 values were measured in one sample. These T1 and T2 relaxation times were accurately predicted with use of a standard pure lysozyme protein solution with the same concentration as the specimen. In addition, the observed T1- and T2-weighted signal intensities on the 41 MR images were predicted from an analysis of pure protein solutions. This study concludes that the primary causes of the variable T1 and T2 relaxation times of chronic sinonasal secretions are the macromolecular protein concentration, the amount of free water, and the specimen viscosity. Furthermore, an orderly and predictable transition of these signal intensities occurs over time.
.A
Som PM; Dillon WP; Fullerton GD; Zimmerman RA; Rajagopalan B; Marom Z.
.I 125646
.U
89316331
.S
Radiology 8910; 172(2):521-5
.M
Adult; Case Report; Cholesterol/*; Ear Diseases/DI/RA; Ear, Middle/*/RA; Granuloma/*DI/RA; Human; Magnetic Resonance Imaging/*; Male; Tomography, X-Ray Computed.
.T
Cholesterol granulomas of the middle ear cavities: MR imaging.
.P
JOURNAL ARTICLE.
.W
Symptomatic cholesterol granuloma developed in the middle ear cavities in three cases. At computed tomography (CT) after the administration of contrast material, the granulomas appeared as nonspecific, nonenhanced soft-tissue masses with variable bone erosion. These features are indistinguishable from those of other similar clinical entities, especially cholesteatoma, paraganglioma, and endaural brain hernia. At magnetic resonance (MR) imaging, cholesterol granulomas had a more characteristic appearance. In two cases, the granulomas were depicted as areas of high signal intensity with both T1- and T2-weighted sequences. In the third case, an expansile mastoid cholesterol cyst exhibited medium signal intensity on T1-weighted images, with only a small hyperintense area and a hypointense area located in the cystic wall. Correlations between CT, MR, and microscopic findings show that MR imaging is far superior to CT in tumoral characterization, which is crucial for planning surgical approaches. MR imaging has limitations, however, particularly its inability to depict subtle bone abnormalities.
.A
Martin N; Sterkers O; Mompoint D; Julien N; Nahum H.
.I 125647
.U
89316333
.S
Radiology 8910; 172(2):535-9
.M
Adolescence; Adult; Aged; Aged, 80 and over; Brain/*PA; Brain Diseases/DI/PA; Child; Child, Preschool; Female; Human; Infant; Magnetic Resonance Imaging/*; Male; Middle Age.
.T
Focal signal-intensity variations in the posterior internal capsule: normal MR findings and distinction from pathologic findings.
.P
JOURNAL ARTICLE.
.W
Cranial magnetic resonance (MR) imaging studies in 117 control patients were reviewed to evaluate for focal signal-intensity variations in the posterior internal capsule. Rounded foci of increased signal intensity were found near the junction of the posterior limb and retrolenticular portion of the internal capsule on axial T2-weighted images in 56% of patients imaged at 1.5 T and in 50% imaged at 0.5 T. Corresponding hypointense foci were found on T1-weighted images in 64% of control patients imaged at 1.5 T and in 69% imaged at 0.5 T. With all sequences, the foci were homogeneous and well defined, without mass effect, and bilaterally symmetric. Comparison was made with MR imaging studies in 32 patients with pathologic involvement of the posterior internal capsule region. Symmetric morphology and signal intensity, sharply defined margins, confinement to a characteristic location, signal intensity approximating that of cortical gray matter on T2-weighted images, and isointensity or hypointensity on spin-density-weighted images appear to characterize normal posterior capsular foci and distinguish them from foci of pathologic lesions. A region that stained less intensely than the surrounding internal capsule was noted in tissue blocks from two normal brain specimens, corresponding in morphology and position to the signal-intensity changes seen on MR images. The properties of this focus suggest that it may represent fibers of the parietopontine tract.
.A
Mirowitz S; Sartor K; Gado M; Torack R.
.I 125648
.U
89316334
.S
Radiology 8910; 172(2):541-8
.M
Adult; Aspartic Acid/AA/AN; Brain Chemistry; Brain Diseases/DI/ME; Brain Neoplasms/AN/*DI; Choline/AN; Creatinine/AN; Cysts/DI/ME; Diagnosis, Differential; Female; Glioma/AN/DI; Glutamine/AN; Human; Inositol/AN; Lactates/AN; Male; Meningeal Neoplasms/AN/DI; Meningioma/AN/DI; Middle Age; Neurilemmoma/AN/DI; Nuclear Magnetic Resonance/*DU; Phosphocreatine/AN; Support, Non-U.S. Gov't.
.T
Noninvasive differentiation of tumors with use of localized H-1 MR spectroscopy in vivo: initial experience in patients with cerebral tumors [see comments]
.P
JOURNAL ARTICLE.
.W
A recently developed method for image-selected localized hydrogen-1 magnetic resonance (MR) spectroscopy was assessed in the differential diagnosis of nine primary and secondary cerebral tumors, including four gliomas, two meningiomas, one neurilemoma, one arachnoid cyst, and one metastasis of breast cancer. Well-resolved H-1 MR spectra of these tumors were obtained in vivo with a conventional 1.5-T whole-body MR imaging system. All tumor spectra were remarkably different from spectra from normal brain tissue. Spectra obtained from different tumors exhibited reproducible differences, while histologically similar tumors yielded characteristic spectra with only minor differences. The observed spectral alterations reflect variations in concentrations and relaxation times of the H-1 MR sensitive pool of free (mobile) metabolites within the tissues. In most cases, the concentrations of N-acetyl-aspartate and creatine/phosphocreatine are reduced below detectability, whereas choline-containing compounds are generally enhanced. The spectral differences between the tumors are mainly due to the differing concentrations of lipids, lactic acid, and carbohydrates. Localized H-1 MR spectroscopy may become an important clinical tool for the differentiation of tumors as well as for therapeutic control.
.A
Bruhn H; Frahm J; Gyngell ML; Merboldt KD; Hanicke W; Sauter R; Hamburger C.
.I 125649
.U
89316335
.S
Radiology 8910; 172(2):549-54
.M
Adult; Age Factors; Female; Hippocampus/*AH; Human; Laterality; Magnetic Resonance Imaging/*; Male; Reference Values; Sex Factors; Support, Non-U.S. Gov't; Temporal Lobe/*AH.
.T
Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults.
.P
JOURNAL ARTICLE.
.W
Volumes of the right and left anterior temporal lobes and hippocampal formations were measured from magnetic resonance images in 52 healthy volunteers, aged 20-40 years. Subjects were selected by age, sex, and handedness to evaluate possible effect of these variables. Data were normalized for variation in total intracranial volume between individuals. Right-left asymmetry in the volumes of the anterior temporal lobes and hippocampal formations was a normal finding. The anterior temporal lobe of the non-dominant (right) hemisphere was larger than the left by a small (mean right-left difference, 2.3 cm3) but statistically significant amount (P less than .005) in right-handed subjects. No significant effect of age or sex was seen in normalized right or left anterior temporal lobe volume. The right hippocampal formation was larger than the left for all subjects by a small (mean right-left difference, 0.3 cm3) but statistically significant amount (P less than .001). No effect of age, sex, or handedness was seen in normalized hippocampal formation volumes.
.A
Jack CR Jr; Twomey CK; Zinsmeister AR; Sharbrough FW; Petersen RC; Cascino GD.
.I 125650
.U
89316336
.S
Radiology 8910; 172(2):555-9
.M
Adult; Aged; Aged, 80 and over; Breast/RE; Breast Neoplasms/PA/*RT; Carcinoma, Ductal/PA/*RT/SC; Female; Human; Middle Age; Neoplasm Recurrence, Local; Prognosis; Radiotherapy/AE; Radiotherapy Dosage.
.T
Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma.
.P
JOURNAL ARTICLE.
.W
Between 1978 and 1985, 393 of 2,765 (14%) patients with operable cancer of the breast (clinical stage T0-3N0-2M0) were irradiated after excisional biopsy and staging axillary dissection. Of 77 patients with microscopic axillary metastases, 68 received systemic adjuvant therapy. Treatment failed locally in 26 cases, and there were seven patients with distant metastasis. The three major factors for increased local treatment failure were (a) age below 40 years (P = .003), (b) negative estrogen receptor assay result (P = .03), and (c) failure to deliver a radiation boost dose when tumor was present at the margin of the specimen (P = .002). The size of the tumor, the nodal status, the progesterone receptor assay result, and the presence of ductal carcinoma in situ mixed with infiltrating carcinoma did not show a significant influence on local recurrence. In 274 of 393 (70%) patients, cosmesis was evaluated. The four major factors affecting cosmesis favorably were (a) utilization of a wedge (P less than .0001); (b) treatment of two fields a day (P less than .0001); (c) failure to use a separate treatment port to the regional lymph nodes, so as to avoid field junctions (P = .0003); and (d) small size of specimen (less than 50 cm2) (P = .0171). A second or third cancer was found in 39 of the 393 (10%) patients; contralateral breast cancer was the most common form (n = 23), followed by genitourinary cancer (n = 5). The most frequent complication was arm edema (6%).
.A
Ryoo MC; Kagan AR; Wollin M; Tome MA; Tedeschi MA; Rao AR; Hintz BL; Kuruvilla AM; Nussbaum H; Streeter OE Jr; et al.
.I 125651
.U
89316337
.S
Radiology 8910; 172(2):561-4
.M
Brachytherapy/MT; Human; Male; Methods; Models, Structural; Prostatic Neoplasms/PA/*RT; Radiotherapy Dosage.
.T
Multiplanar arc boost radiation therapy for prostate cancer.
.P
JOURNAL ARTICLE.
.W
Localized prostatic carcinoma may be treated with either radical surgery or radiation therapy. Radiation therapy techniques for localized prostatic carcinoma include mega-voltage external irradiation or interstitial implantation, usually with iodine-125 seeds. Two external-beam techniques, multiplanar arc and biplanar arc, are additional options for the treatment of localized prostatic carcinoma. Film dosimetry measurements were made in pelvic phantoms to compare the isodose distributions of various external-beam radiation therapy techniques for boost treatment of prostate target volumes. Idealized calculations were performed to determine the isodose distribution of an I-125 implant. A comparison of these techniques shows that the multiplanar and biplanar arc techniques produce isodose distributions that may be useful in the treatment of prostate carcinoma.
.A
Serago CF; Lewin AA; Houdek PV; Schwade JG; Abitbol AA.
.I 125652
.U
89316338
.S
Radiology 8910; 172(2):565-8
.M
Adult; Aged; Combined Modality Therapy; Dysgerminoma/PA/*RT/SU; Human; Male; Middle Age; Neoplasm Recurrence, Local; Orchiectomy/*; Prognosis; Testicular Neoplasms/PA/*RT/SU.
.T
Stage II seminoma: results of postorchiectomy irradiation.
.P
JOURNAL ARTICLE.
.W
One hundred forty patients with testicular seminoma were treated at the State University of New York Health Science Center at Syracuse between 1966 and 1985. Disease was classified as stage II in 32 patients (23%): stage IIA in 21 patients and stage IIB in 11 patients. All patients underwent irradiation below the diaphragm after a radical orchiectomy, and 28 underwent planned mediastinal and supraclavicular irradiation. The median follow-up was 8 1/2 years; 24 of 32 patients have been followed up for more than 5 years. Twenty-eight patients remain alive and well; four patients died of intercurrent disease. Two patients developed a recurrent seminoma in the mediastinum; a variant lymphangiographic pattern was shown in these patients, and they were cured. A third patient developed a non-seminomatous "recurrence" in the ipsilateral, unirradiated, inguinal nodes and is well after chemotherapy.
.A
Sagerman RH; Kotlove DJ; Regine WF; Chung CT; King GA; Dalal PS.
.I 125653
.U
89316339
.S
Radiology 8910; 172(2):569-70
.M
Human; Needles; Nephrostomy, Percutaneous/IS; Pressure; Ureter/*PP; Ureteral Obstruction/DI; Urodynamics; Urology/*IS.
.T
Double-lumen needle for percutaneous ureteral pressure-flow studies.
.P
JOURNAL ARTICLE.
.W
Ureteral perfusion studies in patients without preexisting renal access currently must be intermittently interrupted for intrarenal pressure measurement. A double-lumen needle has been successfully placed in four patients (two with native and two with transplanted kidneys). This permits simultaneous perfusion and intrarenal pressure monitoring yet maintains the safety and ease of use of a single skinny needle.
.A
Epstein DH; Hunter DW; Coleman CC; Derauf BJ; Krenzel C; Schlam BW; Moradian GP; Castaneda F; Castaneda-Zuniga WR; Amplatz K.
.I 125654
.U
89316340
.S
Radiology 8910; 172(2):570-4
.M
Human; Magnetic Resonance Imaging/*IS/MT; Male; Prostate/AH/*PA; Prostatic Neoplasms/DI.
.T
Prostate: MR imaging with an endorectal surface coil.
.P
JOURNAL ARTICLE.
.W
An endorectal surface coil has been developed to obtain high-resolution magnetic resonance images of the prostate. The probe consists of a surface coil mounted on the inner surface of a balloon. The balloon is concave to ensure tight seating against the prostate. The coil has been used in 15 patients with biopsy-proved prostatic carcinoma and in two healthy volunteers. The axial images were obtained with a 12-16-cm field of view and a 3-mm section thickness. Compared with images obtained with a body coil, the surface coil images better demonstrate prostatic anatomy and pathologic conditions.
.A
Schnall MD; Lenkinski RE; Pollack HM; Imai Y; Kressel HY.
.I 125655
.U
89316342
.S
Radiology 8910; 172(2):577
.M
Angiography/AE/*MT; Human; Prospective Studies.
.T
Routine transbrachial angiography [letter; comment]
.P
COMMENT; LETTER.
.A
Millward SF.
.I 125656
.U
89316343
.S
Radiology 8910; 172(2):577-8
.M
Breast Diseases/RA; Breast Neoplasms/*RA/RT/SU; Calcinosis/*RA; Combined Modality Therapy; Female; Human; Mammography/*; Mastectomy, Segmental/*; Neoplasm Recurrence, Local.
.T
Breast microcalcifications after lumpectomy and radiation therapy [letter; comment]
.P
COMMENT; LETTER.
.A
Hall FM.
.I 125657
.U
89316345
.S
Radiology 8910; 172(2):579-80
.M
Breast Neoplasms/*RA; Carcinoma in Situ/*RA; Carcinoma, Ductal/*RA; Female; Human; Mammography/*.
.T
Circumscribed intraductal carcinoma of the breast [letter; comment]
.P
COMMENT; LETTER.
.A
Hall FM.
.I 125658
.U
89316346
.S
Radiology 8910; 172(2):580
.M
Hepatic Vein Thrombosis/*RI; Human; Liver/*RI.
.T
Budd-Chiari syndrome [letter; comment]
.P
COMMENT; LETTER.
.A
Halkar RK.
.I 125659
.U
89317128
.S
Rev Infect Dis 8910; 11(3):369-78
.M
Adolescence; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Human; Immune Tolerance; Male; Middle Age; Mycoses/*CO; Neoplasms/*CO; Neutropenia/CO; Opportunistic Infections/*CO; Prognosis; Retrospective Studies.
.T
New spectrum of fungal infections in patients with cancer.
.P
JOURNAL ARTICLE.
.W
We report on 44 cancer patients who had serious infections with unusual fungal pathogens and who were cared for at our cancer center between 1974 and 1986. Twelve different fungal species accounted for these infections, including Trichosporon beigelii, Fusarium species, Geotrichum candidum, Curvularia species, Drechslera species, Penicillium species (but not Penicillium marneffei), Rhodotorula rubra, Pseudallescheria boydii, Pichia farinosa, Torulopsis pintolopesii, Saccharomyces cerevisiae, and Cunninghamella bertholletiae. Skin lesions were noted in seven patients, and sinusitis occurred in four. Twenty-four patients had disseminated infection, 12 had involvement of a single organ, and eight had fungemia alone. Features that correlated with a poor prognosis were persistent neutropenia and disseminated visceral infection but not fungemia alone. We suggest that unusual fungi have now emerged as significant pathogens in this patient population. Fungal sinusitis, previously caused by Aspergillus species and the phycomycetes, also occurs as a result of some of these newly recognized fungi. A high level of suspicion should be maintained when any of these unusual fungi are cultured from clinical specimens from immunocompromised patients.
.A
Anaissie E; Bodey GP; Kantarjian H; Ro J; Vartivarian SE; Hopfer R; Hoy J; Rolston K.
.I 125660
.U
89317129
.S
Rev Infect Dis 8910; 11(3):379-90
.M
Adolescence; Adult; Aged; Aged, 80 and over; Antifungal Agents/TU; Candidiasis/CO/DT/*EP; Catheters, Indwelling; Comparative Study; Cross Infection/CO/DT/*EP; Female; Human; Leukemia/CO; Lymphoma/CO; Male; Middle Age; Neoplasms/CO; Neutropenia/CO; Postoperative Complications/BL; Prognosis; Regression Analysis; Retrospective Studies; Risk Factors; Septicemia/*EP.
.T
Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome.
.P
JOURNAL ARTICLE.
.W
We reviewed 135 cases of candidemia occurring between 1983 and 1986 to examine oncologic and nononcologic populations and assess factors for survival. Candida albicans was the most common species (51%); Candida tropicalis occurred most frequently in leukemia patients (57%), whereas Candida parapsilosis and Torulopsis glabrata were associated with solid tumors and nononcologic diseases. Risk factors identified were: preceding surgery, antibiotics, cannulas, and steroids in solid tumor and nononcologic diseases; and chemotherapy and neutropenia with hematologic malignancies. Even transient cannula-associated candidemia was not a benign process. Intravenous cannulas were common portals of entry (39%) in debilitated patients without cancer (59%) and were associated with high mortality (55%). Overall mortality was 59%, candidemia directly contributing to death in 75% of cases. In patients with candidemia, failure to initiate therapy with amphotericin B had a negative influence on outcome, whereas analysis of the entire group identified severity of underlying illness as the dominant cofactor influencing outcome.
.A
Komshian SV; Uwaydah AK; Sobel JD; Crane LR.
.I 125661
.U
89317131
.S
Rev Infect Dis 8910; 11(3):407-12
.M
Adenocarcinoma/CO; Adolescence; Adult; Aged; Brain Abscess/CO; Case Report; Child, Preschool; Female; Human; Immune Tolerance; Immunosuppression; Leukemia/*CO; Leukemia, Lymphocytic, Acute/CO; Lymphoma/*CO; Male; Middle Age; Neoplasms/*CO; Nocardia Infections/*CO/MO/TH; Ovarian Neoplasms/CO; Retrospective Studies.
.T
Nocardial infection in patients with neoplastic disease.
.P
JOURNAL ARTICLE.
.W
During the 13 years from 1974 through 1986, nocardial infection was diagnosed in 14 cancer patients treated at the M. D. Anderson Cancer Center (Houston). Underlying diseases included solid tumors in eight patients and hematologic malignancies in five; there was no underlying disease in one patient. The types of infection were bronchopneumonia, cavitary pneumonia, empyema, brain abscess, meningitis, and cutaneous abscesses. Eleven patients received antineoplastic therapy prior to the onset of their infection. Among the 11 patients in whom infection was diagnosed antemortem, nine who were treated with sulfadiazine or trimethoprim-sulfamethoxazole had a favorable response to therapy. Nocardiosis occurs infrequently in cancer patients but causes serious infection. Physicians must be alert to this possibility so that appropriate therapy can be given promptly and the chances of a favorable outcome thereby increased.
.A
Berkey P; Bodey GP.
.I 125662
.U
89317136
.S
Rev Infect Dis 8910; 11(3):464-9
.M
Adolescence; Adult; Age Factors; Child; Child, Preschool; Comparative Study; Female; Hepatitis A/*EP; Hepatitis, Viral, Human/*EP; Human; Infant; Israel; Jews; Male; Middle Age; Military Personnel; Seasons; Sex Factors; Socioeconomic Factors.
.T
Rise in the incidence of viral hepatitis in Israel despite improved socioeconomic conditions.
.P
JOURNAL ARTICLE.
.W
The incidence of viral hepatitis (mostly type A) in Israel, an area highly endemic for the disease, was examined between 1951 and 1985. During a period of improved standards of living, the overall reported incidence of the disease increased. In the Jewish population, the age of peak incidence shifted from 1-4 y to 5-9 y; this change is compatible with improved sanitation. However, whereas the absolute incidence declined among children 1-4 y old, it doubled among those 5-9 y old over the same period. The peak incidence in the non-Jewish population remains in children 1-4 y old. One possible explanation for the rise in overall incidence is an increase in the ratio of clinical to subclinical infections due to a shift of peak incidence to an older age group. Seasonal patterns have persisted against a background of changing morbidity, with the maximal incidence from late summer to midwinter. An unexplained, consistent excess incidence among males is observed for all age groups.
.A
Green MS; Block C; Slater PE.
.I 125663
.U
89317137
.S
Rev Infect Dis 8910; 11(3):470-3
.M
Adult; Case Report; Clostridium perfringens; Clostridium Infections/*; Endometritis/*ET; Female; Human; Pregnancy; Puerperal Disorders/*.
.T
Postpartum uterine infection with Clostridium perfringens.
.P
JOURNAL ARTICLE.
.W
Clostridium perfringens is commonly present in the female genital tract. Uterine infection with this organism is a potentially fatal disease infrequently seen in obstetric practice. The manifestations of C. perfringens uterine infection are variable, ranging from endometritis to gas gangrene with fulminant septicemia. The usual precipitating event has been septic abortion, but such infections can also occur spontaneously in uterine tumors and after complicated deliveries requiring mechanical intervention. Diagnosis may be aided by radiologic techniques, and treatment involves high-dose penicillin and possibly surgery. We report two cases and review the clinical presentation and the diagnostic and therapeutic aspects of this disease.
.A
Dylewski J; Wiesenfeld H; Latour A.
.I 125664
.U
89317140
.S
Rev Infect Dis 8910; 11(3):486-93
.M
Adolescence; Adult; Aged; Aged, 80 and over; Female; Heroin Dependence/CO; Human; Infection/CO/*EP; Male; Middle Age; Retrospective Studies; Substance Dependence/*CO; Support, Non-U.S. Gov't; Switzerland.
.T
Infectious complications in drug addicts: seven-year review of 269 hospitalized narcotics abusers in Switzerland [published erratum appears in Rev Infect Dis 1990 Jan-Feb;12(1):165]
.P
JOURNAL ARTICLE.
.W
In a retrospective survey of patients hospitalized in the Department of Medicine of the University Hospital, Basel, Switzerland, from 1980 to 1986, we found 269 patients with history of past or current drug abuse. The charts of these patients were analyzed for infectious complications according to defined criteria. Heroin was the principal drug consumed by 95%. In 127 patients (47%) at least one infectious complication was diagnosed. In 125 (31%) of 404 admissions, the infectious problem was the main reason for hospitalization. Among the 269 patients, 217 infective episodes occurred. Pulmonary infections were the most frequently occurring (52 episodes). There were 44 cases of viral hepatitis, 30 of human immunodeficiency virus infection, and 25 of minor genital infections. Bone and joint infections and sepsis/endocarditis were diagnosed in seven cases each. The overall mortality was 4.1%; however, only three of the 11 deaths were attributed to infections. Intravenous drug addiction is complicated by a high morbidity because of infections that were seldom lethal during the observed period.
.A
Scheidegger C; Zimmerli W.
.I 125665
.U
89317143
.S
Rev Infect Dis 8910; 11(3):506-7
.M
Adult; Endocarditis/*ET; Female; Human; Male; Middle Age; Mitral Valve Prolapse/*CO; Recurrence; Rheumatic Heart Disease/*CO.
.T
Recurrent native-valve infective endocarditis [letter]
.P
LETTER.
.A
Cheng TO.
.I 125666
.U
89317145
.S
Rev Infect Dis 8910; 11(3):508-10
.M
Animal; Diarrhea/*ET; Human; Protozoa/*PY; Protozoan Infections/*ET; Virulence.
.T
Blastocystis hominis infection in humans [letter]
.P
LETTER.
.A
Kain K; Noble M.
.I 125667
.U
89317146
.S
Rev Infect Dis 8910; 11 Suppl 4:S669-896
.M
Animal; Hemorrhagic Fevers, Viral/*BL; Hemostasis/*; Human; Support, U.S. Gov't, Non-P.H.S..
.T
International Symposium on Hemostatic Impairment Associated with Hemorrhagic Fever Viruses. 26-28 May 1987, Leesburg, Virginia. Proceedings.
.P
JOURNAL ARTICLE.
.I 125668
.U
89317158
.S
Rev Infect Dis 8910; 11 Suppl 4:S771-6
.M
Animal; Arenaviridae/*IM; Cell Line; Complement/*IM; Guinea Pigs; Hemorrhagic Fever Viruses, American/*IM/PY; Human; Immune Sera/IM; Macaca mulatta; Male; Rabbits; Vero Cells; Virulence.
.T
Actions of complement on Junin virus.
.P
JOURNAL ARTICLE.
.W
Fresh sera from normal rhesus monkeys, guinea pigs, and rabbits inactivated 90%-99% of the infectivity of Vero cell-passaged, attenuated strains of Junin virus (JV) within 60 minutes. Selective depletion studies showed that inactivation occurred by the classical complement pathway. Complement had little effect on virulent JV strains. Adsorption of the fresh sera with JV-infected Vero cells showed that inactivation was not mediated by low levels of antibodies in normal sera. The cells used for propagation of the virus affected inactivation: virus passaged in Vero cells (a continuous African green monkey kidney line) was more susceptible than virus passaged in FRhL-2 cells (a diploid strain derived from fetal rhesus monkey lung). Complement was important for in vitro neutralization of virulent JV strains by immune sera but was unnecessary for neutralization of attenuated strains. Thus, complement may be important in host resistance to Argentine hemorrhagic fever in two ways: first, complement activation may contribute to the attenuated phenotype of some strains; and second, complement may be necessary for efficient neutralization of virulent strains.
.A
Kenyon RH; Peters CJ.
.I 125669
.U
89317160
.S
Rev Infect Dis 8910; 11 Suppl 4:S783-9
.M
Diagnosis, Differential; Female; Human; Lassa Fever/BL/DI/*EP/MO; Liberia; Male; Platelet Count; Pregnancy; Pregnancy Complications, Infectious/BL/DI/*EP/MO; Retrospective Studies; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S..
.T
Clinical features of Lassa fever in Liberia.
.P
JOURNAL ARTICLE.
.W
Two hundred thirteen cases of Lassa fever (LF) were diagnosed by virus isolation and seroconversion at Curran Lutheran Hospital in Zorzor, Liberia, between July 1980 and April 1986. An additional 40 cases of probable and presumptive LF were diagnosed on the basis of single serum samples. Of the 246 assessable patients, 23 (9%) died; no data were available for seven patients. Five (16%) of 32 pregnant women and three (43%) of seven immediately postpartum women died. Four (26%) of 15 children less than 12 years died. Case-fatality rates among 125 nonpregnant women and 67 men were approximately 6%. Among 150 patients studied in detail, the case-fatality rate was also 9%. Seventeen (11%) of these patients had abnormal bleeding; of these, six (35%) died. Most platelet counts were at low normal to mildly depressed levels. However, serial counts in seven patients suggested a decrease on about days 10-12 of illness. The symptoms of LF in Liberia are those of a viral syndrome. Edema, sometimes marked, is noted in seriously ill patients. A great variation in mortality and incidence of abnormal bleeding is recorded in reported series of LF; it appears that hemorrhage is a marker for cases with a high mortality. The incidence and severity of hearing defects in LF outbreaks vary. Elucidation of a number of clinical problems in LF requires more information on how strain differences affect the pattern of illness.
.A
Frame JD.
.I 125670
.U
89317161
.S
Rev Infect Dis 8910; 11 Suppl 4:S790-3
.M
Adult; Case Report; Disease Outbreaks/*; Ebola Virus; Female; Hemorrhagic Fevers, Viral/BL/*EP/MO; Human; Male; Middle Age; Retrospective Studies; Zaire.
.T
Firsthand clinical observations of hemorrhagic manifestations in Ebola hemorrhagic fever in Zaire.
.P
JOURNAL ARTICLE.
.W
About 5 weeks after the beginning of the outbreak of Ebola virus fever in Yambuku, Zaire, several acute cases of the disease were observed. All of those affected had the following common signs and symptoms: sudden onset of high fever, with chills, headache, myalgia, anorexia, nausea, abdominal pain, sore throat, expressionless face, and profound prostration. In some cases, on around the fifth day of the acute phase, the appearance of an exanthematous rash on the trunk announced the hemorrhagic manifestations: hemorrhagic conjunctivitis, bleeding ulcerations in the mouth and on the lips, gingival bleeding, hematemesis, and melena; epistaxis, ear bleeding, hematuria, and postpartum hemorrhages were also reported. All these hemorrhagic cases had a fatal outcome within about a week. The hemorrhagic manifestations were less severe in the cases that occurred by the end of the outbreak than in the first reported cases. Hemorrhagic manifestations were less frequent and less severe, or even absent, in the nonfatal cases (convalescents, serologically confirmed). No biologic investigation of the hemostatic impairment could be performed under the emergency conditions of this field study.
.A
Sureau PH.
.I 125671
.U
89317162
.S
Rev Infect Dis 8910; 11 Suppl 4:S794-800
.M
Animal; Blood Chemical Analysis; Blood Coagulation Tests; Cross Infection/BL/*EP/MO; Female; Hemorrhagic Fever, Crimean/BL/*EP/MO; Human; Male; Namibia; Platelet Count; South Africa; Tanzania; Zaire.
.T
The clinical pathology of Crimean-Congo hemorrhagic fever.
.P
JOURNAL ARTICLE.
.W
Observations were made of 15 fatal and 35 nonfatal Crimean-Congo hemorrhagic fever (CCHF) infections diagnosed from February 1981 to March 1987 in Kimberly and Sandringham, Republic of South Africa. Following an incubation period of 2-9 days after exposure to infection, patients had a sudden onset of disease with fever, nausea, severe headache, and myalgia. Petechial rash and hemorrhagic signs such as epistaxis, hematemesis, and melena supervened on days 3-6 of illness. Deaths occurred on days 5-14 of illness. Patients with fatal infections had thrombocytopenia and markedly elevated levels of serum aspartate and alanine aminotransaminases, gamma-glutamyltransferase, lactic dehydrogenase, creatine kinase, bilirubin, creatinine, and urea. Total protein, albumin, fibrinogen, and hemoglobin levels were depressed. Values for prothrombin ratio, activated partial thromboplastin time, thrombin time, and fibrin degradation products were grossly elevated, findings that indicate the occurrence of disseminated intravascular coagulopathy. Many of the clinical pathologic changes were evident at an early stage of the disease and had a highly predictive value for fatal outcome of infection. Changes were present but less marked in nonfatal infections.
.A
Swanepoel R; Gill DE; Shepherd AJ; Leman PA; Mynhardt JH; Harvey S.
.I 125672
.U
89317164
.S
Rev Infect Dis 8910; 11 Suppl 4:S807-14
.M
Animal; Blood Coagulation; Blood Coagulation Tests; Disease Models, Animal/*; Disseminated Intravascular Coagulation; Female; Hemostasis/*; Liver/PA; Macaca/*; Macaca mulatta/*; Male; Rift Valley Fever/*BL/PA; Viremia.
.T
Hemostatic derangement produced by Rift Valley fever virus in rhesus monkeys.
.P
JOURNAL ARTICLE.
.W
Rift Valley fever (RVF) is an important cause of disease in animals and humans in sub-Saharan Africa. In a small percentage of human cases, the disease is complicated by hemorrhage, which often is associated with a fatal outcome. Inoculation of rhesus monkeys with the Zagazig Hospital strain of RVF virus produced a clinical picture similar to illness in humans. Ten of 17 monkeys developed clinical evidence of hemostatic impairment. When coagulation tests were performed, this group of monkeys had significant abnormalities, including evidence for disseminated intravascular coagulation. These abnormalities were much less pronounced in the remaining seven monkeys-whose only sign of illness was transient fever-and, in general, they paralleled the level of viremia and the degree of elevation in levels of serum hepatic enzymes. Autopsy of the three monkeys with severe disease revealed hepatic necrosis.
.A
Cosgriff TM; Morrill JC; Jennings GB; Hodgson LA; Slayter MV; Gibbs PH; Peters CJ.
.I 125673
.U
89317165
.S
Rev Infect Dis 8910; 11 Suppl 4:S815-25
.M
Animal; Cell Line; Cytopathogenic Effect, Viral; Female; Human; Interferon Alfa, Recombinant/IM/*TU; Macaca mulatta; Male; Neutralization Tests; Para-Influenza Virus Type 1; Rift Valley Fever/*PC/TH; Rift Valley Fever Virus/IM; Viremia/*PC/TH.
.T
Prevention of Rift Valley fever in rhesus monkeys with interferon-alpha.
.P
JOURNAL ARTICLE.
.W
Prophylactic and therapeutic efficacy of recombinant leukocyte A interferon (rIFN-alpha A) and Sendai virus-induced human leukocyte interferon (HuIFN-alpha) administered intramuscularly to Rift Valley fever virus (RVFV)-infected rhesus monkeys was studied. Clinical, virologic, immunologic, and hemostatic parameters were monitored. Five daily inoculations of 5 X 10(5) units of either interferon product per kilogram of body weight, initiated 24 hours before or 6 hours after RVFV infection, prevented or greatly suppressed viremia. No clinical signs of disease or laboratory evidence of impaired hemostasis was observed. Serum neutralizing antibody to RVFV was detected within 6 days of virus inoculation. Prophylactic administration of 5 X 10(4) or 5 X 10(3) units of rIFN-alpha A per kilogram also limited viremia, hepatocellular damage, and hemostatic derangement. Untreated, RVFV-infected, control monkeys developed high-titered viremia, clinical disease, and impaired hemostasis. These data suggest that rIFN-alpha A and HuIFN-alpha are effective in protecting RVFV-infected rhesus monkeys from viremia and hepatocellular damage and may be beneficial in human RVF infection.
.A
Morrill JC; Jennings GB; Cosgriff TM; Gibbs PH; Peters CJ.
.I 125674
.U
89317173
.S
Rev Infect Dis 8910; 11 Suppl 4:S864-76
.M
Animal; Disease Outbreaks/*; Disease Reservoirs; Hemorrhagic Fever, Epidemic/DI/*EP/TM; Human; Korea; Support, U.S. Gov't, Non-P.H.S..
.T
Hemorrhagic fever with renal syndrome in Korea.
.P
JOURNAL ARTICLE.
.W
Several clinical variants of hemorrhagic fever with renal syndrome (HFRS) are caused by Hantaan and related viruses. Since 1951, 500-900 patients with HFRS have been hospitalized annually in Korea. Although HFRS is associated primarily with rural areas, it is now being recognized as an urban problem and a particular hazard to laboratory staff using rodents for research. Recently, epidemic outbreaks of leptospirosis and scrub typhus have occurred during the HFRS season, leading to confusion in diagnosis. Serologic diagnosis of HFRS is based on the demonstration of IgM antibodies to Hantaviruses by the indirect fluorescent antibody technique or enzyme-linked immunosorbent assay. The specific Hantavirus causing infection can be identified on the basis of titers of plaque-reduction neutralizing antibody. Results of studies with monoclonal antibodies suggest that viral subtypes exist for each Hantaviral serotype presently recognized. While infection with Hantaviruses is known to be a problem of worldwide dimensions, present evidence indicates that it occurs over a wider area than previously recognized. Vertical transmission of Hantaan virus in a pregnant woman has been documented.
.A
Lee HW.
.I 125675
.U
89317174
.S
Rev Infect Dis 8910; 11 Suppl 4:S877-83
.M
Antigen-Antibody Complex/AN; Antiplasmin/AN; Antithrombin III/AN; Blood Coagulation; Blood Coagulation Disorders/*BL; Blood Coagulation Factors/AN; Blood Coagulation Tests; Complement 3/BL; Disseminated Intravascular Coagulation; Fibrin Fibrinogen Degradation Products/AN; Fibrinogen/AN; Fibrinolysis; Hemorrhagic Fever, Epidemic/*BL; Human; Kallikrein/AN; Plasminogen/AN; Platelet Count; Prekallikrein/AN.
.T
Coagulopathy in hemorrhagic fever with renal syndrome (Korean hemorrhagic fever).
.P
JOURNAL ARTICLE.
.W
The pathophysiology of bleeding manifestations in hemorrhagic fever with renal syndrome (HFRS) was elucidated by serially evaluating coagulation and fibrinolytic profiles and complement alterations in patients with HFRS. In the early stage of the disease, platelet counts, platelet survival time, and platelet aggregation in vitro decreased. Prolongation of bleeding time, prothrombin time, and activated partial thromboplastin time was noted, with decreases in coagulation factors II, V, VIII, IX, and X. Levels of fibrinogen were decreased, and those of fibrinogen-fibrin degradation products in serum and urine were increased. Concentrations of plasminogen, alpha 2-plasmin inhibitor, and antithrombin III in plasma were depressed. Procoagulant activity was present in plasma. Circulating immune complexes were found, whereas serum levels of C3 were decreased. In the early stage of HFRS, thrombocytopenia, defects in platelet function, and disseminated intravascular coagulation may play central roles in the pathogenesis of bleeding manifestations. Vasculopathy and immunologic aberrations also may play a role.
.A
Lee M; Kim BK; Kim S; Park S; Han JS; Kim ST; Lee JS.
.I 125676
.U
89317176
.S
Rev Infect Dis 8910; 11 Suppl 4:S891-6
.M
Creatinine/BL; Disseminated Intravascular Coagulation; Greece; Hematocrit; Hematuria; Hemorrhagic Fever, Epidemic/*BL/EP; Human; Hypoproteinemia; Leukocyte Count; Platelet Count; Prothrombin Time; Support, U.S. Gov't, Non-P.H.S.; Thrombocytopenia; Urea/BL.
.T
Hemorrhagic fever with renal syndrome in Greece: clinical and laboratory characteristics.
.P
JOURNAL ARTICLE.
.W
The clinical and laboratory characteristics of a severe form of hemorrhagic fever with renal syndrome (HFRS) in Greece are presented. Twenty-seven patients with serologically confirmed HFRS were studied; 10 required renal dialysis, six had hemorrhagic manifestations, and four died. In patients with hemorrhagic manifestations, the platelet counts were generally less than 100,000 cells/microL. In three patients findings were compatible with disseminated intravascular coagulation. Laboratory investigation showed a consistent rise in levels of serum urea nitrogen and creatinine beginning on the fifth or sixth day of illness and reaching a maximum level between the ninth and 12th days of illness. The disease in Greece more closely resembles the Asian form of HFRS (Korean hemorrhagic fever) than the Scandinavian form of the disease (nephropathia epidemica) because of the high mortality rate, the occurrence of hemorrhagic manifestations, and the severity of the clinical disease.
.A
Antoniadis A; LeDuc JW; Acritidis N; Alexiou-Daniel S; Kyparissi A; Saviolakis GA.
.I 125677
.U
89317369
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):111-4
.M
Adult; Aged; Echocardiography, Doppler; Female; Heart Neoplasms/DI/SC/*SU; Human; Male; Middle Age; Myxoma/DI/*SU.
.T
Urgent indications for surgery in primary or secondary cardiac neoplasm.
.P
JOURNAL ARTICLE.
.W
Ten patients underwent resection of primary or secondary cardiac tumor. Two-dimensional transthoracic echocardiography per se accurately located the endoluminal cardiac mass in nine patients, and transesophageal echocardiography demonstrated a right atrial tumor in the tenth case. The indications for urgent surgery included prior embolic events (3 cases), syncopal attacks (2) or echocardiographic evidence of a multilobulated mass (2 cases). The operative strategy was standardized for atrial tumors, but for malignant myocardial neoplasm both the anatomic site and the extent of tumor growth determined the surgical procedure. Histologic examination showed myxoma in seven cases, fibroma in one and metastases of malignant melanoma in two cases. The course after resection of endoluminal benign tumor was uneventful apart from transient atrial fibrillation in four cases. Follow-up echocardiography (after 4-28 months) showed no recurrent growth. In both cases of intracardiac metastases there was recurrence within 6 to 8 months after resection of the growth.
.A
Hake U; Iversen S; Schmid FX; Erbel R; Oelert H.
.I 125678
.U
89317371
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):121-5
.M
Animal; Aorta/*DE; Cardioplegic Solutions; Coronary Vessels/*DE; Endothelium, Vascular/*DE; Hypertonic Solutions/*PD; Organ Preservation/*MT; Pulmonary Artery/*DE; Support, Non-U.S. Gov't; Swine; Swine, Miniature.
.T
Intracellular-type solution flush for preservation of myocardium and coronary and pulmonary artery flow surface.
.P
JOURNAL ARTICLE.
.W
Modified Euro-Collins solution (ECS), which has been successfully used in kidney, liver and lung transplantation, was tested concerning myocardial and endothelial preservation in nine piglets. In six (group I), 1-hour cardiac arrest was induced with cold modified ECS, and in three (group II) heart-lung transplantation was performed, using modified ECS for graft preservation. In group I myocardial energy preservation was determined with biochemical assays for adenosine triphosphate, creatine phosphate, lactate and creatine 5, 15, 30 and 60 minutes after aortic clamping, and preservation of endothelium in the aorta and coronary arteries was studied with scanning electron microscopy. In group II electron microscopy was performed on endothelial samples from the ascending aorta and coronary and pulmonary arteries of the heart-lung block after excision, after 2 hours of ischemia, and after 1-2 hours of reperfusion. High-energy phosphates decreased progressively during the ECS cardioplegia in group I, and circulatory support was required during the post-transplantation reperfusion period in group II. The endothelial lining in all specimens was remarkably well preserved, however. Modified ECS flush thus was ideal for vascular endothelium but, because of its poor energy-preserving capacity, unsuitable for cardioplegia.
.A
Lehtola A; Harjula A; Talja M; Heikkila L; Salmenpera M; Merikallio E; Harkonen M; Mattila S.
.I 125679
.U
89317373
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):135-8
.M
Animal; Aorta/PH; Blood Pressure; Coronary Circulation; Free Radicals; Heart Rate; Hypoxanthines/*ME; In Vitro; Male; Myocardium/*ME; Oxygen/*ME; Perfusion; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Time Factors; Tissue Survival/*; Xanthine Oxidase/*ME.
.T
Oxygen free radicals decrease survival time of isolated rat hearts.
.P
JOURNAL ARTICLE.
.W
Effects of oxygen free radicals (OFR), enzymatically generated in the coronary circulation, were studied in isolated rat hearts retrogradely perfused with Krebs-Ringer solution. Control hearts (n = 6) functioned adequately for at least 5 hours. When rat hearts (n = 6) received xanthine oxidase (XOD) and hypoxanthine (HX) in order to generate OFR, survival time was reduced to 31 +/- 0.4 min (mean +/- SEM). Infusion of XOD (n = 8) or HX (n = 5) alone also reduced cardiac survival time, to 32 +/- 6 min and 139 +/- 23 min, respectively. When allopurinol (an inhibitor of XOD) was given together with XOD (n = 6), survival time (277 +/- 30 min) was similar to the control value. The production of OFR did not result in depressed coronary flow or heart rate, but reduced the aortic pulse pressure. OFR thus can depress cardiac function and may ultimately cause cardiac arrest.
.A
Semb AG; Vaage J; Laumann JW; Klingen G; Ilebekk A.
.I 125680
.U
89317377
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):155-64
.M
Anastomosis, Surgical; Animal; Dogs; Heart Atrium/SU; Heart Defects, Congenital/SU; Heart Valves/SU; Methods; Pulmonary Artery/SU; Pulmonary Circulation/*; Pulmonary Valve/*SU.
.T
A new physiologic correction technique for re-establishment of pulmonary circulation. Experimental surgical development.
.P
JOURNAL ARTICLE.
.W
A new physiologic technique is presented for surgical correction of truncus arteriosus, pseudotruncus, transposition of the great arteries, double right ventricular outflow tract with subpulmonary ventricular septal defect and certain cases of Fallot's tetralogy. The basis of the technique are creation of a neo-right atrium, neo-pulmonary trunk, neo-right atrioventricular valve and a neo-pulmonary valve by right angular atriotomy and insertion of a homologous pericardial patch with a monocuspid valve. The pulmonary circulation is re-established by anastomosis of the neo-pulmonary trunk to the pulmonary tree. The technique was used on 26 mongrel dogs. In 14 the experiments were preliminary, to evaluate the technique's validity, and in the other 12 it was performed with extracorporeal circulation and the hemodynamic status was studied at 30 and 180 min postoperatively. The technique and its results and potential advantages are described. Clinical application is considered to be feasible.
.A
Fantidis P; Gamallo Amat C; Sanz Galeote E; Fernandez Ruiz MA; Cordovilla Zurdo G; Ballester J; Huerta D; Vega P; Granados M; De Miguel E.
.I 125681
.U
89317381
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):177-9
.M
Adult; Aged; Biopsy; Female; Human; Lymphatic Diseases/*PA; Male; Mediastinoscopy/*; Mediastinum/*; Middle Age; Retrospective Studies.
.T
Mediastinoscopy in the investigation of primary mediastinal lymphadenopathy.
.P
JOURNAL ARTICLE.
.W
Mediastinoscopy was introduced by Carlens (1) in 1959 to obtain lymph node biopsies from the superior mediastinum in patients with bronchogenic carcinoma. The technique has been widely accepted for clinical staging as a guide to operability and prognosis. We report on a consecutive retrospective series of 110 patients undergoing mediastinoscopy between 1982-1986 for primary mediastinal lymphadenopathy in order to assess the diagnostic value and safety of the procedure. Mediastinoscopy gave a positive histological diagnosis in 74.5% of cases with no false negative results. There were no deaths and one complication only (pneumothorax). This study shows mediastinoscopy to be a safe, accurate and cost effective procedure minimising hospital stay and allowing appropriate treatment to be immediately commenced upon diagnosis. Mediastinoscopy obviates the need for expensive computed tomography or nuclear magnetic resonance scans and we conclude that it is the investigation of choice for primary mediastinal lymphadenopathy after confirmation by plain chest radiography.
.A
Pattison CW; Westaby S; Wetter A; Townsend ER.
.I 125682
.U
89317382
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):181-4
.M
Actinomycosis/*DI/SU; Adult; Aged; Diagnostic Errors; Empyema/DI; Female; Human; Lung/RA; Lung Diseases/*DI/SU; Male; Middle Age; Pleura/RA; Pleural Diseases/*DI/SU; Thoracoscopy.
.T
Thoracic actinomycosis.
.P
JOURNAL ARTICLE.
.W
Nine cases of thoracic actinomycosis treated in the period 1966-1987 are reported. Three of the patients presented with a clinical picture of empyema and six were admitted for suspected primary pulmonary neoplasm. No case was correctly diagnosed preoperatively. The final diagnosis was based on direct microscopy (2) or culture (1) of drained pus in the empyema cases and on histologic examination of resected tissue in the others. In one case the correct diagnosis was missed when a palpable tumour mass was not extirpated at exploratory thoracotomy, and was made only when clinical deterioration necessitated a second operation. Good clinical results can be expected from surgical eradication of an intrathoracic focus of actinomycosis in conjunction with appropriate antibiotic therapy.
.A
Jensen BM; Kruse-Andersen S; Andersen K.
.I 125683
.U
89317384
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):189-91
.M
Arterio-Arterial Fistula/*CN/SU; Case Report; Coronary Vessel Anomalies/*SU; Female; Heart Valve Prosthesis; Human; Middle Age; Mitral Valve Insufficiency/*SU; Pulmonary Artery/*AB/SU; Rheumatic Heart Disease/*SU.
.T
Surgical correction of congenital left coronary-pulmonary artery fistula and rheumatic mitral valve disease. Case report.
.P
JOURNAL ARTICLE.
.W
A 56-year-old woman with stenosis and incompetence of the mitral valve and clinical signs of congestive heart failure was found to have a communication between the left anterior descending coronary artery and the pulmonary trunk. A mitral valve prosthesis was inserted and the fistula was closed from within the pulmonary artery.
.A
Lanzillo G; Alessandrini F; Bartoccioni S; Bombardieri G; Intonti MA; Pragliola C; Morelli M; Baruffi E.
.I 125684
.U
89317385
.S
Scand J Thorac Cardiovasc Surg 8910; 23(2):81-6
.M
Adult; Aged; Arrhythmia/PP/RI/*SU; Female; Heart Function Tests; Heart Ventricle/PP/RI/*SU; Hemodynamics; Human; Male; Middle Age; Prospective Studies.
.T
Encircling endocardial ventriculotomy for malignant ventricular arrhythmias. Effect on cardiac performance.
.P
JOURNAL ARTICLE.
.W
Cardiac performance and hemodynamics were studied with radionuclide ventriculography in 19 survivors of aneurysmectomy and encircling endocardial ventriculotomy for recurrent, sustained ventricular arrhythmia (group I). To characterize the effect of the ventriculotomy on cardiac function, comparisons were made with a similar group of patients who underwent aneurysm surgery for angina pectoris and/or congestive heart failure (group II). Functional classification revealed no difference between the groups and they achieved the same level of exercise after surgery. No intergroup difference was found postoperatively with respect to right or left ventricular ejection fraction, regional ejection fractions, peak ejection rate, cardiac index or stroke volume. Peak filling rate was also similar, as were cardiac volumes. Exercise did not change any parameter of this intergroup similarity. The authors conclude that most patients with moderately impaired left ventricular function who undergo left ventricular aneurysmectomy with encircling endocardial ventriculotomy do not differ in postoperative hemodynamics and systolic or diastolic function from those treated with simple aneurysmectomy.
.A
Mangschau A; Amlie JP; Forfang K; Rootwelt K; Froysaker T; Geiran O.
.I 125685
.U
89317420
.S
Sci Am 8910; 261(1):25-6
.M
Base Sequence; Brain Chemistry/*; DNA, Mitochondrial/*; Florida; Fossils/*; Gene Amplification; Human; Paleontology/*.
.T
Molecular archaeology. DNA from a 7,000-year-old brain opens new vistas in prehistory.
.P
JOURNAL ARTICLE.
.A
Benditt J.
.I 125686
.U
89317423
.S
Sci Am 8910; 261(1):78-83
.M
Amniotic Fluid/PH; Cholecystokinin/PH; Digestion; Eating; Endocrine Glands/*PH; Energy Metabolism; Female; Fetal Development/*; Gastrins/PH; Gastrointestinal Hormones/PH; Gastrointestinal System/*PH; Growth/*; Human; Infant; Infant, Newborn/*GD; Lactation/PH; Pregnancy/*PH; Somatostatin/PH; Sucking Behavior/PH; Vagus Nerve/PH; Weight Gain.
.T
The gastrointestinal tract in growth and reproduction.
.P
JOURNAL ARTICLE.
.A
Uvnas-Moberg K.
.I 125687
.U
89317424
.S
Sci Am 8910; 261(1):84-90
.M
Color; Color Perception/*PH; Human; Space Flight/*.
.T
Space coloristics.
.P
JOURNAL ARTICLE.
.A
Vasyutin VV; Tischenko AA.
.I 125688
.U
89317452
.S
Science 8910; 245(4914):123-4
.M
Micronesia; Nuclear Warfare/*; Plutonium; Radioactive Fallout/*; United States.
.T
Fallout from Pacific tests reaches Congress [news] [published erratum appears in Science 1989 Sep 15;245(4923):1167] [see comments]
.P
NEWS.
.A
Marshall E.
.I 125689
.U
89317453
.S
Science 8910; 245(4914):124-5
.M
Animal; Animal Welfare/*; Animals, Laboratory/*; Dogs/*; Primates/*.
.T
Compromise in sight on animal regulations [news]
.P
NEWS.
.A
Holden C.
.I 125690
.U
89317454
.S
Science 8910; 245(4914):126
.M
Amino Acid Sequence; Base Sequence; Computer Communication Networks/*; Computer Systems/*; Information Systems/*; Molecular Biology/*; National Institutes of Health (U.S.); United States.
.T
Bionet bites the dust [news]
.P
NEWS.
.A
Marx JL.
.I 125691
.U
89317455
.S
Science 8910; 245(4914):126
.M
Animal; Rabies/PC/*VE; Rabies Vaccine/*; Raccoons/*; Vaccines, Synthetic; Virginia.
.T
Virginia OKs rabies vaccine test [news]
.P
NEWS.
.A
Sun M.
.I 125692
.U
89317456
.S
Science 8910; 245(4914):130
.M
Energy-Generating Resources/*; Solar Energy/*; Ultraviolet Rays/*; Water Pollution, Chemical/*.
.T
Sun-powered pollution clean up [news]
.P
NEWS.
.A
Pool R.
.I 125693
.U
89317457
.S
Science 8910; 245(4914):131
.M
Base Sequence/*; Chromosome Mapping/*; Chromosomes, Human/*; Human; National Institutes of Health (U.S.)/*; Plants/*GE; United States.
.T
Genome projects are growing like weeds [news]
.P
NEWS.
.A
Palca J.
.I 125694
.U
89317459
.S
Science 8910; 245(4914):154-9
.M
Amino Acid Sequence; Capsid/*ME/UL; Crystallography; Electron Probe Microanalysis; Electrophoresis, Polyacrylamide Gel; Macromolecular Systems; Molecular Sequence Data; Mosaic Viruses/*AN/GE/UL; Plant Viruses/*AN/GE/UL; Protein Conformation; RNA, Viral/*ME/UL; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Protein-RNA interactions in an icosahedral virus at 3.0 A resolution.
.P
JOURNAL ARTICLE.
.W
Nearly 20 percent of the packaged RNA in bean-pod mottle virus (BPMV) binds to the capsid interior in a symmetric fashion and is clearly visible in the electron density map. The RNA displaying icosahedral symmetry is single-stranded with well-defined polarity and stereochemical properties. Interactions with protein are dominated by nonbonding forces with few specific contacts. The tertiary and quaternary structures of the BPMV capsid proteins are similar to those observed in animal picornaviruses, supporting the close relation between plant comoviruses and animal picornaviruses established by previous biological studies.
.A
Chen ZG; Stauffacher C; Li Y; Schmidt T; Bomu W; Kamer G; Shanks M; Lomonossoff G; Johnson JE.
.I 125695
.U
89317461
.S
Science 8910; 245(4914):175-7
.M
Animal; Blastocyst; Cell Line; Centromere; Chromosomes, Human/*; DNA/*GE; Human; Metaphase; Mice; Mice, Transgenic/*; Microinjections; Nucleic Acid Hybridization; Ovum; Support, Non-U.S. Gov't; Transfection/*.
.T
Introduction of human DNA into mouse eggs by injection of dissected chromosome fragments.
.P
JOURNAL ARTICLE.
.W
A procedure has been developed for introducing exogenous DNA into mouse eggs by injection of chromosome fragments. Chromosome fragments were dissected from human metaphase spreads and microinjected into the pronuclei of fertilized mouse eggs. Many of the injected eggs subsequently exhibited normal pre- and postimplantation development. Embryos obtained from eggs injected with centromeric fragments retained human centromeric DNA as demonstrated by in situ hybridization analysis. From eggs injected with noncentromeric fragments, a mouse was obtained whose tail tissue exhibited the presence of human DNA. This procedure should facilitate incorporation of very large (more than 10 megabases) DNA fragments into cells and embryos without the need for cloned sequences.
.A
Richa J; Lo CW.
.I 125696
.U
89317464
.S
Science 8910; 245(4914):183-6
.M
Actins/PH; Animal; Capillaries; Cell Adhesion; Chemotactic Factors/*PD; Cytoskeleton/DE/UL; Lung/*BS; Microfilaments/DE/UL; N-Formylmethionine Leucyl-Phenylalanine/PD; Neutrophils/*CY/DE/UL; Rabbits; Scintillation Counting; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Mechanics of stimulated neutrophils: cell stiffening induces retention in capillaries.
.P
JOURNAL ARTICLE.
.W
The effect of peptide chemoattractants on neutrophil mechanical properties was studied to test the hypothesis that stimulated neutrophils (diameter, 8 micrometers) are retained in pulmonary capillaries (5.5 micrometers) as a result of a decreased ability of the cell to deform within the capillary in response to the hydrodynamic forces of the bloodstream. Increased neutrophil stiffness, actin assembly, and retention in both 5-micrometer pores and the pulmonary vasculature were seen in response to N-formyl-methionyl-leucyl-phenylalanine. These changes were abolished in cells that had been incubated with 2 micromolar cytochalasin D, an agent that disrupts cellular actin organization. A monoclonal antibody directed at the CD11-CD18 adhesive glycoprotein complex did not inhibit the increase in stiffness or retention in pores. These data suggest that neutrophil stiffening may be both necessary and sufficient for the retention that is observed. Hence, neutrophil sequestration in lung and other capillaries in the acute inflammatory process may be the result of increased stiffness stimulated by chemoattractants.
.A
Worthen GS; Schwab B 3d; Elson EL; Downey GP.
.I 125697
.U
89317465
.S
Science 8910; 245(4914):186-8
.M
Angiotensin-Converting Enzyme Inhibitors/*PD; Animal; Balloon Dilatation; Blood Pressure/DE; Cell Division/DE; Male; Muscle, Smooth, Vascular/*DE/PA; Pyridazines/*PD; Rats.
.T
Inhibitors of angiotensin-converting enzyme prevent myointimal proliferation after vascular injury.
.P
JOURNAL ARTICLE.
.W
The role of a local angiotensin system in the vascular response to arterial injury was investigated by administering the angiotensin-converting enzyme (CE) inhibitor cilazapril to normotensive rats in which the left carotid artery was subjected to endothelial denudation and injury by balloon catheterization. In control animals, by 14 days after balloon injury, the processes of smooth muscle cell (SMC) proliferation, migration of SMCs from the media to the intima, and synthesis of extracellular matrix produced marked thickening of the intima, with reduction of the cross-sectional area of the lumen. However, in animals that received continuous treatment with the CE inhibitor, neointima formation was decreased (by about 80 percent), and lumen integrity was preserved. Thus, the angiotensin-converting enzyme may participate in modulating the proliferative response of the vascular wall after arterial injury, and inhibition of this enzyme may have therapeutic applications to prevent the proliferative lesions that occur after coronary angioplasty and vascular surgery.
.A
Powell JS; Clozel JP; Muller RK; Kuhn H; Hefti F; Hosang M; Baumgartner HR.
.I 125698
.U
89317466
.S
Science 8910; 245(4914):188-90
.M
Animal; Immune Tolerance/*; Killer Cells, Natural/DE/IM; Male; Mesencephalon/DE/*IM; Microinjections; Morphine/AD/AI/*PD; Naltrexone/PD; Rats; Rats, Inbred F344.
.T
The periaqueductal gray matter mediates opiate-induced immunosuppression.
.P
JOURNAL ARTICLE.
.W
The periaqueductal gray matter of the mesencephalon (PAG) subserves a variety of diverse autonomic functions and also appears to be a site for opiate action in the induction of immunosuppression. Microinjections of morphine into the PAG, but not into other opiate receptor-containing neuroanatomical sites, result in a rapid suppression of natural killer (NK) cell activity. The NK cell suppression can be blocked by prior peripheral administration of the opiate antagonist naltrexone. These findings demonstrate that certain central actions of opiates that produce changes in NK cell function are mediated through opiate receptors in the PAG and identify a brain region involved in opiate regulation of immune function.
.A
Weber RJ; Pert A.
.I 125699
.U
89317467
.S
Science 8910; 245(4914):190-2
.M
Afferent Pathways; Animal; Glycine/*ME; Goldfish; Membrane Potentials; Microelectrodes; Potassium Channels/ME; Serotonin/*PH; Support, Non-U.S. Gov't; Synapses/*PH.
.T
Effect of serotonergic afferents on quantal release at central inhibitory synapses.
.P
JOURNAL ARTICLE.
.W
Although most examples of modulation of synaptic transmission have been obtained from excitatory rather than from inhibitory connections, serotonin (5HT) is now shown to cause a presynaptic facilitation of release of the inhibitory neurotransmitter glycine. Brief local injections of this amine, or application of a 5HT uptake blocker, produce a long-lasting enhancement of both spontaneous and evoked inhibitory currents in the teleost Mauthner cell. Quantal analysis showed that the probability of release is increased. Focal recording indicated that 5HT acts directly on the inhibitory terminals, possibly reducing potassium conductances. Double staining with specific antibodies demonstrated a morphological substrate for this effect. Nerve endings that contain 5HT contact inhibitory terminals directly apposed to postsynaptic glycine receptors.
.A
Mintz I; Gotow T; Triller A; Korn H.
.I 125700
.U
89317468
.S
Science 8910; 245(4914):192-4
.M
Afferent Pathways/PH; Animal; Axons/PH; Efferent Pathways/PH; Electrophysiology; Geniculate Bodies/CY/*PH; Organ Culture; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Synapses/PH; Tissue Culture; Visual Cortex/CY/*PH.
.T
Neural connections between the lateral geniculate nucleus and visual cortex in vitro.
.P
JOURNAL ARTICLE.
.W
Neural connections were established in cocultures of rat visual cortex (VC) and lateral geniculate nucleus (LGN), which were isolated in early infancy. Morphological and electrophysiological studies showed that the cortical laminar organization of afferent and efferent connections in the coculture preparations was similar to that in the adult VC. The results indicate the existence of intrinsic mechanisms in VC and LGN that guide the formation of synaptic connections with the appropriate targets.
.A
Yamamoto N; Kurotani T; Toyama K.
.I 125701
.U
89317469
.S
Science 8910; 245(4915):243-4
.M
Animal; Animals, Transgenic; DNA, Viral/ME; Male; Patents; Rabbits; Spermatozoa/*/ME; SV40 Virus/GE; Transfection/*.
.T
Further liaisons with sperm [letter; comment]
.P
COMMENT; LETTER.
.A
Birnstiel ML; Busslinger M.
.I 125702
.U
89317471
.S
Science 8910; 245(4915):249-50
.M
Defoliants, Chemical/*AE; Dioxins/*AE; Government; Herbicides/*AE; Human; Tetrachlorodibenzodioxin/*AE; United States; Veterans/*; Vietnam; 2,4-Dichlorophenoxyacetic Acid/*AE; 2,4,5-Trichlorophenoxyacetic Acid/*AE.
.T
Agent Orange: Congress impatient for answers [news] [see comments]
.P
NEWS.
.A
Barinaga M.
.I 125703
.U
89317472
.S
Science 8910; 245(4915):250
.M
Government Agencies/*; Peer Review/*ST; United States.
.T
NSF peer review under fire from Nader group [news]
.P
NEWS.
.A
Marshall E.
.I 125704
.U
89317476
.S
Science 8910; 245(4915):290-3
.M
Animal; Chromatography, Ion Exchange; Female; Male; Mass Fragmentography; Nuclear Magnetic Resonance; Pheromones/*IP; Sex Attractants/AN/CS/*IP; Sex Behavior, Animal/*; Snakes/*PH; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Sex pheromones in snakes.
.P
JOURNAL ARTICLE.
.W
The majority of pheromones identified to date are insect pheromones, which are volatile in nature. Identification of nonvolatile pheromones have been relatively rare, especially in vertebrates. Male and female garter snakes use pheromones to mediate sexual behavior. The female sex attractiveness pheromone of the Canadian red-sided garter snake, Thamnophis sirtalis parietalis, consists of a novel series of nonvolatile saturated and monounsaturated long-chain methyl ketones, whereas the male sex recognition pheromone contains squalene. These compounds were isolated, identified, and partially synthesized, and field tests show them to be biologically active.
.A
Mason RT; Fales HM; Jones TH; Pannell LK; Chinn JW; Crews D.
.I 125705
.U
89317477
.S
Science 8910; 245(4915):293-5
.M
Animal; Blood Flow Velocity; Blood Pressure; Cardiac Output; Diving; Heart Rate; Pulmonary Artery/*PH; Pulmonary Circulation/*; Snakes/*PH; Support, U.S. Gov't, P.H.S.; Vascular Resistance.
.T
Pulmonary blood flow regulation in an aquatic snake.
.P
JOURNAL ARTICLE.
.W
Regulation of pulmonary blood flow was studied during voluntary diving in the aquatic file snake, Acrochordus granulatus. Measurements of pressure and blood flow in pulmonary and systemic vessels indicate that blood flow completely bypasses the lung for significant periods during prolonged and quiescent submergence (greater than 30 minutes). When the lung is ventilated, pulmonary blood flow increases to 36 milliliters per minute per kilogram of body mass (measured in the anterior pulmonary artery), and the cardiac output largely bypasses the systemic circulation. These reciprocating patterns of preferential blood flow reflect inverse relations between flow and vascular resistance, with the result that systemic and pulmonary arterial pressures remain virtually constant throughout repetitive dive cycles. Neuropharmacological studies of freely diving snakes and isolated, perfused lung preparations show that pulmonary blood flow is regulated by an interplay of adrenergic vasodilatation and cholinergic vasoconstriction within the densely innervated lung vasculature. The patterns of blood circulation shown by diving Acrochordus reflect an unusual lability of intracardiac shunts.
.A
Lillywhite HB; Donald JA.
.I 125706
.U
89317630
.S
South Med J 8910; 82(7):809-10
.M
Delivery of Health Care/*TD; United States.
.T
The last legacy, or, Sisyphus revisited [editorial]
.P
EDITORIAL.
.A
Thomison JB.
.I 125707
.U
89317632
.S
South Med J 8910; 82(7):815-7
.M
Catastrophic Illness/*EC; Chronic Disease/*EC; Delivery of Health Care/*EC; Ethics, Medical/*; Human; United States.
.T
Ethical issues in chronic, severe, catastrophic illnesses.
.P
JOURNAL ARTICLE.
.A
Churchill LR.
.I 125708
.U
89317633
.S
South Med J 8910; 82(7):818-21
.M
Delivery of Health Care/*EC; Human Rights/*; Social Justice/*; United States; United States Public Health Service/*.
.T
Economic welfare versus social justice.
.P
JOURNAL ARTICLE.
.A
Windom RE.
.I 125709
.U
89317634
.S
South Med J 8910; 82(7):822-4
.M
Aged; Aged, 80 and over; Decision Making/*; Delivery of Health Care/*EC; Female; Human; Infant Mortality; Life Expectancy; Male; United States.
.T
Critical decisions in medical care: birth to death.
.P
JOURNAL ARTICLE.
.A
Lamm RD.
.I 125710
.U
89317635
.S
South Med J 8910; 82(7):825-8
.M
Adolescence; Adult; Educational Status; Epidemiologic Methods; Female; Georgia; Health Surveys; Human; HIV Seropositivity/*EP; Marriage; Parity; Pregnancy; Pregnancy Complications, Infectious/*EP; Prenatal Diagnosis; Risk Factors; Substance Abuse; Urban Health.
.T
Seroprevalence of human immunodeficiency virus infection in a prenatal population at high risk for HIV infection.
.P
JOURNAL ARTICLE.
.W
To determine the seroprevalence of human immunodeficiency virus infection in prenatal patients at high risk for HIV infection we tested 513 women from December 1985 through July 1987 at an inner-city hospital in Atlanta, Georgia. Demographic and HIV risk information was collected from all seropositive women. Twenty-nine (6%) of the 513 women tested were positive for HIV on enzyme-linked immunosorbent assay and Western blot analysis. Twenty-six (90%) of seropositive women gave a history of intravenous drug use. Two (7%) had sexual partners known to have AIDS or AIDS-related complex (ARC), and one (3%) was Haitian. Seropositive women were at remarkable risk for other sexually transmitted diseases. The majority of pregnancies ended in term births. This serosurvey defines an obstetric population with a high seroprevalence, and has stimulated us to institute routine voluntary antepartum screening for HIV.
.A
Lindsay MK; Peterson HB; Mundy DC; Slade BA; Feng T; Willis S; Stine P; Klein L.
.I 125711
.U
89317637
.S
South Med J 8910; 82(7):833-6, 840
.M
Anemia, Sickle Cell/*CO/EH; Child, Preschool; Comparative Study; Florida; Haiti/EH; Human; Infant; Penicillins/TU; Septicemia/*EH/ET/PC; Support, U.S. Gov't, P.H.S..
.T
Increased incidence of bacteremia in Haitian children with sickle cell anemia.
.P
JOURNAL ARTICLE.
.W
Children with sickle cell anemia who were less than 5 years old were observed over a three-year period. Those born to recent Haitian immigrants accounted for 108.4 patient-years. They had seven episodes of Streptococcus pneumoniae bacteremia and five due to Haemophilus influenzae for rates of 6.5 and 4.6 episodes per 100 patient-years, respectively. Children born to American parents were observed for 131.3 patient-years and had three episodes and one episode, respectively, for rates of 2.3 and 0.76 episodes per 100 patient-years. The differences in the overall rate of bacteremia were significant (P less than .015). Leukocyte counts and percentage of erythrocytes with pits, indicating decreased splenic function, were similar for the two groups. The Haitian families had lower annual incomes, but values for both groups were so low that their difference is unlikely to be related to the increased infection rate. Although no cause for the higher rate of bacteremia could be found, the approach to febrile illness in Haitian children with sickle cell anemia should be even more aggressive than usual. In addition to Haemophilus influenzae immunization, antibiotics effective against penicillin-resistant species should be used in the initial antibiotic coverage of their febrile illnesses.
.A
Pegelow CH.
.I 125712
.U
89317638
.S
South Med J 8910; 82(7):837-40
.M
Adult; Arkansas; Disease Outbreaks/*; Epidemiologic Methods; Feces/MI; Female; Food Microbiology; Gastroenteritis/*EP; Human; Male; Meat/*; Restaurants; Salmonella/IP; Salmonella Food Poisoning/*EP.
.T
Epidemic of restaurant-associated illness due to Salmonella newport.
.P
JOURNAL ARTICLE.
.W
In June and July 1982, a large outbreak of gastroenteritis associated with a barbecue restaurant involved 120 persons in central Arkansas. The illness was characterized by diarrhea, abdominal pain, and vomiting; 23 patients (19%) were hospitalized. Epidemiologic investigation showed that persons who became ill were more likely to have eaten ham or pork sandwiches at the restaurant before their illness than those who remained well. Stool cultures from 19 customers and each of the eight restaurant employees were positive for Salmonella newport. Cultures of a ham slice obtained from the restaurant and a partially consumed pork sandwich obtained from one ill person both grew Salmonella of same serotype.
.A
Narain JP; Lofgren JP.
.I 125713
.U
89317639
.S
South Med J 8910; 82(7):841-2
.M
Carpal Tunnel Syndrome/*DT; Double-Blind Method; Electrodiagnosis; Human; Pyridoxine/*TU; Random Allocation.
.T
Treatment of carpal tunnel syndrome with vitamin B6: a double-blind study.
.P
JOURNAL ARTICLE.
.W
We undertook a randomized, double-blind, placebo-controlled study to investigate the therapeutic effect of vitamin B6 on carpal tunnel syndrome. After ten weeks in the study, ten of 15 patients improved (this included patients given placebo and those given no treatment). Vitamin B6 seems to have no advantage over conservative therapy for carpal tunnel syndrome. This study also suggests that repeat electrodiagnostic testing is no more useful than clinical symptoms in deciding on surgical intervention after unsuccessful conservative therapy.
.A
Stransky M; Rubin A; Lava NS; Lazaro RP.
.I 125714
.U
89317640
.S
South Med J 8910; 82(7):843-4
.M
Adult; Femoral Fractures/*CO; Follow-Up Studies; Fractures, Ununited/*ET; Gait; Human; Tibial Fractures/*CO; Time Factors; Wound Healing.
.T
Severe trauma to the lower extremity: long-term sequelae.
.P
JOURNAL ARTICLE.
.W
Limb salvage after major traumatic injury to the lower extremity has become commonplace in modern trauma centers. Despite initial successful limb salvage, however, long-term complications often occur. We present 121 patients who were treated for complications after major injuries to the lower limb at Rancho Los Amigos Medical Center. In general, these patients required a total of 224 surgical procedures over an average of approximately three years after injury to achieve a successful outcome. Final limb function, however, was often impaired.
.A
Moore TJ; Green SA; Garland DE.
.I 125715
.U
89317642
.S
South Med J 8910; 82(7):849-52
.M
Aged; Arteriosclerosis/*TH; Atherosclerosis/CO/MO/PP/*TH; Embolism/ET/MO/PP/*TH; Female; Human; Leg/*BS; Male; Middle Age; Nifedipine/TU; Prognosis; Sympathectomy.
.T
Atheromatous embolism: varied clinical presentation and prognosis.
.P
JOURNAL ARTICLE.
.W
Microemboli composed of atheromatous debris can produce sudden failure of one or many organ systems. The soft tissues of the lower extremity are almost always involved, and may sustain the only significant injury. Atheromatous embolization occurs more commonly than is recognized, and its incidence may be increasing. We report ten cases that demonstrate the variability in presentation and prognosis. These data and a review of the existing literature suggest an extremely grave prognosis in patients with generalized organ system involvement, as opposed to those patients with involvement of the lower extremity only. Treatment consists of general supportive care. Anticoagulation or lytic therapy appears to be of no benefit, and may actually contribute to embolization. We discuss new pharmacologic agents as possible treatment for the intense local ischemia, and recommend selective use of lumbar sympathectomy in cases of impending loss of lower extremity tissue.
.A
Jennings WC; Corder CN; Jarolim DR; Blackwell J; Cherian J; Chen D.
.I 125716
.U
89317644
.S
South Med J 8910; 82(7):857-9
.M
Adult; Age Factors; Aged; Aged, 80 and over; Comparative Study; Female; Hospitalization/*EC; Human; Length of Stay; Male; Prognosis; Prospective Studies; Wounds and Injuries/CO/*EC/MO.
.T
High cost of trauma care in the elderly.
.P
JOURNAL ARTICLE.
.W
Trauma in the elderly is a significant public health problem in terms of morbidity, mortality, and expenditure of health care resources. We compared injury severity score, length of stay, hospital charges, and mortality rate in a group of 60 elderly patients and a group of 60 younger patients admitted to our hospital. The older group had an average hospital stay that was more than four days longer, at an average hospital charge of $15,769.55, and their mortality rate was 15% versus 0% among the younger group. Despite early and aggressive care, the elderly continue to pose an important problem for trauma centers in terms of both length of stay and cost.
.A
Ross N; Timberlake GA; Rubino LJ; Kerstein MD.
.I 125717
.U
89317645
.S
South Med J 8910; 82(7):860-3
.M
Adolescence; Adult; Aged; Female; Gas Gangrene/*ET/MO; Human; Male; Medical Records; Middle Age; Neoplasms/*CO; Neutropenia/CO; Support, Non-U.S. Gov't.
.T
Necrotizing gas-forming infections in cancer patients.
.P
JOURNAL ARTICLE.
.W
Necrotizing gas-forming infections in cancer patients present some unique characteristics, such as nontraumatic, spontaneous clostridial gangrene and gangrene involving an ischemic tumor mass. These infections can be rapidly progressive and uniformly fatal without surgical debridement. We review ten cases of gas gangrene seen during an 18-year period. Four were caused by Clostridium species and six by other organisms. Neutropenia was present in seven patients. During the last nine years, Clostridium septicemia occurred in 54 patients; in only two of those patients did gas gangrene ensue.
.A
Chu DZ; Fainstein V; Bodey GP; Hopfer RL; Luna MA; Hickey RC.
.I 125718
.U
89317649
.S
South Med J 8910; 82(7):880-4
.M
Georgia; Human; Infant Mortality/TD; Infant, Low Birth Weight/*; Infant, Newborn; Intensive Care Units, Neonatal/*TD; Patient Admission/*TD.
.T
Neonatal intensive care admissions: changing profile in Georgia, 1974 to 1982.
.P
JOURNAL ARTICLE.
.W
Birthweight-specific admission rates were reviewed from 1974 to 1982 for Georgia's five regional perinatal centers. Analysis of birthweight-specific neonatal intensive care unit (NICU) admissions as a proportion of total live births revealed an upward trend for infants weighing 1,000 to 1,499 gm and a downward trend for those weighing 2,000 gm or more. This method revealed no significant trends for infants of weight groups less than 500 gm or 500 to 999 gm. Analysis of birthweight-specific admissions as a proportion of total NICU admissions revealed significant increases for all birthweight groups of less than 2,000 gm, with decreases in admissions for infants weighing more than 2,000 gm. Analysis of mortality data revealed improved survival for infants weighing less than 1,500 gm, but some centers showed increases in neonatal mortality, postneonatal mortality, or infant mortality among infants weighing 2,500 gm or more. During this study, low birthweight infants comprised an increasingly larger proportion of neonatal intensive care admissions. This trend evolved gradually through the process of regionalization and can be directly linked to the cost requirements of regional neonatal intensive care units.
.A
Floyd RL; Murphy CC; Dillon J; Floyd VD.
.I 125719
.U
89317651
.S
South Med J 8910; 82(7):892-6
.M
Faculty, Medical/*; Internship and Residency; Medical Directors/*/ED; Schools, Medical/*/OG; Southeastern United States; Surgery/*ED; Surgery Department, Hospital/OG.
.T
Pedigrees of southern surgical chairmen.
.P
JOURNAL ARTICLE.
.W
This review details the birth, medical education, surgical training, and previous academic appointments of the chairmen of departments of surgery in the medical schools in the geographic distribution of the Southern Medical Association.
.A
Cohn I Jr.
.I 125720
.U
89317652
.S
South Med J 8910; 82(7):897-9
.M
Wit and Humor/*; Writing/*.
.T
Dizzy medical writing: report on recent relapses.
.P
JOURNAL ARTICLE.
.A
Fred HL; Robie P.
.I 125721
.U
89317654
.S
South Med J 8910; 82(7):902-4
.M
Case Report; Child; Combined Modality Therapy; Dwarfism/*CO; Epiphyses, Slipped/*ET/RA/TH; Femur/RA; Fracture Fixation, Internal; Human; Male; Traction.
.T
Slipped capital femoral epiphysis associated with Russell-Silver syndrome.
.P
JOURNAL ARTICLE.
.W
Slipped capital femoral epiphysis has been described in several syndromes associated with short stature and endocrine disturbances. I have presented a case of slipped capital femoral epiphysis in conjunction with Russell-Silver syndrome.
.A
Limbird TJ.
.I 125722
.U
89317655
.S
South Med J 8910; 82(7):905-6
.M
Adult; Carcinoma, Squamous Cell/*CO/RT/SU; Case Report; Cervix Neoplasms/*CO/RT/SU; Female; Human; Inflammatory Bowel Diseases/*CO; Radiation Injuries.
.T
Early cervical cancer coexistent with idiopathic inflammatory bowel disease.
.P
JOURNAL ARTICLE.
.W
Early invasive carcinoma of the cervix may be treated by surgery or radiation therapy. Two patients with early cervical cancer are presented whose concomitant inflammatory bowel disease figured significantly in the selection of surgery as treatment. The use of radiotherapy in the face of inflammatory bowel disease, however, is not clearly addressed in the literature.
.A
Hoffman M; Kalter C; Roberts WS; Cavanagh D.
.I 125723
.U
89317656
.S
South Med J 8910; 82(7):907-10
.M
Adenoma/BL/*CO; Aged; Antitubercular Agents/AE; Case Report; Female; Human; Hyperthyroidism/BL/ET; Thyroid Neoplasms/BL/*CO; Thyroxine/*BL; Triiodothyronine/*BL; Tuberculosis, Pulmonary/*CO/DT.
.T
Hyperthyroidism without elevated levels of thyroxine and triiodothyronine in a patient with pulmonary tuberculosis.
.P
JOURNAL ARTICLE.
.W
We have reported a case of toxic thyroid adenoma with low T3 and low T4 syndrome in a patient who received antituberculous drugs for active pulmonary tuberculosis. Search for thyroid-hormone-binding antibodies was negative. Thyroid lobectomy was done and histologic examination confirmed toxic thyroid adenoma; two months after operation the patient was clinically and biologically euthyroid. During the course of a severe nonthyroidal illness, normal thyroid hormone levels must be regarded as an indicator of hyperthyroidism. In addition, we believe that rifampin has a significant effect on thyroid function tests and results of thyroid physiology.
.A
Archambeaud-Mouveroux F; Dejax C; DeBuhan B; Bonnaud F.
.I 125724
.U
89317657
.S
South Med J 8910; 82(7):910-3
.M
Case Report; Empyema/*ET/RA; Human; Ketoconazole/TU; Lung Diseases, Fungal/*CO/DT/RA; Male; Middle Age; Pleural Effusion/ET/RA; Potassium Iodide/TU; Sporotrichosis/*CO/DT/RA.
.T
Empyema associated with pulmonary sporotrichosis.
.P
JOURNAL ARTICLE.
.W
Sporothrix schenckii produces an insidious debilitating illness in humans. The lungs are seldom involved and pleural involvement is distinctly unusual, with only four patients described in the literature. We have described a patient with both parenchymal lung disease and pleural effusion. The characteristics of the pleural fluid were unlike those previously reported, and suggest that the coexistence of a parenchymal Sporothrix infiltrate may alter the nature of the pleural fluid to mimic an empyema rather than a self-limited hypersensitivity reaction.
.A
Fields CL; Ossorio MA; Roy TM.
.I 125725
.U
89317658
.S
South Med J 8910; 82(7):914-6
.M
Case Report; Catheters, Indwelling/*AE; Cecal Neoplasms/DT; Colonic Diseases/*ET/RA; Female; Fluorouracil/AD; Human; Infusions, Parenteral/*IS; Intestinal Perforation/*ET/RA; Middle Age.
.T
Intraperitoneal chemotherapy complicated by erosion of a Tenckhoff catheter into the colon.
.P
JOURNAL ARTICLE.
.W
Insertion and maintenance of intraperitoneal catheters must be done with meticulous attention to detail. We recommend insertion under direct vision to minimize the incidence of intestinal perforation during catheter placement. Intraperitoneal catheters should not be placed in close proximity to a fresh intestinal anastomosis because this position may promote anastomotic dehiscence. Communication between the catheter and the intestinal lumen necessitates catheter removal.
.A
Holt RW; Petrilli ES; Evans SR; Ahlgren JD.
.I 125726
.U
89317661
.S
South Med J 8910; 82(7):924-6
.M
Arteriovenous Malformations/*RA; Case Report; Diagnosis, Differential; Hemoptysis/*ET; Human; Male; Middle Age; Pulmonary Artery/*AB/RA; Pulmonary Embolism/CO/*RA; Pulmonary Veins/*AB/RA; Tomography, X-Ray Computed.
.T
Pulmonary embolism masquerading as pulmonary arteriovenous malformation on computerized tomography.
.P
JOURNAL ARTICLE.
.W
A 57-year-old man with massive hemoptysis was thought to have a pulmonary arteriovenous malformation (PAVM) on the basis of computerized tomography of the chest. Angiography, however, revealed a pulmonary artery embolus as the case of the hemoptysis; the tomographic appearance of PAVM had been mimicked by the delay of contrast material within the involved pulmonary artery proximal to the occluding embolus. This finding suggests caution in the use of CT to diagnose PAVM, especially in clinical situations compatible with other diagnoses, and confirms the importance of pulmonary angiography in the definitive evaluation of suspected PAVM.
.A
Kollef MH; Dunn TL.
.I 125727
.U
89317664
.S
South Med J 8910; 82(7):931-2
.M
Adult; Age Factors; Breast Neoplasms/*MO; Female; Human; Mammography/*; Middle Age.
.T
Mammography screening in women under age 50 (a clinician's viewpoint) [letter]
.P
LETTER.
.A
Elliott RL.
.I 125728
.U
89317665
.S
South Med J 8910; 82(7):932
.M
Adult; Case Report; Feces, Impacted/*ET; Female; Human; Pica/*CO.
.T
Fecal impaction due to geophagia [letter]
.P
LETTER.
.A
Wrenn K.
.I 125729
.U
89317666
.S
South Med J 8910; 82(7):932-3
.M
Face; Hair Removal/*; Human; Male; Physicians/*; Time and Motion Studies.
.T
Health manpower. II. Physician time expended in shaving [letter]
.P
LETTER.
.A
Riley HD Jr.
.I 125730
.U
89317668
.S
South Med J 8910; 82(7):934
.M
Environmental Exposure; Glycine/*AA/PO; Herbicides/*PO; Human.
.T
Exposure to Roundup [letter]
.P
LETTER.
.A
Jensen PC.
.I 125731
.U
89317670
.S
Spine 8910; 14(6):558-68
.M
Adult; Aged; Aged, 80 and over; Fibrosis; Human; Intervertebral Disk/*BS/IR/PA; Intervertebral Disk Displacement/CO; Middle Age; Models, Theoretical; Nerve Compression Syndromes/ET; Spinal Nerve Roots/*PA; Support, Non-U.S. Gov't; Veins/PA; Venous Insufficiency/ET/*PA.
.T
Intervertebral foramen venous obstruction. A cause of periradicular fibrosis?
.P
JOURNAL ARTICLE.
.W
Disc herniation into the intervertebral foramen (IVF) or osteophytic outgrowths from the margins of the apophyseal joints that project into the IVF may compress the neural structures, but in this cadaveric study of 160 lumbar foramens (age range, 35-91 years), the authors have found that they were much more commonly associated with compression and distortion of the large venous plexus within the IVF. In the absence of direct nerve compression (seen in only eight specimens), the most severe neural changes were associated with compression, congestion, and resultant dilatation of foraminal veins. Pathologic changes within and around the nerve root complex included peri- and intraneural fibrosis, edema of nerve roots, and focal demyelination. Inflammatory cells were notably absent. Vascular changes within the thickened fibrous sheath about damaged nerves, namely, basement membrane thickening, suggestive of endothelial cell injury also were observed. The association between vascular compression, tissue fibrosis, and endothelial injury distant from the compression may be causal--probably due to ischemia as a result of reduced venous outflow. Such observations have led the authors to propose that venous obstruction may be an important pathogenic mechanism in the development of perineural and intraneural fibrosis.
.A
Hoyland JA; Freemont AJ; Jayson MI.
.I 125732
.U
89317671
.S
Spine 8910; 14(6):569-73
.M
Animal; Cauda Equina/*; Edema/*ET/PA; Equipment and Supplies; Nerve Compression Syndromes/*CO/PP; Peripheral Nerve Diseases/ET/PA; Support, Non-U.S. Gov't; Swine; Time Factors.
.T
Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression.
.P
JOURNAL ARTICLE.
.W
Edema formation in spinal nerve roots of the pig cauda equina was studied following experimental compression at various pressure levels, durations, and rates of onset, using a fluorescence microscopic technique. The time-pressure thresholds for the occurrence of edema in the nerve roots were: following rapid onset of compression (0.05-0.1 seconds), 2 minutes at both 50 mm Hg and 200 mm Hg, and following slow onset of compression (the pressure was slowly increased during 15-20 seconds), 2 hours at 50 mm Hg and 2 minutes at 200 mm Hg. Generally, the edema formation was more pronounced after rapid than after slow onset of compression. The data in this study also indicate that intraneural edema might be more easily formed in nerve roots than in peripheral nerves after compression injury.
.A
Olmarker K; Rydevik B; Holm S.
.I 125733
.U
89317672
.S
Spine 8910; 14(6):574-6
.M
Animal; Body Fluids/PA/PH; Ganglia, Spinal/*PH; Nerve Compression Syndromes/PA/*PP; Pressure; Rats; Rats, Inbred Strains; Stress, Mechanical; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment syndrome in nerve roots.
.P
JOURNAL ARTICLE.
.W
Spinal nerve roots including the dorsal root ganglion (DRG) often are mechanically deformed in connection with degenerative and traumatic conditions of the spine. However, the pathophysiology underlying various functional changes, including pain production, in such conditions is incompletely known. In this study, the tissue fluid pressure in the DRG of L5 nerve roots of rats was measured before and after compression. Normal values were found to be 3.7 +/- 0.3 cm H2O (2.7 +/- 0.2 mm Hg). After mechanical compression, the endoneurial fluid pressure in the ganglia rose to 9.6 +/- 1.7 cmk H2O (7.1 +/- 1.2 mm Hg) (P less than 0.001). Histologic examination revealed edema and haemorrhage in the endoneurial space of the DRG. Pressure increase in the DRG as a result of mechanical deformation by, for example, a herniated disc might be expected to reduce blood flow to the sensory nerve cell bodies in the DRG. This may be a mechanism underlying the production of nerve root pain, which previously has not been described.
.A
Rydevik BL; Myers RR; Powell HC.
.I 125734
.U
89317673
.S
Spine 8910; 14(6):577-9
.M
Backache/*ME/PP; Body Height; Body Weight; Bone and Bones/*ME; Female; Human; Male; Middle Age; Minerals/*ME; Posture/*; Sex Characteristics/*; Support, Non-U.S. Gov't.
.T
Bone mineral content, gender, body posture, and build in relation to back pain in middle age.
.P
JOURNAL ARTICLE.
.W
In 575 55-year-old residents of Malmo, Sweden, the authors studied the interrelationships between back pain and bone mineral content, degree of kyphosis and lordosis, height, and weight, and in women also the age of menarche and menopause, and number of childbirths. Men with back pain tended to be heavier than those without back pain. Back pain was not related to body height nor to degree of kyphosis or lordosis. In women, a positive correlation was found between the degree of kyphosis and lordosis and body weight. Body height in women also was correlated to degree of kyphosis, but not to the degree of lordosis. In men, the authors found no such relationships. Bone mineral content was not related to the occurrence of back pain but to body height and weight in men and in women. Back pain in women was not related to the age at menarche or menopause, nor to the number of children to whom they had given birth.
.A
Bergenudd H; Nilsson B; Uden A; Willner S.
.I 125735
.U
89317674
.S
Spine 8910; 14(6):580-3
.M
Adolescence; Adult; Female; Human; Kyphosis/*PA; Lordosis/*PA; Lumbosacral Region; Male; Middle Age; Movement/*; Orthopedic Equipment/*; Posture/*; Spine/*PA; Statistics; Support, Non-U.S. Gov't; Thorax.
.T
Measurement of spinal sagittal configuration and mobility with Debrunner's kyphometer.
.P
JOURNAL ARTICLE.
.W
A considerable number of instruments have been described for noninvasive measurements of the sagittal configuration and mobility of the thoracolumbar spine. With Debrunner's kyphometer, it is possible to obtain this information in approximately 1 minute in a clinical setting. A minor modification of the kyphometer to increase its range of measurement of lumbar extension is described. Repeatability of measurements with the instrument was studied on 31 healthy individuals in a randomized cross-over model. In another study, ten individuals were examined ten times each by the same investigator within 3 weeks. These studies showed good reproducibility for measurements with the kyphometer. The importance of standardized instructions for measurement procedures is emphasized. The statistical approach to repeatability of measurements is discussed.
.A
Ohlen G; Spangfort E; Tingvall C.
.I 125736
.U
89317675
.S
Spine 8910; 14(6):584-90
.M
Adolescence; Adult; Aged; Aged, 80 and over; Aging/PH; Backache/*PP; Child; Female; Forecasting; Human; Lumbosacral Region; Male; Medical Records; Middle Age; Movement/*; Questionnaires; Spine/*PP; Statistics.
.T
Variation in lumbar sagittal mobility with low-back trouble.
.P
JOURNAL ARTICLE.
.W
The influence of low-back trouble on lumbar sagittal mobility was explored in 958 individuals aged 10 to 84 years. Experience of low-back trouble was determined by questionnaire, and categorized as none, a previous history, or a current spell. Maximal mobility was estimated from flexicurve records of back surface curvature. The results for adults revealed that mean mobility values were reduced by both previous and current low-back trouble, particularly in the upper lumbar region, when compared with nonsufferers. Stepwise regression analyses showed that variation in mobility was best accounted for by the cumulative effects of age and sex. These variables accounted for approximately one-third of the variation in mobility: low-back trouble only accounted for an additional 1%. At the extremes of the range, both hypomobility and hypermobility were identified as risk indicators for low-back trouble. Relative hypermobility was not confined to subjects with no history of back trouble; some current sufferers had particularly high levels of mobility. Similarly hypomobility was found in nonsufferers as well as in those with back trouble. The data indicated that young adults (notably males) with previous low-back trouble may not recover their previous mobility on symptomatic resolution. The finding of hypermobility in current sufferers indicates that mobilization therapy may not be appropriate for such patients.
.A
Burton AK; Tillotson KM; Troup JD.
.I 125737
.U
89317676
.S
Spine 8910; 14(6):591-3
.M
Adult; Aged; Aged, 80 and over; Evaluation Studies; Female; Human; Laminectomy; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Age; Myelography; Spinal Stenosis/PP/RA/*SU; Spondylolisthesis/PP/RA/SU; Tomography, X-Ray Computed.
.T
Preoperative and postoperative instability in lumbar spinal stenosis.
.P
JOURNAL ARTICLE.
.W
Sixty-one patients operated on for spinal stenosis, without a fusion, were studied retrospectively. Preoperative instability, as revealed by functional myelography, was found to predict a poor prognosis (P less than 0.01). Women had less favorable results (P less than 0.05). The "slipping" group was significantly more often radically decompressed than the "nonslipping" group (P less than 0.01). Postoperative slipping was found in 26 patients, significantly more often in those with unsatisfactory results (P less than 0.001).
.A
Johnsson KE; Redlund-Johnell I; Uden A; Willner S.
.I 125738
.U
89317677
.S
Spine 8910; 14(6):594-601
.M
Adult; Backache/RA/SU/*TH; Bone Nails; Equipment Design; Female; Human; Intervertebral Disk/RA; Male; Middle Age; Orthopedic Fixation Devices/*; Palliative Treatment; Prognosis; Spinal Fusion; Spine/*/RA/SU.
.T
The role of external spinal skeletal fixation in the assessment of low-back disorders.
.P
JOURNAL ARTICLE.
.W
A variety of tests are currently used in an attempt to predict pain relief following arthrodesis of the lumbar and lumbosacral spine. External spinal skeletal fixation provides a means by which specific spinal motion units can be rigidly immobilized. A trial of temporary external fixation was investigated for its value in predicting the outcome of surgical fusion. Thirty-five patients with chronic low-back pain have been prospectively studied. The results show a statistically significant superiority of temporary external spinal fixation in predicting surgical result as compared with plain radiographs, discograms and facet blocks.
.A
Esses SI; Botsford DJ; Kostuik JP.
.I 125739
.U
89317678
.S
Spine 8910; 14(6):602-3
.M
Adult; Female; Human; Intervertebral Disk/*; Intervertebral Disk Displacement/PP/TH; Leg/*PP; Male; Middle Age; Pain/*; Posture/*; Spinal Diseases/PP/TH; Thorax/*PP.
.T
Cross leg pain and trunk list.
.P
JOURNAL ARTICLE.
.W
The prognostic significance of gravity-induced trunk list and cross leg pain was investigated in 113 patients who had root tension signs from a lumbar disc lesion. Cross leg pain, (a positive contralateral straight leg raising sign) and list was associated with poor prognosis for conservative management. There was a high incidence of disc sequestration and extrusion in the operated patients with cross leg pain. It was concluded that cross leg pain is probably a contraindication to chymopapain injections, and the surgeon should be aware of the possibility of a migrated disc fragment during operation on patients with cross leg pain.
.A
Khuffash B; Porter RW.
.I 125740
.U
89317679
.S
Spine 8910; 14(6):604-5
.M
Aged; Female; Hip Joint/*AH/RA; Human; Lumbosacral Region; Male; Middle Age; Spine/*AH/RA; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
3D-location of the L5-S1 fulcrum in relation to the hip.
.P
JOURNAL ARTICLE.
.W
The purpose of the present study was to measure the three-dimensional distance between the hips and L5-S1 joint in vivo so that this data could then be used in computer programs predicting the load at the lumbosacral joint from posture and anthropometric data. Twenty-one subjects were investigated with computed tomography; consecutive transverse slices were taken from the low-back to proximal thigh, and three-dimensional coordinates were recorded. The distance between the hips and the L5-S1 joint was 122 mm, corresponding to 6.9% and 7.5% of body height for men and women, respectively (P less than 0.05).
.A
Nemeth G; Ohlsen H.
.I 125741
.U
89317680
.S
Spine 8910; 14(6):606-10
.M
Human; Lumbar Vertebrae/*PH/RA; Physiology/IS/MT; Pressure; Regression Analysis; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Prediction of the compressive strength of human lumbar vertebrae.
.P
JOURNAL ARTICLE.
.W
The compressive strength of 98 specimens of motion segments of human thoracolumbar spines was measured. In addition, the density of the trabecular bone in the midplane of the vertebrae was assessed by quantitative computed tomography (QCT); the size of the vertebral endplates was measured by CT as well. The results show that the compressive strength of thoracolumbar vertebrae can be predicted from the product of density and end-plate area, with an error of estimate of 1 kN. The data of the experiment allow for an in vivo prediction of the strength of vertebrae to quantify the risk of fracture in physically very demanding tasks, to support expert opinion in trauma cases, or to assist in therapeutic decisions in cases of severe osteoporosis.
.A
Brinckmann P; Biggemann M; Hilweg D.
.I 125742
.U
89317681
.S
Spine 8910; 14(6):611-5
.M
Human; Ligaments/*PH; Lumbosacral Region; Physiology/IS; Rotation; Spine/*PH; Stress, Mechanical.
.T
Torsional stability of the lumbosacral junction. Significance of the iliolumbar ligament.
.P
JOURNAL ARTICLE.
.W
Previous study has shown that the iliolumbar ligament is important in restraining flexion, extension, and lateral bending of L5 on S1, and its effect on axial rotation was not apparent at 6 N-m of loading. An apparatus was devised to further evaluate its role in relation to the torsional stability of the lumbosacral junction. Torque-rotation characteristics were studied with 24 cadaveric lumbosacral-pelvic specimens. The specimens were divided into three groups. In Group A, the "facet joints," lumbosacral disc and the iliolumbar ligament were all intact. In Group B, the "facet joints" were removed, and in Group C, both the "facets" and the iliolumbar ligament were removed. The results indicated that the ligament was important in maintaining torsional stability of the lumbosacral junction and contributed to 35.2% of the normalized elastic strain energy of the junction.
.A
Chow DH; Luk KD; Leong JC; Woo CW.
.I 125743
.U
89317682
.S
Spine 8910; 14(6):616-9
.M
Adult; Aged; Dyes/DU; Female; Human; Injections; Intervertebral Disk/*PA/RA; Magnetic Resonance Imaging/*; Male; Middle Age; Neck.
.T
Evaluation of cervical disc degeneration with ultralow field MRI and discography. An experimental study on cadavers.
.P
JOURNAL ARTICLE.
.W
The purpose of this study was to test the value of low-field magnetic resonance imaging (MRI) and discography in visualizing disc degeneration of the cervical spine. Plain roentgenograms, MR images, discograms, and macroanatomic appearance of the cervical spines of ten cadavers were compared. At levels C4-5-C7-T1, general disc degeneration seen in discography correlated well with macroanatomy (weighted kappa (Kw) = 0.77). The nuclear shape in MRI showed a weak correlation with macroanatomy (Kw = 0.31) and general disc degeneration in discography (Kw = 0.32), whereas nuclear intensity in MRI underestimated such changes. Magnetic resonance imaging showed posterior extension of the nucleus in most cases where moderate or severe leaking was seen in discography. The latter phenomenon represents an increase to our information on structural changes not available by any other noninvasive and nonirradiative method of examination.
.A
Viikari-Juntura E; Raininko R; Videman T; Porkka L.
.I 125744
.U
89317683
.S
Spine 8910; 14(6):620-4
.M
Activities of Daily Living; Adolescence; Adult; Backache/*; Child; Female; Human; Male; Orthopedic Fixation Devices/*; Postoperative Period; Questionnaires; Retrospective Studies; Scoliosis/PP/*SU; Spinal Fusion.
.T
Back pain after Harrington rod instrumentation for idiopathic scoliosis.
.P
JOURNAL ARTICLE.
.W
The purpose of this study is to compare preoperative and postoperative back pain problems in 182 patients operated on for idiopathic scoliosis. Preoperatively 32% of the patients presented with back pain, increasing to 66% postoperatively. Minor degrees of back pain increased (from 45 to 65%) and more severe complaints decreased (from 55 to 35%). Moderate to severe back pain increases from 0 to 46%, together with lower hook placement from L1 to L5. It is concluded that, ideally, the lower limit of the fusion should not go beyond L1 or L2. Lower fusions are prone to give more back pain, with major problems, however, only in a minority of cases (7% in fusions to L4-L5).
.A
Fabry G; Van Melkebeek J; Bockx E.
.I 125745
.U
89317684
.S
Spine 8910; 14(6):625-31
.M
Adolescence; Adult; Child; Evaluation Studies; Female; Human; Lumbosacral Region; Male; Middle Age; Scoliosis/RA/*SU; Spine/RA/*SU; Support, Non-U.S. Gov't; Thoracic Radiography/*; Thorax.
.T
An analysis of the effect of the Zielke operation on S-shaped curves in idiopathic scoliosis. The use of EVAs showing that correction of the thoracic curve occurs in its lower part: significance of the thoracolumbar spinal segment.
.P
JOURNAL ARTICLE.
.W
This paper analyzes the initial effect of the Zielke VDS operation on S-shaped idiopathic spinal curves in 17 patients with particular reference to the thoracic spine. The curves are evaluated by conventional methods (Cobb angle, apical vertebral rotation, kyphosis, and lordosis) and by a new method using end vertebra angles (EVAs). Three new surgical correction indices are used. In the lower curve, the surgical correction averaged 81%, and it is usually larger than that induced in the thoracic curve by about 48% (surgical correctability index). The lower curve correction is asymmetric, occurring more in its lower part (lower EVA) than in its upper part (upper EVA), a difference that the authors attribute to the restraint imposed by the rib cage on the upper EVA of the lower curve. In the upper (thoracic) curve, the surgically induced correction is variable and averages 33% (range, 6-69%). It is related significantly to preoperative bending film flexibility. The thoracic curve correction also is asymmetric, occurring more in its lower part (lower EVA) than in its upper part (upper EVA), which usually remains stable. The kyphosis angle decreases by an average of 7 degrees. The thoracic apical vertebral rotation shows variable changes. The findings show that the correction of the upper curve occurs mainly in the thoracolumbar spinal segment. It is suggested that this junctional segment of the spine is of importance in determining the limits of both instrumentation and fusion for idiopathic scoliosis.
.A
Wojcik AS; Webb JK; Burwell RG.
.I 125746
.U
89317685
.S
Spine 8910; 14(6):632-5
.M
Bone Wires/*; Human; Materials Testing/*MT; Orthopedic Fixation Devices/*; Spinal Diseases/*TH; Support, Non-U.S. Gov't.
.T
Segmental spinal instrumentation. A study of the mechanical properties of materials used for sublaminar fixation.
.P
JOURNAL ARTICLE.
.W
Segmental spinal instrumentation with sublaminar fixation is widely used but a variety of materials and techniques are being employed for both scoliosis and other spinal surgery. This study addresses the question as to which is best. Both the materials and the methods of securing them were studied. The materials tested were stainless steel 316L, Ortron 90 high nitrogen steel, titanium alloys, nylon straps, and Mersilene tapes. Doubled cold-worked 00.84-mm diameter stainless steel formed in a knot with a twist proved to be the strongest and most secure means of fixation with a yield value of 1,610 N. Attention to the details of technique and material such as the incorporation of a secondary twist and avoidance of hot-worked stainless steel may reduce the incidence of implant failure.
.A
Crawford RJ; Sell PJ; Ali MS; Dove J.
.I 125747
.U
89317686
.S
Spine 8910; 14(6):636-42
.M
Adolescence; Biomechanics; Braces/*ST; Child; Equipment Design; Evaluation Studies; Human; Lumbar Vertebrae; Pressure; Scoliosis/*TH; Thoracic Vertebrae.
.T
The biomechanical effectiveness of the Boston brace in the management of adolescent idiopathic scoliosis.
.P
JOURNAL ARTICLE.
.W
The present study assesses the biomechanical effectiveness of the Boston brace on a group of 14 patients with adolescent scoliosis. Interface pressure measurements were performed at the appropriate compression pads within the brace when it was first applied and on two further sessions within the 6-month period of brace treatment. A corresponding series of Cobb angle measurements also were performed. Mean values of total force exerted through the brace of 58 +/- 18 N were associated with an initial curve correction of 37 +/- 21%. This mean force level was maintained throughout the study, although the mean curve correction at 6 months had reduced to 15 +/- 14%. In addition to biomechanical parameters, factors relating to the nature of the individual curve were important in determining the overall effectiveness of the Boston brace system.
.A
Chase AP; Bader DL; Houghton GR.
.I 125748
.U
89317687
.S
Spine 8910; 14(6):643-5
.M
Adult; Case Report; Cauda Equina/*; Cerebrospinal Fluid/*CY/ME; Human; Male; Paraganglioma/PA/*SC; Peripheral Nerve Neoplasms/*SC; Spinal Cord Neoplasms/*/PA; Thorax.
.T
Paraganglioma of the thoracic spinal cord with cerebrospinal fluid metastasis.
.P
JOURNAL ARTICLE.
.A
Constantini S; Soffer D; Siegel T; Shalit MN.
.I 125749
.U
89317688
.S
Spine 8910; 14(6):645-6
.M
Adolescence; Athletic Injuries/*; Case Report; Female; Fractures/*ET; Gymnastics; Human; Lumbar Vertebrae/*IN/RA; Thoracic Radiography; Thoracic Vertebrae/*IN/RA.
.T
Atypical multivertebral fracture due to hyperextension in an adolescent girl. A case report.
.P
JOURNAL ARTICLE.
.A
Ferrandez L; Usabiaga J; Curto JM; Alonso A; Martin F.
.I 125750
.U
89317764
.S
Surg Clin North Am 8910; 69(4):755-63
.M
Aged; Aged, 80 and over; Aorta, Abdominal/SU; Aortic Aneurysm/*SU; Female; Heart Diseases/ET; Human; Length of Stay; Male; Middle Age; Postoperative Complications/MO; Risk Factors.
.T
Repair of abdominal aortic aneurysms in high-risk patients.
.P
JOURNAL ARTICLE.
.W
Today, repair of an abdominal aortic aneurysm with interposition prosthetic graft replacement is the only reliable method of preventing aneurysm rupture. The Mayo experience demonstrates that this repair also can be accomplished in high-risk patients with very acceptable morbidity and low mortality rates. However, it must be emphasized that these results are related not only to the surgical procedure itself but also to vigorous perioperative medical support, including intraoperative pharmacologic enhancement of cardiac function, intra-aortic balloon counterpulsation if necessary, and intensive postoperative pulmonary management. When resources are available for intensive intraoperative and postoperative support, direct graft repair is the treatment of choice for high-risk patients with abdominal aortic aneurysms.
.A
Pairolero PC.
.I 125751
.U
89317796
.S
Surg Neurol 8910; 32(2):105-10
.M
Adolescence; Adult; Brain/RA; Child; Child, Preschool; Craniotomy/*; Female; Human; Male; Subdural Empyema/RA/*SU; Tomography, X-Ray Computed.
.T
Craniotomy improves outcome in subdural empyema.
.P
JOURNAL ARTICLE.
.W
Renewed uncertainty regarding the best technique of surgical therapy (burr holes versus craniotomy) for subdural empyema prompted a review of the experience with this disease entity at UCLA. Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with total removal of pus, and appropriate antibiotic therapy. The clinical syndrome of subdural empyema can overlap that of other intracranial infections; infants and young children present with a different syndrome than older children and adults. Computed tomography scanning is nearly always diagnostic but may be equivocal or normal; magnetic resonance imaging may become the diagnostic study of choice. Multiple organisms are often cultured, which requires multiple drug therapy.
.A
Feuerman T; Wackym PA; Gade GF; Dubrow T.
.I 125752
.U
89317797
.S
Surg Neurol 8910; 32(2):111-5
.M
Action Potentials; Adult; Brain/*BS; Case Report; Cerebral Hemorrhage/ET/PP; Cerebrovascular Circulation; Craniopharyngioma/PP/*SU; Female; Human; Middle Age; Motor Neurons; Pituitary Neoplasms/PP/*SU; Postoperative Complications; Veins/*SU.
.T
A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part I. Clinical study.
.P
JOURNAL ARTICLE.
.W
The interhemispheric translamina terminalis approach has made total removal of a craniopharyngioma less risky. Nevertheless, one of the pitfalls of this approach is cutting of the draining veins combined with retraction. A case of craniopharyngioma in which a subcortical hematoma developed is reported. The divided draining veins and the 60-minute retraction period were thought to have caused this complication. We therefore determined the clinical effect of cutting the draining veins and retraction on the regional cerebral blood flow and the motor nerve action potential. There were marked changes and a hematoma occurred mostly when the veins were divided and retraction was applied over the area.
.A
Kanno T; Kasama A; Shoda M; Yamaguchi C; Kato Y.
.I 125753
.U
89317798
.S
Surg Neurol 8910; 32(2):116-20
.M
Action Potentials; Animal; Brain/*BS; Cerebrovascular Circulation; Craniopharyngioma/PP/*SU; Dogs; Macaca; Motor Neurons; Pituitary Neoplasms/PP/*SU; Veins/*SU.
.T
A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part II. Experimental study.
.P
JOURNAL ARTICLE.
.W
The authors have reported a case of a craniopharyngioma removed by the interhemispheric translamina terminalis approach, and the postoperative development of a subcortical hematoma. We suspected that the cause of the subcortical hematoma was dividing the bridging veins and applying a retractor over them. In this paper, we report our experimental study, using dogs and monkeys, to evaluate the effect of cutting the vein and applying a retractor over it. The incidence of a subcortical hematoma was highest (60%) when the veins were cut and the retraction was applied. Vein occlusion only did not cause hematoma to develop, and the retraction alone caused 13% of the hematomas. This clearly indicated that the clinical case reported in Part I developed the subcortical hematoma postoperatively because the frontal bridging vein was cut and a retractor was applied for 60 minutes over the cut vein.
.A
Kasama A; Kanno T.
.I 125754
.U
89317799
.S
Surg Neurol 8910; 32(2):121-5
.M
Adult; Brain Neoplasms/*PA/RA; Case Report; Chondroma/*PA/RA; Female; Human.
.T
Intracranial chondroma. Case report.
.P
JOURNAL ARTICLE.
.W
We present a rare case of intracranial chondroma originating from the falx cerebri. Diagnostic procedures and surgical management are discussed, with special reference to computed tomography, magnetic resonance imaging, and pathologic findings.
.A
Kretzschmar HA; Eggert HR; Beck U; Furmaier R.
.I 125755
.U
89317800
.S
Surg Neurol 8910; 32(2):126-30
.M
Arteriovenous Fistula/RA/*TH; Case Report; Child; Child, Preschool; Embolization, Therapeutic/*; Female; Human; Male; Vertebral Artery/*.
.T
Balloon embolization of nontraumatic vertebral arteriovenous fistulae in children.
.P
JOURNAL ARTICLE.
.W
Two children, aged 4 and 8 years, with nontraumatic extracranial vertebral arteriovenous fistula are described. Under general anesthesia and with fluoroscopic guidance, using a percutaneous endovascular technique, latex detachable balloons were used to successfully occlude the fistulae. The patients were monitored with somatosensory and auditory evoked potentials and kept hypotensive for 24 hours. Immediate and follow-up angiography 1 year later showed obliteration of the fistula in both patients. The management of this rare condition is discussed.
.A
Sadasivan B; Mehta B; Dujovny M; Malik GM; Ausman JI.
.I 125756
.U
89317802
.S
Surg Neurol 8910; 32(2):137-43
.M
Adult; Case Report; Cerebral Arteriovenous Malformations/*PP/SU; Cerebrovascular Circulation/*; Cold; Diffusion; Female; Heat; Human; Male; Middle Age; Monitoring, Physiologic/*.
.T
Monitoring of cortical blood flow during excision of arteriovenous malformation by thermal diffusion method.
.P
JOURNAL ARTICLE.
.W
The cortical blood flow adjacent to arteriovenous malformations was monitored in six patients before, during, and after excision of arteriovenous malformations using a thermal diffusion probe. In a large arteriovenous malformation, a progressive increase in cortical blood flow up to two times the preexcision value was noted with occlusion of the feeding arteries. Lowering arterial pressure to keep normal cortical blood flow during and after operation resulted in minimum brain edema and an excellent result. Direct measurement of cortical blood flow is of value in determining the precise level of hypotension to prevent brain edema and ischemia that may occur with excision of a large arteriovenous malformation.
.A
Nagao S; Ueta K; Mino S; Fujiwara T; Honma Y; Ito T; Ohmoto T; Ohkawa M.
.I 125757
.U
89317803
.S
Surg Neurol 8910; 32(2):144-51
.M
Adult; Carbamazepine/*AE/BL/ME/PK; Case Report; Drug Interactions; Female; Human; Male; Middle Age; Nervous System Diseases/*CI; Propoxyphene/*AE/ME.
.T
Catastrophic neurologic signs due to drug interaction: Tegretol and Darvon.
.P
JOURNAL ARTICLE.
.W
Eight cases of carbamazepine toxicity from interaction with propoxyphene are reported. Serum concentrations of carbamazepine increased up to sixfold. All patients were symptomatic and two were hospitalized. Practitioners prescribing propoxyphene acutely for pain should be aware of this significant interaction.
.A
Oles KS; Mirza W; Penry JK.
.I 125758
.U
89317805
.S
Surg Neurol 8910; 32(2):156-8
.M
Brain Neoplasms/*DI; Case Report; Diagnosis, Differential; Female; Human; Middle Age; Neurilemmoma/*DI; Pituitary Neoplasms/*DI; Sella Turcica/RA.
.T
Primary intrasellar schwannoma: case report.
.P
JOURNAL ARTICLE.
.W
A case is presented of a primary intrasellar and suprasellar schwannoma mimicking a pituitary tumor clinically, endocrinologically, and radiographically.
.A
Wilberger JE Jr.
.I 125759
.U
89317807
.S
Surg Neurol 8910; 32(2):165
.M
Neurosurgery/*; Specialties, Medical/*.
.T
Specialization in neurosurgery.
.P
JOURNAL ARTICLE.
.A
Hoffman HJ.
.I 125760
.U
89317808
.S
Surg Neurol 8910; 32(2):91-7
.M
Adult; Case Report; Catheterization/*; Cerebral Arteriovenous Malformations/RA/*TH; Embolization, Therapeutic/*; Female; Human; Male.
.T
A new microcatheter system for endovascular treatment of cerebral arteriovenous malformations.
.P
JOURNAL ARTICLE.
.W
A new microcatheter system was used for diagnostic and therapeutic purposes in three cases of arteriovenous malformation. This microcatheter is used with a steerable guidewire and provides high selectivity of the target vessels and greater catheter maneuverability than does balloon catheters. Tissue adhesive was safely injected for the therapeutic embolization in two of the cases. With this system, however, the utmost attention is necessary to prevent reflux of the tissue adhesive and to avoid lacerating the feeding vessels with the guidewire. This microcatheter system was found to be very useful for diagnostic and therapeutic procedures in endovascular treatment of cerebral arteriovenous malformations.
.A
Komiyama M; Yasui T; Fu Y; Yagura H; Baba M; Hakuba A; Nishimura S.
.I 125761
.U
89317809
.S
Surg Neurol 8910; 32(2):98-104
.M
Animal; Brain/*EM; Fetus/SU; Frontal Lobe/AH/EM; Occipital Lobe/CY/*SU; Sheep/*EM; Support, Non-U.S. Gov't.
.T
Effect of excision of occipital lobe tissue on about the 70th day of gestation on the growth and development of the sheep's brain.
.P
JOURNAL ARTICLE.
.W
A unilateral occipital excision was performed on 14 fetal lambs at about the 70th day of gestation, and the brains were examined postnatally for gross morphological and histologic changes. Three operated brains revealed a posterior shift of the principal transverse sulcus in the ipsilateral hemisphere. This sulcus is remote from the area of excision, which was usually represented by a cystic cavity. Histologic examination showed that the dorsal lateral geniculate body was reduced in size in all but three of the operated brains. In two brains with the changed gyral pattern there was also a reduction in the size of the white fiber tracts of the frontal lobe. No evidence of neural regeneration was found in any of the brains. The implications of these findings from the point of view of possible neurosurgical intervention in the fetus are considered.
.A
Chapman SA; Bannister CM.
.I 125762
.U
89317875
.S
Surv Ophthalmol 8910; 33 Suppl:399-475
.M
Glaucoma/*/DI/TH; Human.
.T
Detection and management of early glaucoma. Based on a symposium. Brussels, Belgium, September 1987.
.P
JOURNAL ARTICLE.
.I 125763
.U
89317876
.S
Surv Ophthalmol 8910; 33 Suppl:401-2; discussion 409-11
.M
Adult; Aged; Axoplasmic Flow; Glaucoma/CO/*PA; Human; Intraocular Pressure; Middle Age; Ocular Hypertension/CO; Optic Nerve Diseases/*PA; Retinal Ganglion Cells/CY.
.T
Histology of optic nerve damage in ocular hypertension and early glaucoma.
.P
JOURNAL ARTICLE.
.A
Minckler DS.
.I 125764
.U
89317877
.S
Surv Ophthalmol 8910; 33 Suppl:403-4; discussion 409-11
.M
Glaucoma/*DI; Human; Perimetry; Visual Fields/*.
.T
Visual field changes in early glaucoma and how to recognize them.
.P
JOURNAL ARTICLE.
.A
Heijl A.
.I 125765
.U
89317878
.S
Surv Ophthalmol 8910; 33 Suppl:405-6; discussion 409-11
.M
Contrast Sensitivity/*; Glaucoma/*PP; Human; Intraocular Pressure; Ocular Hypertension/*PP.
.T
Contrast sensitivity changes in ocular hypertension and early glaucoma.
.P
JOURNAL ARTICLE.
.A
Bron AJ.
.I 125766
.U
89317879
.S
Surv Ophthalmol 8910; 33 Suppl:407-8; discussion 409-11
.M
Color Perception; Glaucoma, Open-Angle/*DI; Human; Intraocular Pressure; Visual Fields.
.T
Psychophysical changes in early glaucoma.
.P
JOURNAL ARTICLE.
.A
Drance S.
.I 125767
.U
89317880
.S
Surv Ophthalmol 8910; 33 Suppl:413-4; discussion 421-2
.M
Glaucoma/CO/*PA; Human; Nerve Fibers/PA; Ocular Hypertension/CO/PA; Retina/*PA.
.T
Retinal nerve fiber layer and neuroretinal rim changes in ocular hypertension and early glaucoma.
.P
JOURNAL ARTICLE.
.A
Airaksinen PJ.
.I 125768
.U
89317881
.S
Surv Ophthalmol 8910; 33 Suppl:415-6; discussion 421-2
.M
Flowmeters; Fundus Oculi; Human; Intraocular Pressure; Ocular Hypertension/*DT; Random Allocation; Regional Blood Flow; Retina/*BS; Timolol/*PD.
.T
Topical timolol and the human retinal circulation.
.P
JOURNAL ARTICLE.
.A
Grunwald JE.
.I 125769
.U
89317882
.S
Surv Ophthalmol 8910; 33 Suppl:417-8; discussion 421-2
.M
Glaucoma, Open-Angle/*PA; Human; Optic Disk/*PA; Visual Fields.
.T
Optic disc changes in early glaucoma.
.P
JOURNAL ARTICLE.
.A
Kitazawa Y; Matsubara K.
.I 125770
.U
89317883
.S
Surv Ophthalmol 8910; 33 Suppl:419-20; discussion 421-2
.M
Bradycardia/CI; Heart Rate/DE; Human; Intraocular Pressure/DE; Ocular Hypertension/*DT; Optic Disk/*DE; Time Factors; Timolol/*PD; Visual Fields.
.T
Reversibility by timolol of optic nerve disc cupping and pallor in ocular hypertensives.
.P
JOURNAL ARTICLE.
.A
Schwartz B.
.I 125771
.U
89317884
.S
Surv Ophthalmol 8910; 33 Suppl:423-5; discussion 435-6
.M
Computers; Glaucoma, Open-Angle/*DT/PA/PP; Human; Intraocular Pressure/DE; Longitudinal Studies; Middle Age; Perimetry/*MT; Scotoma; Time Factors; Timolol/*TU; Visual Fields/DE.
.T
Computerized perimetric monitoring and study of scotomatous fluctuations in timolol-treated open-angle glaucoma patients.
.P
JOURNAL ARTICLE.
.A
Pecori-Giraldi J.
.I 125772
.U
89317885
.S
Surv Ophthalmol 8910; 33 Suppl:427-8; discussion 435-6
.M
Comparative Study; Follow-Up Studies; Glaucoma/*DT; Human; Intraocular Pressure/DE; Perimetry; Pilocarpine/*PD; Prospective Studies; Random Allocation; Time Factors; Timolol/*PD; Visual Fields/*DE.
.T
Quantification and monitoring of visual field defects and a prospective, randomized comparison of pilocarpine and timolol using computerized perimetry.
.P
JOURNAL ARTICLE.
.A
Sponsel WE.
.I 125773
.U
89317886
.S
Surv Ophthalmol 8910; 33 Suppl:429-30; discussion 435-6
.M
Adrenergic Beta Receptor Blockaders/*PD; Carteolol/PD; Comparative Study; Drug Screening; Follow-Up Studies; Glaucoma, Open-Angle/*DT/SU; Human; Intraocular Pressure/DE; Propanolamines/PD; Timolol/PD; Visual Fields/*DE.
.T
Early visual field changes with beta-blocking agents.
.P
JOURNAL ARTICLE.
.A
Collignon-Brach J.
.I 125774
.U
89317887
.S
Surv Ophthalmol 8910; 33 Suppl:431-3; discussion 435-6
.M
Glaucoma/SU/*TH; Human; Intraocular Pressure; Laser Surgery; Prognosis; Visual Fields.
.T
The effect of treatment on progression of glaucoma.
.P
JOURNAL ARTICLE.
.A
Greve EL.
.I 125775
.U
89317888
.S
Surv Ophthalmol 8910; 33 Suppl:441-2; discussion 449-50
.M
Age Factors; Blindness/ET; Glaucoma/CO/EH/*EP; Human; Intraocular Pressure; Myopia/ET; Ocular Hypertension/ET; Racial Stocks; Risk Factors; Vision Screening; Visual Fields.
.T
Epidemiology as it relates to screening for glaucoma.
.P
JOURNAL ARTICLE.
.A
Sommer A.
.I 125776
.U
89317889
.S
Surv Ophthalmol 8910; 33 Suppl:443-4; discussion 449-50
.M
Equipment Design; Glaucoma/*DI; Glaucoma, Open-Angle/DI; Human; Vision Screening/*IS; Visual Fields/*.
.T
An optimized visual field screening method.
.P
JOURNAL ARTICLE.
.A
Henson DB.
.I 125777
.U
89317890
.S
Surv Ophthalmol 8910; 33 Suppl:445-6; discussion 449-50
.M
Adult; Age Factors; Aged; Glaucoma, Open-Angle/*PC; Human; Intraocular Pressure/*; Middle Age; Ocular Hypertension/*PC; Tonometry/EC; Vision Screening/*EC/MT.
.T
Value of intraocular pressure measurement as a screening tool for glaucoma.
.P
JOURNAL ARTICLE.
.A
Le Blanc R.
.I 125778
.U
89317891
.S
Surv Ophthalmol 8910; 33 Suppl:447-8; discussion 449-50
.M
Glaucoma/*DI; Human; Intraocular Pressure; Nerve Fibers/CY; Ophthalmoscopy/*; Optic Disk/*PA; Retina/*PA; Visual Fields.
.T
Ophthalmoscopy in the detection of optic disc and retinal nerve fiber layer changes in early glaucoma.
.P
JOURNAL ARTICLE.
.A
Iwata K.
.I 125779
.U
89317892
.S
Surv Ophthalmol 8910; 33 Suppl:451-2; discussion 459-60
.M
Aqueous Humor/SE; Ciliary Body/ME; Comparative Study; Glaucoma/*ME; Human; Receptors, Adrenergic, Alpha/*PH; Receptors, Adrenergic, Beta/*PH.
.T
Physiology and pharmacology of alpha and beta receptors in the eye.
.P
JOURNAL ARTICLE.
.A
Sears ML.
.I 125780
.U
89317894
.S
Surv Ophthalmol 8910; 33 Suppl:455-6; discussion 459-60
.M
Adrenergic Beta Receptor Blockaders/*PD; Age Factors; Cardiovascular System/*DE; Comparative Study; Drug Interactions; Glaucoma/*DT; Heart Diseases/CO; Heart Rate/DE; Human; Intraocular Pressure/DE; Lung/*DE; Lung Diseases/CO; Propanolamines/PD; Timolol/PD.
.T
Cardiovascular and pulmonary effects of beta-blocking agents: implications for their use in ophthalmology.
.P
JOURNAL ARTICLE.
.A
Collignon P.
.I 125781
.U
89317895
.S
Surv Ophthalmol 8910; 33 Suppl:457-8; discussion 459-60
.M
Cardiovascular System/*DE; Comparative Study; Double-Blind Method; Exercise Test/*; Heart Rate/DE; Human; Propanolamines/*PD; Random Allocation; Timolol/*PD.
.T
Comparison of the effect of timolol versus betaxolol ophthalmic on cardiopulmonary exercise performance in healthy volunteers.
.P
JOURNAL ARTICLE.
.A
Dickstein K.
.I 125782
.U
89317896
.S
Surv Ophthalmol 8910; 33 Suppl:461-2; discussion 471-2
.M
Adrenergic Beta Receptor Blockaders/*TU; Glaucoma/*DT; Heart Rate/DE; Human; Timolol/TU.
.T
Review of clinical studies of beta-blocking agents.
.P
JOURNAL ARTICLE.
.A
Zimmerman TJ.
.I 125783
.U
89317897
.S
Surv Ophthalmol 8910; 33 Suppl:463-4; discussion 471-2
.M
Follow-Up Studies; Glaucoma, Open-Angle/*DT; Human; Intraocular Pressure/DE; Optic Disk/PA; Timolol/*TU; Visual Fields/DE.
.T
Ten-year follow-up of timolol-treated open-angle glaucoma.
.P
JOURNAL ARTICLE.
.A
Goethals M.
.I 125784
.U
89317898
.S
Surv Ophthalmol 8910; 33 Suppl:465-6; discussion 471-2
.M
Acetazolamide/PD; Adrenergic Beta Receptor Blockaders/*PD; Carteolol/PD; Comparative Study; Glaucoma/DT; Glaucoma, Open-Angle/*DT; Human; Intraocular Pressure/*DE; Optic Disk/*DE; Pilocarpine/PD; Propanolamines/PD; Timolol/PD.
.T
Pressure compliance test of the optic nerve head: influence of different antiglaucoma drugs.
.P
JOURNAL ARTICLE.
.A
Pillunat LE; Stodtmeister R.
.I 125785
.U
89317899
.S
Surv Ophthalmol 8910; 33 Suppl:467-8; discussion 471-2
.M
Administration, Topical; Comparative Study; Drug Therapy, Combination; Glaucoma/*DT; Human; Intraocular Pressure/DE; Pilocarpine/*PD; Timolol/*PD.
.T
Overview of efficacy and local tolerability of a new timolol/pilocarpine combination.
.P
JOURNAL ARTICLE.
.A
Vogel R.
.I 125786
.U
89317900
.S
Surv Ophthalmol 8910; 33 Suppl:469-70; discussion 471-2
.M
Forecasting; Glaucoma/*TH; Glaucoma, Open-Angle/*TH; Human; Intraocular Pressure; Laser Surgery; Longitudinal Studies.
.T
Future trends in the management of glaucoma.
.P
JOURNAL ARTICLE.
.A
Hitchings RA.
.I 125787
.U
89318393
.S
Stroke 8910; 20(7):841-3
.M
Aged; Aging/PH; Cerebrovascular Disorders/*EP/RA; Female; Human; Male; Middle Age; Minnesota; Risk Factors; Tomography, X-Ray Computed.
.T
Incidence rates of stroke in the eighties: the end of the decline in stroke? [editorial]
.P
EDITORIAL.
.A
Kuller LH.
.I 125788
.U
89318395
.S
Stroke 8910; 20(7):850-2
.M
Cerebral Infarction/RA; Cerebrovascular Disorders/PP/*RA; Female; Glucose Tolerance Test; Human; Male; Medical Records; Risk Factors; Tomography, X-Ray Computed/*.
.T
Prevalence of silent stroke in patients presenting with initial stroke: the Framingham Study.
.P
JOURNAL ARTICLE.
.W
It is common to find computed tomography scan evidence of prior stroke without a history of such an event. The frequency, risk factors for, and relevance of silent strokes are unknown. The Framingham cohort of 5,184 men and women aged 30-62 years and free of stroke at entry to the study have been followed with periodic examinations since 1950. We studied the silent strokes found on computed tomography scan of all initial strokes that occurred between January 1, 1979, and July 31, 1987. During these 8 1/2 years, 164 initial strokes occurred; 124 had computed tomography scans performed. There were 13 (10%) with silent stroke, 71 had abnormalities related to their presenting acute stroke, and 40 had normal computed tomography scans. There were 15 silent lesions; eight were lacunar infarcts in the basal ganglia-internal capsule area, seven were small cortical infarcts. Glucose intolerance was the sole risk factor that occurred significantly more frequently (11 of 13) in the group with silent lesions (p less than 0.04) than in the group with computed tomography evidence of acute stroke. Silent stroke is not rare; it was present in at least 10% of acute initial stroke patients arising in a general population. The relation of these silent lesions to the development of "vascular" dementia and poststroke disability deserves further study.
.A
Kase CS; Wolf PA; Chodosh EH; Zacker HB; Kelly-Hayes M; Kannel WB; D'Agostino RB; Scampini L.
.I 125789
.U
89318396
.S
Stroke 8910; 20(7):853-7
.M
Cerebral Ischemia, Transient/EP; Cerebrovascular Disorders/*EP/RA; Disability Evaluation; Female; Human; Italy; Male; Recurrence; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
First-year results of a community-based study of stroke incidence in Umbria, Italy.
.P
JOURNAL ARTICLE.
.W
The SEPIVAC study (Italian initials for "epidemiologic study of incidence of acute cerebrovascular disease") is a community-based epidemiologic survey of incidence and outcome of cerebrovascular disease in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,101 people live. All cases were registered with the study either by notification from general practitioners or by check of hospital admission within the study area and in the two hospitals of Perugia. Death certificates were looked at as well. Patients were registered with the study when the clinical picture fulfilled the definition of stroke and transient ischemic attack (TIA) adopted for this study. Patients were followed up at approximately 30 days and 6 months. During the first year of the study (September 1, 1986 to August 31, 1987), 189 cases were registered: 108 suffered a "first ever in a lifetime" stroke, 30 a recurrent stroke, and 51 a "first ever in a lifetime" transient ischemic attack. Sixty-one percent of patients (71% of first strokes) had a computed tomography scan. For our study, the crude annual incidence rate of first stroke was 2.2 per 1,000 (confidence intervals 1.81-2.66); the standardized rate to the European population was 1.36 (confidence intervals 1.06-1.74). At least 83% of first strokes were due to cerebral ischemia; in 26 cases a clinical diagnosis of lacunar ischemia was made. The 30-day case fatality rate was 21%; 25% of our patients had recovered completely or almost completely after 1 month.
.A
Ricci S; Celani MG; Guercini G; Rucireta P; Vitali R; La Rosa F; Duca E; Ferraguzzi R; Paolotti M; Seppoloni D; et al.
.I 125790
.U
89318397
.S
Stroke 8910; 20(7):858-63
.M
Adult; Age Factors; Aged; Cerebrovascular Disorders/EH/*EP; Disability Evaluation; Ethnic Groups; Female; Human; Male; Middle Age; Risk Factors; Sex Factors; Support, Non-U.S. Gov't; Taiwan.
.T
Prevalence of stroke in Taiwan.
.P
JOURNAL ARTICLE.
.W
We investigated the prevalence of stroke in Taiwan in an epidemiologic study of stroke, diabetes, and cardiovascular disease that used a two-phase survey design. The study population was drawn by cluster sampling and consisted of both urban and rural communities from four regions of Taiwan. There were 8,705 people 36 years of age or older interviewed during the period of October 1 to December 31, 1986, and 143 cases of completed stroke were later identified by a neurologist. The point prevalence rate for people aged 36 or older in our study was 1,642/100,000 population (95% confidence interval 1,389-1,942/100,000). Prevalence rates differed significantly among the four study regions and between urban and rural communities; prevalence was greater in northern Taiwan and in urban communities. Percentages of the major types of stroke in 143 stroke survivors were as follows: cerebral infarction 67.1% (96 cases), cerebral hemorrhage 14.0% (20 cases), subarachnoid hemorrhage 4.2% (six cases), and unclassified 14.7% (21 cases). Of the stroke survivors, 67.1% were independent in activities of daily living, and 75.5% were independent in ambulation. Hypertension, heart disease, diabetes mellitus, and a family history of stroke were significantly more common in stroke survivors than in strokefree individuals.
.A
Hu HH; Chu FL; Chiang BN; Lan CF; Sheng WY; Lo YK; Wong WJ; Luk YO.
.I 125791
.U
89318398
.S
Stroke 8910; 20(7):864-70
.M
Cerebrovascular Disorders/*PP; Evaluation Studies; Human; Neurologic Examination/*/ST; Support, U.S. Gov't, P.H.S..
.T
Measurements of acute cerebral infarction: a clinical examination scale.
.P
JOURNAL ARTICLE.
.W
We designed a 15-item neurologic examination stroke scale for use in acute stroke therapy trials. In a study of 24 stroke patients, interrater reliability for the scale was found to be high (mean kappa = 0.69), and test-retest reliability was also high (mean kappa = 0.66-0.77). Test-retest reliability did not differ significantly among a neurologist, a neurology house officer, a neurology nurse, or an emergency department nurse. The stroke scale validity was assessed by comparing the scale scores obtained prospectively on 65 acute stroke patients to the patients' infarction size as measured by computed tomography scan at 1 week and to the patients' clinical outcome as determined at 3 months. These correlations (scale-lesion size r = 0.68, scale-outcome r = 0.79) suggested acceptable examination and scale validity. Of the 15 test items, the most interrater reliable item (pupillary response) had low validity. Less reliable items such as upper or lower extremity motor function were more valid. We discuss methods for improving the reliability and validity of brief examination scales to be used in stroke therapy trials.
.A
Brott T; Adams HP Jr; Olinger CP; Marler JR; Barsan WG; Biller J; Spilker J; Holleran R; Eberle R; Hertzberg V; et al.
.I 125792
.U
89318399
.S
Stroke 8910; 20(7):871-5
.M
Acute Disease; Aged; Cerebral Infarction/PP/*RA; Female; Human; Male; Neurologic Examination; Prospective Studies; Support, U.S. Gov't, P.H.S.; Time Factors; Tomography, X-Ray Computed/*.
.T
Measurements of acute cerebral infarction: lesion size by computed tomography.
.P
JOURNAL ARTICLE.
.W
As part of a prospective therapy study of 65 patients with acute, nonhemorrhagic, cerebral infarction, computed tomographic scans of the head were obtained at admission, 7-10 days, and 3 months. The scans were analyzed for the presence, site, size, and volume measurement of the infarction. At 7-10 days, the mean infarction volume as measured by computed tomography was 55 cm3 or about 4 x 4 x 3.5 cm (range = 0-507 cm3). At 3 months, the mean infarction volume decreased by 25% to 41 cm3. For the 26 scans showing infarction at the time of admission, the mean lesion volume was 33 cm3 at admission, 51 cm3 at 7-10 days, and 49 cm3 at 3 months. With lesion size at 7-10 days expressed as percentage of total brain volume, the mean infarction size was only 5%. Of the 49 patients with lesions revealed by computed tomography at 7-10 days, 20 had an infarction of 1% or less of total brain volume, while only six had an infarction of 20% or more of total brain volume. The lesion volumes as measured by the 7-10-day computed tomography correlated with the neurologic examination scores on admission (Spearman's rank-order correlation = 0.78) and with the scores at 1 week (Spearman's rank-order correlation = 0.79).
.A
Brott T; Marler JR; Olinger CP; Adams HP Jr; Tomsick T; Barsan WG; Biller J; Eberle R; Hertzberg V; Walker M.
.I 125793
.U
89318400
.S
Stroke 8910; 20(7):876-83
.M
Adult; Aged; Aged, 80 and over; Blood Pressure; Cerebral Angiography; Cerebral Embolism and Thrombosis/*ET/PA; Cerebral Hemorrhage/ET/*PA/RA; Cerebral Infarction/ET/*PA/RA; Cerebrovascular Disorders/*ET/PA/PP; Female; Heart Diseases/*CO; Human; Male; Middle Age.
.T
Hemorrhagic infarct of the brain without a reopening of the occluded arteries in cardioembolic stroke.
.P
JOURNAL ARTICLE.
.W
We examined the brains of 14 patients (four men and 10 women, mean age 68.9 years) who died from brain herniation after cardioembolic stroke with persistent occlusion of the internal carotid-middle cerebral arterial axis. Our examination showed hemorrhagic infarct in seven patients and pale infarct in the other seven, contradicting the commonly proposed pathophysiologic mechanism for the development of hemorrhagic infarct that the opening of previously occluded vessels makes an infarct hemorrhagic. Analysis of blood pressure after stroke revealed one or more surges of arterial hypertension or rapid rise of blood pressure in patients with hemorrhagic infarct without a reopening of the occluded artery. Such arterial hypertension was not always present in patients with pale infarct. Hemorrhage into an infarct with persisting occlusion of the proximal artery is assumed to occur when the involved blood vessels are exposed to the force of arterial blood pressure from the leptomeningeal collaterals. This occurs when arterial blood pressure rises after stroke in the presence of efficient leptomeningeal collaterals and before occlusion of these collaterals by a swollen cerebral hemisphere containing a large infarct.
.A
Ogata J; Yutani C; Imakita M; Ishibashi-Ueda H; Saku Y; Minematsu K; Sawada T; Yamaguchi T.
.I 125794
.U
89318404
.S
Stroke 8910; 20(7):904-10
.M
Animal; Brain/*ME; Cerebral Cortex/ME; Cerebral Ischemia/*ME/PP/TH; Cerebrovascular Circulation; Corpus Striatum/ME; Dopamine/ME; Fatty Acids, Nonesterified/*ME; Glutamine/ME; Hypothermia, Induced/*; Male; Neuroregulators/*ME; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain.
.P
JOURNAL ARTICLE.
.W
We have demonstrated previously that mild intraischemic hypothermia confers a marked protective effect on the final histopathological outcome. The present study was carried out to evaluate whether this protective effect involves changes in the degree of local cerebral blood flow reductions, tissue accumulation of free fatty acids, or alterations in the extracellular release of glutamate and dopamine. Rats whose intraischemic brain temperature was maintained at 36 degrees C, 33 degrees C, or 30 degrees C were subjected to 20 minutes of ischemia by four-vessel occlusion combined with systemic hypotension. Levels of local cerebral blood flow, as measured autoradiographically, were reduced uniformly in all experimental animals at the end of ischemia by gas chromatography after tissue extraction and separation by thin layer chromatography. A massive ischemia-induced accumulation of individual free fatty acids was observed in animal groups whose intraischemic brain temperature was maintained at either 36 degrees C or 30 degrees C. Extracellular neurotransmitter levels were measured by microdialysis; the perfusate was collected before, during, and after ischemia. In rats whose intraischemic brain temperature was maintained at 36 degrees C, dopamine and glutamate increased significantly during ischemia and the early period of recirculation (by 500-fold and sevenfold, respectively). In animals whose brain temperature was maintained at 33 degrees C and 30 degrees C, the release of glutamate was completely inhibited, and the release of dopamine was significantly attenuated (by 60%). These results suggest that mild intraischemic hypothermia does not affect the ischemia-induced local cerebral blood flow reduction or free fatty acid accumulation.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Busto R; Globus MY; Dietrich WD; Martinez E; Valdes I; Ginsberg MD.
.I 125795
.U
89318405
.S
Stroke 8910; 20(7):911-7
.M
Acetylcholine/PD; Animal; Brain Injuries/PA/*PP; Cats; Endothelium, Vascular/*PP/UL; Muscle, Smooth, Vascular/UL; Sodium Chloride; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vasodilation/*/DE; Wounds, Nonpenetrating/PA/*PP.
.T
Recovery of impaired endothelium-dependent relaxation after fluid-percussion brain injury in cats.
.P
JOURNAL ARTICLE.
.W
The effect of a moderate level of fluid-percussion brain injury on acetylcholine-induced cerebral arteriolar vasodilation was examined for 12 hours after trauma in anesthetized cats equipped with cranial windows. The cats were then perfused with aldehydes, and the pial arteries were prepared for electron microscopy. Immediately after brain injury, the normal vasodilator response to topical application of acetylcholine was converted to vasoconstriction. By 4 hours after trauma, the ability of small pial arterioles (diameters less than 100 microns) to dilate after acetylcholine application had returned to the pretrauma level and was observed to be normal at both 8 and 12 hours after trauma (p less than 0.05). The vasodilator response of large caliber arterioles (diameters greater than or equal to 100 microns) at 4, 8, and 12 hours after injury was reduced relative to the pretrauma response but was significantly improved relative to their response at 30 minutes after trauma (p less than 0.05). Moreover, the response of large vessels at 4, 8, and 12 hours in injured animals was equal to that observed in noninjured control animals assessed at 4, 8, and 12 hours after window implantation. At 12 hours after injury, the ultrastuctural characteristics of both large and small vessels resembled their preinjury state. These data suggest that the impairment of acetylcholine-induced endothelium-dependent relaxation observed in cats after fluid-percussion brain injury is not irreversible but returns to normal (small arterioles) or exhibits significant recovery (large arterioles) within 4 hours after injury.
.A
Ellison MD; Erb DE; Kontos HA; Povlishock JT.
.I 125796
.U
89318406
.S
Stroke 8910; 20(7):918-24
.M
Animal; Brain/*ME; Cerebral Embolism and Thrombosis/ME; Cerebral Ischemia, Transient/*ME/PP; Cerebrovascular Circulation; Cerebrovascular Disorders/ME; Lipid Peroxides/*BI; Male; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't; Time Factors; Tissue Distribution.
.T
Increased lipid peroxidation in vulnerable brain regions after transient forebrain ischemia in rats.
.P
JOURNAL ARTICLE.
.W
We examined cerebral lipid peroxidation, estimated by a thiobarbituric acid test, in rat brain regions after 30 minutes of severe forebrain ischemia and at recirculation periods of up to 72 hours. The lipid peroxide levels remained unaltered in all brain regions during ischemia and during the first hour of recirculation but were selectively increased between 8 and 72 hours of recirculation in the ischemia-sensitive regions of the hippocampus, striatum, and cortex. The most pronounced increases (30-37%) were seen at 48 hours of recirculation. In contrast, lipid peroxide levels were unchanged in infarcted brain regions 24 hours after intracarotid injection of microspheres, indicating that reoxygenation of the ischemic brain is a prerequisite for lipid peroxidation. We assessed the lipid peroxidation capacity of cerebral homogenates obtained from rats subjected to ischemia and recirculation by measuring the production of lipid peroxides after aerobic incubation. The homogenates from rats exposed to 30 minutes of ischemia or to 1 hour of recirculation were not more susceptible to peroxidation. However, the production of lipid peroxides was selectively increased in the hippocampus, striatum, and cortex at 8-48 hours of recirculation, suggesting a loss of efficacy of the antioxidant systems. These results, showing a delayed and long-lasting increase in lipid peroxidation that occurs in ischemia-sensitive brain regions and parallels the development of neuronal necrosis, support the hypothesis that free radical processes participate in postischemic neuronal damage.
.A
Bromont C; Marie C; Bralet J.
.I 125797
.U
89318408
.S
Stroke 8910; 20(7):930-7
.M
Animal; Autoradiography/MT; Brain/PA/PP; Cerebral Arteries/PA/*PP; Cerebral Infarction/PA; Cerebral Ischemia/PA/PP; Cerebrovascular Circulation/*; Male; Rats; Rats, Inbred Strains; Support, Non-U.S. Gov't.
.T
Regional cerebral blood flow and histopathologic changes after middle cerebral artery occlusion in rats.
.P
JOURNAL ARTICLE.
.W
Changes in regional cerebral blood flow were correlated with the distribution of histopathologic signs of brain injury in 35 rats after middle cerebral artery occlusion. Rats were allowed to survive for periods of up to 4 weeks after the operation, and we focused particular interest on the time course of blood flow changes from the initial ischemic events to the late stage of infarction. Regional blood flow was measured using [14C]iodoantipyrine and a quantitative autoradiographic technique. Blood flow in regions with histologic signs of infarction (i.e., the lateral caudoputamen and adjacent neocortex) was below 0.238 ml/g/min, corresponding to 15% of normal values for those regions. In perifocal regions without infarction such as the medial caudoputamen and globus pallidus, cerebral blood flow was also reduced, but it never declined below 20% of its normal value. The decrease in cerebral blood flow was most marked during the first hours after occlusion. Thereafter, cerebral blood flow values gradually normalized, and at 4 weeks there were no significant differences compared with the contralateral side. The border between cortical regions with hypoperfusion and normal cerebral blood flow was rather sharp in the coronal plane, but in the sagittal plane there was a more gradual transitional region. The region with hypoperfusion, observed in the sagittal plane, was most widespread in the acute stage, and normalization of flow occurred particularly from anterior and posterior cortical regions toward the ischemic focus. The possibility for penumbral conditions in the cortex thus exists, particularly in the anterior and posterior borders of the infarction, and remains for several hours after the initial insult.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Bolander HG; Persson L; Hillered L; d'Argy R; Ponten U; Olsson Y.
.I 125798
.U
89318409
.S
Stroke 8910; 20(7):938-46
.M
Adenosine Triphosphate/ME; Animal; Cerebral Arteries; Cerebral Ischemia/*ET/ME/PP; Constriction; Diencephalon/*BS; Electroencephalography; Hydrogen-Ion Concentration; Male; Models, Cardiovascular; Nervous System/PP; Rats; Rats, Inbred Strains; Respiration; Telencephalon/*BS.
.T
A modified four-vessel occlusion model for inducing incomplete forebrain ischemia in rats.
.P
JOURNAL ARTICLE.
.W
The four-vessel occlusion (4VO) model of Pulsinelli and Brierley (Stroke 1979;10:267-272) has been modified for use in halothane-nitrous oxide-anesthetized, physiologically controlled rats that were ventilating spontaneously. Selection criteria for the classification of severity of ischemia were established by correlating changes in the electroencephalogram and the general physiological status with measurements of regional blood flow and regional energy metabolism. In 13% of animals, 4VO did not cause flattening of the electroencephalogram, and such animals were classified as undergoing only "oligemia." In 65% of rats, the electroencephalogram flattened and blood pressure sharply increased with 4VO, whereas spontaneous respiration continued. This group exhibited almost complete ischemia in autoradiographic blood-flow studies, severe acidosis, and depletion of adenosine 5'-triphosphate and glucose in the forebrain and, hence, was classified as the "ischemia" group. The remaining 22% stopped breathing after vascular occlusion and were rejected for further study. Survival experiments of ischemic animals revealed the typical postischemic sequelae, with primary metabolic recovery after 8 hours of recirculation in all brain structures followed after 8-24 hours by severe biochemical deterioration and neuronal death in the striatum and hippocampus. Postischemic seizure activity was rare. The main advantages of the present modification in comparison with the original method are 1) the application of anesthesia without loss of primary selection criteria, 2) the possibility of invasive physiological monitoring, and 3) the absence of postischemic seizures, which eliminates the necessity for secondary selection criteria.
.A
Schmidt-Kastner R; Paschen W; Ophoff BG; Hossmann KA.
.I 125799
.U
89318412
.S
Stroke 8910; 20(7):957-8
.M
Adult; Case Report; Cerebral Infarction/*CO/RA; Echocardiography; Heart Septal Defects, Ventricular/*CO/DI; Human; Male; Occipital Lobe/RA; Support, Non-U.S. Gov't; Tomography, X-Ray Computed.
.T
Cerebral infarction and ventricular septal defect.
.P
JOURNAL ARTICLE.
.W
With the availability of contrast echocardiography, patent foramen ovale is frequently detected in patients with stroke, especially in those with no clear etiology and/or the young patient with stroke. Before this report, an association of stroke with ventricular septal defect had not been reported. In this communication, we describe a 38-year-old patient who developed an occipital lobe infarction and who, on investigation, was found to have a ventricular septal defect. Other investigations, which included four-vessel cerebral angiography, collagen disease workup, and coagulation profile, were all normal. We believe this case further extends the spectrum of cerebral ischemic events that may occur with intracardiac shunts.
.A
Shuiab A.
.I 125800
.U
89318413
.S
Stroke 8910; 20(7):959-62
.M
Acute Disease; Cerebral Infarction/*BL; Erythrocyte Deformability/*; Human; Leukocytes, Mononuclear/*PH; Male; Neutrophils/*PH; Reference Values; Statistics; Support, U.S. Gov't, P.H.S..
.T
Blood cell rheology in acute cerebral infarction.
.P
JOURNAL ARTICLE.
.W
Recently it has been hypothesized that leukocyte rheology could be a relevant variable of the microcirculation during cerebral ischemia. However, relatively few studies have been carried out on the rheologic behavior of leukocytes in vascular diseases. This study aimed at quantifying the filterability through Nuclepore filters (mean pore diameter 5 microns) of both leukocyte subpopulations and red blood cells in patients with acute stroke compared with age-matched healthy controls. Leukocytes were separated by density into polymorphonuclear and mononuclear cells. Filterability of the red blood cells and polymorphonuclear and mononuclear subpopulations in buffer was measured using a constant-flow and low-positive pressure system. We used one-way analysis of variance, signed rank sum, and simple and multiple regression tests for statistical analysis. Twenty consecutive male patients with acute ischemic infarction were compared with 20 age-matched healthy subjects. Mononuclear cell filterability was impaired in acute stroke (7.26 +/- 2.00) compared with the controls (5.55 +/- 1.23) (p less than 0.01). Polymorphonuclear cell filterability was less, but still significantly (p less than 0.05), impaired in acute infarction (5.75 +/- 0.87 vs. 4.19 +/- 0.43). The results show that leukocyte and, especially, mononuclear cell filterability is impaired in acute infarction, while no differences exist in red blood cell filterability.
.A
Mercuri M; Ciuffetti G; Robinson M; Toole J.
.I 125801
.U
89318414
.S
Stroke 8910; 20(7):963-7
.M
Adult; Brain Diseases/ET/PA/PP; Cerebral Ventricles/*PA; Cerebrovascular Circulation; Human; Magnetic Resonance Imaging/*; Middle Age; Models, Neurological.
.T
Periventricular lesions on MRI. Facts and theories.
.P
JOURNAL ARTICLE.
.A
Chimowitz MI; Awad IA; Furlan AJ.
.I 125802
.U
89318415
.S
Stroke 8910; 20(7):968
.M
Cerebral Embolism and Thrombosis/CO/ET; Cerebral Ischemia/*DT/ET; Heparin/*TU; Human.
.T
To heparinize or not: an unsettled issue [letter]
.P
LETTER.
.A
Caplan LR.
.I 125803
.U
89318416
.S
Stroke 8910; 20(7):968-9
.M
Carotid Arteries/RA/*SU; Cerebral Angiography/AE; Endarterectomy/*; Hospitals, Teaching/*; Human; Postoperative Complications.
.T
Carotid endarterectomy in a teaching hospital [letter; comment]
.P
COMMENT; LETTER.
.A
Lyden PD; Rothrock JF; Taft BJ.
.I 125804
.U
89318441
.S
Transfusion 8910; 29(6):471-2
.M
Blood Transfusion/*UT; Human; Joint Commission on Accreditation of Healthcare Organizations; Quality Assurance, Health Care/*; United States; Utilization Review/*.
.T
Quality patient care and blood usage review [editorial]
.P
EDITORIAL.
.A
van Schoonhoven P.
.I 125805
.U
89318443
.S
Transfusion 8910; 29(6):477-85
.M
Alleles; Blood Grouping and Crossmatching; Chromosomes, Human, Pair 16; DNA Probes/*; Female; Globin/GE; Histocompatibility Testing; Human; Male; Paternity/*; Polymorphism (Genetics)/*; Probability; Restriction Fragment Length Polymorphisms/*; Support, Non-U.S. Gov't.
.T
Characteristics of a DNA probe (pa3'HVR) when used for paternity testing.
.P
JOURNAL ARTICLE.
.W
DNA probes that detect polymorphic loci in the human genome are finding widespread application in many areas of genetic testing. Paternity testing represents one area for the application of probe technology; this report presents data obtained in a paternity testing program with a probe (pa3'HVR) derived from a locus (D16S85) approximately 8 kilobases (kb) downstream from the alpha globin gene complex on chromosome 16. The pa3'HVR probe used under stringent conditions of hybridization detects a highly polymorphic locus in chromosomal DNA digested with Pvu 2 restriction endonuclease. Alleles at the D16S85 locus were grouped into 58 size bins differing from one another by 100 base pairs in the black and white populations. The most common alleles detected in whites fell into the 2.3-kb group with a collective frequency of 0.1849. In blacks, the most common allele group is 2.0 kb with a collective frequency of 0.1333. The probe was used for restriction fragment length polymorphism mapping in conjunction with standard paternity testing techniques in 100 paternity cases. Thirty direct exclusions were encountered in the 100 cases with standard testing methods, versus 27 exclusions with the pa3'HVR probe alone. Four exclusions detected with standard methods were not detected with the probe and one exclusion detected with the probe was missed by standard testing. The probability of excluding a falsely accused man by use of the pa3'HVR probe was approximately 90 percent. In cases where exclusions were not encountered, the data obtained with the pa3'HVR probe increased the paternity index calculated from standard testing by about 16-fold.2+ informative for paternity testing.
.A
Allen RW; Bliss B; Pearson A.
.I 125806
.U
89318444
.S
Transfusion 8910; 29(6):486-90
.M
Adult; Animal; Blood Grouping and Crossmatching; Blood Groups/*/IM; Blood Proteins/AN/ME; Chimpansee troglodytes/*BL; Comparative Study; Glycosylation; Hemagglutination Tests; Human; Isoantibodies; Kell Blood-Group System/*/IM; Molecular Weight; Precipitin Tests; Species Specificity; Support, U.S. Gov't, P.H.S..
.T
Comparison of human and chimpanzee Kell blood group systems.
.P
JOURNAL ARTICLE.
.W
Kell antigens on chimpanzee (Pan troglodytes) red cells were determined using specific human alloimmune and murine monoclonal antibodies. After avoidance of interspecies reactions, chimpanzee red cells were found to react with most Kell system antibodies. The chimpanzees had phenotypes similar to those of humans. The main difference was that all of 27 chimpanzee red cell samples tested were of the K:6, -7, phenotype, while in humans most are K:-6, 7. The most common chimpanzee Kell blood group phenotype was K:-1,2,-3,4,5,6,-7,11,12,13,14, 15,18,19,22. Murine monoclonal anti-K2 and -K14 immunoprecipitated a 97-kD protein from chimpanzee red cells and a 93-kD protein from human red cells. Enzymatic deglycosylation yielded proteins of about 79 kD for humans and 77 kD for chimpanzees. Both human and chimpanzee Kell proteins reacted equally well on Western blots with polyclonal rabbit antibody to human Kell protein, which indicated close homology.
.A
Redman CM; Lee S; ten Huinink D; Rabin BI; Johnson CL; Oyen R; Marsh WL.
.I 125807
.U
89318447
.S
Transfusion 8910; 29(6):500-4
.M
Blood Transfusion/*AE; Breast Neoplasms/EP/*MO/SU; Carcinoma/EP/*MO/SU; Female; Human; Mastectomy; Models, Statistical; Neoplasm Recurrence, Local; Postoperative Period; Preoperative Care; Prognosis; Random Allocation; Retrospective Studies; United States.
.T
Blood transfusion exposure does not influence survival in patients with carcinoma of the breast.
.P
JOURNAL ARTICLE.
.W
There is abundant evidence of immune modulation induced by exposure to blood transfusions. Some studies have demonstrated a detrimental effect of transfusion on the recurrence of malignant disease and survival. We retrospectively studied the impact of blood transfusion exposure on 229 patients with breast cancer who were seen from July 1973 to September 1980, had at least 5 years' follow-up and had been randomized by therapy at the time of diagnosis. The patients were divided into four groups according to transfusion history: Group 1 (111 patients), no transfusion; Group 2 (34 patients), first transfusion after mastectomy; Group 3 (41 patients), first transfusion at mastectomy; and Group 4 (43 patients), first transfusion before mastectomy. All transfused patients received red cells or whole blood or both. At the time of analysis, 124 (54%) of the patients had died. Only Group 2 was statistically associated with decreased survival; recurrence of disease was 85 percent in this group, compared with 53 percent to 61 percent in the other three groups (p = 0.006, log-rank test). In general, Group 2 patients received transfusions because of recurrent disease. We conclude that transfusions before or at mastectomy are not associated with increased recurrence or reduced survival in patients with breast cancer.
.A
Kieckbusch ME; O'Fallon JR; Ahmann DL; Moore SB.
.I 125808
.U
89318449
.S
Transfusion 8910; 29(6):508-13
.M
Adsorption; Adult; Blood Grouping and Crossmatching; Blood Groups/*IM; Coombs' Test; Human; Indicators and Reagents; Isoantibodies/*AN/GE; Male; MNSs Blood-Group System/IM; Papain/*; Phenotype; Sialoglycoproteins/IM.
.T
Heterogeneity of anti-U demonstrable by the use of papain-treated red cells.
.P
JOURNAL ARTICLE.
.W
When red cells (RBCs) are treated with papain, one form of the U antigen, which we have named UPS (U papain-sensitive), is almost completely removed or denatured. A second form, UPR (U papain-resistant), remains unaltered on the treated RBCs. Tests on 42 examples of anti-U showed that two contained only anti-UPS, 19 contained only -UPR, and 21 contained separable -UPS and -UPR. In those sera containing both antibodies, anti-UPR was always the stronger of the two. These findings suggest 1) that UPS is located on the Ss sialoglycoprotein (glycophorin B) at a position distal to a papain-sensitive site or that the cleavage point is within the portion of the SGP that comprises UPS, and 2) that UPR is located between the papain-sensitive site and the RBC membrane. The UPS determinant was not denatured by neuraminidase, L-cysteine, trypsin, ficin, or alpha-chymotrypsin, and it was only partially denatured by pronase. The finding that RBCs treated with para-chloromercuribenzoic acid or para-chloromercuriphenyl sulfonic acid did not react with anti-UPR but did continue to react with anti-UPS suggests that the in situ configuration of UPR, but not UPS, is dependent on the presence of one or more disulfide bonds. RBCs of the S-s-U+(weak) phenotype were shown to carry markedly reduced amounts of both UPS and UPR.
.A
Issitt PD; Marsh WL; Wren MR; Theuriere M; Mueller K.
.I 125809
.U
89318450
.S
Transfusion 8910; 29(6):514-20
.M
Adsorption; Antibodies, Monoclonal; Antigen-Antibody Reactions; Antilymphocyte Serum; ABO Blood-Group System/*IM; Blood Group Incompatibility/DI; Blood Grouping and Crossmatching/*/MT; Blood Platelets/*IM; Chloroquine; Human; IgG/ME; Immune Sera; Support, Non-U.S. Gov't.
.T
The importance of ABH antigens in platelet crossmatching.
.P
JOURNAL ARTICLE.
.W
In the present study, the frequency with which ABH incompatibility could be detected in platelet crossmatches was determined. The effect of chloroquine elution on ABH antigens was also evaluated, and a technique was developed to remove IgG anti-A from group O plasma using a chemically synthesized human blood group A trisaccharide antigen covalently linked to crystalline silica (Synsorb-A). Group O plasmas were found to be incompatible with 52 percent of group A platelets and 17 percent of group B platelets (p less than 0.05). In contrast, anti-A from group B plasmas rarely produced a positive crossmatch, and no anti-B that reacted with platelets could be demonstrated in group A plasmas. IgG anti-A reactions with group A platelets were eliminated in 100 percent of the group O plasmas tested after treatment with the synthetic solid-phase immunoadsorption technique. Synsorb-A may be a useful adjunct to platelet serologic testing when group O sera need to be tested against A platelets. Group A platelets bound less anti-A after exposure to chloroquine, but only 17 percent of platelets became negative when crossmatched with group O plasma. It was concluded that increased IgG binding occurs in a majority of platelet crossmatches using a k-ELISA technique when group O recipients are tested against group A donors. These results offer a potential explanation for conflicting results in studies of transfusion results with ABH-incompatible platelets. Transfusions of group B platelets to incompatible recipients may be more likely to yield satisfactory increments than incompatible transfusions of group A platelets, but this remains to be proven. There appear to be significant differences between red cells and platelets in regard to serologic reactivity in the ABH system.
.A
Heal JM; Mullin A; Blumberg N.
.I 125810
.U
89318451
.S
Transfusion 8910; 29(6):521-3
.M
Blood Component Removal/*IS; Blood Donors/*; Comparative Study; Female; Glucose/AA/AD; Human; Infusions, Intravenous; Leukocyte Count; Male; Platelet Count; Plateletpheresis/AE/*IS/MT; Prospective Studies; Support, U.S. Gov't, P.H.S..
.T
Comparison of plateletpheresis using two cell separators and identical donors.
.P
JOURNAL ARTICLE.
.W
For prospective comparison of product yield and volume, collection efficiency, white cell (WBC) and red cell (RBC) contamination, donor acceptability, and staff acceptance, each of 31 donors underwent plateletpheresis on two different cell separators (the Fenwal CS-3000 and the COBE Spectra). The same operator performed the paired procedures and collected all study data. The instruments provided equivalent high-yield platelet products (CS-3000: 5.3 x 10(11); Spectra: 5.7 x 10(11]. Platelet collection efficiency was greater with the Spectra (81%) than with the CS-3000 (57%) (p less than 0.0005). All products contained less than 1 mL of RBCs, but the Spectra products were more likely to contain less than 10(6) WBCs (14/31) than those of the CS-3000 (1/31) (p less than 0.001). In the remaining products, the mean WBC contamination was 1.0 x 10(8) for the CS-3000 and 0.03 x 10(8) for the Spectra (p less than 0.001). More ACD-A anticoagulant was infused with Spectra (463 mL) than with CS-3000 procedures (400 mL) (p = 0.002). Although postdonation ionized calcium (Ca2+) levels and the percentage of decrease in Ca2+ were not significantly different between groups, more Spectra donors experienced symptoms of hypocalcemia (20/31 vs 9/31; p = 0.015). CS-3000 products had lower mean volumes (217 mL) than Spectra collections (300 mL) (p less than 0.0005). Both instruments were accepted well by volunteer donors and the technical staff.
.A
Bertholf MF; Mintz PD.
.I 125811
.U
89318452
.S
Transfusion 8910; 29(6):524-7
.M
Bleeding Time; Blood Platelets/PH/*TR; Buffers; Cell Separation/MT; Cell Survival/*; Glucose/AA; Human; Indium Radioisotopes/DU; Liver/ME; Platelet Count; Sodium Chloride; Spleen/ME.
.T
Viability and functional integrity of washed platelets.
.P
JOURNAL ARTICLE.
.W
The viability and functional integrity of saline- and ACD-saline-washed platelets were compared with those of unwashed platelets. After template bleeding time (TBT) was measured, 15 healthy volunteers underwent plateletpheresis and ingested 600 mg of aspirin. Autologous 111In-labeled platelets were transfused: unwashed (n = 5), washed with 0.9 percent saline solution (SS) (n = 5), and washed with a buffered 12.6 percent solution of ACD-A in 0.9 percent saline solution (n = 5). After transfusion, we measured TBT at 1, 4, and 24 hours; platelet survival at 10 minutes and 1, 4, and 24 hours and daily for 6 days; and the percentage of uptake in liver and spleen by quantitative whole-body radionuclide scintigraphy at 24 and 190 hours. We found that saline washing affected platelet recovery, 23.47 +/- 12 percent (p less than 0.001) as compared to 52.43 +/- 17 percent (p less than 0.002) for ACD-saline and 73.17 +/- 8 percent for control; that saline washing resulted in a greater liver uptake than control and ACD-saline-washed platelets (31.9 +/- 8% [p less than 0.001] vs 17.7 +/- 4.1 and 19.3 +/- 2.1% [p greater than 0.1], respectively); that, unlike control and ACD-saline-washed platelets, saline-washed platelets did not shorten bleeding time; and that neither type of washing affected survival. Although ACD-saline washing affects recovery, it also results in intact function, normal survival, higher recovery than SS platelets, and no significant liver uptake.
.A
Pineda AA; Zylstra VW; Clare DE; Dewanjee MK; Forstrom LA.
.I 125812
.U
89318453
.S
Transfusion 8910; 29(6):528-33
.M
Binding, Competitive; Blood Platelets/ME/*PH/UL; Blood Preservation/*/MT; Cell Survival; Human; Microscopy, Electron, Scanning; Phosphoinositides/*BL; Plasma; Platelet Activating Factor/ME/*PD; Platelet Aggregation/*; Platelet Count; Receptors, Endogenous Substances/*AN; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tritium.
.T
Response to platelet-activating factor in human platelets stored and aged in plasma. Decrease in aggregation, phosphoinositide turnover, and receptor affinity.
.P
JOURNAL ARTICLE.
.W
Human platelet concentrates were stored in polyolefin bags at 22 to 24 degrees C on a horizontal shaker for up to 8 days. At different intervals, aliquots of platelet-rich plasma (PRP) were removed aseptically and five variables, i.e., platelet counts, morphology, platelet-activating factor (PAF)-stimulated aggregation, phosphoinositide turnover, and [3H]PAF binding to platelet receptors, were studied. The number of platelets did not change during the 8 days of storage. Scanning electron microscopy of the platelets revealed a gradual morphologic change from biconcave flat discs to irregular, crenated forms. The PAF-induced aggregation of platelets declined with time of storage. A decrease to 50 percent of the Day 1 aggregatory response to PAF was evident on Day 2, and there was a further decline to about 20 percent by Day 6. Similarly, PAF receptor-coupled phosphoinositide turnover, as monitored by 32P incorporation into individual phosphoinositides, decreased dramatically with storage. After 2 to 3 days of storage, the phosphoinositide turnover was reduced to 50 percent of the original response, and it continued to decline to about 25 percent of original response by Day 5 or 6. The binding of [3H]PAF to washed human platelets indicated subtle changes between Days 2 and 4, which became more noticeable by Day 6. These results have raised the possibility of changes in the number of the receptors and/or their affinity for the ligand during storage. We conclude that although the number of platelets was maintained during storage for 8 days, a general deterioration of their responses to PAF occurred at the levels of cell surface receptor, transmembrane signaling (phosphoinositide turnover), and response (aggregation).
.A
Shukla SD; Morrison WJ; Klachko DM.
.I 125813
.U
89318455
.S
Transfusion 8910; 29(6):539-43
.M
Beta-Thromboglobulin/AN; Blood Platelets/AN/CL/*PA; Blood Preservation; Centrifugation, Density Gradient; Cryoprotective Agents; Cytoplasmic Granules/AN; Freezing/*; Human; Lactate Dehydrogenase/BL; Platelet Aggregation; Platelet Factor 4/AN; Support, Non-U.S. Gov't; Thromboxane B2/BI.
.T
Differences in the susceptibility of platelets to freezing damage in relation to size.
.P
JOURNAL ARTICLE.
.W
Previous studies have shown that cryopreservation of normal platelets induces a reduction in the contents of secretion granules, the generation of thromboxane B2, and aggregability. The present study investigates whether these changes in the total population occur to the same extent in four size-dependent subpopulations with mean platelet volumes of 4.2, 5.7, 8.0, and 11.1 microns 3, obtained by counterflow centrifugation. Cryopreservation reduced the contents of the alpha granule markers and the generation of thromboxane B2 in the platelets from the four fractions to the same extent as in the platelets from the total suspension. Maximal aggregation of the platelets in response to collagen was measured by optical aggregation. The average decrease in light transmission after freezing was 47 +/- 3 percent (SEM) for the platelets in the total population, 40 +/- 3 percent for the largest platelets, and 65 +/- 5 percent for the smallest platelets, which indicates that aggregability was better preserved in the larger platelets than in the smaller cells. It is possible that, in the smallest platelets, a decrease in thromboxane generation of approximately 70 percent becomes rate-limiting for aggregation. Further improvements in the clinical use of freeze-preserved platelets may be sought in the preparation of concentrates with relatively high counts of large platelets.
.A
van Prooijen HC; van Heugten JG; Riemens MI; Akkerman JW.
.I 125814
.U
89318456
.S
Transfusion 8910; 29(6):544-8
.M
Blood Transfusion/*AE/MO; Case Report; Cholecystectomy/*/AE/MO; Erythroderma/*ET/MO; Female; Graft vs Host Disease/*ET/MO; Haplotypes; Histocompatibility Testing; Human; Male; Middle Age; Pedigree; Postoperative Complications/ET/MO; Retrospective Studies.
.T
Fatal erythroderma (suspected graft-versus-host disease) after cholecystectomy. Retrospective analysis.
.P
JOURNAL ARTICLE.
.W
Fatal postoperative erythroderma (POE) developed in a 52-year-old woman with gallstones who underwent elective cholecystectomy. During surgery, she was transfused with 3 units of unirradiated packed red cells stored in the liquid state for at least 4 days after collection. The POE is believed to have been the result of transfusion-associated graft-versus-host disease (TA-GVHD). The diagnosis of GVHD was based upon the characteristic clinical picture and retrospective HLA typing. The implicated donor was homozygous for an HLA haplotype that appeared to be shared with the recipient: A24-CBL-Bw52-DR2-DRw52-DQw1, the most common haplotype in the Japanese population. This case raises the possibility that a transfusion of relatively fresh blood from a donor who has no HLA antigens incompatible with the recipient may result in GVHD in patients with no apparent immunoincompetence who are undergoing relatively minor surgery with no chemotherapy or radiation therapy.
.A
Otsuka S; Kunieda K; Hirose M; Takeuchi H; Mizutani Y; Nagaya M; Sato G; Kasuya S; Matsutomo K; Noma A; et al.
.I 125815
.U
89318457
.S
Transfusion 8910; 29(6):549-51
.M
Aged; Blood Group Incompatibility/*BL/ET; Blood Grouping and Crossmatching; Blood Groups/*IM; Case Report; Cell Separation; Coombs' Test; Enterobacteriaceae Infections/*BL/CO; Human; IgA/*BI; Isoantibodies/*BI; Kell Blood-Group System/*IM; Male.
.T
Anti-K1 of the IgA class associated with Morganella morganii infection.
.P
JOURNAL ARTICLE.
.W
An anti-K1 alloantibody developed in a patient infected with Morganella morganii. The serologic behavior and response to dithiothreitol initially suggested that the alloantibody was an IgM. However, flow cytometry and the separation of immunoglobulin classes by serum chromatography revealed that the anti-K1 was constituted solely of IgA. These data suggest that bacteria-induced red cell antibodies might be of the IgA class.
.A
Pereira A; Monteagudo J; Rovira M; Mazzara R; Reverter JC; Castillo R.
.I 125816
.U
89318459
.S
Transfusion 8910; 29(6):558
.M
Blood Transfusion/*ED; Health Services Needs and Demand/*; Health Services Research/*; Human; Internship and Residency/*; United States.
.T
Resident education in transfusion medicine: a multi-institutional needs assessment [letter; comment]
.P
COMMENT; LETTER.
.A
Popovsky MA.
.I 125817
.U
89318460
.S
Transfusion 8910; 29(6):558-9
.M
Hemophilia/*CO; Hepatitis B/*CO; Human; Italy.
.T
Hepatitis B virus type 2 in Italian hemophiliacs [letter]
.P
LETTER.
.A
Tagariello G; Traldi A; Cavalletto D; Pontisso P; Alberti A.
.I 125818
.U
89318461
.S
Transfusion 8910; 29(6):559
.M
Adult; Case Report; Female; Hemagglutination Tests/*; Hemagglutinins/*PH; Human; Hydrocortisone/*IM; Pregnancy.
.T
Hydrocortisone-associated hemagglutination in a pregnant woman [letter]
.P
LETTER.
.A
Pagliaro PP; Veneroni G.
.I 125819
.U
89318463
.S
Transfusion 8910; 29(6):560-1
.M
Blood Transfusion/*/MT; Cell Separation/*/MT; Human; Reticulocytes/*.
.T
Preparation of reticulocyte-rich red cells using LeucoPREP [letter]
.P
LETTER.
.A
Nance SJ; Garratty G.
.I 125820
.U
89318464
.S
Transfusion 8910; 29(6):561
.M
Adolescence; Adult; Blood Transfusion/*AE; Child; Child, Preschool; Human; HTLV-I Infections/*ET; Middle Age; Thalassemia/*CO.
.T
HTLV-I infection in multitransfused patients with thalassemia [letter]
.P
LETTER.
.A
Politis C; Papaevangelou G; Sinakos Z; Trichopoulou E; Roumeliotou A.
.I 125821
.U
89318465
.S
Transfusion 8910; 29(6):561-2
.M
Blood Donors/*; Blood Proteins/*AN; Human; Plasmapheresis/*ST.
.T
Adaptation of the Bio-Rad protein microassay to a 96 well microtitre procedure for monitoring plasmapheresis donors [letter]
.P
LETTER.
.A
Howie RI; Murray SA; Wasi S.
.I 125822
.U
89318466
.S
Transfusion 8910; 29(6):562-3
.M
Blood Platelets/*TR; Cell Separation/*/MT; Human; Leukocytes/*.
.T
Preparation of leukocyte-poor platelet concentrates [letter] [see comments]
.P
LETTER.
.A
Patten E; Patel S.
.I 125823
.U
89318625
.S
Urol Clin North Am 8910; 16(3):417-606
.M
Adrenal Gland Diseases/*SU; Human.
.T
Adrenal surgery.
.P
JOURNAL ARTICLE.
.I 125824
.U
89318642
.S
Urol Clin North Am 8910; 16(3):607-11
.M
Human; Impotence/*SU; Male; Penile Erection; Penis/BS/*SU; Postoperative Care; Vascular Surgery/MT.
.T
Penile venous surgery.
.P
JOURNAL ARTICLE.
.W
Excessive venous flow during erection is an acknowledged cause of impotence. At the turn of the century, Wooten and Lydston reported a cure rate of roughly 50 per cent after ligation of the deep dorsal vein of the penis. In 1979, Ebbehoj and Wagner restored potency in three of four patients with venous leakage. Later, Virag reported the diagnostic technique of dynamic cavernosography and proposed deep venous ligation. In 1985, Wespes and Schulman reported an 80 per cent success rate for correction of venogenic impotence by ligating the deep dorsal vein and its tributaries. Since then, Bennett and associates have achieved success in six of eight patients, and Lewis and Puyau report a 50 to 75 per cent success. With the technique described above, after careful selection and proper diagnostic testing, impotence has resolved or erection improved in more than 80 per cent of our patients.
.A
Lue TF.
.I 125825
.U
89318662
.S
Urology 8910; 34(1):1-9
.M
Adenocarcinoma/MO/*RT; Aged; Animal; Comparative Study; Fast Neutrons/*TU; Follow-Up Studies; Human; Male; Neoplasm Recurrence, Local; Neutrons/*TU; Prospective Studies; Prostatic Neoplasms/MO/*RT; Radiation Dosage; Random Allocation; Support, U.S. Gov't, P.H.S..
.T
Fast neutron radiotherapy for locally advanced prostate cancer. Update of a past trial and future research directions.
.P
JOURNAL ARTICLE.
.W
Between June, 1977, and April, 1983, the Radiation Therapy Oncology Group (RTOG) sponsored a phase III study comparing fast neutron radiotherapy as part of a mixed beam (neutron/photon) regimen with conventional photon (x-ray) radiotherapy for patients with locally advanced (Stages C and D1) adenocarcinoma of the prostate. A total of 91 analyzable patients were entered into the study with the two treatment groups balanced in regard to all major prognostic variables. The current analysis is for a median follow-up of 6.7 years (range 3.4-9.0 yrs.). The results are statistically significant in favor of the mixed-beam group of all parameters mentioned. At five years the freedom from local/regional relapse rate is 81 percent on the mixed-beam arm compared with 60 percent on the photon arm. The actuarial overall survival rate at five years is 70 percent on the mixed beam compared with 56 percent on the conventional photon arm. The determinantal survival at five years (which excluded death due to intercurrent disease in patients clinically free of cancer) was 82 percent on the mixed-beam arm compared with 61 percent on the photon arm. The type of therapy appeared to be the most important predictor of both local tumor control and patient survival in a step-wise Cox analysis. There was no difference in the treatment-related morbidity for the two patient groups. Mixed-beam therapy may be superior to standard photon radiotherapy for treatment of locally advanced prostate cancer.
.A
Krieger JN; Krall JM; Laramore GE; Russell KJ; Thomas FS; Maor MH; Hendrickson FR; Griffin TW.
.I 125826
.U
89318664
.S
Urology 8910; 34(1):14-7
.M
Antineoplastic Agents, Combined/AE/*TU; Bleomycins/AD; Cisplatin/AD; Combined Modality Therapy; Follow-Up Studies; Human; Ifosfamide/AD; Retroperitoneal Neoplasms/DT/MO/SU/*TH; Retrospective Studies; Risk Factors; Teratoma/*DT; Vinblastine/AD.
.T
Risk/benefit of treating retroperitoneal teratoid bulky tumors.
.P
JOURNAL ARTICLE.
.W
Inductive polychemotherapy of germinal cell tumors in advanced stages (T0-4N3M0,1) is effective, yet accompanied by serious side effects. Partial remission necessitates resection of the residual tumor. The complications of the salvage operation are tolerable in proportion to its curativity. In a retrospective analysis, we evaluated the occurrence of toxic side effects and the frequency of intra- and postoperative complications in 128 patients with retroperitoneal teratoid bulky tumor. With a follow-up of three to one hundred ten months (means = 43 months), 91 patients (71%) are alive without evidence of disease; 28 patients (22%) died of apparent tumor progression.
.A
Jaeger N; Weissbach L; Hartlapp JH; Vahlensieck W.
.I 125827
.U
89318666
.S
Urology 8910; 34(1):22-7
.M
Adult; Follow-Up Studies; Human; Impotence/*SU; Ligation/MT; Male; Middle Age; Penis/*BS/SU; Postoperative Complications; Recurrence; Veins/SU; Venous Insufficiency/*SU.
.T
Venous surgery in erectile dysfunction: a critical report on 116 patients.
.P
JOURNAL ARTICLE.
.W
From June, 1985, to December, 1987, we operated on 116 impotent patients suffering from venous incompetence of the cavernous bodies. A total of 115 patients underwent ligation of the deep dorsal vein of the penis. After a mean follow-up of 12.9 months, 67 patients (58.3%) were still able to obtain satisfactory erections. In 39 cases (33.9%), however, adjuvant corpus cavernosum autoinjection therapy was necessary. Eleven patients were submitted to spongiosolysis after ligation of the deep dorsal penile vein because of a distal venous leakage, consisting of venous shunts between the corpora cavernosa and the corpus spongiosum. After a mean follow-up of 14.2 months, 9 patients (81.8%) reported excellent penile rigidity; 5 of these patients, however, needed corpus cavernosum autoinjection therapy to maintain erectile function. One patient with ectopic veins emerging from the right crus of the penis was operated on successfully from a perineal approach. Serious complications did not occur in any of the patients. Despite the recurrence rate of 13 percent, venous surgery is an effective treatment for most patients concerned and offers a more physiologic erectile function than can be achieved by implantation of a penile prosthesis.
.A
Treiber U; Gilbert P.
.I 125828
.U
89318667
.S
Urology 8910; 34(1):28-32
.M
Adult; Aged; Human; Impotence/*DI/ET/RI; Male; Middle Age; Papaverine/*DU; Penis/*BS/RI; Regional Blood Flow; Support, Non-U.S. Gov't; Vascular Diseases/*CO; Venous Insufficiency/CO/RI; Xenon Radioisotopes/*DU.
.T
Diagnosis of vasculogenic impotence: combination of penile xenon-133 washout and papaverine tests.
.P
JOURNAL ARTICLE.
.W
The present study evaluates both penile xenon-133 washout (XWT) and papaverine tests (PT) in the diagnosis of vasculogenic impotence. XWT was accomplished by subcutaneous injection of xenon-133 (1-2 mCi in 0.1 mL saline solution) into the dorsal coronal prepuce. Abnormal XWT was suggested in patients whose clearance time (T1/2) was longer than 7.5 minutes and whose penile blood flow rate (Q) was less than 6 mL/100 g tissue/min. PT was done by intracavernous injection of papaverine (60 mg in 20 mL normal saline). Abnormal PT was indicated in patients whose onset of full erection was more than ten minutes after papaverine injection and whose duration of erection was less than one hour. Ten young and 11 older normal volunteers were examined with XWT only; all showed normal results. A total of 60 impotent patients were examined with both XWT and PT and were classified into four groups: in 2 patients (3.3%) both XWT and PT were normal (group I); in 8 (13.3%) XWT was abnormal and PT normal (group II); in 14 (23.3%) XWT was normal and PT abnormal (group III); and in 36 (60%) both XWT and PT were abnormal (group IV). On further examination with bilateral hypogastric arteriography in 10 XWT-abnormal patients and on surgical correction of abnormal curvature in 5 XWT-abnormal patients, all (100%) were proved to have penile arterial insufficiency. Erection cavernosography performed in 15 PT-abnormal patients confirmed penile venous insufficiency in 80 percent. We conclude both XWT and PT are simple and effective for evaluation of the penile arterial blood flow and venous competence, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Lin SN; Liu RS; Yu PC; Chang LS; Yeh SH; Kuo JS.
.I 125829
.U
89318668
.S
Urology 8910; 34(1):33-5
.M
Adult; Bladder/*; Case Report; Endoscopy/*; Foreign Bodies/*TH; Human; Male; Urethra/*.
.T
Endoscopy for removal of unusual foreign bodies in urethra and bladder.
.P
JOURNAL ARTICLE.
.W
Numerous reports have been published concerning intraurethral foreign bodies. Two patients required endoscopic intervention: one for the removal of screws from the urethra and the other for extraction of a calculus. The technique utilized the Wolf universal nephroscope and stone dislodger with 3 jaws, and its success prevented a more aggressive surgical approach.
.A
Schnall RI; Baer HM; Seidmon EJ.
.I 125830
.U
89318670
.S
Urology 8910; 34(1):39-42
.M
Adult; Carcinoma in Situ/*CO/PA; Carcinoma, Transitional Cell/*CO/PA; Case Report; Female; Hemorrhage/*ET; Human; Kidney Diseases/*ET; Kidney Neoplasms/*CO/PA; Kidney Pelvis/PA.
.T
Severe hemorrhage secondary to primary, isolated in situ carcinoma of renal pelvis.
.P
JOURNAL ARTICLE.
.W
Primary transitional cell carcinoma in situ of the renal pelvis is usually found in association with ureteral or vesical neoplasms. However, a case of primary carcinoma in situ of the renal pelvis without previous or concomitant ureteral or vesical carcinoma is presented. Microscopic hematuria is a common finding in cases of carcinoma in situ. Gross hematuria is unusual, but not rare. However, severe hemorrhage (hematocrit 12.1, hemoglobin 3.3 g/dL) as the presenting feature is rare. Diagnosis of such microscopic isolated lesions can be difficult to make pre-operatively. Only after nephrectomy will such a lesion be diagnosed, as was the case in this patient.
.A
Gonzales J; Hashmat AI.
.I 125831
.U
89318671
.S
Urology 8910; 34(1):43-5
.M
Bladder Neck Obstruction/*ET; Case Report; Human; Male; Middle Age; Necrosis; Prostate/PA; Prostatitis/*CO/PA; Wegener's Granulomatosis/*CO.
.T
Wegener granulomatosis: prostatic involvement and bladder outlet obstruction.
.P
JOURNAL ARTICLE.
.W
Renal involvement is present in about 90 percent of patients with Wegener granulomatosis and only sporadically is the remainder of the genitourinary tract affected. Prior to 1974, the mean survival rate was five months from the time of diagnosis. Since 1974, therapy with cytotoxic drugs, cyclophosphamide or azathioprine, has produced remissions in about 95 percent of patients. Herein, a case is reported that presented with bladder outlet obstructive symptoms, secondary to prostatic involvement with Wegener granulomatosis. After treatment with cyclophosphamide and prednisone, the patient's urinary obstructive symptoms promptly resolved.
.A
Vaught WW; Wilson TM; Raife MJ; Horne DW.
.I 125832
.U
89318673
.S
Urology 8910; 34(1):49
.M
Bandages/*; Hemostasis, Surgical/*IS; Human; Hypospadias/*SU; Male.
.T
Simple effective hypospadias repair dressing.
.P
JOURNAL ARTICLE.
.A
Patil UB; Alvarez J.
.I 125833
.U
89318674
.S
Urology 8910; 34(1):50
.M
Administration, Intravesical; Formaldehyde/*AD/AE; Human; Urinary Diversion/*/MT.
.T
Is there a safe intravesical use of 10% formalin?
.P
JOURNAL ARTICLE.
.A
Zimmern PE; Zappala SM; Stratton MJ.
.I 125834
.U
89318676
.S
Urology 8910; 34(1):56-7
.M
Adult; Bladder Neoplasms/*PA/PP; Case Report; Female; Human; Leiomyoma/*PA/PP; Urodynamics.
.T
Bladder leiomyoma.
.P
JOURNAL ARTICLE.
.W
We herein present a case of leiomyoma of the urinary bladder discovered during evaluation for stress urinary incontinence. The histologic findings of this benign tumor and its urologic implications are reviewed.
.A
Jacobs MA; Bavendam T; Leach GE.
.I 125835
.U
89318678
.S
Urology 8910; 34(1):62-4
.M
Adolescence; Child; Child, Preschool; Comparative Study; DTPA/DU; Female; Human; Injections, Intravenous; Kidney/*IN/RA/RI; Male; Urography.
.T
A comparative study of intravenous urograms and radionuclide renal scans in diagnosis of renal trauma.
.P
JOURNAL ARTICLE.
.W
We analyzed 31 patients who underwent intravenous urograms (IVU) and radionuclide renal scans (RNRS) in the investigation of blunt abdominal trauma, and compared the IVU to the RNRS in the definition of blunt renal injuries, and their correlation with patients' symptoms and signs. Thirteen patients had abnormal IVU and 12 had abnormal RNRS (42% of the 31 patients). In 8 patients findings on IVU correlated with those on RNRS (62%), and in 5 patients findings were different (38%). Only 2 patients (6.5%) had significant differences which may have influenced further treatment. Only 1 patient required operative management. Follow-up IVUs were performed on 6 of the 13 patients who had abnormal radiologic studies. The radionuclide renal scan was shown to be as accurate as the intravenous urogram in defining renal trauma. Patients who undergo liver-spleen scans for investigation of blunt abdominal trauma, and who may have renal trauma, may well undergo RNRS at the same time and obviate the need for an IVU, without any diagnostic compromise.
.A
Flax S; McLorie G; Churchill BM; Gilday DL.
.I 125836
.U
89318679
.S
Urology 8910; 34(1):65-7
.M
Adult; Aged; Binding Sites; Carcinoma, Renal Cell/*AN; Female; Human; Kidney Neoplasms/*AN; Male; Middle Age; Receptors, Estrogen/*AN; Receptors, Progesterone/*AN.
.T
Estrogen and progesterone binding sites in renal cell carcinoma.
.P
JOURNAL ARTICLE.
.W
Twenty-five renal cell carcinomas were assayed for estrogen and progesterone receptor levels. Estrogen specific binding was present in only 4 patients (16%) and progesterone specific binding in 7 patients (28%). In all cases these receptors were present in very low titers, less than 10 fm/mg. We believe that earlier reports citing significant estrogen and progesterone binding activity may reflect high levels of nonspecific protein binding.
.A
Orovan WL; Ryan ED.
.I 125837
.U
89318953
.S
West J Med 8910; 150(6):662-4
.M
Adolescence; Adult; Aorta, Thoracic/*IN/SU; Emergencies; Female; Human; Male; Middle Age; Wounds, Nonpenetrating/*SU.
.T
Surgical management of traumatic disruption of the descending aorta.
.P
JOURNAL ARTICLE.
.W
During an 11 1/2-year period, 20 consecutive patients presenting with a traumatic disruption of the proximal descending aorta underwent an emergency operative repair. The mean age was 26 years (range 15 to 62), and 13 (65%) were male. Associated injuries were frequent and required additional major operative procedures in half of the cases. Two patients died as a result of associated intracranial injuries, for a hospital survival of 90%. The operative repair was accomplished by graft replacement of the involved segment of the aorta in all but one patient who underwent a primary repair. Simple aortic crossclamping was used in 8 patients (40%) and heparinless femoral-femoral venoarterial bypass in 12 patients (60%). Neither renal failure nor paraplegia in any of the patients. Four patients required thoracic reoperations. These results indicate that an aggressive multidisciplinary surgical approach can produce favorable results in patients with traumatic descending aortic injuries.
.A
Young JN; Stallone RJ; Iverson LI; Ennix CL Jr; Ecker RR; May IA.
.I 125838
.U
89318957
.S
West J Med 8910; 150(6):687
.M
Human; Quality of Health Care/*.
.T
Now that health care is worth something [editorial]
.P
EDITORIAL.
.I 125839
.U
89318958
.S
West J Med 8910; 150(6):687-9
.M
Acquired Immunodeficiency Syndrome/*CO; Human; Opportunistic Infections/*CO; Tuberculosis/*CO.
.T
Tuberculosis and HIV infection--new opportunities for an old pathogen [editorial]
.P
EDITORIAL.
.A
Chaisson RE.
.I 125840
.U
89318959
.S
West J Med 8910; 150(6):689-90
.M
Fractures, Ununited/*/TH; Human; Leg Injuries/*.
.T
Fracture nonunion [editorial]
.P
EDITORIAL.
.A
Gershuni DH.
.I 125841
.U
89318960
.S
West J Med 8910; 150(6):691-4
.M
Aged; Case Report; Extremities; Female; Human; Middle Age; Neck; Paralysis/*ET; Spinal Cord Injuries/*CO; Syndrome.
.T
Central cervical spinal cord syndrome due to minor hyperextension injury [see comments]
.P
JOURNAL ARTICLE.
.A
Peterson DI; Altman K.
.I 125842
.U
89318961
.S
West J Med 8910; 150(6):694-6
.M
Aged; Aneurysm, Infected/*CO; Aorta, Abdominal; Aortic Aneurysm/*CO; Case Report; Fever of Unknown Origin/*ET; Human; Male.
.T
Mycotic aneurysm presenting as fever of unknown origin.
.P
JOURNAL ARTICLE.
.A
Asthana S; Walker D; Iyengar S; Shafran S; Conly J.
.I 125843
.U
89318962
.S
West J Med 8910; 150(6):697
.M
Human; Osteoporosis/*PC.
.T
Preventing osteoporosis [letter]
.P
LETTER.
.A
Bailie IE.
.I 125844
.U
89318963
.S
West J Med 8910; 150(6):697 -8
.M
Air Pollutants/*AN; Air Pollutants, Radioactive/*AN; California; Radon/*AN.
.T
Radon testing of California homes [letter]
.P
LETTER.
.A
Kizer KW.
.I 125845
.U
89318964
.S
West J Med 8910; 150(6):698
.M
Animal; Ants; California; Cockroaches; Insecticides/*; Pest Control/*LJ.
.T
"Miraculous insecticide chalk"--An unregistered household insecticide [letter]
.P
LETTER.
.A
Kizer KW; Poorbaugh JH.
.I 125846
.U
89318965
.S
West J Med 8910; 150(6):698
.M
Blood Gas Monitoring, Transcutaneous; Human; Sleep Apnea Syndromes/*DI.
.T
Screening for sleep apnea [letter]
.P
LETTER.
.A
Nestor JJ; Likosky W; Sinclair G.
.I 125847
.U
89318966
.S
West J Med 8910; 150(6):698-9
.M
Amoxicillin/*PO; Case Report; Child, Preschool; Hematuria/*CI; Human; Male.
.T
Amoxicillin overdose with gross hematuria [letter]
.P
LETTER.
.A
Bright DA; Gaupp FB; Becker LJ; Schiffert MG; Ryken TC.
.I 125848
.U
89318968
.S
West J Med 8910; 150(6):705-7
.M
Aged; Attitude of Health Personnel/*SN; Comparative Study; Decision Making; Female; Human; Life Support Care/SN; Male; Nurse-Patient Relations; Nurses/*; Patient Participation/*; Physician-Patient Relations; Physicians/*; Quality of Life; Respiration, Artificial; Resuscitation/*SN; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Washington.
.T
Understanding of elderly patients' resuscitation preferences by physicians and nurses.
.P
JOURNAL ARTICLE.
.W
We compared the understanding by family physicians and nurses of their elderly outpatients' preferences for cardiopulmonary resuscitation and mechanical ventilation under 3 scenarios reflecting varying qualities of life. Physicians and nurses correctly predicted patients' treatment preferences in from 59% to 84% and 53% to 78% of cases, respectively, for the various decisions. For most decisions, neither physicians nor nurses were significantly more accurate in their predictions than expected by chance alone. Moreover, nurses and physicians did not significantly agree with one another in their predictions of patients' preferences for any of these decisions. These results suggest that while nurses' and physicians' perceptions of patients' preferences for life-sustaining treatment are not necessarily similar, neither nurses nor physicians systematically understand their elderly patients' resuscitation preferences.
.A
Uhlmann RF; Pearlman RA; Cain KC.
.I 125849
.U
89318969
.S
West J Med 8910; 150(6):708-13
.M
Adolescence; Adult; Caucasoid Race; Female; Hispanic Americans/*; Human; Indians, North American/*; Male; Mexico/EH; Middle Age; New Mexico; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Wounds and Injuries/EH/*MO.
.T
Injury mortality in New Mexico's American Indians, Hispanics, and non-Hispanic whites, 1958 to 1982.
.P
JOURNAL ARTICLE.
.W
New Mexico has extraordinarily high injury mortality rates. To better characterize the injury problem in New Mexico, we calculated proportionate injury mortality and age-adjusted and age-specific injury mortality rates for the state's 3 major ethnic groups--American Indians, Hispanics, and non-Hispanic whites. According to death certificate data collected from 1958 to 1982 and US population census figures, age-adjusted mortality rates for total external causes varied widely between the sexes and among the ethnic groups. Males in each ethnic group consistently had higher average annual age-adjusted external mortality rates than females. Injury mortality rates for American Indians of both sexes were 2 to 3 times higher than those for the other New Mexico ethnic groups. Motor vehicle crashes were the leading cause of death from injury for all 3 groups. Homicide accounted for twice the proportion of injury death in Hispanic compared with non-Hispanic white males (12.5% and 6.1%, respectively), while the proportion of males dying of suicide was highest in non-Hispanic whites. Deaths from excessive cold and exposure were leading causes of injury mortality for American Indians, but these causes were not among the leading causes of injury mortality for Hispanics or non-Hispanic whites. We conclude that the minority populations in New Mexico are at high risk for injury-related death and that the major causes of injury mortality vary substantially in the state's predominant ethnic populations.
.A
Sewell CM; Becker TM; Wiggins CL; Key CR; Hull HF; Samet JM.
.I 125850
.U
89318970
.S
West J Med 8910; 150(6):714-7
.M
Attitude of Health Personnel/*SN; Female; Human; Male; Marijuana Smoking/*LJ; Middle Age; Physicians/*; Street Drugs; Support, U.S. Gov't, P.H.S.; United States.
.T
Physicians' attitudes toward the legalization of marijuana use.
.P
JOURNAL ARTICLE.
.W
We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.
.A
Linn LS; Yager J; Leake B.
.I 125851
.U
89318971
.S
West J Med 8910; 150(6):718-22
.M
California; Cost Control; Hospital Bed Capacity, 300 to 499; Hospitals, Teaching/*UT; Human; Professional Staff Committees; Utilization Review/*OG.
.T
An example of hospital utilization review.
.P
JOURNAL ARTICLE.
.A
Wilson LD.
.I 125852
.U
89319735
.S
J Am Board Fam Pract 8910; 2(3):143-4
.M
Certification/*; Family Practice/*; Human; United States.
.T
Certificates of added qualifications [editorial]
.P
EDITORIAL.
.A
Pisacano NJ.
.I 125853
.U
89319738
.S
J Am Board Fam Pract 8910; 2(3):154-5
.M
Acquired Immunodeficiency Syndrome/*CO; Human; Syphilis/CO/DI/*TH.
.T
Diagnosis and treatment of syphilis in HIV-infected patients.
.P
JOURNAL ARTICLE.
.A
Goldschmidt RH.
.I 125854
.U
89319741
.S
J Am Board Fam Pract 8910; 2(3):169-71
.M
Adult; Cesarean Section/*; Delivery/*; Family Practice; Female; Hospitals, Community; Human; Infant, Newborn; Internship and Residency; Pennsylvania; Pregnancy; Reoperation; Trial of Labor/*.
.T
Vaginal birth after cesarean section in a community hospital: a family practice residency experience.
.P
JOURNAL ARTICLE.
.W
Several tertiary care, multicenter studies have shown vaginal birth after Cesarean section (VBAC) to be a viable alternative in a select patient population. The premise of our study was that VBAC is a safe option in a community hospital setting. Any patient meeting the criteria of the American College of Obstetricians and Gynecologists (ACOG) was eligible for a trial of labor, and ACOG guidelines regarding mandatory facilities and personnel were followed. One hundred six women with a history of previous Cesarean section were delivered of infants during the study period. Of these, 16 attempted a trial of labor, and 13 (81.3 percent) had vaginal births with minimum morbidity. There were no instances of scar disruption. Thirty-nine percent of the patients who were successful with VBAC had had a previous vaginal birth. By offering VBAC, the participating physicians were able to reduce their repeat Cesarean section rate by 12 percent.
.A
Guerdan BR; McKenna JP; Wright JC.
.I 125855
.U
89319742
.S
J Am Board Fam Pract 8910; 2(3):172-90; discussion 190
.M
Antihypertensive Agents/AE/*TU; Atenolol/AE/TU; Drug Combinations/AE/TU; Enalapril/AE/TU; Family Practice; Human; Hydrochlorothiazide/AE/TU; Hypertension/*DT/PP; Middle Age; Prospective Studies; Quality of Life; Support, Non-U.S. Gov't; Triamterene/AE/TU; United States; Verapamil/AE/TU.
.T
Managing hypertension in family practice: a nationwide collaborative study of the use of four antihypertensives in the treatment of mild-to-moderate hypertension. A report from CEN. Clinical Experience Network.
.P
JOURNAL ARTICLE.
.W
The goals of this prospective, nonexperimental study were to examine the ways in which family physicians select from among four antihypertensive agents for their patients and to provide an overall perspective on how these agents perform in the management of hypertension in primary care. Three hundred seventy-eight family physicians treated 3608 mild and moderate hypertensives with one of the following medications: atenolol (n = 564 patients), enalapril maleate (n = 677), verapamil hydrochloride in sustained-release form (n = 1861), or a fixed combination, hydrochlorothiazide/triamterene (n = 506). The resultant four groups of patients differed in several demographic and clinical measures: age, gender, race, concurrent disease, diastolic and systolic blood pressures, heart rate, and history of hypertension. The patient profiles for each group suggest appropriate matching of drugs to individual patient needs: younger patients and those with higher heart rates more often received the beta-blocker; blacks were more frequently assigned to the diuretic and less often to the beta-blocker; patients with concurrent diseases and a longer history of hypertension were more often assigned to the angiotensin-converting-enzyme (ACE) inhibitor or the calcium channel blocker. Rates of success, defined by the percentages of patients staying on the selected drug and experiencing a reduction of at least 10 mmHg or achieving a diastolic pressure less than or equal to 90 mmHg, were in the same range for all four groups (55 to 62.5 percent). Patients evaluated their quality of life and gave enalapril and verapamil SR the highest ratings. The rapid completion of the study, the quality of the results, and the high rates of follow-up and compliance show that family practice is an excellent setting for conducting clinical research.
.I 125856
.U
89319745
.S
J Am Board Fam Pract 8910; 2(3):204-7
.M
Adenocarcinoma/*PA/SU; Adult; Case Report; Colonic Polyps/*PA/SU; Colonoscopy; Human; Male; Physicians, Family.
.T
Small colon polyps: the primary physician's dilemma.
.P
JOURNAL ARTICLE.
.W
This case report and literature review is presented to alert primary care physicians performing flexible sigmoidoscopy and limited colonoscopy to the malignant potential of even diminutive polyps. The term "polyp" refers to any circumscribed mass of tissue that arises from mucosa and protrudes into the lumen of the gastrointestinal tract. The significance of this lesion in the rectum and colon is its propensity for malignant change. Although small polyps in the region of the rectum tend to be hyperplastic and those more proximal tend to be adenomas with a significant malignant potential, there is no way to distinguish them visually; hence, all need to be biopsied. The following case report shows the necessity of identifying neoplastic lesions within diminutive polyps (less than 1 cm). Standard biopsy technique usually removes these lesions; nevertheless, when histology confirms the presence of adenoma or carcinoma, the patient requires additional evaluation of the entire large intestine and more frequent follow-up examinations.
.A
Varma JR; Melcher RE.
.I 125857
.U
89319746
.S
J Am Board Fam Pract 8910; 2(3):208-11
.M
Adolescence; Athletic Injuries/*CO; Axillary Vein/*; Case Report; Constriction, Pathologic/CO; Contraceptives, Oral, Synthetic/*AE; Female; Human; Ribs/*; Subclavian Vein/*; Syndrome; Thrombosis/*ET.
.T
"Effort" thrombosis of the axillary and subclavian vein associated with cervical rib and oral contraceptives in a young woman athlete.
.P
JOURNAL ARTICLE.
.W
"Effort" thrombosis, also called the Paget-Schroetter syndrome or primary thrombosis of the upper extremity, has been well documented in the literature. However, in our review of the United States, Canadian, and British literature, we found only 52 cases in which it was related to sports participation. We report a case of axillary and subclavian vein "effort" thrombosis in a young woman athlete, who was predisposed to thrombosis by all three postulates of the Virchow triad: namely, (1) stasis caused by constriction from a cervical rib, (2) increased coagulability as a result of oral contraceptive use, and (3) vessel wall injury because of competitive softball participation. Of the available therapeutic plans, we believe that athletes with "effort" thrombosis should have aggressive treatment that is initiated as early as possible to prevent swelling, tingling numbness, easy fatigue of the arm, and pain on prolonged use of the affected extremity.
.A
Aquino BC; Barone EJ.
.I 125858
.U
89319748
.S
J Am Board Fam Pract 8910; 2(3):216-7
.M
Agoraphobia/*ET; Fear/*; Human; Panic/*; Phobic Disorders/*ET.
.T
Panic-agoraphobia [letter; comment]
.P
COMMENT; LETTER.
.A
Gulledge AD.
.I 125859
.U
89319749
.S
J Am Board Fam Pract 8910; 2(3):217-8
.M
False Negative Reactions; Female; Human; Pregnancy; Puerperium/*; Vaginal Smears/*.
.T
Postpartum pap smear [letter; comment]
.P
COMMENT; LETTER.
.A
Baxley EG.
.I 125860
.U
89319750
.S
J Am Board Fam Pract 8910; 2(3):218
.M
Cesarean Section; Family Practice/*; Female; Human; Pregnancy; Prenatal Care/*; Rural Population/*.
.T
Rural obstetric care [letter; comment]
.P
COMMENT; LETTER.
.A
Allen W.
.I 125861
.U
89319751
.S
J Am Board Fam Pract 8910; 2(3):218-20
.M
Anesthesia, Epidural/*; Anesthesia, Obstetrical/*; Female; Human; Pregnancy.
.T
Epidural anesthesia [letter; comment]
.P
COMMENT; LETTER.
.A
Grumboch K; Abrams Y.
.I 125862
.U
89319753
.S
J Am Board Fam Pract 8910; 2(3):220-1
.M
Adult; Blood Gas Analysis; Female; Human; Pulmonary Embolism/BL; Thromboembolism/*BL.
.T
Thromboembolic disorders [letter; comment]
.P
COMMENT; LETTER.
.A
Allen BD.
.I 125863
.U
89320201
.S
AJR Am J Roentgenol 8910; 153(2):257-60
.M
Aged; Atelectasis/*RA; Follow-Up Studies; Human; Lung/*RA; Male; Middle Age; Pleura/RA; Tomography, X-Ray Computed/*.
.T
CT features of rounded atelectasis.
.P
JOURNAL ARTICLE.
.W
Rounded atelectasis (folded lung syndrome) is a form of pulmonary collapse associated with pleural thickening that can mimic a neoplasm on plain chest radiographs. The abnormality was diagnosed radiologically in nine patients in whom follow-up varied from 1 to 6 years. Four patients had bilateral lesions, making a total of 13 examples. The CT findings were analyzed and compared with previously published criteria for the diagnosis of this disorder. In all cases, CT showed a rounded mass, 3.5-7.0 cm in diameter, abutting a thickened pleural surface in the lung periphery. The margin closest to the hilum was blurred by the entering vessels in 92% of the cases. Our experience suggests that the CT findings of rounded atelectasis are characteristic of the abnormality.
.A
McHugh K; Blaquiere RM.
.I 125864
.U
89320202
.S
AJR Am J Roentgenol 8910; 153(2):261-3
.M
Aged; Aged, 80 and over; Biopsy; Breast Neoplasms/DI/*SU; Comparative Study; Female; Human; Mastectomy; Methylene Blue/DU; Middle Age; Prospective Studies; Rosaniline Dyes/DU; Tolonium Chloride/*DU.
.T
Toluidine blue dye as a breast localization marker.
.P
JOURNAL ARTICLE.
.W
We compared the efficacy of toluidine blue dye vs methylene blue as a visual marker for breast localizations in vitro and in vivo. In phase 1, the dyes were injected into 10 mastectomy specimens and allowed to diffuse for 24-48 hr. In phase 2, the breasts of four premastectomy patients were injected with the dyes and the dyes were allowed to diffuse for 3 3/4, 12, 24, and 47 hr before mastectomy. In phase 3, the breasts of 18 women in whom 20 breast localizations were performed before excisional biopsy were injected with methylene blue or toluidine blue up to 2 hr 10 min before the biopsy. All excised stained breast tissue was evaluated blindly. The amount of pain associated with injections of the dye was recorded. The 22 women in phases 2 and 3 had had mammograms before, and the parenchymal patterns had been classified according to Wolfe. In the patients injected 3 3/4, 12, 24, and 47 hr before mastectomy, more intense staining with less diffusibility was seen with toluidine blue than with methylene blue. In the 20 localization procedures before excisional biopsy, no difference in intensity of staining or radius of diffusion was seen between methylene blue and toluidine blue with maximal diffusion times of 2 hr 10 min. Breast parenchymal pattern did not correlate with stain intensity or diffusibility. The six patients in whom both methylene blue and toluidine blue were injected and the 18 patients in whom either dye was injected felt less discomfort at the time of injection of toluidine blue than of methylene blue. Our results suggest that toluidine blue causes less discomfort and produces a more intense stain with a smaller diffusion radius than methylene blue regardless of breast parenchymal pattern.
.A
Czarnecki DJ; Feider HK; Splittgerber GF.
.I 125865
.U
89320203
.S
AJR Am J Roentgenol 8910; 153(2):265-71
.M
Adult; Aged; Breast Neoplasms/PA/*RA; Calcinosis/PA/RA; Carcinoma/PA/*RA; Female; Human; Mammography/*; Middle Age.
.T
Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation.
.P
JOURNAL ARTICLE.
.W
Of the five identified radiographic patterns of ILC, the most common was a poorly defined asymmetric density with architectural distortion. Areas of ILC frequently are of low density, not much greater than that of the surrounding parenchyma. The mammographic appearance may reflect the behavior of ILC tumor cells, which travel in linear array ("single file") along and around the arborizing ducts that serve as scaffolding for these small, malignant cells that permeate the parenchyma without a central nidus. This feature of ILC may also help explain why tumors may be palpable as areas of vague induration or thickening rather than as discrete masses. When tumors are hidden in dense breast tissue (pattern 3) and not well imaged by mammography or when there are subtle mammographic changes (pattern 1), sonography may help confirm the presence of a solid mass. Most of the suspected tumors imaged by sonography were palpable as discrete masses or areas of induration.
.A
Mendelson EB; Harris KM; Doshi N; Tobon H.
.I 125866
.U
89320204
.S
AJR Am J Roentgenol 8910; 153(2):272
.M
Breast Neoplasms/RA/*SU; Female; Human; Mammography/*MT; Posture.
.T
Preoperative localization of inferior breast lesions.
.P
JOURNAL ARTICLE.
.A
Pisano ED; Hall FM.
.I 125867
.U
89320205
.S
AJR Am J Roentgenol 8910; 153(2):273-4
.M
Catheterization/IS/*MT; Female; Galactorrhea/*RA; Human; Lactation Disorders/*RA; Mammography/*MT.
.T
A coaxial technique for performing galactography.
.P
JOURNAL ARTICLE.
.A
Berna JD; Guirao J; Garcia V.
.I 125868
.U
89320206
.S
AJR Am J Roentgenol 8910; 153(2):275-6
.M
Anaphylaxis/*CI; Barium Sulfate/*AE/DU; Case Report; Colon/*RA; Enema/*; Female; Human; Middle Age.
.T
Fatal hypersensitivity reaction during a barium enema [see comments]
.P
JOURNAL ARTICLE.
.A
Feczko PJ; Simms SM; Bakirci N.
.I 125869
.U
89320207
.S
AJR Am J Roentgenol 8910; 153(2):277-80
.M
Biomechanics; Deglutition/*; Esophagogastric Junction/PH/RA; Human; Image Processing, Computer-Assisted/*; Methods; Oropharynx/PH/*RA; Posture; Support, U.S. Gov't, P.H.S.; Video Recording/*.
.T
Interactive computer program for biomechanical analysis of videoradiographic studies of swallowing.
.P
JOURNAL ARTICLE.
.A
Logemann JA; Kahrilas PJ; Begelman J; Dodds WJ; Pauloski BR.
.I 125870
.U
89320210
.S
AJR Am J Roentgenol 8910; 153(2):291-2
.M
Cholelithiasis/*TH; Human; Lithotripsy/*.
.T
The current status of biliary lithotripsy: a survey of members of the Society of Gastrointestinal Radiologists.
.P
JOURNAL ARTICLE.
.A
Bova JG.
.I 125871
.U
89320211
.S
AJR Am J Roentgenol 8910; 153(2):293-5
.M
Adult; Aged; Case Report; Gastrointestinal Diseases/*RA; Gastrointestinal System/RA; Human; Male; Sarcoidosis/*RA; Stomach Diseases/RA.
.T
Gastrointestinal sarcoidosis: radiographic findings.
.P
JOURNAL ARTICLE.
.A
Levine MS; Ekberg O; Rubesin SE; Gatenby RA.
.I 125872
.U
89320212
.S
AJR Am J Roentgenol 8910; 153(2):296-8
.M
Angiography/*IS; Catheterization/*IS; Hepatic Artery/*/RA; Human; Liver Neoplasms/RA/TH.
.T
A loop catheter for superselective catheterization of the hepatic artery.
.P
JOURNAL ARTICLE.
.A
Ohno K; Yamashita M; Kushima K; Mathuno H; Fujita M; Murakami K.
.I 125873
.U
89320215
.S
AJR Am J Roentgenol 8910; 153(2):307-12
.M
Adenoma/DI; Adolescence; Adrenal Gland Neoplasms/*DI/SC; Adult; Aged; Carcinoma/DI; Child; Child, Preschool; Diagnosis, Differential; Female; Human; Magnetic Resonance Imaging/*/MT; Male; Middle Age; Pheochromocytoma/DI; Retrospective Studies; ROC Curve.
.T
MR evaluation of adrenal masses at 1.5 T.
.P
JOURNAL ARTICLE.
.W
We retrospectively studied the value of MR imaging at 1.5 T to distinguish between nonadenomatous (n = 17) and adenomatous (n = 15) adrenal masses on the basis of (1) signal-intensity ratios on T1- and T2-weighted spin-echo images, (2) T2 relaxation times, and (3) T2 relaxation-time ratios. Univariate and then multivariate logistic regression were applied to these quantitative parameters to determine which of these best discriminated nonadenomas from adenomas, and whether or not more than one of these parameters improved the prediction. The adrenal mass/liver signal-intensity ratio on T2-weighted spin-echo images could not be used to differentiate nonadenomas from adenomas. Adrenal mass/fat signal-intensity ratios on T2-weighted spin-echo images, adrenal/liver T2 relaxation-time ratios, and adrenal mass T2 relaxation times were best for distinguishing nonadenomas from adenomas. By using a T2 value of greater than 61 msec, the true-positive ratio/false-positive ratio of differentiating nonadenomas from adenomas was 100%/20%; at greater than 82 msec, it was 64%/0.06%. The adrenal mass/fat signal-intensity ratios on T2-weighted spin-echo images and the adrenal/liver T2 relaxation-time ratios showed similar inherent discriminatory capacity. Overlap remains despite the use of these parameters. On the basis of this preliminary information, we conclude that MR has merit for the characterization of adrenal masses at 1.5 T. T2 relaxation time of the adrenal mass shows the greatest promise for discriminating nonadenomas from adenomas.
.A
Baker ME; Blinder R; Spritzer C; Leight GS; Herfkens RJ; Dunnick NR.
.I 125874
.U
89320217
.S
AJR Am J Roentgenol 8910; 153(2):317-9
.M
Aged; Aged, 80 and over; Female; Human; Magnetic Resonance Imaging/*; Middle Age; Neoplasm Staging; Neoplasms, Embryonal and Mixed/DI/PA; Retrospective Studies; Sarcoma/*DI/PA; Uterine Neoplasms/*DI/PA.
.T
Mixed mullerian sarcoma of the uterus: MR imaging findings.
.P
JOURNAL ARTICLE.
.W
MR images of seven patients with histologically documented mixed mullerian sarcoma were analyzed retrospectively to determine whether the scans showed findings that could suggest the diagnosis. Spin-echo T1- and T2-weighted sagittal and transverse images from either a 0.35- or a 1.5-T unit were available for each patient. MR image analysis included evaluation of tumor signal intensity on T1 and T2 images; tumor location, size, and extent; depth of myometrial invasion; and presence of pelvic metastases. In all seven patients, MR images showed a large endometrial mass deeply invading the myometrium or beyond. In addition, MR images showed intraperitoneal (two patients) and ovarian (one patient) metastases. Although the massiveness of the tumors on initial presentation may suggest the diagnosis of mixed mullerian sarcoma, the MR imaging findings are nonspecific and mimic invasive endometrial carcinoma.
.A
Shapeero LG; Hricak H.
.I 125875
.U
89320219
.S
AJR Am J Roentgenol 8910; 153(2):325-6
.M
Adult; Blood Vessels/IN; Case Report; Human; Infarction/ET/*RA; Kidney/*BS/RA; Lymph Node Excision/*AE; Male; Retroperitoneal Space; Tomography, X-Ray Computed/*.
.T
Focal renal infarction after retroperitoneal lymph-node dissection: CT diagnosis.
.P
JOURNAL ARTICLE.
.A
Zissin R; Hertz M; Apter S; Madgar I.
.I 125876
.U
89320221
.S
AJR Am J Roentgenol 8910; 153(2):335-9
.M
Adolescence; Adult; Female; Human; Magnetic Resonance Imaging; Male; Middle Age; Sarcoma/DI/*RA; Soft Tissue Neoplasms/DI/*RA; Tomography, X-Ray Computed.
.T
The radiologic manifestations of alveolar soft-part sarcoma.
.P
JOURNAL ARTICLE.
.W
Alveolar soft-part sarcoma is a rare soft-tissue tumor of unknown cellular origin that is characterized histologically by its organized "pseudoalveolar" pattern. The radiologic findings in 11 patients with this neoplasm were reviewed. The six men and five women were 16-48 years old (mean, 27 years). Nine patients had untreated primary tumors (thigh, four; forearm, two; and buttock, rectus abdominis muscle, and infratemporal fossa, one each) and two had locally recurrent masses (one each in the retroperitoneum and retrocrural space). All patients were evaluated by conventional radiography, two by sonography, eight by CT, five by angiography, and three by MR. Conventional radiographs showed the soft-tissue mass in only four patients; four lesions caused destruction of adjacent bone and two had soft-tissue calcification. Unenhanced CT showed low-attenuation lesions in four of five patients. The lesions were hypervascular on contrast-enhanced CT or angiography in each of nine patients studied. Prominent draining veins were shown by CT or angiography in five patients. Three lesions had a prolonged capillary stain on angiography. Alveolar soft-part sarcoma should be considered in the differential diagnosis of a hypervascular soft-tissue mass, particularly in the thigh of a young adult.
.A
Lorigan JG; O'Keeffe FN; Evans HL; Wallace S.
.I 125877
.U
89320222
.S
AJR Am J Roentgenol 8910; 153(2):341-4
.M
Human; Knee Joint/*AH; Ligaments, Articular/AH; Magnetic Resonance Imaging/*; Tendons, Para-Articular/AH.
.T
Normal variations in MR imaging of the knee: appearance and frequency.
.P
JOURNAL ARTICLE.
.A
Watanabe AT; Carter BC; Teitelbaum GP; Seeger LL; Bradley WG Jr.
.I 125878
.U
89320224
.S
AJR Am J Roentgenol 8910; 153(2):351-4
.M
Adolescence; Child; Child, Preschool; Diabetes Mellitus/DI/ET; Human; Infant; Magnetic Resonance Imaging/*; Pituitary Gland, Posterior/AH/*PA; Pituitary Neoplasms/CO/DI; Sella Turcica/AH/PA; Support, Non-U.S. Gov't.
.T
MR imaging of the posterior hypophysis in children.
.P
JOURNAL ARTICLE.
.W
The posterior lobe of the pituitary gland was studied by MR imaging in 30 children without pituitary gland disease and compared with studies from a group of 13 children with central diabetes insipidus, including eight cases of primary diabetes insipidus and five cases of diabetes insipidus secondary to suprasellar tumors (four proved germinomas, one still unknown tumor). Two components in the sella turcica were identified in all 30 children without pituitary gland disease, and the posterior lobe was identified as a high-intensity structure on T1-weighted images. In all 13 patients with diabetes insipidus, the normal hyperintense signal of the posterior hypophysis was absent on T1-weighted images. Three patients with suprasellar tumors presented with a progressively enlarging pituitary stalk on follow-up. Our findings show that absence of the normal hyperintense signal of the posterior lobe is closely related to a loss of function of the neurohypophysis. Size or signal modification of the pituitary stalk should suggest the development of a suprasellar tumor.
.A
Gudinchet F; Brunelle F; Barth MO; Taviere V; Brauner R; Rappaport R; Lallemand D.
.I 125879
.U
89320226
.S
AJR Am J Roentgenol 8910; 153(2):363-7
.M
Bladder/*RA; Bladder Diseases/RA; Case Report; Child, Preschool; Diagnostic Errors; Female; Human; Infant; Infant, Newborn; Male; Urinary Catheterization/*.
.T
Catheter malposition during cystography: a cause of diagnostic errors [see comments]
.P
JOURNAL ARTICLE.
.A
Zerin JM; Lebowitz RL.
.I 125880
.U
89320227
.S
AJR Am J Roentgenol 8910; 153(2):369-73
.M
Adolescence; Adult; Bone Cysts/*DI/PA/RA/TH; Child; Child, Preschool; Embolization, Therapeutic/*; Female; Human; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed.
.T
Aneurysmal bone cysts: imaging findings and embolotherapy.
.P
JOURNAL ARTICLE.
.A
Cory DA; Fritsch SA; Cohen MD; Mail JT; Holden RW; Scott JA; DeRosa GP.
.I 125881
.U
89320230
.S
AJR Am J Roentgenol 8910; 153(2):383-5
.M
Adolescence; Adult; Aged; Ambulatory Care/*; Headache/ET; Human; Middle Age; Myelography/AE/IS/*MT; Needles/*.
.T
Outpatient myelography with fine-needle technique: an appraisal.
.P
JOURNAL ARTICLE.
.W
Postmyelography headaches are produced mostly by CSF leakage at the dural puncture site and are therefore largely dependent on the size of the needle used. Our study of 300 consecutive outpatients who had lumbar myelograms performed with 25- and 26-gauge spinal needles shows that the procedure has become virtually innocuous. We recommend that 26-gauge spinal needles be widely adopted as the standard for fluoroscopically controlled intrathecal injections of contrast material.
.A
Vezina JL; Fontaine S; Laperriere J.
.I 125882
.U
89320231
.S
AJR Am J Roentgenol 8910; 153(2):387-91
.M
Contrast Media; DTPA/*DU; Human; Laminectomy; Magnetic Resonance Imaging/*; Organometallic Compounds/*DU; Spinal Cord Neoplasms/*DI/SU; Spinal Neoplasms/*DI/SU; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S..
.T
Contrast enhancement in spinal MR imaging.
.P
JOURNAL ARTICLE.
.W
We evaluated 44 patients with suspected spinal tumors or previous laminectomies with gadolinium-DTPA MR imaging in order to characterize the enhancement in normal, postoperative, and neoplastic intraspinal tissue. Using the signal intensity of CSF as an internal control, we calculated the percentage increase in signal intensity from pre- to postgadolinium studies. Tumors (astrocytoma, ependymoma, schwannoma) enhanced 70-350%; epidural scar, normal epidural venous plexus, and dorsal root ganglion enhanced up to 200%. Contrast enhancement does not per se distinguish neoplastic from normal tissue. Enhancement with gadolinium-DTPA appeared to increase the conspicuousness of intramedullary tumors but not intraosseous metastases. We believe that gadolinium-enhanced MR imaging is a valuable adjunct to routine MR imaging in the evaluation of intraspinal neoplastic processes and may be useful in delineating normal and postoperative structures in the spinal canal.
.A
Breger RK; Williams AL; Daniels DL; Czervionke LF; Mark LP; Haughton VM; Papke RA; Coffer M.
.I 125883
.U
89320232
.S
AJR Am J Roentgenol 8910; 153(2):393-8
.M
Cervical Vertebrae; Comparative Study; Epidural Neoplasms/*DI; Epidural Space; Human; Intervertebral Disk Displacement/DI; Magnetic Resonance Imaging/*/MT; Prospective Studies; Spinal Diseases/*DI.
.T
Gradient-echo MR imaging of the cervical spine: evaluation of extradural disease.
.P
JOURNAL ARTICLE.
.W
A prospective study was undertaken on 204 consecutive patients comparing low flip angle gradient-echo and T1-weighted spin-echo techniques in the MR evaluation of cervical extradural disease. Four patient groups were studied with varying gradient-echo TEs (6 or 13 msec) and flip angles (10 degrees or 60 degrees). Images were evaluated independently for contrast behavior and anatomy, then directly compared for conspicuity of lesions. The FLASH sequences (especially with a 10 degrees flip angle) produced better conspicuity of disease in half the imaging time. T1-weighted spin-echo sequences were more sensitive to marrow changes and intradural disease. The short TE sequence (6 msec) did not produce any diagnostic advantage over the longer TE sequence (13 msec). A fast and sensitive MR examination for cervical extradural disease combines a sagittal T1-weighted spin-echo acquisition with sagittal and axial FLASH 10 degrees sequences.
.A
VanDyke C; Ross JS; Tkach J; Masaryk TJ; Modic MT.
.I 125884
.U
89320233
.S
AJR Am J Roentgenol 8910; 153(2):399-405
.M
Adolescence; Adult; Diagnosis, Differential; Human; Intervertebral Disk/PA/RA; Lumbar Vertebrae/PA/RA; Magnetic Resonance Imaging/*; Middle Age; Osteomyelitis/*DI/RA; Retrospective Studies; Spinal Diseases/*DI/RA; Spondylitis/*DI/RA; Thoracic Vertebrae/PA/RA; Tuberculosis, Spinal/*DI/RA.
.T
MR imaging characteristics of tuberculous spondylitis vs vertebral osteomyelitis.
.P
JOURNAL ARTICLE.
.W
Retrospective evaluation was made of four patients with tuberculous spondylitis who had been studied by MR with T1- and T2-weighted images in the sagittal plane and spin-density-weighted images in the axial plane. Evaluation was made of the distribution of abnormal signals within the body and posterior elements of the vertebrae, the intervertebral disk, and the associated paraspinal and epidural areas. In two of the cases, three-level involvement was seen with noninvolvement of intervening disks; metastases were misdiagnosed. One patient had anterior/inferior erosion of the vertebral body without visualization of the disk. The last patient had the more typical MR characteristics of intervertebral disk infection. Plain film examination showed only degenerative changes in three of the four cases. MR revealed more extensive involvement than the plain films did. Involvement of the posterior element and posterior vertebral body was prominent in three of the four cases. This is a significant finding since these patients are more likely to have neurologic symptoms and require laminectomy. Follow-up examinations in two cases showed increased signal on T1-weighted images, suggesting infiltration of hemopoietic marrow with fat, as has been described for degenerative osteoarthritis. The anatomy of the microcirculation of the vertebral body is related to the patterns of vertebral osteomyelitis, and discrepancies can be seen between the findings in our cases and the MR criteria previously noted for pyogenic vertebral osteomyelitis. The MR findings in our patients generally were more typical of neoplasm than of infection. These findings may reflect the characteristics of the tuberculous organism relative to the age-dependent pattern of vertebral microcirculation. Correct diagnosis of tuberculous spondylitis in young to middle-aged adults requires correlation of MR and clinical findings.
.A
Smith AS; Weinstein MA; Mizushima A; Coughlin B; Hayden SP; Lakin MM; Lanzieri CF.
.I 125885
.U
89320234
.S
AJR Am J Roentgenol 8910; 153(2):407-12
.M
Human; Magnetic Resonance Imaging/*; Mucocele/*DI/RA; Paranasal Sinus Diseases/*DI/RA; Paranasal Sinuses/PA/RA; Tomography, X-Ray Computed/*.
.T
Mucoceles of the paranasal sinuses: MR imaging with CT correlation.
.P
JOURNAL ARTICLE.
.W
The MR findings in six cases of paranasal sinus mucoceles are described. Two basic MR appearances were encountered: either moderate to marked signal hypointensity in the expanded sinuses on T1- and T2-weighted images (four patients) or moderate to marked signal hyperintensity on T1- and T2-weighted images (two patients). These patterns appear to represent inspissated or hydrated sinus contents, respectively. CT correlation revealed hyperdense mucoceles in the decreased MR signal group and hypo- or isodense mucoceles in the increased MR signal group. Superimposed allergic Aspergillus sinusitis was also present in two patients with hypointense mucoceles on MR.
.A
Van Tassel P; Lee YY; Jing BS; De Pena CA.
.I 125886
.U
89320235
.S
AJR Am J Roentgenol 8910; 153(2):413-7
.M
Fluoroscopy/IS; Human; Leg/*BS; Models, Structural; Phlebography/*/IS/MT; Radiographic Image Enhancement/*; Thrombophlebitis/RA.
.T
Digital venography of the lower extremity.
.P
JOURNAL ARTICLE.
.W
A digital 33-cm fluoroscopic system equipped with conventional spot-film and digital or video hard-copy capabilities was evaluated for its usefulness in diagnosing deep venous thrombosis of the lower extremities. The impact of different fluoroscopic field sizes, spatial resolution, and contrast variance was measured by using phantoms. The results indicate that the physical characteristics of the digital system are acceptable for lower-extremity venography. Digital fluoroscopic hard copy was compared with conventional spot films in 22 examinations. The digital examinations were as accurate as the conventional examinations. Procedure time, exposure to radiation, film costs, and repeated injections of contrast medium because of errors in exposure were reduced with the digital method. The need for extra technologists was eliminated. The advantages of digital radiographic displays, postprocessing, storage, and transmission were maximized. Digital fluoroscopic examinations were as accurate as conventional spot films and were found to have many advantages.
.A
Lee KR; Templeton AW; Cox GG; Dwyer SJ 3d; McClure CB.
.I 125887
.U
89320236
.S
AJR Am J Roentgenol 8910; 153(2):419-25
.M
Abdomen/*AH; Adipose Tissue/AH; Female; Human; Magnetic Resonance Imaging/*/MT; Male; Pelvis/*AH.
.T
Sampling bandwidth and fat suppression: effects on long TR/TE MR imaging of the abdomen and pelvis at 1.5 T.
.P
JOURNAL ARTICLE.
.W
In MR imaging, the sampling bandwidth is the rate at which the signal is digitized by the analog-to-digital converter. Reducing the sampling bandwidth can decrease noise in long TE images at the expense of increases in the artifacts of chemical-shift misregistration and motion. We compared 39 pairs of axial images with bandwidths of 32 kHz and 8-10 kHz. In 23 of these comparison studies (six female pelvis, seven male pelvis, 10 abdomen), all other variables were held constant, and in 16 comparisons (10 female pelvis, six male pelvis), signal from fat was suppressed in images with reduced bandwidth. Six patients with 11 liver lesions were included in those undergoing abdominal imaging. In three patients, fat was suppressed in images of the abdomen. The contrast-to-noise ratio was greater with reduced bandwidth for urine vs fat (24.5 vs 17.2; p less than .05) and central vs peripheral parts of the prostate gland (34.1 vs 22.7; p less than .02). In the abdomen, the contrast-to-noise ratio was increased between liver and right kidney (36.6 vs 25.2; p less than .01) and between liver and lesion (30.2 vs 18.2; p less than .005), but the motion-induced artifact was worse. An increase in chemical-shift misregistration did not affect the appearance of the internal structure of the uterus, prostate gland, or liver, but it made examination of the ovaries, seminal vesicles, and extrahepatic tissues difficult. The chemical-shift artifact in pelvic images could be eliminated by suppressing signal from fat with frequency-selective saturation pulses, but results were less satisfactory in the abdomen. When reduced bandwidth and fat suppression were combined, the contrast-to-noise ratio was improved for endometrium vs myometrium (22.9 vs 15.2; p less than .05) and central vs peripheral parts of the prostate gland (62.7 vs 28.5; p less than .02). Reduction of the sampling bandwidth is a promising technique for imaging the pelvis with small field of view and long TR/TE, but it currently appears less promising for images in the upper abdomen at 1.5 T. The increased chemical-shift artifact caused by reduced bandwidth can be eliminated by suppressing signal from fat.
.A
Mitchell DG; Vinitski S; Rifkin MD; Burk DL Jr.
.I 125888
.U
89320237
.S
AJR Am J Roentgenol 8910; 153(2):427
.M
Communication/*; Microcomputers/*; Radiology/*.
.T
Pictures for radiologic reports: use of a hand-held image scanner [letter]
.P
LETTER.
.A
Yokoyama K; Nakashima N; Takata Y; Tokuue K; Furuse M.
.I 125889
.U
89320238
.S
AJR Am J Roentgenol 8910; 153(2):428-9
.M
Bile Ducts, Intrahepatic/*; Case Report; Cholangiography; Cholelithiasis/RA/*TH; Endoscopy; Human; Lithotripsy/*; Male; Middle Age.
.T
Percutaneous ultrasonic lithotripsy and endoscopic removal of retained intrahepatic stone [letter]
.P
LETTER.
.A
Hoe J; Goh P; Tan EC.
.I 125890
.U
89320239
.S
AJR Am J Roentgenol 8910; 153(2):428-9
.M
Breast/*; Female; Human; Mammography/*; Prosthesis/*.
.T
Radiopaque markers on mammary implants [letter]
.P
LETTER.
.A
Sullivan DC; Shaw DR.
.I 125891
.U
89320244
.S
AJR Am J Roentgenol 8910; 153(2):431-2
.M
Human; Magnetic Resonance Imaging/*MT; Shoulder/*AH.
.T
MR imaging of the shoulder: optimizing surface-coil positioning [letter]
.P
LETTER.
.A
Glickstein MF.
.I 125892
.U
89320245
.S
AJR Am J Roentgenol 8910; 153(2):432-3
.M
Acquired Immunodeficiency Syndrome/CO; Adult; Candidiasis/CO/*RA; Case Report; Female; Human; Hyoid Bone/*/RA; Osteomyelitis/CO/*RA; Tomography, X-Ray Computed/*.
.T
CT of hyoid osteomyelitis [letter]
.P
LETTER.
.A
Schweitzer ME; Felsberg G; Bardfeld P.
.I 125893
.U
89320290
.S
Am Heart J 8910; 118(2):228-33
.M
Angioplasty, Transluminal/*; Coronary Vessels; Female; Follow-Up Studies; Human; Male; Middle Age; Myocardial Infarction/MO/PP/*TH; Recurrence; Stroke Volume; Vascular Patency.
.T
Long-term follow-up of patients treated with coronary angioplasty for acute myocardial infarction.
.P
JOURNAL ARTICLE.
.W
Long-term follow-up data for patients treated with coronary angioplasty (PTCA) for acute myocardial infarction are limited. Therefore the long-term outcome of 336 consecutive patients treated with PTCA at a median of 4.5 hours (range 0.5 to 48 hours) from symptom onset was evaluated. The in-hospital mortality was 11.1% (37 patients). Follow-up is complete for 293 of 299 (98%) hospital survivors at a median of 24 months. Of patients discharged, the mean age was 55 +/- 11 years, 49% received intravenous thrombolytic therapy, 53% had multivessel coronary artery disease, and the mean ejection fraction was 48 +/- 10%. Post-discharge survival was 96.1% at 1 year and 93.6% at 2 years by life table analysis. Post-discharge survival was independently predicted by no prior myocardial infarction (96.9% versus 87.3% 2-year survival, p less than 0.001 by log rank analysis) and infarct artery patency at hospital discharge (which had its major impact on survival early after hospital discharge: [97.4% versus 93.4% 1-year survival but 94.2% versus 93.4% 2-year survival; overall p = 0.02]). For patients with analyzable ventriculograms at hospital discharge, ejection fraction greater than or equal to 40% was also a significant independent predictor of survival (98.1% versus 85.8% 2-year survival, p = 0.01). For patients with a successful PTCA, time from symptom onset to catheterization and angioplasty less than or equal to 4 hours versus greater than 4 hours was also an independent predictor of outcome (97.1% versus 91.4% 2-year survival; p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Kander NH; O'Neill W; Topol EJ; Gallison L; Mileski R; Ellis SG.
.I 125894
.U
89320291
.S
Am Heart J 8910; 118(2):234-47
.M
Adult; Aged; Angina Pectoris/PP/RA; Aorta/PA/*PP; Aortography/*; Blood Flow Velocity; Compliance; Coronary Disease/PA/*PP/RA; Female; Human; Magnetic Resonance Imaging/*; Male; Middle Age; Regional Blood Flow; Support, U.S. Gov't, P.H.S.; Syndrome.
.T
The function of the aorta in ischemic heart disease: a magnetic resonance and angiographic study of aortic compliance and blood flow patterns.
.P
JOURNAL ARTICLE.
.W
Regional compliance of the ascending aorta, aortic arch, and the descending aorta was measured in 70 normal subjects at varying ages, in 17 patients with coronary artery disease (10 coronary artery disease patients, 3 with syndrome X), and in 13 trained athletes using magnetic resonance imaging. Ascending aortic compliance was measured angiographically in 22 patients with documented coronary artery disease and in 11 patients with syndrome X. Magnetic resonance velocity mapping was used in six patients with documented coronary artery disease and in three patients with syndrome X to study two-dimensional velocity profiles in the proximal and mid-ascending aorta and to quantify both forward and reverse flow. The measurements were compared with earlier published measurements from 24 normal subjects. It was found that patients with ischemic heart disease or syndrome X had decreased or no measurable aortic compliance and that they had significantly reduced or abnormal ascending aortic reverse flow likely to cause reduced coronary artery flow. A new theory is advanced that decreased myocardial perfusion leading to ischemic heart disease has two sources: (1) insufficient blood flow into the coronary artery inlet due to abnormal aortic function and independent of coronary artery stenosis and (2) local coronary artery stenosis. Observations supporting the theory are presented.
.A
Bogren HG; Mohiaddin RH; Klipstein RK; Firmin DN; Underwood RS; Rees SR; Longmore DB.
.I 125895
.U
89320292
.S
Am Heart J 8910; 118(2):248-55
.M
Animal; Comparative Study; Electrocardiography; Heart Ventricle; Methods; Myocardial Infarction/*CO; Support, Non-U.S. Gov't; Swine; Tachycardia/CO/PP/*TH.
.T
Conversion of induced ventricular tachycardia by single and serial chest thumps: a study in domestic pigs 1 week after experimental myocardial infarction.
.P
JOURNAL ARTICLE.
.W
A single chest thump (CT) is widely accepted in the emergency treatment of ventricular asystole, whereas there exists controversy about this method for the interruption of ventricular tachycardia (VT). Hitherto, delivering serial chest thumps (SCTs) has been described only once for the treatment of VT. A systematic analysis for interruption of VT by CT or SCTs (or both) is lacking. We have therefore investigated this subject in five domestic pigs after experimental myocardial infarction. Manual conversion was attempted in 20 induced VTs. Six VTs were converted by CT, seven VTs were converted by the first SCTs, and six VTs were converted by the last of multiple (two to seven) SCTs. The overall success was 95%. There were no serious complications. The rate of successful SCTs exceeded the rate of VT by 10% to 126%. The technique of SCTs, the mechanisms of manual conversion, and the controversial opinions regarding the value of precordial thumping in asystole, VT, and ventricular fibrillation are discussed. SCTs should be practiced only very cautiously in patients until further experience is available.
.A
Gertsch M; Hottinger S; Mettler D; Leupi F; Gurtner HP.
.I 125896
.U
89320293
.S
Am Heart J 8910; 118(2):256-64
.M
Aged; Arrhythmia/ET/*PP; Electrocardiography/*; Female; Heart/RI; Human; Male; Middle Age; Monitoring, Physiologic; Myocardial Infarction/*CO/PP/RI; Prognosis; Signal Processing, Computer-Assisted; Stroke Volume; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Tachycardia/PP; Time Factors.
.T
Prognostic significance of the signal-averaged ECG depends on the time of recording in the postinfarction period.
.P
JOURNAL ARTICLE.
.W
Serial recordings of the signal-averaged ECG and the 24-hour ambulatory ECG were obtained from 156 patients with acute myocardial infarction up to 5 days (phase 1), 6 to 30 days (phase 2), and 31 to 60 days (phase 3) after the infarction. Left ventricular ejection fraction by radionuclide ventriculography was also determined in phase 2. The signal-averaged ECG was abnormal during one or more of the three phases in 51 patients (31%). In 35 of these patients (69%) the recording changed category between normal and abnormal with the highest prevalence of abnormal recording occurring during phase 2. Eight patients had ventricular tachycardia/ventricular fibrillation in the first 48 hours after myocardial infarction. The signal-averaged ECG was abnormal in only one of these patients. Twelve patients had late arrhythmic events during the first year of follow-up (four sudden deaths and eight instances of documented ventricular tachycardia or ventricular fibrillation). Nine of the 12 patients had an abnormal signal-averaged ECG in phase 2 and four of these nine had a normal recording in phase 1. Five patients had a transient abnormal signal-averaged ECG in phase 1, whereas six patients had an abnormal recording only in phase 3. None of these 11 patients had an arrhythmic event. Stepwise logistic regression showed that an abnormal signal-averaged ECG in phase 2 has the most significant relation to late arrhythmic events. Both an abnormal signal-averaged ECG and a left ventricular ejection fraction less than 40%, but not complex ventricular arrhythmias, were independent significant risk factors for late arrhythmic events.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
el-Sherif N; Ursell SN; Bekheit S; Fontaine J; Turitto G; Henkin R; Caref EB.
.I 125897
.U
89320294
.S
Am Heart J 8910; 118(2):265-71
.M
Animal; Cardiac Pacing, Artificial; Cats; Electric Stimulation; Female; Male; Myocardial Infarction/*CO; Myocardial Reperfusion; Propranolol/*TU; Refractory Period, Neurologic; Support, Non-U.S. Gov't; Time Factors; Ventricular Fibrillation/ET/*PC/PP.
.T
The effect of beta-adrenergic blockade on vulnerability to ventricular fibrillation and inducibility of ventricular arrhythmia in short- and long-term feline infarction models.
.P
JOURNAL ARTICLE.
.W
Previous investigation, predominantly in the short-term canine model, has documented a potent antifibrillatory effect of beta-adrenergic blockade. To determine whether the protection afforded by beta blockade is species- and model-specific, we studied 23 chloralose-anesthetized cats. Eight animals were studied over a short term and underwent serial determinations of the ventricular fibrillation (VF) threshold prior to and 1 minute after occlusion of the left anterior descending coronary artery (LAD) and immediately following reperfusion of a 10-minute occlusion. Beta-blocking doses of intravenous propranolol (P) (0.5 mg/kg) attenuated the fall in VF threshold during acute ischemia. Increasing the dose of P to 1 mg/kg did not provide further protection, nor did P protect against reperfusion VF. The other 15 animals underwent a preliminary surgical procedure during which the LAD was completely and irreversibly occluded (nine animals) or in which a sham procedure was performed (six animals). Two weeks later, we measured ventricular refractoriness at several left ventricular sites, ventricular inducibility using programmed electrical stimulation, and VF thresholds both before and after administration of intravenous P (1 mg/kg). Ventricular refractory periods in the infarcted zones were significantly increased compared with normal sites and with values obtained in sham-operated animals. In addition, VF thresholds in the infarcted animals were lower than those obtained in the sham-operated group. Before treatment, a reproducible sustained ventricular tachyarrhythmia was induced by means of programmed stimulation in seven of the nine chronically infarcted animals but in none of the sham-operated animals (p less the 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Luketich J; Friehling TD; O'Connor KM; Kowey PR.
.I 125898
.U
89320295
.S
Am Heart J 8910; 118(2):272-80
.M
Adrenergic Beta Receptor Blockaders/*AD/AE/TU; Adult; Aged; Arrhythmia/*DT/PP; Cardiac Pacing, Artificial; Electrocardiography; Exercise Test; Female; Heart Ventricle; Human; Male; Middle Age; Recurrence; Tachycardia/DT/PP.
.T
Antiarrhythmic efficacy of solitary beta-adrenergic blockade for patients with sustained ventricular tachyarrhythmias.
.P
JOURNAL ARTICLE.
.W
To assess the efficacy and predictability of solitary beta-adrenergic blocker (BB) therapy for ventricular tachyarrhythmia (VT), 30 patients (16 men and 14 women) with a mean age of 55 years, who initially had sustained ventricular tachycardia (70%) or ventricular fibrillation (30%), were studied. Results of baseline arrhythmia tests showed VT on ECG monitoring in 57% of the patients, during exercise in 50%, induced by programmed stimulation in 69%, increasing to 86% during isoproterenol. BB therapy prevented inducible VT during programmed stimulation in 37% of the patients, prevented VT on ECG monitoring in 54%, and prevented VT during exercise in 83%. Long-term BB therapy was given to 24 of 30 patients, whereas six other patients with hemodynamically unstable VT during BB therapy received other long-term treatment. During a mean follow-up of 824 days, 6 of 24 patients had recurrent VT. BB therapy was discontinued in two patients because of side effects. Long-term success was predicted by left ventricular ejection fraction greater than 45%, absence of coronary disease, and age less than 60 years (all p less than 0.02). Neither suppression of arrhythmia during exercise testing, nor results of programmed stimulation or ECG monitoring were predictive of outcome. Thus beta-adrenergic blockers can be effective as solitary antiarrhythmic therapy in selected patients with VT.
.A
Brodsky MA; Allen BJ; Luckett CR; Capparelli EV; Wolff LJ; Henry WL.
.I 125899
.U
89320296
.S
Am Heart J 8910; 118(2):281-7
.M
Adult; Age Factors; Cardiac Pacing, Artificial; Coronary Vessels/RA; Electrocardiography; Female; Heart/RA; Heart Arrest/ET/*PP; Heart Catheterization; Heart Diseases/DI/RA; Hemodynamics; Human; Male; Resuscitation; Support, U.S. Gov't, P.H.S..
.T
Young adult survivors of sudden cardiac arrest: analysis of invasive evaluation of 22 subjects.
.P
JOURNAL ARTICLE.
.W
Twenty-two young adult (mean age 27.8 +/- 5.3 years) survivors of sudden cardiac arrest underwent invasive cardiac assessment. Initial evaluation by cardiac catheterization, coronary angiography, and hemodynamic studies identified two groups of young survivors. The first consisted of 13 (60%) subjects who had definable structural cardiac or lung disease accountable for a cardiac arrest event. Dilated cardiomyopathy dominated this group. Mitral valve prolapse, hypertrophic cardiomyopathy, left ventricular hypertrophy, anomalous origin of the right coronary artery, and tetralogy of Fallot were also encountered. The second group included nine subjects (40%) with normal cardiac structure and normal hemodynamic parameters. Electrophysiologic testing demonstrated in three of these patients the presence of Wolff-Parkinson-White syndrome. The electrophysiologic studies had a higher yield in reproduction of life-threatening arrhythmias among the subjects in the second group as opposed to the first group. The observation that 10 subjects (45%) from both groups had preceding symptoms varying from palpitations and chest pain to syncope and recurrent cardiac arrest events, is in contradiction to previous findings in the literature and raises a question of appropriate evaluation of young adults with cardiac symptoms.
.A
Topaz O; Perin E; Cox M; Mallon SM; Castellanos A; Myerburg RJ.
.I 125900
.U
89320297
.S
Am Heart J 8910; 118(2):288-91
.M
Animal; Dogs; Electric Countershock/IS/*MT; Electrocardiography; Support, Non-U.S. Gov't.
.T
Superiority of biphasic shocks in the defibrillation of dogs by epicardial patches and catheter electrodes.
.P
JOURNAL ARTICLE.
.W
Currently available internal cardiac defibrillators use a uniphasic, truncated exponential waveform morphology of about 6 msec in duration at an energy level of 23 to 33 joules. To determine if improved defibrillation could be achieved with a different waveform morphology, we implanted 4.5 cm2 titanium patches to the left and right ventricle of 28 dogs. After ventricular fibrillation was induced, defibrillation was attempted using 7, 12, 13, or 17 joules. A 5 msec rectangular uniphasic waveform morphology was compared with a 10 msec rectangular biphasic waveform with the lagging 5 msec pulse of half the amplitude of the leading 5 msec. In an additional seven dogs, a transvenous bipolar catheter was placed with the distal electrode in the right ventricular apex and the proximal electrode in the superior vena cava. Biphasic and uniphasic shocks were compared at 14 joules. In the patch-patch system, the biphasic waveform was superior to the uniphasic waveform at 7 joules (67% versus 35%, p less than 0.001) and at 12 joules (93% versus 78%, p less than 0.001). No statistically significant differences were achieved at 13 joules or 17 joules. In the catheter electrode system with a delivered energy of 14 joules, the biphasic waveform was more effective than the uniphasic waveform (87% versus 27%, p less than 0.001). Manufacturers of automatic implantable defibrillators should consider this information in the design of future automatic implantable defibrillators.
.A
Flaker GC; Schuder JC; McDaniel WC; Stoeckle H; Dbeis M.
.I 125901
.U
89320299
.S
Am Heart J 8910; 118(2):299-307
.M
Adolescence; Aorta, Thoracic/PP; Aortic Coarctation/*PP/TH; Balloon Dilatation; Blood Flow Velocity; Child; Child, Preschool; Echocardiography; Echocardiography, Doppler/*; Heart Catheterization; Human; Infant; Infant, Newborn; Pressure; Support, Non-U.S. Gov't.
.T
Doppler ultrasound in the prediction of pressure gradients across aortic coarctation.
.P
JOURNAL ARTICLE.
.W
Although pressure gradients across valvar obstructions can be estimated by incorporating peak flow velocity distal to obstruction into a modified Bernoulli equation, such attempts in aortic coarctations have not been uniformly successful. The purpose of this study was to examine the value of several Doppler flow parameters in predicting pressure gradient across the aortic coarctation. Twenty-eight patients, aged 14 days to 13 years, in whom Doppler variables and catheterization pressure gradients were measured within 24 hours of each other, were included in the study. There were 60 pairs of such data. Correlation coefficients between catheter pressure gradient on the one hand and Doppler peak flow velocity and Doppler pressure gradient (DPG) estimates using (1) distal velocity and (2) both distal and proximal velocities (DPV) in the Bernoulli equation on the other were 0.74 to 0.76. Subgrouping the subjects into native coarctations, coarctations immediately after and 6 to 30 months after balloon angioplasty did not improve the correlation coefficient. Duration-related measures of Doppler flow curve distal to the coarctation, namely, acceleration time and antegrade flow time (AFT), corrected (to heart rate) and uncorrected, improved the correlation coefficient to 0.82 (p less than 0.001). A combination of magnitude- and duration-related parameters appears to give the best fit, and the catheter gradient can be estimated by 0.31 DPG using DPV + 0.22 AFT fraction + 0.04 AFT - 16.67 (r = 0.92). Also, the mean Doppler flow velocity decreased (p less than 0.001) from 3.62 +/- 0.45 to 2.65 +/- 0.53 m/sec following balloon angioplasty of aortic coarctation; this improvement persisted (2.66 +/- 0.54 m/sec) on follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Rao PS; Carey P.
.I 125902
.U
89320300
.S
Am Heart J 8910; 118(2):308-14
.M
Aged; Aged, 80 and over; Blood Flow Velocity; Comparative Study; Echocardiography/*; Echocardiography, Doppler; Heart/*RI; Heart Diseases/PP; Human; Male; Middle Age; Mitral Valve/*PP; Support, Non-U.S. Gov't; Technetium Tc 99m Pertechnetate/DU.
.T
Instantaneous transmitral flow using Doppler and M-mode echocardiography: comparison with radionuclide ventriculography.
.P
JOURNAL ARTICLE.
.W
To improve the accuracy of Doppler echocardiographic indices of left ventricular filling, we derived two indices of instantaneous transmitral flow with the use of Doppler velocities and M-mode echocardiography. These indices were calculated from the product of pulsed Doppler mitral velocities and either the excursion of the anterior mitral leaflet or the separation of both mitral leaflets as measures of the changing mitral orifice area. The derived flow indices and the mitral velocities alone were compared to left ventricular filling as determined by radionuclide ventriculography in 24 patients. When compared as areas under the matched decile divisions of the derived filling sequences by linear regression analysis, the relationship for combined Doppler and M-mode versus radionuclide left ventricular filling was closer to the line of identity (slope = 0.98 and 0.94 using the anterior mitral leaflet and both mitral leaflets, respectively, both p = NS versus the line of identity) than was the relationship for mitral velocities alone versus radionuclide left ventricular filling (slope = 0.74, p less than 0.05 versus the line of identity). The instantaneous mitral volume flow indices more closely resemble the time course and shape of radionuclide left ventricular filling curves than do mitral velocities alone, and the application of these indices should assist the quantitative description by Doppler echocardiography of left ventricular filling.
.A
Hoit BD; Rashwan M; Verba J; Pretorius T; Sahn DJ; Bhargava V.
.I 125903
.U
89320301
.S
Am Heart J 8910; 118(2):314-9
.M
Aminophylline/PD; Angina Pectoris/CI/*ME/PP; Coronary Circulation/*DE; Dipyridamole/*DU/PD; Echocardiography; Electrocardiography; Exercise Test; Female; Human; Male; Middle Age; Myocardial Contraction/DE; Myocardium/*ME; Oxygen Consumption/*DE.
.T
Role of myocardial oxygen consumption in dipyridamole-induced ischemia.
.P
JOURNAL ARTICLE.
.W
The aim of this study was to assess whether myocardial oxygen consumption can be responsible for aminophylline resistance in dipyridamole-induced ischemia. We analyzed 163 consecutive patients who had a positive low-dose (0.56 mg/kg over 4 minutes) dipyridamole-echocardiography test, requiring intravenous aminophylline as an antidote. All patients also performed an exercise stress test. In 141 of these patients, the signs of ischemia were reversed by administration of intravenous aminophylline (group I), while the remaining 22 patients were resistant to aminophylline (240 mg/kg over 3 minutes) and received additional treatment with nitrates to relieve ischemia (group II). The increase in rate-pressure product (RPP = mm Hg x beats/min x 100) measured during the exercise stress test in the patients in group I was significantly greater than that determined during dipyridamole-induced ischemia (204 +/- 41 versus 145 +/- 33, p less than 0.01). However, the increases in RPP under both conditions were similar for the patients in group II (147 +/- 24 versus 150 +/- 20, p = ns). In patients with dipyridamole-induced ischemia who were resistant to aminophylline, the rise in myocardial oxygen consumption--probably linked to reflex sympathetic activation--might maintain ischemia independently from flow maldistribution, which should be reversed by aminophylline.
.A
Picano E; Lattanzi F; Distante A; L'Abbate A.
.I 125904
.U
89320302
.S
Am Heart J 8910; 118(2):319-24
.M
Adult; Anaerobic Threshold/*; Exercise/*; Female; Heart Rate; Heart Ventricle/PH; Human; Male; Middle Age; Posture/*; Pulmonary Gas Exchange; Stroke Volume/*; Supination; Support, Non-U.S. Gov't.
.T
Responses of left and right ventricular ejection fractions to aerobic and anaerobic phases of upright and supine exercise in normal subjects.
.P
JOURNAL ARTICLE.
.W
The effects of aerobic and anaerobic exercise on ventricular performance were studied in 13 normal subjects who underwent simultaneous pulmonary gas exchange evaluation and exercise radionuclide ventriculography in the supine and upright postures. Right and left ventricular ejection fraction was measured serially at 2-minute intervals during exercise. The anaerobic threshold occurred at 74% and 80% of maximum heart rate, respectively, during upright and supine exercise. Left and right ventricular ejection fractions rose from rest to the anaerobic threshold (p less than 0.01, p less than 0.01, respectively) and there was a further increase between the anaerobic threshold and maximum exercise (p less than 0.01, p less than 0.01, respectively). The rate of rise of ejection fraction beyond the anaerobic threshold was slightly blunted compared with the rise prior to attaining the anaerobic threshold. There was no significant difference in ventricular performance between supine and upright exercise. The data demonstrate that ventricular performance increases steadily during exercise and is not limited by the conversion of aerobic to anaerobic metabolism.
.A
Rodrigues EA; Maddahi J; Brown H; Pantaleo N; Freeman M; Koerner S; Waxman A; Berman DS.
.I 125905
.U
89320303
.S
Am Heart J 8910; 118(2):325-33
.M
Animal; Dogs; Female; Heart/*AH/RI; Male; Myocardial Contraction/*; Organ Weight; Radionuclide Angiography; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Radionuclide left ventricular contractile indices and their relationship to heart size in dogs.
.P
JOURNAL ARTICLE.
.W
To identify possible mechanisms to explain differences between the maximum time-varying elastance (Emax) and end-systolic pressure-volume (Ees) slope values calculated with radionuclide angiography and to establish whether they have a relationship to heart size, we studied 16 dogs that were instrumented with micromanometer left ventricular catheters and had red blood cells tagged with technetium-99m for radionuclide angiography. Hemodynamics and radionuclide angiograms were obtained under control conditions and during six additional steady-state loading conditions. Isochronal Emax averaged 7.14 +/- 2.54 mm Hg/ml, while Ees averaged 5.68 +/- 1.88 mm Hg/ml (p less than 0.01), but they were highly correlated (r = 0.95, p less than 0.001). This observation was related to the assumption of linearity when curvilinearity was present and to the important influence of timing on these relationships. The Emax and Ees slope values were compared to dog weight; left ventricular weight, which ranged from 85 to 142 gm (mean 113 +/- 18 gm); and left ventricular end-diastolic volume, which ranged from 15 to 56 ml (mean 29 +/- 10 ml) using multiple regression analyses. The Emax and Ees slope values demonstrated a comparable inverse linear relationship with only left ventricular end-diastolic volume (r = 0.76 and -0.69, p less than 0.001 and p less than 0.01). We conclude that the differences between Emax and Ees slope values calculated with radionuclide angiography are related to the assumption of linearity when curvilinearity is present and to the importance of the timing of systolic events and that both Emax and Ees are comparably related to left ventricular end-diastolic volume.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Starling MR; Mancini GB; Montgomery DG; Gross MD.
.I 125906
.U
89320305
.S
Am Heart J 8910; 118(2):341-6
.M
Cardiomyopathy, Hypertrophic/*PA; Heart Septum/*PA; Human; Microscopy, Polarization/*MT; Support, Non-U.S. Gov't.
.T
An improved method for detecting and quantifying cardiac muscle disarray in hypertrophic cardiomyopathy.
.P
JOURNAL ARTICLE.
.W
The presence of muscle disarray in hypertrophic cardiomyopathy (HC), although well established, has only been semiquantitatively assessed. A quantitative method that uses polarized light microscopy is described. Hematoxylin and eosin-stained sections of ventricular septa from six HC patients and six normal hearts were examined. Cell orientations were measured in five regions from each section using a polarizing microscope with a rotating stage. Histograms of cell orientation angles were plotted and the mean and angular deviation of each sample were calculated. In normal hearts, cells were predominantly aligned parallel to each other. Orientation distributions were sharply peaked, with angular deviations ranging from 4 to 13 degrees. For HC, the sharp peak was lacking and angular deviations varied from 7 to 37 degrees; some distributions were bimodal. Areas in HC septa that appeared normal by gross inspection had abnormal orientation distributions. Polarized light microscopy provides an improved method of detecting and quantifying cellular disorganization in HC.
.A
Whittaker P; Romano T; Silver MD; Boughner DR.
.I 125907
.U
89320306
.S
Am Heart J 8910; 118(2):347-54
.M
Adolescence; Adult; Child; Child, Preschool; Constriction, Pathologic; Heart Defects, Congenital/*PA/RA/SU; Human; Infant; Magnetic Resonance Imaging/*; Pulmonary Artery/*PA/RA.
.T
Evaluation of pulmonary arterial morphology in cyanotic congenital heart disease by magnetic resonance imaging.
.P
JOURNAL ARTICLE.
.W
Before and after surgical therapy, the anatomy of the pulmonary arteries in cyanotic congenital heart disease is often distorted. Pulmonary arterial anatomy was evaluated by magnetic resonance imaging (MRI) and angiography in 20 patients, ages 3 months to 20 years, with cyanotic heart disease associated with decreased pulmonary blood flow. Excellent correlation between MRI and angiographic estimates of pulmonary artery diameter was obtained (main pulmonary artery, r = 0.96; right pulmonary artery, r = 0.93; left pulmonary artery, r = 0.96). A similar excellent correlation (kappa = 0.83) was found in the assessment of the presence and severity of proximal pulmonary arterial stenoses. However, stenoses in the peripheral pulmonary arteries visualized with angiography were missed with MRI. MRI and angiography showed complete agreement in determining the patency of 11 surgical shunts. MRI did not demonstrate all of the systemic collateral vessels present with angiography, and the distal connections of collaterals were not detected with MRI. MRI is comparable to angiography in the evaluation of central pulmonary arterial anatomy over a wide range of ages. These findings suggest an important role for noninvasive MRI in the serial evaluation of pulmonary artery morphology in patients with cyanotic congenital heart disease before and after surgical repair.
.A
Canter CE; Gutierrez FR; Mirowitz SA; Martin TC; Hartmann AF Jr.
.I 125908
.U
89320309
.S
Am Heart J 8910; 118(2):381-91
.M
Aortic Diseases/DI; Arteriosclerosis/*DI; Atherosclerosis/*DI; Catheterization/IS; Fiber Optics; Human; Lasers/*DU/IS; Spectrometry, Fluorescence/*.
.T
Spectral diagnosis of atherosclerosis using an optical fiber laser catheter.
.P
JOURNAL ARTICLE.
.W
This communication demonstrates that fluorescence spectra of human aorta with good S/N ratios can be collected using an optical fiber laser catheter. The performance of this catheter is compared to a non-fiber optic collection system with an equivalent delivery/collection geometry. For a given sample, fluorescence lineshapes obtained using the two systems are identical; differences in peak fluorescence intensity are related to the different collection efficiencies of the two systems. It is shown that the fluorescence lineshape of arterial tissue depends on the delivery/collection geometry of the detection system, and that this is due to the interaction of absorption and fluorescence within the artery wall. This effect is investigated systematically using a specially designed collection system. Results are analyzed qualitatively using a simple, one-dimensional model of tissue fluorescence. With this analysis, we present design requirements for a collection system in which such geometric effects are eliminated, and show that our optical fiber laser catheter satisfies these requirements.
.A
Richards-Kortum R; Mehta A; Hayes G; Cothren R; Kolubayev T; Kittrell C; Ratliff NB; Kramer JR; Feld MS.
.I 125909
.U
89320310
.S
Am Heart J 8910; 118(2):391-9
.M
Animal; Blood Pressure; Blood Vessels/*; Coronary Arteriosclerosis/PA/SU; Endoscopy/*IS/MT; Femoral Artery; Iliac Artery; Irrigation/IS/MT; Support, Non-U.S. Gov't; Swine; Vascular Surgery/*.
.T
Intraoperative angioscopy: principles of irrigation and description of a new dedicated irrigation pump.
.P
JOURNAL ARTICLE.
.W
The value of intraoperative angioscopy in the detection and immediate correction of technical errors and deficiencies during vascular surgery has been previously documented. The inability to see through blood remains the most significant limitation to the general application of angioscopy. Local irrigation with a balanced salt solution is the most commonly used method to clear the blood from a restricted field in a particular vessel. We have developed a new catheter irrigation pump system (maximum flow rate 340 ml/min) to establish and maintain visibility of the field during intraoperative angioscopy. Furthermore, we have demonstrated the safety of irrigating with high volume flows in the peripheral arteries and defined the basic principles of irrigation for angioscopy. The prototype pump tested in this study provides a wide range of flow rates and permits precise measurements of the fluid delivered. The instrument's display and its control with a single foot pedal makes its use relatively simple, obviating the need for additional support personnel while increasing the efficacy and safety of the angioscopic examination and increasing the number of situations where angioscopy may be very useful.
.A
Miller A; Lipson WE; Isaacsohn JL; Schoen FJ; Lees RS.
.I 125910
.U
89320311
.S
Am Heart J 8910; 118(2):400-2
.M
Aged; Angina Pectoris/*ET; Angina, Unstable/DI/*ET/RA; Case Report; Endocarditis, Bacterial/CO; Female; Heart Aneurysm/*CO/DI/ET/RA; Heart Ventricle; Human; Staphylococcal Infections/CO.
.T
Left ventricular pseudoaneurysm presenting as unstable angina.
.P
JOURNAL ARTICLE.
.A
Hui P; Ports T.
.I 125911
.U
89320313
.S
Am Heart J 8910; 118(2):404-7
.M
Aged; Angina Pectoris/*ET/PP/RA; Blood Flow Velocity/DE; Case Report; Collateral Circulation/DE; Coronary Circulation/*DE; Coronary Vessels/*RA; Female; Human; Papaverine/*AE/DU.
.T
Papaverine-induced chest pain due to coronary vascular steal: demonstration with angiographic and intracoronary flow velocity measurements.
.P
JOURNAL ARTICLE.
.A
Gudipati CV; Kern MJ; Aguirre FV; Deligonul U.
.I 125912
.U
89320314
.S
Am Heart J 8910; 118(2):407-10
.M
Aorta/SU; Arterio-Arterial Fistula/DI/*ET; Case Report; Child, Preschool; Coronary Vessel Anomalies/*SU; Coronary Vessels/*/SU; Echocardiography; Echocardiography, Doppler/*; Female; Human; Postoperative Complications/*; Pulmonary Artery/*/SU; Support, Non-U.S. Gov't.
.T
Left coronary artery-to-pulmonary artery communication (a late postoperative complication after the Takeuchi procedure for repair of anomalous origin of left coronary artery from the pulmonary artery) detected by color Doppler flow mapping.
.P
JOURNAL ARTICLE.
.A
Moises VA; Maciel BC; Swensson RE; Valdes-Cruz LM; Daily PO; Sahn DJ.
.I 125913
.U
89320316
.S
Am Heart J 8910; 118(2):413-5
.M
Electrocardiography/*; Heart Block/*PP; Heart Conduction System/*PP; Human.
.T
Progressive prolongation of the second conduction interval throughout successive 3:2 Wenckebach sequences: the double Wenckebach phenomenon [see comments]
.P
JOURNAL ARTICLE.
.A
Oreto G; Luzza F; Satullo G.
.I 125914
.U
89320317
.S
Am Heart J 8910; 118(2):415-7
.M
Arrhythmia/ET/PP/TH; Case Report; Chagas Cardiomyopathy/*CO; Chronic Disease; Electric Countershock/*IS; Electrocardiography; Female; Heart Block/ET/*TH; Human; Middle Age; Myocarditis/*CO; Pacemaker, Artificial/*.
.T
Automatic implantable defibrillator with VVI pacemaker in a patient with chronic Chagas myocarditis and total atrioventricular block.
.P
JOURNAL ARTICLE.
.A
de Paola AA; Horowitz LN; Miyamoto MH; Pinheiro R; Ferreira DF; Terzian AB; Cirenza C; Guiguer N Jr; Andrade JC; Fo EE.
.I 125915
.U
89320318
.S
Am Heart J 8910; 118(2):417-9
.M
Adult; Balloon Dilatation/*/IS/MT; Case Report; Female; Human; Tricuspid Valve Stenosis/PA/*TH.
.T
Percutaneous double balloon valvuloplasty for severe tricuspid stenosis.
.P
JOURNAL ARTICLE.
.A
Goldenberg IF; Pedersen W; Olson J; Madison JD; Mooney MR; Gobel FL.
.I 125916
.U
89320319
.S
Am Heart J 8910; 118(2):419-21
.M
Aged; Case Report; Diagnostic Errors; Echocardiography/*; Esophageal Motility Disorders/*DI/PA/RA; Esophagus/PA/RA; Heart Atrium/PA; Human; Male; Mediastinal Neoplasms/*DI/RA.
.T
Presbyesophagus masquerading as an extracardiac mass on echocardiography.
.P
JOURNAL ARTICLE.
.A
Hoit BD; Eppert D.
.I 125917
.U
89320320
.S
Am Heart J 8910; 118(2):421-3
.M
Acquired Immunodeficiency Syndrome/*CO; Adult; Biopsy/*MT; Case Report; Echocardiography; Heart Neoplasms/*DI/ET/PA; Human; Lymphoma/*DI/ET/PA; Male.
.T
Transvenous biopsy diagnosis of cardiac lymphoma in an AIDS patient.
.P
JOURNAL ARTICLE.
.A
Andress JD; Polish LB; Clark DM; Hossack KF.
.I 125918
.U
89320321
.S
Am Heart J 8910; 118(2):423-4
.M
Aged; Aged, 80 and over; Aortic Valve Stenosis/*CO/SU; Case Report; Coronary Circulation; Heart Septal Defects, Atrial/CO/PP/*SU; Human; Male.
.T
Surgical repair of atrial septal defect in an 89-year-old man: progressive shunt due to concomitant aortic stenosis.
.P
JOURNAL ARTICLE.
.A
Pryor RE; Giannetto L; Bashore TM.
.I 125919
.U
89320322
.S
Am Heart J 8910; 118(2):424-5
.M
Adolescence; Case Report; Child; DTPA/*DU; Female; Heart Neoplasms/*DI; Human; Magnetic Resonance Imaging/*; Male; Organometallic Compounds/*DU.
.T
Contrast-enhanced magnetic resonance imaging of cardiac tumors in children.
.P
JOURNAL ARTICLE.
.A
Niwa K; Tashima K; Terai M; Okajima Y; Nakajima H.
.I 125920
.U
89320323
.S
Am Heart J 8910; 118(2):426-7
.M
Ganglionic Blockaders/*TU; Heart Failure, Congestive/*DT/PP; Hexamethonium Compounds/*TU; Human.
.T
Hexamethonium, a forgotten drug in relation to "new" concepts in the management of heart failure [editorial]
.P
EDITORIAL.
.A
Freis ED.
.I 125921
.U
89320331
.S
Am J Cardiol 8910; 64(4):1B-43B
.M
Human; Myocardial Infarction/*; Support, Non-U.S. Gov't.
.T
A symposium: Myocardial infarction--direction for the '90s. November 12, 1988, Washington, D.C.
.P
JOURNAL ARTICLE.
.I 125922
.U
89320334
.S
Am J Cardiol 8910; 64(4):22B-24B
.M
Angioplasty, Transluminal/AE/*MT; Comparative Study; Emergencies; Fibrinolytic Agents/TU; Human; Myocardial Infarction/*TH; Random Allocation.
.T
Patient selection for percutaneous transluminal coronary angioplasty in acute myocardial infarction.
.P
JOURNAL ARTICLE.
.W
Whether thrombolytic therapy or immediate angioplasty should be the preferred treatment for patients with acute myocardial infarction has not yet been decided. Emergency angioplasty can be used as primary therapy, as an adjunct to thrombolytic therapy, or as a salvage procedure in patients in whom thrombolysis fails. Immediate angioplasty produces a higher recanalization rate, yet reclosure is more likely with this procedure. In many cases, patient selection for acute angioplasty remains controversial. Randomized trials comparing the results of thrombolysis with those of angioplasty are needed before definitive decisions can be made.
.A
King SB 3d.
.I 125923
.U
89320336
.S
Am J Cardiol 8910; 64(4):29B-32B
.M
Aged; Aspirin/*AD/AE; Drug Administration Schedule; Drug Therapy, Combination; Hemorrhage/CI; Human; Male; Middle Age; Myocardial Infarction/*PC; Warfarin/*AD/AE.
.T
Antithrombotic therapy in the primary prevention of acute myocardial infarction [published erratum appears in Am J Cardiol 1990 Jun 1;65(20):1410]
.P
JOURNAL ARTICLE.
.W
The high factor VII coagulant (VIIc) activity in men at high risk of coronary heart disease suggests that restoring normal hemostatic activity with appropriate oral anticoagulants might constitute effective primary prevention. A pilot study was therefore undertaken of a randomized, double-blind, placebo-controlled trial of long-term, low-dose warfarin therapy. Middle-aged men at high risk (mean VIIc 120% of standard) but without clinical coronary heart disease or contraindications to anticoagulants were randomized to warfarin or placebo. The initial warfarin dose (2.5 mg/day) was increased at intervals to lower VIIc to 70% of standard and increase the prothrombin time international normalized ratio to 1.6. The control participants received the same dose sequence of placebo. The pilot study confirmed the feasibility of the design, the absence of any increased risk of serious bleeding, and the high compliance and low withdrawal rate from randomized treatment. Accordingly, a full-scale thrombosis prevention trial has been launched, which, in addition to low-dose warfarin, includes a low-dose aspirin regimen (75 mg/day) in a factorial design. The aim of this trial is to produce a 30% reduction in coronary heart disease in 6,000 high-risk men aged 45 to 69 years. The men will receive either separate or combined therapy and will be followed up for 5 years. Evidence so far indicates that the risk of bleeding in those receiving combined therapy will be no higher than that in those taking aspirin alone.
.A
Miller GJ.
.I 125924
.U
89320338
.S
Am J Cardiol 8910; 64(4):41B-43B
.M
Double-Blind Method; Drug Administration Schedule; Echocardiography; Heart Diseases/ET/*PC; Heparin/*AD/BL; Human; Myocardial Infarction/CO/*DT; Partial Thromboplastin Time; Support, Non-U.S. Gov't; Thrombosis/ET/*PC.
.T
Prevention of left ventricular mural thrombus.
.P
JOURNAL ARTICLE.
.W
Acute myocardial infarction is associated with a high incidence of left ventricular mural thrombosis, which causes most of the systemic emboli. A double-blind trial was undertaken in patients with anterior transmural myocardial infarction to evaluate the ability of a high-dose heparin regimen to prevent left ventricular mural thrombosis. The high dose consisted of 12,500 U of calcium heparin subcutaneously every 12 hours for 10 days, which was compared with a low dose consisting of 5,000 U every 12 hours. The formation of left ventricular mural thrombosis was assessed by means of 2-dimensional echocardiography on day 10 after infarction. The high-dose group had a significantly lower incidence of left ventricular mural thrombosis than did the low-dose group. This was achieved without increasing the incidence of bleeding. The benefits of high-dose heparin were associated with maintaining plasma heparin concentrations at 0.2 U/ml and activated partial thromboplastin time between 50 and 60 seconds.
.A
Turpie AG.
.I 125925
.U
89320347
.S
Am J Clin Nutr 8910; 50(1):1-8
.M
Child Nutrition/*; Child, Preschool; Cohort Studies; Colombia; Diarrhea, Infantile/*CO; Female; Food, Fortified/*; Growth Disorders/*ET/PC; Human; Infant; Infant, Newborn; Male; National Health Programs; Nutrition Disorders/*CO; Nutritional Requirements; Statistics; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Nutritional supplementation: effects on child stunting because of diarrhea.
.P
JOURNAL ARTICLE.
.W
Research has shown that the positive effect of nutritional supplementation on child growth in malnourished populations is small relative to the large negative effect of diarrheal disease. To test the hypothesis that the effects of supplementation and diarrhea are synergistic in that supplementation modifies the negative effect of diarrhea on linear growth, length and diarrheal morbidity were compared at 36 mo of age for two cohorts of Colombian children: supplemented from birth and unsupplemented. Among unsupplemented children diarrhea was negatively associated with length. Among supplemented children diarrhea had no effect on length and differed from that of unsupplemented children. Thus, supplementation completely offset the negative effect of diarrheal disease on length. Targeting supplementation programs to the critical period of high diarrheal prevalence among infants and young children should increase the effectiveness of such programs in preventing growth retardation associated with diarrhea.
.A
Lutter CK; Mora JO; Habicht JP; Rasmussen KM; Robson DS; Sellers SG; Super CM; Herrera MG.
.I 125926
.U
89320348
.S
Am J Clin Nutr 8910; 50(1):100-8
.M
Adult; Aged; Aged, 80 and over; Aging; Fasting; Female; Human; Male; Middle Age; Nutritional Status; Phytonadione/*BL; Sex Factors; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.; Triglycerides/BL; Vitamin A/BL; Vitamin E/BL; Vitamin K/BL.
.T
Phylloquinone in plasma from elderly and young adults: factors influencing its concentration.
.P
JOURNAL ARTICLE.
.W
Fasting plasma phylloquinone concentrations were determined by reverse-phase high-performance liquid chromatography in a population of young (n = 131) and elderly (n = 195) human subjects. The distribution of values was non-Gaussian but was converted to Gaussian form after a logarithmic transformation of the data. The normal range derived from the lognormal distribution was 0.29-2.64 nmol/L (geometric means = 0.87 nmol/L, median = 0.86 nmol/L). Young females had significantly decreased plasma phylloquinone concentrations when compared with the elderly females whereas concentrations in young males were slightly higher than those in elderly males. A regression model was constructed and revealed that plasma phylloquinone concentrations were positively correlated with plasma triglycerides and alpha-tocopherol. Although the elderly subjects (means = 1.05 nmol/L) had higher levels of phylloquinone than the young subjects (0.94 nmol/L), when the concentration of phylloquinone in plasma is expressed as nanomoles phylloquinone per millimole of triglyceride, the elderly subjects (0.62 x 10(-6) showed decreased levels for phylloquinone compared with the young subjects (0.82 x 10(-6) (p less than 0.001).
.A
Sadowski JA; Hood SJ; Dallal GE; Garry PJ.
.I 125927
.U
89320349
.S
Am J Clin Nutr 8910; 50(1):109-13
.M
Agranulocytosis/*BL; Antibiotics/AD; Diet/*; Fever/ET; Human; Hypoprothrombinemias/CO; Intestines/MI; Neoplasms/BL/*CO; Neutropenia/*BL/ET; Phytonadione/*DF/ME; Prothrombin Time; Support, Non-U.S. Gov't; Vitamin K/AD; Vitamin K Deficiency/ET.
.T
Dietary deficiency of phylloquinone and reduced serum levels in febrile neutropenic cancer patients.
.P
JOURNAL ARTICLE.
.W
In 34 cancer patients with 40 neutropenic febrile episodes requiring broad-spectrum antimicrobial therapy, detailed dietary assessments revealed that deficient and severely deficient phylloquinone intakes (less than or equal to 70 and less than or equal to 25 micrograms/d) were identified during 88% and 38% of all days recorded, respectively. Serum phylloquinone levels and serial prothrombin times (PT) drawn in a similar group of 32 patients revealed that an elevated PT (greater than or equal to 2 s beyond control) was significantly associated (p less than 0.01) with a serum phylloquinone level of less than 4.4 nmol/L. Patients on antimicrobial regimens that suppressed menaquinone-producing intestinal microflora and that contained an N-methylthiotetrazole (NMTT) moiety had an elevated PT significantly more often than did patients receiving antimicrobial agents that preserved the microflora and contained no NMTT moiety (3 of 10 vs 10 of 11, respectively; p = 0.02 Fisher's exact). These data suggest that these patients have a profound deficiency of oral vitamin K intake that may be further augmented by antimicrobial therapy.
.A
Conly J; Suttie J; Reid E; Loftson J; Ramotar K; Louie T.
.I 125928
.U
89320350
.S
Am J Clin Nutr 8910; 50(1):114-9
.M
Adult; Caloric Intake; Chromatography, High Pressure Liquid; Diet/*; Female; Human; Microchemistry; Niacin/AD/*ME; Nicotinamide/*AA/ME/UR; Statistics.
.T
Correlation between niacin equivalent intake and urinary excretion of its metabolites, N'-methylnicotinamide, N'-methyl-2-pyridone-5-carboxamide, and N'-methyl-4-pyridone-3-carboxamide, in humans consuming a self-selected food.
.P
JOURNAL ARTICLE.
.W
N'-methyl-4-pyridone-3-carboxamide (4-py) is the major metabolite of nicotinamide and nicotinic acid in rats. However, because it is complicated to determine 4-py in humans, there is only one report on its excretion. Recently we developed a method for the microdetermination of 4-py by high-performance liquid chromatography. Urinary excretion of 4-py in Japanese students from Teikoku Women's University who consumed self-selected foods was 7.12 +/- 3.25 mumol/d, which is about one-fourth of N'-methylnicotinamide (MNA) and about one-ninth of N'-methyl-2-pyridone-5-carboxamide (2-py) excretion. The correlation coefficient between daily niacin equivalent (NE) intake and daily 4-py excretion was 0.529, which was about the same as the correlation coefficient between daily NE intake and daily 2-py excretion and which was two times higher than the correlation coefficient between daily NE intake and daily MNA excretion.
.A
Shibata K; Matsuo H.
.I 125929
.U
89320351
.S
Am J Clin Nutr 8910; 50(1):120-8
.M
Animal; Animals, Suckling/*ME; Bone Marrow; Cebus; Diet; Erythrocytes/AN; Female; Folic Acid/*AD/ME; Folic Acid Deficiency/BL/*ME/UR; FIGLU Test; Hematocrit; Lactation; Liver/AN; Male; Maternal-Fetal Exchange/*; Milk/AN; Nutritional Status; Pregnancy; Support, U.S. Gov't, P.H.S..
.T
Experimental maternal and neonatal folate status relationships in nonhuman primates.
.P
JOURNAL ARTICLE.
.W
The influence of maternal dietary folic acid intake on folate status was studied in Cebus albifrons monkeys by feeding 10 or 250 micrograms/100 kcal dietary folic acid during pregnancy and 4 wk postpartum. Maternal, infant, and nonpregnant hematologic indices; blood and liver folate concentrations; and urinary formiminoglutamic acid excretion all varied with dietary folate intake and pregnancy status as did milk folate concentration in lactating dams. Maternal folate status, determined by plasma, red blood cell, and milk folate concentrations, as well as urinary formiminoglutamic acid excretion, all were correlated significantly with liver folate concentrations in neonates (r = 0.740, r = 0.919, r = 0.936, and r = -0.851, respectively). Results in these primates showed that neonatal folate status was related significantly to the dietary folate intake and folate status of the mother during pregnancy and lactation.
.A
Blocker DE; Ausman LM; Meadows CA; Thenen SW.
.I 125930
.U
89320352
.S
Am J Clin Nutr 8910; 50(1):129-35
.M
Adult; Biological Availability; Bread/AN; Cereals/AN; Female; Ferric Compounds/*AN; Flour/*AN; Food, Fortified/*; Human; Iron Radioisotopes; Male; Middle Age; Phosphates/*AN; Solubility; Support, Non-U.S. Gov't.
.T
Iron fortification of flour with a complex ferric orthophosphate.
.P
JOURNAL ARTICLE.
.W
The unexpectedly low bioavailability in humans of elemental iron powder prompted us to search for other Fe compounds suitable for Fe fortification of flour that fulfill the two requirements of insolubility in water (due to high water content of flour) and good bioavailability in humans. Systematic studies of compatibility, solubility, and bioavailability led to this study of a microcrystalline complex ferric orthophosphate (CFOP), Fe3H8(NH4)-(PO4)6.6H2O, a well-defined compound. This compound was labeled with 59Fe, and the native Fe in meals was labeled with 55FeCl3. The ratio of absorbed 59Fe to absorbed 55Fe is a direct measure of the fraction of CFOP that joins the nonheme Fe pool and that is made potentially available for absorption. The relative bioavailability of CFOP varied from 30% to 60% when labeled wheat rolls were served with different meals. The CFOP meets practical requirements of an Fe fortificant for flour well, with regard to both compatibility and bioavailability in humans.
.A
Hallberg L; Rossander-Hulthen L; Gramatkovski E.
.I 125931
.U
89320353
.S
Am J Clin Nutr 8910; 50(1):136-40
.M
Adolescence; Adrenal Cortex Hormones/TU; Adult; Ceruloplasmin/BL; Child; Copper/BL; Erythrocytes/AN/EN; Female; Glutathione Peroxidase/AN; Human; Male; Middle Age; Multiple Sclerosis/DT/EN/*ME; Selenium/BL; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Trace Elements/*BL; Zinc/BL.
.T
Trace element status in multiple sclerosis.
.P
JOURNAL ARTICLE.
.W
We compared trace element status in multiple sclerosis (MS) patients (n = 27) with and without treatment with corticosteroids and groups of healthy subjects. Concentrations of plasma ceruloplasmin, selenium, and zinc and erythrocyte (RBC) glutathione peroxidase, Se, and Zn were similar in all groups. RBC copper concentrations were significantly lower in MS patients than in control subjects (mean +/- SEM: 0.048 +/- 0.005 vs 0.060 +/- 0.002 mumol/g Hb) because of decreased RBC Cu with steroid therapy. RBC Zn-Cu ratios were significantly higher (14.9 +/- 1.0 vs 10.1 +/- 0.3) in MS patients than in control subjects, differing in both groups of MS patients. In MS and control subjects, RBC Cu correlated significantly with RBC Zn (r = 0.56, 0.49). Disease acuity and disability had no effect on trace-mineral status. These data suggest that in MS there is altered Cu and Zn homeostasis that may cause or result from the disease and is influenced by corticosteroid therapy. Systemic trace element alterations might provide clinically useful markers of MS.
.A
Smith DK; Feldman EB; Feldman DS.
.I 125932
.U
89320355
.S
Am J Clin Nutr 8910; 50(1):145-50
.M
Adolescence; Adult; Anthropometry; Caloric Intake; Diet/*; Female; Human; Huntington Chorea/CO/GE/*ME; Male; Middle Age; Nutrition Disorders/CO; Nutrition Surveys/*; Nutritional Requirements; Nutritional Status.
.T
Nutritional evaluation of Huntington disease patients.
.P
JOURNAL ARTICLE.
.W
A nutritional survey and evaluation was made in Huntington disease patients by the 24-h-recall method. Control subjects and choreic patients consumed a diet that supplied all the essential amino acids. The diet was hypocaloric, rich in animal protein, and low in fat and carbohydrates. The ratio of calcium to phosphorus in the groups studied was less than 1. High vitamin A and low vitamin C and niacin intakes were observed in Huntington disease patients. Only 17% of control subjects showed weight deficiency; 55% of the patients at stages III and IV of the disease were malnourished despite receiving the same food intake as controls. Although iron intake was deficient in all groups studied, it was enough to maintain normal serum levels of this metal. The deficiencies found in some nutrients do not explain the clinical manifestations observed in Huntington disease patients.
.A
Morales LM; Estevez J; Suarez H; Villalobos R; Chacin de Bonilla L; Bonilla E.
.I 125933
.U
89320356
.S
Am J Clin Nutr 8910; 50(1):151-4
.M
Asia, Southeastern/EH; Bile Acids and Salts/AN; Caloric Intake; Cholesterol/AN; Colon; Colonic Neoplasms/*EP/ME; Coronary Disease/EP/ME; Diet/*; Feces/*AN; Great Britain; Health Surveys/*; Human; London; Steroids/*AN; Support, Non-U.S. Gov't; Vegetarianism.
.T
Diet and fecal steroid profile in a South Asian population with a low colon-cancer rate.
.P
JOURNAL ARTICLE.
.W
South Asian immigrants to England and Wales have low mortality from colon cancer and high mortality from coronary heart disease compared with the general population. In a survey of a predominantly Gujarati population in northwest London, both vegetarians and nonvegetarians had similar total dietary fat intake to the native British population but higher dietary fiber intake. Total fecal bile acid and neutral animal sterol concentrations were lower in South Asians than in a native British comparison group. Sixty-two percent of South Asians excreted detectable quantities of free primary bile acids, which were not present in stools from native British subjects. The ratio of fecal coprostanol to total neutral animal sterols was also lower in South Asians. Low risk of colon cancer in this population may be related to reduced microbial activity in the bowel and low levels of tumor-promoting secondary bile acids.
.A
McKeigue PM; Adelstein AM; Marmot MG; Henly PJ; Owen RW; Hill MJ; Thompson MH.
.I 125934
.U
89320357
.S
Am J Clin Nutr 8910; 50(1):155-67
.M
Adolescence; Adult; Age Factors; Aged; Aged, 80 and over; Aging/*; Analysis of Variance; Caloric Intake/*; Child; Child, Preschool; Diet/*; England; Female; Human; Infant; Male; Middle Age; Nutrition Surveys/*; Quality Control; Sex Factors; Statistics/*; Time Factors.
.T
Between- and within-subject variation in nutrient intake from infancy to old age: estimating the number of days required to rank dietary intakes with desired precision.
.P
JOURNAL ARTICLE.
.W
In prospective studies of diet it is often necessary to know for how many days subjects should record food consumption in order to be able to rank subjects correctly according to their nutrient intakes. Data from six studies--of toddlers, families, schoolchildren, dietitians, pregnant women, and elderly subjects--were analyzed to estimate the number of recording days necessary for energy, 28 nutrients, and the ratio of polyunsaturated to saturated fatty acids (P:S). The most striking finding is that 7 d of diet record do not rank subjects with the degree of accuracy commonly assumed. For some nutrients, such as iron, zinc, nicotinic acid, and pyridoxine, it may be desirable to record diet over a number of short, separate periods to achieve the number of days required. For others, such as copper, retinol, carotene, vitamin B-12, polyunsaturated fatty acids, P:S, and alcohol, alternative methods of assessment based on dietary histories or questionnaires may be more appropriate.
.A
Nelson M; Black AE; Morris JA; Cole TJ.
.I 125935
.U
89320358
.S
Am J Clin Nutr 8910; 50(1):168-71
.M
Adult; Body Water/*AN; Bromides/*AN; Child, Preschool; Chromatography, High Pressure Liquid; Chromatography, Ion Exchange/MT; Extracellular Space/*AN; Female; Human; Infant; Male; Mathematics; Support, U.S. Gov't, P.H.S..
.T
Bromide space determination using anion-exchange chromatography for measurement of bromide.
.P
JOURNAL ARTICLE.
.W
A high-pressure liquid chromatographic method for bromide measurement is used to determine extracellular water volume in humans. The method uses 5 microL serum ultrafiltrate and has a sensitivity of 7.5 pmol. Because of the extreme sensitivity of this method, relatively small quantities of Br can be administered and small amounts of blood are needed for the analysis. By this method, the mean corrected Br space in 82 healthy adults representing a wide range of body weights was 0.218 +/- .034 L/kg (mean +/- 1 SD) with a range of 0.153-0.295 L/kg, which is consistent with reported values. There was a significant, inverse relationship between corrected Br space per kilogram and obesity as measured by body mass index. The corrected Br space in six children aged 3-36 mo was 0.335-0.394 L/kg, which is also consistent with reported values in children of this age. This method for Br measurement can easily and readily be applied for the determination of extracellular water volume.
.A
Miller ME; Cosgriff JM; Forbes GB.
.I 125936
.U
89320359
.S
Am J Clin Nutr 8910; 50(1):177-8
.M
Cholesterol/*BL; Diet/*; Human; Israel.
.T
Diet and serum cholesterol [letter; comment]
.P
COMMENT; LETTER.
.A
Kahn HA; Medalie JH; Balogh M; Groen JJ; Riss E.
.I 125937
.U
89320360
.S
Am J Clin Nutr 8910; 50(1):178-9
.M
Animal; Child; Child, Preschool; Female; Giardiasis/*CO; Human; Intestinal Diseases, Parasitic/*CO; Lactose Intolerance/*ET; Male; Milk/*; South Africa.
.T
Milk intolerance due to lactose and giardiasis [letter]
.P
LETTER.
.A
Tolboom JJ.
.I 125938
.U
89320362
.S
Am J Clin Nutr 8910; 50(1):30-6
.M
Adult; Blood Pressure; Body Weight; Cholesterol/BL; Diet, Reducing/*; Female; Food, Formulated/*; Human; Lipids/*BL; Lipoproteins, HDL/BL; Middle Age; Obesity/BL/*PC; Triglycerides/BL; Wheat/*.
.T
Use of an expanded-whole-wheat product in the reduction of body weight and serum lipids in obese females.
.P
JOURNAL ARTICLE.
.W
To achieve weight reduction and alter serum lipid profiles, an air-expanded whole-wheat protein product (SNW) was used by moderately obese women as a meal substitute for 12 wk. Results were compared with those from a standard low-calorie diet (LCD). The SNW group lost 3.9 kg (means) over the first 6 wk and a further 1.6 kg between weeks 6 and 12. In contrast, the LCD group lost 2.8 kg during the initial 6 wk but failed to achieve weight loss during the second 6 wk. Consequently, the SNW group lost nearly twice as much weight over the 12-wk period as did LCD participants. A beneficial effect of SNW on serum cholesterol and triglycerides was noted; both measures declined in conjunction with the weight loss. Such alterations were greater in the SNW group than in LCD participants. Both schemes proved safe. SNW is safe and effective in weight reduction and serum lipid modification in moderately obese women.
.A
Fordyce-Baum MK; Langer LM; Mantero-Atienza E; Crass R; Beach RS.
.I 125939
.U
89320363
.S
Am J Clin Nutr 8910; 50(1):37-40
.M
Adult; Anthropometry; Blacks/*; Body Weight; Caloric Intake; Dietary Proteins/AD; Female; Human; Middle Age; Nutritional Status; Obesity/*BL; Pyridoxal Phosphate/*BL; Pyridoxine/*AD/PK; Support, Non-U.S. Gov't; Virginia.
.T
Plasma pyridoxal 5'-phosphate concentrations in obese and nonobese black women residing near Petersburg, VA.
.P
JOURNAL ARTICLE.
.W
The vitamin B-6 status of 15 obese and 15 nonobese black women aged 21-51 y who were not taking vitamin supplements was assessed by using plasma pyridoxal 5'-phosphate (PLP) measurements. Ages, heights, and ideal body weights of the two groups were similar as were reported energy, protein, and vitamin B-6 intakes obtained by using 24-h intake data collected on two nonconsecutive days separated by at least 1 wk. The reported vitamin B-6 intakes were 1.18 +/- 0.44 mg/d (means +/- SD). Plasma PLP levels in the obese and nonobese black women were similar; these levels were also similar to those observed previously for white obese and nonobese women having similar physical characteristics. All subjects had plasma PLP levels indicative of adequate status with one possible exception. Obesity did not affect the plasma PLP levels in these black women.
.A
Driskell JA; McChrisley B; Reynolds LK; Moak SW.
.I 125940
.U
89320364
.S
Am J Clin Nutr 8910; 50(1):41-5
.M
Adult; Aged; Anthropometry; Basal Metabolism; Body Composition; Caloric Intake/*; Diet, Reducing/*; Female; Human; Middle Age; Obesity/*DH; Statistics; Time Factors; Weight Loss/*.
.T
Weight loss in 108 obese women on a diet supplying 800 kcal/d for 21 d.
.P
JOURNAL ARTICLE.
.W
A series of 108 obese women were studied for 21 d in a metabolic ward on a diet supplying 800 kcal/d (3.4 MJ/d), with 4.5 g protein nitrogen, 40% energy from fat, and 46% from carbohydrate. The average total weight loss was 5.0 kg. During the second and third week on the diet the rate of weight loss was 211 +/- 77 g/d (mean +/- SD) and individual values were well predicted by admission resting metabolic rate (RMR) (r = 0.66, p less than 0.0001). The calculated energy density of the weight lost in this phase was 7000 kcal/kg (29.3 MJ/kg). However, the weight loss in the first week had a labile component of 815 +/- 1202 g, which was not well predicted by RMR (r = 0.20, p less than 0.05). The effect of this labile component was to obscure the overall rate of weight loss so some of the patients did not show net weight loss until day 13 of the diet, although they were in negative energy balance.
.A
Webster JD; Garrow JS.
.I 125941
.U
89320365
.S
Am J Clin Nutr 8910; 50(1):46-52
.M
Adult; Amino Acids/ME; Caloric Intake; Creatinine/ME; Female; Follicular Phase; Human; Kynurenine/ME; Luteal Phase; Menstrual Cycle/*; Methylhistidines/ME; Nutrition; Serotonin/ME; Support, Non-U.S. Gov't; Tryptophan/AD/*ME.
.T
Menstrual cycle effects on the metabolism of tryptophan loads.
.P
JOURNAL ARTICLE.
.W
The metabolism of tryptophan (Trp) was examined during the follicular and luteal phases of the human menstrual cycle. Eight healthy women were administered capsulated Trp (3 g) or placebo (3 g lactose) during two follicular and two luteal phases of their menstrual cycles. Trp loading resulted in increased plasma concentrations of Trp and kynurenine, in an increase in the ratio of Trp to neutral amino acids in plasma, and in an increase in urinary excretion of Trp and kynurenine at both phases of the menstrual cycle. However at 3 h after Trp ingestion, plasma kynurenine levels in the luteal phase (23.6 +/- 3.1 mumol/L) were 40% higher than in the follicular phase (16.7 +/- 1.1 mumol/L) (p less than 0.05). Urinary kynurenine excretion in the luteal phase (81.6 +/- 14.4 mumol/24 h) was 28% greater than in the follicular phase (63.9 +/- 13.0 mumol/24 h) (p less than 0.05). The results indicate that the catabolism of Trp via the kynurenine pathway is affected by the phase of the human menstrual cycle.
.A
Hrboticky N; Leiter LA; Anderson GH.
.I 125942
.U
89320366
.S
Am J Clin Nutr 8910; 50(1):53-7
.M
Chromatography, Gel; Chromatography, High Pressure Liquid/MT; Chromatography, Ion Exchange; Dialysis; Freeze Drying; Human; Milk Proteins/*AN; Milk, Human/*AN; Nitrogen/*AN; Support, U.S. Gov't, P.H.S..
.T
Isolation of the nonprotein nitrogen fraction from human milk by gel-filtration chromatography and its separation by fast protein liquid chromatography.
.P
JOURNAL ARTICLE.
.W
Human milk (HM) is unique compared with the milk of other species in that nonprotein nitrogen (NPN) constitutes 20-25% of the total N. The NPN fraction consists of a diverse group of compounds with molecular masses less than 10,000 Da (in the picogram to microgram per milliliter range), which have only been partially characterized. We developed a methodology to separate and concentrate the NPN fraction for further analysis. NPN was initially separated from other milk components by Sephadex G-25 gel filtration. Further isolation and separation was carried out by fast protein liquid chromatography gel filtration and ion-exchange chromatography. Molecular masses of unknown peaks were determined by using known molecular mass markers and standards. The methodologies developed lead to the discrete separation of NPN from other milk compounds and can be particularly valuable for isolating peptides in HM.
.A
Donovan SM; Lonnerdal B.
.I 125943
.U
89320367
.S
Am J Clin Nutr 8910; 50(1):58-62
.M
Adult; Aged; Caloric Intake; Cholesterol/*BL; Cholesterol, Dietary/*PD; Diet/*; Dietary Fats/*AD; Dietary Fiber/*AD; Eggs; Female; Human; Hyperlipidemia/BL; Lipids/*BL; Lipoproteins, HDL Cholesterol/BL; Lipoproteins, LDL Cholesterol/BL; Male; Middle Age; Statistics; Support, Non-U.S. Gov't.
.T
Serum lipid response to dietary cholesterol in subjects fed a low-fat, high-fiber diet.
.P
JOURNAL ARTICLE.
.W
To determine whether hyperresponse to dietary cholesterol occurs in individuals consuming a low-fat diet, a study was performed on 58 subjects whose plasma cholesterol had changed by greater than or equal to 5% when intakes of two and seven eggs per week were compared in a previous study. Here, the effect of eating nine, zero, and nine eggs per week was studied over 3 consecutive months. Plasma total, LDL, and HDL cholesterol did not differ significantly. There was no correlation between individuals' lipoprotein changes in this and the previous study. Consistent hyperresponse to moderate cholesterol intake is not apparent in people eating a low-fat, high-fiber diet. Reduction in dietary cholesterol below 400 mg/d produces no further substantial cholesterol lowering.
.A
Edington JD; Geekie M; Carter R; Benfield L; Ball M; Mann J.
.I 125944
.U
89320368
.S
Am J Clin Nutr 8910; 50(1):63-7
.M
Adipose Tissue/*ME/PA; Animal; Anthropometry; Cell Division; Cell Line; Child; Female; Fibroblasts/ME; Glycerolphosphate Dehydrogenase/*BL; Human; Male; Obesity/BL/*ME; Proteins/AN; Rats; Time Factors; Triglycerides/AN; Weight Loss/*.
.T
Adipogenic activity in sera from obese children before and after weight reduction.
.P
JOURNAL ARTICLE.
.W
The adipogenic and mitogenic potentials of sera obtained from obese children before and after weight reduction and from lean control subjects were studied in clonal 3T3 L1 fibroblasts. The sera from the lean (n = 14) and obese (n = 12) children under habitual diet contained similar adipogenic activity. However, when the obese children underwent a weight-reduction program for 3 wk (600 kcal/d), the potential of their sera to stimulate glycero-phosphate dehydrogenase, an index of adipogenic activity, was significantly reduced by 32% (p less than 0.01). Similarly, the mitogenic activity of these sera decreased significantly (202 +/- 15 vs 231 +/- 27 micrograms per dish, p less than 0.01). Testing pooled sera from the different groups in cultured rat adipocyte precursor cells gave similar results. This study suggests that human childhood-onset obesity is not accompanied by increased circulatory factors involved in the formation of new fat cells. The adipogenic and mitogenic activity of sera from obese children may be influenced by long-term dietary restriction.
.A
Hauner H; Wabitsch M; Zwiauer K; Widhalm K; Pfeiffer EF.
.I 125945
.U
89320369
.S
Am J Clin Nutr 8910; 50(1):68-72
.M
Animal; Aorta/*DE/ME/PA; Arteriosclerosis/*ET; Atherosclerosis/EN/*ET/PA; Cholesterol/*BL; Cholesterol Acyltransferase/AN; Cholesterol Esters/AN; Cholesterol, Dietary/*AD/AE; Rabbits; Support, U.S. Gov't, P.H.S..
.T
Short-term exposure to high dietary cholesterol in early life: arterial changes and response after normalization of plasma cholesterol.
.P
JOURNAL ARTICLE.
.W
Elevated serum cholesterol is an established risk factor for the development of atherosclerosis but the effect of high dietary cholesterol in early life on subsequent arterial response to atherogenic diet in adult life is unknown. Weanling rabbits were exposed for 6 wk to a diet containing 0.25% cholesterol, allowed to recover for 9 wk (at least 3 wk after normalization of plasma cholesterol), and subsequently rechallenged with cholesterol to determine atherogenic response. Enhanced activity of acyl-CoA-cholesterol-acyl-transferase in aorta induced by cholesterol feeding persisted even after normalization of serum cholesterol. When rechallenged with cholesterol for 3 mo, these animals displayed significantly (p less than 0.05) increased development of aortic atherosclerosis and accumulation of cholesterol esters when compared with control animals. Exposure to cholesterol in early life appears to cause persistent changes in cholesterol ester synthetic enzyme activity in aorta after normalization of plasma cholesterol and these residual effects might increase aortic response to subsequent cholesterol challenge in adult life.
.A
Subbiah MT; Sprinkle JD; Rymaszewski Z; Yunker RL.
.I 125946
.U
89320371
.S
Am J Clin Nutr 8910; 50(1):80-92
.M
Adult; Amino Acids/*ME; Amino Acids, Essential/AD/*ME; Child, Preschool; Dietary Proteins/AD/ME; Female; Human; Male; Nitrogen/ME; Nutrition/*; Nutritional Requirements; Oxidation-Reduction; Proteins/ME; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
A theoretical basis for increasing current estimates of the amino acid requirements in adult man, with experimental support [see comments]
.P
JOURNAL ARTICLE.
.W
Estimates of the minimum (obligatory) rates of loss of indispensable acids via irreversible oxidation in healthy young adults are predicted from published data for obligatory nitrogen losses and from published values for whole-body protein turnover and the efficiency of amino acid recycling. The estimates obtained by these two different approaches are consistent and equal to or in most cases considerably higher than current values for the upper range of the individual amino acid requirements in healthy adults. From these estimates of the obligatory, or minimum, rates of amino acid oxidation, the minimum requirements for indispensable amino acids are predicted. These are about two to three times higher than current requirement figures. Experimental support for these higher requirement figures is presented, based on published 13C-labeled amino acid tracer studies. When these revised estimates are expressed per unit of protein need, the amino acid pattern is similar to the 1985 Food and Agriculture Organization/World Health Organization/United Nations University amino acid scoring pattern for the preschool child (aged 2-5 y).
.A
Young VR; Bier DM; Pellett PL.
.I 125947
.U
89320372
.S
Am J Clin Nutr 8910; 50(1):9-18
.M
Adipose Tissue/*ME/RA; Analysis of Variance; Anthropometry; Asian Americans; Diabetes Mellitus/EP/*ME/RA; Glucose/*ME; Glucose Tolerance Test; Human; Japan/EH; Male; Middle Age; Obesity/EP/*ME/RA; Skinfold Thickness; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Tomography, X-Ray Computed.
.T
Fatness, fat distribution, and glucose tolerance in second-generation Japanese-American (Nisei) men.
.P
JOURNAL ARTICLE.
.W
The association between amount and distribution of fat and glucose tolerance was examined in 229 second-generation Japanese-American men. According to the results of a 75-g oral glucose tolerance test and by World Health Organization (WHO) diagnostic criteria, 79 men were normal, 72 had impaired glucose tolerance (IGT), and 78 had noninsulin-dependent diabetes mellitus. Diagnostic groups were compared by using 10 measures of fatness derived from body mass indices, skinfold thicknesses, and fat areas, which were determined by computed tomography. IGT men were fatter than normal men on five measures; diabetic men were fatter on four and group differences were marginally significant (p greater than or equal to 0.03). Diabetic subjects had the largest deposits of subscapular (p = 0.01) and more biceps fat than normal men (p = 0.01); IGT men had more midthigh fat than diabetic men (p = 0.01). The diabetes and IGT groups possessed more intraabdominal fat (p = 0.003). For serum glucose levels there was an interaction between body mass index and subscapular fat.
.A
Newell-Morris LL; Treder RP; Shuman WP; Fujimoto WY.
.I 125948
.U
89320373
.S
Am J Clin Nutr 8910; 50(1):93-9
.M
Acetates/AN; Animal; Butyrates/AN; Cecum/DE/*ME; Colorectal Neoplasms/PC; Dietary Fiber/*PD; Fatty Acids/*AN; Gastrointestinal Contents/*AN; Hydrogen-Ion Concentration; Male; Propionates/AN; Support, U.S. Gov't, P.H.S.; Swine; Valerates/AN.
.T
High-fiber diets: influence on characteristics of cecal digesta including short-chain fatty acid concentrations and pH.
.P
JOURNAL ARTICLE.
.W
The effects of two sources of dietary fiber on the characteristics of cecal contents were assessed directly with miniature swine cannulated to facilitate frequent collections of cecal digesta. The short-chain fatty acid (SCFA) concentrations increased and the pH decreased at the same time that meal constituents entered the cecum; PEG was used as a dietary marker. The bean diet resulted in higher concentrations of acetate and total SCFA in cecal digesta, lower concentrations of butyrate, a larger SCFA pool size, and a more acidic pH than did the bran diet. Thus, we conclude that SCFA concentrations and acidity of the digesta are directly related and that dietary fibers can affect simultaneously several variables that are implicated as factors influencing colonic health.
.A
Fleming SE; Fitch MD; Chansler MW.
.I 125949
.U
89320374
.S
Am J Clin Pathol 8910; 92(1):1-9
.M
Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Follow-Up Studies; Gastrointestinal Neoplasms/AN/*PA/SU; Human; Immunohistochemistry; Male; Middle Age; Paraganglioma/AN/*PA/SU.
.T
Gangliocytic paraganglioma.
.P
JOURNAL ARTICLE.
.W
A study of gangliocytic paragangliomas (GPs) of the gastrointestinal tract from 51 patients showed characteristic microscopic features: epithelioid cells with an endocrine growth pattern, spindle cells, and ganglion cells. Forty-nine tumors were located in the duodenum, 1 in the jejunum, and 1 in the pylorus. Twenty-one patients were female, 28 male, and for two the sex was unknown. The average age at presentation was 54 years (range, 23-83). No patient had a recurrence. No neuroendocrine syndrome was found in any patient or patient's family. Immunohistochemical stains in 33 cases yielded the following (proportion positive): S-100 protein 94%, synaptophysin 94%, neuron-specific enolase 94%, pancreatic polypeptide 88%, somatostatin 75%, chromogranin 72%, neurofilament protein 64%, keratin 52%, leu-enkephalin 48%, serotonin (one case), and gastrin (one case). Antisera usually stained one or two of the three major cell types. Pancreatic-type tissue was identified in or near 28 tumors, including the pyloric and jejunal lesions and two in the distal duodenum. The authors conclude that GP is benign; is not associated with endocrine syndromes; contains autonomic, neural, and endocrine cell types; and is related to pancreatic development.
.A
Burke AP; Helwig EB.
.I 125950
.U
89320378
.S
Am J Clin Pathol 8910; 92(1):110-5
.M
Adolescence; Comparative Study; Female; Hepatoma/*PA/SC; Human; Liver Neoplasms/*PA; Microscopy; Microscopy, Electron; Ovarian Neoplasms/*PA/SC.
.T
Hepatoblastoma in an adult with metastasis to the ovaries.
.P
JOURNAL ARTICLE.
.W
A 19-year-old female had ascites, an enlarged liver, pelvic masses, and an alpha-fetoprotein level of 397,000 micrograms/L with a normal beta-human chorionic gonadotropin serum level. Abdominal exploration revealed a large solitary liver mass with bilateral ovarian masses, and bilateral salpingo-oophorectomy and wedge liver biopsy were performed. The tumor was composed of cords, nests, and pseudorosettes of polyhedral cells with eosinophilic cytoplasm and nuclei with prominent nucleoli. The clinical, light microscopic, and immunocytochemical features indicate that the primary liver neoplasm and ovarian metastases were a purely epithelial hepatoblastoma. To the authors' knowledge, this is the first reported case of this type.
.A
Green LK; Silva EG.
.I 125951
.U
89320381
.S
Am J Clin Pathol 8910; 92(1):124-6
.M
Calibration; Human; North America; Prothrombin Time/*ST; Reference Standards; Thromboplastin/*DU; World Health Organization.
.T
Special report: a simple system for the derivation of International Normalized Ratios for the reporting of prothrombin time results with North American thromboplastin reagents.
.P
JOURNAL ARTICLE.
.W
The World Health Organization international scale of reporting prothrombin time results is based on the calibration of thromboplastins against an international reference preparation to derive an International Sensitivity Index (ISI). Once the ISI has been assigned to an individual thromboplastin reagent, the derivation of International Normalised Ratios (INRs) for reporting results depends on mathematic formulae requiring a special calculator or mathematic tables. This causes difficulties and errors. A simplified system for interpretation of INRs with the range of thromboplastins widely used in North America is therefore presented, which obviates the need for mathematic procedures for the derivation of INR equivalents. It should thus facilitate the application of the INR system and of safer therapeutic ranges.
.A
Poller L; Hirsh J.
.I 125952
.U
89320382
.S
Am J Clin Pathol 8910; 92(1):127-8
.M
Bone Marrow/PA; Diagnosis, Differential; Hodgkin's Disease/*PA; Human; Leukemia, Myelocytic, Acute/*PA; Myelodysplastic Syndromes/*PA.
.T
Myelodysplasia and acute leukemia following treatment for Hodgkin's disease [letter; comment]
.P
COMMENT; LETTER.
.A
McKenna RW; Brunning RD.
.I 125953
.U
89320383
.S
Am J Clin Pathol 8910; 92(1):16-21
.M
Adolescence; Adult; Aged; Aged, 80 and over; Anus/MI/*PA; Anus Neoplasms/*MI; Carcinoma, Squamous Cell/*MI; Comparative Study; Condylomata Acuminata/*MI; DNA, Viral/AN; Female; Human; Male; Middle Age; Nucleic Acid Hybridization; Papillomaviruses/GE/*IP; Support, Non-U.S. Gov't.
.T
Human papillomavirus DNA determination of anal condylomata, dysplasias, and squamous carcinomas with in situ hybridization.
.P
JOURNAL ARTICLE.
.W
Infection with types 6, 11, 16, and 18 of the human papillomavirus (HPV) is associated with condylomatous, dysplastic, or carcinomatous changes in the genital tract. Emerging evidence suggests that a similar series of lesions develops in the anal canal after exposure to the same HPV types. In situ hybridization was performed with the use of biotinylated DNA probes to HPV 6, 11, 16, and 18, so as to determine the frequency of HPV DNA in 45 perianal and/or anal condylomata, 6 anal intraepithelial neoplasias, and 13 anal squamous cell carcinomas. Of the 33 perianal and/or anal condylomata in which HPV DNA was detected, 13 contained HPV 6 and 11, 12 HPV 6, 7 HPV 11, and 1 HPV 6, 11, and 18. Two of four severe anal dysplasias contained HPV 16, whereas one case each of mild and moderate anal dysplasia contained HPV 6. No HPV DNA was detected in the anal squamous cell carcinomas. The study demonstrated the presence of HPV DNA in 73% of condylomata and 67% of anal dysplasias. The observations suggest that the cloacogenically derived anal epithelium is susceptible to infection by the same HPV types as infect the similarly derived epithelium of the lower female genital tract and that these HPV types result in some similar lesions, i.e., condylomata and dysplasias in both sites. A role in the genesis of anal cancer was not found in this study.
.A
Duggan MA; Boras VF; Inoue M; McGregor SE; Robertson DI.
.I 125954
.U
89320384
.S
Am J Clin Pathol 8910; 92(1):22-6
.M
Adult; Aged; Biopsy, Needle; Breast/*PA; Breast Neoplasms/*PA; Carcinoma/PA; Carcinoma in Situ/*PA; Comparative Study; Human; Hyperplasia/PA; Middle Age; Support, Non-U.S. Gov't.
.T
Fine-needle aspiration of mammary lobular carcinoma in situ and atypical lobular hyperplasia.
.P
JOURNAL ARTICLE.
.W
Cytologic features of fine-needle aspirations (FNAs) of the breast from three patients with either lobular carcinoma in situ (LCIS) or atypical lobular hyperplasia (ALH) are described and compared with those in six patients with infiltrating lobular carcinoma (ILC). FNAs of LCIS and ALH were characterized by loosely cohesive cell groups composed of uniform cells with frequent eccentric nuclei, minimal nuclear atypia, and occasional intracytoplasmic lumina. FNAs from ILC had some overlapping features with ALH and LCIS but were generally more cellular and had a higher proportion of noncohesive single cells with more nuclear atypia and pleomorphism. Intracytoplasmic lumina were consistently found in invasive and noninvasive lobular lesions and may represent the most useful cytologic clue for their recognition. FNAs with the above features are atypical and suggestive of ALH or LCIS. Excisional biopsy should be performed in such cases to confirm the presence of ALH or LCIS and to evaluate for ILC.
.A
Salhany KE; Page DL.
.I 125955
.U
89320385
.S
Am J Clin Pathol 8910; 92(1):27-35
.M
Adult; Biopsy, Needle; Breast Neoplasms/PA/*SC; Diagnosis, Differential; Female; Human; Male; Middle Age; Prognosis.
.T
Fine-needle aspiration cytology of metastatic neoplasms in the breast.
.P
JOURNAL ARTICLE.
.W
Twenty cases of metastatic neoplasms in the breast were identified in a series of 1,034 fine-needle aspirations (FNAs) of the breast, of which 389 were malignant. Patients with breast carcinomas in whom metastasis to the contralateral breast developed were excluded from this study. This series consisted of 17 women and 3 men, ranging in age from 28 to 63 years (mean, 49 years). The tumors included oat cell carcinoma (three), melanoma (three), ovarian serous carcinoma (one), bronchogenic adenocarcinoma and squamous carcinoma (four and two, respectively), lymphoma (two), carcinoid (two), transitional cell carcinoma (one), plasma cell myeloma (one), and rhabdomyosarcoma (one). In two patients, the breast mass was the first manifestation of an extramammary cancer (two adenocarcinoma of the lung). Eleven patients died of disseminated cancer shortly after the breast metastasis was diagnosed. In most cases, the aspirates displayed the cytologic features characteristic of the primary tumors, thereby establishing the metastatic nature of the neoplasm. In four cases (two carcinoids, one myeloma, and one rhabdomyosarcoma), the cytologic features were difficult to differentiate from a primary breast carcinoma; however, the final diagnosis was established by electron microscopic examination and immunocytochemical studies on the aspirates. One case (adenocarcinoma of the lung) was misdiagnosed as primary breast carcinoma on both FNA and mastectomy specimen. Because metastatic neoplasms in the breast may mimic primary breast tumors, the authors recommend the following: (1) Evaluation of FNA of breast should be done with complete knowledge of the patient's clinical history. (2) The possibility of metastasis should be suspected in lesions with unusual cytologic patterns. (3) Ancillary studies on FNA can be helpful in interpreting selected cases.
.A
Sneige N; Zachariah S; Fanning TV; Dekmezian RH; Ordonez NG.
.I 125956
.U
89320386
.S
Am J Clin Pathol 8910; 92(1):36-41
.M
Adult; Aged; Aged, 80 and over; Biopsy, Needle/*MT; Bronchoscopy/*MT; Comparative Study; Diagnosis, Differential; Female; Human; Lung Neoplasms/*PA; Male; Middle Age; Predictive Value of Tests.
.T
Transbronchial fine-needle aspiration. Reliability and limitations.
.P
JOURNAL ARTICLE.
.W
Transbronchial needle aspiration is a new method of sampling pulmonary, paratracheal, and mediastinal masses. A total of 116 aspirations of the lung performed during a two-and-a-half-year period were reviewed. The results were compared with those of bronchial wash, bronchial brush, sputum, transbronchial forceps biopsy, and histologic material subsequently obtained during surgery or at autopsy. Clinical information was also reviewed. Transbronchial needle aspiration was performed on 104 patients, yielding 116 specimens. With the use of a combination of aspiration, wash, brush, sputum, and forceps biopsy, malignancy was detected in 48 patients. Open biopsy, mediastinoscopy, and transcutaneous needle aspiration increased the number of malignant neoplasms detected to 72. The tumors were detected in 67% of these 72 cases by a combination of all bronchoscopic methods. Transbronchial aspiration correctly identified 36% of malignant cases compared with 35% identified by wash, 39% by brush, 25% by sputum, and 59% by forceps biopsy. The overall accuracy of the techniques was 56% for aspiration, 48% for wash, 56% for brush, 35% for sputum, and 71% for forceps biopsy. Malignant cases were associated with cellular transbronchial aspirates, good preservation of cell detail, and a high degree of cytologic/histologic correlation regarding cell type. Transbronchial fine-needle aspiration has the potential for improving the diagnostic ability of bronchoscopy. However, the high incidence of false negative diagnoses is the main limitation for the technique, and the responsible factors are discussed.
.A
Wagner ED; Ramzy I; Greenberg SD; Gonzalez JM.
.I 125957
.U
89320388
.S
Am J Clin Pathol 8910; 92(1):51-6
.M
Animal; Biopsy, Needle; Electron Probe Microanalysis/*; Freezing/*; Frozen Sections/*; Liver/ME/PA; Mammae/ME/PA; Microtomy/*; Potassium/ME; Rats; Rats, Inbred Strains; Sodium/ME; Support, Non-U.S. Gov't.
.T
Rapid freezing of small biopsies and standard for cryosectioning and X-ray microanalysis.
.P
JOURNAL ARTICLE.
.W
A method for clamp-freezing of small biopsies for ultrathin cryosectioning is described. A formvar film is used to support the specimen before freezing with a pair of pliers, precooled in liquid nitrogen. This method makes it possible to align the piece of tissue close to a drop of standard solution and freeze the two simultaneously. After clamping, the flat, frozen sample contains both the piece of tissue and the standard in one solid block, which may thus be sectioned as a whole. The method has been used in the surgical theater, yielding good results with needle biopsies of the prostate and cystoscopically obtained biopsies of bladder tumors. The time lapse between excision and freezing may be less than 30 seconds, which represents a great improvement compared with the far more time-consuming mincing of tissue and mounting of the pieces on metal pins. From the frozen specimen, a large number of sections with good morphologic characteristics may be produced. The method was evaluated with the use of rat liver and lactating mammary tissue. Directly frozen tissue with intact blood supply was compared with biopsies prepared as described. Redistribution of Ca could not be demonstrated in either specimen type. However, the results indicate that the monovalent ions are far more mobile, and a significant increase of the Na:K ratios was observed in the biopsies compared with directly frozen tissue.
.A
Tvedt KE; Kopstad G; Halgunset J; Haugen OA.
.I 125958
.U
89320389
.S
Am J Clin Pathol 8910; 92(1):57-61
.M
Adult; Automation; Benzophenoneidum/DU; Erythrocyte Count/*IS; Flow Cytometry/*IS; Hematologic Diseases/BL; Human; Lasers; Reticulocytes/*.
.T
An automated optoelectronic reticulocyte counter.
.P
JOURNAL ARTICLE.
.W
Microscopic reticulocyte counting is time consuming and imprecise. A new reticulocyte counter has been developed, and the authors evaluated its utility for laboratory use. The counter, R-1000 of Sysmex-TOA Medical Electronics Company, Kobe, Japan, is based on the principles of flow cytometry. Reticulocytes are detected as fluorescent cells stained with a basic dye, auramine O, under argon-laser light. The automated count had high correlation to the manual count (r = 0.941). Linearity and reproducibility were both high. About 60 specimens were tested in one hour. Not only the reticulocyte percentage and count but also the maturity of reticulocytes was found from the intensity of the fluorescence, whether high, moderate, or slight. Normal reference values were 0.007 +/- 0.0055 (0.70 +/- 0.55%) for the reticulocytes, (4.63 +/- 1.09) X 10(9)/L for the reticulocyte count, 2.3 +/- 1.9% for highly fluorescent cells, 18.7 +/- 5.1% for moderately fluorescent cells, and 78.8 +/- 6.6% for cells with slight fluorescence. In patients with suppressed bone marrow function, such as is caused by chemotherapy, the reticulocyte fraction and count were low, and cells with slight fluorescence increased. In patients in whom bone marrow function was stimulated, such as with hemolytic anemia, the reticulocyte percentage, reticulocyte count, and highly fluorescent cells were high. Patients with chronic renal failure being treated by hemodialysis had a similar reticulocyte pattern to that in hemolytic anemia except that the reticulocyte count was decreased. Results for elderly patients were not different from those of healthy young controls. Some patients with a normal reticulocyte count and percentage had numerous highly fluorescent cells, perhaps because of hemolytic anemia not yet identified. Automated reticulocyte counting provides reliable data, so such measurement should be useful for analysis of the kinetics of red blood cells and for the study of the pathogenesis of anemia.
.A
Kojima K; Niri M; Setoguchi K; Tsuda I; Tatsumi N.
.I 125959
.U
89320391
.S
Am J Clin Pathol 8910; 92(1):68-72
.M
Adolescence; Agammaglobulinemia/ET/*IM; Child; Child, Preschool; Comparative Study; Enzyme-Linked Immunosorbent Assay; Female; Human; IgG/*CL; Male; Nephrotic Syndrome/CO/*IM; Recurrence; Support, Non-U.S. Gov't.
.T
IgG subclasses in children with nephrotic syndrome.
.P
JOURNAL ARTICLE.
.W
To determine whether the hypogammaglobulinemia of childhood nephrotic syndrome is characterized by symmetric depression of the IgG subclasses, the authors compared the IgG subclass concentrations in nephrotic patients in relapse versus remission. The authors used a highly sensitive monoclonal antibody-based enzyme immunoassay that allows quantitation with comparable precision of all four subclasses. They analyzed 28 sera obtained from 22 nephrotic patients during relapse (n = 16) and/or remission (n = 12). The mean ages of the two groups were similar. IgG1 and IgG2 were significantly decreased during relapse compared with remission, whereas IgG3 and IgG4 were not significantly different. This pattern of asymmetric depression of IgG subclasses supports a cause other than urinary losses in the pathogenesis of this abnormality.
.A
Warshaw BL; Check IJ.
.I 125960
.U
89320392
.S
Am J Clin Pathol 8910; 92(1):73-7
.M
Adult; Cell Separation; Flow Cytometry; Human; Immunohistochemistry; Leukocytes/*CL; Mathematics; Models, Theoretical; Phenotype; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S..
.T
A Venn diagram model that allows triple-label immunophenotypic analysis of cells based upon double-label measurements.
.P
JOURNAL ARTICLE.
.W
Using Venn diagrams derived from set theory, a mathematic model is presented that allows triple-label immunophenotypic analysis of cells based upon double-label measurements. Practical applications of this method are illustrated and discussed. Using this model, triple-label data concerning Leu-8 and Leu-9 (CD7) antigen co-expression by Leu-4+ (CD3+) leukocytes were derived from double-label measurements obtained with a single laser flow cytometer. Mean values were as follows: Leu-4+8+9+ (62%), Leu-4+8-9+ (36%), Leu-4+8+9- (0%), and Leu-4+8-9- (0%). Examples are given of additional models based upon similar principles.
.A
Wood GS.
.I 125961
.U
89320393
.S
Am J Clin Pathol 8910; 92(1):78-81
.M
Adolescence; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Human; Infant; Infant, Newborn; Male; Microscopy; Middle Age; Predictive Value of Tests; Reagent Strips/*DU; Retrospective Studies; Urine/*AN/CY/MI.
.T
Eliminating unnecessary urine microscopy. Results and performance characteristics of an algorithm based on chemical reagent strip testing [see comments]
.P
JOURNAL ARTICLE.
.W
The ability of a urinalysis reagent strip to predict the presence of formed elements in the sediment was evaluated. The sensitivity of individual biochemical analytes varies from 0.51 to 0.85; however, the combined sensitivity of positive reactions for either protein, nitrite, leukocyte esterase, and/or hemoglobin is 0.95. Leukocyte esterase activity becomes detectable at a concentration of 15 white blood cells per high-power field (WBCs/HPF). Proteinuria is nonspecifically related to pyuria and detects a minimum concentration of 6 WBCs/HPF, and the hemoglobin reaction detects 6 red blood cells/HPF. Most false negative reactions are associated with bacteriuria. A positive chemical reagent strip test can be safely and effectively used as a prerequisite for routine urine microscopic examination.
.A
Wenz B; Lampasso JA.
.I 125962
.U
89320394
.S
Am J Clin Pathol 8910; 92(1):82-5
.M
Adult; Agammaglobulinemia/ET; Hematologic Diseases/ET; Human; Immunoglobulins, Surface/*BI; Leukemia, B-Cell, Chronic/CO/*IM; Neoplasm Staging; Retrospective Studies.
.T
Correlation of clinical outcome with the degree of surface immunoglobulin (sIg) expression in B-cell chronic lymphocytic leukemia.
.P
JOURNAL ARTICLE.
.W
Peripheral blood from 121 consecutive adult patients with B-cell chronic lymphocytic leukemia (B-CLL) was immunophenotyped, and three groups with differing surface immunoglobulin (sIg) expression patterns were identified: Group A, 82 patients (68%) with weak sIg expression in greater than 20% of the circulating lymphocytes; Group B, 16 patients (13%) with either undetectable sIg or weak sIg expression limited to less than 20% of the lymphocytes; and Group C, 23 patients (19%) with strong sIg expression in greater than 20% of the lymphocytes. The histories of these patients were reviewed retrospectively, and the median follow-up in Groups A, B, and C was nine, ten, and nine years, respectively. Disease progression, defined as the development of cytopenia(s) (hemoglobin less than or equal to 100 g/L [less than or equal to 10 g/dL] or platelet count less than 100 X 10(9)/L [less than 100 X 10(3) microL]) and/or the development of newly palpable splenomegaly or lymphadenopathy, was least in Group B (6%) versus Group A (34%) versus Group C (30%) (P = 0.08). The incidence of hypogammaglobulinemia among patients who had protein electrophoresis performed was 7% in Group B versus 46% in Group A versus 45% in Group C (P = 0.036). The authors conclude that adult patients with B-CLL in whom sIg is undetectable or weakly expressed in less than 20% of the circulating lymphocytes may have an even more indolent clinical course than those with more widespread sIg expression.
.A
Tefferi A; Li CY; Phyliky RL.
.I 125963
.U
89320395
.S
Am J Clin Pathol 8910; 92(1):86-8
.M
Biopsy, Needle/IS/*MT; Human; Syringes; Vacuum.
.T
Fine-needle aspiration by vacuum tubes [see comments]
.P
JOURNAL ARTICLE.
.W
Fine-needle aspiration of subcutaneous masses, accepted in many parts of Europe and the Americas as a routine diagnostic technique, employs a syringe holder to facilitate the creation of a vacuum to withdraw cells. This investigation demonstrates that a vacuum tube used in venipuncture can be used to supply the negative pressure to suck cells into the needle. This apparatus is more readily available than a syringe holder in hospitals and clinics, and particularly provides the operator with a more dexterous approach to the mass because the fingers holding the needle can be much closer to the mass being immobilized by the other hand.
.A
Holmquist ND.
.I 125964
.U
89320396
.S
Am J Clin Pathol 8910; 92(1):89-92
.M
Amniotic Fluid/*AN; Blood Transfusion; Comparative Study; Erythroblastosis, Fetal/*DI/TH; Human; Infant, Newborn; Monocytes/*PA; Predictive Value of Tests; Spectrophotometry; Support, Non-U.S. Gov't.
.T
Monocyte monolayer assay: an efficient noninvasive technique for predicting the severity of hemolytic disease of the newborn.
.P
JOURNAL ARTICLE.
.W
The authors performed monocyte monolayer assays (MMAs) with the use of normal donor monocytes, and homologous reagent red blood cells, sensitized in vitro, with antibodies in maternal sera. The sera were from 16 pregnant women with Rh antibodies, drawn at the time of amniotic fluid analysis. They compared the predictive value (PV) of the MMAs and the delta OD 450 of amniotic fluid in forecasting the need for transfusing the infant. The PV of the delta OD 450 result in Liley zone mid II-III was 100%, but in zones 0 to low II it was only 60% (13 samples from ten women were in these zones but four babies required transfusion). In contrast, the PV of a positive (greater than 20% reactivity) MMA was 91% (one false positive result) and the PV of a negative MMA was 100%. Thus, the MMA was more efficient than amniotic fluid analysis at predicting hemolytic disease of the newborn severe enough to require transfusion. The noninvasive MMA could be used as a screening test, reducing the number of amniocenteses or ultrasound evaluations performed on Rh-sensitized women.
.A
Nance SJ; Nelson JM; Horenstein J; Arndt PA; Platt LD; Garratty G.
.I 125965
.U
89320483
.S
Am J Med Sci 8910; 298(1):20-7
.M
Aged; Alzheimer's Disease/ME/*PP; Diet; Dietary Proteins/AN; Energy Metabolism; Female; Human; Iron/ME; Male; Middle Age; Nutrition Disorders/ME; Nutritional Status/*; Prospective Studies; Retrospective Studies; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Vitamins/AN/TU.
.T
Nutritional status of free-living Alzheimer's patients.
.P
JOURNAL ARTICLE.
.W
Self-reported, dietary intake and biochemical estimates of thiamine, riboflavin, folate, vitamin B-12, protein, and iron were compared in 22, free-living elders by individuals who had senile dementia of the Alzheimer's type (SDAT) and in 41 who were cognitively normal (CN). The two groups did not differ significantly in their intake of these nutrients or the number of deficiency states for intake (less than 67% RDA). Low serum transketolase (thiamin; p less than 0.055), red blood cell (RBC) folate (p less than 0.06), and serum vitamin B-12 (p less than 0.05) levels occurred more often in SDAT patients than in CN subjects. Individuals in both groups who used multivitamin supplements had significantly higher biochemical values for thiamine (p less than 0.03), riboflavin (p less than 0.01), and vitamin B-12 (p less than 0.003) than nonsupplement users. Because of the differences in vitamin B-12 and RBC folate levels between groups, a retrospective analysis was performed on a larger group of subjects drawn from a geriatric assessment clinic. Patients with SDAT had significantly lower serum vitamin B-12 (p less than 0.01) and lower RBC folate (p less than 0.03) values than CN subjects. Which mean values for vitamin B-12 and RBC folate were grouped by degree of impairment in SDAT subjects, vitamin B-12 was significantly lower in mildly and moderately impaired subjects than in those with normal cognition. Mean values for both nutrients did not differ significantly between severely impaired and CN subjects. There was a significant quadratic relationship between cognitive impairment and biochemical values for vitamin B-12.(ABSTRACT TRUNCATED AT 250 WORDS)
.A
Renvall MJ; Spindler AA; Ramsdell JW; Paskvan M.
.I 125966
.U
89320485
.S
Am J Med Sci 8910; 298(1):34-7
.M
Adult; Bone Neoplasms/*DT/RA/SC; Carcinoma/*DT/RA/SC; Case Report; Human; Male; Mithramycin/*TU; Neoplasms, Unknown Primary/*/PA/RA; Remission Induction; Tomography, X-Ray Computed.
.T
Metastatic carcinoma of unknown primary: complete response to second-line treatment with plicamycin.
.P
JOURNAL ARTICLE.
.W
In selected groups of patients, metastatic carcinoma of unknown primary (MCUP) is highly responsive to cisplatin-based combination chemotherapy. These therapeutic responses usually are partial and shortlived. The authors report the case of a 41-year-old man whose MCUP relapsed after responding to cisplatin, bleomycin, and etoposide. Alternate-day treatment with plicamycin induced a second complete remission (CR) in this patient with minimal hematologic and metabolic toxicity. Plicamycin may prove effective in enhancing CR rate, prolonging CR duration, and salvaging cisplatin failures in MCUP.
.A
Hescock H Jr; Parker M; Wang TY; Ballinger R; Balducci L.
.I 125967
.U
89320486
.S
Am J Med Sci 8910; 298(1):38-40
.M
Adult; Atrophy; Case Report; Female; Human; Hypopituitarism/BL/*RA; Middle Age; Pituitary Gland/*RA; Pituitary Hormones/BL; Tomography, X-Ray Computed.
.T
Pituitary atrophy in patients with Sheehan's syndrome.
.P
JOURNAL ARTICLE.
.W
The cases of two women with anterior hypopituitarism after obstetrical catastrophies with blood loss and hypovolemia are reported. Endocrine studies demonstrated unresponsiveness of all the pituitary hormones on provocative testing in both patients. In one woman, clinically apparent diabetes insipidus was also present. Computed tomography of the hypothalamic pituitary area disclosed empty sella in both patients. A combination of appropriate biochemical and radiologic techniques permits the in vivo documentation of pituitary atrophy, and Sheehan's syndrome should be added to the list of conditions causing secondary empty sella.
.A
Barkan AL.
.I 125968
.U
89320487
.S
Am J Med Sci 8910; 298(1):41-3
.M
Case Report; Dehydration/*CO/DT; Demyelinating Diseases/*ET; Human; Hypotonic Solutions; Isotonic Solutions; Male; Middle Age; Muscle Hypotonia/*CO/DT; Pons/*; Risk Factors; Sodium Chloride/TU.
.T
Danger of central pontine myelinolysis in hypotonic dehydration and recommendation for treatment.
.P
JOURNAL ARTICLE.
.W
Isotonic saline is the fluid most commonly used for treatment of asymptomatic hypotonic dehydration, but as shown in the case presented in this article, rapid increase in serum sodium may follow administration of isotonic saline, leading to the development of central pontine myelinolysis (CPM). Because the necessity of rapid correction is less, whereas the risk of CPM is greater with chronic asymptomatic hyponatremia than with acute hyponatremia, use of a half normal saline might be more appropriate than normal saline for treating certain patients with hypotonic dehydration with asymptomatic hyponatremia. The calculations indicate that half normal saline will expand the extracellular volume quite effectively, but the rate of increase in serum sodium will be considerably slower than that with normal saline.
.A
Oh MS; Uribarri J; Barrido D; Landman E; Choi KC; Carroll HJ.
.I 125969
.U
89320490
.S
Am J Med Sci 8910; 298(1):59-68
.M
Adjustment Disorders/CL/ET/PX; Affect; Antidepressive Agents, Tricyclic/TU; Case Report; Depression/CL/*ET/PX; Depressive Disorder/CL/ET/PX; Diagnosis, Differential; Disease/*CO; Drugs/AE; Human; Male; Middle Age; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S..
.T
Depression and medical illness.
.P
JOURNAL ARTICLE.
.W
Depression is the most common psychiatric complication of severe medical illness, and it occurs in about 20% of cases. Diagnosis of depression in patients with serious medical illness requires modified criteria. Treatment also must be adjusted for patients with such dual diagnoses.
.A
Petty F.
.I 125970
.U
89320492
.S
Am J Med Sci 8910; 298(1):8-14
.M
Calcium/*PD; Human; Hyaluronic Acid/*; Light; Molecular Conformation; Potentiometry; Scattering, Radiation; Support, U.S. Gov't, P.H.S.; Viscosity.
.T
Calcium destabilizes and causes conformational changes in hyaluronic acid.
.P
JOURNAL ARTICLE.
.W
The physical properties of proteoglycans found in the extracellular matrix influence the behavior of resident macromolecules, micro-ions, and cells. The forces stabilizing structured regions of hyaluronic acid (HA), a major component of extracellular matrix, were measured. The free energy of stability associated with structured regions within human HA was determined by potentiometric titration. A plot of free energy versus temperature demonstrated that the secondary structure was most stable at 25 degrees C and was destabilized at temperatures near 50 degrees C. In the presence of 5 mM CaCl2, the free energy of stability of the structured regions was reduced by 30 cal/mole. Classical light scattering and viscosity measurements confirmed the impact of calcium on HA. CaCl2 (5 mM) reduced the radius of gyration of HA. Above concentrations of 3 mM calcium, the viscosity of 0.1% HA solutions was reduced sharply. The ability of cells to secrete calcium, combined with the exquisite sensitivity of HA to calcium, may permit cell-mediated modification of the extracellular matrix and thus may facilitate cell motility.
.A
Gabriel DA; Carr ME Jr.
.I 125971
.U
89320515
.S
Am J Obstet Gynecol 8910; 161(1):1-4
.M
Biomechanics; Cardiovascular Diseases/*CI; Cardiovascular System/DE/EM; Female; Fetal Diseases/*CI; Fetus/DE; Human; Infant, Newborn; Pregnancy; Prospective Studies; Sympathomimetics/*AE/PO/TU; Tocolysis/*AE.
.T
Fetal and neonatal cardiovascular complications from beta-sympathomimetic therapy for tocolysis.
.P
JOURNAL ARTICLE.
.W
beta-Sympathomimetic drugs cross the placenta freely. Just as these agents cause serious cardiovascular changes in the mother, they may cause severe cardiovascular complications in the fetus. beta-Sympathomimetic agents for tocolysis have been associated with fetal heart rate and rhythm disturbances, hydrops, stillbirth, neonatal cardiac failure, myocardial ischemia and infarction, and neonatal death. Prospective studies have documented changes in interventricular septa of babies exposed to these drugs. Histologic changes have been reproduced in animal models and in vitro similar to those seen in infants with myocardial disease caused by beta-mimetic therapy. The mechanism of beta-mimetic toxicity appears to be increased myocardial intracellular calcium leading to overexcitation and cell necrosis. Since serious fetal cardiovascular effects may occur with beta-mimetic use, benefits should clearly outweigh risks before these drugs are administered.
.A
Katz VL; Seeds JW.
.I 125972
.U
89320516
.S
Am J Obstet Gynecol 8910; 161(1):10-6
.M
Adult; Aged; Alcohol Drinking; Contraceptives, Oral; Disease/PP; Female; Human; Infertility; Middle Age; Ovarian Neoplasms/*ET; Parity; Risk Factors; Support, U.S. Gov't, P.H.S..
.T
A case-control study of epithelial ovarian cancer.
.P
JOURNAL ARTICLE.
.W
With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.
.A
Hartge P; Schiffman MH; Hoover R; McGowan L; Lesher L; Norris HJ.
.I 125973
.U
89320519
.S
Am J Obstet Gynecol 8910; 161(1):111-4
.M
Breech Presentation/*; Cesarean Section/*; Comparative Study; Delivery/*; Female; Human; Pregnancy; Pregnancy Outcome; Retrospective Studies; Twins/*; Version, Fetal/*.
.T
Management of the nonvertex second twin: primary cesarean section, external version, or primary breech extraction.
.P
JOURNAL ARTICLE.
.W
Six hundred eighty-two consecutive twin deliveries were reviewed. Included in the study were 136 sets of vertex-nonvertex twins with birth weights greater than 1500 gm. A primary attempt at delivery of the second twin by external version was performed on 41 twins, 55 twins underwent attempted breech extraction, and 40 patients had a primary cesarean section solely because of physician preference. There were no differences in the incidence of neonatal morbidity or mortality among the modes of delivery. External version was associated with a higher failure rate than primary breech extraction (p less than 0.01). External version was associated with complications (fetal distress, cord prolapse, and compound presentation) that were not seen in the other two groups. Primary breech extraction of the second nonvertex twin weighing greater than 1500 gm appears to be a reasonable alternative to either cesarean section or external version.
.A
Gocke SE; Nageotte MP; Garite T; Towers CV; Dorcester W.
.I 125974
.U
89320522
.S
Am J Obstet Gynecol 8910; 161(1):121-7
.M
Adult; Age Factors; China; Contraceptives, Oral/AE; Diet; Female; Human; Infertility; Intrauterine Devices; Pregnancy; Pregnancy Complications, Neoplastic/*; Reproduction; Trophoblastic Tumor/CI/*ET; Uterine Neoplasms/CI/*ET.
.T
Gestational trophoblastic disease: a case-control study from the People's Republic of China.
.P
JOURNAL ARTICLE.
.W
A case-control study involving 331 patients with complete hydatidiform mole and 662 community controls matched to the cases on age and timing of pregnancy was conducted in Beijing, China. A history of a term birth was associated with reduced risk (odds ratio = 0.6, 95% confidence interval 0.4 to 0.9), with some evidence of further decrease with multiple births. Previous spontaneous abortions were not related to risk, although those with a prior induced abortion were at elevated risk, particularly if two or more abortions were involved (odds ratio = 2.8, 95% confidence interval 1.4 to 5.7). A history of having sought medical advice for infertility was associated with reduced risk (odds ratio = 0.5, 95% confidence interval 0.2 to 0.8), but those who reported use of herbal medicines during a first trimester of a previous pregnancy were at excess risk (odds ratio = 2.2, 95% confidence interval 1.3 to 3.6). In addition, a statistically significant trend in risk was observed with years of oral contraceptive use (odds ratio = 2.6, 95% confidence interval 0.9 to 6.9 for greater than or equal to 4 years of use). Dietary habits and family histories of cancer or trophoblastic disease were not related to risk in this study.
.A
Brinton LA; Wu BZ; Wang W; Ershow AG; Song HZ; Li JY; Bracken MB; Blot WJ.
.I 125975
.U
89320524
.S
Am J Obstet Gynecol 8910; 161(1):136-40
.M
Aorta/PP; Blood Flow Velocity; Echocardiography, Doppler; Female; Fetal Distress/*PP; Heart/*PP; Heart Ventricle; Human; Pregnancy; Regional Blood Flow.
.T
Right ventricular dysfunction in human fetal compromise.
.P
JOURNAL ARTICLE.
.W
Fetal M-mode echocardiography was performed in 13 pregnancies complicated by intrauterine distress. Absent end-diastolic blood velocity in the fetal descending aorta was documented by pulsed Doppler examinations. The right ventricular fractional shortening of these fetuses was decreased and the ratio of the right/left ventricular end-diastolic diameters was increased. The left ventricular size and myocardial contractility did not differ from normal pregnancy. These findings reveal that relative right ventricular heart dysfunction is associated with severe intrauterine distress.
.A
Rasanen J; Kirkinen P; Jouppila P.
.I 125976
.U
89320525
.S
Am J Obstet Gynecol 8910; 161(1):141-5
.M
Acoustic Stimulation; Fetal Heart/*PH; Fetal Movement/*; Gestational Age; Heart Rate; Human; Infant, Newborn; Vibration.
.T
Preterm and term fetal cardiac and movement responses to vibratory acoustic stimulation.
.P
JOURNAL ARTICLE.
.W
To assess fetal response to vibratory acoustic stimulation, 24 preterm (group A; less than 36 weeks' gestation) and 30 term (group B; greater than or equal to 36 weeks' gestation) pregnancies were studied. Study variables were perceived fetal movement, fetal heart rate, and fetal heart rate pattern. Observer- and patient-perceived fetal movement responses were noted in most cases but were slightly more common in term patients (group A: + fetal movement, patient 87.5%/observer 87.5%) group B: + fetal movement, patient 96.7%/observer 90%). Baseline changes in fetal heart rate (greater than or equal to 10 beats/min) were observed in 46% of preterm fetuses and 70% of term fetuses. Tachycardia (fetal heart rate greater than 160 beats/min) was a common finding in both groups. In group A, tachycardia after vibratory acoustic stimulation persisted more than 1 minute in 29.2% and more than 5 minutes in 12.5% of patients. In group B tachycardia beyond 1 and 5 minutes was noted in 73.3% and 50% of patients, respectively. A significant shift to "awake" fetal heart rate patterns occurred in both groups; 29% to 79% was noted in group A (p less than 0.001) and 46.7% to 90% in group B (p less than 0.001). When vibratory acoustic stimulation was used, the high occurrence of increased baseline, tachycardia, and emergence of unusual fetal heart rate patterns must be recognized to adequately interpret fetal heart rate tracings.
.A
Thomas RL; Johnson TR; Besinger RE; Rafkin D; Treanor C; Strobino D.
.I 125977
.U
89320526
.S
Am J Obstet Gynecol 8910; 161(1):146-9
.M
Age Factors; Birth Rate/*; Cesarean Section/*; Dystocia/SU; Female; Human; Physicians/*; Pregnancy; Professional Practice; Sex Factors.
.T
Effect of physician characteristics on the cesarean birth rate [see comments]
.P
JOURNAL ARTICLE.
.W
The rising cesarean birth rate has become of increasing concern to the obstetric profession and the public. There is a general consensus that the major obstetric indications responsible for the rising rate are dystocia, fetal distress, breech presentation, and previous cesarean delivery. However, the role of sociologic or nonmedical factors has not been established. This retrospective study examines the effect of the physician's age, experience, gender, and practice setting (solo versus group practice) on the cesarean birth rate. The analysis is based on 6327 private deliveries performed by 48 attending obstetrician/gynecologists at a New York City Hospital from January 1983 through December 1985. Although no significant differences were found according to the gender or practice setting of the physicians, older, more experienced physicians performed significantly fewer cesarean sections for dystocia and a higher percentage of forceps deliveries and breech extractions. These results suggest that physician characteristics may affect the type of delivery that is performed.
.A
Berkowitz GS; Fiarman GS; Mojica MA; Bauman J; de Regt RH.
.I 125978
.U
89320527
.S
Am J Obstet Gynecol 8910; 161(1):150-4
.M
Adult; Cesarean Section/*; Ethics, Medical/*; Female; Fetal Death; Fetal Distress/SU; Human; Jurisprudence/*; Patient Compliance; Pregnancy.
.T
Court-ordered cesarean section: an analysis of ethical concerns in compelling cases.
.P
JOURNAL ARTICLE.
.W
Two previously unreported cases are presented in which court-ordered cesarean sections were considered appropriate by physicians. An analysis of the factors that compel physicians to deem court-ordered intervention appropriate is presented. When the significance of a third-trimester fetal death or a lifetime physical or mental disability is balanced against the demand to uphold maternal autonomy at all costs, the recognized ethical principles of beneficence, nonmaleficence, justice, obstetric contract keeping, and acting in the patients' best interests combine, in rare situations, to override concerns for individual maternal autonomy and justify court-ordered intervention.
.A
Elkins TE; Andersen HF; Barclay M; Mason T; Bowdler N; Anderson G.
.I 125979
.U
89320530
.S
Am J Obstet Gynecol 8910; 161(1):162-7
.M
Adolescence; Adult; Cecum/*TR; Female; Human; Ileum/*TR; Medical Illustration; Reoperation; Vagina/*AB/IN; Wounds and Injuries/*TH.
.T
Ileocecal vaginal construction.
.P
JOURNAL ARTICLE.
.W
In 10 patients, six with previously failed vaginal reconstruction of Mayer-Rokitansky syndrome, two with male pseudohermaphroditism, one with a history of Wertheim-Meigs operation followed by irradiation of the true pelvis, and one with vaginectomy caused by trauma, a neovagina was created out of cecal or ileocecal segments. Advantages of this technique are the excellent blood supply to the ileocecal region and the long vascular pedicle. The supplemental application of terminal ileum for prolongation of the cecal vaginoplasty allows for tensionless anastomosis between the neovagina and the vulva, even in patients with difficult anatomic conditions. A detailed description of the operative technique and indications for ileocecal and cecal vaginoplasty are presented, and the techniques in current use for vaginal replacement are reviewed and discussed.
.A
Burger RA; Riedmiller H; Knapstein PG; Friedberg V; Hohenfellner R.
.I 125980
.U
89320532
.S
Am J Obstet Gynecol 8910; 161(1):17-24
.M
Artificial Intelligence; Expert Systems/*; Female; Genital Diseases, Female/*DI; Gynecology/*MT; Human; Software.
.T
Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology.
.P
JOURNAL ARTICLE.
.W
Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.
.A
Small SL; Muechler EK.
.I 125981
.U
89320534
.S
Am J Obstet Gynecol 8910; 161(1):174-7
.M
Adolescence; Aging/PH; Endocrine Glands/*PH; Female; Human; Menarche/*; Menstrual Cycle; Sex Hormones/BL; Uterus/*GD.
.T
Uterine development and endocrine relationships after menarche.
.P
JOURNAL ARTICLE.
.W
Uterine volume and ovarian/uterine ratio during the first 6 postmenarchal years in 143 women were compared with an adult control group. Plasma gonadotropins and sex steroids were also correlated with uterine volume in adolescents. Uterine volume increased progressively and correlated positively with advancing postmenarchal (r = 0.24; p less than 0.05) and chronologic (r = 0.23; p less than 0.05) age. However, normal adult uterine volume was not yet reached by the highest postmenarchal (6 years) and chronologic (18 years) age. The ovarian/uterine ratio decreased gradually with increasing postmenarchal age but was always higher (0.22) than that of control subjects (0.12). Uterine volume correlated positively with plasma estradiol (r = 0.25; p less than 0.05) and dehydroepiandrosterone (r = 0.22; p less than 0.05) and its sulfate (r = 0.22; p less than 0.05) levels. This study indicates that the uterus continues to grow after menarche in conjunction with increasing hormone levels.
.A
Porcu E; Venturoli S; Fabbri R; Orsini LF; Sganga E; Brondelli L; Paradisi R; Flamigni C.
.I 125982
.U
89320535
.S
Am J Obstet Gynecol 8910; 161(1):177-8
.M
Adult; Ascites/*CO/SU; Case Report; Drainage; Female; Hodgkin's Disease/CO; Human; Hydrothorax/*CO; Laparotomy; Leiomyoma/*CO/SU; Ovarian Neoplasms/*CO/SU.
.T
Leiomyoma of the ovary with ascites and hydrothorax.
.P
JOURNAL ARTICLE.
.W
A case is described in which a leiomyoma of the ovary was accompanied by hydrothorax. There was no reaccumulation of fluid after oophorectomy.
.A
Nicoll JJ; Cox PJ.
.I 125983
.U
89320536
.S
Am J Obstet Gynecol 8910; 161(1):179-83
.M
Adult; Anthropometry; Female; Fetal Development/*; Forecasting; Human; Infant, Newborn/*PH; Pregnancy; Pregnancy Trimester, Third; Reference Values; Twins/*.
.T
Individual growth curve standards in twins: prediction of third-trimester growth and birth characteristics.
.P
JOURNAL ARTICLE.
.W
The ability of Rossavik growth models, determined from measurements obtained before 24 weeks, to predict third-trimester growth and birth characteristics in normally growing twins has been investigated. Third-trimester values for head circumference, abdominal circumference, and femur diaphysis length were predicted with an accuracy of +/- 6% to 9% (95% to 98% of percent deviations). For thigh circumference and estimated weight, the comparable values were +/- 15% and +/- 16%, respectively. The head circumference at birth was predicted without bias; the random error was approximately +/- 5% (94% of percent differences). Weight, abdominal circumference, and thigh circumference were systematically overestimated (3.1%, 14.9%, and 11.3%, respectively) as a result of differences in prenatal and postnatal measurement procedures. After correction for systematic errors, these parameters could be predicted with random errors of -11.5% to 7.2% (weight), -12.8% to 5.4% (abdominal circumference), and -15.3% to 10.0% (thigh circumference). Growth Potential Realization Index values were found to have means of approximately 100% and ranges from 91% to 118%. These results are similar to those for singletons and indicate that individual assessment of growth in twins can be carried out with the same methods used for singletons.
.A
Stefos T; Deter RL; Hill RM; Simon NV.
.I 125984
.U
89320537
.S
Am J Obstet Gynecol 8910; 161(1):184-7
.M
Birth Weight; Human; Infant Mortality/*; Infant, Low Birth Weight/*; Infant, Newborn; Intensive Care Units, Neonatal/*; Probability; Racial Stocks; Sex Factors; Support, Non-U.S. Gov't.
.T
Effect of birth weight, race, and sex on survival of low-birth-weight infants in neonatal intensive care [see comments]
.P
JOURNAL ARTICLE.
.W
Survival for low-birth-weight infants has traditionally been analyzed by birth weight categories spanning considerable ranges of weight. We developed a finer description of survival rates to allow estimation of survival percentages for infants of any specific birth weight between 500 and 2500 gm. Our sample consisted of 16,183 infants treated in tertiary neonatal intensive care between 1980 and 1987. Their survival data were analyzed by 50 gm increments between 500 and 2500 gm, and a continuous survival curve was constructed by log linear regression methods. Mortality differences between males and females and blacks and whites were analyzed. Survival for females was higher than males between 500 and 1500 gm and higher for blacks than whites between 650 and 1500 gm. Between 1500 and 2500 gm, no significant effects of birth weight, race, or sex were observed, with survival remaining stable at approximately 95% across all combinations of variables.
.A
Resnick MB; Carter RL; Ariet M; Bucciarelli RL; Evans JH; Furlough RR; Ausbon WW; Curran JS.
.I 125985
.U
89320538
.S
Am J Obstet Gynecol 8910; 161(1):188-92
.M
Comparative Study; Female; Fetal Growth Retardation/DI/*PP; Fetal Movement/*; Fetus/PH; Human; Oxygen/*ME; Pregnancy; Reference Values; Respiration.
.T
Effects of maternal hyperoxia on the biophysical assessment of fetuses with suspected intrauterine growth retardation.
.P
JOURNAL ARTICLE.
.W
Fifty-two third-trimester fetuses with suspected intrauterine growth retardation were studied by means of a computer-assisted biophysical assessment scheme, which used maternal hyperoxia as a diagnostic probe. Biophysical data examined included percentage of time spent in breathing, mean breath rate, and percentage of time spent in body movement during a 90-minute observation: 30-minute baseline, 15-minute hyperoxia, and 45-minute posthyperoxia. Mean baseline movement in fetuses found as neonates to have intrauterine growth retardation (N = 18) was significantly lower than that of normal fetuses (N = 34). Fetal body movements and breathing movements increased significantly after hyperoxia in the intrauterine growth retardation group but not in the normal group. Increases of more than 75% over baseline for fetal breathing and more than 250% over baseline for fetal body movements yielded a sensitivity of 56%, specificity of 94%, positive predicative value of 83%, and negative predicative value of 80%. Maternal hyperoxia during biophysical testing may improve the accuracy of detecting intrauterine growth retardation.
.A
Ruedrich DA; Devoe LD; Searle N.
.I 125986
.U
89320540
.S
Am J Obstet Gynecol 8910; 161(1):200-1
.M
Adult; Aorta/*SU; Aortic Diseases/CO/TH; Arterial Occlusive Diseases/CO/TH; Case Report; Diabetes Mellitus, Insulin-Dependent/*/CO; Female; Femoral Artery/*TR; Human; Pregnancy; Pregnancy in Diabetes/*; Pregnancy Outcome.
.T
Pregnancy after aortofemoral bypass grafting in a diabetic patient.
.P
JOURNAL ARTICLE.
.W
A case of pregnancy after an aortofemoral bypass graft for atherosclerosis in an insulin-dependent diabetic is described. Pregnancy after this type of surgery in a diabetic patient has not been described previously.
.A
Bradley-Watson PJ.
.I 125987
.U
89320541
.S
Am J Obstet Gynecol 8910; 161(1):202-6
.M
Adaptation, Physiological/DE; Analgesia/*; Delivery; Drug Administration Schedule; Female; Fentanyl/*/AD/BL; Human; Infant, Newborn/PH; Labor/*; Nervous System/DE; Pregnancy.
.T
Fentanyl citrate analgesia during labor.
.P
JOURNAL ARTICLE.
.W
Fentanyl citrate is a potent short-acting narcotic reported to cause less nausea and sedation than morphine or meperidine hydrochloride. The purpose of this prospective investigation was to determine whether a safe but adequate intrapartum dosing schedule is possible. A total of 137 women with uncomplicated term pregnancies were offered a standard intravenous dose (50 mcg or 100 mcg hourly as needed) of fentanyl citrate during active labor. Temporary analgesia and mild sedation were apparent in each case. The cumulative dose varied in accordance with maternal needs (mean, 140 +/- 42 micrograms; range, 50 mcg to 600 micrograms). Apart from a brief decrease in fetal heart rate variability that lasted 30 minutes, no worrisome pattern was apparent from exposure to fentanyl citrate. Pediatric examinations were performed without knowledge of analgesic therapy on infants exposed to fentanyl citrate and those not exposed to analgesics. No differences were found in frequencies of newborn depressed respirations, low Apgar scores, or neurologic and adaptive capabilities at two hours and 24 hours postnatally. With the use of the described dosing schedule, fentanyl citrate was helpful during labor and did not cause immediate or prolonged hazards to the mother and unborn infant.
.A
Rayburn W; Rathke A; Leuschen MP; Chleborad J; Weidner W.
.I 125988
.U
89320542
.S
Am J Obstet Gynecol 8910; 161(1):207-11
.M
Carbohydrates/PD; Female; Fertilization/*/DE; Human; Lectins/PD; Male; Mannose/*PD; Ovum/*DE; Pregnancy; Sperm-Ovum Interactions/*DE; Spermatozoa/*DE; Support, Non-U.S. Gov't; Zona Pellucida/*DE.
.T
Significance of D-mannose as a sperm receptor site on the zona pellucida in human fertilization.
.P
JOURNAL ARTICLE.
.W
The role of monosaccharides in human fertilization was studied by testing their effects on penetration of spermatozoa into mature human oocytes (zona penetration test). When oocytes were pretreated with concanavalin A, wheat germ agglutinin, or Ricinus communis agglutinin-I at a concentration of 100 micrograms/ml, no spermatozoa were found to bind to or penetrate through the zona pellucida. Penetration of spermatozoa was restored when the zona pellucida pretreated with wheat germ agglutinin and Ricinus communis agglutinin-I were rinsed with N-acetyl-D-glucosamine (wheat germ agglutinin inhibitor) and D-galactose (Ricinus communis agglutinin inhibitor), respectively. Conversely, the blocking effect of concanavalin A on sperm penetration was not reversed by treatment with D-mannose (concanavalin A inhibitor). Furthermore, pretreatment of spermatozoa with D-mannose (50 mmol/L) completely inhibited sperm penetration through the zona pellucida. However, sperm penetration was clearly demonstrated when the zona pellucida was pretreated with D-mannose. These data suggest that D-mannose residues are essential in, or sterically closely related to, the sperm receptor site on the human zona pellucida.
.A
Mori K; Daitoh T; Irahara M; Kamada M; Aono T.
.I 125989
.U
89320544
.S
Am J Obstet Gynecol 8910; 161(1):213-20
.M
Acid-Base Equilibrium/*; Child Development/*; Discrimination (Psychology); Human; Infant, Newborn/*ME; Language Tests; Nervous System/*GD; Neuropsychological Tests; Support, Non-U.S. Gov't.
.T
Acid-base status at birth and neurodevelopmental outcome at four and one-half years [see comments]
.P
JOURNAL ARTICLE.
.W
Two hundred thirty term infants with measured acid-base status in umbilical arterial blood at birth were selected from 1210 consecutive deliveries for detailed neurodevelopmental follow-up at age 4 1/2 years; 203 were examined. Cutoff points approximately 1 SD from the mean (pH less than or equal to 7.10; base deficit greater than 12 mmol/L) were used to define acidosis. No statistically significant associations between acidosis and developmental outcome were found. The highest proportion of unimpaired children was found among those who were most severely acidotic at birth (pH less than or equal to 7.04; 2 SD below mean), but this finding was not statistically significant. These findings suggest that the ability of the fetus to produce an acidosis in response to the stress of labor may be beneficial to long-term outcome. The 10 nonacidotic babies with 1-minute Apgar scores of less than or equal to 3 showed statistically significant deficits in some areas. Coincident acidosis was not associated with a worse outcome for infants with low Apgar scores.
.A
Dennis J; Johnson A; Mutch L; Yudkin P; Johnson P.
.I 125990
.U
89320545
.S
Am J Obstet Gynecol 8910; 161(1):221-8
.M
Animal; Biological Availability; Blood Glucose/*ME; Brain/*ME; Cerebral Ischemia/*ME; Electroencephalography; Female; Fetus/*ME; Pregnancy; Sheep; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.; Time Factors.
.T
The effect of elevated blood glucose on the electroencephalogram and cerebral metabolism during short-term brain ischemia in fetal sheep.
.P
JOURNAL ARTICLE.
.W
The effect of cerebral ischemia on cerebral metabolism and the electroencephalogram was studied with and without prior glucose infusion in near-term normoxic fetal sheep. At normal blood glucose levels, the electroencephalogram decreased in amplitude during ischemia. At elevated blood glucose levels the electroencephalographic amplitude was much less attenuated by ischemia although Fast Fourier Transforms revealed a shift toward slower frequencies. Under either normal or elevated blood glucose conditions, ischemia caused cerebral oxygen consumption to decrease, glucose uptake to increase, and a net efflux of lactate to occur. Elevated blood glucose appears to help maintain electroencephalographic activity during ischemia, perhaps by fueling additional anaerobic energy production. The relationship between the electroencephalogram, brain metabolism, and brain damage remains to be defined.
.A
Chao CR; Hohimer AR; Bissonnette JM.
.I 125991
.U
89320546
.S
Am J Obstet Gynecol 8910; 161(1):229-33
.M
Animal; Dinoprostone/DU; Electromyography; Female; Forskolin/PD; Muscle, Smooth/*PH; Pregnancy; Support, U.S. Gov't, P.H.S.; Uterine Contraction/*/DE; Uterus/*PH; Vehicles.
.T
Uncoupling of excitation from contraction in uterine smooth muscle in near-term ewes.
.P
JOURNAL ARTICLE.
.W
We infused forskolin in 30% ethanol or 30% ethanol systemically in seven chronically catheterized near-term sheep to determine the response of ovine uterine musculature to cyclic adenosine monophosphate stimulation. Maternal and fetal arterial pressure, fetal venous pressure, intrauterine pressure, and uterine electromyogram activity were monitored continuously. Prostaglandin E2 was infused at a delivery rate that caused a minimal 5 mm Hg increase in intrauterine pressure with definite contraction-like pressure spikes and associated uterine electromyogram activity. Forskolin (10 mg in 30% ethanol) or ethanol (vehicle) was then infused for 20 minutes. The prostaglandin E2 challenge was repeated 3 minutes later and again every 30 minutes over a 2 1/2-hour period. Data were analyzed by repeated measures analysis of variance. Infusion of ethanol (n = 2) had no apparent effect on either the intrauterine pressure or the uterine electromyogram response to prostaglandin E2 challenge. Forskolin infusion (n = 5) caused an attenuation of the intrauterine pressure response to prostaglandin E2 for 93 minutes. This effect was greatest 33 minutes after the infusion ended when the integrated pressure signal was 37% of the initial prostaglandin E2 response. The forskolin infusion had no effect on uterine electromyogram response to prostaglandin E2. We conclude that forskolin causes an uncoupling of excitation from contraction in the intact near-term ovine uterus.
.A
Reid DL; Hollister MC; Davidson SR; Phernetton TM; Rankin JH.
.I 125992
.U
89320547
.S
Am J Obstet Gynecol 8910; 161(1):234-40
.M
Animal; Diabetes Mellitus, Non-Insulin-Dependent/*; Dietary Fats/*PD; Female; Fertility/DE; Glucose Tolerance Test; Pregnancy; Pregnancy in Diabetes/*PP; Pregnancy Outcome; Rats; Rats, Inbred Strains/*PH; Time Factors.
.T
Gestational diabetes in the BHE rat: influence of dietary fat.
.P
JOURNAL ARTICLE.
.W
Two studies were performed to assess the effect of fat feeding on glucose tolerance before, during, and after gestation of BHE rats. In the first study 5% or 22% fat diets were fed from 3 weeks before mating until after gestation. In the second study, these diets were fed from weaning until 400 days of age. Glucose tolerance before and after gestation was not affected by diet in the short-term study. At 19 days' gestation, glucose tolerance had deteriorated in the pregnant rats that were fed with 22% fat diet. In the long-term study, abnormal glucose tolerance was observed before mating in rats that were fed the 22% fat diet. Tolerance improved during gestation and post partum, but still was not normal. Fertility and pup survival were significantly (50%) reduced in rats that were fed the 22% fat diet. These findings suggest that either short-term or long-term feeding of a 22% fat diet to BHE rats results in a model for human gestational diabetes that might be worthy of further study.
.A
Bue JM; Hausman DB; Berdanier CD.
.I 125993
.U
89320548
.S
Am J Obstet Gynecol 8910; 161(1):241-7
.M
Ampyrone/*PD; Animal; Antipyrine/*AA; Blood Gas Analysis; Blood Glucose/AN; Body Temperature; Dinoprost/BL; Dinoprostone/BL; Female; Fetal Blood; Fever/*ME; Pregnancy; Pregnancy, Animal/BL/*ME/PH; Prostaglandin Antagonists/*PD; Prostaglandins/BI; Reference Values; Regional Blood Flow; Sheep; Support, Non-U.S. Gov't; Uterus/BS.
.T
Effect of inhibiting prostaglandin synthesis in pregnant sheep with 4-aminoantipyrine under normothermic and hyperthermic conditions.
.P
JOURNAL ARTICLE.
.W
Infusion of the prostaglandin synthetase inhibitor 4-aminoantipyrine at a rate of 20 mg/min via the fetal tarsal vein during normothermic conditions (ambient temperatures = 24 degrees C) significantly decreased the concentrations of prostaglandins E2 and F2 alpha in maternal and fetal arterial plasma and in uterine and umbilical vein plasma. The infusion was associated with a small but significant rise in fetal temperature and a fall in fetal arterial pH. Respiratory alkalosis developed in fetuses during hyperthermia by raising the ambient temperature to 43 degrees C for 8 hours. In contrast, infusion of 4-aminoantipyrine during hyperthermia produced fetal metabolic acidosis as indicated by a fall in fetal pH and an increase in PaCO2, even though the ewe remained hypocapnic. Four of the 10 fetuses died during or shortly after the 4-aminoantipyrine infusion during hyperthermia. These results indicate that uteroplacental prostaglandin synthesis is essential to allow the fetus to adapt to an increase in body temperature and suggests that prostaglandin synthetase inhibitors should be used with caution during pregnancy.
.A
Andrianakis P; Walker DW; Ralph MM; Thorburn GD.
.I 125994
.U
89320550
.S
Am J Obstet Gynecol 8910; 161(1):25-8
.M
Adult; Breech Presentation/*; Case Report; Cesarean Section/*; Delivery; Female; Human; Pregnancy; Reoperation; Trial of Labor.
.T
Breech presentation after cesarean section: always a section?
.P
JOURNAL ARTICLE.
.W
A retrospective review of 71 breech deliveries after previous cesarean was done to determine the need for repeat cesarean section. Twenty-four (33.8%) women were allocated to the elective repeat cesarean section group and forty-seven (66.2%) patients were allocated to a trial of labor group. Thirty-seven (78.7%) were delivered of their infants vaginally. A total of 37 of the 71 women (52.1%) had successful vaginal deliveries. Neonatal morbidity did not differ for women who were delivered vaginally or by cesarean section. Maternal febrile morbidity was significantly higher in the cesarean section group than in the vaginal delivery group (p less than 0.001). On the basis of these data, a trial of labor seems reasonable in carefully selected cases of breech presentation after a previous cesarean section.
.A
Ophir E; Oettinger M; Yagoda A; Markovits Y; Rojansky N; Shapiro H.
.I 125995
.U
89320551
.S
Am J Obstet Gynecol 8910; 161(1):254
.M
Endocrine Diseases/CO; Female; Fetal Death/DI/*ET; Human; Infection/CO; Pregnancy.
.T
Fetal death: diagnosis and management [letter; comment]
.P
COMMENT; LETTER.
.A
Merlob P.
.I 125996
.U
89320553
.S
Am J Obstet Gynecol 8910; 161(1):255-6
.M
Blood Transfusion, Intrauterine/*MT; Blood Vessels/EM; Female; Fetal Diseases/TH; Hematologic Diseases/TH; Human; Pregnancy; Time Factors.
.T
Frequency and timing of intravascular intrauterine transfusions reconsidered [letter; comment]
.P
COMMENT; LETTER.
.A
Voto LS; Margulies M.
.I 125997
.U
89320554
.S
Am J Obstet Gynecol 8910; 161(1):256-7
.M
Cesarean Section/*; Female; Human; Hysterectomy/*; Maternal Mortality; Pregnancy; Reoperation; Risk-Taking/*; Statistics.
.T
Basic reference gambles recommended for utility assessment [letter; comment]
.P
COMMENT; LETTER.
.A
Thornton JG; Lilford RJ.
.I 125998
.U
89320556
.S
Am J Obstet Gynecol 8910; 161(1):258-9
.M
Anemia/BL/*DI; Female; Ferritin/*BL; Human; Pregnancy; Pregnancy Complications/*DI.
.T
Role of ferritin supported in diagnosis of anemias of pregnancy [letter; comment]
.P
COMMENT; LETTER.
.A
Goodlin RC.
.I 125999
.U
89320558
.S
Am J Obstet Gynecol 8910; 161(1):259
.M
Female; Human; Infant, Newborn; Infant, Newborn, Diseases/*CI; Labor; Oxytocin/*AE/TU; Pregnancy; Seizures/*CI.
.T
Oxytocin may explain neonatal seizures [letter; comment]
.P
COMMENT; LETTER.
.A
Goodlin RC.
.I 126000
.U
89320559
.S
Am J Obstet Gynecol 8910; 161(1):29-32
.M
Birth Weight; Cesarean Section/*; Delivery/*; Female; Gestational Age; Human; Infant Mortality; Infant, Newborn; Infant, Premature; Pregnancy; Pregnancy Outcome; Surgical Wound Dehiscence/ET; Trial of Labor; Twins/*; Uterine Rupture/ET.
.T
Vaginal birth after cesarean delivery in the twin gestation.
.P
JOURNAL ARTICLE.
.W
The pregnancy outcomes of 56 women with a twin gestation and a prior cesarean birth were analyzed to determine whether a trial of labor was a reasonable consideration. Of these patients, 31 (55%) underwent an elective repeat cesarean delivery and 25 (45%) attempted vaginal delivery. Of those who attempted vaginal delivery, 18 (72%) were vaginally delivered of both infants. The dehiscence rate among women with twin pregnancies who attempted a trial of labor was 4% compared with 2% in women with singleton pregnancies. There were no significant differences in maternal or neonatal morbidity or mortality rates in trial of labor versus no trial of labor groups. We conclude in this limited population that a trial of labor in a twin gestation after a previous cesarean delivery appears to be a reasonable consideration. The usual safeguards for attempted vaginal delivery in the twin gestation should be followed.
.A
Strong TH Jr; Phelan JP; Ahn MO; Sarno AP Jr.
.I 126001
.U
89320561
.S
Am J Obstet Gynecol 8910; 161(1):35-6
.M
Adult; Case Report; Drug Interactions; Female; Human; Magnesium Sulfate/*AE/PD; Neuromuscular Diseases/*CI; Neuromuscular Junction/DE; Nifedipine/*AE; Pregnancy; Tocolysis.
.T
Neuromuscular blockade with magnesium sulfate and nifedipine [see comments]
.P
JOURNAL ARTICLE.
.W
A patient who received tocolysis with nifedipine developed neuromuscular blockade after 500 mg of magnesium sulfate was administered. This reaction demonstrates that nifedipine can seriously potentiate the toxicity of magnesium. Caution should be exercised when these two tocolytics are combined.
.A
Snyder SW; Cardwell MS.
.I 126002
.U
89320562
.S
Am J Obstet Gynecol 8910; 161(1):36-7
.M
Adult; Case Report; Cesarean Section/*; Female; Fetal Monitoring/*MT; Heart Rate/*; Human; Intraoperative Period; Pregnancy.
.T
Usefulness of continuous fetal heart rate monitoring during cesarean section [see comments]
.P
JOURNAL ARTICLE.
.W
Cesarean section performed because of fetal distress routinely leaves the fetus unmonitored for a variable period of time (perioperatively and intraoperatively). We present in this report two cases in which continuous fetal heart rate monitoring during cesarean section modified the obstetric management for the benefit of the mother and of the fetus.
.A
Petrikovsky BM; Cohen M; Tancer ML.
.I 126003
.U
89320563
.S
Am J Obstet Gynecol 8910; 161(1):38-42
.M
Adult; Aged; Female; Human; Middle Age; Parity; Prodrugs; Risk Factors; Skin Diseases/*ET/PC; Vitamin A/PD; Vulvar Diseases/*ET/PC.
.T
Risk factors for vulvar lichen sclerosus.
.P
JOURNAL ARTICLE.
.W
To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.
.A
Sideri M; Parazzini F; Rognoni MT; La Vecchia C; Negri E; Garsia S; Arnoletti E; Cecchetti G.
.I 126004
.U
89320566
.S
Am J Obstet Gynecol 8910; 161(1):5-9
.M
Models, Theoretical; Nomenclature; Perinatology/*ST; Quality Control; Research; Statistics.
.T
Understanding and eliminating errors in perinatal research.
.P
JOURNAL ARTICLE.
.W
Research studies published in the scientific literature have had a rapid impact on medical practice, especially in clinical obstetrics. Recently, incentives to control medical costs without sacrificing the quality of care have placed increased importance on studies that truly demonstrate clinical effectiveness. In addition, there are ethical concerns that improperly designed or conducted studies adversely affect medical practice and place patients at unnecessary risk. This article summarizes potential sources of error and encourages the valid interpretation of the results and conclusions of experimental studies by making four suggestions: (1) the errors and limitations that may be present in the methodology should be described and explanations given how the errors might have affected the results and why the limitations are acceptable; (2) the methods selected should allow an answer to the question proposed; (3) the investigator should verify that the appropriate statistical test is used; and (4) when unexpected or hard to explain results are found, verification before publication should be undertaken.
.A
Block BS.
.I 126005
.U
89320567
.S
Am J Obstet Gynecol 8910; 161(1):50-5
.M
Cervix Uteri/CY/*ME; DNA, Viral/*ME; Female; Human; Nucleic Acid Hybridization; Papillomaviruses/*GE; Pregnancy/*ME; Pregnancy Trimester, Third; Prospective Studies; Puerperium/ME.
.T
Increased frequency of detection of human papillomavirus deoxyribonucleic acid in exfoliated cervical cells during pregnancy.
.P
JOURNAL ARTICLE.
.W
Exfoliated cells of the uterine cervix obtained from women during pregnancy and at the time of their first postpartum examination were used to monitor the prevalence of human papillomavirus infections in this population and to study the natural fluctuations in viral expression. When deoxyribonucleic acid hybridization analysis alone was used to monitor the presence of human papillomavirus infection, 20.9% of our study population had results that were positive for human papillomavirus deoxyribonucleic acid during their first-trimester examinations. A dramatic increase in the percentage of women with positive results for human papillomavirus deoxyribonucleic acid was observed at the time of the patients' third-trimester examinations (46%). The overall increase in human papillomavirus-positive patients was a combination of a small number of patients who had positive results on their first examination and negative results on their second examination, and a larger number of patients who had negative results on their first-trimester examination and positive results for human papillomavirus deoxyribonucleic acid in the exfoliated cervical cells at the time of their third-trimester examination. The total percentage of patients with positive results for human papillomavirus deoxyribonucleic acid in their cervical cells at one or both assay points during pregnancy was 52.5%. Samples obtained at the postpartum examination demonstrated a dramatic decrease in the number of samples positive for human papillomavirus deoxyribonucleic acid (17.5%). This result was a combination of a large decrease in human papillomavirus-positive patients coupled with a small increase in detectable levels of human papillomavirus deoxyribonucleic acid in cervical samples from patients who had negative results on their previous examination. This study demonstrates a very high level of detectable human papillomavirus deoxyribonucleic acid in exfoliated cervical cells obtained during pregnancy and shows that the detectable levels of human papillomavirus deoxyribonucleic acid fluctuate during pregnancy.
.A
Rando RF; Lindheim S; Hasty L; Sedlacek TV; Woodland M; Eder C.
.I 126006
.U
89320568
.S
Am J Obstet Gynecol 8910; 161(1):55-9
.M
Adult; Amniotic Fluid/ME; Biomechanics; Cervix Uteri/CY/ME; Cesarean Section; Delivery/*; DNA, Viral/ME; Female; Human; Infant, Newborn; Nasopharynx/ME; Papillomaviruses/GE; Pregnancy; Prospective Studies; Tumor Virus Infections/*TM.
.T
Mechanism for human papillomavirus transmission at birth.
.P
JOURNAL ARTICLE.
.W
We attempted to investigate mechanisms, in addition to sexual contact, by which human papillomaviruses associated with anogenital tract lesions could be transmitted. Samples of exfoliated cervical cells were obtained from 45 pregnant women and were assayed by Southern blot hybridization analysis for the presence of human papillomavirus nucleic acids. Twenty-five of the 45 women had cells positive for human papillomavirus deoxyribonucleic acid. A neonatal nasopharyngeal aspirate was obtained at term and analyzed for the presence of human papillomavirus deoxyribonucleic acid. We documented the presence of human papillomavirus deoxyribonucleic acid in the oral pharyngeal cavity of the neonates in 15 of 45 nasopharyngeal samples analyzed. Amniotic fluid was obtained from 13 patients when their membranes were artificially ruptured. These samples were assayed for the presence of human papillomavirus deoxyribonucleic acid; two of the 13 amniotic fluid samples contained human papillomavirus deoxyribonucleic acid. The detection of human papillomavirus deoxyribonucleic acid in the oral cavity of neonates is indicative of a perinatal mechanism of viral transmission. The detection of human papillomavirus deoxyribonucleic acid in the amniotic fluid may suggest an in utero mechanism of transmission. However, problems encountered in collecting the amniotic fluid samples preclude us from definitive interpretation of these data.
.A
Sedlacek TV; Lindheim S; Eder C; Hasty L; Woodland M; Ludomirsky A; Rando RF.
.I