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3895958
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Millions of women worldwide continue to suffer from vulvovaginal candidiasis, which is second only to anaerobic bacterial vaginosis in the United States. Evidence is presented of an increasing incidence of vulvovaginal candidiasis, the cause of which is unclear, but this increase is probably the result of multiple factors including widespread abuse of antibiotics, possibly oral contraceptives, and most important inadequate vaginal therapy. Some women never experience vulvovaginal candidiasis, others have infrequent episodes, and a third subpopulation have recurrent episodes resulting in considerable morbidity and suffering. Two fundamental questions face investigators: the mechanism whereby asymptomatic colonization converts to symptomatic disease and the elusive explanation for frequent recurrences of vulvovaginal candidiasis. Although several factors have been identified as predisposing to recurrent vulvovaginal candidiasis (pregnancy, oral contraceptives, exogenous hormones, antibiotics, diabetes mellitus, etc.), the majority of women with recurrent vulvovaginal candidiasis do not have recognizable predisposing factors. What has emerged over the last few years is the awareness that different pathogenic mechanisms may be operative in individual patients responsible for a spectrum of clinical manifestations. Understanding the pathogenic mechanisms is essential if we are to progress in treatment. In addition to the study of newer antimycotic agents, new strategies of therapy are required and must be individualized for patients with recurrent vulvovaginal candidiasis.
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3895959
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Ergosterol is an essential constituent of the fungal cytoplasmic membrane. Clotrimazole and other azoles interfere with the ergosterol biosynthesis in a concentration-dependent fashion. Although low concentrations exhibit only a partially inhibitory effect, high concentrations may completely block ergosterol synthesis. Reduction of fungal growth and inhibition of growth and fungicidal action during prolonged incubation are the corresponding effects at the cellular level that are a consequence of ergosterol depletion. The inoculum effect, the influence of the incubation period, and the influence of nutrient media, three factors that often complicate susceptibility testing in vitro, can also be explained by the mode of action of azole compounds. Another interesting characteristic of azole antifungals was revealed by the observation that hyphae and pseudomycelia of Candida albicans are much more susceptible to azoles than are yeast cells. Even 1% of the minimum inhibitory concentration of clotrimazole may totally inhibit mycelial growth in vitro. This may be of clinical importance, since germination was reported to enhance adherence of C. albicans to buccal and vaginal epithelial cells.
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3895960
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One hundred ninety-nine female patients with candidal vulvovaginitis were included in an open, randomized, mycologically controlled study carried out at three Dutch gynecologic clinics to determine the efficacy and tolerability of a single vaginal tablet containing 500 mg clotrimazole in comparison with a 6-day treatment with vaginal tablets containing 100 mg clotrimazole. Both groups were comparable in age, body weight, and duration and severity of the infection, and in both groups the percentage of patients who were also treated for vulvitis with a 1% clotrimazole cream and the percentage of the male partners who were treated were equal. Four weeks after therapy, 84 of the 102 patients (82.4%) treated with one dose of 500 mg clotrimazole were cured and 82 of the 97 patients (84.5%) of the 6-day treatment group were cured. The clinical symptoms improved parallel to the improvement of mycologic findings. Both the vaginal tablets containing 500 mg and those containing 100 mg clotrimazole were well tolerated by the patients. After 1 week the results of the single-dose treatment with 500 mg clotrimazole were slightly better than those of the 6-day treatment with vaginal tablets of 100 mg clotrimazole. After 4 weeks the results were reversed, but it should be considered that this could be due to reinfection of the patients.
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3895962
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Single-dose treatment of vulvovaginal candidiasis with a 500 mg clotrimazole vaginal tablet was compared to 3-day treatment with two 100 mg vaginal tablets administered daily in 115 patients enrolled in a double-blind trial, 101 of whom were evaluated for efficacy. Patients with clinically and mycologically active disease were treated (visit 1) and examined at 5 to 10 days (visit 2) and again at least 27 days (visit 3) post treatment. At visit 2, mycologic tests and clinical examinations were negative in 37 of 48 patients receiving single-dose treatment (77%) and in 47 of 53 patients receiving 3-day treatment (89%). Corresponding results for visit 3 were 65% and 74%, respectively. There were no significant differences in treatment response between groups, and only three patients reported adverse reactions. These data show that single-dose treatment with clotrimazole, 500 mg, is as safe and effective as the more complex 3-day regimen.
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3895963
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A multicenter, double-blind study of 103 patients with clinically and mycologically documented vulvovaginal candidiasis compared single-dose treatment with a 500 mg clotrimazole vaginal tablet to 3-day treatment with two 100 mg clotrimazole vaginal tablets administered daily. Patients were examined 5 to 10 days (visit 2) and at least 27 days (visit 3) post treatment. At visit 2, mycologic and clinical examinations were negative in 43 of 48 efficacy-evaluable patients receiving clotrimazole, 500 mg (90%), versus 42 of 47 efficacy-evaluable patients receiving clotrimazole, 200 mg (89%). Similarly, at visit 3, 75% of patients receiving clotrimazole, 500 mg, had treatment success versus 72% receiving clotrimazole, 200 mg. There were no significant intergroup treatment differences, indicating that single-dose treatment with clotrimazole, 500 mg, is equipotent to the multidose regimen.
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3895961
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The results of all the controlled trials carried out at the Department of Genito-Urinary Medicine at the Cardiff Royal Infirmary over the past 16 years are summarized. All except one of these trials were carried out with patients having acute vulvovaginal candidiasis. One trial involved treating only patients with recurring candidal infection. In all the acute trials, there were practically no mycologic relapses 7 days after completion of treatment whatever the regimen used, but at 35 days after completion of treatment the mycologic relapse rate was in the region of 20% to 25%. It is concluded that following the elimination of any known predisposing cause of vaginal candidiasis, the intravaginal application of 500 mg of an imidazole preparation is as effective a treatment as any other regimen. In recurrent cases, monthly treatment with such a dose may be adequate to control the patient's symptoms. Mycologic relapse may not be accompanied by symptoms, but in recurrent cases there is a closer relation between mycologic relapse and symptoms.
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3895964
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Eleven cases of major congenital anomalies were diagnosed in conjunction with arrest of dilatation or descent. In three cases, the diagnosis of fetal death was made. In the remainder, despite extensive counseling, the mothers refused cesarean section for an anomalous fetus. Fetal decompression resulted in prompt vaginal delivery in 10 of 11 cases.
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3895966
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Outpatient keratoplasty in 103 patients (46 males and 57 females ranging in age from 1 to 90 years) produced no instances of infection, shallow or flat anterior chambers, or anterior synechia formation. Postoperative discomfort was minimal.
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3895971
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An important objective of occupational therapy practice is to maximise functional potential in patients who have physical disabilities. Pressure sores are a major complication in the medical course of these individuals. Therefore, prevention, or at least the proper management, of these sores becomes an important focus for occupational therapists who treat the physically disabled patient. Occupational therapists often prescribe wheelchair cushions to relieve pressure and reduce the risk of ulceration. Unfortunately, occupational therapy literature offers few articles dealing with this significant problem. This paper presents a historical review of wheelchair cushions and details some of the physiological and clinical research efforts that are the basis of prescription practice today.
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3895972
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Three types of direct-bonding metal bases were used to determine the effect of five commercial surface treatments on in vitro tensile bond strength. The proprietary treatments were etching, silanation, surface activation, etching plus silanation, and etching plus surface activation. Nontreatment was used as a control. The bases were of the mesh, photo-etched, and grooved types. Bases were loaded with a no-mix adhesive to plastic substrates. The grooved base had the highest bond strength with no treatment. Etching improved the bond strength of the grooved bracket by 56%. Silanation improved the bond strength of the mesh bracket by 28%. Surface treatments did not improve the bond strength of the photo-etched bracket.
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3895973
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The liver is a major parenchymal target organ of acute graft-versus-host disease (aGVHD) after bone marrow transplantation in the rat. The authors have analyzed the nature of cellular infiltrates in the liver using monoclonal antibodies against white cell subsets and investigated the anatomic distribution of the inflammatory cell subsets inside the liver parenchyma. Several types of white cells are present in a normal control liver: In the portal area the T-helper (Th) cells predominate, (surface) immunoglobulin-expressing B cells are present in ample numbers, and most of the phagocytes are Ia-positive. In the central vein area the T-suppressor/killer cells (Tsk) dominate, no B cells are present, and most of the phagocytes are Ia-negative. During aGVHD the number of T cells increases rapidly in the portal area; and after an initial strong increase, the Th/Tsk ratio decreases but remains still above 1. In the central vein area there is also an increase in the number of T cells, compared with that in the syngeneic recipient, but the Th/Tsk ratio rapidly decreases and remains uniformly below 1. During aGVHD the B cells entirely disappear from the portal area, whereas a small but distinct number of mature plasma cells with intracellular immunoglobulin appear in the central vein area. Following irradiation the Ia-positive phagocytic cells entirely disappear from the portal area and decrease distinctly in number in the central vein area. During aGVHD the number of Ia-positive phagocytes increases again in both locations. In the central vein area the positive phagocytes are seen over the background level, and, concomitantly, the Ia-negative phagocytes disappear.
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3895974
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The subjective life of the young infant is examined in the light of classical psychoanalytic theory and of recent empirical studies of early infant behavior and development. The concepts of symbiosis and omnipotence are argued to be products of poetic but largely misguided reconstructions from adult experience, providing a questionable developmental foundation for contemporary psychodynamic theories of object relations.
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3895975
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Insulin encapsulated in lipid vesicles and targeted to hepatocytes by means of a digalactosyl diglyceride moiety [(designated vesicle encapsulated insulin (VEI)] was administered intravenously to conscious catheterized diabetic dogs to determine the effects of hepatic and extrahepatic glucose utilization. Our results indicate that VEI administered intravenously to diabetic dogs over a dose range of 0.5 to 2.0 mU X kg-1 X min-1 reduces hepatic glucose output or induces hepatic glucose uptake without causing any significant alteration in the rate of extrahepatic glucose utilization. Steady-state comparisons of 1.0 mU X kg-1 X min-1 VEI with intraportal and peripherally administered insulin revealed that VEI and intraportal insulin result in significantly less extrahepatic glucose utilization than does an equivalent dose of peripherally administered insulin (6.36 +/- 1.21 and 5.08 +/- 0.97 vs. 8.82 +/- 1.61 mg X kg-1 X min-1; P less than 0.03). Through the use of VEI, we were able to significantly alter the deposition of intravenously administered glucose from 11% hepatic and 89% extrahepatic noted with peripheral insulin to 35% hepatic and 65% extrahepatic with VEI (P less than 0.03). Thus, by encapsulating insulin into a lipid carrier specifically targeted to the liver, selective hepatic insulinization can be achieved. As a result of this approach, one can alter the distribution of a glucose load to favor hepatic deposition.
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3895976
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A potential effector of the protein-sparing adaptation to fasting could be the increased availability of endogenous long-chain fatty acids. Were this hypothesis correct, infusion of medium-chain triglycerides to increase the plasma concentration of medium-chain fatty acids might also result in protein sparing. However, in most in vitro studies in rat muscle, octanoate increases the oxidation of the essential amino acid leucine. Therefore leucine metabolism was assessed with infusions of [3H]leucine and a-[14C]ketoisocaproate ([14C]KIC) before and during an infusion of trioctanoin in conscious dogs. Plasma octanoate increased from less than 30 to 528 microM over the 3 h of infusion. Plasma leucine and KIC concentrations decreased by 65-70% (P less than 0.01) over the first 2 h of infusion. Leucine oxidation, estimated from the expired 14CO2 and the plasma [14C]KIC specific activity, as well as from an open two-pool model, decreased. By use of these isotope models, the rates of leucine coming from and going to protein decreased (P less than 0.05 to P less than 0.01). Interconversion of leucine and KIC estimated from the open two-pool model decreased by 80% (P less than 0.01). These changes were accompanied by a 36% decrease in the plasma concentration of total plasma amino acids. Within the confines of the isotope models employed, these data are consistent with the hypothesis that increased fatty acid oxidation decreases protein turnover and may spare essential amino acids.
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3895978
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The aim of this study was to determine the role of changes in renal arterial pressure (RAP), renal hemodynamics, and tubular reabsorption in mediating the natriuretic and antinatriuretic actions of angiotensin II (ANG II). In seven anesthetized dogs, endogenous ANG II formation was blocked with captopril, and ANG II was infused intravenously at rates of 5-1,215 ng X kg-1 X min-1 while RAP was either servo-controlled at the preinfusion level or permitted to increase. When RAP was servo-controlled, ANG II infusion at all rates from 5-1,215 ng X kg-1 X min-1 decreased urinary sodium excretion (UNaV) and fractional sodium excretion (FENa) while increasing fractional reabsorption of lithium (FRLi) (an index of proximal tubular fractional sodium reabsorption) and causing no change in calculated distal tubule fractional sodium reabsorption (FRDNa). When RAP was permitted to increase, ANG II infusion rates up to 45 ng X kg-1. min-1 also decreased UNaV and FENa while increasing FRLi and causing no change in FRDNa. However, at 135 ng X kg-1 X min-1 and above, UNaV and FENa increased while FRLi and FRDNa decreased when RAP was allowed to rise, even though renal blood flow and filtration fraction were not substantially different from the values observed when RAP was servo-controlled. Filtered sodium load was slightly higher when RAP was permitted to increase during ANG II infusion compared with when RAP was servo-controlled, although the differences were not statistically significant. Thus, even very large doses of ANG II cause antinatriuresis when RAP is prevented from increasing.(ABSTRACT TRUNCATED AT 250 WORDS)
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3895977
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What digestive adaptations enable mammals to process much more food in much less time with equal or higher digestive efficiency than reptiles and thus to sustain much higher metabolic rates? To answer this question, we measured glucose and proline uptake in small intestinal sleeves of three mammal and three reptile species of similar body size and natural diet. All species exhibit saturable, stereospecific uptake of D-glucose and Na+-dependent L-proline uptake. Passive permeability to glucose is high in hamsters and low in the other species. Uptake increases with temperature up to a maximum around 45-50 degrees C. This temperature dependence may help explain why reptiles bask after meals and why their digestion is impaired if basking is prevented. The total uptake capacity of the small intestine for glucose and proline is seven times higher in mammals than similar-sized reptiles, mainly because the area of mammalian intestine is 4-5.5 times greater. Minor reasons for the higher uptake capacity of mammals are that the transport activity of mammal intestine normalized to quantity of tissue is up to twofold higher and that reptile intestine operates at a lower temperature at night. Vmax for glucose transport varies 10-fold among species, but apparent differences in Km values may be unstirred-layer artifacts. Carrier-mediated uptake of glucose and proline is measurable in the colon of at least three species, but the uptake capacity of the colon is less than 10% of that of the small intestine. An appendix presents a method for measuring the microscopic area of intestines with ridges rather than villi, applies this method to desert iguana intestine, and measures area amplification due to villi in wood rat intestine.
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3895980
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Calcium-tolerant adult cardiac myocytes were kept in culture under serum-free conditions in the presence of physiological concentrations of insulin. Up to 4 days, 70% of cells retained their in vivo rodshaped morphology without gross structural alterations. During that period a constant ATP-to-ADP ratio was observed with a mean value of 10.6 +/- 0.5 (n = 4). The rate of [14C]phenylalanine incorporation remained unaltered up to 63 h in culture. Insulin binding to cultured cells was found to be time-and temperature-dependent, reversible, and highly specific. Scatchard analysis of equilibrium binding data showed a curvilinear plot with a high-affinity segment yielding an apparent dissociation constant of 4.5 X 10(-10) mol/l and a receptor number of 125,000 sites/cell. Both affinity and receptor number remained unaltered between 18 and 66 h in culture. [14C]phenylalanine incorporation was stimulated by 108% in cardiocytes cultured in the presence of high concentrations of insulin (1.7 X 10(-7) mol/l) for 63 h, when compared with control cells cultured in the absence of insulin. These data demonstrate the retention of structural integrity, insulin receptors, and insulin responsiveness in primary cultured adult cardiac myocytes and provide a useful model for long-term studies on the regulation of insulin action on the heart.
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3895979
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When a heart is in a stable inotropic state, the end-systolic pressure-volume points of each work cycle fall on a straight line regardless of the magnitude of the afterload or the initial end-diastolic volume: cardiac O2 consumption (MVO2) per beat is linearly correlated with ventricular systolic pressure-volume area (PVA), defined in terms of stroke work and potential energy components. Moreover, if the basal and activation components of the cardiac energy cycle are subtracted, hearts operate at a constant PVA/MVO2 efficiency. The present review examines the energetic implications of these results for current muscle models, discussing the energetic background of earlier skeletal muscle viscoelastic models and examining differences between the vectorial outputs of ion transport ATPases and myofibrillar ATPases. The PVA data point to a unique stoichiometric relationship between myocardial energy flux and vectorial output, and it is shown that most existing myocardial O2 consumption data can be reconciled with the PVA concept. However, most muscle models would not predict a linear stoichiometric relation between energy flux and pressure-volume potential energy. We pose the question as to whether there is an undiscovered autoregulatory process at work in muscle.
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3895981
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This study critically tests the ability of microspheres to accurately measure perfusion to ischemic myocardium. The left anterior descending coronary artery was cannulated and perfused with arterial blood. The perfusion line was clamped, and a sidearm between the clamp and the cannula was opened to the atmosphere, allowing blood to flow retrograde from the distal segment of the artery. Measurement of regional blood flow during retrograde flow diversion with 15-micron microspheres revealed essentially zero flow to the perfused segment (0.005 ml X min-1 X g-1). Measurements under the same conditions by either 86Rb uptake or 133Xe washout revealed that an appreciable perfusion of the tissue persisted during retrograde flow diversion (0.043 and 0.11 ml X min-1 X g-1, respectively, for the 2 methods). Thus we have identified a condition during which microspheres indicate zero flow to the tissue but diffusible tracers can both be washed in and washed out at a brisk rate. We conclude that with simple occlusion there is a hidden component of perfusion to an ischemic zone that cannot be measured by microspheres, causing them to underestimate flow by about 25% in that condition.
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3895982
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Myocardial and nonmyocardial cell nuclei were isolated from ventricles of adult male Wistar rats by means of sucrose density centrifugation. RNA polymerase activity in myocyte nuclei was approximately 80-90% higher than in nonmyocytes. Total myocyte chromatin template activity using Escherichia coli RNA polymerase was linear and about onefold greater than the nonmyocyte fraction over a fivefold range of chromatin concentrations. Preincubation time required for RNA polymerase to form a stable binding complex with chromatin was at least 40 min for myocyte and 30 min for nonmyocyte nuclear subsets. Titration of chromatin against a fixed amount of RNA polymerase (5 micrograms) showed that 5 micrograms of myocyte chromatin (as DNA) and 8 micrograms of nonmyocyte chromatin (as DNA), respectively, were required to saturate the enzyme. These results indicate that myocyte chromatin can support greater enzyme binding than can nonmyocyte chromatin. The distribution of DNA fragments from isolated myocyte and nonmyocyte nuclei were similar when alkaline sucrose density centrifugation was used. Chromatin prepared from these nuclear subsets showed no difference in degree of DNA fragmentation. These observations indicate that compared with nonmuscle cells, myocytes from adult rat hearts have higher RNA polymerase activity, greater overall chromatin template function, and higher binding capacity for RNA polymerase. Collectively, these data suggest that adult cardiac muscle cells should have a larger potential for RNA synthesis than nonmuscle cells.
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3895983
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We have investigated the mechanisms by which chemical renal medullectomy with 2-bromoethylamine hydrobromide (200 mg/kg body wt) produces hypertension in rats. Groups of chemically medullectomized rats were compared with normal rats and rats that had been partially nephrectomized to produce an equivalent fall in glomerular filtration rate. Mean arterial pressure was elevated in the medullectomized (142 +/- 6 mmHg) compared with normal rats (124 +/- 3). In the medullectomized animals this was associated with significant tachycardia (483 +/- 15 vs. 450 +/- 6 beats/min) and an increase in cardiac output (61.1 +/- 5.0 vs. 49.9 +/- 2.2 ml X min-1 X 100 g body wt-1). Plasma volume was significantly reduced in medullectomized rats (2.16 +/- 0.15 vs 3.29 +/- 0.20 ml/100 g body wt), whereas exchangeable sodium was unchanged (39.9 +/- 0.5 vs. 39.7 +/- 0.5 meq/kg body wt). By contrast, both plasma volume and exchangeable sodium were increased in partially nephrectomized rats. These results are consistent with the hypothesis that chemical medullectomy produces hypertension by increased selective sympathetic efferent activity, raising cardiac output and postcapillary venular resistance. This may be the consequence of reducing the secretion of a renomedullary humoral substance that normally inhibits such activity.
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3895984
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Fasting plasma insulin (PI) and glucose (PG) concentrations were measured throughout the body weight cycle of marmots. Animals gained weight during summer, and in late fall body weight peaked, after which they ceased feeding. Each month euthermic animals were injected intra-arterially with either dextrose (500 mg/kg) or porcine insulin (0.1 U/kg), and blood samples were collected over the subsequent 2 h. During weight gain fasting PI concentration and pancreatic B-cell response to injected dextrose increased markedly. Maximal insulin release to a dextrose challenge was measured during peak body weight or when body weight initially began to decline. The PG concentration after exogenous insulin administration was slight (less than 10%) in the fall but increased approximately 25% in the spring after marmots lost weight. Basal PG levels were not significantly different throughout the year. Basal fasting PI concentrations were significantly higher during the fall (P less than 0.01). It is suggested that in the fall, when marmots are obese, hyperinsulinemia and peripheral insulin resistance appear. Furthermore, in two animals with an increase in body weight of approximately 30% or less over the summer, peripheral resistance was demonstrable, albeit not as marked as in animals that appropriately doubled their body weights when given food ad libitum. Thus we hypothesize that factors other than adiposity, i.e., food intake, central nervous system input to the pancreatic B-cell, and/or changes in B-cell sensitivity to PG, may contribute to the observed peripheral insulin resistance and may be involved in body weight regulation.
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3895985
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Insulin binding to receptors in a partially purified hypothalamic membrane preparation is altered by prolonged starvation. To define further the relationship between hypothalamic insulin binding and energy balance, we studied the Richardson's ground squirrel, a hibernator that exhibits spontaneous 6- to 8-mo body weight cycles when kept in constant conditions. Isolated pancreatic islets from squirrels killed during the weight gain phase had greater glucose-stimulated insulin secretion than those from weight loss phase animals, and adipocytes showed significantly greater glucose incorporation into total lipid in response to insulin. Differences in lipogenesis were not attributable to changes in insulin-binding capacity. Hypothalamic tissue from weight gain phase animals bound more insulin than that from weight loss phase animals. Maximal binding was correlated with pancreatic islet responsiveness and maximal insulin-stimulated lipogenesis. The strong positive correlation between peripheral metabolic events associated with spontaneous alterations in energy balance and the binding kinetics of hypothalamic insulin receptors suggests that insulin may play an important role in the central regulation of body weight.
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3895987
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The authors examined dose-response relationships in 62 agoraphobic patients receiving either imipramine or placebo under double-blind conditions in conjunction with behavioral interventions. At the end of 12 weeks, patients treated with imipramine had improved significantly more than placebo patients. Results revealed that the beneficial therapeutic effect of imipramine was dose dependent and suggested that optimal response in agoraphobia may require doses of 150 mg/day or more. The results also indicated that side effects can significantly interfere with the buildup of optimal dose in agoraphobic patients treated with imipramine. The authors briefly discuss the implications of these findings for clinical practice and future research.
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3895992
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To determine whether changes in prenatal care utilization and adverse pregnancy outcomes occurred among poor residents of Washington State during the recent recession, we examined all births occurring from 1980 to 1983 to women in the poorest census tracts of the three major metropolitan counties in Washington State (N = 15,735). A comparison sample consisted of all births occurring in the highest income census tracts (N = 16,295). Because the impact of the recession was hypothesized to be greatest in 1982, rates in 1982 were compared with rates in 1980. The proportion of births receiving late or no prenatal care increased in both the low-income tracts (6.2 per cent to 8.2 per cent) and the high-income tracts (1.6 per cent to 2.3 per cent). The proportion of low birthweight infants increased only in the low-income tracts (6.3 per cent to 7.4 per cent). The prevalence of maternal anemia (hematocrit less than 30) also increased only in the low-income tracts (0.7 per cent to 1.7 per cent). While we were unable to ascertain the financial status of the individuals who suffered the adverse outcomes, the findings for the low-income census tracts are consistent with the hypothesis that an increase in adverse pregnancy outcomes occurred among the poor in Washington State during the recent recession.
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3895994
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Sera from 42 patients complaining of infertility were evaluated by indirect immunofluorescence for the presence of antibodies to the endometrium. The presence or absence of antibodies was matched with the findings at laparoscopy. Of the 42 patients examined for infertility, 28 (66.7%) had laparoscopic findings that corresponded to the presence or absence of endometriosis. Of 28 patients with positive antibody tests, 24 (85.7%) were found to have endometriosis. No correlation between the degree of immunofluorescence and the clinical severity of endometriosis could be determined. These findings suggest the possibility of developing a noninvasive immunological test for the presence of endometriosis.
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3895993
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This article has focused on the relatively low priority accorded industrial wastes compared to human wastes by the public health community in the period from 1876 through 1932. The critical reason for this prioritization was the potential for acute health effects from human wastes as compared with the belief that industrial wastes had only indirect effects. State departments of health normally only responded to industrial wastes when they endangered the potable nature of water supplies or interfered with water and sewage treatment processes. Within the public health community, however, a relatively small group of interdisciplinary professionals argued for attention to the indirect health effects of industrial wastes and their impacts on the total stream environment. In conjunction with other groups interested in clean streams--such as sportsmen and manufacturers who required high quality process water--they pushed for a broader state legislative mandate in regard to pollution control. Some states created new bureaus or boards with responsibility for industrial wastes and the larger stream environment but the attack on industrial pollution remained limited in this period. The final significant development regarding industrial pollution and public health concerned the formulation by Streeter-Phelps of the Public Health Service of a theory of stream purification with a set of general quantitative indicators. This application was of particular importance in regard to the high-oxygen consuming nature of organic industrial wastes and the wide variety of effluents that existed. Industrial wastes constituted what Harvey Brooks, in his essay "Science Indicators and Science Priorities" calls a very "messy" research problem--one that does "not lend itself to elegant and widely applicable generalizations."(ABSTRACT TRUNCATED AT 250 WORDS)
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3895998
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A rapid and simple assay for detecting Plasmodium falciparum in human blood was developed. The assay is based on DNA-DNA spot hybridization, using radiolabeled P. falciparum DNA as a probe and finger prick blood as the assay sample. It is very sensitive, able to detect parasitemia levels of 0.0001% in 10 microliter of blood. The assay can be quantified and used to estimate parasitemia levels. Several hundred blood samples can be processed simultaneously, and the entire procedure is completed within 24 hr. This assay can be useful for epidemiological surveys, for screening of blood by blood banks and for health authorities examining immigrants and tourists coming from malaria infested areas.
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3896000
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Plasma protein binding of quinine was measured in 12 patients with cerebral malaria on the first and seventh day of treatment, and in 7 patients with uncomplicated falciparum malaria on admission and also one month later. Binding was significantly higher and therefore the proportion of free drug was lower in cerebral malaria patients (free: total quinine concentration; 7.2 +/- 3.5%, mean +/- SD, on admission; 7.4 +/- 5.3% on day 7) compared with uncomplicated malaria patients on admission (10.2 +/- 5.8%) or following recovery (11.0 +/- 5.5%, n = 6) P = 0.011. Binding was significantly correlated with the red cell/total concentration ratio r = 0.56, P less than 0.0001. The ratio of cerebrospinal fluid to free (unbound) plasma quinine was 0.55 +/- 0.33 which suggests that quinine does not freely cross the blood brain barrier. These findings are relevant to the interpretation of total plasma or serum concentration, and may explain the rarity of serious quinine toxicity in severe falciparum malaria.
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3895999
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Sensitivity of Plasmodium falciparum to several antimalarial drugs was determined by in vitro and in vivo tests. Chloroquine resistance in vitro was detected in 97 of 101 patients from different geographic areas of Colombia. Sensitivity to amodiaquine in vitro was observed in 29 of 30 P. falciparum isolates. In vitro sensitivity to amodiaquine was observed in 16 patients infected with chloroquine-resistant P. falciparum. In vitro sensitivity to quinine was demonstrated in 57 P. falciparum isolates. Two infections from the Amazon base (2/24) were resistant to mefloquine in vitro at concentrations of 5.7 and 16 pmol/well. Resistance to Fansidar, a sulfadoxine-pyrimethamine combination, was described in 9 patients from the Amazon region. One patient showed recrudescence of the infection 41 days after treatment. The current distribution and degree of resistance of P. falciparum to widely used antimalarial drugs requires the evaluation of therapeutic schemes based on combinations of fast blood schizontocides with slow acting drugs. These associations may reduce the development of multidrug-resistant isolates and retard the spread of resistant populations of P. falciparum parasites.
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3896001
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In a volunteer with infection induced by injection of the mefloquine-sensitive, multidrug-resistant Vietnam Smith isolate of P. falciparum, parasitemia recurred following treatment with the candidate antimalarial drug enpiroline. Parasitemia also recurred after subsequent treatment with mefloquine and again after retreatment with the same drug. All recurrences were at the RI level. Parasite drug sensitivities determined by a semi-automated isotope microdilution method after the second and third recurrences revealed a progressive decrease in sensitivity to all arylaminoalcohols tested (halofantrine, enpiroline, and mefloquine). Decreased sensitivity persisted after 30 days of isolate culture. The parallel changes in parasite sensitivity to the synthetic arylaminoalcohols argue for development of drugs which are chemically dissimilar.
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3896008
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Basic principles of production of monoclonal antibodies are discussed in this paper. In order to illustrate the usefulness of such production, studies of a new monoclonal antibody designated KF-2 which defines a unique cell-surface antigen found exclusively in the stratum spinosum of man and lower primates are recounted.
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3896014
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In a double-blind clinical trial of 48 patients, nalbuphine, morphine, and pethidine were compared by on-demand intravenous analgesia during the first 24 hours after cholecystectomy. Overall pain relief (visual analogue score) was recorded by the patients as 50 (SEM 4) for nalbuphine, 44 (SEM 4) for morphine and 53 (SEM 5) for pethidine. These scores were not significantly different. The mean demand for each drug over the 24-hour period was 70 (SEM 12) mg for nalbuphine, 46 (SEM 6) mg for morphine and 614 (SEM 49) mg for pethidine. Pain on movement, either during deep breathing or turning, was found to be less well controlled after nalbuphine (70, SEM 2), and pethidine (67 SEM 7) than after morphine (52, SEM 5; p less than 0.01). The incidence of side effects was similar with each drug. Nalbuphine is a useful postoperative analgesic, as effective as pethidine. Nalbuphine 15 mg is apparently equipotent with morphine 10 mg or pethidine 120 mg by this mode of administration.
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3896015
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This paper describes an experiment performed by J. Pal of Vienna in 1900, which showed that physostigmine reverses the neuromuscular blocking properties of curare. Pal's original article is translated from the German.
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3896016
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In a randomised double-blind trial in postoperative ambulant day case dental patients suprofen 200 mg (29 patients) was compared with dextropropoxyphene hydrochloride 65 mg and paracetamol 650 mg (Cosalgesic, 28 patients) both available four times daily for 3 days. Suprofen was better than cosalgesic in the patients' opinion of initial (p = 0.01) and overall pain relief (p = 0.08) compared to Cosalgesic and the second night's sleep was better (p = 0.01). Side effects were reported in six suprofen patients and 10 cosalgesic patients (two suffering from vomiting withdrew). Suprofen, a non-steroidal anti-inflammatory drug is as good as, or better than, a widely used opioid-paracetamol mixture for ambulant patients with postoperative dental pain.
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3896017
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A case is reported of a 23-year-old man who became hypothermic within 4 hours of exposure. Full physical recovery occurred within 5 hours of an asystolic cardiac arrest using simple rewarming techniques.
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3896019
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In a prospective controlled randomised trial on patients undergoing operative repair of fractured neck of femur via a lateral incision, the postoperative analgesic requirements of one group of patients who received a lateral cutaneous nerve block were compared with a second group who received no block. The former group were found to need significantly less intramuscular pethidine in the first 24 hours, and 44% required no supplementary analgesia whatsoever during this period. The time to first dose of opioid in the remainder was greatly increased. No untoward sequelae associated with the nerve block were seen.
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3896018
|
Computer administered depression and anxiety rating scales were used in a pilot study to screen patients attending a regional pain relief unit. Patients found the procedure acceptable and helpful. There was a poor correlation between the computer assessments and doctors' ratings, with in general a much greater degree of morbid depression and anxiety revealed by the computer. Computer administered rating scales may be useful as a screening tool in pain clinic patients to identify those at risk of significant psychiatric morbidity.
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3896021
|
A rapid and convenient spectrophotometric assay has been devised to measure proteolysis. The assay is based on the reaction of o-phthalaldehyde (OPA) and 2-mercaptoethanol with amino groups released during proteolysis of a protein substrate. The reaction is specific for primary amines in amino acids, peptides, and proteins, approaches completion within 1 to 2 min at 25 degrees C (half-times of approx 10-15 s), and requires no preliminary heating or separation of the hydrolyzed products from the undegraded protein substrate prior to performing the assay. The OPA assay was relatively as successful as a 2,4,6-trinitrobenzenesulfonic acid (TNBS) procedure in predicting the extent of hydrolysis of a protein substrate. The utility of the OPA method was demonstrated by measuring the degree of proteolytic degradation caused by trypsin, subtilisin, Pronase, and chymotrypsin of various soluble protein substrates. Ethanethiol (instead of 2-mercaptoethanol) or 50% of dimethyl sulfoxide can be included in the assay solution to stabilize certain OPA-amine products. The present method approaches the sensitivity of ninhydrin and TNBS procedures, is more convenient and rapid, and could substitute for these reagents in most assay systems.
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3896022
|
Clotting of casein provides a sensitive method for detection of proteases after gel electrophoresis. The method is here designated "caseogram." After electrophoresis the gel was equilibrated with 0.15-0.3 M sodium acetate, pH 5.3, and an 1% agarose gel containing 1% skim-milk powder in 0.1 M sodium acetate, pH 5.3, was placed on top of the electrophoresis gel. By incubation at 37 degrees C for 2 h the protease-containing zones produced distinct precipitates in the skim-milk gel. For permanent documentation the skim-milk gel was stained with amido black. The detection limit for pepsin A is 5 ng in the caseogram against 25 ng by hemoglobin digestion at pH 2.5. For calf chymosin it is 1 ng against 100 ng by digestion of hemoglobin at pH 3.5. Caseograms work well after agar gel electrophoresis, after different types of immunoelectrophoresis, and after isoelectric focusing or disc electrophoresis in polyacrylamide gels. Since inert proteins do not interfere with the detection, the method is especially suitable for analysis of crude samples. Samples containing pepsinogen or pepsinogen-like zymogens may be activated at pH 2 before equilibration at pH 5.3.
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3896023
|
High-performance liquid chromatography on an ion exchanger column was successfully used for a rapid biochemical analysis of crystals of yeast tRNAAsp and aspartyl-tRNA synthetase as well as cocrystals formed by the synthetase and the tRNA.
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3896024
|
A qualitative assay which can be adapted to screen large numbers of Escherichia coli colonies for the presence of soluble enzymes is described. In a test of the system using a new, especially sensitive assay for isocitrate dehydrogenase activity, colonies producing the enzyme could be correctly identified at the 70% level after 2 h of incubation and at the 100% level after 8 h of incubation. The completed reactions are stable for several days at room temperature.
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3896025
|
A highly sensitive and specific method for the assay of dipeptidyl-aminopeptidase II (DAP II) in crude enzyme preparations such as serum and tissue homogenates has been established by using a newly synthesized fluorogenic substrate, 7-Lys-Ala-4-methylcoumarinamide. The enzymatically formed 7-amino-4-methylcoumarin was determined by high-performance liquid chromatography with fluorescence detection. The activities of other aminopeptidases in human serum and rat brain homogenates were completely inhibited by o-phenanthroline without any effect on DAP II activity to permit specific determination of DAP II. The limit of sensitivity for DAP II activity was about 300 fmol/30 min. DAP II activity was found to be increased in sera from cancer patients, in contrast to the decrease in serum DAP IV activity. DAP II activity was found to be unequally distributed in rat brain regions, and the highest activity was found in the hypothalamus.
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3896026
|
Determination of glycolic acid by stable isotope dilution was applied to the measurement of the glycolic acid pool size in tomato and maize leaves during photorespiration. Detached leaves were maintained in the presence of 18O2; [13C]glycolate was added to the foliar extract as an internal standard and the mixture of biological glycolate and [13C]glycolate was analyzed by combined gas chromatography-mass spectrometry. The level of foliar glycolate pool was measured via the 13C label, and 18O incorporation was determined.
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3896028
|
The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.
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3896029
|
The authors studied the effects of positive end-expiratory pressure (10 cmH2O PEEP), abdominal compression, and neck compression on dural venous sinus pressure (VSP) in seated dogs. Abdominal compression increased the central venous pressure (CVP) as well as both the systemic arterial pressure and the cardiac output and thus may offer a useful substitute for an antigravity suit. Except when CVP was greater than 8 mmHg, there was little or no correlation between CVP and VSP. Moreover, each method increased VSP, but this effect was closely related to VSP prior to application of the method (pre-VSP). On comparing the VSP changes in relation to the pre-VSP levels when they were either above or below -1.0 mmHg, significant differences were noted in VSP increases, i.e., -0.4 +/- 1.3 (mean +/- SEM) and 4.3 +/- 1.2 mmHg by PEEP, 1.9 +/- 0.3 and 6.4 +/- 0.4 mmHg by abdominal compression, and 10.2 +/- 1.3 and 1.5 +/- 0.5 mmHg by neck compression, respectively. This indicates that PEEP and abdominal compression were more effective in increasing relatively highly negative pre-VSP (less than -1.0 mmHg), while neck compression greatly increased pre-VSP when it was at or above a slightly negative pressure (-1.0 mmHg). The authors conclude that a single application of any one of these three methods during sitting-position surgery may not be effective in increasing cerebral dural sinus pressure.
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3896035
|
Atherosclerotic plaques and high grade stenosis in the carotid circulation are responsible for symptoms of cerebral and retinal ischemia. Identification of these lesions by angiography has been the "gold standard" for which the decision of endarterectomy depended. The recent introduction of high resolution carotid ultrasonography has allowed us to compare thirty-seven surgical specimens with the results of preoperative screening with angiography. UCI had a 97% correlation whereas angiography was accurate only 70%. More importantly there were ten negative angiograms in patients with clinically active ulcerative plaque disease. If surgery were based solely on the angiographic appearance of ulcerative plaques or high grade stenosis, then less than half of the patients have received the correct treatment. UCI deserves to be considered the new reference standard.
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3896036
|
981 lower limbs belonging to 829 subjects, 67.6% of which were females, have been examined. The average venous pressure at the tibial posterior vein was 101 +/- 12 mmHg and 102 +/- 13 mmHg on the internal saphenous vein. In 311 lower limbs with femoro-iliac thrombosis, venous pressures are slightly higher than in 670 lower limbs with calf veins occlusion. In the 44.4% of cases the phlebothrombosis was clearly dependent on traumas, deliveries, surgical operations or other conditions. The relationships between the supposed aetiopathogenesis of the affection and the pressure values have been examined. The 6.7% refers to phlebitis, which caused pulmonary embolism during their acute phase. The different objective and subjective symptoms have, furthermore, been taken into consideration. It has been noticed by the analysis of the diagrams of the pressure values in the time that the same values which are considerably high at the initial phase of the iliac postphlebitic syndrome, are always high in the following years. On the other hand, in postphlebitic syndrome of the leg those pressures whose value are not remarkably high in the initial phase, increase from the second to the fourth year after the arising of phlebitis and, finally become stable at fairly high values, but still lower than those of iliac syndrome. The venous orthostatic pressure of internal saphenous vein in the iliac postphlebitic syndrome was also found to exceed the deep pressures, likely because of the altered saphenous discharge at the cross level.
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3896037
|
Peripheral circulatory effects of insulin were studied in the diabetic patients with and without autonomic neuropathy. Forearm blood flow, calf venous volume and calf venous distensibility were measured by strain gauge plethysmography. In the diabetic patients with autonomic neuropathy, mean blood pressure fell from 96 +/- 5 to 88 +/- 5 mmHg after an intravenous injection of 4 U of monocomponent insulin (p less than 0.001). Forearm vascular resistance decreased from 53.99 +/- 8.29 to 45.88 +/- 7.76 mmHg X ml-1 X 100ml-1 X min-1 after insulin (p less than 0.01). Insulin increased calf venous volume from 1.20 +/- 0.19 to 2.23 +/- 0.44 ml/100ml (p less than 0.05) and calf venous distensibility from 0.039 +/- 0.004 to 0.082 +/- 0.016 ml/mmHg (p less than 0.05). In contrast, in the diabetic patients without autonomic neuropathy, there were no significant changes in the mean blood pressure, forearm vascular resistance, calf venous volume and calf venous distensibility. Symptoms of hypoglycaemia did not occur in any patient. These results suggest that insulin has a vasodilator action on both resistance and capacitance vessels, which may be one of the main factors in insulin-induced hypotension.
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3896027
|
The LH response to 100 or 1000 ng of LH-RH was studied in adult male rats treated neonatally with 500 micrograms of estradiol benzoate or olive oil. The dose of 100 ng elicited the same LH increase in both groups, but the estrogenized animals responded more when 1000 ng of LH-RH was injected. These data suggest that the decreased LH response to orchidectomy found in estrogenized animals is not due to a failure in pituitary responsiveness to LH-RH.
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3896038
|
Since its first discovery in 1948, serotonin (5-HT) has been the subject of considerable interest. Its potent vasoactivity led to the hypothesis that altered serotonin metabolism was responsible for the pathophysiology of cerebrovascular disease (infarction & hemorrhage) with documentation of elevated levels of serotonin in CSF. If (5-HT) serotonin-mediated release is ultimately responsible for cerebral edema, vasospasm and infarction in experimental and human stroke, then an opportunity exists to pharmacologically block these effects with serotonin-antagonizing agents. This hypothesis has been tested in the laboratory with several agents that inhibit biogenic amines resulting in promising data suggesting a reduction in damage and disability. Since the "natural history of human stroke" results in a 30-40% mortality within the first three weeks, an aggressive new attempt should be directed to increasing the number of survivors in this initial period of high risk. In this regard Sansert (methysergide) was considered worthy of clinical trials.
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3896039
|
The evaluation of an emergency room patient with acute chest pain is often difficult. Recently, computers have been employed to develop protocols for identifying which patients are likely to have acute myocardial infarctions and to benefit, therefore, from admission to a relatively scarce coronary care unit bed. We have tested the latest computer-derived instrument in a municipal hospital and found it to be less reliable than the clinical judgement of physicians.
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3896042
|
The prevalence of atherosclerotic lesions at the carotid bifurcation with asymptomatic Meck bruits has been evaluated in 71 patients, 42 males, ages ranging from 19 to 84 yrs, referred to our non-invasive vascular laboratory for an echo-Doppler (duplex) scan, associated with spectral analysis (Mark V ATL with Flow analyzer 459). Fifty-nine patients had mid-neck or high-neck bruits (30 bilateral), 12 had low-neck bruits (4 bilateral). The internal carotid arteries were classified as normal, minimal stenosis (diameter reduction 20%), moderate stenosis (20-49%), severe stenosis greater than or equal to 50%), total occlusion. Twenty-four of the internal carotid arteries homolateral to a mid- or high-neck bruit were normal, 84% had stenosis of various degree (16% severe), 2% were occluded. Stenoses of various degree were also present on the contralateral side of the bruit. No lesions above a diameter reduction of 20% were present in the internal carotid arteries corresponding to a low-neck bruit. The echo-Doppler (duplex) system, being capable of spanning the whole spectrum of the internal carotid occlusive disease, allows us to limit the number of the invasive diagnostic procedures in asymptomatic patients.
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3896043
|
During revascularisation procedures repeated left ventriculography using iodine contrast materials may be an unnecessary burden on left ventricular performance. We therefore investigated in 10 patients the diagnostic quality of low dose ventriculography using a video image processor which enhanced digital left ventricular images. It is concluded that low dose ventriculography using up to 70% dilution of contrast can be diagnostic in 90% of all cases, depending of the side of interest.
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3896040
|
Non-sustained ventricular tachycardia (VT) in the late post myocardial infarction (MI) period (7-21 days) has been reported to be a predictor of sudden death. We suspected that patients with 3 beat VT on Holter monitoring in the late infarction period would demonstrate electrical instability at electrophysiologic studies. Forty-seven patients were identified as having at least 3 beat VT on Holter monitoring. Eighteen patients refused electrophysiologic studies or were not referred by their attending physician. The mean ejection fraction of this group was 43 +/- 16%. Eight patients have died, 3 sudden deaths in 13 +/- 5 months, a 17% incidence of sudden death. Twenty-nine patients underwent invasive electrophysiologic studies. Their mean ejection fraction was 37 +/- 7%, and 28 had inducible, 18 sustained ventricular tachycardia and 10 non-sustained VT. No complications were noted with electrophysiological testing in the post infarction patients. Using programmed electrical stimulation studies an effective antiarrhythmic agent preventing VT induction (usually experimental) could be found for each patient. After a mean follow-up of 12.5 +/- 4 months, the patient without inducible VT is alive and 26 of the 28 "inducible" patients are alive and well. Two patients died, one of stroke and one due to pump failure following a second MI. No sudden deaths were observed in this group. Two patients had breakthrough arrhythmias and were treated by alternative antiarrhythmic therapy that was also effective at the initial electrophysiologic studies. Thus, PES studies post MI are safe and may be an effective way to assess therapy for patients in the early post MI period, identified at high risk for sudden death.
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3896041
|
Physiology and pathophysiology of blood fluidity are reviewed focussing the clinical relevance of the different hyperviscosity syndromes with particular respect to the microcirculation and thromboembolic complications. A new therapeutical approach is presented with pentoxifylline, a drug which largely satisfies the complex requirements of a compound affecting most of the determinants of disturbed blood fluidity. The presented data of the multifunctional pharmacological properties of pentoxifylline on blood components and vessel wall suggest this drug as indicated for the treatment of the disorders of blood fluidity linked with many diseases. Its antihemostasiological and antithrombotic potential also offers the facility for prevention of postoperative thrombotic events and in vessel surgery to avoid reocclusion.
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3896044
|
Recent investigations suggest an interdependence between blood fluidity and walking performance in patients with peripheral arterial occlusive disease (PAOD). Therefore, various blood fluidity variables (erythrocyte aggregation, erythrocyte flexibility, plasma viscosity, plasma proteins) were studied in groups of healthy subjects and claudicants with severe PAOD (exhausted perfusion reserve) receiving intravenous treatment with Trental (600 mg Pentoxifylline b.i.d., 21 days). Erythrocyte flexibility (expressed by filterability through micropore filters), red cell aggregation and plasma viscosity deteriorate with progression of disease especially in Stage IIb and III Fontaine classification, with walking distance below 150 m. Trental treatment resulted in patients with advanced POAD stages in improvement of red cell filterability, red cell aggregation, decrease of plasma viscosity, increase in absolute walking distance and relief from rest pain, suggesting that such patients are accessible to conservative treatment with hemorheologically active agents.
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3896046
|
Forty-five hypertensive patients, 28 women and 17 men, age range between 35 and 65 years (mean 50 years), with blood pressures which current therapy did not succeed to control, were submitted to several examinations in order to identify the cause of their hypertension. We found isolated or combined abnormal values of aldosterone, renin, calcium and or potassium as the only alterations in 19 patients. We distinguished 4 groups descretionally classified according to biochemical alterations: renin and aldosterone increase, renin increase, aldosterone increase, calcium and or potassium reduction. The therapy used, intentionally aimed at the correction of the biochemical alterations found. Normal blood pressure was achieved in all patients and simultaneously the biochemical alterations also became normal in patients with isolated hyperreninemia, with combined hyperreninemia and hyperaldosteronemia and in those with hypocalcemia and or hypopotassemia. In patients were only isolated hyperaldosteronemia was found, this condition returned to normal in all except one. We suggest that besides the disturbances in sodium distribution other electrolytes or biochemical alterations may also play an equally important role in regulating, and sustaining essential hypertension.
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3896045
|
Many epidemiological studies have shown up the frequent association of arterial hypertension (HT) with atherosclerosis of different localizations. However, many of the drugs used to treat HT are contraindicated in patients with peripheral vascular disease (PVD), because they cause unfavorable metabolic changes or vasoconstriction. The aim of the present study was to assess the effect of a proven hypotensive drug, captopril, on the peripheral circulation. The drug appeared to be effective in improving blood flow to lower limbs, prolonging the pain. Free interval and increasing the angle/arm arterial pressure index.
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3896047
|
The reliability of continuous wave (CW) Doppler imaging and Duplex scanning in the assessment of carotid artery disease has been evaluated prospectively in comparison with biplanar angiography. Of 130 comparisons the sensitivity of Doppler imaging was 89% and specificity 99% in the detection of greater than or equal to 50% internal carotid stenosis, and 87% and 99% respectively in the diagnosis of internal carotid occlusion. Of 118 comparisons the sensitivity of Duplex scanning was 93% and specificity 98% in the detection of greater than or equal to 50% internal carotid stenosis, and 93% and 99% respectively in the diagnosis of internal carotid occlusion. CW Doppler imaging and Duplex scanning are accurate techniques in the diagnosis and categorisation of internal carotid artery disease. CW Doppler imaging is an effective screening technique for the presence of greater than or equal to 50% internal carotid artery stenosis. Duplex scanning also has the potential for improved detection of early internal carotid artery disease and study of the natural history of atherosclerosis.
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3896048
|
In order to evaluate the occurrence of hemostatic disorders, 37 patients with transient ischemic attacks (TIAs) and 50 control subjects were studied by means of the Hemostatic Balance Index (H.B.I.) derived from Raby's Thrombodynamic Potential Index (T.P.I.) and Fearnley's Whole Blood Diluted Lysis Time (W.B.D.L.T.). Results showed a significant increase in T.P.I. and a tendency to a decrease in fibrinolytic activity in the TIA group: H.B.I. was shown to be significantly increased, thus indicating a pro-thrombotic imbalance in these patients. The occurrence of similar changes in TIA females when compared to male patients marks the importance of plasmatic factors in the mechanism of thrombotic disorders in females with cerebrovascular disease.
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3896049
|
Angina occurring in patients with Takayasu's aortitis is attributed to the narrowing of the coronary ostium and/or aortic regurgitation. We treated a patient with Takayasu's aortitis with effort angina, in whom there was no obstruction of the ostium or aortic regurgitation. Treadmill exercise stress test revealed significant ST depression in leads V4-6, II, III and aVF with chest pain. Examinations of lactate in coronary sinus as well as arterial blood suggested the occurrence of myocardial ischemia during atrial pacing. The DPTI/TTI index was decreased and the left ventricular end-diastolic pressure was increased during angina. It is considered that the reduced coronary perfusion pressure resulted from a low diastolic aortic pressure and the elevated left ventricular end-diastolic pressure decreased the DPTI/TTI index and contributed to the development of subendocardial ischemia.
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3896050
|
Allergy to insulin is extremely rare and is, in part, due to the differences in amino acid sequence of animal and human insulin. We report here a 37-year-old, white, pregnant woman who was allergic to beef/pork, purified pork, as well as human insulin. She reacted with a wheal and flare reaction in response to intradermal human and purified porcine insulins. She was desensitized to human insulin in order to continue insulin therapy during pregnancy. The course of this patient emphasizes that some patients are allergic even to human insulin and may require desensitization prior to insulin therapy.
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3896052
|
The identification of Enterobacteriaceae is examined in the context of the recent field of research assisted by multi-criteria decisions. In particular, the authors discuss the limitations of two approaches of assisted identification based on completely different mathematical concepts: the calculation of the probabilities (used in commercial centres) and the aggregation of pre-orders by a model of assisted decision such as Electra II. In order to reduce the errors of interpretation inherent in the use of any model, the authors propose the use of computer assisted systems of bacterial identification in bacteriology laboratories.
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3896051
|
Asthma can be over-diagnosed, but is more often under-diagnosed. The diagnosis can be made by demonstrating the reversibility of airway obstruction or by a provocation test if the baseline spirometry is normal. The most frequent causes of missing the diagnosis are (1) atypical clinical presentation, (2) misconceptions about age of onset of childhood asthma, and (3) the coexistence of another chronic respiratory illness that may have a more dramatic clinical picture and constitute a "red herring." It is fascinating to speculate on the similarities and differences between classical asthma (which has a usually completely reversible obstruction) and the hyperreactivity and partial reversibility of chronic inflammatory diseases like COPD or CF. Unfortunately much remains to be investigated and little is known at present about these questions. Even in classical asthma, chronic or recurrent inflammation (even by late allergic reaction) could worsen the basic hyperreactivity and this could be amenable to treatment or prevention.
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3896053
|
The performance of a new reagent strip method for determining the urine specific gravity was evaluated. 342 clinical specimens were assayed in duplicate by the new method and by the "falling drop" technique. The reproducibility (two lots of strips, four operators) was very good (96.2 per cent agreement between replicates within a range of 0,0100 specific gravity units). The correlation with the comparative method was satisfactory [81,2 per cent concordance within a range of 0,0100 specific gravity units]. No interference was found from ketones, blood or urobilinogen. The influence of proteins and glucose is discussed. The practical advantages of the new method are described.
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3896054
|
We have used in routine fluorescein labelled monoclonal antibodies to detect directly C. trachomatis in genital smears from 68 men with urethritis and 32 women with leukorrhoea or cervicitis. We have compared the results with those obtained by culture on cycloheximide treated McCoy cells stained by Giemsa. C. trachomatis was detected in men respectively from 31 per cent of urethral specimens by culture and 29 per cent by direct test and in women from 12 per cent of cervical specimens by culture and 9 per cent by direct test. There was agreement between the results in 92 per cent of the specimen tested. Discrepancies were observed in case of low number of inclusions in culture or low number of elementary bodies in direct test. The direct test seems a rapid and sensitive method and can be performed by many laboratories.
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3896056
|
In spite of all the scientific and technical advances in recent years, shock that is not rapidly correctable with fluid can have a morbidity rate exceeding 80%. Consequently awareness of such precipitating factors as sepsis and early diagnosis and treatment are essential. Treatment should be rapid and should follow a previously outlined protocol. Such protocols should include correction of the precipitating problem and aggressive resuscitation to assure adequate ventilation and oxygenation of the blood and optimal oxygen delivery to the tissues. Fluid and blood should be given as needed until filling pressures begin to rise rapidly with further fluid infusion. With hemorrhagic shock in previously healthy individuals, a hemoglobin level of 10.0 g/dL is usually adequate. In older, septic, or cardiogenic shock patients, a hemoglobin level of 12.5 to 14.0 may be preferable. If an optimal preload does not increase cardiac output to normal or higher levels, inotropic agents should be used. If shock still persists, one must be sure that the arterial pH is not excessively high or low. Glucocorticoids may then be given in low dose (200 mg hydrocortisone) in case some degree of adrenal insufficiency is present. They can also be given in high doses (equivalent to 150 mg/kg hydrocortisone) early in septic shock primarily to prevent excess complement activation and to preserve membrane integrity. Vasopressors may occasionally be required if there is excessive vasodilation, especially if there is persistent hypotension in the presence of high-grade coronary or cerebral artery stenosis. Vasodilators may be used to try to correct myocardial ischemia (nitroglycerin), excessive preload (nitroglycerin), or excessive afterload (nitroprusside or hydralazine). Combinations of vasodilators and inotropic agents may be required in some patients with high systemic vascular resistance and persistently low cardiac outputs. Mechanical assist with IABP can be of great value in persistent cardiogenic shock. Diuretics may occasionally help prevent renal failure in patients who are persistently oliguric after blood flow and pressure are restored. Heparin is occasionally of value if DIC develops with no concomitant fibrinolysis. Antibiotics are important in septic shock and may also be important if persistent shock has reduced gastrointestinal mucosal integrity so that bacteria and bacterial products can enter the portal system.(ABSTRACT TRUNCATED AT 400 WORDS)
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3896057
|
Adult respiratory distress syndrome (ARDS) is a multietiologic acute and progressive pulmonary dysfunction that may be precipitated by any of a number of pathogenic agents. Clinical and experimental studies suggest that activation of complement and blood neutrophils plays a significant role in the development of pulmonary vascular injury, which is an important pathophysiological feature of ARDS. Although the specific cellular and biochemical mechanisms resulting in the development of ARDS are unknown, it has been suggested that oxygen-derived free radicals generated from complement-activated granulocytes may be involved, directly or indirectly, in the destruction of lung vascular endothelium and alveolar tissue matrix. This hypothesis is supported by recent experimental studies showing that acute lung injury secondary to systemic complement activation can largely be prevented by interventions that scavenge for hydroxyl radicals or restrict availability of ionic iron.
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3896059
|
Contemporary cerebral-cardiopulmonary resuscitation investigations in the experimental laboratory have defined mechanisms for blood flow during closed-chest CPR and have demonstrated that the current CPR technique produces limited systemic perfusion. Modified closed-chest CPR techniques usually improve perfusion. Unfortunately few laboratory CPR studies have actually investigated resuscitation and survival. In addition, the animal model employed (prolonged ventricular fibrillation) may have limited clinical relevance, based on clinical experience and resuscitation practice, and data reporting techniques and their interpretation may be affected by control values that are not normal because of the effects of anesthetics. Closed-chest CPR was intended to buy time until a countershock could be delivered. Clinical and laboratory experience indicate that this goal can be met. Cerebral perfusion during closed-chest CPR is low, but adequacy from a functional perspective following restoration of circulation has not been carefully studied. Preservation of neuronal integrity after restoration of spontaneous circulation may be more important than cerebral perfusion during cardiac arrest and CPR. The role and benefit of open-chest CPR have yet to be determined, because this technique will most likely be used after conventional CPR failure. New and different experimental models are required to meet clinical needs and challenges. The alliance between practitioner and investigator should be strengthened if common goals are to be attained.
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3896058
|
Histopathological data obtained from different experimental models of hypoxia and ischemia were evaluated in order to extend current knowledge of mechanisms responsible for delayed neuronal cell death. Special attention is given to the distribution of calcium (Ca2+) in vulnerable areas during the postischemic period. Between an initial defensive Ca2+ sequestration, which is completely reversible, and final toxic Ca2+ overload, which is associated with irreversible neuronal necrosis, important Ca2+ shifts could be demonstrated cytochemically. Such shifts occur mainly at excitatory presynaptic sites and seem to precede structural ischemic cell change in postsynaptic areas. Recent results obtained with some Ca2+ entry blockers indicate that prophylactic treatment and postischemic intervention prevent cytosolic Ca2+ overload and reduce delayed brain injury.
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3896062
|
The management of closed head injury has improved recently. Mortality rates for severe trauma are lower and outcomes are more favorable. Advances are related to improved diagnostic tools, such as computerized tomography scanning, aggressive supportive care, standardized evaluation criteria, and program-oriented rehabilitation. Further progress depends on sophisticated triage, including delivery of the patient to an experienced head-injury unit, as well as successful manipulation of cellular and subcellular processes to maintain brain homeostasis. Recent developments in the pathophysiology, diagnosis, and treatment of closed head injury are reviewed, and promising research avenues are discussed.
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3896061
|
Despite advances in the understanding of the pathophysiology of cerebral ischemia, no single brain resuscitation therapy has yet been shown to be clinically superior to brain-oriented intensive care. Basic concepts in cardiopulmonary-cerebral resuscitation (CPCR) are discussed, as are two specific phases of CPCR, cerebral preservation and cerebral resuscitation. Cerebral preservation is initiated during cardiac arrest (ie, prior to restoration of spontaneous circulation [ROSC]) and includes use of artificial perfusion techniques and drugs to produce cerebral perfusion during this phase. Cerebral resuscitation is brain-oriented therapy initiated after ROSC. Pharmacologic agents currently under study for cerebral resuscitation include the barbiturates, calcium antagonists, and iron chelators. With respect to defining efficacy of the pharmacologic agents, the concept of therapeutic window is important. Although no agent has been proven clinically, several appear to be promising.
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3896060
|
Presented is a rationale for use of a new class of drugs, the iron chelating agents, in advanced cardiac life support (ACLS) to prevent late deaths and brain damage following successful cardiopulmonary resuscitation. The relevant biochemical hypothesis states that free iron ions, liberated from bound intracellular stores during ischemia, catalyze initiation of free radical mediated reactions that propagate through membrane lipids and proteins. Progressive ultrastructural damage may result, ultimately causing deterioration of function and death. Chelation of intracellular iron by deferoxamine, a commercially available drug that distributes to the intracellular space and has a great affinity for iron ions, may prevent such reactions. A hypothesis concerning relevant pathological chemistry is developed in detail.
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3896063
|
We report a unique complication of intravenous drug abuse, central embolization of a needle from a peripheral site. A heroin addict dislodged a needle into the soft tissues of the forearm during self injection. Immediate surgical attempts to visualize and remove the needle were unsuccessful. On a subsequent admission, chest radiograph showed the needle in the right mid-lung field. No attempt at removal was made.
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3896064
|
Blood from 171 pregnant and 65 nonpregnant cows was taken at slaughter for culture and examined during the culturing period for Trypanosoma theileri once a week for 5 weeks. Of the 171 fetuses from the pregnant cows, 119 (69.6%) were greater than or equal to 4 months gestation; blood samples from these fetuses were also taken for culture. Of 236 cows (81 of 171 [47.4%] pregnant and 20 of 65 [30.8%] nonpregnant cows), 101 (42.8%) were culture positive. More of the pregnant than nonpregnant cows were culture positive (P less than 0.05). More beef cows (48.0%) than dairy cows (34.1%) were culture positive (P less than 0.025). Two of the 119 (1.7%) fetus samples were found culture positive. The percentages of positive cultures from Brucella-reactor cows, 18 of 40 (45.0%), and from non-Brucella-reactor cows, 83 of 196 (42.3%), were similar. However, both of the culture-positive fetuses were from Brucella-reactor cows.
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3896065
|
A total of 524 staphylococcal isolates from bovine milk were identified, using the API Staph-Ident system and conventional biochemical methods. The API Staph-Ident system correctly identified 192 of 201 (95.5%) Staphylococcus aureus isolates, but was correct on only 23 of 323 (7.1%) non-S aureus isolates.
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3896066
|
Seven horses were used to compare the Gambee, the crushing, and a 2-layer inverting suture pattern composed of a simple continuous layer in the mucosa oversewn with a continuous Lembert pattern in the seromuscular layer. Horses were evaluated at 30 days for adhesion formation, lumen diameter, and quality of healing at the anastomotic sites. One horse was euthanatized 9 days after surgery after 24 hours of ileus and colic; necropsy revealed septic peritonitis and widespread adhesions. One horse had no adhesions. The remaining horses had adhesions associated with 50% of the Gambee and 50% of the crushing anastomoses. There were no adhesions related to the 2-layer inverting techniques in these 6 horses. There was no significant difference in percentage reduction of lumen diameters between the 3 techniques, and there was no evidence of chronic obstruction resulting from any of the anastomotic techniques. Histologically, the inflammatory response and fibrosis were minimal in the single layer patterns, but there was increased fibrosis and suture tract inflammation in the 2-layer inverting technique.
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3896067
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This experiment was designed to establish a model for the study of gastrointestinal disturbances as a result of prolonged endotoxin uptake in the horse. The hepatic portal vein of 7 horses was catheterized (through flank incisions) to give chronic hepatic portal infusions of lipopolysaccharide (LPS, endotoxin). Lipopolysaccharide was infused at a rate of 1 microgram/kg of body weight/hr for 24 hours. Two of the horses were infused with saline solution for 12 hours before LPS infusions were given. Lipopolysaccharide was shown to affect behavior and hematologic and coagulation values. The 1st hour was critical for the LPS-infused horses; yet by 4 hours, the horses had apparently become refractory to continued infusion of LPS. During the 1st hour, all horses collapsed without an accompanying hypotension. A decrease in polymorphonuclear leukocytes (neutrophils) was seen during this time and was accompanied by a shortening of the recalcification tests, 1-stage prothrombin time, and activated partial thromboplastin time. There was an increased concentration of circulating fibrinogen/fibrin degradatory products. All of the LPS-infused horses showed signs of hoof discomfort and either stood with the 4 feet together beneath the body or continually shifted their weight from one front foot to the other. Hoof temperature decreased approximately 3 degrees (C) during this time and remained decreased for the duration of the experiment.
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3896068
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A panel of 55 monoclonal antibodies to an Actinobacillus sp isolate (As8C strain) cultured from the epididymides of an infected ram was produced. Cell lines producing 5 of these antibodies were cloned and expanded by hybridoma tumor production in Balb/c mice. An isotype profile revealed that 1 cloned antibody belonged to the immunoglobulin (Ig) M class and the 4 remaining antibodies belonged to the IgG class. Within the IgG class, 1 clone produced IgG1, 1 clone produced IgG2a, and 2 clones produced IgG2b. Ascites fluid antibody titers from the cloned hybridomas ranged from 6,400 to 51,200, as determined by enzyme-linked immunosorbent assay. Specificity of the antibodies to target As8C antigens could be demonstrated by enzyme-linked immunosorbent assay inhibition. Ascites fluid from 2 clones contained antibodies that agglutinated As8C. Two additional clones produced antibodies capable of only partial agglutination, whereas 1 clone produced antibody that did not agglutinate As8C. The indirect fluorescent antibody test revealed that target antigens for at least 4 of the 5 monoclonal antibodies were most likely located on the bacterial cell surface. Antigens were extracted from As8C, using 5 surface active chemicals. An attempt to immunoprecipitate these antigens in agarose by reacting individual extracts with each of the antibodies was unsuccessful.
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3896069
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Migration of bovine macrophages under agarose was used to assess cellular immunity in 7 nonvaccinated calves and 9 calves vaccinated with Salmonella typhimurium. The 9 vaccinated calves were allotted to 4 groups. Group I calves were vaccinated twice orally with small doses of virulent S typhimurium; group II calves were vaccinated twice orally with genetically altered aromatic-dependent (aro-) S typhimurium SL3261; group III calves were vaccinated twice IM with small doses of virulent S typhimurium; and group IV calves were vaccinated twice IM with aro- S typhimurium SL1479. Samples of blood were obtained from these calves at 2 weeks after the 2nd vaccinal dose was given, and lymphocytes were harvested, using lymphocyte separation medium. Lymphocytes in serum-free medium were then incubated with S typhimurim antigen for 48 hours. Lymphocytes were then transferred to antigen-free medium and incubated for 48 hours, and the supernatant was assayed for the migration-inhibition factor (MIF). Lymphocyte supernatant was assayed for MIF by incubating it for 48 hours with 2.0 X 10(4) alveolar macrophages in agar wells. The macrophage migration distance was measured and compared with control values. Macrophage migration was inhibited in the presence of supernatant of lymphocytes from vaccinated calves that had been incubated with antigen, indicating the presence of the MIF in the supernatant. Migration distances, as a percentage of control, were 33% for group I calves (oral vaccination, virulent vaccinal organism), 60% for group II calves (oral vaccination, aro- vaccinal organism), 41% for group III (IM vaccination, virulent organism), and 25% for group IV (IM vaccination, aro- vaccinal organism).(ABSTRACT TRUNCATED AT 250 WORDS)
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3896070
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From 1940 through 1978, fifty-eight strains of Pasteurella multocida (serotype 3) were isolated from turkeys throughout the United States and were examined for R-plasmids. Forty-one of the isolates contained plasmid DNA, of which 7 isolates were found to encode resistance to tetracycline, streptomycin, and sulfonamides, or to streptomycin and sulfonamides. The R-plasmids were 2 to 10 megadaltons, nonconjugal, and contained a moles percent guanine plus cytosine ratio in the range of 57 to 61. The R-plasmids did not belong to any of the 19 incompatibility groups evaluated, including Inc Q. Digestion with restriction endonuclease indicated that 2 of the plasmids from P multocida isolated in 1960 and 1962 were identical, whereas 4 of the 5 plasmids obtained from P multocida isolated after 1966 were identical, with the 5th plasmid closely related to the other 4. The results indicated that R-plasmids were not widely dispersed among P multocida (serotype 3) isolated from turkeys in the United States. The nontransmissible nature of these plasmids was probably the major reason for their lack of dissemination.
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3896071
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Ninety dogs naturally infected with Dirofilaria immitis and 103 noninfected dogs, as determined by necropsy, were used to compare the sensitivity and specificity of the cuticular and somatic reactions of the indirect fluorescent antibody test (IFA-C and IFA-S, respectively) and 2 enzyme-linked immunosorbent assays (ELISA). In microfilaremic and amicrofilaremic heartworm-infected dogs, negative results were common for all serotests. In dogs without adult heartworms at necropsy, 32% to 49% were positive, using 1 ELISA, 27% to 29% were positive with the other ELISA, 15% to 36% were positive with the IFA-S, and 0% to 1% were positive using the IFA-C, depending on the classification of borderline reactions. The prevalence of false positive serotests was probably not due to the detection of precardial stages of D immitis in dogs obtained from areas of low endemicity. Until the causes of the false-positive tests are resolved, the use of currently available serotests for routine diagnostic screening or as criteria for instituting treatment is not recommended.
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3896072
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A study was conducted to determine whether body fluids undergo a net shift from one compartment to another during endotoxin-induced shock in the pony, and whether flunixin meglumine alters these endotoxin-induced changes in the volumes of body fluid compartments. Total blood, RBC, and plasma volumes were determined, using 51Cr-labeled RBC and PCV that were corrected for trapped plasma. Total body water was measured by distribution of 3HOH. Arterial blood pressure was measured directly, using a blood pressure transducer. Treatment (flunixin meglumine, 1.1 mg/kg of body weight) was given to 6 of the 12 ponies 1 minute before an IV injection of Escherichia coli endotoxin (100 micrograms/kg of body weight, LD100). The PCV and RBC volume increased in both groups; however, the hemoconcentration was less in flunixin meglumine-treated ponies. In nontreated ponies, total blood volume and plasma volume decreased significantly during the first hour after endotoxin administration. In treated ponies, total blood volume did not vary significantly, and plasma volume decreased only slightly. In both groups, the increase in PCV was apparently due to splenic contraction, which increased the number of circulating RBC. Hemoconcentration was further increased in nontreated ponies by the loss of plasma into the interstitial space. Flunixin meglumine reduced plasma loss, minimized hemoconcentration, and maintained normal blood volume. Total body water remained constant in treated and nontreated ponies.
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3896073
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Bovine adherent mononuclear leukocytes were incubated with bacterial lipopolysaccharides (LPS) in vitro, and these cells produced a factor that increased the blastogenic reaction of mouse thymocytes to concanavalin A. This factor most resembles interleukin 1. The LPS were also cytotoxic for bovine adherent mononuclear leukocytes in a dose-and time-dependent manner. Cytotoxicosis was determined by the release of cytoplasmic lactic dehydrogenase. This cytotoxicosis was blocked by treating the cells with corticosteroids. Variation in the reaction to LPS occurred in cells collected from the same cow on different days and from cells collected from different cows.
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3896074
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To investigate a possible mechanism involved in the enhancement of Salmonella typhimurium infection in chickens concurrently infected with Eimeria tenella, S typhimurium was given orally to chickens 7 days after E tenella inoculation. The number of viable S typhimurium decreased in the ceca of chickens not inoculated with E tenella, whereas the number gradually increased in the ceca of chickens inoculated with E tenella. Cecal contents were analyzed for pH value, oxidation-reduction potential, and amounts of short-chain fatty acids and bile acids. In the ceca of E tenella-inoculated chickens, the oxidation-reduction potential significantly (P less than 0.05) shifted to the oxidative phase, and the concentration of volatile fatty acids (acetic acid, propionic acid, and butyric acid) significantly (P less than 0.05) decreased. In both aerobic and anaerobic incubations, the number of viable S typhimurium in vitro decreased as the molar concentration of fatty acids increased. Experimental evidence indicated that multiplication of S typhimurium in the ceca of E tenella-inoculated chickens was associated with decreased concentrations of volatile fatty acids.
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3896076
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We investigated whether the plateau of the dose-response to nonsensitizing stimuli, such as methacholine, could be explained by the airway dilation that follows lung inflation in nonasthmatics. We used maximal expiratory partial flow-volume curves to measure the response of the airways to doubling doses of inhaled methacholine up to 256 mg/ml (a noncumulative dose of 340 mumol delivered to the mouth during tidal breathing) in 12 nonasthmatics on 2 days. Maximal expiratory complete flow-volume curves and FEV1 were also obtained along with the partial curves. Flows were measured at 40% of control vital capacity using the complete (V40c) and the partial (V40p) curves. A maximal response plateau of 2 or more doubling concentrations was demonstrated in all subjects based on V40p, and in 10 subjects based on FEV1. The level of the plateau was the highest for the V40p (mean +/- SD = 65 +/- 19% of baseline), intermediate for V40c (45 +/- 22%), and the lowest for FEV1 (16 +/- 11%). There was more than a 100-fold range in responsiveness expressed as the provocative concentration to cause a 40% fall of baseline in V40p (PC40); the lower the PC40, the higher the level of the plateau. All the results were reproducible between the 2 days. We also investigated whether the plateau may have been due to a tachyphylactic effect of cumulative doses of methacholine. The maximal response after increasing concentrations of methacholine up to 256 mg/ml was not different from the response obtained after a single dose of 256 mg/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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3896077
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Bronchomotor tone after deep inspiration and bronchial responsiveness to methacholine were studied at 4:00 A.M. and 4:00 P.M. in 14 normal and 13 asthmatic subjects. Bronchomotor tone was assessed with respiratory resistance (Rrs) measured by the forced oscillation method. Bronchial responsiveness to methacholine and baseline Rrs were higher at 4:00 A.M. than at 4:00 P.M. in both normal and asthmatic subjects (p less than 0.01). The difference in methacholine threshold between 4:00 P.M. and 4:00 A.M. In asthmatics was similar to that in normal subjects. Immediately after deep inspiration, Rrs decreased more at 4:00 A.M. than at 4:00 P.M. In normal subjects. In contrast, asthmatic subjects showed a significantly greater immediate increase in Rrs after deep inspiration at 4:00 A.M. than at 4:00 P.M. It is suggested that the bronchoconstrictive effect after deep inspiration is a distinguishing characteristic of asthmatics.
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3896078
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We studied the responses to antigen in animals selected from a colony of inbred dogs sensitized to specific allergens to determine if they had characteristics similar to those of human asthmatics. They were immunized with ragweed and grass pollen extracts (10 micrograms in alum) immediately after routine vaccination with attenuated live virus (distemper and hepatitis) and killed bacteria (Leptospira) at 4, 8, and 12 wk of age. Subsequently, ragweed and grass injections were repeated every 2 months. Immunized dogs made specific IgE-antibodies in serum averaging 3 to 4 times that of control animals (no immunization with pollen or vaccine). They showed positive skin responses to the injection of ragweed pollen extract, whereas control dogs did not respond to ragweed pollen by quantitative skin test or inhalation challenge. In immunized dogs under barbiturate anesthesia, air-flow resistance of the total respiratory system increased from 0.60 +/- 0.07 (mean +/- SEM) before to 12.6 +/- 3.4 cm H2O/lps 5 min after the start of antigen aerosol; respiratory resistance remained increased for 20 min and was associated with 0 hypoxemia and increased arterial plasma histamine. In addition, airway responsiveness to both inhaled histamine and methacholine was greater in immunized dogs than in nonimmunized dogs of comparable age. Airway responses to each agonist were highly reproducible on repeated testing. These results indicate that physiologic responses to antigen by inbred, ragweed-sensitized dogs resemble human asthma closely and that these dogs appear suitable for a variety of experimental studies of asthma with respect to pathogenesis, diagnosis, prevention, and treatment.
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3896080
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We measured lung clearance of aerosolized technetium-labeled diethylenetriamine pentaacetic acid (99mTcDTPA) as an index of alveolar epithelial permeability in rabbits exposed to cigarette smoke. Eighteen rabbits were randomly assigned to 3 equal-size groups: control, all smoke exposure (ASE), and limited smoke exposure (LSE). Cigarette or sham smoke was delivered by syringe in a series of 5, 10, 20, and 30 tidal volume breaths with a 20-min counting period between each subset of breaths to determine 99mTcDTPA biologic half-life (T1/2). Mean T1/2 minimum (i.e., the smallest T1/2 observed) was significantly lower (p less than 0.05) for ASE and LSE rabbits than by control rabbits. We observed a significant difference at 20 and 30 breath exposures between the control and ASE group mean values (% baseline) for T1/2, arterial blood pressure, and peak airway pressure. A combination of light and electron microscopy showed focal alveolar edema and hemorrhage in the ASE and LSE groups but no alveolar-capillary membrane damage. In summary, acute cigarette smoke exposure increases alveolar permeability as measured by 99mTcDTPA clearance, but there was no detectable ultrastructural alteration of the alveolar-capillary membrane.
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3896079
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Ham's F12 medium supplemented with insulin (Ins), transferrin (Tf), epidermal growth factor (EGF), hydrocortisone (HC), T3, cholera toxin (CT), and bovine hypothalamus extract (BHE) was developed for in vitro growth of human nasal epithelial (HNE) cells. The HNE cells were dissociated from freshly excised nasal polyps or turbinates with protease. Colony-forming efficiency of primary HNE cells was approximately 5%. Growth studies showed Ins, BHE, and CT were essential for growth; HC, EGF, Tf, and T3 were also stimulatory for growth. The growth rate in this serum-free, hormone-supplemented medium was 24 h per population doubling. Up to 20 population doublings and 3 passages of dissociated HNE cells could be achieved. Addition of serum to this culture medium inhibited epithelial cell growth. Vitamin A had no apparent effect on cell growth but induced an alteration in the morphologic characteristics of the cell. The epithelial nature of cultured cells was confirmed by positive staining with antihuman keratin antibody, ultrastructural studies, and by formation of a columnar, ciliated epithelium in denuded tracheal grafts repopulated by these cultured HNE cells. Biochemical analyses of glycoproteins (labeled with 3H-glucosamine and/or 35S-sulfate) secreted by cultured HNE cells were unable to demonstrate the secretion of mucinlike glycoproteins in culture. Instead, major secretory products of cultured cells were hyaluronate and heparan sulfate. These results were in agreement with morphologic observations that showed no mucus-secreting granules in cultured cells. Dome formation was observed in high cell density cultures. We conclude that HNE cells can be cultured in well-defined culture media. As indicated by formation of domes, these cells may be useful for in vitro ion transport studies. Further differentiation, however, may be required for studies of mucin synthesis.
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3896081
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To determine whether bronchoalveolar lavage reflects the histologic aspects of the lung histology in patients with sarcoidosis and hypersensitivity pneumonitis, cells recovered from lavage fluid were compared with tissue sections from transbronchial lung biopsies in 33 patients. The evaluation of cellular types and their topographic distribution in situ was determined by using monoclonal antibodies in combination with immunohistochemical techniques. Cell counts in bronchoalveolar lavage and lung biopsies were significantly correlated both in sarcoidosis and hypersensitivity pneumonitis. In fact, the relative proportions of inflammatory and immunocompetent cells recovered from lavage fluid accurately overlapped those observed in lung tissue sections. However, in patients with more pronounced alveolitis, the frequency of macrophages in tissue sections was higher than that observed in the bronchoalveolar lavage, and the degree of lymphocytes in the lavage was higher than that observed in the corresponding biopsy. Specifically, in these patients the lavage underestimated the amount of macrophages in the lung biopsies and overestimated the number of lymphocytes that were present in the lung parenchyma. This was more evident in patients with hypersensitivity pneumonitis, where the intensity of alveolitis was higher than in sarcoidosis. Our data support the idea that, at least in patients with sarcoidosis and hypersensitivity pneumonitis, bronchoalveolar lavage correctly samples the alveolitis. Discrepancies in patients with very high intensity alveolitis could be due to a more pronounced recirculation of lymphocytes from the parenchyma to the alveolar spaces.
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3896082
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Many studies have been carried out in the past 10 yr dealing with the possible role of elastase in the pathogenesis of pulmonary emphysema. These include newer observations in animal models revealing augmentation of elastase-induced lesions by lathyrogens or by exposure to cigarette smoke. In general, the animal model experiments have focussed attention on repair-processes in the lung and shown that such processes may exert a major influence on the outcome of the initial proteolytic insult. Human studies exploring correlations between elastase levels in neutrophils or serum and development of disease have provided conflicting data; however, measurement of enzymes in pulmonary secretions have yielded more suggestive results. Assessments of lung elastase inhibitors in humans continue to support the importance of alpha-1-proteinase inhibitor in the protection of the lower respiratory tract, but newer information on locally produced, low molecular weight elastase inhibitors indicates that these, too, may play a significant role. Attempts have been made to link cigarette smoking to the development of emphysema at the chemical and cellular levels. These studies have focussed on: (1) the recruitment of elastase-producing leukocytes to smokers' lungs, (2) inactivation of lung elastase-inhibitors by tobacco products or by metabolites released from tobacco-stimulated lung cells, and (3) interference with elastin neosynthesis (repair) in the smoker. Additional information is also available concerning the biochemical properties of neutrophil and macrophage elastases, although it is still unclear which of these enzymes plays the predominant role in chronic lung injury associated with smoking. Perhaps the greatest advance in the emphysema field in recent years involves new discoveries concerning the structure and function of the alpha-1-proteinase (elastase) inhibitor. Applications of recombinant DNA technology and genetic engineering have made it possible to design modified inhibitors with striking new properties. These agents may enjoy significant clinical application in the not too distant future.
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3896084
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Intra-abdominal abscess, resulting either from primary intraperitoneal disease or as a complication of surgery, remains a serious problem with high patient mortality if not treated early and adequately. The initial attempt at diagnosis rests on strong clinical evidence supported by nonspecific laboratory findings. The most helpful advance over conventional x-ray studies has been the advent of noninvasive imaging techniques such as ultrasonography or computed tomography. Radioisotopic scanning with gallium or indium makes possible a generalized survey of the peritoneal cavity, but only after a delay from the time of injection. Ultrasonography is somewhat limited in utility, particularly in the left subphrenic space, and CT scanning remains the technique with highest resolution. These noninvasive imaging techniques also have the potential for directed percutaneous catheter drainage.
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3896087
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The pacemaker syndrome is a complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those suggesting low cardiac output or congestive heart failure, temporally related to the onset of ventricular pacing, are indicative of the pacemaker syndrome. The evolution of a clinically recognized syndrome, an analysis of possible mechanisms and clinical manifestations, and diagnostic approaches and their implications for management are discussed.
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3896085
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One hundred seventy elderly women with stage II breast cancer, stratified on the basis of the number of positive axillary nodes and estrogen receptor status, were randomly assigned to receive tamoxifen or placebo for 24 months in a prospective, double-blind, adjuvant trial. The median age was 71 years with a range from 65 to 84 years. The overall percentage of patients disease-free at 4 years was 76% for those given tamoxifen and 52% for those given placebo (p = 0.0004). Benefit was seen in all subgroups of patients treated with tamoxifen. Two years of tamoxifen therapy represents an effective postoperative adjuvant treatment for elderly women with stage II breast cancer, resulting in improved time to relapse, statistically fewer distant first recurrences, and minimal toxicity. No improvement in overall survival has been seen yet.
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3896088
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The use of pulmonary artery flow-directed catheters has assumed epidemic proportions without clinical trials establishing improved outcome as a result of their use. During the past 10 years, however, it has become clear that improved outcome is found only in small groups of patients and that use of these catheters is associated with considerable risks of morbidity and mortality. A clinical trial is urgently needed to assess the balance between risks and benefits. While awaiting such trials, physicians should limit catheter use to circumstances in which there is a large probability that the data will result in more effective management; the measurements should only be used to answer specific questions about patient therapy. This situation will occur in a relatively small number of patients.
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3896092
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Amrinone is a new positive inotropic agent available in oral and intravenous preparations. Twelve patients with Stage III cardiac failure of ischaemic (6 cases), myocardial (5 cases) or valvular (1 case) origin, were treated with oral amrinone. The protocol included a complete clinical, radiological and biochemical work-up, an exercise stress test, cardiac catheterisation and echocardiography before entering the trial. The patients underwent clinical examination, stress testing and echocardiography at the 4th, 8th and 12th week of treatment with 300 mg daily of amrinone. Two patients had to be withdrawn from the trial because of thrombocytopaenia; one patient deteriorated and eventually died of pulmonary embolism. There was a marked improvement in the 8 patients who achieved the trial, with an average gain of 40 watts on exercise testing, a mean reduction of 16 mm Hg in diastolic pulmonary pressures, and an increase of 11 p. 100 in EF and velocity of circumferential fibre shortening. Four additional patients were given intravenous amrinone (1 cc/kg relayed with an infusion of 1 ng/kg/min). Ventricular end-diastolic pressures fell by 9 mm Hg and cardiac index rose by 1.02 1/min/m2. Tolerance was good with no arrhythmic complications or significant variations in mean arterial pressure or heart rate. Although certain reserves have to be made with regards of tolerance of oral amrinone, the drug would seem to be useful and effective in the intravenous form. Further studies are under way.
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3896096
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Since the discovery of the satiety effect of CCK in 1973, progress has been made and problems have been encountered. The progress has included the accumulation of strong, indirect evidence that exogenous CCK acts in the abdomen to activate vagal afferent fibers and that exogenous CCK may be useful in the treatment of bulimia and obesity in humans. The most pressing problem is the current lack of evidence for the hypothesis that the satiety effect of exogenous CCK reveals a physiological function of endogenous CCK released by food entering the small intestine during a meal. Since clarification of this problem and exploitation of the current progress seem possible with current ideas and techniques, the satiety effect of CCK should continue to receive considerable experimental attention.
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3896099
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Eight neuroleptic-resistant schizophrenic patients were treated with ceruletide, a cholecystokinin-like peptide, in a placebo-controlled, double-blind, crossover study. Ceruletide or placebo was administered intramuscularly twice a day for 4 consecutive days while patients were maintained on a constant dose of fluphenazine. There were no changes in either the positive or negative symptoms of schizophrenia between the periods of placebo and ceruletide administration. To further characterize ceruletide actions we also administered it to seven normal volunteers and evaluated its effects on cognition and mood. Volunteers were administered ceruletide (0.3 micrograms/kg or 0.6 micrograms/kg) or saline placebo intramuscularly. Ceruletide had no effects on recent or remote memory or attention, but the higher dose did cause a significant increase in fatigue. These results suggest that although CCK-like peptides lack antipsychotic or cognitive effects they do induce mild sedation. This sedation may be part of a "satiety-like" state induced by peripheral administration of CCK.
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