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The coxsackievirus and adenovirus receptor (CAR) was identified as a common cellular receptor for both viruses, but its biological and pathogenic relevance is uncertain. Knowledge of CAR localization in the human cardiovascular system is limited but important with respect to CAR-dependent viral infections and gene transfer using CAR-dependent viral vectors. Explanted failing hearts from 13 patients (8 with dilated cardiomyopathy [DCM] and 5 with other heart diseases [non-DCM]) and normal donor hearts (n=7) were investigated for the expression levels and subcellular localization of CAR and the adenovirus coreceptors alpha(v)beta(3) and alpha(v)beta(5) integrins. CAR immunoreactivity was very low in normal and non-DCM hearts, whereas strong CAR signals occurred at the intercalated discs and sarcolemma in 5 of the 8 DCM hearts (62.5%); these strong signals colocalized with both integrins. In all hearts, CAR was detectable in subendothelial layers of the vessel wall, but not on the luminal endothelial surface, and on interstitial cells. Human CAR (hCAR) expressed in rat cardiomyocytes was targeted to cell-cell contacts, which resembled CAR localization in DCM hearts and resulted in 15-fold increased adenovirus uptake.

Is human coxsackie-adenovirus receptor colocalized with integrins alpha ( v ) beta ( 3 ) and alpha ( v ) beta ( 5 ) on the cardiomyocyte sarcolemma and upregulated in dilated cardiomyopathy : implications for cardiotropic viral infections?

The aim of the study was to investigate the effects of hormone replacement therapy (HRT) on myocardial repolarization characteristics in postmenopausal women without coronary artery disease. Fifty-one consecutive healthy postmenopausal women (age 48 +/- 5) with negative exercise stress testing were prospectively enrolled into the study. Standard 12-lead electrocardiograms were obtained to evaluate the effects of 6 months of HRT on QT intervals, corrected QT intervals (QTcmax and QTcmin), QT dispersion (QTd), and corrected QTd (QTcd). Hormone regimens were continuous 0.625 mg/day conjugated equine estrogen (CEE) plus 2.5 mg/day medroxyprogesterone acetate (MPA) or 0.625 mg/day CEE alone depending on the hysterectomy status. Although not statistically significant, CEE alone or in combination with MPA increased QTmax and QTmin values. However, the increase in QTmin was greater than the increase in QTmax, which resulted in statistically significant shortening of QTd (P = 0.007 in CEE and P < 0.001 in CEE + MPA groups). There was a significant prolongation of QTcmin values after 6 months in patients assigned to the CEE group (P = 0.001). The QTcd values were significantly shortened by HRT with both regimens (for CEE group 49 +/- 13 ms vs 38 +/- 13 ms, P = 0.01; for CEE + MPA group 49 +/- 14 ms vs 36 +/- 13, P < 0.001).

Does hormone replacement therapy shorten QT dispersion in healthy postmenopausal women?

Early and complete myocardial reperfusion is the goal when treating a patient with acute myocardial infarction. To achieve this in each individual, an on-line, accurate, easily handled and preferably noninvasive technique to monitor flow alterations is needed. Recurrent ST-segment elevation has been shown to reflect cyclic disturbances in perfusion. We have retrospectively analyzed ST variability in 102 patients with acute myocardial infarction randomized to 100 mg of rt-Pa or placebo. Patients were monitored for 24 hours using vectorcardiography. Patients alive at one year (86%) had significantly less ST variability during the first four hours: 4.3 versus 7.1 episodes, P = 0.007. Patients having six or more ST episodes showed a 31.3% one-year mortality as compared to no mortality in patients having no ST variability. Furthermore ST variability was reduced by fibrinolysis.

Does sT variability during the first 4 hours of acute myocardial infarction predict 1-year mortality?

Calcium represents a key mediator of cold ischemia/reperfusion (CIR) injury presumably by affecting mitochondrial function. In this study, we investigated cellular and mitochondrial changes of calcium homeostasis in sublethally damaged human endothelial cells. Changes in cellular and mitochondrial calcium concentrations were studied after cold ischemia in University of Wisconsin solution for 12 hr and reperfusion in ringer solution. Cytosolic-free calcium concentration ([Ca2+]c) and mitochondrial-free calcium content ([Ca2+]m) were analyzed by fura-2 and rhod-2 fluorescence, respectively. Pretreatment of cells with ruthenium red (RR) or a H+-ionophore was used to inhibit mitochondrial calcium uptake. Mitochondrial membrane potential (DeltaPsim) was measured by 5,5',6,6'-tetrachloro- 1,1',3,3'-tetraethylbenzimidazolylcarbocyanine iodide and 3,3'-dihexyloxacarbocyanine iodide fluorescence. Twelve-hr cold ischemia did not induce apoptosis in endothelial cells. In such sublethally damaged cells, [Ca2+]c rose from approximately 20 nmol/L after cold ischemia to approximately 120 nmol/L during reperfusion. Pretreatment with RR leads to an approximately 5-fold rise in [Ca2+]c. Image analysis revealed a significant increase of [Ca2+]m in a subpopulation of mitochondria during reperfusion. This was not the case in RR-pretreated cells. DeltaPsim decreased significantly during cold ischemia and was sustained during reperfusion. The loss of DeltaPsim can be related to a reduced portion of mitochondria exhibiting high DeltaPsim.

Does a subpopulation of mitochondria prevent cytosolic calcium overload in endothelial cells after cold ischemia/reperfusion?

Previously we reported that cultures of fine-needle aspiration biopsy (FNAB) samples synthesize different cytokine pattern depending on the alloimmune response towards the kidney graft. However, we failed to find a clear picture for growth factors implicated in early T-cell activation (interferon-gamma, interleukin [IL]-4, IL-12), although we observed that interleukin-1 receptor antagonist (IL-1ra) was associated with absence of acute rejection. We have now studied tumor necrosis factor-alpha (TNF-alpha) and its two soluble receptors, sTNFRI and sTNFRII, IL-1beta and soluble IL-1 receptor II (sIL-1RII), and leukemia inhibitory factor (LIF), all potential modulators of T-cell activation. Sixty-six cadaver kidney transplants (KTX) were divided into four groups: group 1, day 7 after KTX, stable (n=30); group 2, day 7 after KTX, 8+/-4.5 days before acute rejection (n=12); group 3, first day of acute rejection (n=17); and group 4, day 14 after KTX, stable (n=32). Patients from groups 1 and 4 remained rejection-free for the first 6 months. All rejection episodes were confirmed by core renal biopsy. FNAB samples were cultured according to our published methodology, and culture supernatants were collected at 48 hr and analyzed by ELISA for IL-1beta, sIL-1RII, TNF-alpha, sTNFRI, sTNFRII, and LIF. Serum levels for sIL-1RII, sTNFRI, and sTNFRII were also measured. FNAB cultures from groups 1 and 4 synthesized significantly lower amounts of sTNFRI and sTNFRII than those from either groups 2 or 3. Both sTNFRI and sTNFRII reached high positive and negative predictive values for acute rejection. IL-1beta and sIL-1RII were synthesized by all groups but without differences. No trace of LIF and TNF-alpha was found. sTNFRII was significantly higher in serum from group 3.

Is sTNFRI and sTNFRII synthesis by fine-needle aspiration biopsy sample cultures significantly associated with acute rejection in kidney transplantation?

To evaluate whether thoracic epidural anesthesia (TEA) can reduce the incidence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Forty-one patients undergoing CABG were treated with TEA intraoperatively and postoperatively. Another 80 patients served as the control group. The sympathetic and parasympathetic activities were evaluated by analysis of neuropeptides, catecholamines and heart rate variability (HRV), preoperatively and postoperatively. Postoperative AF occurred in 31.7% of the TEA-treated patients and in 36.3% of the untreated patients (p = 0.77). TEA significantly suppressed sympathetic activity, as indicated by a less pronounced increase of norepinephrine and epinephrine (p = 0.03, p = 0.02) and a significant decrease of neuropeptide Y (p = 0.01) postoperatively in TEA-treated patients compared to untreated patients. The HRV variable expressing sympathetic activity was significantly lower and the postoperative increase in heart rate was significantly less in the TEA group than in the control group after surgery (p = 0.01, p < 0.001). Among patients developing AF, the maximal number of supraventricular premature beats per minute increased significantly in untreated patients postoperatively but remained unchanged in TEA-treated patients (p = 0.004 versus p = 0.86).

Does thoracic epidural anesthesia influence the occurrence of postoperative sustained atrial fibrillation?

Platelet concentrates (PCs) for premature infants may be subjected to filtration, centrifugation, and various storage conditions before transfusion. As there are few data on the cumulative effect of these procedures on PCs, platelet properties (including biochemical and functional in vitro assays) were evaluated after the processing of single units of PCs through a 1-unit-capacity high-efficiency white cell (WBC)-reduction filter followed by syringe storage at either 22 or 37 degrees C for 6 hours. Two- and 5-day-old PCs, volume-reduced PCs, and prestorage WBC-reduced PCs were evaluated. WBC filtration consistently resulted in a 3 to 4 log10 reduction in WBCs, with less than 15-percent platelet loss. No adverse effects of platelet function or evidence of increased platelet activation as determined by the percentage of P-selectin positivity were noted. A decrease in pH associated with increased lactate production and consumption of glucose was observed following syringe storage under all conditions tested. Such changes were most pronounced, however, with volume-reduced PCs stored at 37 degrees C (pH 6.31 +/- 0.15, lactate 23.0 +/- 3.06 mmol/L). All pH levels at the end of storage were above the minimum Food and Drug Administration requirement (pH 6.0).

Does in vitro characteristics of white cell-reduced single-unit platelet concentrate stored in syringes?

DNA profiles from variable number of tandem repeat (VNTR) loci typically are composed of two bands, one derived from each member of the homologous pair of chromosomes. DNA profiles composed of more than two bands result from mutations, and the question arises as to the mechanism underlying these unusual multi-banded DNA profiles. An alleged father in a paternity test was found to have a five-banded DNA profile at the D10S28 locus when his DNA was subjected to single-locus restriction fragment length polymorphism mapping with the restriction enzyme Pvu II. Several results suggest that this complex DNA profile is the result of several single-base changes within the VNTR locus. First, there was no evidence of partial digestion of the DNA with Pvu II. Furthermore, the multi-banded allele happened, in this case, to be transmitted to the child, who also showed a five-banded pattern composed of four bands inherited from the alleged father and one band inherited from the mother. Second, digestion of this DNA with Hae III resulted in the visualization of just two bands at the D10S28 locus.

Do single-base substitutions give rise to a five-banded DNA profile at the D10S28 locus?

To study the prognosis of gastric remnant cancer following radical resection (group 1) compared with that of primary gastric cancer of the upper third of the stomach following radical resection (group 2). Cohort study with a 5-year follow-up. A university hospital in Austria. Group 1 consisted of 43 patients, and group 2, of 61. Postoperative deaths and deaths during the follow-up period that were not related to gastric cancer were excluded. Fifteen patients in group 1 (34.9%) presented with stage I cancer; 10 (23.3%), stage II; 13 (30.2%), stage III; and five (11.6%), stage IV. Twenty patients in group 2 (32.8%) presented with stage I cancer; 12 (19.7%), stage II; 15 (24.6%), stage III; and 14 (22.9%), stage IV (Union Internationale Contre le Cancer staging classification, 1987). Overall and stage-related 5-year survival rates. The overall 5-year survival rate was 53.5% in group 1 and 32.8% in group 2 (P < .05). The stage-related 5-year survival rate in group 1 was 100% for stage I and 80% for stage II. In group 2, the stage-related 5-year survival rate was 65% for stage I and 25% for stage II (both, P < .01). No significant difference was noted for stages III and IV.

Does gastric remnant cancer have a better prognosis than primary gastric cancer?

Non-insulin-dependent diabetes mellitus (NIDDM) is a major risk factor for stroke in the middle-aged population, but few prospective population-based studies are available in the elderly. Moreover, the importance of metabolic control and the duration of diabetes in diabetic subjects has remained controversial. There are no previous studies on association of insulin with the risk of stroke. The present study examined whether NIDDM, its metabolic control and duration, and insulin level predict stroke. We measured cardiovascular risk factors including glucose tolerance, plasma insulin, and glycosylated hemoglobin A1c in a Finnish cohort of 1298 subjects aged 65 to 74 years and investigated the impact of these risk factors on the incidence of both fatal and nonfatal stroke during 3.5 years of follow-up. Of 1298 subjects participating in the baseline study, 1069 did not have diabetes and 229 had NIDDM. During the 3.5-year follow-up, 3.4% (n = 36) of nondiabetic subjects and 6.1% (n = 14) of NIDDM subjects had a nonfatal or fatal stroke. The incidence of stroke was significantly higher in diabetic women compared with nondiabetic women (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.65 to 3.06). In contrast, the risk of stroke was not significantly higher in diabetic men than in nondiabetic men (OR, 1.36; 95% CI, 0.44 to 4.18). In multivariate logistic regression analyses including all study subjects, fasting and 2-hour glucose (P < .01 and P < .05, respectively), glycosylated hemoglobin A1c (P < .01), atrial fibrillation (P < .05), hypertension (P < .05), and previous stroke (P < .01) predicted stroke events. In diabetic subjects, fasting and 2-hour glucose (P < .01 and P < .05, respectively), glycosylated hemoglobin A1c (P < .05), the duration of diabetes (P < .05), and atrial fibrillation (P < .05) were the baseline variables predicting stroke events. Finally, fasting insulin (P < .05), hypertension (P < .05), and previous stroke (P < .01) were associated with stroke incidence in nondiabetic subjects.

Are non-insulin-dependent diabetes and its metabolic control important predictors of stroke in elderly subjects?

To test the influence of continuously administered enteral feeding on gastric pH and gastric colonization in patients receiving or not receiving topical antimicrobial prophylaxis of the oropharynx and stomach, including sucralfate as stress ulcer prophylaxis. Prospective, open trial. Two university hospital general intensive care units (ICUs). Patients (n = 95) with an ICU stay for at least 5 days. Thirty-one patients received antimicrobial agents into the stomach and oropharynx in combination with sucralfate (1 g/6 hrs) as stress ulcer prophylaxis. Sixty-four other patients did not receive antimicrobial prophylaxis or sucralfate, but instead received gastric pH-increasing stress ulcer prophylactic agents, if indicated. Gastric colonization and gastric pH were measured on admission and subsequently at least two times a week. Forty-eight patients (14 receiving and 34 not receiving antimicrobial prophylaxis) received enteral feeding. Both enteral feeding and gastric pH-increasing stress ulcer prophylaxis independently increased gastric pH: the risks for a gastric pH of > 3.5 were, respectively, 4.54 and 2.04 (odds ratios). Enteral feeding also increased the risk for gastric colonization by potentially pathogenic microorganisms (odds ratio = 4.52). Patients receiving both topical antimicrobial prophylaxis and sucralfate remained free of gastric colonization for a longer period than those patients receiving gastric pH-increasing stress ulcer prophylaxis. In these two groups, patients without enteral feeding remained free of gastric colonization for a longer period than those patients receiving enteral feeding.

Does continuous enteral feeding counteract preventive measures for gastric colonization in intensive care unit patients?

The authors sought to determine how temporary insulin suppression might alter the catabolic effects of cortisol, glucagon, and epinephrine. The metabolic responses to injury include hypermetabolism, accelerated net skeletal muscle protein breakdown, glucose intolerance, and insulin resistance. These alterations are associated with increased stress hormone concentrations. Insulin elaboration is usually suppressed immediately after an injury but is abundant later during convalescence. An infusion of hydrocortisone, glucagon, and epinephrine increases both stress hormone concentrations and insulin levels. It induces many of the metabolic alterations seen in critically ill patients, but it does not affect net muscle breakdown. Seven healthy adults received a stress hormone infusion for 3 days in two separate studies. During one study they, also received an infusion of the somatostatin analogue, octreotide (0.005 micrograms/kg/min), to suppress insulin elaboration for the first 24 hours. During the other study (control), insulin was permitted to rise unchecked. Stress hormone concentrations, hypermetabolism (+/- 20% above basal), and leukocytosis were similar during both study periods. When insulin elaboration was temporarily suppressed, whole-body nitrogen loss was increased during the first 48 hours, and the efflux of amino acids from the forearm after 72 hours of infusion was 60% greater than the control level.

Do early hormonal changes affect the catabolic response to trauma?

Our purpose was to investigate whether markers for activation of the immune system are present in patients with preeclampsia by assessing maternal plasma and amniotic fluid for tumor necrosis factor-alpha and interleukin-1 beta. Twenty-one patients with severe preeclampsia composed the study group (group A). An antepartum comparison group was composed of healthy nulliparous patients not in labor and matched for gestational age (group B). Another control group consisted of term nulliparous patients in labor with uneventful pregnancies (group C). Maternal plasma samples were collected from all patients at recruitment and from patients in groups A and C immediately after delivery and again 20 to 24 hours post partum. Amniotic fluid was also collected from patients in groups A and C during labor. All samples were collectively assayed for tumor necrosis factor-alpha and interleukin-1 beta by specific enzyme-linked immunoassays. Before labor tumor necrosis factor-alpha was detected more frequently in the plasma of preeclamptic patients than in the plasma of patients in group B (12/16 vs 5/16, p < 0.05) and in higher concentrations (median 35 pg/ml vs median 0 pg/ml, p < 0.05). Although tumor necrosis factor-alpha was frequently detected in the plasma of patients in group C in early labor (16/20), concentrations were higher in the four preeclamptic patients first sampled in early labor (210 pg/ml vs 65 pg/ml, p < 0.05). Similarly, amniotic fluid levels of tumor necrosis factor-alpha were increased in preeclamptic patients compared with control patients. At delivery tumor necrosis factor-alpha was more likely to be identified in the plasma of preeclamptic patients and was found in higher concentrations, but by 20 to 24 hours post partum measurements in the preeclamptic and control patients were similar. There were no differences in the frequency with which interleukin-1 beta was detected or the concentration of interleukin-1 beta in any of the samples.

Is tumor necrosis factor-alpha elevated in plasma and amniotic fluid of patients with severe preeclampsia?

To determine the effect of the presence of a patent foramen ovale on the right-to-left shunt in patients with respiratory failure who receive positive end-expiratory pressure (PEEP). Convenience sample with randomized application of PEEP. General intensive care unit of a university teaching hospital. A total of 46 mechanically ventilated patients with respiratory failure requiring an inspired oxygen concentration of at least 50% and a PEEP of at least 5 cm of H2O. Randomized application of PEEP (0 and 10 cm of H2O). A patent foramen ovale was detected by saline contrast transesophageal echocardiography. The alveolar-to-arterial oxygen difference and the right-to-left shunt were calculated from arterial and venous blood gas sampling. In patients without a patent foramen ovale (n = 39), the alveolar-to-arterial oxygen difference and the shunt fraction decreased (-50 mm Hg [95% CI, -21 to -67] and -0.05 [CI, -0.03 to -0.07], respectively) after adding PEEP (10 cm of H2O). In patients with a patent foramen ovale (n = 7), minimal changes were noted in the alveolar-to-arterial oxygen difference (4 mm Hg, P > 0.2), but the shunt fraction increased (0.05, CI, 0 to 0.09). Adding PEEP (10 cm of H2O) increased the shunt fraction in 6 of 7 (86%) patients with a patent foramen ovale, whereas the shunt increased in only 7 of 39 (18%) patients without a patent foramen ovale (P < 0.007).

Does positive end-expiratory pressure increase the right-to-left shunt in mechanically ventilated patients with patent foramen ovale?

Transesophageal echocardiography (TEE) has been used recently to detect atrial thrombi before cardioversion of atrial arrhythmias. It has been assumed that embolic events after cardioversion result from embolism of preexisting atrial thrombi that are accurately detected by TEE. This study examined the clinical and echocardiographic findings in patients with embolism after cardioversion of atrial fibrillation despite exclusion of atrial thrombi by TEE. Clinical and echocardiographic data in 17 patients with embolic events after TEE-guided electrical (n = 16) or pharmacological (n = 1) cardioversion were analyzed. All 17 patients had nonvalvular atrial fibrillation, including four patients with lone atrial fibrillation. TEE before cardioversion showed left atrial spontaneous echo contrast in five patients and did not show atrial thrombus in any patient. Cardioversion resulted in return to sinus rhythm without immediate complication in all patients. Thirteen patients had cerebral embolic events and four patients had peripheral embolism occurring 2 hours to 7 days after cardioversion. None of the patients were therapeutically anticoagulated at the time of embolism. New or increased left atrial spontaneous echo contrast was detected in four of the five patients undergoing repeat TEE after cardioversion including one patient with a new left atrial appendage thrombus.

Does exclusion of atrial thrombus by transesophageal echocardiography preclude embolism after cardioversion of atrial fibrillation . A multicenter study?

To examine conditions that determine the nature of the blood-borne, ACAID-inducing signal produced after intracameral injection of antigen. Balb/c mice were splenectomized, rested, and injected in the anterior chamber with various antigens. Two days later the animals were bled, the plasma and white cells were isolated, and these fractions were transferred to naive mice (with spleens). Recipients were immunized subcutaneously within 2 to 7 days and delayed type hypersensitivity was assessed 10 to 14 days after immunization by challenge with the appropriate antigen. The antigens HSV-1, TNP-coupled cells, and P815 tumors cells induced a soluble ACAID-inducing signal found in the plasma portion of blood. The soluble protein antigens bovine serum albumin (BSA) and conalbumin induced a cell-associated signal. When T-cells were included with protein antigens, a soluble (not cellular) ACAID-inducing signal was induced.

Is the immune response and the eye : the ACAID inducing signal dependent on the nature of the antigen?

To assess temporary expatriation as a risk factor for HIV infection in a rural area of Senegal and to examine the transmission of HIV from expatriates to their families. Cross-sectional study in identified expatriates and in a representative cluster sample of the general population from the same geographical area in northern Senegal. In 1989, a survey (including questionnaire and serological tests for HIV-1 and HIV-2) was conducted in all expatriates currently living in 11 villages in northern Senegal and spouses of all expatriates (present or not) from this area ('expatriate' group, n = 258). In parallel, a cluster sample of 600 adults was drawn from eight villages of the same area, of whom 414 were selected as the control group since they and their spouses had not travelled outside Senegal in the last 10 years. In the 'expatriate' group, sera from 39 subjects were confirmed as HIV-positive by Western blot [17 out of 63 men (27.0%) and 22 out of 195 women (11.3%)]. Of these subjects, 33 were infected by HIV-1, four by HIV-2 and two had a dual HIV-1/2 profile. In contrast, only two subjects (one man and one woman) from the control group were infected by HIV-2 and none by HIV-1. In men, HIV-1 seroprevalence was associated with age < 40 years [odds ratio (OR), 7.4; P = 0.03] and previous sexually transmitted disease (STD) symptoms (OR, 13.5; P = 0.03), whereas the risk factors in women were age < 25 years (OR, 3.7; P = 0.04), being a widow (OR, 30.4; P < 0.01) and presence of sexual activity over the last 2 years (OR, 21.3; P < 0.01).

Is temporary expatriation related to HIV-1 infection in rural Senegal?

We measured the activity of S-adenosylmethionine decarboxylase, a key regulatory enzyme of polyamine biosynthesis, in the temporal cortex of patients with epilepsy. Cortical surgical specimens were obtained following anterior temporal lobe resection for intractable epilepsy. Enzyme activity was compared in nonepileptogenic (n = 16) and epileptogenic (spontaneously discharging; n = 19) regions. Mean enzyme activity was increased by 44% in samples from epileptogenic cortex compared with samples from nonepileptic regions. The S-adenosylmethionine decarboxylase activity in regions of focal epileptogenic discharges was also increased in five patients compared with paired samples from the nonepileptogenic portion of the same gyrus (+55%).

Is activity of S-adenosylmethionine decarboxylase , a key regulatory enzyme in polyamine biosynthesis , increased in epileptogenic human cortex?

Nonsteroidal anti-inflammatory drug (NSAID) use is increasingly recognized as a major factor associated with peptic ulcer disease and complications. We undertook a multicenter, double-blind, placebo-controlled trial to evaluate efficacy and safety of nizatidine in preventing ulcer formation in patients with osteoarthritis who were taking NSAIDs. After endoscopy to rule out the presence of an acute ulcer, 496 patients were randomized to receive nizatidine, 150 mg twice daily (248 patients) or placebo (248 patients) for 3 months. Repeated endoscopies were performed monthly. We defined failure as development of a peptic ulcer (> or = 0.3 cm in diameter). Baseline characteristics tested were comparable for the two groups with regard to age, sex, ulcer history, and Helicobacter pylori status. Overall ulcer occurrence in the nizatidine group (9.7%) was not significantly different from that in the placebo group (13.7%; P = .163). High-risk subgroups (patients with ulcer history and patients > or = 65 years of age), however, revealed statistically fewer ulcers for patients receiving nizatidine (P = .035 and P = .042, respectively). Analysis of antacid use showed significantly less use in nizatidine recipients, although there were similar percentages of patients showing improvement in dyspeptic symptoms in each treatment group. We failed to observe a conclusive correlation between H pylori status at baseline, as measured by serum immunoglobulin antibody, and development of an ulcer.

Does nizatidine prevent peptic ulceration in high-risk patients taking nonsteroidal anti-inflammatory drugs?

To study a possible relationship between serum levels of estrogens and androgens and the tumor content of estrogen receptors and progesterone receptors in endometrial cancer. Fifty postmenopausal patients were included. Receptors were determined biochemically in tissue cytosol by dextran charcoal-coated assay and immunohistochemically on frozen sections. Serum sex hormones were measured by radioimmunoassays. Tumor biochemical progesterone receptor content correlated positively (p < 0.05) with free estradiol serum levels. No correlations were observed between estrogen receptor content and any of the serum sex hormones. The progesterone/estrogen receptor ratio, calculated from the biochemical values, correlated positively (p < 0.05) with the serum levels of free estradiol. This relation was not affected by tumor histologic grade or stage. Furthermore, this ratio correlated positively with body mass index, probably reflecting a correlation between body mass and serum estrogens. Biochemical and immunohistochemical receptor values were correlated.

Does progesterone receptor content in endometrial carcinoma correlate with serum levels of free estradiol?

To introduce readers to the use of pentoxifylline for diabetes-induced peripheral vascular disease. The article provides background on the pathophysiology of diabetic foot ulcers as well as a review of the literature on the therapeutic use of pentoxifylline for treating this disorder. A MEDLINE search was used to identify pertinent literature, including review articles and case reports. Key index terms included pentoxifylline, diabetic foot ulcer, neuropathy, peripheral vascular disease, and intermittent claudication Basic pharmacologic data regarding absorption, distribution, metabolism, and excretion were reported in normal subjects as well as in patients with renal impairment. Open and controlled clinical trials also were analyzed; subjective symptoms were reported. The economic implications also were reported. The pharmacist's role in patient education is discussed. Pentoxifylline 800 mg/d was found to be effective in improving the symptoms in patients with noninsulin-dependent diabetes mellitus, including improvement in walking distance, paresthesia, skin temperature, and subjective overall response. In nondiabetic patients, statistically significant differences in leg-ulcer healing were found between the treatment and placebo groups. Case reports illustrated healing times, which ranged from two weeks to six months. Pentoxifylline use in both insulin-dependent and noninsulin-dependent patients was assessed in clinical trials, with improvement of symptoms in both patient types.

Do clinical update on pentoxifylline therapy for diabetes-induced peripheral vascular disease?

This study evaluated the relation between body iron stores and coronary artery disease. It has been suggested that total body iron stores are an independent risk factor for acute myocardial infarction (AMI). Our study population consisted of 46,932 members of a prepaid health plan who were > or = 30 years old and who received a standard health check between 1969 and 1971. Blood collected during this examination was analyzed for serum iron and total iron-binding capacity. Transferrin saturation (TS), calculated as (serum iron/total iron-binding capacity) x 100, was categorized as low (< or = 10%), normal (11% to 61%), or elevated (> or = 62%). Hospital stays for AMI were identified from the health plan's computerized discharge records for its Northern California Region through December 31, 1991. Mean follow-up time was 14.1 years. During the follow-up period, 969 men and 871 women had an AMI-related hospital stay. Analysis of AMI-related hospital stays was performed overall and by sex. Age-adjusted incidence rates were obtained for each TS level, and proportional hazards regression models were used to assess the significance of TS as a risk factor for AMI, controlling for other known coronary disease risk factors. Our results did not show iron deficiency as defined by low TS to be protective against AMI. Subjects with increased iron stores indicated by TS > or = 62% had a relative risk for AMI of 1.3, which was not statistically significant.

Are iron stores associated with acute myocardial infarction?

Prolonged inhibition of diaphragmatic function occurs after thoracic and upper abdominal surgery. It was hypothesized that thoracic epidural anesthesia on the day after a thoracotomy could block inhibitory neural pathways and increase the shortening of costal and crural diaphragmatic segments. Pairs of sonomicrometer crystals were implanted into the costal and crural regions of the diaphragm through a right lateral thoracotomy in 14 30-kg, 4-5-month-old lambs. One day after surgery, a thoracic epidural catheter was placed at the T8-T9 level. Regional diaphragmatic shortening normalized to end-expiratory length (%LFRC), was measured by sonomicrometry in these awake lambs. Changes in gastric (delta Pgas), esophageal (delta Pes), and transdiaphragmatic (delta Pdi) pressures were measured with transnasal balloon catheters. End-tidal carbon dioxide (FETCO2), costal and crural electromyogram (Edi), and tidal volume (VT) were measured. Inductance plethysmography was used in four lambs to assess relative contributions of the rib cage and abdomen to VT. Control values were obtained during quiet breathing and while rebreathing at up to 10% FETCO2. To block thoracic dermatomes, 1% or 2% lidocaine was injected through the epidural catheter. Measurements were repeated after each lidocaine injection. There was no change of resting length with 1% lidocaine; costal resting length increased by 22% with 2% lidocaine. After 2% lidocaine, costal %LFRC increased from control both during quiet breathing (8.7 +/- 0.7 to 18.1 +/- 1, mean +/- SEM%) and at FETCO2 10% (22.1 +/- 2 to 33.7 +/- 3%). VT during quiet breathing was unchanged after 1% lidocaine but increased from 235 +/- 16 to 283 +/- 28 ml after 2% lidocaine. At 10% FETCO2, delta Pdi was unchanged after 1% lidocaine and decreased from 36.5 +/- 4.3 to 26.3 +/- 4.9 cmH2O after 2% lidocaine. Regional delta Edi was unchanged with both 1% and 2% lidocaine at rest and during carbon dioxide rebreathing. Plethysmography in three lambs showed a reduction in rib cage contribution to tidal volume with 2% lidocaine during quiet breathing.

Does thoracic epidural anesthesia increase diaphragmatic shortening after thoracotomy in the awake lamb?

Langerhans' cells (LC) in several tumors have been related to a better postoperative prognosis. We have performed the present study in order to verify this hypothesis for oesophageal squamous cell carcinoma (OSCC). A retrospective analysis of histologic preparations of OSCC was made. For the identification of LC, the deparaffinized sections were stained with anti S-100 protein antibody using the avidin-biotin-peroxidase complex (ABC) method. We assessed the presence of LC in the whole tumour, in the stroma and in the epithelium. We also analyzed their influence on postoperative survival and their relation to histologic differentiation, wall involvement, peritumoral lymphocytic infiltration and microscopic growth type. 35 patients who underwent standard esophagectomy for OSCC. None had received radiotherapy and none died from postoperative complications. LC were found in 88.6% of patients. In 31.4% only in the epithelium and 17.1% exclusively in the stroma. Mean cellular density was greater in epithelium (NS). A higher two-year survival was found in patients with a greater cellular density without statistical significance. More than 15 LC/mm2 were associated with infiltrative growth type tumors whereas less than 15 LC/mm2 were associated with infiltrative growth type ones (P < 0.01). No statistical significant correlations were found with other parameters.

Do [ Langerhans cells influence the postoperative survival of esophageal epidermoid carcinoma ]?

To compare the pregnancy outcomes during IVF-ET when different dosages of hMG are used after follicular phase suppression with leuprolide acetate (LA). Retrospective chart review. Hospital-based IVF-ET program. From January 1990 to December 1992, 264 cycles reached ET after LA downregulation and gonadotropin stimulation. Higher doses of gonadotropins, as measured by both average daily dose and total dose per cycle, were associated with lower clinical pregnancy rates. This effect was independent of age, basal FSH level, endometrial thickness, maximal E2 levels, number of eggs retrieved, and embryos transferred.

Are high dosages of gonadotropins associated with poor pregnancy outcomes after in vitro fertilization-embryo transfer?

To review our results with carotid endarterectomy using primary closure and to study the incidence of true recurrence in this group of patients. A secondary objective was to review the effect of risk factors on recurrence of stenosis following carotid endarterectomy. Cohort study. University hospital. Over 3 years, 232 patients underwent 268 endarterectomies. Transient ischemic attacks developed in 119 patients, asymptomatic stenosis in 108 patients, and stroke in 41 patients. One hundred fifty-seven patients (184 operations) qualified for late analysis by completing all aspects of follow-up. Serial duplex scans recorded stenosis (> 50% diameter reduction). Clinical evaluation identified transient ischemic attacks and stroke. Overall, 12 recurrent stenoses developed in the 184 patients available for study during a follow-up of 24 months (6.5% incidence of late stenosis). Of these 12 patients, only eight had either a normal completion angiogram or a normal carotid duplex scan within 3 months of surgery, thus qualifying for analysis as having developed true recurrent stenosis. True recurrent stenosis occurred in eight (4.3%) of 184 patients. Risk factor analysis did not reveal a statistically significant impact on recurrent stenosis, but several trends were identified. Gender and consumption of tobacco may predispose toward the development of recurrent stenosis.

Does carotid endarterectomy with primary closure adversely affect the rate of recurrent stenosis?

To determine whether the levels of serum myoglobin and the occurrence of fasciculations and postoperative symptoms following a single dose of succinylcholine are modified by the prior administration of midazolam. Randomized, double-blind, placebo-controlled study. Outpatient surgical service of a university hospital. 69 ASA physical status I and II healthy, adult female outpatients undergoing laparoscopy (for diagnosis or tubal ligation) with general anesthesia that included succinylcholine. Patients received pretreatment of either a saline placebo (Group 1, n = 31) or intravenous midazolam 0.03 mg/kg (Group 2, n = 38) 5 minutes before succinylcholine. Serum myoglobin prior to pretreatment and at 5 (t5) and 30 (t30) minutes after succinylcholine was determined by radioimmunoassay. Pain was assessed by telephone interview 24 to 36 hours postoperatively. Baseline myoglobin levels ranged from 14 to 69 ng/ml; the 5- and 30-minute samples varied widely (range, 16 to 900 ng/ml). The rise was 3 or more SDs above the baseline mean in 23% and 42% of Group 1 at t5 and t30, respectively, and in 21% and 35% of Group 2 at t5 and t30, respectively. The differences between groups were not significant. The frequency of fasciculations (77% in Group 1, 87% in Group 2), postoperative sore throat (64% in Group 1, 57% in Group 2), and myalgias (44% in Group 1, 51% in Group 2) also was not significantly different between groups.

Does midazolam pretreatment ameliorate myoglobinemia or the clinical side effects of succinylcholine?

Our purpose was to determine if there is a difference in outcome associated with choice of gonadotropin-releasing hormone analog in in vitro fertilization treatment cycles. A retrospective analysis of 510 consecutive in vitro fertilization cycles with patient-selected use of either nafarelin (Synarel) or leuprolide (Lupron) was performed. Of 510 consecutive patient cycles, 284 patients (56%) chose nafarelin and 226 (44%) chose leuprolide. In the nafarelin group 64 cycles (34% of retrievals) resulted in deliveries. In the leuprolide group 37 (24%) resulted in delivery (p < 0.05). There were 260 patients in their first cycle of treatment, with 157 (60%) choosing nafarelin, resulting in 33 deliveries (34% per retrieval). Leuprolide, used in 103 (40%) of first cycles, resulted in 12 deliveries (20% per retrieval), (p = 0.052).

Does the choice of a gonadotropin-releasing hormone analog influence outcome of in vitro fertilization treatment?

Active cigarette smoking has been established as a potent risk factor for carotid atherosclerosis in clinical populations; however, neither the role of active smoking in general populations nor the impact of environmental tobacco smoke has been well described. The association between carotid artery wall thickness and cigarette smoking was studied in 12,953 black and white men and women, aged 45 to 65 years, examined in the Atherosclerosis Risk in Communities Study. Participants were classified as current smokers (n = 3525), past smokers (n = 4315), never smokers reporting weekly exposure to environmental tobacco smoke (ETS or "passive smoking") of at least 1 hour (n = 3339), or never smokers reporting no weekly exposure to ETS (n = 1774). Carotid artery intimal-medial thickness (IMT) was measured by B-mode ultrasound. Increased IMT was observed in each category, in order from smallest to greatest increase: never smokers not exposed to ETS, never smokers exposed to ETS, past smokers, and current smokers. The larger IMT observed in the nonsmoking group exposed to ETS compared with the nonsmokers not exposed persisted after control for diet, physical activity, body mass index, alcohol intake, education, and major cardiovascular risk factors. Among past and current smokers, increased pack-years of exposure was associated with increased IMT. Among nonsmoking men exposed to ETS, there was a significant increase in IMT with increasing number of hours per week of ETS exposure.

Are active and passive smoking associated with increased carotid wall thickness . The Atherosclerosis Risk in Communities Study?

Previous studies indicate that spontaneously hypertensive rats (SHR) have an exaggerated renal vascular response to angiotensin II (Ang II). Inasmuch as angiotensin receptors are coupled to diverse signalling mechanisms via G-proteins, the purpose of this study was to determine whether the enhanced renal vascular response to Ang II in SHR is due to signalling pathways that involve Gi and/or Go. Age-matched SHR and normotensive Wistar-Kyoto rats were administered an intravenous injection of either pertussis toxin (10 micrograms/kg) or vehicle, and 6 days later were prepared for study. Renal vascular responses to Ang II were determined by infusing Ang II into the aorta just above the left renal artery while monitoring renal blood flow and arterial blood pressure. Inhibition of the bradycardic response to N6-cyclopentyladenosine (an adenosine A1 receptor agonist) verified that pertussis toxin interrupted Gi coupled pathways. Renovascular responses to Ang II were significantly greater (p = 0.0009) in vehicle-treated hypertensive rats when compared with vehicle-treated normotensive rats. Pertussis toxin significantly decreased renovascular responses to Ang II in both hypertensive (p < 0.0001) and normotensive (p = 0.0101) rats, but more so in hypertensive rats. In pertussis toxin-treated rats renovascular responses to Ang II were similar in hypertensive versus normotensive rats.

Does pertussis toxin normalize enhanced renovascular responses to angiotensin II in spontaneously hypertensive rats?

The effects of growth hormone (GH) on the luminal transport of amino acids and glucose by the human small intestine were investigated. The anabolic effect of growth hormone administration is associated with nitrogen retention and an increase muscle strength, but the impact of growth hormone on nutrient uptake from the gut lumen has not been examined. Twelve healthy patients received a daily subcutaneous dose of low-dose GH (0.1 mg/kg), high-dose GH (0.2 mg/kg), or no treatment (controls) for 3 days before surgery. At operation, ileum (8 patients) or jejunum (4 patients) was resected, and brush border membrane vesicles (BBMVs) were prepared by differential centrifugation. Vesicle purity was confirmed by a 16-fold enrichment of marker enzymes. The carrier-mediated transport of glutamine (System B), leucine (System L), alanine (System B), arginine (System y+), MeAIB (methyl alpha-aminoisobutyric acid [System A]), and glucose (Na(+)-dependent glucose transporter) by BBMVs was measured by a rapid mixing/filtration technique. Treatment with low-dose GH resulted in a statistically insignificant increase in amino acid transport rates in jejunal and ileal BBMVs. High-dose GH resulted in a generalized 20%-to 70%-stimulation of amino acid transport, whereas glucose transport was not affected. The effects of GH were similar in ileum and jejunum. Kinetic analysis of the transport of glutamine (the most abundant amino acid in the body and the principal gut fuel) and the essential amino acid leucine revealed that the increase in transport was caused by a 50% increase in carrier Vmax, consistent with an increase in the number of functional carriers in the brush border membrane. Pooled analysis of transport velocities demonstrated that total rates of amino acid uptake from the gut lumen were increased significantly by 35% in GH-treated patients.

Does growth hormone enhance amino acid uptake by the human small intestine?

Adolescents are increasingly at risk for infection with human immunodeficiency virus (HIV) and other sexually transmitted diseases, especially in poor urban minority communities. To aid the design of interventions in these communities, this study investigated the role of knowledge, attitudes, perceived parental monitoring, and peer behavior in the onset and progression of sexual behavior in children at risk for exposure to HIV. A computerized personal interview was administered to 300 African-American 9- to 15-year-old children living in six public housing developments in a large US city. Although children's knowledge about the hazards of sex increased with age, their sexual activity also increased (from 12% sexually experienced at 9 years of age to more than 80% experienced at 15 years of age). Parental monitoring appeared able to influence sexual activity. However, the perceived behavior of friends was associated with the rate at which sexual activity progressed with age and the degree to which condom use was maintained with age.

Does social influence on the sexual behavior of youth at risk for HIV exposure?

To determine the mechanisms for exercise impairment in symptomatic patients with systemic sclerosis (SSc) using breath-by-breath expired-gas analysis with incremental exercise testing. Prospective, open trial. Fifteen consecutive patients with SSc seen at the Medical University Hospital (a tertiary referral center) with complaints of exercise intolerance underwent pulmonary function testing (spirometry, helium dilution lung volumes, and diffusing capacity of carbon monoxide) and incremental exercise testing on a cycle ergometer measuring oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (R), oxygen saturation, blood pressure, and heart rate (HR). Values for oxygen uptake at anaerobic threshold (VO2AT) were derived graphically by blinded clinicians experienced in exercise testing, and the results were averaged. Ventilatory reserve and oxygen pulse were calculated from measured values, and all data were subjected to analysis by standard clinical algorithms. Of 15 patients studied, 14 had either restrictive lung disease or normal results of spirometry on pulmonary function testing. One patient with a history of tobacco use had evidence of airways obstruction. Three patients were unable to exercise maximally (as determined by maximum respiratory exchange ratio [Rmax] greater than 1.09 or maximum heart rate [HRmax] greater than 85% predicted), and exercise testing was terminated in one with Mobitz type II atrioventricular block. The following data (mean +/- SEM) were obtained from 11 maximally exercising patients: VO2max 795 +/- 75 mL oxygen (O2)/min, R 1.34 +/- 0.05, VO2AT/VO2max predicted 0.21 +/- 0.02, O2 pulse 5.1 +/- 0.4 mL O2/beat, ventilatory reserve 0.52 +/- 0.06, and tidal volume/forced vital capacity ratio 0.46 +/- 0.02. Of the 11 patients completing breath-by-breath expired-gas analysis, all had circulatory impairment to exercise, as determined by low O2 pulse and low VO2 at anaerobic threshold, and circulatory impairment was limiting in 9 of 11 patients. Of those nine patients, four had evidence of impaired gas exchange compatible with pulmonary vascular disease. Arterial oxygen desaturation occurred in 2 of 11 patients.

Does failure of the circulatory system limit exercise performance in patients with systemic sclerosis?

To evaluate the relationship of corpus callosum atrophy to cerebral cortical oxygen metabolism and cognitive function in patients with Alzheimer's disease. Prospective clinicoradiologic correlation with magnetic resonance imaging and positron emission tomography. A university hospital. Ten right-handed male patients with Alzheimer's disease, aged 46 to 70 years (mean +/- SD 57 +/- 6 years), and 14 age- and sex-matched right-handed control subjects. The midsagittal corpus callosum areas (on T1-weighted magnetic resonance images), cerebral metabolic rate of oxygen (measured with positron emission tomography using the oxygen-15 steady-state technique), and the IQs of the Wechsler Adult Intelligence Scale. Compared with control subjects, the patients had significantly decreased callosal areas with a posterior predominance of the degree of atrophy. The area of anterior and posterior halves of the corpus callosum had a significant correlation with the value of oxygen metabolism in the frontal and parietotemporo-occipital association cortices, respectively. The total area of the corpus callosum was significantly related to the total and verbal IQs of the Wechsler Adult Intelligence Scale.

Does callosal atrophy parallel decreased cortical oxygen metabolism and neuropsychological impairment in Alzheimer 's disease?

To determine the electroencephalographic (EEG) changes induced by mild hyperthermia during enflurane anesthesia and to test the reliability of two new infrared thermometers. Prospective laboratory evaluation. The Thermoregulation Research Laboratory at the University of California, San Francisco. 6 healthy female volunteers aged 30 +/- 8 years. Epidural anesthesia (approximately T10 dermatome) was induced and maintained using 2-chloroprocaine anesthesia. General anesthesia was induced by inhalation of nitrous oxide and enflurane and maintained with enflurane at an end-tidal concentration of 1.7%. A minimum of 2 degrees C core hyperthermia was induced by active cutaneous warming, and the volunteers subsequently were passively cooled. EEG data were recorded from gold cup electrodes positioned at FP1 and FP2, with the reference electrode at CZ and the ground lead on the mastoid. In addition to routine EEG parameters, we evaluated the bispectral index. Bispectral analysis quantifies the phase coupling between various frequencies in the power spectrum and may be a useful measure of anesthetic depth. Core temperature was measured at the left tympanic membrane and distal esophagus. Core temperature also was determined from the right ear using two new, infrared tympanic membrane thermometers. One of these directly measures tympanic temperature, and the other extrapolates core temperature from the external ear canal. Induction of 2 degrees C core hyperthermia did not produce statistically significant or clinically important changes in beta or delta power, the 95% spectral edge frequency, or the bispectral index. Temperatures recorded from the right ear by the direct thermometer were 0.27 degrees C +/- 0.33 degrees C less than those measured in the left ear, but the values correlated well (r2 = 0.95 +/- 0.04). Temperatures recorded from the right ear by the core temperature extrapolater were 0.42 degrees C +/- 0.33 degrees C lower than those measured in the left ear, and the correlation between values was slightly worse (r2 = 0.83 +/- 0.16).

Does mild core hyperthermia alter electroencephalographic responses during epidural-enflurane anesthesia in humans?

In a randomized study of hemiparetic stroke patients with a median age of 75 years, functional recovery was significantly better in those who received additional sensory stimulation (n = 38), including electrostimulation, than in control patients (n = 40) given the same physiotherapy and occupational therapy; group differences for balance, mobility, and activities of daily living were significant. The present study was designed to investigate postural control in patients who survived more than 2 years after stroke onset. The 48 survivors (mean, 2.7 years; range, 2.0 to 3.8 years), 22 from the treatment group and 26 from the control group, were compared with 23 age-matched healthy subjects. Subjects were perturbed by vibrators applied to calf muscles or with galvanic vestibular stimulation. We evaluated postural control in terms of sway variances or sway velocities and the dynamics of postural control as a feedback system using system identification with a model previously validated for human postural control. Significantly more patients of the treatment group than of the control group maintained stance during perturbations (P < .01). Among patients capable of maintaining stance during perturbation, the control patients were characterized by significant divergence from normal values in two of the three characteristic parameters of dynamic postural control (ie, swiftness and stiffness; P < .05) compared with the treatment subgroup or age-matched subjects.

Does sensory stimulation promote normalization of postural control after stroke?

The Ciba Corning 512 coagulation monitor (CC512) can be used to monitor heparin therapy by performing an activated partial thromboplastin time (APTT) at the patient's bedside. This study was designed to compare the CC512 results to results using the laboratory system. The relative sensitivities of both systems to the effect of oral anticoagulant therapy also was investigated. Activated partial thromboplastin times were performed with both the CC512 and laboratory system on 74 specimens from patients receiving i.v. heparin therapy, and on 14 specimens from patients on warfarin only. Heparin assays were performed on 43 of the specimens from the heparinized patients. When a patient was receiving heparin only, the APTT results of the CC512 proved to be similar to existing laboratory methods. The CC512 APTT results of patients on warfarin only were markedly prolonged, whereas the laboratory APTTs were only slightly affected.

Does the effect of oral anticoagulant therapy on APTT result from a bedside coagulation monitor?

Vasoactive intestinal polypeptide (VIP) has been suggested to be an inhibitory neurotransmitter in the sphincteric and nonsphincteric smooth muscles of the gut. However, the relative gene expression of VIP in these functionally diverse regions is not known. The gastrointestinal smooth muscle sphincters of opossums were excised from the adjoining nonsphincteric smooth muscles. RNAs were isolated and subjected to blot hybridizations with VIP complementary DNA probe. Relative expression of VIP gene was quantitated using the densitometric scanning of the VIP messenger RNA (mRNA) transcripts. The cellular specificity of VIP gene expression was investigated in cultures of neuroblastoma cells and myenteric plexuses and compared with those of the smooth muscle cells. The data showed higher levels of VIP mRNA in the sphincteric than the adjoining nonsphincteric tissues. VIP mRNA were found in significantly higher amounts in the myenteric neurons and neuroblastoma cells than in the smooth muscle cells.

Is vasoactive intestinal polypeptide gene expression characteristically higher in opossum gastrointestinal sphincters?

The purpose of this study was to determine the effectiveness of microwave balloon angioplasty in sealing arterial dissections and to characterize the histologic features associated with this intervention. Coronary dissection accompanying balloon dilation is frequently associated with abrupt closure and acute ischemic complications. Effective management of this complication remains an active area of investigation. Because thermal energy is effective in welding separated atherosclerotic plaques, a microwave-based catheter system that provides controlled local heating was utilized in vessels with angioplasty-induced dissections. Iliac artery dissections were induced in ahypercholesterolemic rabbit model. Vessels were randomly assigned to treatment with standard balloon angioplasty (control vessels) or microwave balloon angioplasty using an average temperature of 80 degrees C. The response of the artery was assessed angiographically and histologically. Angiographic success, defined as a reduction of dissection length by > 50% or the resolution of lumen haziness, was achieved in 63% of microwave-treated vessels and in 16% of control vessels (p < 0.005). Dissection length (mean +/- SD) was reduced 8.0 +/- 4.8 mm in microwave-treated vessels compared with 0.1 +/- 7.9 mm in vessels receiving standard balloon inflations (p < 0.005). Cellular necrosis was more commonly observed in microwave-treated vessels than in control vessels (73% vs. 17%, p < 0.05), but less intraluminal thrombus was seen in vessels exposed to microwave energy (p < 0.05).

Does microwave balloon angioplasty effectively seal arterial dissections in an atherosclerotic rabbit model?

To identify the characteristic MR findings in extrapyramidal cerebral palsy. Six patients who had suffered intrapartum asphyxia and who subsequently developed extrapyramidal cerebral palsy were identified. Asphyxia was evidenced by severe neonatal systemic acidosis as documented by a venous cord pH of less than 7.0 whenever available, or acidosis in subsequent arterial blood gas samples, and clinical signs of an acute hypoxic-ischemic encephalopathy during the neonatal period. In addition, 1- and 5-minute Apgar scores were 3 or less, and there had been need for intubation or vigorous resuscitation in the delivery room. There were three boys and three girls, all born at term, with birth weight appropriate for gestational age, and without a history of bilirubin levels above 15 mg/dL. MR imaging at 1.5 T was performed between 1 and 19 years of age. In all subjects focal high signal abnormality was demonstrated in the posterior putamen and the anterior or posterior thalamus. There were no other findings in most cases.

Does clinical and MR correlate in children with extrapyramidal cerebral palsy?

Little is known about the emotional impact of physician-initiated advance directive discussions. One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices of a discussion of health promotion issues. Prediscussion, immediate postdiscussion, and 1-week postdiscussion measures of positive and negative affect were measured for both groups. Neither discussion topic resulted in adverse emotional or attitudinal responses. Only the advance directive participants showed positive affective and attitudinal responses to the discussion, including an increase in positive affect, an increased sense of physician-patient understanding, and increased thought and discussion about life-support issues in the week following the discussion. For those participants receiving the advance directive discussion, longer physician-patient relationships and higher educational levels significantly predicted a more positive affective response. Lower scores on indices of mental and physical health and a stronger belief that physicians should discuss advance directive issues significantly predicted a more negative affective response to the advance directive discussion.

Do elderly outpatients respond favorably to a physician-initiated advance directive discussion?

To determine whether chronic calcium channel blocker therapy exaggerates the rise in plasma potassium concentration ([K+]) after succinylcholine administration. Prospective clinical study. University and Veterans Affairs hospitals. 36 ASA physical status III and IV male patients: 21 patients taking chronic calcium channel blockers and 15 patients not receiving calcium channel blockers, all of whom were scheduled for inpatient surgical procedures with general anesthesia. In all patients, anesthesia was induced with high-dose opioids plus a sedative-hypnotic, and intubation was facilitated with 1 to 1.5 mg/kg succinylcholine without nondepolarizing neuromuscular blocker pretreatment. Plasma [K+] was measured prior to induction and 1, 3, 5, 8, 11, and 15 minutes after succinylcholine was administered. A modest average peak rise of 0.5 mEq/L in plasma [K+] was observed, but there were no differences between patients who were or were not receiving calcium channel blockers.

Do calcium channel blockers enhance increases in plasma potassium after succinylcholine in humans?

To develop and apply an immunochemical approach to the study of drug-plasma protein conjugates derived from the anti-arthritic drug D-penicillamine (DP). An antiserum with specificity for protein-conjugated DP was raised in a rabbit. Plasma samples from patients receiving DP or from incubations of isolated normal plasma with DP were analysed for DP-derived conjugates by Western blotting using the anti-drug antibody. A single DP-positive protein band was detected in plasma samples from 15/16 patients with rheumatoid arthritis receiving DP but in none of 20 patients of similar disease status who had not taken DP. The positive band appeared in patients' plasma during the course of treatment with DP. It was seen under nonreducing but not reducing conditions indicating that the drug is disulphide linked to the protein. The drug-modified protein migrated to a position intermediate between the trailing edge of albumin and the leading edge of transferrin (both non-reduced) suggesting a molecular weight of between 66 and 77 kDa. Incubations of normal human plasma, but not purified albumin or transferrin, with low concentrations of DP generated the same distinct band plus several less intense DP-positive bands.

Does a western blot approach to detection of human plasma protein conjugate derived from D-penicillamine?

The principal objective of this study was to determine whether a relationship exists between trough cyclosporine concentrations measured by HPLC and the development of acute graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation. A retrospective analysis of 59 consecutive human leukocyte antigen-matched bone marrow transplants. Patients received uniform GVHD prophylaxis with cyclosporine and methotrexate. Whole blood trough cyclosporine concentrations were measured at least twice weekly during hospitalization and weekly after discharge. A dedicated bone marrow transplant unit in an academic center. The means of cyclosporine concentrations were assessed for each patient on a weekly basis during the first 50 days after transplant. These means were compared between patients developing grade 2-4 acute GVHD and patients without significant GVHD. Eighteen patients developed acute GVHD at a median of 25 days after bone marrow transplant (range 10-50). There was no correlation between the development of GVHD and patient age, diagnosis, donor age, donor gender, donor-recipient gender mismatch, and time to neutrophil engraftment (> 1000 x 10(6) cells/L). Although mean weekly cyclosporine concentrations were consistently lower in patients developing acute GVHD, the difference in values compared with those of patients with GVHD was not statistically significant. Mean weekly cyclosporine concentrations at the time of neutrophil engraftment were statistically associated with the development of GVHD. Patients with GVHD had mean +/- SD concentrations of 174 +/- 69 ng/mL, significantly lower than 254 +/- 114 ng/mL in patients without GVHD. Furthermore, the rate of GVHD was 82 percent in patients with mean concentrations < 200 ng/mL at the time of neutrophil engraftment as compared with a rate of 34 percent in patients with concentrations > or = 200 ng/mL (relative risk = 2.4). Also, mean cyclosporine concentrations measured during the week of onset of GVHD were significantly lower compared with mean cyclosporine concentrations of all other patients at risk of GVHD during that week.

Does cyclosporine monitoring improve graft-versus-host disease prophylaxis after bone marrow transplantation?

This prospective clinical trial was designed to assess the ability of the mammary stimulation test to predict preterm birth in a private nulliparous population. The mammary stimulation test was performed between 26 and 28 weeks' gestation by 267 nulliparous women with singleton pregnancies. Test results were blinded to both patient and referring physician. Pregnancy outcome data were collected from the perinatal database and medical records. The mammary stimulation test was positive in 45 of 266 (17%) patients. Delivery occurred at < 37 weeks in 27 patients (10.2%) and at < 34 weeks in five (1.9%). The mammary stimulation test demonstrated a sensitivity of 37%, a specificity of 84%, a positive predictive value of 20%, and a negative predictive value of 92% for delivery at < 37 weeks' gestation. For delivery at < 34 weeks' gestation the mammary stimulation test had a sensitivity of 60%, a specificity of 82%, a positive predictive value of 6%, and a negative predictive value 99%. The odds ratio for delivery at < 37 weeks was 3.0 (95% confidence interval 1.3, 7.1), and for delivery at < 34 weeks the odds ratio was 7.0 (95% confidence interval 1.1, 43.0). One third of preterm deliveries were secondary to idiopathic preterm labor, and the mammary stimulation test was positive in 77.8% (seven of nine) of these pregnancies. Patients with a positive test were more likely to require observation in labor and delivery for preterm uterine contractions (34% vs 4.3%, p < 0.01), and they were more likely to demonstrate change at cervical examination (14% vs 2%, p < 0.01).

Does mammary stimulation test predict preterm birth in nulliparous women?

The effect of chronic pancreatitis and insulin on the expression of the hepatic facilitative glucose transporter protein (GLUT-2) was determined in rats. Chronic pancreatitis is associated with diabetes mellitus or impaired glucose tolerance. Suppression of hepatic glucose production (HGP) by insulin is impaired, although the mechanism is unknown. Normal rats, rats with chronic pancreatitis induced 12 to 16 weeks earlier by oleic acid injection into the pancreatic ducts, and sham-operated rats were studied. Isolated, single-pass liver perfusion was performed, during which glucagon (1.2 pM) was infused, with or without insulin (0.6 or 1.2 nM). The suppression of HGP production by insulin was compared with changes in GLUT-2 in the membrane fraction of liver biopsies obtained before and after hormone perfusion. Glycogen-rich (fed) livers of normal rats (n = 16) demonstrated a dose-dependent suppression of hepatic glucose production by insulin (50 +/- 5% HGP induced by glucagon alone during 1.2-nM insulin perfusion) and a dose-dependent decrease in GLUT-2 (30 +/- 13% of basal level during 1.2-nM insulin perfusion). Sham-operated rats (n = 6) also showed reductions in HGP (51 +/- 4%) and GLUT-2 (14 +/- 10%) during 1.2-nM insulin perfusion. In contrast, rats with chronic pancreatitis (n = 6) showed no suppression of HGP during 1.2-nM insulin perfusion, and an increase in GLUT-2 (+20 +/- 6%) after insulin perfusion (p < 0.02 vs. sham).

Is insulin regulation of hepatic glucose transporter protein impaired in chronic pancreatitis?

Recent studies of piglet cryptosporidiosis showed an injury-induced impairment of sodium-glucose cotransport and a prostaglandin-mediated inhibition of neutral NaCl absorption. Because glutamine has been shown to stimulate both neutral and electrogenic Na+ absorption, this study examined the mechanism of prostaglandin-mediated inhibition of NaCl absorption and the effect of glutamine on these processes. Ileal mucosa from control and infected pigs was mounted in Ussing chambers for flux studies or incubated with [14C]glutamine or [14C]-glucose for metabolism studies. Glucose and glutamine induced equivalent increases, 2-2.5 microEq.cm-2.h-1, in Na+ absorption and short-circuit current in control ileum. Despite a reduction in villous surface area to one third of the control, glutamine enhanced both neutral and electrogenic Na+ absorption in the infected ileum by 3.5 +/- 0.5 microEq.cm-2.h-1, whereas glucose was only half as effective (P < 0.05). In addition, glutamine was oxidized to CO2 at rates three times those of glucose. Indomethacin enhanced, whereas amiloride, prostaglandin E2, and Cl-free solutions inhibited the glutamine-induced neutral Na+ transport.

Does glutamine stimulate prostaglandin-sensitive Na ( + ) -H+ exchange in experimental porcine cryptosporidiosis?

To determine CO and gastric mucosal perfusion in patients during elective major surgery; to seek a relationship with subsequent outcome. Prospective descriptive study. University hospital. 51 patients undergoing elective major surgery of an anticipated duration of greater than 2 h who were at risk of developing gut mucosal hypoperfusion and postoperative organ failure. CO was determined by oesophageal Doppler measurement of aortic blood flow. Gastric mucosal perfusion was determined by tonometric assessment of gastric mucosal pH (pHi). Blood pressure and urine flow were measured. At the end of surgery no patients were oliguric or hypotensive. Post-operatively morbidity, mortality, duration and cost of stay in the ITU and hospital were assessed. There were 32 patients with evidence of gastric mucosal ischaemia at the end of surgery (pHi < 7.32) despite maintenance of CO. This group of patients spent a mean of 4.7 (range 0-33) days in the ITU, 14 developed major complications (7 with multiple organ failure [MOF] and 6 died. In 19 patients gut mucosal perfusion was maintained during surgery (pHi > or = 7.32); these patients demonstrated an increase in CO of 48.4% (95% confidence interval 21.3 -75.6) and spent a mean of 1.0 (range 0-4) days in the ITU. Only one developed a major complication and none died. The total cost of post-operative care for the 51 patients was estimated at pounds 356650. Mean cost per patient in the low pHi group was significantly greater at pounds 8845 (range pounds 600--pounds 42,700) compared to pounds 3874 (range pounds 2,600--pounds 9,600) in the normal pHi group. The total.cost of post-operative care for the 7 patients who developed MOF was pounds 171,450 i.e. 48% of the total cost.

Is intra-operative gut mucosal hypoperfusion associated with increased post-operative complications and cost?

Frequent allelic deletion affecting the mutated in colon cancer/adenomatous polyposis coli (MCC/APC) and p53 tumor suppressor gene loci has been reported in human cancers. However, simultaneous correlative analyses of these two abnormalities or their timing in gastric tumorigenesis have not been performed. To ascertain the relation between and timing of allelic deletions of MCC/APC and p53 in gastric carcinogenesis, 52 matched sets of normal tissue, gastric carcinoma, and adjacent gastric dysplasia were evaluated. Allelic deletion was seen in 33% of informative cancers at MCC, in 34% at APC, and in 64% at p53. Losses involving MCC correlated exactly with those affecting APC. Limited mutational analysis failed to reveal point mutations in selected exons of MCC. The frequencies of allelic losses at the two loci did not differ significantly among histological types. There was no allelic loss in gastric dysplasia. Interestingly, allelic deletion at MCC/APC was never detected in tumors negative for allelic deletion of p53.

Are allelic deletions of MCC/APC and p53 frequent late events in human gastric carcinogenesis?

The molecular mechanism of propofol anesthesia has been related to facilitation of the inhibitory neurotransmission mediated by gamma-aminobutyric acid (GABA). In the current study, the authors examined the direct actions of propofol on the acutely dissociated mammalian central neurons. Hippocampal pyramidal neurons were dissociated after enzymatic treatment of the brain slices of the rat. Single neurons were voltage-clamped using the whole cell configuration of the patch clamp technique, and drugs were applied with a rapid drug-application system. In the pyramidal neurons voltage-clamped at -60 mV, propofol evoked a transmembrane inward current, which desensitized at high concentrations of the anesthetic. The peak amplitude of the current increased sigmoidally with increasing doses of propofol applied. A least-squares fitting gave a dissociation constant of 1.2 x 10(-5) M and a Hill coefficient of 1.8, thereby indicating that clinical concentrations of propofol evoke the current, and that the anesthetic cooperatively activates the channel. The threshold concentration was less than 10(-6) M. The reversal potential for the current shifted according to the chloride equilibrium potential predicted by the Nernst equation, indicating that the current was carried by chloride ions. Bicuculline and strychnine suppressed the current in a concentration-dependent manner, in which the former was almost 40-fold more potent than the latter. The propofol-induced current cross-desensitized with the GABA-induced current, but no such interaction was observed with the glycine-induced current. Ro15-1788 (10(-6) M), an allosteric benzodiazepine antagonist, had no effect on the response. Diazepam (10(-6) M) enhanced the propofol-induced current, but pentobarbital (10(-6) M and 3 x 10(-5) M) did not affect the current.

Does propofol activate GABAA receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat?

By understanding the signal transduction pathways through which a cell responds to changes in environmental oxygen levels, we may be able to therapeutically exploit this response by manipulating these pathways. The human adenocarcinoma cell line A549 was exposed to varying durations of hypoxia alone and then plated for survival, or treated with PKC activating agents for 1 h before plating for survival. Western blots were used to determine the kinetics of PKC epsilon and phospholipase C induction. The level of hypoxic killing was directly related to the time of exposure and inversely related to the level of oxygen in the environment. Exposure of the cells to protein kinase C (PKC) activators for 1 h after chronic hypoxic exposure increased cell killing by at least an additional three logs beyond that found for hypoxia alone. Treatment of cells with an inactive phorbol ester 4 alpha-phorbol-12,13-didecanoate (PDA) resulted in no increase in hypoxic cell killing, even at the highest concentrations of PDA which produced no detectable toxicity under normal aerobic conditions. Using inhibitors of phospholipases A2 and C, we were able to completely inhibit the additional hypoxic cell killing induced by TPA, but not the uninduced hypoxic cell killing.

Do activators of protein kinase C selectively mediate cellular cytotoxicity to hypoxic cells and not aerobic cells?

This study evaluated the efficacy of local administration of an antithrombin agent with a hydrogel-coated percutaneous transluminal coronary angioplasty balloon catheter. Intravenous infusion of antithrombin compounds has been shown to inhibit platelet-dependent thrombosis. However, hemorrhage is a common side effect associated with the systemic administration of antithrombin compounds. The potent, irreversible thrombin inhibitor D-Phe-L-Pro-L-Arginyl chloromethyl ketone (PPACK) was used to inhibit thrombus formation in chronic porcine arteriovenous shunts. Platelet deposition was quantitated with gamma camera imaging of 111In-labeled platelets. Intravenous administration of PPACK in swine, in doses sufficient to maximally inhibit thrombus formation, was associated with prolongation of bleeding parameters. The inhibition of thrombosis associated with intravenous PPACK was dose related. The amount of intravenous PPACK necessary for maximal inhibition of thrombus formation for a period of 45 min was 16.9 mg. In contrast, local delivery of PPACK with a hydrogel-coated angioplasty balloon deployed at the site of the thrombus inhibited platelet deposition for at least 45 min after the balloon was removed. Using 3H-labeled PPACK, the calculated amount of PPACK delivered was 33.5 micrograms. There was no change in bleeding time or activated partial thromboplastin time when swine received an intravenous bolus greater than the total amount of PPACK adsorbed onto the balloon (70 micrograms).

Does local delivery of a synthetic antithrombin with a hydrogel-coated angioplasty balloon catheter inhibit platelet-dependent thrombosis?

Controversy exists as to whether patients with subclinical hypothyroidism benefit from treatment. Two randomized trials reported that hypothyroid symptoms improved following thyroid hormone replacement therapy. However, during the initial treatment of overt hypothyroidism with levothyroxine, three studies have demonstrated short-term (6 to 12 months) 5% to 13% reductions in bone density. The current study measures bone density during the initial treatment of subclinical hypothyroidism. Seventeen postmenopausal women with subclinical hypothyroidism (elevated serum thyrotropin [TSH] and normal serum free thyroxine concentrations) and no prior history of thyroid disease were randomly assigned to levothyroxine treatment or no treatment and followed prospectively. Patients in the treatment group had similar initial serum TSH concentrations (9.8 +/- 3.3 versus 8.4 +/- 2.7 microU/mL) but were slightly older (68 +/- 7 years versus 60 +/- 5 years [p < 0.02]). The average dose of levothyroxine needed to normalize serum TSH concentration was 0.072 +/- 0.027 mg. Bone density determinations were not significantly different between the two groups at baseline. After 14 +/- 1 months, single-photon absorptiometry of the wrist decreased by 1.8% +/- 3.2% in the untreated patients and 0.5% +/- 4.1% in the levothyroxine-treated patients (p = NS). Dual-energy X-ray absorptiometry of the lumbar spine decreased by 0.7% +/- 2.9% in the untreated patients and rose 0.1% +/- 4.75% in the levothyroxine-treated patients (p = NS).

Is bone density reduced during the short-term administration of levothyroxine to postmenopausal women with subclinical hypothyroidism : a randomized , prospective study?

Familial defective apolipoprotein B-100 is caused by a substitution of adenine for guanine in exon 26 of the gene coding for apolipoprotein B, which results in the substitution of glutamine for arginine in the putative low-density lipoprotein-receptor binding domain of the mature protein. This amino acid substitution diminishes the binding capacity of the low-density lipoprotein particle for the low-density lipoprotein receptor, which in turn leads to an increase in levels of plasma total and low-density lipoprotein cholesterol. To identify carriers of this mutation by means of molecular biology techniques in a large cohort of Dutch patients living in the Netherlands and in Canada with primary hypercholesterolemia, to establish the frequency of the disorder, and to investigate its clinical signs and symptoms and the response to cholesterol-lowering therapy. A total of 1248 patients were screened, and the mutation was found in 18 patients who were initially all diagnosed as having familial hypercholesterolemia. Ten of 18 patients had tendon xanthomas or an arcus cornealis or both, and eight of 18 patients had angina or other evidence of coronary artery disease.

Is familial defective apolipoprotein B-100 clinically indistinguishable from familial hypercholesterolemia?

To evaluate the possible beneficial effect of pentoxifylline (PTX) on both the decrease of toxicity related to bone marrow transplantation (BMT) and the acceleration of the hematopoietic graft. Twenty consecutive patients treated with BMT received pentoxifylline (400 mg/6 hours, orally) up to day +50 to prevent toxicity derived from BMT. A previous group of 29 consecutive patients transplanted in the same center were used as controls. The different clinical toxicities (mucositis, kidney failure, hepatic venocclusive disease, graft versus host disease, number of days with fever, day of hospital discharge and survival at day +50), the time elapsed until the hematopoietic graft and the levels of tumoral necrosis factor alpha were evaluated. No significant differences were observed in any of the parameters studied in the two groups of patients.

Is [ Pentoxifylline useful in the prevention of toxicity associated with bone marrow transplantation ]?

We investigated whether the selective brain cholecystokinin (CCKB) receptor antagonist, L-365,260, could antagonize the panicogenic effects of CCK-tetrapeptide (CCK-4) in patients with panic disorder. The study employed a double-blind, placebo-controlled, two-period crossover design. Patients (N = 29) received a single oral dose of L-365,260 (10 or 50 mg) or placebo 90 minutes prior to injection of CCK-4. After a 1-week washout period, patients received a different dose of L-365,260 or placebo according to a balanced incomplete block design. The 50-mg dose of L-365,260 was superior to placebo in reducing the number (P < .01) and sum intensity (P < .001) of symptoms induced with CCK-4. Panic attack frequency following CCK-4 injection was 88% for patients receiving placebo, 33% for those receiving the 10-mg dose, and 0% for those receiving the 50-mg dose. The difference between the effects of the 50-mg dose and placebo was statistically significant (P = .002). Increases in heart rate following CCK-4 injection were markedly reduced with both the 50-mg (P < .0001) and 10-mg (P < .01) doses compared with placebo.

Are the panicogenic effects of cholecystokinin-tetrapeptide antagonized by L-365,260 , a central cholecystokinin receptor antagonist , in patients with panic disorder?

This study aimed to determine if cholesterol-lowering therapy improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. Nine patients with hypercholesterolemia were studied before and after cholesterol-lowering therapy with pravastatin (an inhibitor of HMG-CoA reductase) for 6 +/- 3 months, which lowered serum cholesterol from 272 +/- 8 to 187 +/- 16 mg/dL (P < .01). Control patients with serum cholesterol of 218 +/- 23 mg/dL also were studied twice in a similar interval (8 +/- 2 months) with no cholesterol-lowering drugs. Acetylcholine (the endothelium-dependent vasodilator) and papaverine and nitrate (endothelium-independent vasodilators) were infused into the study coronary artery. Changes in the diameter of the epicardial coronary artery and coronary blood flow were assessed by quantitative coronary arteriography and an intracoronary Doppler catheter. In patients with hypercholesterolemia, acetylcholine-induced vasoconstriction of the epicardial artery was less (P < .05) and the acetylcholine-induced increases in coronary blood flow were greater (P < .001) after than before pravastatin. In control patients, responses of the epicardial coronary artery and coronary blood flow to acetylcholine did not change over the follow-up period. The vasomotor responses to papaverine or nitrate were similar between the two groups, and no interval changes in their responses were noted in either group.

Does reduction in serum cholesterol with pravastatin improve endothelium-dependent coronary vasomotion in patients with hypercholesterolemia?

The authors investigated the effects of exogenous growth hormone (GH) on protein accretion and the composition of weight gain in a group of stable, nutritionally compromised postoperative patients receiving standard hypercaloric nutritional therapy. A significant loss of body protein impairs normal physiologic functions and is associated with increased postoperative complications and prolonged hospitalization. Previous studies have demonstrated that standard methods of nutritional support enhance the deposition of fat and extracellular water but are ineffective in repleting body protein. Fourteen patients requiring long-term nutritional support for severe gastrointestinal dysfunction received standard nutritional therapy (STD) providing approximately 50 kcal/kg/day and 2 g of protein/kg/day during an initial 7-day equilibrium period. The patients then continued on STD (n = 4) or, in addition, received GH 0.14 mg/kg/day (n = 10). On day 7 of the equilibrium period and again after 3 weeks of treatment, the components of body weight were determined; these included body fat, mineral content, lean (nonfat and nonmineral-containing tissue) mass, total body water, extracellular water (ECW), and body protein. Daily and cumulative nutrient balance and substrate oxidation studies determined the distribution, efficiency, and utilization of calories for protein, fat, and carbohydrate deposition. The GH-treated patients gained minimal body fat but had significantly more lean mass (4.311 +/- 0.6 kg vs. 1.988 +/- 0.2 kg, p < or = 0.03) and more protein (1.417 +/- 0.3 kg vs. 0.086 +/- 0.1 kg, p < or = 0.03) than did the STD-treated patients. The increase in lean mass was not associated with an inappropriate expansion of ECW. In contrast, patients receiving STD therapy tended to deposit a greater proportion of body weight as ECW and significantly more fat than did GH-treated patients (1.004 +/- 0.3 kg vs. 0.129 +/- 0.2 kg, p < 0.05). GH administration altered substrate oxidation (respiratory quotient = 0.94 +/- 0.02 GH vs. 1.17 +/- 0.05 STD, p < or = 0.0002) and the use of available energy, resulting in a 66% increase in the efficiency of protein deposition (13.37 +/- 0.8 g/1000 kcal vs. 8.04 g +/- 3.06 g/1000 kcal, p < or = 0.04).

Does anabolic therapy with growth hormone accelerate protein gain in surgical patients requiring nutritional rehabilitation?

The competitive N-methyl-D-aspartate antagonist MDL-100,453 was used to determine whether a neuroprotective effect is demonstrable when the drug is administered beginning 30 minutes after the initiation of focal ischemia and whether the effect is related to blood levels of the drug. Forty-eight Sprague-Dawley rats were randomly assigned to one of four intravenous treatment categories: a bolus of 100 mg/kg MDL-100,453 followed by a saline infusion for 24 hours, isotonic saline as a bolus and 100 mg/kg per 24 hours of MDL-100,453 as an infusion over 24 hours, active drug in the bolus and 24-hour infusion, and control treatment of an isotonic saline bolus and infusion. Focal cerebral ischemia was induced by the intraluminal suture, middle cerebral artery occlusion method. The drug infusion was accomplished by an osmotic minipump implanted under the skin and attached to the jugular vein, which delivered drug or vehicle over a period of 24 hours. Infarct volume was calculated using 2,3,5-triphenyltetrazolium chloride staining after 24 hours of middle cerebral artery occlusion. Infarct volume of animals that received the MDL-100,453 bolus injection followed by MDL-100,453 infusion was significantly smaller than that of controls (P < .01). A significant effect of infusion on the reduction of extent of infarct size was also demonstrated (P = .015). Moreover, a statistically significant inverse correlation was demonstrated between the infarct volume and blood levels of MDL-100,453 at 60 minutes and 120 minutes after injection (r = -.33 and r = -.49, respectively).

Does the competitive NMDA antagonist MDL-100,453 reduce infarct size after experimental stroke?

We compared the current antithrombotic strategy of antiplatelet therapy with aspirin, and anticoagulant therapy with heparin, with a specific genetically engineered chimeric antibody (c7E3 Fab) directed against the human glycoprotein IIb/IIIa receptor in an animal model of arterial thrombosis. Anesthetized cynomolgus monkeys (Macaca fascicularis) were instrumented for monitoring of arterial blood pressure, heart rate, and carotid artery flow velocity. Animals were treated with saline (n = 6), aspirin (25 mg PO daily for 3 days; n = 6), heparin (100 U/kg i.v. plus infusion adjusted to maintain activated partial thromboplastin time at 2 to 3 times baseline; n = 6), aspirin plus heparin (as administered separately, n = 6), or c7E3 Fab (0.10 mg/kg i.v., n = 7; 0.15 mg/kg i.v., n = 6; 0.20 mg/kg i.v., n = 6; 0.25 mg/kg i.v., n = 6). Thrombus formation via anodal electrolytic stimulation (100 microA) to the intimal surface of the right carotid artery was initiated 15 minutes after drug administration and continued for 180 minutes. Electrolytic injury to the left carotid artery began 210 minutes after drug administration and continued for 180 minutes. Whole blood cell counts, glycoprotein IIb/IIIa receptor blockade, ex vivo platelet aggregation, template bleeding time, and activated partial thromboplastin time were assessed at various time points throughout the experimental protocol. Hemodynamic and hematologic parameters were comparable among groups at baseline. Treatment with c7E3 Fab inhibited ex vivo platelet aggregation, increased bleeding time, decreased thrombus weight, and increased time to occlusion in a dose-dependent manner in both vessels. Treatment with aspirin, heparin, or the combination of aspirin plus heparin was ineffective for the prevention of carotid artery thrombosis in this model.

Does chimeric 7E3 prevent carotid artery thrombosis in cynomolgus monkeys?

Redundant internal carotid arteries have been considered a risk factor in tonsillectomy, adenoidectomy, and surgical treatment of peritonsillar abscess and also a potentially treatable cause of stroke. However, an association between internal carotid artery redundancy and spontaneous dissection has not yet been clearly demonstrated. We reviewed, for spontaneous carotid artery dissection, records of all patients admitted to our institution during the period from 1986 through 1992 with the diagnosis of stroke or transient ischemic attack. We also reviewed 108 percutaneous cerebral arteriograms performed between September 1992 and December 1992 for presence of carotid artery redundancies. Thirteen patients exhibited spontaneous dissection. Of these, 8 of 13 (62%) patients and 13 of 20 (65%) internal carotid arteries, viewed to the siphon, had significant redundancies, kinks, coils, or loops. Of 108 consecutive arteriograms of patients without dissection, in which 187 internal carotid arteries were viewed to the siphon, there were 20 (19%) patients and 22 (12%) of 187 vessels with significant redundancy. Five patients in the dissection group and 2 in the nondissection group had bilateral internal carotid artery redundancy (P = .0019 and P = .0001, respectively).

Is internal carotid artery redundancy significantly associated with dissection?

Phosphatidylcholine (PC)-phospholipase D (PLD) is an important intracellular signaling pathway in response to a variety of agonists, but little is known about the effects of brain ischemia on the PC-PLD system. We thus have examined the effects of global cerebral ischemia on PLD in rats. We have examined the effects of global ischemia (decapitation or four-vessel occlusion) on PLD and PLC activity in the membrane fraction of rat brains. We measured the PLD and PLC activity in detergent-mixed micelle assay systems using 3H-labeled exogenous substrate. The results demonstrate that basal PLD activity showed a gradual decrease with increased duration (5 to 30 minutes) of ischemia by decapitation in the hippocampus; after 30 minutes of ischemia, PLD activity was significantly decreased compared with the control. Lineweaver-Burk plots showed that the apparent Vmax value of PLD in ischemia was one half of that in the control without changes in Km value. Ischemia by decapitation significantly decreased PLD activity in the brain stem as well as the hippocampus, whereas in four-vessel occlusion study, ischemia significantly decreased PLD activity in the hippocampus but not in the brain stem. Lowered temperature (30 degrees C and 22 degrees C) during ischemic incubation did not reverse the ischemia-induced PLD activity decrease. In contrast to PLD, ischemia by decapitation had no effect on basal phosphatidylinositol-phospholipase C activity or the amount of phospholipase C beta 1 in the membrane fractions from 30-minute ischemic hippocampus by immunoblots probed with the antibody.

Does brain ischemia decrease phosphatidylcholine-phospholipase D but not phosphatidylinositol-phospholipase C in rats?

Sudden death (SD) and acute myocardial infarction (AMI) are the main complications limiting long-term survival after heart transplantation (HT). They are unpredictable and, at present, unpreventable. Platelet aggregation (PA) has recently emerged as a significant prognostic indicator in nontransplanted coronary disease patients. The main purpose of the present study was to evaluate to what extent PA could predict SD and AMI in long-term survivors of HT independently of serum lipid levels. We studied 207 patients. All received triple immunosuppressive therapy. During follow-up, the incidence of SD and AMI was determined, and the independent role of PA as predictor was evaluated with other usual risk factors by a Cox multivariate regression model. There were 11 SDs and 14 AMIs after an average follow-up of 642 days, giving an average incidence rate of 7.3 events per year per hundred patients. By univariate analysis, the most potent predictors were ADP-induced platelet aggregation (positive association) and total cholesterol (negative association). Age and length of time since transplant were not predictors. By multivariate analysis, only the secondary wave of ADP-induced platelet aggregation (P = .001) and high-density lipoprotein cholesterol (P = .03) were independent predictors. The relative risk of SD or AMI based on a comparison between patients with high (> 36%) or low (< 36%) ADP-induced platelet aggregation was 4.3 (95% confidence interval, 1.9 to 9.5, P = .0001).

Are platelet aggregation and HDL cholesterol predictive of acute coronary events in heart transplant recipients?

To evaluate the effects of different frequencies of auricular (ear-to-ear) sine-wave transcutaneous electrical nerve stimulation (TENS), administered at subliminal intensity, on trigeminal nerve sensitivity. In a double-blind protocol, healthy volunteer subjects were administered one of three different frequencies of active TENS (5, 100, or 2,000 Hz) or placebo TENS (no current was passed) for 30 min. Department of Psychology, City University of New York. 72 healthy undergraduate volunteers with no preexisting pain problems (16 men and 56 women), from the Department of Psychology, City University of New York. Pretreatment to posttreatment changes were measured in sensation threshold for a 250-Hz electrical stimulus applied transcutaneously to an area 1 cm anterior to the tragus of the ear (mandibular division of the trigeminal nerve). Analysis of variance indicated no group differences in baseline trigeminal sensation threshold, but there were significant group differences in pretreatment to posttreatment changes in sensation threshold (p < 0.001). A postiori analysis showed significant increases in trigeminal sensation threshold after active TENS as compared to placebo TENS (p < 0.05), with 5- and 100-Hz TENS producing significantly greater hypesthesia than 2,000-Hz TENS (p < 0.05).

Does sine-wave auricular TENS produce frequency-dependent hypesthesia in the trigeminal nerve?

To investigate the relation between hourly fetal urine production rate (HFUPR) and behavioural states 1F and 2F (corresponding to quiet and active sleep, respectively) in normal near term fetuses. An observational study. A clinic for antenatal care at a university hospital. Nineteen healthy pregnant women examined at 37 to 40 weeks of gestation. Fetal behavioural states (1F and 2F) were assessed by means of fetal heart rate patterns (FHR A and FHR B). Using real time ultrasonography, HFUPR (ml/h) was estimated during behavioural states 1F and 2F. During behavioural state 1F, HFUPR was significantly higher than during state 2F (P < 0.01). HFUPR falls by 47% from 50.8 +/- 24.4 ml/h in state 1F to 25.7 +/- 15.0 ml/h in state 2F.

Is urine production rate related to behavioural states in the near term human fetus?

This study set out to show how well samples from general practice registers compare with census data, to describe those characteristics of the population and of the register that influence the response to postal surveys, and to demonstrate how general practice records can be used to assess non-response bias. The data for this study were obtained from a large postal survey about low back pain among the general adult population aged 20-59 years in eight areas of the United Kingdom, using general practice age-sex registers as the sampling frame. The overall response rate was 59%. In the areas chosen, general practice registers yielded samples of size and age-sex composition close to that predicted from national census data. Responses were more likely to be obtained from women, from older age groups and from practices where the sample lists had been inspected for errors. The use of computerized registers and a letter of recommendation from the general practitioner had no effect on the response rate. Inspection of the general practice records of subsamples of respondents and non-respondents to determine consultation rates suggested that there was little response bias in respect of the subject of the survey.

Does evaluation of the use of general practice age-sex register in epidemiological research?

There is increasing recognition of myocardial angiotensin-converting enzyme, which is induced with the development of left ventricular hypertrophy (LVH). The potential physiological significance of subsequent increased angiotensin I to II conversion in the presence of LVH is unclear but has been postulated to cause abnormal Ca2+ handling and secondary diastolic dysfunction. Accordingly, we hypothesized that acute angiotensin-converting enzyme inhibition would result in decreased production of angiotensin II and improved active (Ca(2+)-dependent) relaxation in patients with hypertensive LVH. Intracoronary (IC) enalaprilat was administered to 25 patients with and without LVH secondary to essential hypertension. Indexes of diastolic and systolic LV function were determined from pressure (micromanometer)-volume (conductance) analysis at steady state and with occlusion of the inferior vena cava. Patients were divided into those receiving high- (5.0 mg, n = 15) and low-dose (1.5 mg, n = 10) IC enalaprilat during a 30-minute infusion at 1 mL/min. The high-dose patients were further divided along the median normalized LV wall thickness of 0.671 cm/m2. The time constant of isovolumic relaxation (TauL) was prolonged at baseline in patients receiving high-dose enalaprilat with wall thickness > 0.671 cm/m2 (TauL, 56 +/- 2 versus 44 +/- 2 and 45 +/- 2 milliseconds, respectively, P < .01 by ANOVA) and shortened only in this patient group (TauL, 49 +/- 3 versus 46 +/- 2 and 43 +/- 2 milliseconds, respectively, P < .01 versus baseline and other groups by ANOVA). The improvement in TauL was directly proportional to the degree of LVH (r = .92, P < .001). Although there was a decrease in LV end-diastolic pressure (23 +/- 2 to 15 +/- 1 mm Hg, P < .01) and volume (86 +/- 8 to 67 +/- 9 mL/m2, P < .05) in those patients with a reduction in TauL, this is due to movement down a similar diastolic pressure-volume relation with no change in chamber elastic stiffness (0.023 +/- 0.002 to 0.025 +/- 0.004 mL-1, P = NS).

Does intracoronary angiotensin-converting enzyme inhibition improve diastolic function in patients with hypertensive left ventricular hypertrophy?

To determine if splenectomy results in an increased risk for perioperative infection when analyzed against splenic repair and to identify factors associated with perioperative infection, respiratory complication, and admission to the intensive care unit following surgery for splenic trauma. Data were collected retrospectively from hospital records and analyzed using stepwise multiple logistic regression. San Francisco (Calif) General Hospital, an urban level 1 trauma center. All patients (n = 252) undergoing operation for traumatic splenic injury at San Francisco General Hospital from 1984 through 1990. Patients who died within 24 hours of presentation were excluded from the study. Perioperative infection, respiratory complications, and admission to the intensive care unit. Infection rates and the types of organisms yielded in cultures were similar between patients who underwent splenectomy and repair. Gram-negative and gram-positive organisms were found in equal numbers, and in no group did encapsulated organisms predominate. Splenectomy had no independent impact on any of the three outcome measures. Total blood transfusion was found to be the only independently significant variable associated with perioperative infection and respiratory complication. Total blood transfusion of more than 2 U and Injury Severity Score of greater than 25 were independently significantly associated with admission to the intensive care unit.

Does transfusion significantly increase the risk for infection after splenic injury?

To determine if low gastric intramucosal pH is associated with impaired secretion of gastric acid after pentagastrin stimulation. Prospective study. Intensive care unit of a university teaching hospital. 20 patients requiring mechanical ventilation. All patients with a gastric luminal pH > 4 were given pentagastrin 6 micrograms/kg s.c. to stimulate gastric acid secretion and the response assessed by further measurements of gastric luminal pH. Gastric intramucosal pH (pHi) and luminal pH (pHL) were measured. Patients were divided into two groups on the basis of a low or normal pHi (A value of 7.35 was taken as the lower limit of normal). Patients (n = 6) with normal pHi (7.40 +/- 0.05 [mean +/- SD]) and a luminal pH > 4 (5.65 +/- 1.25) all had a decrease in pHL in response to pentagastrin (decrease in pHL 4.02 +/- 1.52). Of the patients (n = 7) with low pHi (7.2 +/- 0.13) and a pHL > 4 (6.51 +/- 0.48) only one responded to pentagastrin (decrease in pHL for this group 0.93 +/- 1.86). Patients with a pHL < 4 (2.4 +/- 0.71) were not given pentagastrin (n = 7).

Is low intramucosal pH associated with failure to acidify the gastric lumen in response to pentagastrin?