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Background: Cirrhosis in trauma patients is an indicator of poor prognosis, but current trauma injury grading systems do not take into account liver dysfunction as a risk factor. Our objective was to construct a simple clinical mortality prediction model in cirrhotic trauma patients: Cirrhosis Outcomes Score in Trauma (COST)., Methods: Trauma patients with pre-existing cirrhosis or liver dysfunction who were admitted to our ACS Level I trauma center between 2013 and 2021 were reviewed. Patients with significant acute liver trauma (AAST Grade ≥ 3) or those that developed acute liver dysfunction while admitted were excluded. Demographics as well as ISS, MELD, complications, and mortality were evaluated. COST was defined as the sum of age, ISS, and MELD. Univariate and multivariable analysis was used to determine independent predictors of mortality. The area under the receiver operating curve (AUROC) was calculated to assess the ability of COST to predict mortality., Results: A total of 318 patients were analyzed of which the majority were males 214 (67.3%) who suffered blunt trauma 305 (95.9%). Mortality at 30-days, 60-days, and 90-days was 20.4%, 23.6%, and 25.5%, respectively. COST was associated with inpatient, 30-day, and 90-day mortality on regression analyses and the AUROC for COST predicting mortality at these respective time points was 0.810, 0.801, and 0.813., Conclusion: Current trauma injury grading systems do not take into account liver dysfunction as a risk factor. COST is highly predictive of mortality in cirrhotic trauma patients. The simplicity of the score makes it useful in guiding clinical care and in optimizing goals of care discussions. Future studies to validate this prediction model are required prior to clinical use., Competing Interests: Declaration of Competing Interest The authors do not have any conflicts of interest to report., (Copyright © 2023. Published by Elsevier Ltd.)

In this paper, we describe the use of 3D printed devices for both static and flow studies that contain electrospun collagen scaffolds and can accommodate transepithelial/transendothelial electrical resistance (TEER) measurements. Electrospinning was used to create the collagen scaffold, followed by an optimized 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide/N-Hydroxysuccinimide (EDC/NHS) cross-linking procedure to produce stable collagen fibers that are similar in size to fibers in vivo. LC/MS was used to study the leaching of solvent and NHS from the scaffold, with several rinsing steps being shown to eliminate the leaching and promote the culture of Madin-Darby Canine Kidney (MDCK) epithelial cells on the scaffold. Both static and flow 2-part devices were successfully fabricated by 3D printing using either VeroClear or MED610 material (PolyJet printing) and assembling the scaffold between laser cut Teflon gaskets. The devices were designed to easily accommodate commonly used STX2 chopstick electrodes for TEER measurements. A detailed comparison was made between the use of collagen scaffolds vs other electrospun materials for cell culture. The collagen extracellular matrix model displayed a high barrier functionality for up to 7 days. In addition, a different 3D printed device with a collagen scaffold is described to incorporate continuous flow and replenishment of media under the cell layer in a manner that also enables periodic recording of TEER measurements. Overall, this work shows that the combination of biological ECM materials such as collagen into microfluidic devices that incorporate flow have great potential to form more realistic cell culture models in areas such as blood brain barrier research., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Advanced automatic crash notification (AACN) can improve triage decision-making by using vehicle telemetry to alert first responders of a motor vehicle crash and estimate an occupant's likelihood of injury. The objective was to develop an AACN algorithm to predict the risk that a pediatric occupant is seriously injured and requires treatment at a Level I or II trauma center., Methods: Based on 3 injury facets (severity; time sensitivity; predictability), a list of Target Injuries associated with a child's need for Level I/II trauma center treatment was determined. Multivariable logistic regression of motor vehicle crash occupants was performed creating the pediatric-specific AACN algorithm to predict risk of sustaining a Target Injury. Algorithm inputs included: delta-v, rollover quarter-turns, belt status, multiple impacts, airbag deployment, and age. The algorithm was optimized to achieve under-triage ≤5% and over-triage ≤50%. Societal benefits were assessed by comparing correctly triaged motor vehicle crash occupants using the AACN algorithm against real-world decisions., Results: The pediatric AACN algorithm achieved 25% to 49% over-triage across crash modes, and under-triage rates of 2% for far-side, 3% for frontal and near-side, 8% for rear, and 14% for rollover crashes. Applied to real-world motor vehicle crashes, improvements of 59% in under-triage and 45% in over-triage are estimated: more appropriate triage of 32,320 pediatric occupants annually., Conclusions: This AACN algorithm accounts for pediatric developmental stage and will aid emergency personnel in correctly triaging pediatric occupants after a motor vehicle crash. Once incorporated into the trauma triage network, it will increase triage efficiency and improve patient outcomes., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objectives: The "Goals of Patient Care" (GOPC) process uses shared decision making to incorporate residents' prior advance care planning (ACP) or preferences into medical treatment orders, guiding health care decisions at a time of clinical deterioration should they be unable to voice their opinions. The objective was to determine whether GOPC medical treatment orders were more effective than ACP alone in preventing emergency department (ED) visits (no hospitalization), ED visits (with hospitalization), and deaths outside the residential aged care facility (RACF)., Design: The study was a prospective cluster randomized controlled trial, with the intervention being the completion of GOPC process by a geriatrician, following a shared decision-making process, incorporating ACP documents or residents' preferences., Setting and Participants: The study took place in 6 RACFs in Northern Metropolitan Melbourne, Australia. Eligible participants included all permanent residents in participating RACFs for whom written informed consent could be obtained., Measures: The primary outcome was the effect on ED visits and hospitalizations at 6 months. Secondary outcomes included a difference in hospitalization rates at 3 and 12 months, total hospital bed-days, and in-RACF and in-hospital mortality rates., Results: More than 75% of residents participated, 181 randomized to Intervention and 145 to Control. The intervention did not result in a statistically significant change at 6 months; however, at 12 months, it reached statistical significance with 40% reduction in ED visits and hospitalizations compared with Control, with an incident rate ratio 0.63 [95% confidence interval (CI) 0.41-0.99, P = .044]. Mortality rates show increased likelihood of dying in the RACF, with statistical significance at 6 months at a relative risk ratio of 2.19 (95% CI 1.16-4.14, P = .016)., Conclusions and Implications: In the RACF population, GOPC medical treatment orders were more effective than ACP alone for decreasing hospitalization and likelihood of dying outside the RACF. GOPC should be considered by both RACF staff and health services to decrease hospitalization and in-hospital mortality., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Background: Advance care planning (ACP) encompasses a process by which people may express and record their values and preferences for care and treatment should they lose the capacity to communicate them in the future. We believe the effects that ACP can have on the nursing home population is distinct from others and sought to gain insight into the outcomes of relevant studies on the topic., Aim: To identify the effects of ACP interventions on nursing home residents., Design: Systematic review., Methods: A comprehensive literature search was conducted using the following 4 electronic databases, Embase, Medline, PsychINFO, and CINAHL, with no limits on year or language. Gray literature search of relevant journals was also performed as was reviewing of the reference lists of all included articles. Inclusion criteria were randomized controlled trials, controlled trials, pre/post study design trials and prospective studies examining the effects of ACP on nursing home residents. A detailed narrative synthesis was compiled as the heterogeneous nature of the interventions and results precluded meta-analysis., Results: The initial search yielded 4654 articles. Thirteen studies fitted inclusion criteria for analysis. The ACP interventions included (1) 5 studies evaluating educational programs; (2) 5 studies introducing or evaluating a new ACP form; (3) 2 studies introducing an ACP program with a palliative care initiative; and (4) 1 study observing the effect of do not resuscitate orders on medical treatments for respiratory infections. A range of effects of ACP was demonstrated in the study populations. Hospitalization was the most frequent outcome measure used across the included studies. Analysis found that in the nursing home population, ACP decreased hospitalization rates by 9%-26%. Of note, in the 2 studies that included mortality, the decrease in hospitalization was not associated with increased mortality. Place of death is another important effect of ACP. Analysis found significant increases in the number of residents dying in their nursing home by 29%-40%. Medical treatments being consistent with ones' wishes were increased with ACP although not to 100% compliance. Two studies showed a decrease in overall health costs. One study found an increase in community palliative care use but not in-patient hospice referrals., Conclusions: ACP has beneficial effects in the nursing home population. The types of ACP interventions vary, and it is difficult to identify superiority in effectiveness of one intervention over another. Outcome measures also vary considerably between studies although hospitalization, place of death, and actions being consistent with resident's wishes are by far the most common. Very few studies with high quality methodology have been undertaken in the area with a significant lack of randomized controlled trials. More robust studies, especially randomized controlled trials, are required to support the findings., (Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma centre (TC) versus a non-trauma centre (non-TC)., Methods: Transfer Scores (TSs) were computed for 240 injuries that comprise the top 95% most frequently occurring injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) with an Abbreviated Injury Scale (AIS) severity of 2 or greater. A TS for each injury was computed using the proportions of patients involved in a MVC from the National Inpatient Sample (NIS) that were transferred to a TC or managed at a non-TC. Similarly, a TSMAIS that excludes patients with higher severity co-injuries was calculated using the proportion of patients with a maximum AIS (MAIS) equal to the AIS severity of a given injury., Results: The results indicated for injuries of a given AIS severity, body region, and injury type, there were large variations in the TSMAIS. Overall results demonstrated higher TSMAIS values when injuries were internal, haemorrhagic, intracranial or of moderate severity (AIS 3-5). Specifically, injuries to the head possessed a TSMAIS that ranged from 0.000 to 0.889, with head injuries of AIS 3-5 severities being the most likely to be transferred., Discussion and Conclusions: The analysis indicated that the TSMAIS is not solely correlated with AIS severity and therefore it captures other important aspects of injury such as predictability and trauma system capabilities. The TS and TSMAIS can be useful in advanced automatic crash notification (AACN) research for the detection of highly unpredictable injuries in MVCs that require direct transport to a TC., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

In this paper, we describe the fabrication and characterization of a reversibly sealed microchip device that is used to couple microdialysis sampling to microchip electrophoresis. The ability to interface microdialysis sampling and microchip electrophoresis in a device that is amenable to reversible sealing is advantageous from a repeated use standpoint. Commercially available tubing coming from the microdialysis probe is directly inserted into the chip and flow from the probe is interfaced to the electrophoresis portion of the device through integrated pneumatic valves. Fluorescence detection was used to characterize the poly(dimethylsiloxane)-based device in terms of injection reproducibility. It was found that the entire system (microdialysis probe and microchip device) has a concentration response lag time of 170 sec. Microdialysis sampling followed by an electrophoretic separation of amino acids derivatized with naphthalene-2,3-dicarboxaldehyde/cyanide was also demonstrated.

The release of adenosine triphosphate (ATP) from red blood cells (RBCs) flowing through PDMS microchannels has been determined as a function of channel cross-sectional area using a design containing a channel that narrows uniformly. ATP, released from the RBCs in response to the mechanical deformation of their cell membranes, increased as the channel cross-section decreased. One sample of rabbit RBCs released 1.16 +/- 0.11, 1.92 +/- 0.14 and 2.09 +/- 0.10 microM ATP as the median cross-sectional area decreased from 4314 to 3192 to 2052 microm(2), respectively. Numerous samples (n = 6) displayed the same trend. Incubating a sample of RBCs with diamide, a substance known to stiffen cell membranes without harming the cell cytosol, provided evidence that no cell lysis occurred in the microchip device. This novel use of lab-on-a-chip technology allows for channel designs that enable an in vitro study of physiological events that occur in the microcirculation.

The seasonal acclimatization of the carp fish demands physiological compensatory responses. The process involves profound nucleolar adjustments and remarkable changes in rRNA synthesis, which affect ribosomal biogenesis. We have documented that protein kinase CK2, whose activity is related to ribosomal protein L41 and the regulation of rRNA synthesis, was expressed in notably higher amounts in summer-acclimatized carp compared to the cold-season adapted fish. Thus, we approached the study of the functional genomics of carp L41 protein. We report the first cloning of a fish L41 gene encoding the highly conserved 25 amino acids, including approximately 1700 bp regulatory upstream region and the 3(') polyadenylation signal, plus the isolation and characterization of two different L41 cDNAs. We found a clear differential expression of L41, which follows the same pattern as protein kinase CK2beta that transcribes at higher levels in the summer-acclimatized carp than it does in the winter-adapted fish., ((c) 2002 Elsevier Science (USA).)

Purpose: Results from 34 endovascular repairs of abdominal aortic aneurysms are reviewed to identify technical complications and relate them to anatomic and technical features of the operation., Methods: Twenty-one patients underwent attempted tube graft repair (mean follow-up, 13 months). Thirteen patients underwent placement of a bifurcated graft (mean follow-up, 7.2 months)., Results: Twenty-five patients (74%) underwent repair without technical complication (16 tube graft and nine bifurcated graft). Of five patients who had tube graft complications, two involved small iliac arteries and resulted in arterial injury. One of these patients needed a femorofemoral bypass procedure, and the other required conversion to standard operation. Two patients had distal leaks associated with the attachment system, and one patient had misplacement of the distal attachment system. The two patients who had leaks were followed-up; one required operation after 7 months, whereas the other leak sealed. The patient who had distal attachment system misplacement had a second endograft placed within the first to provide a distal seal. The four patients who had bifurcated graft complications involved two graft limb stenoses, one managed with a Palmaz stent and the other with balloon angioplasty. The patient treated with balloon angioplasty had graft thrombosis 1 week after the operation, which resulted in the need for a femorofemoral bypass procedure. Another bifurcated graft patient had a graft limb twist, which has resulted in chronic claudication. One patient had placement of a limb too proximal in the common iliac artery with chronic leak, and an open operation was performed 18 months later., Conclusions: Technical complications in this series seem to be associated with short distal necks, small iliac arteries, tortuous iliac arteries, and atherosclerosis at the aortic bifurcation. We believe that experience and understanding of these issues will reduce the risk of these complications in the future.

Purpose: We examined the clinical and financial outcomes of case management coupled with the initiation of selective use of the intensive care unit (ICU) in all cerebral revascularization procedures., Methods: Three hundred eighty-four procedures in 331 patients were retrospectively reviewed. Morbidity and mortality rates, hospital length of stay, cost, and ICU or hospital readmissions were examined. Hypertension was examined as an independent variable for its effect on patient outcome., Results: Cerebral revascularization, including carotid endarterectomy, vertebral-carotid artery transposition, and subclavian-carotid artery transposition, yielded a 0.78% stroke rate and 0.26% perioperative death rate in this series. ICU admission was necessary in nine patients (2.3%) for cardiac or respiratory instability. Three patients (0.78%) required transfer to the ICU for management of hypertension or hypotension. The mean hospital length of stay after institution of case management was reduced by 2.1 days, and the mean cost was decreased by $1987, a savings of 28.9% of total hospital cost., Conclusion: The dual approach of case management and selective use of the ICU promotes quality patient care, conserves financial resources without adversely affecting morbidity or mortality rates, enhances physician/nurse collaboration, and improves patient satisfaction.

Purpose: This report was designed to elucidate the clinical manifestations of suprarenal aortic occlusion (SRAO) and determine the efficacy of surgical treatment., Methods: A retrospective review of 135 patients with aortic occlusion was undertaken from which the 16 patients (12%) with SRAO were found., Results: Analysis yielded two subsets of patients based on the time-frame over which SRAO developed. Group I (n = 13) had chronic aortic occlusion with proximal propagation of thrombus to involve the suprarenal aorta. They had uncontrolled hypertension and claudication. Surgical treatment included 16 renal reconstructions (nine patients), two nephrectomies, 10 aortobifemoral bypasses, and three extra-anatomic procedures. The operative mortality rate was 23%. In contrast, group II (n = 3) had acute SRAO, manifest by profound lower extremity ischemia and acute renal failure after cardiac dysrhythmias. Two patients were moribund and died shortly after extraanatomic "salvage" procedures. One patient survived aortobifemoral and bilateral renal artery bypass., Conclusion: Chronic SRAO should be suspected in patients with absent femoral pulses and refractory hypertension. Aortic and renal reconstruction offers long-term improvement in hypertension control and relief of claudication. Acute SRAO is a multisystem disorder that is ineffectively managed with extraanatomic "salvage" procedures.

Purpose: Recent studies of perioperative antimicrobial prophylaxis have indicated an improved efficacy of beta-lactamase-stable cephalosporins compared with cefazolin, the most commonly used prophylactic agent. Previous studies in our institution have revealed a superiority of cefamandole to cefazolin in patients undergoing heart surgery, although there was no difference between cefazolin and cefuroxime in patients undergoing peripheral vascular surgery. This study was therefore designed to compare cefamandole with cefazolin in wound infection prophylaxis in clean vascular surgery., Methods: The study was conducted from August 1990 through May 1992 and consisted of 893 patients with aortic or infrainguinal arterial procedures randomized to receive either cefamandole or cefazolin., Results: The difference in infection rates associated with cefamandole versus cefazolin prophylaxis (3.2% vs 1.9%, respectively) was not significant (p = 0.42). A cost savings of approximately $95,000 per year at our institution favors the continued use of cefazolin over cefamandole. Risk factor analysis was carried out for preoperative and postoperative events that might have predisposed to infection. Only preoperative use of aspirin and the postoperative finding of a lymphocele correlated with a higher infection rate., Conclusions: Cefazolin continues to be the most cost-effective antibiotic for prophylaxis in clean vascular surgical procedures.

The traditional approach to recurrent carotid stenosis has been repeat endarterectomy or patch angioplasty. Concern with the durability of repeat carotid endarterectomy has resulted in our use of carotid resection with autogenous graft interposition. This study was designed to determine the outcome and efficacy of carotid resection compared with repeat carotid endarterectomy in the management of recurrent carotid stenosis. From 1974 to 1991, 162 operations (repeat carotid endarterectomy 105, carotid resection 57) were performed for recurrent carotid stenosis. Indication for operation was hemispheric symptoms in 63% of patients, nonlateralizing symptoms in 25%, asymptomatic stenosis in 7%, and previous stroke in 5%. Ninety-one percent of patients had stenosis greater than 90% on arteriography. The perioperative stroke rate for carotid resection was 3.5%, with a subsequent rate of 0.0064 strokes per year. For repeat carotid endarterectomy, the perioperative stroke rate was 1.9% with a subsequent rate of 0.011 strokes per year. Graft patency after carotid resection was 93% (mean follow-up, 35 months). Four patients treated with carotid resection had graft thrombosis, and two of the four remained asymptomatic. After repeat carotid endarterectomy, one patient had carotid thrombosis, and recurrent stenosis greater than 50% developed in 23 patients (mean follow-up, 64 months). Twenty patients treated with repeat carotid endarterectomy underwent an additional operation for further symptomatic recurrent carotid stenosis. We conclude carotid resection is a safe and effective alternative to repeat carotid endarterectomy for patients undergoing operation for recurrent carotid stenosis.

Although cefazolin prophylaxis has proven efficacy in vascular surgery, Staphylococcus aureus wound infections are still an important postoperative complication. In cardiac surgery, cefazolin's susceptibility to hydrolysis by staphylococcal beta-lactamase has been proposed to account for some prophylaxis failures. To determine whether the incidence of vascular wound infections can be reduced by administering a more beta-lactamase-stable cephalosporin, we undertook a prospective, randomized trial of cefuroxime versus cefazolin. Cefuroxime was administered as a 1.5 gm dose before operation and 750 mg every 3 hours during operation. Cefazolin was given as 1 gm before operation and 500 mg every 4 hours during operation. Both agents were continued every 6 hours after operation for 24 hours. Deep wound infections developed in seven of 272 (2.6%) cefuroxime and three of 287 (1.0%) cefazolin recipients (p = 0.2). Staphylococcus aureus wound infections occurred in five cefuroxime versus two cefazolin recipients. In vitro evaluation of six of the study isolates plus an additional eight S. aureus strains from vascular wound infections showed greater susceptibility of the strains to cefazolin than cefuroxime (median minimal inhibitory concentrations of 0.5 and 2.0 micrograms/ml, respectively, p less than 0.05). Furthermore, despite its more frequent intraoperative redosing, cefuroxime exhibited lower trough serum concentrations than cefazolin. Among cefuroxime recipients, infection-associated procedures were significantly longer than infection-free procedures (p less than 0.05), suggesting that low tissue antibiotic concentrations may have contributed to the pathogenesis of these infections. In contrast, the length of the procedure was not a risk factor for infection among cefazolin recipients.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged potassium loading results in an adaptive change in colonic epithelium that increases the capacity for potassium excretion. We evaluated the role of aldosterone in colonic potassium adaptation, because potassium loading also increases the production of aldosterone. Experiments were performed in intact animals and in adrenalectomized rats with a high potassium intake replaced over a prolonged period with low physiologic amounts of corticosterone to provide a stable plasma level of 3 to 5 micrograms/dl. Net electrolyte movement and transmural potential difference were measured by an in vivo luminal perfusion technique. Compared with the rate of potassium secretion of -3.6 +/- 0.5 mu Eq/min/gm dry weight in potassium-loaded rats with intact adrenal glands, net secretion was significantly impaired (P less than 0.025) in potassium-loaded adrenalectomized animals with only corticosterone replacement (-1.1 +/- 0.5 mu Eq/min/gm dry weight). The rate in adrenalectomized animals, however, was comparable to that in intact animals receiving a normal potassium intake (0.3 +/- 0.2 mu Eq/min/gm dry weight). In addition, in intact animals prolonged potassium loading significantly increased transmural potential difference to -68 +/- 6 mV (P less than 0.005), compared with that in adrenalectomized, corticosterone-replaced, potassium-loaded animals (-30 +/- 4 mV) and intact animals with a normal intake of potassium (-25 +/- 7 mV). Net sodium absorption was reduced in aldosterone-deficient animals compared with the value in control and potassium-loaded animals with intact adrenal glands. These data indicate, therefore, that potassium adaptation is not induced in the absence of aldosterone and suggest that hyperaldosteronism plays an important role in induction of colonic potassium adaptation.

Thigh claudication is usually caused by aortoiliac occlusive disease. A patient with unilateral thigh claudication and normal femoral pulses was found to have isolated profunda femoris occlusion and was successfully treated by profundaplasty. Although this syndrome is rare, a review of vascular anatomy of the thigh and mechanisms of claudication explains its existence.

An amputation rate of 8% to 52% and a mortality rate of 13% to 58% make vascular prosthetic graft infections the most dreaded complication facing a vascular surgeon. In 1978 a randomized prospective double-blind study reported a statistically significant decrease in wound infections in patients treated with prophylactic antibiotics whereas the graft infection difference only approached statistical significance. The present study reviews 2614 arterial prosthetic grafts implanted from January 1975 through June 1986. Twenty-four patients were identified as having a prosthetic graft infection, yielding an overall infection rate of 0.92%. Staphylococcus aureus was the most common organism, occurring in one third of the cases. The most common graft material was polytetrafluoroethylene (PTFE) (33%) followed by Dacron (29%), composite PTFE and Dacron (20%), and umbilical vein grafts (9%). Diabetes was a common factor in one third of the patients. Symptoms of infection were present in 15 patients (63%) within 3 months of operation, with 11 patients showing symptoms within 30 days. The longest interval between operation and onset of symptoms was 48 months. Prophylactic antibiotics were administered to 22 of the 24 patients, but in only 7 of the 22 (29.5%) were they given according to our usual practice. All patients required removal of the infected prosthesis, with limb loss in 17% and death in 17%.

The aim of this study was to investigate the nature of urinary lipid in humans with nephrotic syndrome. Fresh urine specimens were fractionated by centrifugation into a lower cellular fraction and an upper noncellular fraction. Of the 11 urine specimens examined, six cellular fractions contained cells (oval fat bodies) that were laden with anisotropic (birefringent) droplets when viewed by polarizing microscopy. The mean total cholesterol excretions for the five urine specimens without anisotropic droplets and the six urine specimens with anisotropic droplets were 8.7 mg/L and 35.5 mg/L, respectively. The cellular fractions of the six urine specimens with anisotropic droplets are enriched in cholesterol esters relative to whole urine. Upon heating, the anisotropic droplets underwent phase transitions characteristic of cholesterol esters, as observed by polarizing microscopy. The mean cholesteric to isotropic phase transition temperature of the anisotropic droplets was 41.3 degrees C. These data indicate that the anisotropic droplets of the oval fat bodies were composed of cholesterol esters acylated largely with monounsaturated fatty acids consistent with cellular origin. The noncellular fractions were subjected to ultracentrifugation (48,000 X g for 2 hours) and then separated into supernate and infranate fractions. The supernate fractions contained minor amounts of lipid, except in two cases of massive lipiduria. In these two cases, the supernate fractions contained many individual anisotropic droplets with lipid composition nearly identical to their cellular fractions. The dispersed lipid of the infranate fractions were invisible by microscope. Nine of the 11 infranate fractions revealed an alpha migrating lipid band by agarose gel electrophoresis. For urine specimens with anisotropic droplets, the infranate fractions contained cholesterol ester fatty acids that were less saturated (as measured by gas-liquid chromatography) than the cellular fractions. Thus, the cholesterol esters of the infranate fractions were derived from a different source (probably high-density lipoproteins) than the cholesterol esters of the cellular fractions.

Thirty-nine patients with renal artery aneurysm (RAA) were seen over a period of 15 years. Among 20 women and 19 men, 31 were found to have solitary aneurysms, and eight had multiple RAA. Thirty-three patients had diastolic hypertension; nine of them proved to be of renovascular origin. Of the 18 patients who underwent RAA resection, 13 had reconstruction for treatment of hypertension, three had a solitary functional kidney, one had recurrent flank pain, and one had resection for prevention of rupture in a woman of childbearing age. Six of the 18 patients had aneurysmorrhaphy with primary repair or patching, seven had a resection with an aortorenal bypass, and five patients had six ex vivo renal reconstructions with multiple anastomoses. Nephrectomy was performed in two patients with RAA rupture at the time of childbirth and in one patient with hypertension and RAA in a poorly functioning kidney. Reconstructive procedures for documented renovascular hypertension in seven patients resulted in improvement in all cases. Blood pressure improved in only six of 10 patients operated on with hypertension and no lateralization of renovascular studies. Eighteen patients were observed for one to 16 years without surgery, and none experienced rupture. Resection of RAA is indicated to treat patients with renovascular hypertension, patients with hypertension and a solitary functional kidney, and selected patients with severe hypertension and to prevent rupture in women who may become pregnant. Other patients with asymptomatic RAA can be safely observed clinically without serial arteriograms and without fear of rupture.(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate drug-protein binding, a sensitive method for the determination of ibuprofen in submilliliter amounts of serum was required. A specific and highly sensitive procedure, based on benzene extraction of the acidified specimen. TLC of the benzene extract residue, fomation of the pentafluorobenzyl esters of the materials eluted from the thin-layer chromatogram, and quantification of the pentafluorobenzyl esters by GLC, was developed. Utilizing electron-capture detection, the method is sensitive to 0.1 microgram of ibuprofen/0.1 ml of serum. Statistical analyses indicated an average recovery of 97.7% with a standard deviation of +/- 7.3%. Mass spectrometric analysis, in conjunction with GLC, confirmed the specificity of the method for the intact drug. The procedure was applied successfully to drug absorption and drug-protein binding studies in humans.