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Forty-five highly susceptible volunteers rated a series of shocks using 32 pain descriptors. Descriptors were given numerical values using magnitude estimation procedures. We assigned the subjects to one of three conditions, analgesia suggestion, relaxation suggestion, or no suggestion. All subjects were administered the shocks and the suggestion appropriate to the group, in both the waking and hypnotic state. The results support the existence of two dimensions of pain which are differentially responsive to suggestion. Hypnotic-analgesia suggestion altered subjects' perceptions of the intensity without changing their perceptions of the unpleasantness of the shocks. Hypnotic-relaxation suggestion reduced the unpleasantness but not the perceived intensity of the stimuli. These findings imply that research into hypnotic pain relief is more easily interpreted if pain is viewed as multidimensional in nature.

The prolate ellipse formula has been shown to be inaccurate and inconsistent in the calculation of total uterine volume. The stepped area-to-volume technique has proven to be both accurate and consistent and provides a value equal to the true uterine volume. When these true volumes were plotted on previously published graphs of total uterine volume derived from the prolate ellipse formula, the graphs were found to be inaccurate. New graphs based on normal values have been constructed, comparing total uterine volume with both biparietal diameter and average gestational age. When 26 abnormal values were plotted on the total uterine volume versus biparietal diameter graph, almost all fell outside the 90 per cent confidence limits. Seven of the abnormal value were from fetuses found to have growth retardation. Six of these cases, including two not appreciated either clinically or ultrasonographically, were detected by this method. The stepped area-to-volume technique should allow reconsideration of the total uterine volume concept and aid in the detection of the subtle changes in uterine size.

To develop a parenteral solution of relatively water-insoluble metronidazole (2-methyl-5-nitro-1H-imidazole-1-ethanol), its phosphate ester was synthesized via two routes. One route utilized 2-cyanoethyl phosphate and the other utilized pyrophosphoryl tetrachloride. The first method used dicyclohexylcarbodiimide as a coupling agent and the cyanoethyl group was removed under mild alkaline conditions. The second method was a one-step procedure in which free acid of metronidazole phosphate was isolated as a crystalline solid. The solubility of metronidazole in various solvents was determined at 25 degrees. From the pH-dependence of its aqueous solubility, the pKa of the conjugate acid of metronidazole was estimated to be 2.62, which agreed well with the pKa values of other nitroimidazoles. Metronidazole phosphate behaved as a zwitterionic compound in an acidic medium with a minimum solubility at pH 2.0. At pH 7, its solubility was approximately 50 times that of metronidazole. The phosphate ester was so soluble at pH higher than 7 that it was difficult to measure the solubility accurately. In human serum, the hydrolysis of metronidazole phosphate followed zero-order kinetics at an initial concentration of 0.25 mg/ml or higher, presumably due to enzyme saturation (0.035 mg/ml/hr at 37 degrees). A reversed-phase HPLC procedure was adopted to monitor the appearance of metronidazole and the disappearance of metronidazole phosphate. Subcutaneous administration of metronidazole phosphate to rats produced a blood level of bioactivity comparable to that observed after administration of metronidazole.

Diarrhea and weight loss may accompany the acquired immunodeficiency syndrome. We studied 30 patients with the syndrome, 20 of whom had diarrhea and weight loss and 10 of whom did not. Patients with identifiable enteric infections or small intestinal Kaposi's sarcoma were excluded. Malabsorption was common in the patients with diarrhea and weight loss, as shown by abnormal D-xylose and 14C-glycerol-tripalmitin absorption tests. In these patients, duodenal biopsy specimens showed a histiocytic infiltrate containing numerous acid-fast organisms in 5 and a mild-moderate chronic inflammation in 13. In asymptomatic patients, duodenal biopsy specimens were normal in 6 and showed chronic inflammation in 4. These results suggest that malabsorption is common in patients with the acquired immunodeficiency syndrome with chronic diarrhea and may contribute to their weight loss.

Peritonitis in patients with pre-existing liver disease and ascites may be secondary to a local abdominal condition which potentially requires surgery for cure, or alternatively, may be spontaneous in origin. For the latter, antimicrobials are therapeutic while surgery is contraindicated. An easily accessible and important clue for distinguishing these forms of peritonitis may be found in the microbiology of ascitic fluid. Visualization on gram stain smear or recovery on culture of multiple organisms and/or anaerobes favors local abdominal disease over spontaneous peritonitis. The presence of Candida species in the ascitic fluid of such patients, although less common, is highly significant. In the absence of peritoneal dialysis, recent abdominal surgery, or risk factors for disseminated candidiasis, the isolation of Candida suggests specifically gastrointestinal perforation.

Inaccuracies in total intrauterine volumes calculated using the prolate ellipse equation have been reported. No previous study has examined all the sources of error. In this study, a comprehensive approach was undertaken. Measurements were obtained from scans of the pregnant uterus in the prone position using an automated water-path scanner (Octoson) and in the supine position using standard static B-mode scanners. Several conclusions could be drawn: 1) From the Octoson prone scans, uterine volumes obtained using the prolate ellipse formula were markedly different from the true uterine volumes obtained by the summation of stepped areas. This showed that the prolate ellipse formula was inaccurate. 2) From the static supine scans, many observer inconsistencies were found in uterine volumes obtained from the prolate ellipse formula. This made the prolate ellipse formula unreliable. 3) Previously published graphs calculated from the prolate ellipse equation, comparing fetal age with total intrauterine volume, were found to vary accuracy, presumably as a result of 1 and 2. A more accurate approach is proposed. Using the outer uterine wall as the boundary, the stepped area-to-volume values of transverse scans taken at 3-cm intervals were found to closely approximate true volumes, with an average error of only 3.5 per cent. Since these measurements encompass the intrauterine contents and the myometrium, it is suggested that the term "total uterine volume" be used instead of "total intrauterine volume."

The techniques we developed to propagate HTM cells in serial cell culture have provided an opportunity to investigate the spectrum of endogenous PGs and other eicosanoids that are produced by these cells. PGE2 and PGF2 alpha were the major cyclooxygenase products detected by both radioimmunoassay and thin-layer chromatography. A small amount of 6-keto PGF1 alpha was also detected, indicating that these cells are able to produce prostacyclin. The observation of a substantial increase in the proportion of PGF2 alpha relative to PGE2 at later time periods after a media change suggests a metabolic conversion of PGE2 to PGF2 alpha by these cells. Bradykinin, thrombin, platelet activating factor, and serum were found to be effective stimulators of PG production by HTM cells, whereas calcium ionophore produced only a minor effect. Using high pressure liquid chromatography, elution profiles of radiolabeled metabolites of AA suggested the presence of certain lipoxygenase products, including LTB4, 12-HETE, 15-HETE, and a small amount of 5-HETE in HTM cells. The formation of these products was inhibited by both DEX and BW 755c, reinforcing the view that metabolic conversions of AA through the lipoxygenase pathway were possible in the trabecular meshwork. We also examined the effects of glucocorticoids on specific protein synthesis in the HTM cells, using 35S-methionine labeling and SDS-PAGE techniques. Short-term (1 day) DEX treatment revealed a major induction of a protein band at approximately 30 kDa. Longer treatments (1 to 3 weeks) resulted in major inductions at approximately 55 kDa inside the cells, with the presence of secreted forms (probably glycoproteins) between 55 and 72 kDa. The short-term DEX effect on protein synthesis a phospholipase inhibitor regulating eicosanoid production within the HTM. The longer-term induction may, on the other hand, be related more directly to the development of steroid glaucoma, based on our findings that the inductions of these proteins correlate with the observed time course and dose-dependence topical glucocorticoid effects on IOP. Continued in vitro and in vivo evaluations of the eicosanoid pathways in cultured HTM cells obtained from normal and glaucomatous human eyes may help to delineate their relationship to IOP regulation and the pathogenesis and treatment of glaucoma. Glucocorticoid-induced proteins may be key participants in the regulation of phospholipase activity and hence may represent a major control mechanism of the AA cascade.(ABSTRACT TRUNCATED AT 400 WORDS)

Various formulas have been employed to compute the circumference of an ellipse. These formulas can be separated into three groups: formulas for a circle, formulas for an incorrect ellipse, and a very complicated formula for a correct ellipse. The errors caused by the first two groups are termed systematic because they occur every time that one of these formulas is used. When measuring fetal head circumference, the errors increase as the fetal head is more ellipsoid, becoming more than 1% when the ratio of the biparietal to fronto-occipital diameter decreases to less than .70. Near term, when the fetal head is large, this could create an error in predicting gestational age of almost .8 weeks. The third group is associated with mathematical random errors because of the difficulty in using a cumbersome equation. All of these formulas and their shortcomings are analyzed. A calculation for the correct circumference of an ellipse is proposed using the simple formula for a circle times a correction factor. The correction factor depends solely on the ratio of the biparietal to fronto-occipital diameter. This formula should minimize random errors and eliminate systematic errors in the calculation of fetal head circumference and will permit a more accurate analysis of fetal age.

The surgical treatment of patients with familial polyposis coli and ulcerative colitis often requires removal of the rectum. Abdominoperineal resection, however, has a substantial morbidity. Ultrasonic fragmentation allows complete removal of the distal rectal mucosa with preservation of the surrounding muscularis. Ten adult mongrel dogs underwent ultrasonic mucosal proctectomy with resection of the proximal rectum and end colostomy. Two months later, the animals were sacrificed and the remaining rectum was removed and examined. The rectal remnant had shrunk and there was fibrous healing of the muscular wall with obliteration of the lumen. There was no mucosal regeneration. Ultrasonic mucosal proctectomy appears to achieve the same results as abdominoperineal resection of the rectum without the morbidity of the perineal dissection. This procedure may be useful in those patients where removal of the rectum is necessary for benign disease and endorectal pull-through is not indicated.

A variety of epithelial malignancies are capable of metastasizing to the bile ducts and gall bladder in a fashion distinct from concurrent spread to the liver. Ultrasonography has proved useful in evaluating obstructive jaundice in this setting and, in the case described, accurately diagnosed acute acalculous cholecystitis caused by a solitary metastasis from carcinoma of the breast to the cystic duct. Exploratory laparotomy confirmed the accuracy of this preoperative diagnosis.

Mucosal proctectomy is becoming the operation of choice in the surgical treatment of patients with ulcerative colitis and familial polyposis coli. Dissection of the rectal mucosa and submucosa from the underlying muscularis is often difficult and, in some instances, impossible to perform. The feasibility of using an ultrasonic device to perform mucosal protectomy was studied in eight dogs. This technique produced coagulative necrosis of the mucosa and muscularis mucosa with marked edema and congestion of the submucosa. The muscularis propria remained intact. Complete destruction of the distal 7 cm of rectal mucosa required a total duration of exposure to the ultrasonic probe of at least 12 minutes. In another five dogs, total colectomy was performed above the area of the mucosal proctectomy followed by endorectal pull-through of the ileum. Follow-up studies revealed healing of the ileonal anastomosis without retraction or stricture. This technique should allow mucosal proctectomy to be performed in those patients in whom standard dissection is not possible due to fibrosis of the submucosal plane.

There have been significant changes in Kuwait's mortality causes between 1969 and 1985: the chronic conditions doubled in percentage while the infectious diseases percentage decreased by two-thirds. Since 1975 the percentage of deaths caused by chronic conditions has exceeded that caused by infectious diseases. These patterns are attributed to changing life styles that have led to improvements in the quality of life in the country. In the Kuwait of the future, many more people will be in the older age categories, which will increase the number of residents who are particularly vulnerable to such degenerative diseases as cardiovascular conditions and malignant neoplasms.

The mortality of spontaneous gastrointestinal perforation in 36 patients with cancer was 84% (30 patients). The main factors responsible for this included failure of recognition, perforation through tumor, advanced uncontrolled disease and multiple organ failure. Six of 19 patients who underwent surgery survived (32%). Five of these patients did not perforate through tumor and their underlying malignancy was in good control. Earlier diagnosis is essential. Prompt surgical intervention and intensive supportive measures are indicated only if additional therapy of the underlying malignancy offers a reasonable chance for continued worthwhile palliation.

The effects of timolol and betaxolol were compared for blocking beta agonist stimulation of cyclic-AMP in cultured human trabecular meshwork cells. Epinephrine (10(-5) M) produced a large and rapid increase in HTM cyclic-AMP; timolol (10(-6) M), at concentrations readily achieved in the aqueous humor after 0.5% eyedrops, completely blocked this effect. Recovery from timolol treatment appeared to be relatively slow, with only a 30-40% recovery observed by 9 hours. In comparison, betaxolol (10(-6) M) produced a smaller blockade of the epinephrine effects; a rapid recovery from the betaxolol effects was observed, with a greater than half-maximal response to epinephrine observed 15 minutes after removal of this beta blocker. These findings may help to explain the clinical observations of an outflow facility effect of epinephrine when used in combination protocols with betaxolol, but not with timolol.

Upper gastrointestinal (UGI) endoscopy was performed in 41 asymptomatic American patients with familial polyposis to assess the prevalence of gastric and duodenal polyps and to characterize their pathological features. Eighteen patients (44%) had UGI endoscopic abnormalities. Six patients had both gastric and duodenal lesions. Eight patients had only gastric polyps, and four had duodenal polyps only. The presence of other extracolonic expressions of polyposis had a suggestive but statistically insignificant correlation with UGI polyps. Patients with familial polyposis and duodenal adenomatous polyps are at high risk for the development of periampullary cancer; screening and identification of these individuals is recommended.

Several studies have shown that the presence of DNA ploidy abnormalities, measured by flow cytometry, may correlate with a poor prognosis in a variety of cancers. The predictive value of these DNA abnormalities in young patients with colorectal cancer has not been well studied. Fifty patients aged 40 years and younger with colorectal adenocarcinoma were studied to determine the correlation of tumor DNA abnormalities with survival. DNA content was determined by flow cytometric analysis and each tumor was categorized as diploid or nondiploid. Of the parameters studied, Dukes' classification and tumor DNA ploidy were found to be significant prognostic indicators. Determination of DNA content seems to provide additional useful prognostic information in young patients with colorectal cancer.

Mesenteric and retroperitoneal cysts are rare intra-abdominal tumors. Ten new patients are presented as well as 152 other cases reported in the English literature. These 162 cases were then analyzed for significant trends. Patients under 10 years of age were significantly different from the older group with respect to a shorter duration of symptoms, a higher number of patients requiring an emergency operation, a lower number of recurrences and the location of the cyst. Patients with retroperitoneal cysts were more likely to have incomplete excision of the cyst and therefore had a higher incidence of recurrence. They also required marsupialization more often. Retroperitoneal cysts should be considered a different entity from mesenteric cysts even though they present clinically in a similar fashion. The outcome of surgical treatment is less satisfactory in patients with retroperitoneal cysts.

Flexible sigmoidoscopy was compared to rigid sigmoidoscopy in the detection of colorectal neoplasia in a select group of patients. A distance of 30 cm or greater was obtained by flexible sigmoidoscopy in 94% of patients and a distance of 50 cm or greater in 46% of patients. A significant number of cancers and adenomas detected by flexible sigmoidoscopy were not detected by rigid sigmoidoscopy. Flexible sigmoidoscopy was tolerated better than rigid sigmoidoscopy but required twice the time. Flexible sigmoidoscopy could be combined with air-contrast barium enema the same day with the one preparation and did not interfere with the x-ray examination. All cancers and a significant number of adenomas detected subsequently on colonoscopy were detected by the combination of flexible sigmoidoscopy and air-contrast barium enema. Although the combination of flexible sigmoidoscopy and air-contrast barium enema is not adequate for thorough diagnostic evaluation of patients with a positive screening test, it may be of value in other select clinical situations. Flexible sigmoidoscopy has the potential for higher yield and better patient tolerance as compared to rigid sigmoidoscopy. This warrants further evaluation.

In this study we show that recombinant human IL-1 alpha (rhIL-1 alpha) protects both genetically resistant and susceptible strains of mice against Listeria monocytogenes infection. Similar levels of protection were observed in all strains tested. These data suggest that innate susceptibility to an infectious agent may not abrogate the ability of rhIL-1 alpha to enhance antibacterial resistance.

In an attempt to identify factors contributing to survival of free fall and impact, we evaluated the records of four patients who survived a jump from the Brooklyn Bridge into the East River in New York Harbor between 1977 and 1985. All four patients were male and ranged in age from 22 to 67 years. They had free falls of between 41.0 and 48.8 meters. All of the patients were brought to the hospital within 24 minutes of entering the water. Three of the four had emergency surgical treatment and the fourth patient had only minor injuries. All four patients survived the suicide attempts. The length of the hospital stay ranged from two to 26 days.

Obstruction to swallowing from recurrent gastric cancer following total gastrectomy or when the tumor is initially unresectable presents a major surgical challenge. Resection of the recurrence or various bypass procedures are indicated, when technically feasible, unless widespread metastases are found. A useful palliative approach for obstructed patients with a limited prognosis is the use of a Celestin endoesophageal tube. This report describes the indications for and method of insertion in two typical clinical situations. Anchoring the tube to the anterior abdominal wall prevents proximal migration of the prosthesis, a complication which occurred six months later in a patient in whom this was not possible.

All patients with gallstone ileus admitted to our institutions between 1938 and 1982 were retrospectively analyzed by grouping the patients into 10-year periods. Forty-five patients were studied, of whom 39 required operation. When hospital statistics for admissions, length of stay, and mortality rates from the Mount Sinai Hospital were compared to the gallstone ileus data, it was found that there has been no significant change in the admission rate for these patients. The mortality rate and length of stay of gallstone ileus patients has also remained constant over the past 25 years despite the general hospital decrease in both of these numbers. There has been no change in the complication rate, duration of symptoms prior to admission, or the preoperative diagnostic rate of gallstone ileus during the duration of this study.

Any motion of the scene during the exposure of a hologram results in a spatial modulation of the recorded fringe contrast. On reconstruction, this produces a spatial amplitude modulation of the reconstructed wavefront, which results in a blurring of the image, not unlike that of a conventional photograph. For motion of the scene sufficient to change the path length of the signal arm by a half wavelength, this blurring is generally prohibitive. This paper describes a proposed holographic technique which offers promise for front light resolution of targets moving at high speeds, heretofore unobtainable by conventional methods.

A special outpatient clinic was established to pioneer newer and more appropriate methods of treating poor personality resource patients. While the clinic apparently served its clientele, the psychiatrists in training felt angry and frustrated in their clinic experience. Analysis of interview data revealed that the trainees were subject to forces that placed them in conflict. The characteristics of the patients, the clinic structure that required subservience of individual gratifications to institutional values, the need to develop a personal sense of competence, and the residents' perception of conflicting values on the part of the staff all contributed to the residents' experience of conflict and frustration. Patterns of conflict resolution were discerned in criticism directed toward the staff but more effectively in apathetic withdrawal of personal investment.