Search

After uniocular anterior chamber inoculation of the KOS strain of HSV-1 in BALB/c mice, acute retinal necrosis develops in the uninoculated eye. These mice exhibit suppression of virus-specific delayed hypersensitivity which is the hallmark of anterior chamber associated immune deviation (ACAID). In contrast, inoculation of C57BL/6 mice with KOS induces vigorous virus-specific DTH, and there is no retinal necrosis in the uninoculated eye. We performed experiments using RH116, a mutant of KOS and SC16, a neurovirulent strain of HSV-1, in BALB/c and C57BL/6 mice to examine whether virus or host factors determine the outcome of anterior chamber inoculation of HSV-1 (ACAID or DTH, retinal necrosis or retinal preservation). We found that high titers of virus (approximately 10(5)) within the first 24 hours in the inoculated eye were linked to the induction of ACAID and that the induction of ACAID following anterior chamber inoculation of HSV-1 is neither an exclusive feature of a strain of virus nor is the ability to develop ACAID a distinguishing characteristic of an individual strain of mice. Taken together, our findings suggest that the interplay of both virus and host factors results ultimately in acute retinal necrosis following anterior chamber inoculation of HSV-1 in the mouse.

Acute autonomic neuropathy is an uncommon syndrome, usually affecting healthy young people. Presentation is often dramatic and initial misdiagnosis is common. We describe two young women with acute autonomic neuropathy who presented with gastrointestinal involvement heralding widespread dysautonomia and review 26 additional cases of acute autonomic neuropathy from the English language literature. Acute autonomic neuropathy can be primarily cholinergic without orthostatic hypotension (26%) or pandysautonomic (74%) involving sympathetic adrenergic functions. Onset has been temporally related to viral syndromes in 20% of cases, with autonomic deficits usually evolving over 1 to 3 weeks. Gastroparesis (69%) and syncope (12%) are frequent presenting complaints. Spinal fluid protein levels are often (75%) elevated in pandysautonomic subtypes. Prolonged and incomplete recovery is the rule (60%), with persistent gastroparesis and orthostatic hypotension. Other specific diseases that occasionally mimic acute autonomic neuropathy include botulism, porphyria, amyloidosis, and paracarcinomatous neuropathies. Acute autonomic neuropathy shares several clinical features with acute idiopathic polyneuropathy (Guillain-Barré syndrome), suggesting an immune-mediated pathogenesis.

Patients with alloantibodies may request directed blood donations from their relatives despite the lack of any scientific data suggesting that blood from these donors is safer. We have derived formulas that are applicable to any ethnic group for calculating the probability that a given class of relatives will have compatible blood for a given patient. These formulas apply to any non-X-linked blood group system (including the ABO and Rh systems) and are simple enough for routine blood bank use in advising patients as to how likely they are to obtain compatible donors. Use of these formulas may be helpful in counseling patients who may have difficulty in obtaining compatible directed donors because of antibodies or an unusual blood type. In general, the presence of an alloantibody should not automatically exclude a patient from utilizing directed donors. Moreover, for patients with antibodies to high-incidence antigens, directed donations from siblings may be the easiest way to obtain compatible blood.

Blood loss usually is not clinically significant during liposuction, but the need for transfusion increases with the amount of tissue removed. Autologous blood donations in preparation for significant blood loss are widely accepted by patients and physicians.

We describe a successful approach to the management of the webbed neck deformity in Turner's syndrome using skin expansion. This case report demonstrates the advantages of this method over previously described techniques.

Although a multitude of operations exist for the treatment of lymphedema, none is highly successful. An experimental model that reliably and easily produces chronic lymphedema in an extremity would be useful to study treatments in a controlled and comparative manner and would enhance our understanding of the physiology and treatment of lymphedema. Many models that simulate clinical lymphedema have been described, but they suffer from cumbersome protocols, high laboratory costs, and an inconsistent yield of permanent lymphedema. We describe an experimental model for chronic lymphedema in the lower extremity of the rat that creates a lymphatic block in the groin induced by radiation treatment and one operation--surgical division of the superficial and deep lymphatics. All animals develop stable chronic lymphedema of the lower extremity within days of operation, with swelling that persists for at least 9 months. A mortality rate of 8 percent was associated with this technique. Methods for quantification of limb swelling are described, as is analysis of the lymphatic block by lymphoscintigraphic imaging of lymph channels and nodes. This model has the advantages of simplicity of technique, cost-effective use of rodent subjects, reproducibility of lymphedema, and quantification of results.

Surgeons who perform office surgery without the presence of personnel trained in anesthesia are responsible for both the surgery and the general condition of the patient. Thus the prevention and management of medical problems that may occur during the operation or in the recovery room become their concerns. Fortunately, medical problems arise infrequently. However, the anxiety of the moment may cloud important details of treatment; as a result, having a preconsidered plan is advised. This paper presents step-by-step outlines that provide safe and effective treatment plans for guiding the surgical team during the management of medical problems during office surgery.

The murine Ia antigens, a group of cell surface glycoproteins, are involved in the control of the immune response. The structure of one of these class II major histocompatibility complex molecules, A alpha, was recently deduced from sequence analysis of a cDNA clone produced from k haplotype mice. We have now isolated and sequenced A alpha cDNA clones from five other mouse haplotypes: d, b, f, u, and q. Sequence comparison revealed a surprisingly high degree of allelic polymorphism. Interestingly, amino acid substitutions were clustered within the first external domain of this polypeptide chain, particularly at a few highly variable positions. Functional implications of A alpha polymorphism and possible mechanisms for its generation are discussed.

A group of 1,617 infants and 1,711 preschool children were studied for symptomatic and asymptomatic urinary infection and followed up for three to five years. Asymptomatic bacteriuria was found in 1.8% of female infants, 0.5% of male infants, 0.8% of preschool girls, and none of the preschool boys. Seventeen percent of the infants and 13% of the preschool children with urinary infection studied roentgenographically had upper tract damage; 46% of the infants and 9% of the preschool children had vesicoureteral reflux. Infants with normal urinary tracts and urinary infection with or without reflux tended to have recurrent infection, whereas the kidneys remained anatomically normal. The infants with high-risk lesions, such as obstructive uropathy and vesicoureteral junction ectopia and deformity, had substantial bacteriuria on screening culture.

Observer variability in interpreting medical tests and in making diagnoses influences both clinical practice and research. Uniform classification of epileptic seizures is especially difficult. Although the ILAE classification scheme for seizures has been available for many years, the reliability of this system has not been previously assessed. Verbatim descriptions of seizure manifestations were transcribed from medical records as part of a large, population-based prevalence study of childhood epilepsy conducted in two countries in central Oklahoma. One senior neurologist and three neurology residents reviewed these descriptions independently and classified them by seizure type based on the ILAE system. Unweighted and weighted kappa statistics were used to assess the level of agreement between the study neurologist and each resident. The overall agreement between observer pairs in classifying seizure types based on all available descriptions was relatively poor (kappa = 0.24-0.38). Some improvement was evident when unclassified seizures were excluded, and comparisons were restricted to those based on descriptions with some degree of detail (kappa = 0.34-0.51). When specific types of seizures were classified, agreement was fair to excellent for most types (kappa = 0.45-0.90), with the exceptions of atypical absence (kappa = 0.11-0.28), partial seizures with secondary generalization (kappa = 0.26-0.40), and generalized motor seizures (kappa = 0.29-0.32). Sources of observer variability in addition to the classification scheme are considered. Use of specific criteria for the categorization of symptoms might improve the reliability of seizure classification.

The safety and efficacy of administering individualized phenytoin sodium loading doses by intravenous infusion were studied on 40 occasions in 37 adult patients having seizures. Doses were calculated based on an average volume of distribution (0.75 L/kg) and desired plasma phenytoin concentration. Total and free phenytoin concentrations were determined before and after the infusion. Phenytoin sodium doses of 225-1300 mg were administered by intravenous infusion at a rate of 40 mg/min after dilution in 0.9% sodium chloride injection to concentrations ranging from 4.5 to 13.5 mg/mL. Infusion rates were reduced if adverse effects occurred. The dosing method accurately achieved desired phenytoin concentrations (predicted mean +/- S.D. concentration, 18.3 +/- 1.6 micrograms/mL; observed mean concentration, 17.4 +/- 2.5 micrograms/mL). Postinfusion concentrations of free phenytoin ranged from 0.8 to 3.6 micrograms/mL (mean +/- S.D., 1.7 +/- 0.6 micrograms/mL). Of 21 patients evaluated for efficacy, 16 responded. A total of 45% of patients experienced pain at the infusion site, which diminished when the infusion rate was reduced. No serious cardiovascular or neurological toxicities occurred. The intravenous infusion method of administration is safe and effective and is useful for rapid achievement of therapeutic phenytoin concentrations in the emergency room setting.

Torticollis can be an isolated deformity or a sign of other neuromuscular disease. Underlying central nervous system or infectious disorders need to be considered and treated. In most patients, an improvement in the aesthetic disability is the primary objective. In general, an operation is indicated for the classical "congenital" muscular torticollis that does not respond to physiotherapy and forceful stretching of the restricting neck band. The mass or "tumor" of "congenital" torticollis requires no specific treatment. Operation may be delayed until age 1, but should probably be completed prior to school age. Reversal of craniofacial asymmetry is best achieved at an early age when there is maximum growth potential. Principles of surgery are (1) identification and release of all restricting bands involving the sternocleidomastoid muscle and other neck structures, (2) moving of the head and neck through a full range of motion prior to the completion of the procedure, and (3) resumption of physical therapy within 2 weeks of operation to prevent recurrent scar contracture. Various operations have been recommended, the most popular and reliable being inferior open tenotomy of the sternal and clavicular heads of the sternocleidomastoid muscle. Incisions should be placed low in the neck along skin lines and not over the clavicle in order to avoid hypertrophic scarring. Other procedures discussed are superior open sternocleidomastoid tenotomy (mastoid release), muscle lengthening procedures, and sternocleidomastoid excision. Only modest results should be anticipated in older children or adults with long-standing disease or advanced craniofacial asymmetry.

We have isolated and sequenced cDNA and genomic clones of the murine E alpha gene, one of the immune response genes of the major histocompatibility complex. Comparison of our data with those recently reported for the human homolog DR alpha shows an identical intron-exon structure, and a good conservation of the protein-coding sequences, including the amino acids potentially involved in organizing the second external protein domain into an immunoglobulin-like fold. Noncoding sequences are less conserved, with the exception of the promoter region. Finally, we show that differential expression of the gene in various cell types appears to be transcriptionally regulated, and that genomic rearrangements do not seem necessary for expression.

We present a case of malignant arrhythmias associated with hypocalcemia and subsequent cardiac arrest in a 20-year-old woman due to ingestion of 3.1 g mesoridazine in a suicide attempt. There were unexplained alterations in serum electrolytes preceding the cardiac arrest. The patient subsequently recovered and was transferred to a psychiatric hospital. Despite the paucity of data on the potential cardiotoxicity associated with mesoridazine overdose, this case demonstrates that malignant arrhythmias and cardiac arrest occur; consequently, these patients probably require constant ECG monitoring.

A series of tables based on mathematical calculations is given as guidelines for the number of directed donors needed by members of various ethnic/racial groups to provide a desired number of units of blood with a selected probability of achieving this result. From these tables, certain conclusions can be drawn. Unrelated donors who do not know their blood type are an inefficient source of directed donors. Rh-negative patients are unlikely to obtain enough directed-donor units from either related or unrelated donors with confidence unless these donors known their blood type. In general, siblings, parents, and offspring are the most efficient directed donors from the standpoint of compatibility. Cousins, uncles, aunts, nieces, and nephews are not much more likely to be compatible than unrelated donors are. It is easier to obtain suitable directed-donor units among Hispanics than among whites, blacks, or Asians, due to their skewed blood group frequencies. In general, using O-negative directed donors for Rh-positive recipients does not significantly increase the likelihood of finding suitable donors.

Morphologic and morphometric studies were carried out on eight cases of pure and mixed colloid carcinoma of the breast initially diagnosed by fine needle aspiration (FNA). Key morphologic features included (1) cellular smears, (2) single cells, loose aggregates and cohesive groups of cells bathed in a mucinous background, (3) single cells displaying nuclear eccentricity and (4) little variation in nuclear size or shape, with bland-to-accentuated chromatin and rare nucleoli. These morphologic features are compared with those observed in pregnancy adenoma, lobular carcinoma, fibroadenoma, ductal carcinoma and medullary carcinoma. A morphometric study employing the major and minor axes of the nucleus, its axis product and axis ratio was also performed. Statistical treatment confirmed that the nuclear axis product (a size factor) distinguished colloid carcinoma from the other breast lesions, except the small-cell type of ductal carcinoma. Furthermore, the nuclear axis ratio (a shape factor) discriminates pregnancy adenoma and small-cell ductal carcinoma from the other breast lesions studied. By combining morphologic and morphometric criteria, one can specifically separate colloid carcinoma from the other breast lesions when examining smears obtained by FNA. Since colloid carcinoma is usually composed of cells with a relatively benign-appearing cytomorphology, the importance of recognizing this entity in fine needle aspirates is emphasized.

Pre and post race serum malondialdehyde (MDA), creatine kinase (CK) and lactate dehydrogenase (LDH) levels were studied in runners following an 80 km (50 mile) race. MDA is an indicator of lipid peroxidation. Subjects averaged 47.4 years (range 35-60), had a mean maximal oxygen uptake (VO2max) of 48.2 ml/kg, and averaged 121 km (75 miles) per week in training. Throughout the race, runners maintained a pace approximating 72% of VO2max. Previous data from our laboratory indicated a high correlation between resting MDA and total CK and CK-MB. Present resting data confirms prior results (r = 0.84 and 0.69 respectively). In addition, the relationship established at rest persisted following exercise (r = 0.62 and 0.85 respectively). Post race CK, CK-MB, LDH and MDA values for all subjects were significantly greater than resting values (p less than 0.01). Mean post CK and CK-MB levels were nearly 10 and 4 times lower, respectively, than prior values from our laboratory in subjects following a 100 km (62 mile) race. It was concluded that post exercise serum enzyme elevations, universally accepted as a marker of tissue damage, correlate well and may be related to an exercise induced lipid peroxidation.

Signet-ring adenocarcinoma cells in serous fluids have been classically described as possessing vacuolated cytoplasm and eccentrically placed, crescent-shaped nuclei. We studied serous fluids from six patients that contained signet-ring adenocarcinoma cells by light microscopy; one case was also studied by transmission electron microscopy. We found that the adenocarcinoma cells were more often present in a non-signet-ring configuration. The typical crescent-shaped nucleus was rarely displayed in smears and may be seen only in the cell-block preparation. Special stains (PAS, mucicarmine and Diff-Quick) showed globular cytoplasmic positivity in signet-ring adenocarcinoma cells but not in mesothelial cells. Significant characteristic electron microscopic findings in the signet-ring adenocarcinoma cells included (1) cytoplasmic lumens or invaginations or both, (2) cytoplasmic protrusions and (3) mucin granules of various sizes and densities. Singly or in combination, all of the above features were located on one side of the nucleus, which suggests that signet-ring adenocarcinoma cells retain some degree of cellular polarity.

A case of angiomatoid malignant fibrous histiocytoma was studied by fine-needle aspiration biopsy and routine histologic methods. Smears from aspirated material consisted of numerous large loose cellular aggregates with occasional single cells. Histiocytelike cells and lymphocytes were the prominent cell types with lesser numbers of spindle-shaped, fibroblastlike cells. Moderate cytologic atypia was noted. A cystic mass with the above cytologic findings occurring in the superficial soft tissue of the extremity of a young patient should suggest the diagnosis of an angiomatoid malignant fibrous histiocytoma.

Class II major histocompatibility complex (MHC) molecules, the Ia antigens, are intimately involved in regulating the intensity and specificity of the cellular and humoral responses to T cell-dependent antigens. One approach to understanding the mechanism of this regulation is to analyze the structure and allelic polymorphism of Ia molecules. In addition there are regulatory polymorphisms in the expression of the I-E alpha and I-E beta class II MHC polypeptide chains. Analysis of the cDNA sequence indicates that I-A and I-E alpha chains are similar with short stretches of homology and other regions of nonhomology. Analysis of Northern blots of mRNA indicates that at least three separate types of regulatory polymorphisms result in failure of expression of I-E alpha. Comparison of allelic sequences of six alleles of the I-A alpha chain shows that almost all of the allelic polymorphism is in the first domain and that within the first domain it is clustered in three allelic hypervariable regions within the first domain of I-A alpha. The structural and functional implications of these findings are discussed.

Hallucinogenic drugs are unique in that they produce the desired hallucinogenic effects at what are considered non-toxic doses. The hallucinogenic drugs can be categorised into 4 basic groups: indole alkaloid derivatives, piperidine derivatives, phenylethylamines and the cannabinols. The drugs reviewed include lysergic acid diethylamide (LSD), phencyclidine (PCP), cocaine, amphetamines, opiates, marijuana, psilocybin, mescaline, and 'designer drugs.' Particularly noteworthy is that each hallucinogen produces characteristic behavioural effects which are related to its serotonergic, dopaminergic or adrenergic activity. Cocaine produces simple hallucinations, PCP can produce complex hallucinations analogous to a paranoid psychosis, while LSD produces a combination of hallucinations, pseudohallucinations and illusions. Dose relationships with changes in the quality of the hallucinatory experience have been described with amphetamines and, to some extent, LSD. Flashbacks have been described with LSD and alcohol. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug. The principles involve differentiating the patient's symptoms from organic (medical or toxicological) and psychiatric aetiologies and identifying the symptom complex associated with the particular drug. Panic reactions may require treatment with a benzodiazepine or haloperidol. Patients with LSD psychosis may require an antipsychotic. Patients exhibiting prolonged drug-induced psychosis may require a variety of treatments including ECT, lithium and l-5-hydroxytryptophan.

Linitis plastica of the stomach is usually difficult to diagnose preoperatively and can extend locally and metastasize widely before recognition. This insidious manner of spread may cause unusual presentations in organs distant from the stomach. The authors recently treated two patients who were initially found to have radiologic abnormalities of the colon and bladder, respectively. One patient was surgically explored with a view towards the resection of a primary colonic tumor, the other to determine the nature of a bladder tumor. Intraoperative histologic interpretation of frozen tissue samples from the gastric wall in each case radically altered the surgical approach and the prognosis. The clinical presentations illustrate that it may be difficult to obtain preoperative diagnostic tissue samples in such cases and that it is important for the surgeon to inspect and palpate the stomach wall during all abdominal explorations for cancer.