Search

Endoscopic injection sclerosis is a therapeutic alternative in the management of esophageal varices. Complications of sclerotherapy have been minor, including fever, bacteremia, and abnormal chest x-ray. We performed a prospective study to evaluate the frequency of postsclerosis bacteremia. Bacteremia was detected in 14 procedures (50%). There were no cases of bacteremia in a group of control patients with esophageal varices undergoing upper gastrointestinal endoscopy without sclerosis (p less than 0.05). Bacteremia was transient and unrelated to the presence of fever or other clinical complications. The organism most commonly cultured from blood, alpha-hemolytic streptococcus, probably represents a contaminant from the oropharynx, introduced into the bloodstream during sclerosis. We conclude that injection sclerotherapy of esophageal varices is associated with a higher incidence of bacteremia than routine upper endoscopy and that selected patients may require antibiotic prophylaxis when undergoing this procedure.

To investigate Piaget's theory of object concept development, a series of 6 tasks was administered in a combined longitudinal/cross-sectional design incorporating a number of methodological controls. The tasks spanned the entire sensorimotor period and included single versus sequential displacements combined with visible or invisible hidings. 36 infants from 5 to 32 months of age at initial testing were drawn equally from day-care and home settings. All infants received the 6 tasks during each of 3 testing sessions over a 6-month period. Clear evidence was obtained for task ordinality as proposed by Piaget, with ordinality coefficients ranging from .71 to .82 for the 3 testing sessions. Performance changes across the 3 sessions were also ordinal in 80% of the cases. Expected age, task, and session effects and accompanying interactions were also obtained.

Optical methods for monitoring neuron activity were developed because these methods lend themselves to simultaneous multiple-site measurements. With the use of new voltage-sensitive dyes, the dye-related pharmacology and photodynamic damage appear to be relatively unimportant. Using multiple-site measurements made with a 124-element photodiode array, we estimated that approximately 30 of the 200 neurons present in the Navanax buccal ganglion make action potentials during feeding and that approximately 300 of the 1100 neurons present in the Aplysia abdominal ganglion are active during the gill-withdrawal reflex. The fact that a light mechanical touch to the siphon skin activated such a large number of neurons in the abdominal ganglion suggests that understanding the neuronal basis of the gill-withdrawal reflex and its behavioral plasticity may be forbiddingly difficult.

The patient who volunteers to be a subject for Part II of the certifying examination in psychiatry and neurology is an indispensable but surprisingly invisible participant in a highly controversial process. A survey of the attitudes of 78 patients toward this experience revealed that although they experienced a significant degree of stress, the overwhelming majority viewed their participation in strongly positive terms. The patient's loyalty to the host institution and the manner in which the patient is prepared for the experience appear to be the major factors in determining a positive outcome.

The absorption, fluorescence, dichroism, and birefringence of stained squid axons were measured during action potentials and voltage clamp steps in an effort to find large optical signals that could be used to monitor membrane potential. Changes in all four optical properties were found that were linearly related to membrane potential and, with several new dyes, the signal-to-noise ratios were larger than any obtained previously. The problem of photodynamic damage was greatly diminished; with a merocyaninerhodanine dye, the photodynamic damage associated with intense light and the presence of oxygen was negligible. The absorption change obtained with this dye was relatively large; it could be measured with a signal-to-noise ratio of 100:1 during a single action potential.

Conduction in focally demyelinated frog nerves has been measured optically using potential-sensitive dyes. Absorption changes were recorded with an array of photodiodes positioned in the image plane of a microscope. Both the amplitude and conduction velocity of the optical signals decreased in the demyelinated region. Conduction was improved after exposure to the potassium channel blocking agent 4-aminopyridine.

The adenomatous colonic polyp, a neoplastic lesion, is the precursor of most if not all carcinomas of the colon and rectum. Confirmatory evidence is derived from epidemiological, histological and clinical data demonstrating a close parallelism between adenomas and cancer of the colon. Based on current knowledge, all colonic polyps should be removed to prevent the development of colonic cancer. However, since the risk of malignancy within an adenoma is related to its size, histology and the degree of dysplasia, practical considerations dictate that all polyps 1 cm in diameter or larger should be removed upon their detection by barium enema or colonoscopy since such adenomas are the ones most likely to contain malignancy. The endoscopic removal of colon polyps can be efficiently and safely accomplished when established principles of colonoscopy and electrosurgery are followed. This technique requires the proper equipment, a skilled endoscopy assistant, and an experienced endoscopist with the ability to adeptly perform colonoscopy, an understanding of the basic concepts of electrocautery and knowledge of the various structural configurations of colonic polyps. Colonoscopic polypectomy will avoid the need for surgical resection in most instances. Management of the malignant colonic polyp remains controversial. The patient with a sessile or pseudo-pedunculated polyp containing invasive cancer should undergo colonic resection. Surgery is not necessary for the majority of patients whose pedunculated adenomas contain invasive cancer, unless the malignancy is poorly differentiated, the cancer invades lymphatics or vascular channels, or tumour is seen at or near the resection margin. Surveillance colonoscopy after endoscopic polypectomy should be performed in most instances within one year to look for recurrent tumour, missed polyps or a metachronous adenoma. Subsequently, colonoscopy should be performed every two years in patients with multiple index polyps, and every three years after removal of a single index adenoma.

Several factors that affect the suitability of opticaL methods for monitoring neuron activity were evaluated in several species of gastropod molluscs. The mean cell body diameter and the total number of cells in the central nervous system were determined In 6 preparations and qualitative evaluations were made for an additional 25 species. There was a factor of 10 difference in mean diameter between species with the smallest cells (prosobranchs) and those with the largest (certain opisthobranchs). Several opisthobranchs had about 5000 central neurons; we estimate that the prosobranchs and pulmonates had at least 5 times as many neurons. When the opacity to transmitted light was measured the percent transmissions of circumesophageal ganglia were between 4% and 40%. We attempted to measure optical signals associated with spike activity in 20 gastropod species; in most species signals were readily detected in single trials.

Infants' sensitivity to correlations or co-occurrences among attributes may play a role in abilities ranging from pattern or object recognition to category formation. The present set of experiments investigated 4-, 7-, and 10-month-old infants' ability to perceive and base novelty responses on correlations among perceptual attributes in a category-like context (i.e., with the correlation embedded in a set of discriminable stimuli). In a habituation-dishabituation paradigm, 10-month-old infants clearly responded on the basis of the correlation among attributes. In contrast, 4- and 7-month-old infants responded primarily on the basis of specific featural information, but did not respond reliably to the correlation. It is suggested that the sensitivity to correlated attributes demonstrated by 10-month-old infants may have implications for the processes underlying the infants' categorization abilities.

1. In an attempt to obtain information about structural changes related to electrical activity in Electrophorus electroplates, we have determined the size and time course of the changes in light scattering and in bire-fringence that occur during and after the discharge of the electric organ.2. The changes in light intensity detected with a photomultiplier were never greater than 0.2% for a single discharge, and were often much smaller than this, but records with an acceptable ratio of signal to noise could be obtained by signal-averaging techniques.3. A single stimulus led to a decrease, then an increase, and finally another decrease in the light scattered by slices of the main electric organ. These three phases were designated E1, E2 and E3.4. E1 started at the beginning of the action potential, and its peak was reached at the same time as the completion of repolarization, even when the repolarization was delayed by cooling or hastened by drawing larger currents from the tissue.5. E2 was proportional to the integral of the current flowing through the slice of electric organ, and may arise from the swelling and shrinking of the tubules that stud the faces of the electroplates. It developed within a millisecond or two of the start of an applied current, and lasted for about 100 msec.6. E3 was a variable decrease in scattering that lasted for some seconds.7. A stimulus also led to a transient increase in the birefringence of the electric organ. The optical change followed the change in electrical potential across the innervated faces of the electroplates with a delay of somewhat under 50 musec.8. This voltage-dependent change in birefringence may arise from a Kerr effect (electric birefringence) in the membrane or from compression of the membrane.

1. When light scattering was measured during hyperpolarizing and depolarizing voltage-clamp steps, relatively large scattering changes were found during the depolarizing steps. These large changes were found to depend on the time integral of the ionic current and not on the changes in conductance or potential.2. The current-dependent changes were examined at several scattering angles, and three distinct time courses were found. At 30-120 degrees , the main change occurred after the current when steps of 2-5 msec duration were used. This change was called I-90 degrees . At 15-30 degrees , the change occurred with the same time course as the time integral of the current. This change was called I-25 degrees . At 5-15 degrees the scattering change occurred with a time course intermediate between that of I-90 degrees and I-25 degrees . This change was called I-10 degrees .3. In all experiments, outward potassium and outward sodium currents led to similar light scattering changes indicating that specific effects of the cation carrying the current across the membrane were not involved.4. The size of I-90 degrees was reduced by 29% when an isethionate artificial sea water was substituted for the normal chloride artificial sea water. This reduction equalled the reduction predicted for a transport number effect at the membrane-solution interface. The time course of I-90 degrees was similar to the predicted time course for a volume change in the periaxonal space, and such volume changes were tentatively identified as the origin of I-90 degrees .5. Because of difficulties in measuring the time course of I-25 degrees , it was not possible to distinguish between a water of hydration effect and a transport number effect as the cause of this change. Similarly, the origins of I-10 degrees were not identified. Only I-10 degrees was altered in size and time course when the external refractive index was increased with bovine albumin.6. When the scattering changes during the action potential were examined in light of the voltage-clamp experiments, we concluded that the forward-angle change was potential-dependent and that the long-lasting change at right angles probably represented a swelling of the periaxonal space resulting from the fact that chloride carried a significant fraction of the outward current during the action potential.

1. To obtain information about structural events that occur in axons, changes in light scattering from squid giant axons were measured during action potentials and voltage-clamp steps.2. The scattering changes were measured at several scattering angles. Because the changes in scattering divided by the resting scattering were between 10(-6) and 10(-5), signal-averaging techniques were used to increase the signal-to-noise ratio.3. The scattering changes during the action potential were different at different angles. Two types were found, one at 10-30 degrees (forward angles) and the other at 60-120 degrees (right angles).4. At forward angles, there was a transient scattering decrease during the action potential. The time course of the change was similar to that of the action potential; this change was thought to be potential-dependent.5. At right angles, there was a transient scattering increase during the action potential followed later by a second, longer-lasting increase. Indirect evidence indicated that neither component could be totally potential-dependent.6. To further analyse these effects, scattering was measured during voltage-clamp steps. The changes seen during hyperpolarizing steps were presumed to be potential-dependent; again two different changes were found, one at forward angles and one at right angles.7. The potential-dependent change at right angles occurred with a time course that could be approximated by a single exponential with a time constant tau = 24 musec. The change at forward angles required two exponentials, tau(1) = 23 musec, tau(2) = 900 musec, to represent its time course.8. The size of both potential-dependent changes was proportional to the square of potential. The change at right angles, but not that at forward angles, was increased in size by the addition of butanol or octanol to the bathing solution.

1. Observations have been made on the changes in optical retardation accompanying the passage of impulses along crab leg nerves and squid giant axons.2. The nerves were mounted on the stage of a polarizing microscope, at 45 degrees to the planes of polarization and analysis, brightly illuminated with white light. During the nerve impulse the intensity of the light passing the analyser decreased temporarily by 1 part in 10(3)-10(6). Signal-averaging techniques were used to obtain an acceptable ratio of signal to noise.3. The changes in light intensity recorded under these conditions were shown to arise almost entirely from alterations in retardation, with little or no interference from scattering, absorption, linear dichroism or optical rotation effects; the occurrence of stimulus and coupling artifacts was also ruled out.4. In the squid giant axon, the retardation change was shown to be located in a thin cylinder immediately surrounding the axoplasm, and to have a radially oriented optic axis.5. The time course of the decrease in optical retardation was very similar to that of the action potential recorded with an intracellular electrode, suggesting that the retardation closely followed the electrical potential across the membrane.

1. An analysis has been made of the change in optical retradation of the membrane elicited by the application of voltage-clamp pulses in squid giant axons.2. The retardation response consists of three separate voltage-dependent components. For freshly mounted axons, defined as being in state 1, hyperpolarizing pulses give a rapid increase in the light intensity measured with crossed polarizers which has been termed the fast phase. This is followed by a rather slow return towards the base line termed the rebound. On treatment of the axon with certain agents that include tetrodotoxin, high calcium and terbium, the rebound disappears and the fast phase slows down, increases in size, and has a new slow component added to it. This transition from state 1 to a second state, 2, appears to be irreversible.3. In state 1, the time constant of the fast phase is 20-40 musec at 13 degrees C; it has a very large negative temperature coefficient (Q(10) = Ca.(1/8)). The size of the retardation change is independent of temperature and varies as the square of the applied voltage, but the voltage-retardation curve is symmetrical about a point well beyond zero membrane potential, at an internal potential of around + 70 mV. In state 2, the time constant is about five times larger, and varies much less markedly with temperature; the apex of the voltage-retardation curve is shifted to + 200 mV.4. The rebound has a time constant of the order of 20 msec at 13 degrees C. A 10 degrees rise in temperature more than halves the time constant and roughly doubles the amplitude of the rebound. The voltage dependence of the rebound differed from that of the fast phase.5. The slow component of state 2 has a time constant of about 2 msec which does not change noticeably between 10 and 25 degrees C. The size of this component seems to be linearly dependent on the applied voltage, rather than obeying a square law.6. A tenfold increase in external calcium concentration had no discernible effect on the fast and slow phases, but reversibly reduced the amplitude of the rebound nearly to half.7. In experiments on perfused axons, the retardation response was not measurably altered by any of the modifications made to the composition of the perfusing fluid.8. There was some indication of the possible existence of a small current- or conductance-dependent component of the retardation response.9. These phenomena seem likely to originate either from molecular relaxation processes analogous with the Kerr effect, or from changes in membrane thickness under the influence of the pressure exerted by the electric field. However, the specific molecules involved in the retardation response cannot yet be identified.

1. Changes in light scattering from stimulated crab leg nerves were measured in an effort to study changes in structure that occur during the action potential.2. The peak changes in scattering after individual stimuli were 10(-4)-10(-5) of the resting scattering; signal averaging techniques were used to increase the signal-to-noise ratio.3. During the compound action potential there was a transient increase in the 90 degrees scattering which reached a peak about 20 msec after the stimulus. This increase was probably not due to a change in axon volume. Its time course was somewhat slower than that of birefringence changes measured at the same time.4. In normal sea water the transient increase was followed by a longer lasting (persistent) decrease in scattering. This persistent decrease could be converted to an increase by reducing the tonicity of the sea water or by raising the external refractive index. This scattering change may represent a swelling of the axon resulting from the ionic exchanges that occur during the action potential.