Outpatient coronary arteriography

A total of 12,719 outpatient coronary angiograms have been performed, using the Sones Technique, at Butterworth Hospital in Grand Rapids, Michigan, over the past 14 years. A consecutive series of 5,107 of these outpatient angiograms were selected for review here. Sixty-one percent of these patients were diagnosed with coronary artery disease. No deaths occurred in this series. Only 2.22% of patients in this series had complications. Outpatient coronary angiography is a safe, cost-effective, and efficient diagnostic technique.     

Differential diagnosis of sonographically detected tumours in the fetal cervical region

Differential diagnosis of sonographically detected fetal neck tumours is difficult. The sonographic criteria for encephalomyelocele, lymphangioma/hygroma, teratoma, sarcoma, haemangioma, neuroblastoma and goitre are given on the basis of the authors' own observations and information from the literature. Elevation of alpha-fetoprotein in the amniotic fluid is a frequent but non-specific finding. Chromosome analysis after amniocentesis can be a useful supplementary procedure for assessing the prognosis and deciding upon the delivery procedure. Sonographic detection of a tumour in the fetal neck region enables preparations to be made for dystocia and postnatal dyspnoea of the newborn. The obstetrician must cooperate closely with paediatricians, neurologists, surgeons and ENT specialists.     

A rapid microprocedure for isolating RNA from multiple samples of human and rat brain

In order to establish a routine procedure for isolating undegraded RNA from small amounts of rat and human brain tissue, several techniques were investigated. Initial studies demonstrated that undegraded RNA could not be reproducibly isolated from milligram amounts of brain tissue homogenized in an aqueous medium. Several isolation techniques utilizing tissue homogenization in the denaturing agent guanidinium chloride were compared. This method of homogenization, followed by sedimentation of RNA through cesium chloride, resulted in good yields of undegraded translationally active RNA. A maximum of 6 RNA samples could be processed simultaneously. In contrast, when homogenization in guanidinium chloride was followed by repeated guanidinium chloride-ethanol precipitations many samples could be processed simultaneously. The resulting RNA yields were low. The introduction of several modifications in the guanidinium chloride-ethanol precipitation technique resulted in a high yield of undegraded translationally active RNA. DNA was removed by two guanidinium-ethanol precipitations. Residual protein was digested with proteinase K. RNA was precipitated after extraction with phenol-chloroform-isoamyl alcohol. This refined procedure allows the recovery, in high yields, of translationally active undegraded RNA which is both DNA and protein free. Thirty-six samples can be processed in one day.     

The treatment of agoraphobia with biofeedback and systematic desensitization

The aim of this study is to use biofeedback techniques in combination with systematic desensitization in the treatment of generalized phobias with high anxiety, such as agoraphobia. We state the advantages accruing from the combination of these two techniques. Four clinical cases of agoraphobia are presented, in each of which some of the above-mentioned advantages are evident.     

Gingival bleeding in an experimental clinical trial design

An experimental clinical trial design is described in which the onset of gingival bleeding was used as an indicator of early gingivitis. Twenty-nine dental students participated in a double-blind crossover trial utilising chlorhexidine as a known plaque inhibitor. The onset of gingival bleeding was assessed in three ways, one of which yielded a statistically significant difference in favour of the active mouthrinse (P = 0.02). The method has a role in screening agents believed to be active against gingivitis.     

A comparison of d-amphetamine, l-amphetamine, and methamphetamine self-administration in rhesus monkeys

Rhesus monkeys were trained to self-administer cocaine on a fixed-ratio 10 schedule of reinforcement during a daily 3 hr session. d-amphetamine, l-amphetamine, and methamphetamine, at various dosages, were substituted for the cocaine for six consecutive sessions. The animals were returned to cocaine baseline between each test series. All three drugs were self-administered at rates higher than saline control levels. d-Amphetamine and metamphetamine were equipotent in maintaining self-administration behavior and both were approximately 4 times more potent than l-amphetamine.     

Experimental gastric ulcers in the fundic gland area following transplantation of the gastric-wall pedicles

Using adult mongrel dogs, a portion of the anterior gastric wall of the pyloric gland area was transplanted into the fundic gland area using the Z-plastic procedure forming an islet. Three weeks postoperatively, 2 per cent histamine in sesame oil was injected intramuscularly in a daily dose of 2 mg/kg body weight. Ulcers developed in the graft in nine of 19 animals. The factors responsible to the development of the ulcers may well be circulatory disturbance and reduction of mucosal resistance following surgical insult, and continuous irritation caused by gastric juice. When a portion of the anterior gastric wall of the fundic gland area was transplanted into the fundic gland area followed by administration of histamine in sesame oil, ulcers developed in the graft only in four of 12 animals. Histological examination revealed the regenerated epithelium at the margin of the ulcers. Thus the ulcers presently induced may provide an useful experimental model for ulcers in the fundic gland area.     

An unusual foreign body in the bladder 7 years after a Stamey endoscopic bladder neck suspension

Delayed migration of the suture and bolster after an endoscopic bladder neck suspension across tissue planes, with subsequent erosion into the bladder, is uncommon. We present a case of late migration of the suture and bolster occurring 7 years after a Stamey endoscopic bladder neck suspension. A 56-year-old woman had undergone a Stamey procedure in June 1990. In January 1997 she presented with discomfort in the left iliac fossa and the groin. A midstream sample of urine showed microscopic hematuria. Imaging and endoscopic examinations revealed a calcified lesion on the left lateral wall of the bladder, attached to the Stamey sutures. Cystolitholapaxy was attempted, but during the procedure it became obvious that there was a calcified cuff attached to the suture. This was removed endoscopically, along with its suture. Cystoscopy should be considered early in the evaluation of patients presenting with lower abdominal discomfort or irritative voiding symptoms after retropublic bladder neck suspension.     

A modified technique for ethanol injection of liver tumors: preliminary results

The technique for ethanol injection of liver tumors was modified in order to obtain less reflux with a better intratumoral distribution of ethanol, leading to more extensive necrosis and to a reduction of pain. The needle was stopped just before its entrance into the tumor and ethanol was injected while the needle was advanced a little beyond the distant border of the tumor. Pain and change in echogenicity during and immediately after each injection were evaluated in 11 patients with 38 malignant lesions who received 90 injections with the new or 46 with the conventional technique. Computed tomography and biopsies were used for later follow-up. With the new technique the injected tissue volume converted much more markedly to high echogenicity (p 0.005), the pain was significantly reduced (p 0.001), and posttreatment biopsies significantly less often contained viable cells (p 0.005). These preliminary results suggest that the modified injections were more effective and less painful, and have enabled us to inject a larger volume of ethanol at each session to reduce the number of treatments. Correspondence to: N. M. Elgindy     

Percutaneous insertion of CSF ventriculoatrial shunts — a new technique

Summary In conventional techniques concerning insertion of ventriculoatrial shunt systems, the route to the caval system is accomplished by a lateral rightsided neck dissection and isolation usually of the facial or the external jugular vein, in order to introduce the atrial catheter into the internal jugular vein and consequently the superior vena cava.A new approach for catheterization of the internal jugular vein is proposed. The technique is a combination of the well proven approach for percutaneous catheterization of the vein and a technique used in the implantation of permanent pacemaker leads.We find the method suitable for cases whenever a VA-shunt is prefered.