Peritoneal carcinomatosis: preoperative CT with intraperitoneal contrast material.

Thirty-five abdominal computed tomographic (CT) scans of 27 patients with peritoneal metastases from a mucin-producing tumor of the appendix, colon, small bowel, or ovary were retrospectively reviewed. Fifteen scans were obtained of 15 patients after CT with intraperitoneal infusion of contrast material (IP), and 20 scans were obtained of 16 patients with CT without IP. Subsequent exploratory laparotomy revealed that all 27 patients had multi-focal spread of peritoneal metastases. The sensitivity of CTIP and CT without IP for detection of peritoneal metastases at all sites of involvement was 61% and 59%, respectively. For CTIP, the highest sensitivity was in the right subphrenic space (88%), splenic hilum (86%), and left subphrenic space (83%). For CT without IP, the highest sensitivity was noted in the splenic hilum (100%), left subphrenic space (75%), and left paracolic gutter (75%). CTIP and CT without IP had low sensitivity for detection of disease in the greater omentum (50% each) and small-bowel mesentery (38% and 59%, respectively), two areas that had the highest frequency of metastases.     

Hemodynamic alterations secondary to an electrical burn in the rat: a pilot study

Rats subjected to a standard electrical burn of 250 volts for 10 seconds receive a severe injury stimulating a pronounced systemic circulatory response. Initial postinjury hyperemia is replaced by a low perfusion state within 24 hours. Our study demonstrates the difficulty in isolating regional microcirculatory alterations under such circumstances. Modification of the burn model or the method of fluid resuscitation may minimize the influence of this dynamic systemic response.     

The use of noxythiolin (Noxyflex 'S') as an antiseptic irrigant in upper urinary tract drainage following percutaneous nephrolithotomy

Percutaneous nephrostomy drainage for the relief of obstruction or stone removal has become a common procedure. Despite the routine use of prophylactic antibiotics, nephrostomy urine frequently becomes infected (approximately 30% of cases). Noxythiolin irrigation has been used to prevent and treat bladder infections. A double-blind, placebo controlled study was carried out in 20 patients undergoing a single-stage percutaneous nephrolithotomy to evaluate the use of noxythiolin as an upper urinary tract antiseptic. In the patients whose nephrostomy tubes were irrigated with a 2.5% solution of noxythiolin, significant bacterial infection was eliminated from the nephrostomy urine and colonisation of the catheter tip was markedly reduced. Noxythiolin also rendered pre-operative infected bladder urine sterile. There were no untoward local or systemic sequelae in either group of patients. This study indicates that irrigation of the upper urinary tract with noxythiolin solution is safe and may be a useful adjunct to reduce the risk of sepsis in patients undergoing percutaneous drainage procedures.     

Ethanol reduces tolerance, sensitization, and up-regulation of D2-receptors after subchronic haloperidol

To study the interrelationships between dopamine D2-receptor density and behavioral responses after chronic treatment with neuroleptics female Wistar rats received haloperidol (HP; 14 mg/l), ethanol (ETOH; 5 vol.%), a combination of both, or tap water as drinking fluids for one or two weeks. Mean intake doses ranged between 1.28 and 1.48 mg/kg/day (HP) and between 3.7 and 4.8 g/kg/day (ETOH). HP administered for one or two weeks raised the number of [3H]spiroperidol binding sites in the striatum by 55%. Concomitant administration of ETOH diminished the increase of Bmax to 23%. The up-regulation was even reversed when ETOH was added with a delay of one week, although the drug alone had no effect on dopamine-D2-receptor density. KD values were not substantially affected. During HP treatment the rats established a tolerance to the motor sedation which was measured by circadian motility recordings. Coadministration of ETOH reduced the development of tolerance, the activity remained at a depressed level. Acute applications of HP (0.3, 0.6, and 0.9 mg/kg, or saline, respectively) also revealed tolerance to the drug for various behavioral responses (exploratory locomotion, rearing, rotarod performance, catalepsy). The tolerance was reduced in all those animals which had received combinations of ETOH and HP. The reduction was most pronounced for the cataleptic response. Pretreatment with ETOH alone had no effect. Sensitization to dopamine agonists was studied by apomorphine-induced stereotypies (licking, sniffing, and forepaw scratching). As expected, chronic HP enhanced the responses. The increased number of stereotypies was reduced in rats pretreated with the combination, although ETOH alone did not affect the response. The reduction was most pronounced for licks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Double mutation (A171T and D444H) is a common cause of profound biotinidase deficiency in children ascertained by newborn screening the the United States. Mutations in brief no. 128. Online

Biotinidase deficiency is inherited as an antosomal recessive trait that, unless treated with pharmacologic doses of biotin, can result in neurologic and cutaneous symptoms. We have identified two new mutations in exon D of the biotinidase gene of children with profound biotinidase deficiency ascertained by newborn screening. Transition 511G->A near the 5' end of exon D results in a substitution of threonine for alanine 171 (A171T) and transversion 1330G->C occurs close to the 3' end of exon D causing a substitution of histidine for aspartic acid 444 (D444H). The D444H mutation was detected in four individuals from our normal population whose mean serum biotinidase activity is 5.25 nmol/min/ml, which is significantly lower than the mean normal activity (7.1 nmol/min/ml). We calculated that this mutation causes a 52% loss of activity in the aberrant enzyme. Twenty-three individuals with the D444H mutation were found by allele specific oligonucleotide analysis of DNA from 296 randomly-selected, anonymous dried-blood spots. We estimate the frequency of this allele in the general population to be 0.039. In contrast, no individuals in 376 have the A171T mutation. Fourteen children (eleven probands and three siblings) out of the 31 enzyme-deficient children have both the A171T and D444H mutations. Both mutations are inherited from a single parent as a double mutation allele. The nine families in which this allele was identified are of mostly European ancestry, although the mutation cannot be attributed to a specific nationality or ethnic group. The serum of a child who is homozygous for the double mutation allele has very little CRM and the aberrant enzyme has very low biotinylhydrolase activity and no botinyl-transferase activity. This double mutation allele (A171T and D444H) is a common cause of profound biotinidase deficience in children ascertained by newborn screening in the United States.     

Clinical comparison of the Roche Septi-Chek and Dupont Isolator blood culture systems

A study was conducted to compare the recovery of clinical isolates by the DuPont Isolator and Roche Septi-Chek blood culture systems. A total of 5,262 blood culture specimens were processed by the two systems. Of these, 358 cultures contained significant isolates: 219 were positive in both systems, 68 were recovered only by Isolator, 71 were recovered by Septi-Chek only (not statistically significant). Of the isolates recovered in both systems, 159 were positive the same day, 55 were recovered first by Isolator, and 5 were recovered first by Septi-Chek. In cases where Isolator recovered organisms first, the average difference in time was one to two days. Regarding particular groups of organisms, there was no difference between the systems in recovery of Enterobacteriaceae, anaerobes, yeast, and gram-positive bacteria, except for Streptococcus pneumoniae. Septi-Chek recovered S. pneumoniae significantly more often. These results suggest that these two systems are essentially comparable, except with S. pneumoniae, although the Isolator frequently provided results more rapidly.     

The distribution of ions in the smooth muscle of the guinea-pig taenia coli

1. Tracer movements and ionic composition have been observed in the smooth muscle of the guinea-pig taenia coli in vitro at 4, and 35 degrees C. The muscle was quiescent at 4 degrees C, and did not show spontaneous electrical nor mechanical activity for 25 min after re-warming. It was therefore possible to make observations on the quiescent tissue at 35 degrees C.2. The rate of loss of tracer sodium was sensitive to changes of temperature, with an average Q(10) of 3.4 +/- 0.4 on warming in the range 4-35 degrees C. Exponential analysis of (24)Na efflux at 35 degrees C showed an initial rapid phase, a second phase with t((1/2)) = 2 min, and a slowly exchanging phase. The second phase was most sensitive to changes of temperature and contained 15 m-mole Na/kg fresh wt. The corresponding transmembrane flux in spontaneously active muscle at 35 degrees C would then be 30 p-mole cm(-2) sec(-1), and 20% of the available metabolic energy would be needed to maintain this exchange.3. The rate of loss of tracer sodium was reduced in potassium-free or sodium-free solutions, but the effects were not impressive.4. The cell size increased at 4 degrees C, and fell again on warming while Na and Cl left the cell and K was taken up. Cell chloride content was linearly related to cell size.5. The observations are interpreted on the assumption that the cytoplasm is osmotically isotonic and electrically neutral, and that some Na, K and Cl are sequestered elsewhere in the tissue. It is concluded that the quiescent smooth-muscle cell membrane is rather more permeable to sodium than the skeletal-muscle cell membrane.     

Users and non-users of doctors — implications for self-care

Sixty patients who visited their general practitioner were matched with 60 patients registered with the same doctor, who were of the same sex and in the same ten-year age group, and who had not visited the doctor for at least one year, but had recently experienced symptoms similar to those presented by the attending patients.

Comparison of the 60 pairs revealed the following differences, all substantial although not all statistically significant. The patients who visited the doctor perceived themselves as less healthy, fewer had attempted self-treatment, more reported serious personal problems, and fewer reported obstacles to visiting the doctor.

Differences between the pairs were negligible for total number of current ailments, effectiveness of self-treatment, if used, optimism about the healing powers of doctors, and fear of troubling their doctor with trivia.