Jejunoileal arteriovenous malformation: localization for resection by segmental bowel staining techniques.

Arteriovenous malformations, submucosal vascular lakes, of the jejunum and ileum which cause chronic gastrointestinal bleeding and anemia are easily identified before operation by selective arteriography but difficult at operation owing to lack of physical signs. This report is concerned with a patient who had such a lesion located in the proximal jejunum. The involved segment was easily identified at operation by injection of Indigo Carmine solution during operation into the involved jejunal artery subselectively catheterized immediately prior to operation. The duration of jejunal staining before resection was 45 minutes in this case and varied from 35 to 55 minutes in five other patients who had right colectomy for carcinoma, providing the opportunity to inject accurately in a conveniently located radiology suite before operation. Safe, convenient, longer periods of staining which could be performed at the time of original diagnosis were demonstrated in dog experiments using "biologic" colloidal carbon in which the bowel segment was well stained at the time of sacrifice five days after injection. There were no gross or microscopic signs of injury to bowel.     

Behavioral studies of stimulus deprivation amblyopia in monkeys

Contrast sensitivity and increment-threshold functions were studied for three rhesus monkeys with stimulus deprivation amblyopia. The monkeys' right eyelids were sutured closed before the age of 1 month for periods of two weeks, 19 months and 23 months. Contrast sensitivity measurements for all three monkeys showed greatly reduced visual function in the deprived eye with a high spatial frequency cut-off 6 octaves lower in the deprived than the nondeprived eyes. The increment-threshold data collected for the two long-term lid-sutured monkeys showed both photopic and scotopic abnormalities in the deprived eyes. For example, with complete dark adaptation although the spectral sensitivity data for both the deprived and nondeprived eyes were well fit by the scotopic luminosity function, the sensitivity for the deprived eye was approximately 4 log units lower than the nondeprived eye. In addition, the spectral sensitivity data for the deprived eyes showed scotopic luminosity functions for achromatic adapting field luminances of 188, 750 and 3000 td whereas the nondeprived eye showed normal photopic function for all light adapted conditions. Even when the spectral sensitivity measurements were made in the presence of intense blue backgrounds, the data obtained for the deprived eyes were best described as showing scotopic function over the short wavelengths and photopic function only at the longer wavelengths. The increment-threshold functions for achromatic stimuli showed normal rod-cone interactions in the nondeprived eyes, but the functions were monotonic for the deprived eyes over a 9 log unit range of background luminances. Therefore, the results of these experiments show that stimulus deprivation causes profound defects for visual resolution, rod saturation and the rate of change of sensitivity with light adaptation.     

Evaluation of serum beta 2-microglobulin as a prognostic indicator in myelomatosis

Serum beta 2-microglobulin (beta 2-m) is frequently increased in patients with myelomatosis. The possibility that it could provide a biochemical indicator of prognosis was tested in a group of 129 patients from 3 centres, all serum analyses being carried out in one laboratory by radioimmunoassay. A strong association between the pretreatment serum beta 2-m level and survival was demonstrated, the data for the 2 main subgroups being very similar. In further detailed analyses of 64 patients, serum beta 2-m proved to be a stronger indicator of prognosis than current "standard" clinical and laboratory data, including stage determined by the method of Durie and Salmon and the combination of haemoglobin level and blood urea. The association between serum beta 2-m and survival remained close after treatment as indicated by the findings at one year. The serum beta 2-m in myeloma reflects the tumour mass and also reduced glomerular filtration when renal failure supervenes. It is concluded that the serum beta 2-m is a powerful prognostic indicator in myelomatosis and of considerable value in the investigation of patients with the disease.     

Liquid versus nonliquid heparinization of blood samples

Recent studies demonstrate that liquid heparinization of blood samples causes errors in PCO2 that range from 6% to 40%. Various nonliquid forms of heparin are available as alternatives.     

Metabolic and anthropometric changes with weight cycling in wrestlers.

Repeated cycles of weight loss and regain have come to be known as weight cycling. This phenomenon is frequently observed in athletes who must meet specific weight categories to qualify for competition. The purpose of this study was to determine the metabolic and anthropometric changes that occur with rapid weight loss/regain cycles in competitive wrestlers. Collegiate wrestlers were divided into two groups, "cyclers" (N = 8) and "noncyclers" (N = 6), based on their reported dieting history. Measurements included a 3-d diet record, resting energy expenditure (REE), skinfold and girth measures, and biochemical tests at three time points: preseason, peak season, and off-season. All anthropometric measures changed with time, and a diet group by time interaction was observed for the trunk to extremity skinfolds ratio (T/E) (P < 0.05), with greater fat loss and regain from the trunk area of the cyclers. There were no differences in REE within or between groups. Serum triiodothyronine (T3) values decreased over time (P < 0.01). Large weight losses appear to have occurred due to both dieting and short-term dehydration, and although physiological changes were observed, a training effect may have overridden any metabolic influence of weight cycling.     

Premedication for elective Caesarean section

Four coded, but otherwise unidentified, premedicants were prescribed in randomised order for 219 patients who were to undergo elective Caesarean section. Seventy-six (35%) of these patients affirmed at the pre-operative visit that they were not anxious. Diazepam 5 mg and lorazepam 1 mg appeared to be superior to the placebo and to 10-6 ml of 90% alcohol in inducing calmness and/or drowsiness, although the differences were not statistically significant. The incidence of awareness or unpleasant dreams was considerably higher in the placebo and alcohol series (6.2% and 7.5%) than in the diazepam and lorazepam series (nil and 2.1%). There was no remarkable difference in the condition of the immediate newly-born related to the premedicant received by the mother, any small differences being much less impressive than that related to the duration of the U-D interval. No notable differences were observed in the long term conditions between the infants in the placebo, alcohol and diazepam series but the incidence of "reluctance to feed". If relief from preoperative anxiety-and possibly a reduction in the likelihood of awareness-without undue effect upon the infant is considered desirable, diazepam 5 mg is the preferred choice from the four drugs investigated.     

The effects of anterior lesions on performance on a story comprehension test: left anterior impairment on a theory of mind-type task

Participants with unilateral anterior or posterior lesions were compared to a healthy group on a theory of mind-type task that involved explaining the words or actions of story characters in a series of brief vignettes. Participants also carried out a set of non-social neuropsychological tests. Those with left anterior brain lesions (n=6) showed impairment relative to those with right anterior (n=13), left (n=4) and right (n=8) posterior lesions and healthy participants (n=60) in story comprehension, and their errors commonly involved failure to make non-literal interpretations. The left anterior lesion participants also showed impairment on some measures of executive function. The implications of the findings for our understanding of impairments in story comprehension after brain injury are discussed in terms of models of executive function and theory of mind.     

Revision of failed total hip arthroplasty with a proximal femoral modular cemented stem

We have designed a modular cemented femoral component for revision of failed total hip arthroplasty in which deficiency of the proximal femur is such as to require a variable extrafemoral portion of the stem. We present the results of the first 74 operations in 72 patients; 56 of the patients had grade-3 or grade-4 femoral deficiency as defined by Gustilo and Pasternak and 24 had fractures of the proximal femur, of which 22 were periprosthetic. There was or had been infection in 19 hips. At a mean follow-up of 5 years 9 months (1 to 12 years) nine stems were radiologically loose of which three had been revised. There were no failures in 45 cases in which there was fixation of the distal stem of 10 cm or more. Dislocation occurred in nine patients and there were four cases of infection in the 19 which were, or had been, infected previously. There were no neurovascular complications and no intraoperative femoral fractures. The femoral bone stock improved radiologically in 45 hips of which 29 showed considerable reformation of the proximal femur; 27 remained unchanged and two showed increasing osteoporosis.     

Combined modality trials of the Cancer and Leukemia Group B in stage III non-small-cell lung cancer: analysis of factors influencing survival and toxicity.

BACKGROUND: Combined modality therapy (CMT) is the standard of care for patients with unresectable stage III non-small-cell lung cancer (NSCLC); however, insufficient data are available regarding prognostic factors in this disease setting. PATIENTS AND METHODS: Six hundred and ninety-four patients included in five trials conducted by the Cancer and Leukemia Group B evaluating CMT in stage III NSCLC were included in this analysis. The primary objective was to identify factors that were predictors of survival and selected radiation-related toxicities using Cox regression models and logistic regression analysis. RESULTS: The Cox model shows that performance status (PS) 1 [hazard ratio (HR) 1.24; 95% confidence interval (CI) 1.06-1.45; P=0.009] and thoracic radiation therapy (TRT) only (HR 1.58; 95% CI 1.22-2.05; P=0.001) predicted for poorer survival, while baseline hemoglobin >/=12 g/dl predicted for improved survival (HR 0.67; 95% CI 0.55-0.81; P 5% weight loss (OR 2.9; 95% CI 1.3-6.6; P=0.008) and patients receiving concurrent chemoradiation (OR 7.3; 95% CI 3.4-15.6; P=0.0001). CONCLUSIONS: Baseline hemoglobin and PS, as well as the use of CMT, have the greatest effect on survival in unresectable stage III NSCLC. The use of concurrent chemoradiation increases the risk of esophagitis, which remains the primary radiation-related toxicity.