Similarity of pulmonary rejection patterns among heart-lung and double-lung transplant recipients

The transbronchial biopsy and clinical courses of 9 double-lung and 1 single-lung recipients surviving greater than 10 days were analyzed and compared to those of 15 heart-lung transplants performed during the same time period. Of these, 8 isolated lung (LT) and 11 heart-lung transplant (HLT) recipients survived greater than 50 days and were at risk of developing obliterative bronchiolitis believed to be a form of chronic rejection. Cyclosporine-based immunosuppression, in combination with azathioprine and steroids, was used for 22 of 25 patients. Two double-lung recipients and 1 heart-lung patient received FK506 as the sole immunosuppressive agent; 90% and 62% of LT, and 67% and 54% of HLT recipients developed acute and chronic rejection, respectively (P = NS). The average time to first episode of acute (30.2 days [LT] versus 21.5 days [HLT]) and chronic rejection (146 days [LT] versus 193.7 days [HLT]) was not different between groups (P = NS). Age (34.2 [LT] versus 29.1 [HLT]) and sex (M:F, 5:5 [LT] versus 5:10 [HLT]) were also not found to be discriminators. The histologic diagnosis of chronic rejection was associated with significant declines in FEV1.0 and FEF25-75 (P less than 0.02). There was only one instance of cardiac rejection among the heart-lung transplant recipients. Heart-lung and isolated lung transplant patients appear to be at similar risk for developing acute or chronic pulmonary rejection.     

The effect of CO2 and non-CO2-generating buffers on cerebral acidosis after cardiac arrest: A 31P NMR study

There is controversy regarding the use of alkalinizing agents during reperfusion after cardiac arrest. The potential deleterious effects of sodium bicarbonate (bicarb) administration, including paradoxic cerebral acidosis, have led to the search for alternative agents. Tromethamine (tris) is a non-CO2-generating buffer that has been proposed for use during cardiopulmonary resuscitation. The purpose of this experiment was to compare the ability of tris with bicarb to correct brain pH (pH B) during reperfusion after a 12-minute cardiac arrest. Adult mongrel dogs were instrumented and placed in the bore of a Bruker Biospec 1.89 tesla superconducting magnet system. Ventricular fibrillation was induced; after 12 minutes, cardiopulmonary bypass was initiated and maintained for two hours with minimum flows of 80 mL/kg/min. Bicarb (n = 5) or tris (n = 5) were administered to correct arterial pH as rapidly as possible. 31P NMR spectra were obtained at baseline and throughout ischemia and reperfusion. The pH B was determined with the inorganic phosphate relative to the phosphocreatine resonance signal shift. Profile analysis indicates a difference between groups (P less than .02) related to an initial delay in pH B correction in the tris group. By 48 minutes of reperfusion, pH B did not differ between the groups. Moreover, there was no evidence of paradoxic cerebral acidosis in the bicarb group. Although tris corrects blood pH as quickly as bicarb, it is less effective in correcting pH B. Absence of paradoxic acidosis may be caused by efficient elimination of CO2 by cardiopulmonary bypass.     

Generation of monoclonal antibodies reactive with nuclear proteins of human primary breast tumors

Nuclear proteins were extracted from purified nuclei of human primary breast tumors (BrT) and bladder tumors and of human normal breast, kidney and lymphocytes by enzymatic treatment. SDS-Polyacrylamide gel electrophoresis of nuclear proteins from breast tumors showed different bands in the molecular weight zones from 25 to 220 kDa which were absent or present only as traces in normal breast tissue. Murine monoclonal antibodies (MAbs) have been produced using nuclear extracts of human primary breast tumors as immunogens. Approximately 2,000 hybridomas were generated from 5 hybridizations. According to their reactivity to BrT nuclear extracts and mammary carcinoma cell line MCF-7, seven hybridomas were selected and cloned. They were further characterized with histological immunoperoxidase assays of formaldehyde-fixed BrT paraffin tissue sections. MAb 6A3 particularly gave strong nuclear staining with all BrT specimens while MAb 1D8 showed both nuclear and cytoplasmic staining with only some of them. Specimens from mammoplasty did not react with these MAbs. Immunoblotting of BrT nuclear extracts as developed with MAbs 6A3 and 1D8 revealed major protein bands with molecular weight of 120 and 130 kDa. The potential use of these MAb-defined BrT-related nuclear proteins as markers for human breast cancer was suggested.     

Progressive myotonia in foals resembling human dystrophia myotonica

A severe and progressive neuromuscular disorder accompanied by clinical, electrophysiological, and pathological features resembling human dystrophia myotonica was observed in three foals. This disorder was apparent as early as 1 month of age and involved progressive skeletal muscle dysfunction, initially characterized by proximal muscle hypertrophy and hypertonicity with subsequent muscle stiffness, weakness, and atrophy. Multisystem involvement was manifested in one case by testicular hypoplasia, early cataract formation, and borderline glucose intolerance. Prolonged dimpling of these large rear-limb muscles was elicited by percussion. Myotonic discharges were identified by electromyography. Percussion dimpling and the typical myotonic discharges persisted after neuromuscular blockade. Distinctive histologic muscle changes included ring fibers, sarcoplasmic mass formation, variation in fiber diameter size, and internally positioned nuclei.     

Screening School Personnel for Cardiovascular Disease Risk Factors: Short-Term Impact on Behavior and Perceived Role as Promoters of Heart Health

Background.Few controlled studies have evaluated the impact of community-based screening to detect risk factors for cardiovascular disease (CVD) on behavior change. This study examined the short-term impact of school-based screening on smoking, leisure time exercise, and fat consumption of personnel working in schools offered CVD risk factor screening. Also, the impact of screening on the perceptions that teachers have of their role in promoting heart health at school and the frequency of discussing heart health issues with students was investigated.Methods.The impact of screening was investigated in a before–after study design comparing behaviors of staff working in eight inner-city elementary schools offered the screening with those of staff working in eight matched comparison schools. Data were collected in self-administered questionnaires 2 weeks before and 4 months after screening.Results.A total of 209 subjects in the intervention schools completed the baseline questionnaire. Of these, 125 (59.8%) participated in the screening and completed the 4-month follow-up questionnaire. In the comparison schools, 135 of 177 subjects who completed the baseline questionnaire (76.3%) also completed the follow-up questionnaire. Multivariate analysis of covariance detected no changes in cigarette or fat consumption, but subjects exposed to the screening significantly increased their level of physical activity. Also, teachers exposed to screening increasingly supported the notion that teachers have a role in promoting heart-healthy behaviors among their students.Conclusions.Although several methodological limitations might have influenced the results, these data suggest that screening and counseling for CVD risk factors is an effective strategy to positively influence level of physical activity. If screening does increase motivation and interest among teachers to become heart-health role models or educators, the benefits of school-based screening could extend well beyond those who actually participate.     

Rectal pain of extrarectal origin

Conclusion We believe that the levator spasm syndrome, coccygodynia, and chronic prostatitis are disorders which frequently may cause rectal pain. In these conditions, the diagnosis may be overlooked easily, due to the vague and unusual terms in which patients describe their complaints, or because of coexistent, unrelated, anorectal disorders. In the presence of vague rectal pain, digital examination should include all pelvic structures within reach of the finger. Read at the meeting of the American Proctologic Society, Denver, Colorado, June 10 to 13, 1968.