Relationship between baroreflex sensitivity, renin suppression and natriuresis in salt-sensitive rabbits.

This study determined the influence of baroreflex sensitivity (BRS) on the rate of urinary sodium excretion and plasma renin activity (PRA) in response to a saline infusion in conscious male rabbits specifically bred for high (Group I; n = 7) and low (Group II; n = 10) BRS and in seven control animals. Only Group II showed significant increases in blood pressure on a chronic high-salt intake. After ensuring that each animal was in sodium balance, a (0.7-0.9%) saline infusion of 3-4 ml/kg per h for 90 min (25% daily sodium intake for each rabbit) was given and urine collected at 15-min intervals via a bladder catheter. No differences were found in control urine volumes, urinary sodium or PRA. Group I excreted over 50% of the sodium load and Group II less than 20% within 90 min. PRA fell by more than 30% within 30 min in six Group I rabbits but decreased by less than 30% or increased in Group II. In the control animals, sodium excretion rates and PRA suppression were also much greater in those with high BRS. A highly significant correlation (r = 0.808, P less than 0.01) was found between the per cent of the sodium load excreted and BRS. It is suggested that the delayed sodium excretion and blood pressure elevation in salt-sensitive subjects may be due to a genetic impairment in baroreflex control of renal sympathetic nerve activity.     

Comparison studies of HPV detection in areas at different risk for cervical cancer.

The hypothesis of a geographical correlation between HPV detection rates and incidence of cervical cancer has been investigated in studies of various types. However, results from these studies are equivocal, in contrast to findings concerning other suspected risk factors which seem to correlate well with the cervical cancer incidence. Possible explanations include (1) greater sensitivity of ecological studies to cumulative exposures such as lifetime number of sexual partners, lifetime smoking and seroprevalence of herpes simplex virus type 2, than to HPV DNA prevalence which does not reflect cumulative exposure to HPV and (2) misclassification in the HPV diagnosis leading to wrong prevalence estimates. In future research, it will be important to establish the sensitivity and specificity of the different methods and conduct intra- and interlaboratory validation studies in order to standardize methods. In spite of the limitations of cross-sectional studies, the measurement of HPV prevalence and its correlation with, for example, sexual behaviour is still valuable for our understanding and interpretation of the role of HPV infections.     

Report on a conference on organic solvents and the nervous system.

At two scientific conferences in 1985, one in Copenhagen sponsored by the Nordic Council of Ministers and the World Health Organization (WHO), the other in Raleigh, NC, it was concluded that chronic toxic encephalopathy may develop following long-term occupational exposure to organic solvents (1,2). The terms organic affective syndrome, mild and severe chronic toxic encephalopathy were suggested for this condition describing increasing severity. In May 1990, a conference on organic solvents and the nervous system was held in Copenhagen sponsored by the Commission of the European Communities and the Danish Ministry of the Environment (3). Scientists and representatives from the governments, industries, and labour organisations from the EEC and US participated.     

Limitations of laser treatment for malignant dysphagia.

Of 86 patients with inoperable malignant dysphagia, 68 (79 per cent) underwent successful palliation by endoscopic laser therapy, of whom 24 remained well palliated until the time of death. In 18 patients laser treatment was unsuccessful and nine of these underwent intubation, eight successfully. After successful laser therapy, dysphagia recurred in 44 patients a mean of 7.8 weeks later. Of these, 31 received palliation until death by dilatation with or without laser therapy, and 13 required intubation. The overall laser-related complication rate was 12 per cent with a mortality rate of 4 per cent. The intubation-related mortality rate was 9 per cent.     

Development and long-term fate of a cellular lining in fibrous polyurethane vascular prostheses implanted in the dog carotid and femoral artery. A scanning and light microscopical study up to 53 months after implantation.

The development and long-term fate of the inner cellular lining in 72 small caliber (3 mm inner diameter) fibrous polyurethane vascular prostheses explanted from dog carotid and/or femoral arteries at times ranging from 1.5 weeks up to 53 months after implantation were studied by scanning electron and light microscopy. A continuous cellular ingrowth from the vascular stumps into the 3 cm long prostheses was observed, which eventually resulted in a complete cellular lining 6 months after implantation. No other ways of endothelialization were noted. In fully endothelialized prostheses, the cellular ingrowth extended approximately 8 mm into the prostheses and consisted of several layers of fibroblasts and smooth muscle cells, covered by a very thin endothelioid cell layer. The newly developed lining was firmly anchored onto the inner prosthetic surface by means of cellular protrusions extended into the fibrous texture of the prosthetic wall. It was concluded that under experimental conditions in the dog complete endothelialization can be obtained in fibrous polyurethane vascular prostheses and that the lining remained thin and stable throughout the observation period of 53 months after implantation.     

Effect of breast feeding on the plasma cholesterol and growth of infants

The effect of breast-feeding on plasma cholesterol, body weight, and body length was studied longitudinally in a large free-living cohort of infants (n = 512) from birth until the age of 1 year. Of the cohort, 21.4% were exclusively breast-fed for at least 3 months, 39.3% received bottle-feeding, and 39.3% received a combination of breast- and bottle-feeding. At birth the plasma cholesterol was similar in the three groups. After 3 months the mean plasma cholesterol and proportion of hypercholesterolemic infants in the breast-fed group were significantly (p less than 0.001) higher than that of the other two groups. These differences had disappeared at the age of 1 year. Breast-fed infants weighed less at 3 and 12 months, but body length was similar to those of the other groups. These results suggest that breast-feeding elevates plasma cholesterol by a direct mechanism and that the effect persists only as long as the breast-feeding is continued.     

Thermoreceptive lamina I trigeminothalamic neurons project to the nucleus submedius in the cat

Summary The technique of antidromic mapping with a roving array of electrodes was used to demonstrate that lamina I trigeminothalamic cells responsive specifically to skin temperature project to the n. submedius (Sm) in the medial thalamus of the cat. This finding indicates that Sm receives thermoreceptive in addition to nociceptive information.     

Permissive Hypercapnia and Intravascular Oxygenator in the Treatment of Patients with ARDS

Abstract: This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H₂O (p = 0. 005) and minute ventilation from 13 ± 3. 5 to 11 ± 3 L/min. CO₂ removal by IVOX allowed a significant decrease in Paco₂ from 66 ± 15 to 59 ± 13 mm Hg. Improvement of oxygenation with IVOX was not signify cant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study     

Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group.

OBJECTIVE: The authors determined the most useful predictors of common bile duct (CBD) stones as diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent laparoscopic cholecystectomy (LC). METHODS: Prospective and retrospective collection of historical, biochemical and ultrasonographic data was used. Receiver operating characteristics curve analysis was used to determine optimal biochemical cut-off values. Multivariate analysis using logistic regression with generation of the best model identifying independent predictors of CBD stones also was employed. Prospective validation of the model was performed on an independent group of patients. RESULTS: Endoscopic retrograde cholangiopancreatographies were performed before LC in 106 patients, and after LC in 33. Only four of ten clinical variables evaluated independently predicted the presence of CBD stones. The optimal model predicted a 94% probability of CBD stones in a patient older than 55 years of age who presented with an elevated bilirubin (over 30 mumol/L) and positive ultrasound findings (a dilated CBD, and a CBD stone seen on ultrasound). This model was validated prospectively in a subsequent series of 49 patients in which the probability of CBD stone was only 8% when all four predictors were absent. CONCLUSIONS: The identified independent clinical predictors of a CBD stone helps select a population of symptomatic gallstone bearers who benefit most from cholangiographic assessment.