Effect of sialyl Lewis(x) oligosaccharide on myocardial and cerebral injury in the pig

BACKGROUND: Although administration of the sialyl Lewis(x) oligosaccharide may reduce myocardial injury after ischemia-reperfusion, its effect on coronary and cerebral microvascular regulation and its clinical application during cardiac operation have not been examined. METHODS: Pigs were placed on normothermic cardiopulmonary bypass after 30 minutes of left anterior descending coronary artery occlusion. The hearts were then arrested with cold high potassium cardioplegia. After 1 hour the cross-clamp was removed and the pigs were weaned from cardiopulmonary bypass and perfused for an additional 1 hour. CY-1503 (a sodium salt of the sialyl Lewis(x) oligosaccharide, n = 6) was administered before reperfusion. Six other pigs received saline vehicle. Endothelium-dependent relaxation of precontracted coronary and brain arterioles (70 to 180 microm) to adenosine 5'-diphosphate and endothelium-independent relaxation to sodium nitroprusside were studied in vitro with videomicroscopy. Control values were obtained from uninstrumented pigs. Myeloperoxidase activity in the myocardium and brain was measured to quantify neutrophil infiltration. Cardiac function and perfusion were assessed by left ventricular systolic pressure, maximum rate of increase of left ventricular pressure, left anterior descending coronary artery blood flow and percent segmental shortening, and cerebral vascular resistance, internal carotid artery blood flow, and the constitutively expressed and inducible isoform of nitric oxide synthase mRNA were measured. RESULTS: The impaired myocardial contractile function after ischemia and cardioplegia was not improved by administration of CY-1503. The reduced endothelium-dependent relaxation responses of coronary and brain arterioles during ischemia followed by cardioplegia and cardiopulmonary bypass were improved with CY-1503, but the altered pattern of organ perfusion was not improved. Myeloperoxidase activity was increased in the heart after ischemia-cardioplegia and in the brain after cardiopulmonary bypass. CY-1503 reduced myeloperoxidase activity in both the myocardium and in the brain. Expressions of myocardial inducible isoform or constitutively expressed nitric oxide synthase were not altered in the heart. CONCLUSIONS: Although the sialyl Lewis(x) oligosaccharide does reduce neutrophil infiltration and endothelial injury in the coronary and cerebral microcirculation after cardiopulmonary bypass, it does not have significant beneficial acute effects on organ perfusion or function in the myocardium or brain.     

Surgical management of ocular motor cranial nerve palsies

This article reviews the various surgical treatment approaches currently used in the management of ocular motor cranial nerve palsies. Regardless of the approach, the final goal is improved alignment, especially in the primary and reading positions.     

Endophthalmitis from Mycobacterium bovis-bacille Calmette-Guérin after intravesicular bacille Calmette-Guérin injections for bladder carcinoma

PURPOSE: To present clinical and histologic findings of intraocular infection with Mycobacterium bovis-bacille Calmette-Guérin after intravesicular bacille Calmette-Guérin injections for treatment of bladder carcinoma. METHODS: A 77-year-old man was initially seen with visual acuity of 20/200, focal retinitis, vasculitis, and progressive vitreous opacity in the right eye and visual acuity of light perception, intraocular inflammation, and a dense cataract in the left eye 14 months after intravesicular injection of live bacille Calmette-Guérin organisms. RESULTS: Vitreous cultures in the right eye demonstrated growth of bacille Calmette-Guérin organisms. Bilateral loss of light perception occurred despite systemic antimy-cobacterial therapy. Histopathologic examination demonstrated nongranulomatous inflammation and acid-fast bacilli in both eyes. CONCLUSION: Delayed endogenous endophthalmitis may develop after intravesicular bacille Calmette-Guérin injection that may not respond to systemic agents. Intravitreal therapy may be indicated.     

Commissioning new buildings: equipment

Any new building will, with occasional exceptions, require new furnishings and equipment. In principle the organisation of this is straightforward. In practice it is a complicated exercise, full of snags. Phillip Simons discusses some of the problems.     

Early tertiary elephant-shrews from Egypt and the origin of the Macroscelidea

Recent expeditions to the Fayum Depression, Egypt, have made possible the discovery of mandibles and a maxilla of a new genus and species of late Eocene elephant-shrew as well as initial evidence of the upper dentition of the early Oligocene taxon Metoldobotes. These fossils demonstrate that macroscelideans underwent a significant radiation in the Early Tertiary of Africa. Two new subfamilies are recognized and described. These Tertiary macroscelideans are the most primitive elephant-shrews known and indicate that previous hypotheses of a close phylogenetic relationship between macroscelideans and either lagomorphs, erinaceotans, or tree-shrews are unlikely. Rather, the dental anatomy of the Fayum macroscelideans provides evidence for a derivation of the order from within the Condylarthra.     

Experimental measurement of impulse response and noise for an emission computed tomography system

Experimental studies have been made of the impulse response and noise characteristics of a tomographic system using a gamma camera. Fourier transform, deconvolution and iterative methods have been used with a CDC 6600 computer to reconstruct images from data obtained for various experimental arrangements of sources in a cylindrical phantom. It is shown that with an appropriate attenuation correction the impulse response in the reconstruction is substantially constant, independent of the position of the source in the phantom and that the reconstruction technique used is of secondary importance.The resolution obtained for the impulse response and the relative noise level throughout the non image part of the reconstructions is shown for different experimental situations.The measured variance in the reconstruction of an extended uniform activity source was found to be somewhat below the theoretical value except at high count densities (above 1,000 counts per image element) where the limit of accuracy of the reconstruction is shown to be imposed by the variation in the camera sensitivity over the field of view.     

The neuro-ophthalmology of systemic lupus erythematosus

Conclusion Experience with many patients with SLE and a review of the literature indicate that neuro-ophthalmic abnormalities are frequently found in patients with SLE.The optic disc may become swollen in patients with SLE either as a result of local retinal lesions or secondary to increased intracranial pressure. Some of the cases with increased intracranial pressure resemble the entity of pseudotumor cerebri.Patients with SLE may develop an optic neuropathy. The pathogenesis appears either to be demyelinative or secondary to parenchymal microinfarcts. Some of the patients develop a clinical syndrome identical to Devic's desease. The response to corticosteroids is unpredictable. Acute anterior ischemic optic neuropathy is rare in patients with SLE.Homonymous hemianopias may occur in isolation or in association with hemiplegia, aphasia or hemisensory defects. Both formed and unformed visual hallucinations are commonly encountered, and patients may have transient amaurosis or geniculocalcarine (cortical) blindness. Visual hallucinations identical to those seen in migraine, and vascular headaches appear to be more common in patients with SLE than among controls.Diplopia occurs in patients with SLE most often as a transient phenomenon associated with vertigo. Transient ptosis may also occur. These findings, like the transient bilateral amaurosis, suggest the picture of insufficiency in the vertebrobasilar system. Diplopia may also occur from fixed lesions in the brain stem and several instances of internuclear ophthalmoplegia have been recognized. If ophthalmoplegia or ptosis develop in a patient with SLE it should suggest the possibility that the patient has myasthenia gravis which occurs with unusually high frequency among patients with SLE.     

Insights from semantic dementia on the relationship between episodic and semantic memory

An influential theory of long-term memory, in which new episodic learning is dependent upon the integrity of semantic memory, predicts that a double dissociation between episodic and semantic memory is not possible in new learning. Contrary to this view, we found, in two separate experiments, that patients with impaired semantic memory showed relatively preserved performance on tests of recognition memory if the stimuli were perceptually identical between learning and test. A significant effect of semantic memory was only seen when a perceptual manipulation was introduced in the episodic task. To account for these findings, we propose a revision to current models of long-term memory, in which sensory/perceptual information and semantic memory work in concert to support new learning.     

Educational progress,behaviour, and motor skills at 10 years in early treated congenital hypothyroidism

AIM—To assess educational attainments, behaviour, and motor skills at 10 years of age in a group of children with congenital hypothyroidism identified by neonatal screening.SUBJECTS—59 children with congenital hypothyroidism born in 1978-81, 31 cases with pretreatment thyroxine (T4) values of 40 nmol/l or below (group I) and 28 less severe cases with T4 values over 40 nmol/l (group II), together with 59 classroom control children matched for age, sex, social class, and main language spoken at home.METHODS—The Neale analysis of reading ability; the child health and education study written test of mathematics; Rutter behaviour questionnaires for parents and teachers; the Oseretsky test of motor proficiency (short form).RESULTS—On all measures the congenital hypothyroidism children in group I had less satisfactory scores for educational attainments, behaviour, and motor skills than those in group II and controls. For reading the differences were small and did not reach statistical significance, but the deficits in mathematics and total motor skills were statistically significant (p < 0.01). There were more striking and statistically significant differences in behaviour scores, particularly with respect to attentional difficulties. Although less striking, these were also apparent in the group II children with mild hypothyroidism.CONCLUSIONS—At the age of 10 years severe congenital hypothyroidism is associated with some mild impairment in educational and motor attainments. Behaviour problems are also common, even in some children with less severe congenital hypothyroidism.