Intraoperative two-dimensional echocardiography in congenital heart disease

Intraoperative epicardial two-dimensional echocardiography was used in 195 patients undergoing surgery for congenital heart disease to evaluate its potential to identify new diagnostic information immediately before and after surgical correction. In 168 patients the preoperative diagnosis was confirmed by intraoperative echocardiography. In four patients, unsuspected findings were revealed, which resulted in modification of the surgical approach. In 18 patients additional morphologic information was obtained which contributed to alteration or refinement of surgical management. The adequacy of cardiac repair was assessed before closure of the chest in all patients. In six patients this information led to immediate reoperation and in four other patients to inotropic drug therapy. During congenital heart surgery, epicardial two-dimensional echocardiography may yield important information for surgical management. The technique is an essential adjunct when preoperative diagnostic studies are not conclusive or when the initial response to repair is unsatisfactory.     

An unexpected Q fever endocarditis. Report of a case

A man with blood culture negative endocarditis since 1983 received in October 1984 a mitral valve bioprosthesis. Reintervention in April 1985 was performed because of a paravalvular leak. In September 1985, mitral insufficiency reappeared and high-titer phase II Q fever antibody was detected, which has since then persisted with concomitant high-titers of phase I antibody. In serum from 1983, phase II antibody was detected on reexamination in September 1985. For unexplained reasons this antibody had not been detected in 1983. The patient has since September 1985 been successfully treated with doxycycline. The current literature is reviewed. Q fever endocarditis should be considered also in Belgium in culture negative endocarditis even in persons with no previous history of valvular disease and no known exposure to animals or unpasteurized dairy products. Quality of viral reagents and diagnosis present sometimes a challenge.     

Protein phosphorylation and tyrosine kinase activity in medullary thyroid carcinomas of the rat

The kinetics of endogenous protein phosphorylation and resultant phosphoprotein patterns were investigated in well-differentiated (DMTC) and undifferentiated (AMTC) medullary thyroid carcinomas of the rat. Cytosolic or particulate fractions from these tumors were incubated with gamma-32P-ATP in the presence of various effectors. Phosphorylation appeared to be predominantly independent of exogenously added cyclic AMP. Magnesium and manganese were equally effective cofactors. For both tumor types 32P incorporation into cytosolic proteins was maximal within 3-4 min after addition of ATP and subsequently decreased gradually within 1 h. In contrast, in particulate preparations maximal incorporation was reached within 30 s and remained constant over a relatively long time span. In both cases, however, 32P incorporation in extracts from DMTCs were 50-100% higher as compared to AMTCs. Comparison of the phosphoprotein patterns of each tumor after in vitro phosphorylation showed some significant differences. A phosphoprotein with molecular weight of 90 kilodalton (90 kD) was exclusively expressed in the cytosol of DMTC, whereas 99- and 84-kD phosphoproteins were only present in the cytosol of AMTC. The DMTC particulate fraction contained two phosphoproteins (with molecular weights of 40 and 37 kD), which were absent from that of AMTC. In addition, a number of proteins were more intensely phosphorylated in one of the tumors, e.g. proteins of 94 and 33 kD in DMTC cytosol and a protein of 78 kD in AMTC cytosol. Calcium induced phosphorylation of five proteins in DMTC cytosol (with molecular weights of 69, 55, 49, 43 and 32 kD), which were less intensely or not phosphorylated in AMTC. Tyrosine kinase activity was investigated using exogenously added poly(glutamine:tyrosine, 4:1) as an artificial substrate. Cytosolic tyrosine kinase activity in DMTC was +/- 50% higher than in AMTC (11.9 +/- 0.6 and 8.2 +/- 1.7 pmol/mg/min, respectively). The enzyme activities in the particulate preparations were much higher than in the cytosols (+/- 100 pmol/mg/min), although considerable variations in enzyme activity between different tumors of either type were observed. Quantitative differences in tyrosine kinase activity between AMTC and DMTC particulate fractions did not seem to exist using this substrate. Phosphoamino acid analysis of endogenously phosphorylated proteins in both AMTC and DMTC showed phosphotyrosine to be present only in cytosolic proteins within the 50-kD molecular weight region, the majority of 32P being on serine and some on threonine.(ABSTRACT TRUNCATED AT 400 WORDS)     

Notifiable malignant lesions in the RSA, 1979-1983--trends and mortality. II. Primary malignant neoplasms of the pleura

From August 1979 to December 1983, 22 cases of and 17 deaths due to primary malignant neoplasms of the pleura were notified to the Department of National Health and Population Development. Correspondingly, 458 deaths due to mesothelioma and malignant neoplasms of the pleura were registered at Central Statistical Services; 4% of these deaths were notified. Most of the deaths due to mesothelioma and malignant neoplasms of the pleura registered were in white males, who showed a mortality rate of 15.8/1,000,000.     

Presence of pancreatic hormones in islet cells with MHC-class II antigen expression

In the normal rat pancreas, only few islet cells express MHC-class II antigens. Their nature and function has not yet been elucidated. We report a method for the purification of Ia-positive islet cells by fluorescence-activated cell sorting. The isolated mononuclear cells appear of nonendocrine origin but contain vacuoles with partially digested secretory vesicles. Both insulin- and glucagon-immunoreactive granules were identified in these vacuoles of varying size and composition. It is suggested that at least part of the rat islet cells with class II antigen expression can exhibit phagocytotic properties leading to the uptake of fragments from damaged endocrine cells. This functional characteristic may implicate this particular islet cell type in the pathology of the endocrine pancreas in type I diabetes.     

The inhibition of glutathione S-transferases: mechanisms, toxic consequences and therapeutic benefits.

Inhibition of the enzymes belonging to the family of glutathione S-transferases is important from several points of view. These involve applications in studies of the catalytic mechanism, e.g. studying the topology and binding characteristics of the active site. Also, from a therapeutic standpoint, inhibition of glutathione S-transferases steadily becomes more interesting, since these enzymes appear to be involved in drug resistance, and in the biosynthesis of a number of important arachidonic acid metabolites such as prostaglandins and leukotrienes. Modulation of the glutathione S-transferase activity could be used to regulate the concentrations of these compounds, Thirdly, unwanted inhibition by xenobiotics makes a cell more vulnerable for alkylating agents and can thus have toxic consequences. This review describes the state of the art, dealing with the various types of inhibiton employed (reversible, irreversible or nonsubstrate ligands). Furthermore, isoenzyme selectivity, organ distribution and interindividual differences are discussed.     

Posttraumatic hyperthermia: a possible result of fronto-diencephalic dysfunction.

A patient with traumatic bifrontal hemorrhagic lesions developed hyperthermia associated with autonomic dysfunction shortly after admission. This case illustrates that posttraumatic hyperthermia may also occur at a markedly less disturbed baseline neurological level, possibly secondary to disruption of fronto-diencephalic pathways.     

Residual lesions on computed tomography after intracerebral hemorrhage

BACKGROUND AND PURPOSE: We investigated the residual abnormalities on computed tomography in a series of patients with proven intracerebral hemorrhage to determine whether the type of lesion is related to the site and size of the initial hematoma. METHODS: In a partially prospective follow-up study, we studied computed tomographic scans of 42 patients with spontaneous intracerebral hemorrhage after 2-24 (median 9) months. RESULTS: Lobar hemorrhages had occurred in 20 patients; the other 22 hemorrhages were in the basal ganglia or thalamus. No residual lesions were found on seven scans (17%), despite residual handicap in three of these seven patients (slight, moderate, and moderately severe). In five cases, the scan showed only focal atrophy, and in two there were only focal calcifications. There were six patients with slit-like lesions (only after deep hemorrhages), 12 with rounded and isolated hypodense areas, and 10 with rounded hypodense areas connected to the ventricular system. The connection between the residual lesion and the ventricular system depended to a large extent on the size of the initial hematoma, but very little on whether it had initially ruptured into the ventricular system. CONCLUSIONS: A retrospective diagnosis of cerebral hemorrhage on radiological grounds can be made with confidence only in a small group of patients with slit-like lesions in the basal ganglia. This diagnosis is impossible in approximately one third of cerebral hemorrhages because the abnormalities are aspecific or have completely disappeared.     

Drug-Induced Antibodies: Interaction of the Drug with a Polymorphic Platelet-Antigen

Preincubation of donor platelets with ticarcillin will prevent the reactivity of a platelet antibody against these platelets, whereas no influence was observed on antisera against HLA, 5A, 5b and ZWa. The implications for the mechanism of drug-induced antibodies with restricted specificity will be discussed.