Arterial line filtration during cardiopulmonary bypass. Neurologic, neuropsychologic, and hematologic studies

One hundred patients who underwent elective cardiac operations were randomized into two groups. Group 1 had a 20 micron nylon screen filter in the arterial line. In Group 2 no filter was used in the arterial line. Neurologic and neuropsychologic examination of the patients was performed with seven psychometric tests of the Wechsler Memory Scale and the Wechsler Adult Intelligence Scale. These tests were conducted before and a mean of 10 days after the operation. Platelet counts and hemoglobin and total protein levels were measured at the onset and at the end of cardiopulmonary bypass. Two patients died during their hospital stay. Neurologic damage with focal signs was found in the postoperative examination in six patients (three in each group). Twenty-eight patients (28.5%) exhibited signs of mild cerebral dysfunction as assessed by the presence of archaic (primitive) reflexes. Fifteen were in Group 1 and 13 in Group 2 (no significant difference). Sixty patients (61%) had decrements greater than one standard deviation in at least one of the three tests that showed most decreased postoperative scores. There were 32 in Group 1 and 28 in Group 2 (no significant difference). When each test was analyzed individually, there were no significant differences between the two groups. Platelet counts decreased, during cardiopulmonary bypass, a mean of 33% in Group 1 and 34.5% in Group 2 (no significant difference). Both hemoglobin and total protein levels remained virtually unchanged. These results indicate that the addition of a small-pore filter in the arterial line does not prevent the neurologic and neuropsychologic disturbances frequently encountered after cardiopulmonary bypass. The filter itself does not appear to have a direct effect on the blood components. Routine use of an arterial line filter remains questionable.     

Inhibitors of urinary stone formation in 40 recurrent stone formers

The excretion of four inhibitors of urinary stone formation (zinc, magnesium, citrates and glycosaminoglycans (GAG) was studied in 20 normal controls and 40 recurrent calcium stone formers who were placed on a fixed diet restricted in calcium, oxalates and purines. We were unable to show any abnormality in the excretion of Zn, Mg or GAG. In 11 patients, a low level of urinary citrate was a significant feature that was associated in most cases with a urinary pH value above 6. Citrate concentration (per litre) and output (per 24 h) were found to be lower than in the controls in 19 and 33% respectively of the determinations. The overall ratio of average urinary citrate concentration in patients and controls was 0.56, a figure in agreement with previous data.     

Volumetrical measurements in vestibular schwannoma, the influence of slice thickness and patient's repositioning.

OBJECTIVE: Conservative treatment in vestibular schwannomas is mainly dependent on optimal tumor size determination. The first objective of this study was to establish interobserver and intraobserver variability and the accuracy and reproducibility of three different measurement methods: one bidimensional and two volumetrical. The second objective was to evaluate the influence of the use of different magnetic resonance imaging (MRI) slice thickness and the influence of patient's repositioning on the measurements' outcome. STUDY DESIGN: Two consecutive studies have been prospectively performed, both mainly concerning volumetrical measurements. SETTING: Both studies were performed in a tertiary academic, multidisciplinary center. PATIENTS: In the first study, 19 patients were included between March 1996 and May 2002, with a total of 52 scans. The second study comprised 14 patients. All patients in the first study had at least two MRI examinations performed according to a standard protocol (T1-weighted gadolinium-enhanced, slice thickness of 3 mm, and interslice gap of 0.3 mm). The population in the second study underwent a conservative wait and scan (W&S) treatment. METHODS: Both studies are discussed separately. In the first study, all scans were measured by four investigators, two of whom performed the measurements twice using three different methods. The first method concerns a manually performed bidimensional surface measurement along the petrous pyramid. The second method concerns a semiautomatic volumetrical measurement on a computer, relying on contour detection, and the last method concerns a fully automatic volume reconstruction also performed on a computer using different gray shade scales.All 14 patients included in the second study underwent three magnetic examinations. Three different T1-weighted gadolinium-enhanced sequences were used: the first using a slice thickness of 1 mm, the second again with 1-mm slice thickness but after having repositioned the patient. In the third sequence, a slice thickness of 3 mm was used. All scans were measured by two investigators using the three different methods, as described previously. RESULTS: The manual surface method shows large intraobserver variability, and its reproducibility is significantly lower compared with volume measurements. Because of a relatively large systematic error in small tumors, sensitivity of growth detection is low. Both volumetrical methods are hardly interobserver- and intraobserver-dependent, and the gray shade method turned out to be the most accurate. Radiologic progression is only significant at a volume increase of at least 50%. The influence of patient repositioning is negligible, whereas the use of 1-mm slice thickness seems to be superior to a 3-mm slice thickness. CONCLUSION: The volumetrical gray shade method is the most accurate method to detect early tumor progression. As tumor increase of at least 50% is needed to be able to speak of statistically significant tumor growth, the absence of radiologic progression does not mean that there is no tumor growth. Repositioning of the patient has no influence on the measurements' outcome, whereas for optimal magnetic resonance imaging examinations, a 1-mm slice thickness protocol seems to be superior.     

Elimination of mycoplasmas from mouse myeloma cells by intraperitoneal passage in mice and by antibiotic treatment

Intraperitoneal passage in mice and antibiotic treatment were evaluated alone and in combination for elimination of mycoplasma contamination of mouse myeloma cell cultures. Intentional infections were established by inoculating Mycoplasma arginini, M. fermentans, M. hyorhinis and M. orale into cell cultures. Successful elimination of mycoplasmas was achieved with all strains tested by intraperitoneal passage in mice, however, cells infected with M. hyorhinis did not survive the infection long enough to be tested. Clindamycin and lincomycin cured cells infected with M. arginini, M. hyorhinis, M. orale but not M. fermentans. M. fermentans were resistant to all antibiotics tested, but could be partially suppressed by clindamycin long enough to permit curing by in vivo passage. M. arginini was eliminated by all antibiotics tested. In vivo passage and treatment with antibiotics is an efficient combination of methods for mycoplasma elimination from cell cultures and has the advantage of being simple and inexpensive.     

Response from the exposed intracranial human auditory nerve to low-frequency tones: basic characteristics

The responses recorded from the exposed intracranial portion of the eighth nerve in man with normal hearing to short bursts of low-frequency tones (500, 1000, and 1500 Hz) consist of two components; these two components can be separated by adding and subtracting, respectively, the responses to tonebursts of opposite polarity. Subtracting the responses to tones of opposite polarity reveals a waveform that resembles the sinusoidal waveform of the stimulus (frequency-following response = FFR), while adding the responses to tones of opposite polarity reveals a slow component, the waveform of which is more variable than the frequency-following component. The initial deflection of the slow component of the response to 1000 Hz and to 1500 Hz is a positive peak followed by a slow, negative deflection, and the response to 1500-Hz tonebursts often shows a clear off-response. The slow component of the response to 500-Hz tones often has an initial negative peak followed by a slow, positive or negative wave. The temporal relationship between the stimulus tone and the frequency-following component changes only slightly when the intensity of the sound is changed, whereas the latency of the slow potential decreases with increasing stimulus intensity. The FFR can be masked by noise, and the results of masking with highpass-filtered noise indicate that the frequency-following response may be generated at a location on the basilar membrane that is tuned to a frequency that is higher than that of the stimulus tone.     

Thymoma--a retrospective study of 48 cases

Of the 48 thymomas operated on between 1968 and 1985 50% were associated with myasthenia gravis, in 25% diagnosis was made due to accidental X-ray findings. In the staging according to Masaoka et al. [10] the following distribution was noted: I:22, II:5, III:18, IV:3. The 5-year survival rate of the 37 curatively resected patients was 78.5% (stage I: 88.6%, stage III: 55.6%). No stage III patient with residual tumor survived more than 2 years. Predominantly epithelial tumors had a significantly worse prognosis as compared to those with lymphocytic predominance. None of the 4 patients with category II thymoma survived more than 15 months. Association with myasthenia proved to have a negative prognostic influence in stage I and II patients. Frequency of local recurrences and metastases is documented. The value of irradiation and chemotherapy is discussed.     

Comparison of transforming, antimitotic and chromosomal aberration-inducing properties of melphalan and cyclophosphamide

Melphalan and cyclophosphamide, cytostatics used for cancer therapy, were investigated for their ability to induce morphological transformation of embryonic cells of the golden hamster and to evoke structural chromosome aberrations. The antimitotic action of both drugs was also investigated. Cyclophosphamide, under conditions in which it did not produce either structural chromosomal aberrations or exerted cytotoxic action, induced morphological transformation of hamster cells. Under the experimental conditions melphalan induced morphological transformation of hamster cells at concentrations not inducing chromosomal aberrations.