Selection criteria for the evaluation of living related renal donors

The documented long-term health of the living related renal donor is a tribute to careful preoperative selection and surgical technique. At our medical center 187 prospective donors were evaluated during a 6-year period and 91 underwent donor nephrectomy. Hypertension, renal artery anomalies and donor indecision were the most common reasons for donor rejection. Recipient health and/or death, or a positive crossmatch after pre-transplant donor specific transfusion were other post-arteriogram reasons not to proceed with transplantation. Women were more likely to undergo nephrectomy than men, and older or heavier donors were more likely to be rejected. Using the transcostal, extrapleural surgical approach for nephrectomy there were no deaths or major complications, and the mean postoperative length of stay was 6.4 days. The average postoperative increase in serum creatinine was 0.33 mg./dl. with an average creatinine at discharge of the patient from the hospital of 1.2 mg./dl. The latter creatinine values varied concordantly with donor age. Only 56% of fully evaluated donors (91 of 159) actually underwent donor nephrectomy. The minimal morbidity sustained by these patients re-emphasizes the importance of careful donor selection.     

Knee joint hemarthrosis--differential diagnostic considerations for planning an operation

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

The cytoskeleton of cultured skin fibroblasts from patients with Huntington's chorea

Cultured skin fibroblasts from patients with Huntington's chorea were prepared for indirect immunofluorescence using monospecific antibodies to tubulin, actin, and fibronectin. The fibroblasts were also visualized by transmission electron microscopy. The fibroblasts were observed after 3 hours of plating and treatment with various concentrations of colcemid and cytochalasin B to test the reaction of the microfibrillar network to stressful conditions. Disorders were not apparent in the cytoskeletal system (microtubules, microfilaments, and intermediate filaments) when compared with normal controls. Fibronectin was arranged in a fibrillar pattern similar to that seen with actin immunofluorescence. This colinear arrangement was not disturbed in Huntington's chorea cells. Microtubules, microfilaments, and 10-nm intermediate filaments became more parallel as the incubation period increased from 3 to 24 hours. This study showed that the cytoskeleton and the attachment of one surface protein (fibronectin) are not affected in Huntington's chorea.     

FPL 62064, a topically active 5-lipoxygenase/cyclooxygenase inhibitor

FLP 62064 [N-(4-methoxyphenyl)-1-phenyl-1H-pyrazole-3-amine] is a dual inhibitor of prostaglandin synthetase and 5-lipoxygenase. The compound had anti-inflammatory activity in vivo in a number of models. It inhibited peritoneal inflammation induced by immune-complex when given locally. When applied to the skin, FPL 62064 inhibited UV irradiation-induced erythema and PGE2 formation in the guinea pig and also oedema formation and eicosanoid production in the mouse ear produced by arachidonic acid. Co-injected with arachidonic acid in rabbit skin, FPL 62064 inhibited oedema and eicosanoid formation.     

The efficacy of tobramycin in the treatment of ulcerative colitis

This paper reports a double-blind placebo-controlled trial of oral tobramycin in acute ulcerative colitis. Eighty-four patients with an acute relapse of ulcerative colitis were randomized to receive oral tobramycin or placebo for 1 week as an adjunct to steroid therapy. At endpoint, 31 of 42 (74%) in the tobramycin group achieved complete symptomatic remission compared with 18 of 42 (43%) in the placebo group (P = 0.008). The tobramycin group achieved better histological scores (P less than 0.05) at endpoint. These findings show that treatment with oral tobramycin improves the short-term outcome of patients with ulcerative colitis in relapse.     

Rapid determination of benzalkonium chloride in pharmaceutical preparations with flow injection liquid-liquid extraction

Benzalkonium chloride was assayed by on-line extraction of the benzalkonium ion with picrate to chloroform. The absorbance of picrate was measured. The extractions were performed with a home-made flow injection extraction unit. Calibration curves (1.5-180 x 10(-4)% w/v) were straight lines (r = 0.9993) and the relative standard deviation of a series of injections was less than or equal to 2%. Pharmaceutical benzalkonium preparations, containing xylometazoline, timolol, phenylephrine or carbachol could also be assayed. The method was compared with a modified HPLC assay.     

Injection of perfluoropropane gas to prevent hypotony in eyes undergoing tube implant surgery

Hypotony after fistulizing surgery is common, and most cases resolve without complications. Occasionally, a flat anterior chamber in phakic or pseudophakic eyes may lead to corneal decompensation or cataract formation. In aphakic eyes that have undergone previous vitreous surgery, flat anterior chambers will not develop, but large choroidal detachments and delayed suprachoroidal hemorrhage may occur while the eye is soft. To maintain intraocular pressure (IOP) in the early postoperative period, the authors used a technique to seal the drainage tube with a Vicryl tie, combined with injection of sodium hyaluronate, sulfur hexafluoride (SF6), or perfluoropropane (C3F8), perioperatively in 28 eyes undergoing glaucoma tube implant surgery. Eight eyes were treated with injection of sodium hyaluronate, 8 with SF6, and 12 eyes with C3F8. Hypotony was significantly less frequent in eyes treated with C3F8 compared with sodium hyaluronate (P less than 0.05). Mean IOP was significantly higher for eyes treated with C3F8 injection compared with sodium hyaluronate for the first 4 days after surgery (P less than 0.05).     

Interactions of iron deficiency and exercise training relative to tissue norepinephrine turnover, triiodothyronine production and metabolic rate in rats

The interactions of iron deficiency and exercise training relative to resting metabolic rate (RMR), tissue norepinephrine (NE) turnover and triiodothyronine (T3) production were examined in male Sprague-Dawley rats. Animals were assigned to iron-deficient (ID) or control (CN) diets and to sedentary (SD) or treadmill-exercise (EX) groups for 6 or 12 wk. Iron-deficient animals (hemoglobin 7.2 +/- 0.2 g 100 mL-1) had a 17% higher RMR and had slower growth rates than CN animals. Exercise training affected growth but not RMR in iron deficiency. Oxygen consumption (Vo2) following pharmacologic injection of norepinephrine was similar in both iron-deficient and exercised groups despite a 35% lower maximal exercise Vo2 in trained iron-deficient rats. NE turnover was lower in heart (55%) and liver (80%) of iron-deficient animals relative to controls. Trained iron-deficient animals had lower NE turnover in interscapular brown adipose tissue (IBAT) than sedentary iron-deficient animals; however, training did not alter NE turnover in control animals. In vitro liver and IBAT T3 production was similar in all groups except for lower activities (40%) in 6-wk iron-deficient, exercised animals. The significant effect of exercise on the growth attenuation of iron-deficient, exercised animals is thus not explained by increased IBAT metabolic activity or a generalized sympathetic nervous system activation. Decreased T3 production during periods of rapid growth and lean body mass development, however, may be important in exercised, iron-deficient animals.