Acute unilateral pulmonary nonventilation due to mucous plugs

Acute bronchial obstruction by mucous plugs may be manifested clinically by dyspnea, hypoxemia, and respiratory alkalosis mimicking pulmonary thromboembolism. In eight cases with complete interruption of ventilation to an entire lung, chest radiography failed to reveal the extent of the obstruction. Perfusion was substantially less affected than ventilation. Routine ventilation-perfusion scintigraphy with technetium-99m DTPA aerosol aids in the diagnosis of acute major bronchial obstruction in patients with suspected pulmonary thromboembolism.     

Low levels of serum thyroglobulin after withdrawal of thyroid suppression therapy in the follow up of differentiated thyroid carcinoma

We evaluated the reliability of very low serum thyroglobulin (Tg) levels (less than 3 ng/ml) obtained after withdrawal of thyroid suppression therapy in 224 patients without anti-Tg antibodies, who had undergone total thyroidectomy (125 patients) or thyroidectomy followed by 1 or more courses of 131I therapy (99 patients), by performing whole body scans after a therapeutic course of 131I given at the same time of Tg measurement. In 79 patients (35%) a positive scan, associated with a very low level of Tg, was noted. The 131I uptake was limited to the thyroid bed in 60 patients, but metastases were demonstrated in 19 patients (8.5%). These results are mainly explained by the much improved performance of scintigraphy after administration of therapeutic doses of 131I. In the majority of patients, especially those whose 131I uptake was limited to the thyroid bed, further scans were negative. Therefore, in these cases, negative Tg values can generally be considered an early indication of satisfactory evolution. However, in 8.5% of all cases, very low Tg levels were associated with metastases. Thus the follow up of thyroid cancer should not rely only upon Tg determination, even after suppression therapy withdrawal.     

Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging

A prospective evaluation of color flow mapping and real-time ultrasound was performed to determine if pseudoaneurysms could be distinguished from other causes of masses surrounding vascular grafts of the lower extremities. Twelve palpable pulsatile masses were imaged. Diagnoses were confirmed at angiography (n = 11), computed tomography (n = 7), aspiration biopsy (n = 5), and operative intervention (n = 6). A swirling pattern of blood flow was seen in six of seven cases of pseudoaneurysm. Lack of flow signals was noted in four of the five collections representing hematoma (n = 2) or infection (n = 2). The seventh case was later shown to be an infected, thrombosed pseudoaneurysm. The single false-positive diagnosis was made early in the series when the flow signals detected were due to transmitted arterial pulsations. The authors conclude that color Doppler flow imaging is useful in the differential diagnosis of pulsatile masses associated with prosthetic grafts. Prosthetic graft pseudoaneurysms have a specific appearance of swirling blood flow arising from a wide neck and are distinguishable from traumatic or iatrogenic pseudoaneurysms of the native vascular tree.     

红外光谱法和X-射线粉末衍射法研究棉酚的多晶型

棉酚是棉子中的一种色素,具有广泛生理活性。棉酚、醋酸棉酚、甲酸棉酚曾初步试用于男性节育,但有一定毒副作用,影响了临床进一步试用。目前国内外学者仍在进一步研究。棉酚的结构式如下:     

Evaluation of different tests based on observations for external model evaluation of population analyses

To evaluate by simulation the statistical properties of normalized prediction distribution errors (NPDE), prediction discrepancies (pd), standardized prediction errors (SPE), numerical predictive check (NPC) and decorrelated NPC (NPC_dec) for the external evaluation of a population pharmacokinetic analysis, and to illustrate the use of NPDE for the evaluation of covariate models. We assume that a model M_B has been built using a building dataset B, and that a separate validation dataset, V is available. Our null hypothesis H₀ is that the data in V can be described by M_B. We use several methods to test this hypothesis: NPDE, pd, SPE, NPC and NPC_dec. First, we evaluated by simulation the type I error under H₀ of different tests applied to the four methods. We also propose and evaluate a single global test combining normality, mean and variance tests applied to NPDE, pd and SPE. We perform tests on NPC and NPC_dec, after a decorrelation. M_B was a one compartment model with first order absorption (without covariate), previously developed from two phase II and one phase III studies of the antidiabetic drug, gliclazide. We simulated 500 external datasets according to the design of a phase III study. Second, we investigated the application of NPDE to covariate models. We propose two approaches: the first approach uses correlation tests or mean comparisons to test the relationship between NPDE and covariates; the second evaluates NPDE split by category for discrete covariates or quantiles for continuous covariates. We generated several validation datasets under H₀ and under alternative assumptions with a model without covariate, with one continuous covariate (weight), or one categorical covariate (sex). We calculated the powers of the different tests using simulations, where the covariates of the phase III study were used. The simulations under H₀ show a high type I error for the different tests applied to SPE and an increased type I error for pd. The different tests present a type I error close to 5% for the global test appied to NPDE. We find a type I error higher than 5% for the test applied to classical NPC but this test becomes close to 5% for NPC_dec. For covariate models, when model and validation dataset are consistent, type I error of the tests are close to 5% for both effects. When validation datasets and models are not consistent, the tests detect the correlation between NPDE and the covariate. We recommend to use NPDE over SPE for external model evaluation, since they do not depend on an approximation of the model and have good statistical properties. NPDE represent a better approach than NPC, since in order to perform tests on NPC, a decorrelation step must be applied before. NPDE, in this illustration, is also a good tool to evaluate model with or without covariates.     

Perforation of the inferior vena cava with aortic and vertebral penetration by a suprarenal Greenfield filter

Various complications have been reported after insertion of the Greenfield filter. This report describes an unusual complication after suprarenal placement of this filter: spreading of the filter struts, with perforation of the inferior vena cava, and penetration of the aorta and a vertebral body, followed by fracture of one of the struts.     

The N-acetylation of sulfamethazine and p-aminobenzoic acid by human liver slices in dynamic organ culture.

N-Acetyltransferase (NAT) polymorphism has been implicated in differences in the susceptibility of individuals to the toxicity of chemicals metabolized by this enzyme system. Investigation into the toxicological consequences of acetylator polymorphism and the mechanism of these effects in humans, however, has been greatly hindered due to the lack of a suitable human tissue culture system for determination of hepatic NAT activity and acetylator status of individuals. An in vitro system has been developed to study NAT activity using human liver slices in dynamic organ culture. Acetylation of para-aminobenzoic acid (PABA) and sulfamethazine (SMZ) by human liver slices was monitored by measuring the disappearance of the parent amine from the incubation medium using the colorimetric procedure of Bratton and Marshall. Presence of the acetyl conjugate was confirmed using HPLC. PABA acetylation rates varied from 0.72-2.52 nmol/hr/mg protein (N = 8). This small variation (less than 4-fold) is consistent with the classification of PABA as a monomorphic substrate. The variation in the rate of SMZ acetylation was greater than 20-fold (0.144-3.68 nmol/hr/mg protein; N = 9). This larger variation is characteristic of SMZ as a polymorphic substrate. A good correlation of N-acetylation activities for SMZ was also found between cytosol and slices prepared from the same human livers. The results obtained indicate that human liver slices in dynamic organ culture can be used for the determination of hepatic NAT activity in humans. These slices may be useful in toxicological studies that seek to relate N-acetylation of chemicals in the human liver with potential toxicity.     

A new model for hetero-orthotopic heart-lung transplantation in the dog

A method of hetero-orthotopic heart-lung transplantation is described in the dog. The model was developed to study patterns of rejection in the transplanted heart and lung, since the dog will not survive bilateral pneumonectomy and loss of the Hering-Breuer reflex. After removal of the recipient's left lung the donor heart and left lung are explanted en bloc. End-to-end connection is made of both left main bronchi, and the donor aorta is joined end-to-side with the recipient's descending aorta. An atrio-atrial anastomosis is performed between the recipient's left and the donor's right atrium. Four experiments were done to develop the surgical technique and 10 long-term studies were performed to investigate rejection patterns. The average survival rate of these animals was 28.5 +/- 8.3 days, ranging from 5 to 53 days. Causes of death were not due to operative complications. Heterotopic heart-lung transplantation is an uncomplicated surgical method which does not require cardiopulmonary bypass or anticoagulation and allows the investigator to study heart and lung grafts in dogs for long-term periods after surgery. Bronchoscopy, bronchoalveolar lavage, and heart and lung biopsies of both donor and recipient organs can be performed.     

Hyperresistance to DNA damaging agents in yeast

Summary In order to study resistance to DNA damaging agents, yeast DNA segments conferring hyperresistance in this organism to such genotoxic agents were selected for among yeast cells transformed by a yeast genome library based on the multi-copy vector plasmid YEp13. Genetic variants hyperresistant to 4-nitroquinohne-N-oxide, formaldehyde, and alkylating agents were isolated and the respective hyperresistance determinants shown to co-segregate with the vector plasmid. Phenotypical characterization indicated different degrees of resistance, few cases of cross-resistance and differing structural stability of the cloned DNA. By transfer to E. coli and subsequent retransformation of yeast a number of plasmids was shown to stably carry the genetic information for hyperresistance.Dedicated to Prof. Dr. Fritz Kaudewitz on the occasion of his 65th birthday