Chest radiograph appearances after head and neck flap reconstructive surgery

The chest radiographs of 17 patients who had undergone pectoralis major myocutaneous flap (PMMF) reconstruction for head and neck cancers were reviewed. Surgical procedure correlated well with radiographic findings, which consisted of the following signs: abnormal axillary and supraclavicular folds, replacement of normal vertical neck fold by an oblique fold, soft tissue mass and loss of facial plane at base of the neck. Unilateral radiolucent hemithorax was present in 41% of cases. In females, loss of breast shadow simulating the post-mastectomy appearance was present.     

Systolic Arterial Pressure Recovery After Ventricular Fibrillation/Flutter in Humans

Although the elective induction of cardiac arrest for implantable defibrillator insertion under general anesthesia is widely used, the hemodynamics of recovery of arterial blood pressure after cardiac arrest is not well-defined. Accordingly, the time course of recovery of systolic arterial pressure was studied in seven patients during the repetitive induction of ventricular fibrillation (n = 6) or ventricular flutter (n = 1). The mean number of episodes of cardiac arrest was 7 ± 2, and the mean drop in systolic pressure was 84 ± 16mmHg. The mean recovery time for systolic pressure was 10 ± 6 seconds, the average systolic pressure recovery rate was 13 ± 14 mmHg/sec, and the mean percent systolic pressure recovery was 94%± 9%. A negative logarithmic relation was found to exist between the rate of systolic arterial pressure recovery and the duration of ventricular fibrillation or flutter with a correlation coefficient of 0.68 to 0.97 (P < 0.05) in five of the seven patients. A linear relation between the time for systolic pressure recovery and duration of asystole was also defined. These results are consistent with the view that prolongation of ventricular fibrillation or flutter increases the duration of arterial pressure recovery through a negative effect on left ventricular contractility. Increased understanding of these relations may lead to increased safety of implantable defibrillator insertion.     

Case report: A patient with primary biliary cirrhosis and autoimmune haemolytic anaemia

Diseases of an autoimmune nature are well recognized in association with primary biliary cirrhosis. Although autoimmune thyroiditis and many rheumatological conditions are well described in primary biliary cirrhosis, autoimmune haematological diseases have been less well reported. We report on a 66 year old North American Indian man with coincident primary biliary cirrhosis and warm antibody haemolytic anaemia. This case report supports the suggestion of an association between autoimmune haemolytic anaemia and primary biliary cirrhosis.     

Metal deposition in post-surgical granulomas of the urinary tract

Fourteen cases of post-surgical granulomatous inflammation of the urinary tract were studied to investigate the possible deposition in the tissues of metals derived from the diathermy instruments used. The granulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electrondense particles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analysis of X-rays showed the presence of tungsten, iron, copper, nickel, chromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, indicating the presence of alloy metals. Analysis of the diathermy instruments showed the cutting loops to be pure tungsten and the 'rollerballs' to be of nickel silver containing copper, zinc, nickel, manganese and iron. Both the loops and balls are supported on stainless steel wires containing iron, chromium, nickel, manganese, molybdenum, copper and vanadium. It is proposed that metallic fragments from the instruments were deposited in the tissues during the surgical procedures and elicited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carcinogenic.     

Blunted Sensitivity to Sucrose in Autoimmune MRL-lpr Mice: A Curve-Shift Study

Lupus-prone MRL-lpr mice show an autoimmunity-associated behavioral syndrome that has many features similar to the effects of chronic stress. The present study evaluated whether autoimmune MRL-lpr mice show reduced responsiveness to sucrose, as observed in normal animals exposed to chronic mild stress. Sixteen-week old MRL-lpr mice and their age-matched congenic MRL +/+ controls were given 0%, 0.5%, 1%, 2%, 4%, 8%, or 16% sucrose solution to drink every 48 h in a one-bottle test. The MRL-lpr mice drank less than controls at all concentrations, except at 16%. The amount of sucrose consumed vs. solution concentration followed a saturation curve. Estimates were obtained for the concentration yielding the half-maximum response (X₅₀) and the response at saturating concentration of sucrose (R_max). The X₅₀ was significantly higher in MRL-lpr than in MRL +/+ mice, indicating a shift to the right of the concentration-intake curve. The R_max did not differ significantly between substrains, suggesting that the autoimmune process did not affect performance capacity. Pretreatment with the immunosuppressant cyclophosphamide diminished the substrain difference in X₅₀, suggesting that reduced sensitivity to sucrose is related to autoimmune/inflammatory factors. These results support the similarity between autoimmunity-associated behavioral syndrome and behavioral changes produced by chronic stress, and suggest common neuroendocrine mechanisms. Because reduced sensitivity to palatable stimulus may reflect blunted hedonic responsiveness (“anhedonia”), it is hypothesized that an autoimmune/inflammatory factor(s) produces the depression found in human lupus, and some cases of affective disorder. Copyright © 1996 Elsevier Science Inc.     

Early family predictors of child and adolescent antisocial behaviour: who are the mothers of delinquents?

This study tested the utility of 29 maternal and familial characteristics for the purpose of prospectively identifying children who are at high risk for antisocial and delinquent outcomes. The family data were drawn from the archives of the Dunedin Multidisciplinary Health and Development Study. The study's design offers certain methodological advantages: the sample is a representative unselected birth cohort; the family measures were taken very early in childhood; information about the child's antisocial behaviour was collected from many different sources and at many different ages; a comparison group of children with other behaviour disorders was included, and it was possible to examine the influence of possible ‘confounding variables'. Three groups of 11-year-old children (antisocial (n = 50), other disorders (n = 37), and non-disordered (n = 220)) were compared on family variables. Nine family variables differentiated the antisocial children from the nondisordered children, the most important of which were parental disagreement about how to discipline the 5-year-old child, and many changes of the child's primary caretaker during childhood. In addition, among the children who were known to police by age 15, prospective family variables accounted for significant amounts of the variance in number of police contacts and age at first police contact.     

Characterization of the Coagulant Activity of Cultured Human Fibroblasts

Skin fibroblasts were cultured fromnormal individuals, from patients withhemophilia, and from known andsuspected carriers of hemophilia. All celllysates studied had similar coagulantactivity unaffected by incubation witha specific antibody to factor VIII and,therefore, presumably not factor VIII.Further investigation indicated that thecoagulant had many properties indistinguishable from those associated with"tissue factor," including heat lability,sedimentation characteristics, and dependency on factor VII for expression ofcoagulant activity. The presence of tissuefactor in skin fibroblasts is consistentwith the wide distribution of this coagulant, and the ability to maintain this material in tissue culture provides anopportunity for further investigation ofthe role of tissue factor in normal andpathologic states.

Submitted on May 22, 1970 Revised on August 20, 1970 Accepted on August 21, 1970