Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.     

The "D circle": closed-circuit operation of the Bain circuit.

A method of converting a Mapleson D (Bain) circuit to closed-circuit operation is presented, utilizing a laboratory air pump and a Waters carbon dioxide absorber canister to recirculate exhaled gas. The elimination of carbon dioxide from the circuit was studied and found to be adequate. The circuit would allow the use of low fresh gas flows for the maintenance of anaesthesia without the danger of carbon dioxide rebreathing. We suggest that such a circuit could provide appropriate conditions of gas humidity and temperature for endotracheal anaesthesia, while realizing the advantage of a circulator in mask anaesthesia is possible. Further design considerations for a "D circle" breathing system for clinical use are discussed.     

Ischemia-reperfusion injury in renal transplantation is independent of the immunologic background

BACKGROUND: Adhesion molecule expression is important to early transplant failure. However, whether or not adhesion molecule-facilitated inflammation is antigen-dependent is unknown. We tested this hypothesis. METHODS: Rat renal grafts were four-hours cold-preserved in University of Wisconsin (UW) solution, transplanted to syngeneic or allogeneic recipients, and harvested after 2, 6, 12, 24, and 48 hours and after 1 week. The first allogeneic group receive no immunosuppression; two additional groups received either low (1.5 mg/kg) or standard (5 mg/kg) cyclosporine A (CsA). Renal function and morphology were determined; frozen sections were immunostained for P-selectin, L-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), platelet endothelial cell adhesion molecule-1 (PECAM-1), leukocyte function associated molecule-1 (LFA-1), very late antigen-4 (VLA-4), as well as for neutrophils and monocytes. RESULTS: Selectins increased rapidly at 2 hours and quickly decreased by 12 hours. While P-selectin was expressed on vasculature, L-selectin was found on inflammatory cells. Neutrophil influx and that of LFA-1-positive cells occurred early, peaked between 12 and 24 hours, and paralleled the maximal impairment in renal function. ICAM-1 and PECAM-1 showed similar kinetics and a diffuse distribution. VCAM-1 increased more slowly after 12 hours, peaked at 24 hours, and was localized predominantly on the endothelium of elastic vessels. Between 24 hours and 1 week, all grafts progressively developed dense VLA-4-positive monocytic infiltrates adjacent to vessels expressing VCAM-1. Functional, morphological, and immunohistochemical parameters did not differ between isografts and allografts at one week. However, by day 10, allografts showed severe vascular and cellular rejection, while injury in isografts resolved. Immunosuppression with CsA did not reverse the inflammation induced by ischemia-reperfusion injury. CONCLUSIONS: The early inflammation after ischemia-reperfusion injury is largely independent of the immunologic background. We suggest that initial injury prevention should receive the highest priority.     

Indoleamine metabolism in maturing mouse brain following extended uptake inhibition with citalopram

1. At various ages between birth and adulthood mice were exposed to the specific uptake inhibitor citalopram (Lu 10-171) once a day for 5 days. 2. Their brains were assayed for 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) as well as indoleamine turnover at selected times after termination of the drug. 3. Younger brain differed from older brain in both stores and turnover. 4. Younger brain demonstrated the effects of citalopram action as much as 3 weeks later with continued elevation of 5-HIAA stores. 5. The possibility that 5-HIAA is an active agent in serotonergic neurogenesis is discussed.     

High measles mortality in infancy related to intensity of exposure

In a West African urban community, measles infection in infants was examined over 5 years (1979-1983). In the age group 0 to 11 months, measles mortality was higher among secondary cases (infected in the house) than among index cases (infected outside the house), and the proportion of secondary cases was significantly higher for this age group than for older children. Intensive exposure related to the social pattern of disease transmission may be important in explaining the high infant mortality observed with measles in developing countries. Mortality during the first 12 months of life increased with age, presumably because of the decrease of maternally derived measles antibodies. In children younger than 6 months of age, who are usually considered to be protected by maternal antibody, intensive exposure may lead to infection, as demonstrated by a high level of measles-specific antibodies in some children exposed to an older sibling with measles. The aim of public health policies should be to change conditions of exposure.     

Cumulative and residual risks of small for gestational age neonates after changing pregnancy-smoking behaviors

This retrospective cohort study examines the relationship between changing pregnancy-smoking behaviors, from the first to the second pregnancy, on second-pregnancy rates of small for gestational age (SGA) neonates. Electronic birth records provided data on 5107 pregnant women who had two singleton births in Kansas City, MO, from 1994 to 2003. Pregnancy-smoking behavior was classified by smoking status (nonsmoker [NS] or smoker [SMK]) during the first (previous)/second (current) pregnancy: NS/NS, NS/SMK, SMK/SMK, and SMK/NS. The overall second-pregnancy SGA rate was 6.7% and varied with pregnancy-smoking behavior: 5.9%, NS/NS; 6.6%, SMK/NS; 12.5%, NS/SMK; and 12%, SMK/SMK; P < 0.001 Current pregnancy-smoking was associated with increased odds ratio (OR) of SGA; SMK/SMK (OR, 2.80; 95% confidence interval [CI], 2.00 to 3.93) versus NS/SMK (OR, 1.83; 95% CI, 1.19 to 2.82) versus SMK/NS (OR, 1.31; 95% CI, 0.65 to 2.65) versus NS/NS (OR, 1.00; 95% CI, reference). Being black (OR, 3.73; 95% CI, 2.91 to 4.79) and having medical risk factors (OR, 1.31; 95% CI, 1.09 to 1.74) also were significantly associated with a SGA neonate in second pregnancy. In conclusion, risk of delivering a SGA neonate in a current pregnancy is related to current rather than previous pregnancy-smoking. Therefore, antismoking socialization during pregnancy should focus on preventing and stopping current pregnancy-smoking, irrespective of past behavior.     

Experimentelle Untersuchungen Über die Jodophilie der Leukocyten

Zusammenfassung In Untersuchungen am Kaninchen wird gezeigt, daß durch Einspritzung von Bakterienstoffen eine Leukocytose mit Auftreten von jodophilen Leukocyten im Blut hervorgerufen werden kann. Die Menge der jodophilen Zellen ist proportional der Menge der einwirkenden Bakterienstoffe. Gleichsinnige Beobachtungen wurden auch am Menschen gemacht.Durch zentralnervöse Reizung (Luftfüllung der Hirnventrikel) werden hochgradige Leukocyten ausgelöst, ohne daß dabei eine Jodophilie der Leukocyten zustande kommt.Diezentralnervöse Reizung, so auch die zentralnervöse Reizung durch Bakterienstoffe, führt zu einer Bereitstellung von Leukocyten im Sinne einer Abwehrreaktion, zu einer Leukocytose. Hiervon zu trennen ist diehumorale Einwirkung der Bakterienstoffe auf die Leukocyten. Die Jodophilie ist eine Reaktion der Leukocyten auf die humorale Einwirkung der Bakterienstoffe, sie stellt eine Stoffwechseländerung innerhalb der Leukocyten infolge dieser Einwirkung der Bakterienstoffe dar.     

Eastern Cooperative Oncology Group phase II studies in advanced measurable colorectal cancer. I. Razoxane, Yoshi-864, piperazinedione, and lomustine

During a 6-month interval, Eastern Cooperative Oncology Group randomized 127 patients who had received prior chemotherapy, and who had advanced measurable, surgically incurable colorectal cancer, to receive piperazinedione (PZD), Yoshi-864, or razoxane (ICRF-159). The observed response (and median survival) rates were: PZD, one of 35 patients (17 weeks); Yoshi-864, one of 34 (19 weeks), and ICRF-159, none of 38 (23 weeks). Among 107 evaluable patients, there were five episodes of life-threatening toxicity with PZD (one death) and four with ICRF-159 (two deaths). In the same protocol, 42 evaluable patients who had not received prior chemotherapy were randomized to be treated with lomustine (CCNU) or one of the three drugs in the "previously treated" trial. One CR (41 weeks) was seen with ICRF-159 and two PRs were seen with CCNU. Life-threatening toxicity occurred in three patients, two who received CCNU (one death) and one who received PZD. No survival advantage was seen. We do not encourage further phase II trials in colorectal cancer with the agents studied.