Plasma α-lipoprotein pattern in acute viral hepatitis

In the present study, the plasma levels of lipoproteins, triglycerides, and cholesterol were followed serially in a group of 57 patients with acute viral hepatitis. Mean plasma triglyceride levels were found elevated at the onset of the disease and gradually returned to normal, while mean plasma cholesterol values, low initially, gradually increased. α-lipoprotein was absent at the early stage of hepatitis in 41 out of 46 patients with mild or moderate course and reappeared gradually during the course of the disease. In 11 cases of viral hepatitis with impending or overt coma, α-lipoprotein was absent for the whole duration of the acute stage and never reappeared in those who eventually died, while it eventually returned to normal in those who survived. The reappearance of α-lipoprotein in acute viral hepatitis appears to be a sensitive index of improvement and a significant prognostic sign.     

The importance of biventricular failure in patients with postoperative cardiogenic shock

To evaluate the importance of severe biventricular failure in patients with postcardiotomy ventricular failure, we analyzed the data from 30 patients treated with ventricular assist devices (VADs) over a five-year period. All patients had profound postoperative ventricular failure refractory to drugs and an intraaortic balloon (IAB). Evaluation of preoperative ventricular function did not allow prediction of which patients would require VADs. However, the development of perioperative myocardial infarction was an important determinant of the need for postoperative support with a VAD. Twenty patients received only a left VAD (LVAD). Four of them had isolated left ventricular failure; 3 were weaned, and 2 survived. None of the 16 patients with biventricular failure who received only an LVAD were weaned. Ten other patients with biventricular failure received biventricular support, either with a right VAD and IAB, or with two VADs. Of these 10 patients, 5 were weaned and 3 survived. Considering all 26 patients with biventricular failure, those receiving biventricular mechanical support (10) had a better chance (p less than 0.025) of being weaned (5/10) and surviving (3/10) than those who received only an LVAD (0/16). We conclude that biventricular failure is common in patients with postcardiotomy ventricular failure and is often the result of perioperative infarction. While patients with isolated left ventricular failure did well with an LVAD only, those with biventricular failure required biventricular mechanical support for survival.     

The respiratory epithelium. III. Histogenesis of epidermoid metaplasia and carcinoma in situ in the human.

The histogenesis of epidermoid metaplasia and carcinoma in situ was analyzed in human bronchial epithelium. The conclusion is that epidermoid metaplasia and carcinoma in situ can result from conversion of mucous cells. This implies the direct transformation of one type of fully differentiated cell to another. The study therefore emphasizes the differentiation potentialities of the mucous cells that can divide and undergo goblet cell hyperplasia and epidermoid metaplasia. Epidermoid metaplasia is a common reaction to injury in the bronchus. In our series of cases it was especially frequent in patients without neoplastic disease who had undergone intratracheal intubation or tracheostomy and who had been maintained on a respirator in the Shock Trauma Unit, University of Maryland. Future studies will be required to distinguish the difference, if any, between epidermoid metaplasia destined to become malignant carcinoma and that which is not. One difference noted in this study was the absence of overt cornification in epidermoid metaplasia in patients without neoplastic disease.     

Nicotinabusus durch Tabakkauen

Zusammenfassung Es wird über einen Patienten berichtet, der sich täglich mindestens 80 mg Nicotin durch Verzehren von Zigarettentabak zugeführt hat, ohne daß Schäden zu beobachten waren. Das Ausbleiben toxischer Erscheinungen wird neben der Gewöhnung der durch die verlangsamte Resorption des Nicotins aus dem Tabak bedingten Wirkungsverzögerung zugeschrieben.     

Adrenerigic agents. 7.1 Synthesis and beta-adrenergic agonist activity of several 2-pyridylethanolamines.

In a search for new selective bronchodilators, three 2-pyridylethanolamines, i.e., 2-tert-butylamino-1-(5-hydroxy-2-pyridyl)ethanol (2b), a related 6-methylsulfonylmethyl (2c), and, a 6-methyl (2d) derivative, were prepared. These compounds were examined for potential bronchodilator activity in an in vitro test for relaxation of guinea pig tracheal tissue. Potential cardiac stimulant activity was evaluated in vitro by measuring changes in the rate of spontaneously beating guinea pig right atrial muscle. Comparison of potency in the tracheal test relative to that in the atrial procedure provides a measure of selectivity. Results of this study indicate that replacement of the phenyl ring of a para-hydroxylated phenylethanolamine with a 2-pyridyl system generally results in compounds which retain a high order of potency in the tracheal test; however, selectivity for tracheobronchial vs. cardiac tissue is markedly greater for the pyridyl derivatives. The alpha-picoline, 2-tert-butylamino-1-(5-hydroxy-6-methyl-2-pyridyl) ethanol (2d), which bears labile protons at a position meta to the ethanolamine side chain, was about equipotent with the corresponding 6-unsubstituted relative 2b. The reason for the failure of these apparently appropriately located labile protons to enhance beta-adrenoreceptor agonist activity is uncertain.