Ultrasonic features of pyogenic liver abscesses

Ultrasonic features of 21 surgically confirmed pyogenic liver abscesses in 18 patients were analyzed. Typical lesions were round or ovoid with a discrete, irregular, echo-poor margin. The number and intensity of internal echoes and sound transmission were variable. Such lesions can be aspirated percutaneously for definitive preoperative diagnosis. Pyogenic liver abscesses appear to have more ragged walls and are less frequently elliptical or multilocular than abscesses elsewhere in the abdomen.     

Mean circadian cosinors of vital signs, performance of blood and urinary constituents in patients with leprosy.

We have herewith examined the characteristics of circadian rhythms in patients with lepromatous leprosy, active or inactive, allowing a comparison with corresponding properties of rhythms in healthy subjects mapped earlier. Group results were illustrated by cosinor plots, produced directly on microfilm by computer. Eventually such reference standards in the form of cosinors, among other displays, notably of waveform, may be individualized and carried on a person's health record. Such a quantitative assessment of an individual's rhythms in health may serve for rigorous comparison with any changes accompanying increased susceptibility or occult or overt disease.     

Hemodynamic Drug Interaction: Peridural Lidocaine and Intravenous Ephedrine

Hypotension following peridural anesthesia with lidocaine was treated by intravenous injection of ephedrine. The ephedrine relieved the cardiovascular depression, but was associated with a concomitant increase in plasma lidocaine concentrations. This increase may push the plasma lidocaine concentration into the toxic region.     

Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy

Background. Levobupivacaine is an effective local anaestheticagent for nerve blockade with less systemic toxicity than racemicbupivacaine. The safety and efficacy of levobupivacaine forscalp blockade during awake craniotomy have not been addressedpreviously. Methods. Serial arterial plasma levobupivacaine concentrationsfollowing scalp blockade were measured to 2 h in 10 patientsbooked for awake craniotomy for epilepsy or tumour surgery.Bilateral scalp blockade providing surgical anaesthesia wasachieved with a mean dose of 177 mg (2.5 mg kg^–1, range1.6–3.2 mg kg^–1) of levobupivacaine (0.5%, 5 mgml^–1) with epinephrine (5 µg ml^–1) added immediatelybefore the block insertion. Results. The maximum measured plasma levobupivacaine concentrationwas 1.58 (0.44) µg ml^–1 [mean (SD)] with a meantime to peak plasma concentration of 12 (4) min. There wereno episodes in any of the 10 patients of symptoms or signs suggestiveof either CNS or CVS toxicity. Conclusions. This study demonstrated a relatively rapid riseof plasma levobupivacaine concentration without evidence ofcardiovascular or central nervous system sequelae in a samplepopulation of patients who may be particularly prone to perioperativeseizures.     

Tick saliva is a potent inhibitor of endothelial cell proliferation and angiogenesis

We report for the first time that saliva of the hard tick and Lyme disease vector, Ixodes scapularis, is a potent inhibitor of angiogenesis. Saliva (< or = 1:500 dilutions) or salivary gland (0.1-0.5 pairs/assay) dose-dependently inhibits microvascular endothelial cell (MVEC) proliferation. Inhibition was also detected with the saliva of the cattle tick Boophilus microplus but not with the salivary gland of Anopheles gambiae, An. stephensi, Lutzomyia longipalpis, Phlebotomus papatasi, Aedes aegypti, Culex quinquefasciatus, and Cimex lectularius. Inhibition of MVEC proliferation by I. Scapularis saliva was accompanied by a change in cell shape (shrinkage of the cytoplasm with loss of cell-cell interactions) and apoptosis which was estimated by expression of phosphatidylserine using the Apopercentage dye, and by a typical pattern of chromatin margination, condensation, and fragmentation as revealed by nuclear staining with Hoechst 33258. The effect of saliva appears to be mediated by endothelial cell alpha5beta1 integrin, because monoclonal antibodies against this but not alphavbeta3, alphavbeta5, alpha9beta1, or alpha2beta1 integrins remarkably block its effect. In addition, SDS/PAGE shows that saliva specifically degrades purified alpha5beta1 but not alphavbeta5 or alphavbeta3 integrins. Incubation of saliva with EDTA and 1,10-phenanthroline, but not phenylmethylsulfonyl fluoride (PMSF), inhibits saliva-dependent degradation of purified alpha5beta1 integrin, suggesting that a metalloprotease is responsible for the activity. Finally, saliva at < or = 1:1,000 dilutions blocks sprouting formation from chick embryo aorta implanted in Matrigel, an in vitro model of angiogenesis. These findings introduce the concept that tick saliva is a negative modulator of angiogenesis-dependent wound healing and tissue repair, therefore allowing ticks to feed for days. Inhibition of angiogenesis was hitherto an unidentified biologic property of the saliva of any blood-sucking arthropod studied so far. Its presence in tick saliva may be regarded as an additional source of angiogenesis inhibitors with potential applications for the study of both vector and vascular biology.