Serum MBP immunoreactivity and immunoglobulin level as markers of tumour type

Summary Forty three patients, admitted to the department of Neurological Surgery for management of central nervous system tumours, were studied pre-operatively for serum myelin basic protein immunoreactivity as a marker of central nervous system lesion and for circulating immunoglobulins and complement (C₃) levels. Myelin basic protein concentration did not appear to correlate with tumour type or grade. Serum immunoglobulin levels were found to be within the normal range but the mean IgM level was significantly higher in the glioma group when compared with meningiomas.     

An audit of anti-D sensitisation in Yorkshire

Objective To determine the likely factors that contribute to RhD sensitisation.
Design Retrospective study of all new cases of RhD sensitisation occurring between 1988 and 1991.
Setting Leeds Blood Centre, National Blood Service, Yorkshire.
Population One hundred and forty-seven cases of RhD sensitisation from 15 obstetric units within the Yorkshire region, of which 129 (312 pregnancies) could be assessed.
Main outcome measures Identification of potential immunising events and adherence with recommendations on anti-D immunoglobulin administration.
Results Twenty-eight women (22%) had immune anti-D antibodies during their first pregnancy or at delivery and 50 (39%) in their second pregnancy. Overall, 98 potential immunising events were identified in 62 women, excluding delivery; 67 women (52%) had no events, other than delivery. Miscarriages and medical terminations of pregnancy accounted for 81% of all identified events. Iatrogenic failure to adhere to recommendations for the administration of anti-D immunoglobulin occurred in a significant proportion of women who subsequently developed immune anti-D antibodies. Anti-D immunoglobulin failed to protect against immunisation despite adherence to the protocol in 20 events (20%), 13 of which involved miscarriages or termination of pregnancy < 20 weeks of gestation. Potentially, antenatal prophylaxis might have prevented 86% of immunisations that were identified during the first pregnancy.
Conclusions The introduction of antenatal administration of anti-D immunoglobulin could significantly reduce the level of sensitisation in primigravidae, and adherence to recommendations for administration of anti-D immunoglobulin could be improved. Consideration should be given to reviewing the current recommendation that a dose of 250 IU of anti-D immunoglobulin is adequate following termination of pregnancy before a gestational age of 20 weeks.     

Differential response of hypertrophied rat hearts to various α1-adrenoceptor agonists

Summary— With respect to the heart, the prolonged existence of hypertension, both in man and in experimental animals is predominantly characterized by an increase in left ventricular myocardial mass. In this process, the autonomic nervous system plays an important role. Although endogenous catecholamine stimulation of the heart is mainly exerted via the β-adrenoceptors, in several mammalian species, the stimulation of cardiac α-adrenoceptors also mediates positive inotropic actions. We investigated the functional responses of isolated hypertrophied hearts taken from spontaneously hypertensive rats (SHR) and rats with an induced aortic stenosis (ASR) to various α₁-adrenoceptor agonists and compared them with those from age matched Wistar Kyoto (WKY) and "sham" operated controls. Accordingly, we studied the functional response to: methoxamine (α₁), cirazoline (α₁) and phenylephrine (α₁ > β₁). The inotropic response to the α₁-adrenoceptor agonists cirazoline and methoxamine proved to be significantly weaker in hypertrophied hearts from SHR and ASR than in non-hypertrophied hearts from WHY and "sham" operated controls ( p < 0.05). The inotropic response to phenylephrine remained intact in hypertrophied myocardial tissue. However, it was significantly reduced when the hearts were pre-treated with the intracellular Ca²⁺-antagonists ryanodine and TMB-8. These findings show that the mechanism of sarcolemmal Ca²⁺ release, activated by phenylephrine, is still intact in the hypertrophied myocardial cell. In conclusion, these data show that cardiac hypertrophy, be it of genetical or mechanical origin, leads to a reduced response of the isolated heart to α₁-adrenoceptor stimulation.     

Enhanced image mammography

A blurred mass subtraction technique has been developed for mammography that will enhance small object contrast and visibility throughout the breast area. The procedure is easy to implement and requires no additional exposure. Perception of low-contrast objects is improved by eliminating extreme light and dark image areas. Contrast of structures within certain parts of the breast is increased by compression into the high-contrast part of the film characteristic curve. Detail visibility is also increased by the edge enhancement produced by this process. This paper describes the enhancement process and gives an analysis of its capabilities and limitations.     

Clinical Assessment of Gestational Age

There is disagreement among authors as to what criteria are most reliable in assessing postnatal fetal age. A comparison–for objectivity, accuracy, and frequency of use– of specific criteria was made using three independent examiners at different educational levels: a second-year medical student, a perinatal nurse practitioner, and a pediatrics resident. It was shown that trained examiners develop favorite criteria which differ among examiners and thus sacrifice accuracy; however, accurate assessment of fetal age can be accomplished by an examiner with minimum clinical knowledge.     

Development of an improved multi-pressure-sensor probe for recording muscle contraction in human intestine

We have developed an improved semiconductor recording probe for monitoring motility of the upper small intestine in humans. The probe consists of six ultraminiature silicon pressure sensors spaced 10 cm apart and encased in a flexible polyurethane sheath. The probe is small [2.67 mm (8F) diameter], is easily passed transnasally, and is tolerated by patients for prolonged recording periods (24–36 hr) with a minimum of discomfort. The initial semiconductor and catheter material were those designed for use in the cardiovascular system, but they proved to be easily damaged by gastric acid and enzymes. After improvement of this probe, we now have recordings from more than 100 patients for an approximate total of 6000 hr of recording time. The improved probe is a durable recording device that facilitates the investigation of motility of the small intestine in humans in health and disease.This study was supported by funds from the Medical Research Service of the Veterans Administration and by National Institutes of Health Clinical Research Center grant RR-82.     

Anesthesia for lung transplantation

Lung transplantation is the only therapeutic option for more than 3,000 individuals in the United States with end-stage lung disease. Innovations in anesthetic and surgical techniques have expanded the indications for lung transplantation. Presently, the major limiting factor in the number of lung transplantations that are performed is the availability of suitable donor organs. Lung transplantation includes a number of surgical procedures, including single-lung, double-lung, bilateral-sequential-single-lung, heart-lung, and lobar transplantation. Patients undergoing lung transplantation present a variety of challenges to the anesthesia team. Critical periods include induction of anesthesia, initiation of positive pressure ventilation, establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Pharmacologic advances have been an important factor in the continued development and success of lung transplantation. Newer immunosuppressive agents have improved the prevention and management of post-transplant rejection. Selective pulmonary vasodilators that are administered via inhalation affect the anesthetic management during the surgical procedure. Technologic advances in monitoring have also been valuable in lung transplantation. Transesophageal echocardiography is commonly used to evaluate intraoperative ventricular function. Continuous cardiac output, mixed venous oxygen saturation, continuous arterial blood gas monitoring, and the bispectral index have also been used to monitor the patient during lung transplantation. Anesthetic management of lung transplantation requires a thorough understanding of end-stage lung disease and pharmacologic and technical considerations that may not be applicable in any other part of anesthetic practice.     

An act of courage: women's decision-making processes regarding outpatient cardiac rehabilitation attendance.

The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: "initial decision," "CR attendance," and "reevaluation." Four data clusters positively influenced the continuation of CR attendance: "Psychological Appraisal," "Program Components," "Staff Behaviors," and "Outcomes." When women encountered a fifth cluster--"Barriers"--they entered the reevaluation phase. Results of this study support specific interventions for each phase.