Adrenal cyst

Adrenal cysts are rare lesions that usually present as incidental findings during surgery or at the time of autopsy. The cysts are usually small, seldom exceeding 10 cm in diameter, and are generally asymptomatic. In those few cases that are symptomatic, radiographic examination is the most important tool in establishing a correct preoperative diagnosis. Of the four main categories, endothelial cysts represent the most common type of adrenal cyst. Simple surgical enucleation of the cyst, with preservation of the remaining adrenal gland, is the treatment of choice.     

Guanabenz degradation products and stability assay.

Guanabenz, [(2,6-dichlorobenzylidene)amino]guanidine, acetate was shown to be the E-isomer. It decomposed to form the Z-isomer, 2,6-dichlorobenzaldehyde, aminoguanidine, and 2,6-dichlorobenzaldehyde semicarbazone. A stability-indicating assay for the intact drug in the presence of all of its decomposition products by the use of UV spectroscopy is presented.     

CONTRIBUTION OF BONE MARROW CELLS AND LACK OF EXPRESSION OF THYMOCYTES IN GENETIC CONTROLS OF IMMUNE RESPONSES FOR TWO IMMUNOPOTENT REGIONS WITHIN POLY-(PHE,GLU)-POLY-PRO--POLY-LYS IN INBRED MOUSE STRAINS

Previous cellular studies on the genetic regulation of immunological responsiveness for two immunopotent regions within the branched chain synthetic polypeptide (Phe, G)-Pro--L demonstrated a direct correlation between the number of detectable immunocompetent splenic precursor cells and the response patterns of SJL, DBA/1, and F₁ mice (21). In order to establish the cellular origin(s) of the genetic defect, the present study first demonstrated that thymus and bone marrow cell cooperation was required for (Phe, G)- and Pro--L-specific immune responses. Secondly, limiting dilution experiments, in which several graded and limiting inocula of marrow cells were mixed with a non-limiting number of 10⁸ thymocytes and injected into irradiated, syngeneic recipients, indicated that the low responsiveness of the SJL and DBA/1 strains to the (Phe, G) and Pro--L specificities, respectively, could be attributed to a reduced number of precursor cells found in bone marrow. About five times more marrow precursors were detected in SJL mice for Pro--L than for (Phe, G), whereas about five times as many precursor cells were estimated for (Phe, G) as for Pro--L in the DBA/1 strain. These differences are similar to those obtained using spleen cells from unimmunized SJL and DBA/1 donors (21), and indicate that these genetically determined variations in responsiveness can be accounted for by differences in the frequencies of monospecific populations of immunocompetent cells present in bone marrow. In contrast, limiting dilution transfers of thymocytes or thymus-derived cells with an excess of syngeneic marrow cells resulted in equally frequent (Phe, G) and Pro--L responses for both SJL ad DBA/1 strains. This finding in conjunction with the observation that the generation of (Phe, G)- and Pro--L-specific responses were associated in individual recipients injected with limiting inocula of thymocytes indicated that a single population of thymocytes was stimulated by (Phe,G)-Pro--L. Therefore, it is improbable that the thymic population of immunocompetent cells contributes to expression of these genetically controlled defects.     

Fetal Monitoring: Do the Benefits Outweigh the Drawbacks?

Recently I returned to teaching prenatal classes after an absence of 18 months. In my first class was a young girl who had been told that her baby was breech. She asked me if I would come with her and her husband in labor. I agreed, anticipating a chance to find out what was new at her teaching hospital and to help her, as well. A few weeks later I got her call, drove over and made my way up to her little labor room. For five minutes we talked. Then she panted quietly and rubbed her abdomen, her husband holding her other hand. At this point the door was propped open and a cabinet-sized machine was rolled into the room, pushed by a nurse. It stopped next to the bed, with a brief pause for the removal of the husband's chair to the corridor outside. The hand which had held the husband's was searched for a vein, and an intrevenous drip of glucose installed. The other arm was connected to a continuous blood pressure gauge. The abdomen was encircled with two belts and the electronic devices on the belts were squirted with jelly and planted firmly on the mother's abdomen, the belts then tightened securely. The monitor was turned on and out rolled a continuous strip of paper bearing the fetal heart rate tracing, the uterine contraction tracing, and the blood pressure tracing. The husband found a perch on a window sill across the room. For the next 7 hours a nurse or resident would come in at 30 minute intervals, study the tracing carefully, and tell the mother that all was well. In the next weeks I learned that nearly half of the women in my classes were being monitored, and the trend has increased in many areas. As a parent educator, I needed to know about fetal monitoring. Are the benefits so great as to justify such absolute domination of labor by machines? Is monitoring too complex to explain ahead of time to parents? I was disturbed by the lack of personal contact on the part of the staff, by the unseated husband and the lack of mobility of the mother. These worries led me to begin a search of the literature and correspondence with monitor manufacturers and several obstetricians who have pioneered in their development.     

An isolated limb infusion technique: a guide for the perfusionist

Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hyperthermia (40 degrees C) combined with chemotherapy agents, primarily melphalan, has resulted in greater cytotoxicity in laboratory studies, which led to the application of hyperthermia in clinical studies during the 1960s. The effectiveness of this regional technique and the absence of any good systemic therapy made hyperthermic-isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma. HILP involves open surgical dissection and cannulation of the peripheral vessels and is associated with moderate morbidity rates. Blood transfusions, systemic drug leak, infection, and damage to the blood vessels and nerves are all potential hazards associated with this technique. Recently, however, there has been increased interest in an alternative technique termed isolated limb infusion (ILI), which was first reported in 1994 from the Sydney Melanoma Unit in Australia. Based on a few single institution experiences, it was found that there are fewer morbidities associated with HILP than with ILI but no compromise in patient outcomes. ILI is a less invasive procedure involving the use of angiographically placed catheters inserted percutaneously through the femoral vessels that does not require blood donor exposure or use of a heart lung machine. Preliminary data suggest that the resultant local hypoxia and acidosis induced by this procedure potentiates the cytotoxic effects of melphalan. Response rates comparing ILI to HILP seem similar, and both are markedly better than systemic chemotherapy. ILI may be a more desirable option because morbidity is greatly reduced and outcomes appear similar. There is a potential role for the perfusionist in the application of ILI, an evolving area of cancer therapy.     

Tardive akathisia and agitated depression during metoclopramide therapy

The authors describe two cases of tardive akathisia following metoclopramide therapy, in which there were concomitant symptoms of agitated depression.     

Vitamin K status of preterm infants with a prolonged prothrombin time

AIM: To investigate the vitamin K status of preterm infants who have a prolonged prothrombin time (PT) in the first month of life. METHODS: Measures of vitamin K status were assessed in 21 preterm infants who were found to have an abnormal PT, despite 0.2-0.5 mg vitamin K(1) prophylaxis at birth. RESULTS: All infants had normal or supraphysiological vitamin K(1) concentrations and undetectable or, in one infant, insignificant PIVKA-II, indicating adequate vitamin K status. CONCLUSION: In preterm infants born at <32 wk gestation who received > or = 0.2 mg vitamin K(1) after delivery, a prolonged PT in the first month of life is unlikely to be due to vitamin K deficiency.