Bilateral popliteal vein aneurysms

An 82-year-old man was admitted with a left hip fracture sustained in a fall. The fracture was surgically repaired. Ipsilateral leg swelling developed over the following 2 weeks. A lower extremity venous duplex scan demonstrated isolated dilatation of the popliteal veins in both lower extremities. Chronic thrombosis was noted in both popliteal veins at the level of this dilatation. Initial duplex scanning also revealed acute thrombus in the left popliteal, posterior tibial, and peroneal veins. A repeat scan 1 week later identified propagation of thrombus into the superficial femoral vein. Popliteal vein aneurysms, although rare, can cause significant morbidity and mortality. The literature is also reviewed.Presented at the Second Annual Winter Meeting of the Peripheral Vascular Surgery Society, Breckenridge, Colo., January 25–27, 1992.     

Accuracy of cardiac output,oxygen uptake and arteriovenous oxygen difference at rest,during exercise and after vasodilator therapy in patients with severe,chronic heart failure

Measurement of cardiac output, arteriovenous oxygen difference and oxygen uptake in patients with heart failure may be subject to technical and biologic inaccuracies. We measured these 3 variables in 16 patients with chronic heart failure at rest and during exercise. When cardiac output was measured by thermodilution and compared with values calculated by the Pick principle, there was a significant correlation at rest (r = 0.91, p < 0.001) and at exercise (r = 0.93, p < 0.001). When the arteriovenous oxygen difference was measured by spectrophotometry of arterial and mixed venous samples and compared with values calculated by the Pick principle, there was a significant correlation at rest (r = 0.80, p < 0.01) and at exercise (r = 0.76, p < 0.01). When oxygen uptake was measured from expired gas analysis and compared with values calculated by the Pick principle, there was a significant correlation at rest (r = 0.84, p < 0.01) and at exercise (r = 0.94, p < 0.001). In addition, 10 patients received vasodilator treatment which increased cardiac output and decreased the arteriovenous oxygen difference at rest and exercise. There was no significant difference between measured and calculated values for the 3 variables under those additional conditions. It is concluded that despite technical and biologic difficulties, cardiac output, arteriovenous oxygen difference and oxygen uptake, when calculated from Pick's principle, yield results equivalent to direct measurement.     

Species differences in the pharmacokinetics of recainam, a new anti-arrhythmic drug

The pharmacokinetics of recainam, an anti-arrhythmic drug, were compared in mice, rats, rabbits, dogs, rhesus monkeys, and man. Bioavailability was virtually complete in monkeys and dogs, 67 per cent in man and 51 per cent in rats. Non-linear kinetics between the oral and i.v. dose in rabbits precluded estimation of bioavailability. Linear plasma dose proportionality occurred in dogs between 6 and 60 mg kg-1 oral doses and rhesus monkeys between 1 and 15 mg kg-1 i.v. doses. A greater than proportional increase in the plasma AUC of recainam occurred between oral doses ranging from 54-208 mg kg-1 in mice, 25-110 mg kg-1 in rats, and 50-100 mg kg-1 in rabbits. In human subjects, the AUC/unit dose was linear between 400 and 800 mg. The terminal elimination t1/2 of recainam ranged from 1-5h in laboratory animals and man. The plasma Cmax and AUC of recainam were virtually identical after single or multiple (21 day) oral doses in dogs. After an i.v. dose, plasma clearance of recainam (l kg-1 .h) was 4.9-5.2 in rats and rabbits and 0.4-1.9 in dogs, rhesus monkeys, and man. The steady state volume of distribution was 2-5 times larger than the total body water of laboratory animals and man. Recainam was very poorly bound (10-45 per cent) to the serum proteins of rodents, rabbits, dogs, rhesus monkeys and man. In rhesus monkeys and man, recainam accounted for 10 per cent and 70 per cent, respectively, of the plasma radioactivity at 6 h post-dose. The pharmacokinetic profile of recainam in dogs most closely resembled that of man.     

Antagonism Between Nafcillin or Oxacillin and Rifampin Against Staphylococcus aureus

By the time-kill method, the combinations of nafcillin plus rifampin and oxacillin plus rifampin were antagonistic against 20 strains of Staphylococcus aureus. No synergism was demonstrated.     

Effects of a Vancomycin-Rifampin Combination on Enterococci

By the time-kill curve method, a vancomycin-rifampin combination showed neither synergism nor antagonism against 43 of 48 strains of enterococci. Antagonism was demonstrated against five strains.     

Calcium influx accompanies but does not cause excitotoxin-induced neuronal necrosis in retina

Several authors have recently proposed that excessive calcium (Ca++) influx into postsynaptic cells may be the mechanism by which excitotoxins such as glutamate (Glu), N-methylaspartate (NMA) and kainic acid (KA) cause neuronal necrosis. Here we have undertaken both in vivo and in vitro studies to explore this hypothesis. Our findings indicate that Ca++ does accumulate selectively in neural elements undergoing degeneration in the in vivo mouse hypothalamus following subcutaneous administration of NMA. However, pretreatment with the putative Ca++ channel blocker nimodipine resulted in augmentation rather than suppression of the toxic action of NMA and Glu on the mouse hypothalamus and eliminating Ca++ from the incubation medium did not interfere with the toxic action of Glu, NMA or KA on the chick embryo retina in vitro. We conclude, therefore, that Ca++ influx is an unlikely explanation for excitotoxin-induced degeneration of retinal or hypothalamic neurons.     

Acquired cystic kidney disease in children undergoing long-term dialysis

Acquired cystic kidney disease (ACKD) occurs in adult patients undergoing long-term dialysis. Early detection is important because clinically significant hematuria and malignancies are associated with ACKD. We evaluated by magnetic resonance imaging (MRI) and ultrasonography (US) the incidence of ACKD in 15 patients aged 7.3–21.6 years (mean 15.9 years) with non-cystic primary renal disease. Nine patients had been treated with peritoneal dialysis only, and 6 with both hemodialysis and peritoneal dialysis for 24–73 months (mean 37 months). Three patients (20%) had no cysts. In 5 patients (33%) with bilateral multiple cysts, the diagnosis of ACKD was made by MRI and US. In another 5 patients, solitary cysts were localized to one kidney by MRI, and in 2 patients solitary cysts were seen in both kidneys. This study documents that ACKD is not limited to older patients with end-stage renal disease. Early detection of these cysts can be accomplished by MRI and is warranted since 1 patient developed neoplastic tubular changes which can precede tumor formation.