Peritoneovenous shunt therapy for leaking ascites in the cirrhotic patient.

Review of clinical and operative records of 86 patients at the Minneapolis VA Medical Center and Mount Sinai Hospital undergoing peritoneovenous (PV) shunt for intractable ascites revealed a subgroup of patients (n = 9) who developed leaking ascites prior to shunting. The etiology of leaking ascites was as follows: 1) ruptured umbilical hernia ( UH ) (four patients), 2) repeated paracentesis (three patients), and 3) postoperative incisional ascitic fluid leak (two patients). Initial therapy included local sterile compression dressing, intravenous antibiotics, and management of fluid and electrolytes. All nine patients underwent subsequent closure of the fascial defect and PV shunt to prevent reaccumulation of ascites (simultaneous procedures were performed in five patients). No patient developed postoperative septic complications, organ failure, gastrointestinal bleeding, or encephalopathy. There were no early deaths; however, three late deaths (18 months, 2, and 4 years) were due to variceal bleeding and/or liver failure. Ascites was well controlled in seven patients with PV shunt alone, the other two ultimately responding to medical therapy. We conclude that peritoneal fluid leaks can be treated successfully by repairing the fascial defect and placing a PV shunt. In the absence of infected ascites and clinical peritonitis, PV shunt may be performed simultaneously with closure of UH , thus preventing the reaccumulation of ascites during the immediate postoperative period.     

Cytotoxicity as an indicator for transport mechanism: evidence that murine bone marrow progenitor cells lack a high-affinity leucine carrier that transports melphalan in murine L1210 leukemia cells

Cytotoxicity of melphalan to murine L1210 leukemia cells was reduced to a limiting maximum value of 50% by 2-aminobicyclo[2,2,1]heptane-2- carboxylic acid (BCH), indicating that cytotoxicity is partially dependent on drug uptake by system L. L-Leucine, but not alpha- aminoisobutyric acid (AIB), completely reduced the remaining 50% of drug cytotoxicity. These results contrast with those obtained with a sensitive host tissue, the bone marow progenitor cells of the white cell series (CFU-C), in that a high-affinity leucine transport system corresponding to system L was not identified.     

Denture stomatitis with multiple intramucosal fistulae

Abstract – A hitherto undescribed clinical and histologic entity occurring in the palate of 13 denture-wearing patients is described. Clinically it is characterized by the presence of small yellowish areas in the hard palate, which on pressure yield a whitish creamy material through multiple openings. The surrounding mucosa may exhibit various degrees of erythema. The histologic changes are characterized by the presence of intramucosal fistulae lined with unkeratinized squamous epithelium. The content of the fistulae, which corresponds to the creamy material expelled, consists of desquamated epithelial cells. These changes have mostly been nodced in elderly females, all wearing maxillary dentures for many years. This entiPf is considered a type of demure stomatitis characterized by intramucosal proliferation of epithelium, possibly because of long-standing chronic irritation from dentures. The origin of the intramucosal fistulae is unknown. The fistulae are believed to originate either from the ductus of the minor salivary glands or from the surface epithelium of the palate.     

Intermediate lymphocytic lymphoma: immunophenotypic and cytogenetic findings

A detailed immunohistologic and cytogenetic analysis of 12 cases of intermediate lymphocytic lymphoma was performed. The characteristic immunophenotype of intermediate lymphocytic lymphoma was: surface IgM and IgD+, BA1+, B1+, BA2-, B2-, B4+, Leu 14+, Leu 1+, HLA-DR+, and common acute lymphocytic leukemia associated (CALLA) antigen negative. Clonal chromosome abnormalities were identified in ten cases, with structural or numerical abnormalities of chromosomes 11 or 12 in nine cases. Five cases had structural abnormalities involving the long arm of chromosome 11; three of these had translocations with chromosome 14 at band q32. Three cases had trisomy 12, and one case had a translocation involving the long arm of chromosome 12. The tenth case had a translocation involving the long arms of chromosomes 7 and 9. These characteristic immunophenotypic and cytogenetic findings suggest a close lineage relationship between intermediate lymphocytic lymphoma and small lymphocytic (well differentiated) lymphoma/chronic lymphocytic leukemia. Their differing clinical, cytologic, and architectural features suggest, however, that intermediate lymphocytic lymphoma should be considered a separate category of lymphocytic lymphoma in the International Working Formulation.     

Noninvasive measurement of gastric accommodation in patients with idiopathic nonulcer dyspepsia

OBJECTIVES: Postprandial symptoms are associated with impaired postprandial gastric accommodation. The aims of this study were to apply a noninvasive method to measure accommodation of the entire stomach in healthy subjects and in patients with idiopathic dyspeptic symptoms, and to assess the frequency of abnormal gastric accommodation and emptying of solids in these patients. METHODS: In 20 healthy volunteers and 32 tertiary referral patients, we used i.v. 99mTc-single photon emission computed tomography (SPECT) to measure fasting and postprandial gastric volumes; we expressed the volume response to feeding ("accommodation") as the change in gastric volume and the ratio of postprandial/fasting volumes. The stomach was identified in transaxial SPECT tomographic images using a semiautomated, intensity-based extraction algorithm. Whole gastric volumes were measured using AnalyzeAVW software. Gastric emptying in patients was measured by scintigraphy. We also assessed dyspeptic symptoms and the association with normal or reduced accommodation. RESULTS: SPECT imaging detects the postprandial change in gastric volume ("accommodation") in health and disease. Among healthy subjects (eight men, 12 women), the postprandial/fasting gastric volume ratio was 4.9+/-1.7 (mean +/- SD; fifth through 95th percentiles 3-8, median 4.6). Thirteen (41%) patients with idiopathic nonulcer dyspepsia had reduced postprandial "accommodation." Gastric emptying was fast in four (13%), normal in 25 (78%), and slow in three (9%) patients. Both tests were normal in 50% of patients. Weight loss of >10 pounds tended to be more frequently observed in those with reduced "accommodation" (62% vs 32%, p = 0.09). CONCLUSIONS: SPECT imaging noninvasively measures fasting and postprandial gastric volumes in humans. Half the patients with idiopathic nonulcer dyspepsia had impaired gastric accommodation or emptying. Reduced gastric "accommodation" was observed in 41% of a group with idiopathic nonulcer dyspepsia. Abnormal gastric emptying is less frequent (22%).     

Why should i comply? Sellers' accounts for (non-)compliance with legal age limits for alcohol sales

Background

Availability is an important predictor of early and excessive alcohol consumption by adolescents. Many countries have implemented age limits to prevent underage purchases of alcohol. However, shop-floor compliance with these age limits appears to be problematic. This study addresses the issue of non-compliance with age limits. Which measures do vendors take to avoid underage alcohol sales, and what do they report as important reasons to comply or not with age limits for alcohol sales?

Methods

Open-ended telephone interviews were conducted with store managers selling alcohol (N = 106). Prior to the interviews, all outlets were visited by an underage mystery shopper in order to measure compliance with the legal age limits on alcohol sales. The interview results are compared against actual compliance rates.

Results

Several measures have been taken to prevent underage sales, but the compliance level is low. Furthermore, open coding resulted in 19 themes, representing both valid and invalid arguments, that vendors mentioned as relevant to their decisions of whether to comply with the law. Compliance with age limits is dependent on the knowledge of the rules and the ability and motivation to follow the rules. The ability aspect in particular seems to be problematic, but in many cases, the motivation to actively comply with the age limits is lacking.

Conclusions

To enhance compliance, it is important to raise the awareness of the importance of age limits and to connect possible violations of the regulations to negative consequences.     

Intracranial potentials correlated with an event-related potential, P300, in the cat

Intracranial recordings of long-latency, event-related potentials were obtained from paralyzed, artificially respirated cats. A modified oddball paradigm was employed in which cats were presented with a randomized series of two tones, a 'frequent' 4 kHz stimulus and a 'rare' 1 kHz stimulus. A tail shock was administered 700 ms after onset of the rare tone. Under these circumstances the stimulus elicited a positive component at the vertex similar to the human P300. Intracranial potentials associated with the rare tone usually manifested components of greater amplitude than did potentials associated with the frequent tone. A positive component occurring in latency between 200 and 350 ms only accompanied the presentation of the rare stimulus. The P300 component, which was positive at the dura, appeared as a negative component within a few millimeters of the surface over a wide area of the marginal and suprasylvian gyri. Changing the probability of the rare stimulus resulted in a reduction in the amplitudes of both the intracranial negative component and the P300 recorded at the skull. Components of large amplitude associated with the rare stimulus were obtained from the region of the hippocampus. These components reversed polarity, sometimes more than once, as the electrode was advanced. Substantial latency differences were often observed between the P300 recorded at the skull and P300-like intracranial components associated with the rare stimulus. These results suggest that the cortices of the marginal and suprasylvian gyri and the hippocampal region contribute to the generation of the cat P300.     

Trends in the severity of self-poisoning.

Of 2947 patients admitted to a district general hospital over an 11-year period for the management of self-poisoning, 148 (5%) required intensive care unit (ICU) treatment. There was a significant increase in the number of self-poisonings admitted each year, whereas the number requiring ICU admission did not change. Therefore the proportion of patients requiring ICU admission fell significantly over the study period (P less than 0.0005). Of 898 patients admitted from 1973 to 1977, 62 (6.9%) were treated in ICU. Of 2049 patients admitted from 1978 to 1983, 86 (4.2%) required ICU treatment. It is felt that this trend is explained by a rise in parasuicidal self-poisonings. The impact of change in drug availability is evident in the significant reduction in ingestion of sedative barbiturates.