Formation and reversibility of S-linked conjugates of N-(1-methyl-3,3-diphenylpropyl)isocyanate, an in vivo metabolite of N-(1-methyl-3,3-diphenylpropyl)formamaide, in rats

The metabolic disposition of N-(1-methyl-3,3-diphenylpropyl) formamide was studied in rats. The water-soluble metabolites, N-acetyl-S-[N-(1-methyl-3,3-diphenylpropylcarbamoyl)]cysteine and S-[N-(1-methyl-3,3-diphenylpropylcarbamoyl)]glutathione, were identified in urine and bile, respectively, of rats doses with the secondary formamide. The structures of these metabolites were confirmed by comparison with synthetic standards and by using liquid chromatography mass spectrometry and fast atom bombardment mass spectrometry. Synthetic standards of these metabolites were obtained by reacting the N-(1-methyl-3,3-diphenylpropyl)isocyanate with glutathione or N-acetylcysteine in methanolic solutions. The isocyanate was obtained in high yield by reacting 1-methyl-3,3-diphenylpropylamine with trichloromethyl chloroformate. The S-linked conjugates released the isocyanate in mild alkali, but were stable under acidic conditions. The released isocyanate was characterized by comparison with the synthetic standard using GC/MS and HPLC. A mechanism is proposed for the base-catalyzed elimination of the isocyanate from the thiol conjugates.     

Mediastinal goiters. A clinical case series

The paper described the treatment of a series of 47 mediastinal goitres. The importance of a thorough preoperative assessment of the lesion and of careful planning of the operative technique are underlined. Cervical collar incision provided adequate exposure in most patients. The Authors conclude that surgical treatment should be recommended in all cases.     

Lateral shoulder graft for microsurgic plasty of hand and foot

The authors have thoroughly studied the versions of anatomic structure, peculiarities of blood circulation and innervation of lateral arm graft at 20 recent cadavers. The graft can be utilized in different modifications; cutaneofascial, subcutaneofascial, musculocutaneous, osteocutaneous. In the clinic were made 8 free microsurgic transplantations of lateral arm graft for plasty of tissues of different genesis in functionally important zones of hand and foot. In long-term post-operative period all patients demonstrated good functional and cosmetic results.     

Insertion of testicular prosthesis: use of vaginal speculum

We have used a vaginal speculum to insert a testicular prosthesis through the inguinal approach over the past four years. We have found this technique to be easily performed and reproducible in allowing the testicular prosthesis to be placed in the normal dependent position in the scrotum.     

Granulomatous Pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome.

A patient with an unusual granulomatous response to infection with Pneumocystis carinii is described. The diagnosis was made by open lung biopsy after two negative bronchoalveolar lavages.     

Endothelial cell antigens recognized by xenoreactive human natural antibodies.

Hyperacute rejection of vascularized, discordant xenografts is generally though to be initiated when natural antibodies of the recipient bind to endothelial cells of the donor organ. While rejection of such xenografts always occurs, the molecular targets of natural antibodies have not been elucidated. The aim of the experiments reported herein was to identify the molecules on porcine endothelial cells that would be recognized by human natural antibodies if a porcine organ were to be transplanted into a human (or rhesus). Toward the end, it was shown that the major components recognized by human serum on porcine endothelial cells are glycoproteins of 115kDa, 125kDa, and 135kDa (gp115/135). Reactivity with these glycoproteins was abrogated by enzymatic cleavage of N-linked oligosaccharides or of subterminal beta-D-gal residues suggesting that the determinants are located on oligosaccharides rather than on the polypeptide cores. The biological relevance of gp115/135 was suggested by experiments in which a similar series of components was shown to be recognized by rhesus natural antibodies and by the absorption of such antibodies by perfusion of porcine kidneys. The gp115/135 antigens were present on porcine platelets but not porcine RBC or lymphocytes. Nevertheless, purified RBC and lymphocytes absorbed human anti-gp115/135, suggesting that human natural antibodies recognize the same or crossreactive carbohydrate determinants expressed on the surface of a variety of cells.     

Efficacy of home health care in patients with peripheral vascular disease

This investigation was designed to study the effects of home health care (HHC) on patients who have been hospitalized with peripheral vascular disease. For a patient to have HHC, the patient had to have a defined wound, educational needs, or both. Sixty patients, 30 with HHC and 30 without, were contacted approximately 30 days after their last hospital discharge. The 30 patients with HHC were deemed to be at increased risk because of multisystem disease with multiple medications, infirmity, early senility, and often complex wounds. In a prospective fashion, each patient was interviewed by either a registered nurse or medical student using a standardized data collection form. The following issues were assessed: incidence of postoperative complications, knowledge of the patient of his or her disease, compliance with medication (knowledge of, regular use), incidence of readmission, and unscheduled clinic or emergency department visits. Upon statistical analysis using the two-sample t-test and Pearson chi-square test, no significant differences were found between the two groups in terms of complications, compliance, or patient education. HHC, therefore, was found to be helpful to patients with peripheral vascular disease. In our study, the use of HHC made the risk of complications in a group of patients with defined teaching needs and wound care needs equal to that in a group with no such defined needs on discharge from the hospital.     

Positive end-expiratory pressure accelerates lung water accumulation in high surface tension edema

The effect of positive end expiratory pressure (PEEP) on the rate of lung water accumulation with high surface tension pulmonary edema was examined. Alveolar surface tension was elevated by inhalation of 15 mg/kg of the aerosolized detergent dioctyl sodium sulfosuccinate (OT). Hemodynamic measurements, blood gases, and colloid oncotic pressures were recorded in anesthesized dogs for 2 hours after surfactant displacement and elevation of PEEP to 10 cm H2O pressure (group II; n = 10). These data were compared with those of an identical protocol that used only 5 cm H2O PEEP (group I; n = 10). Pulmonary extravascular water volume (PEWV) was measured gravimetrically at the end of the experiment. OT inhalation resulted in an immediate fall in Pao2 and rise in venous admixture (QVa/QT), with little change in colloid oncotic pressure or left atrial pressure. In group I, Pao2 and QVa/QT did not improve significantly over 2 hours, whereas both returned to near baseline in group II. PEWV was elevated in group I compared with normal PEWV (historic controls; n = 11) (6.1 +/- 0.07 - 3.6 +/- 0.01 ml/gm dry lung; p less than 0.01); however, PEWV in group II (9.1 +/- 1.0 ml/gm dry lung; p less than 0.01) was greater than in both group I and historic controls. These data indicate that high alveolar surface tension induces pulmonary edema and PEEP accelerates this edema formation.