Proctosigmoidoscopy and rectal biopsy in infants and children.

The medical records of all patients ages 0 to 21 years who underwent proctosigmoidoscopy and/or rectal biopsy over a 27 month period of time were reviewed to determine the efficacy and safety of these procedures in pediatric patients. One hundred twenty-one patients underwent proctosigmoidoscopy; 91 of these also had rectal biopsies. Median age was two years; 21% were less than six months and 8% less than one month of age. Depth of examination was 10 to 15 cm in most patients greater than 10 years of age. Induced friability was the most frequently observed mucosal abnormality. Abnormal findings were almost always present in patients with bloody diarrhea and were quite common in those with rectal bleeding, but less common in those with chronic diarrhea and abdominal pain. Colitis of various causes was the most common cause of blood in the stool; anal fissures were found in only four of 23 patients with rectal bleeding. Both proctosigmoidoscopy and rectal biopsy were needed to exclude the presence of colitis. Mobidity was 0% with proctosigmoidoscopy and 0.34% with rectal suction biopsy.     

Laboratory evaluation of an outbreak of nocardiosis in immunocompromised hosts

Seven patients in a renal unit were proved to have nocardiosis in an interval of nine months. Six of these patients had received renal transplants. Serologic investigation suggested that two additional cases of undiagnosed pulmonary disease were also nocardial, and that there were no subclinical cases in patients or staff. Clinicalserologic correlations indicate that serologic evaluation may be a useful adjunct in diagnosis of nocardiosis, if used early and repeatedly, and to follow response to therapy. Epidemiologic investigations yielded cultures of Nocardia asteroides from air and dust inside the unit and elsewhere in the hospital. Biochemical, metabolic, physical and immunologic characterization of the isolates indicated that those from patients and those from the unit environment were identical, whereas some from outside the unit could be differentiated from these. The “epidemic strain” had type III antigen, which surveys indicated is not the most common type in human nocardiosis (it occurs in association with a minority of human cases). The isolates were of subgroup B, which has been associated with virulence. The characterization methods employed could be useful in studies of nocardial epidemiology. The laboratory studies indicate epidemic spread within the unit of a single organism, and current epidemiologic guidelines, which do not recommend respiratory isolation of cases of pulmonary nocardiosis, may need reconsideration particularly when there are immunocompromised hosts in the environment.     

Increased subcortical and laminar cortical 2-deoxy[14C]glucose uptake during cerebellar stimulation

2-Deoxy[¹⁴C]glucose (2DG) uptake was mapped in brains of conscious rats during cerebellar hemisphere electrical stimulation and compared with sham-operated controls. The 2DG uptake increased bilaterally in cerebellar cortex and deep nuclei, the largest increases being ipsilateral to the stimulating electrode. Structures which increased 2DG uptake bilaterally but had larger contralateral increases included the red nucleus, inferior olive, zona incerta, substantia nigra, globus pallidus, deep mesencephalic nucleus, habenula, reticular tegmental nucleus of the pons, ventroanterolateral and ventromedial nuclei of thalamus, several other thalamic nuclei, and motor-somatosensory cortex. Most of these structures receive efferent fibers from cerebellar nuclei. Cerebellar stimulation produced two bands of 2DG uptake bilaterally in rat motor-somatosensory neocortical laminae IV and Vc-VIa. Shamoperated controls had one band of 2DG uptake in neocortical lamina IV. We postulate that cerebellar stimulation increased 2DG uptake polysynaptically in lamina Vc-VIa by the following pathway: Purkinje cells → deep cerebellar nuclei → ventrolateral and/or ventromedial nuclei of thalamus → lamina Vc-VIa of neocortex. Activation of these cortical laminae could affect cortical seizure foci.     

Acute Hemodynamic Alterations after Mitral Valve Replacement with the Glutaraldehyde-Treated Porcine Heterograft Prosthesis

Perioperative hemodynamic changes following mitral valve replacement using the porcine heterograft prosthesis were measured in 21 patients with acquired mitral valve disease. Preoperatively, a state of compensatory cardiac failure was suggested by the following: an increased heart rate (HR) (96 beats per minute); low cardiac and stroke volume (SVI) indices (2.3 ± 0.10 L/min/m² and 25 ± 2 ml/beat/m²); and increased systemic vascular resistance (SVR) (1,626 ± 116 dyne sec cm^?5). Both the mean pulmonary artery (PAP) and pulmonary capillary wedge pressures (PCWP) were elevated as well (32 ± 3 and 22 ± 2 torr). Immediate hemodynamic improvement followed valve replacement. HR, SVR, PAP, and PCWP all decreased significantly. Twenty-four hours after valve replacement, PAP (23 ± 1 torr) and PCWP (13 ± 1 torr) demonstrated marked declines, SVR was reduced by one-third (1,173 ± 87 dyne sec cm^?5), HR had decreased by 10 beats per minute, and SVI had increased to 30 ± 2 ml/beat/m². The prompt circulatory improvement of patients soon after mitral valve replacement using the porcine heterograft compares favorably with studies in which other valve types were employed and in which postoperative cardiovascular depression was encountered frequently.     

Effectiveness of alternative parent training formats

Alternative formats were compared for training parents of retarded children to teach self-help skills and manage problem behaviors. Sixty-six families with moderately to severely retarded children ages 3-13 were assigned for 3 months to group parent training (n = 37), individual parent training (n = 16), or delayed training control (n = 13). Measures administered before and after training evaluated: (1) parent knowledge of behavior modification, (2) a behavior sample of parent teaching, and (3) child self-help skills and behavior problems. Trained families gained significantly more than control families on parent measures but not on the child self-help skill measure. Group and individually trained families demonstrated almost identical gains. At a 6-month follow-up, group and individually trained families continued to show equal performance. Group training requires about half the professional time per family as individual training, and therefore seems a more cost-effective approach.     

Comparative cardiac oxygen radical metabolism by anthracycline antibiotics, mitoxantrone, bisantrene, 4'-(9-acridinylamino)-methanesulfon-m-anisidide, and neocarzinostatin

This study examined the effects of various anthracycline antibiotics and mitoxantrone, bisantrene, 4'-(9-acridinylamino)-methanesulfon-m-anisidide (m-AMSA), and neocarzinostatin on oxygen radical formation by cardiac sarcoplasmic reticulum and submitochondrial particles. Doxorubicin, daunorubicin, rubidazone, and aclacinomycin A stimulated superoxide production by both heart fractions in a dose-dependent fashion that appeared to follow saturation kinetics. The anthracycline drugs also significantly increased hydrogen peroxide production by heart sarcosomes and submitochondrial particles. On the other hand, mitoxantrone, bisantrene, m-AMSA, and neocarzinostatin did not significantly enhance cardiac reactive oxygen metabolism. Thus, it is unlikely that the mechanism of the cardiac toxicity produced by mitoxantrone and m-AMSA in patients previously treated with anthracycline drugs can be directly related to oxidation-reduction cycling catalyzed by cardiac flavin dehydrogenases.