Chenodeoxycholic acid-3-sulfate. Metabolism and excretion in the rat and hamster and effects on hepatic transport systems

The metabolism and excretion of chenodeoxycholic acid-3-sulfate were determined in rats and hamsters. Constant intravenous infusions of 1, 2, and 3 mumoles/min in rats gave a maximum excretion in bile of 1.25 mumoles/min. Simultaneous infusions of sodium taurocholate at 2.0 mumoles/min and sulfobromophthalein at 0.2 mumole/min had no effects on the maximum excretion rate of chenodeoxycholic acid-3-sulfate. However, the bile acid ester sulfate caused a dose-related reduction in the excretion rate of BSP without affecting bile acid excretion rate and without a reduction in total bile flow. Chromatographic analysis of ester sulfate, a bile acid recovered in bile and urine, indicated that more than 95% had not undergone further metabolic transformation.     

Intraperitoneal insulin administration produces a positive portal-systemic blood insulin gradient in unanesthetized,unrestrained swine

The present study was performed to evaluate the porto-systemic insulin gradient in response to (1) glucose feeding (2) intramuscular insulin administration, and (3) peritoneal insulin administration in unanesthetized swine. The experiment was designed to verify the hypothesis that intraperitoneal insulin administration might lead to a more physiologic portal vein insulin concentration than systemic administration of a similar insulin dose. Studies were performed in 4 domestic swine with chronic, indwelling catheters in the inferior vena cava and portal vein. Unpaired studies of the absolute portal venous and systemic venous insulin concentrations were performed in response to glucose prn(n = 4), 1 unit regular insulin/kg i.m.(n = 4), and 1 unit regular insulin/kg i.p.(n = 5). Timed blood samples were obtained and serum insulin concentrations determined by RIA. Portal and caval serum insulin concentrations following intramuscular insulin injection showed no significant difference. A significant portal vein insulin excess (p < 0.001) was demonstrated following both feeding and intraperitoneal insulin.     

Institutional structures: Catalysts of or barriers to quality care for the institutionalized aged in Scotland and the U.S.

The care of the elderly in two long-term care institutions, one in Scotland and one in the United States, is described, compared, and analyzed. In Scotland three institutional structures, the National Health Service, the Geriatric Service, and the specialty of geriatrics are identified as catalysts of quality care. In the U.S. Medicare and Medicaid, the absence of geriatrics as a specialty, and the nursing home are identified as barriers to quality care for the institutionalized aged. The findings suggest that three components, an adequate government insurance program, professionals who specialize in the care of the aged, and a structure to provide continuing comprehensive care, are essential for a successful program of care for the institutionalized elderly.     

Surface changes in Pseudomonas aeruginosa exposed to chlorhexidine diacetate and benzalkonium chloride

Pseudomonas aeruginosa strains 799 (wild-type) and 799/61 (envelope mutant) were exposed to chlorhexidine diacetate and benzalkonium chloride, and their hydrophobicity measured in a hydrocarbon (xylene) system. Both drugs induced changes in surface hydrophobic properties at concentrations well below those that inhibited cellular growth, A comparison of these findings has been made with a wild-type and an envelope mutant of Escherichia coli, both of which strains are more sensitive than Ps. aeruginosa to these drugs.     

Predictors of outcome in early revascularization after acute myocardial infarction

We have reviewed 44 consecutive patients undergoing myocardial revascularization from 1 to 42 days after myocardial infarction. Operation within 12 days of transmural myocardial infarction carried a substantially high risk, particularly in patients with poor ventricular function. Patients with subendocardial infarction may be safely operated on shortly after infarction has occurred. In those with transmural infarcts, it may be advantageous to delay operation if early and aggressive medical therapy can effectively control the symptoms. This has to be counterbalanced, however, by the realization that the situation should not be allowed to slide into one of irreparable ventricular damage from infarct extension.     

A method for predicting postoperative lung function and its relation to postoperative complications in patients with lung cancer

We predicted the postoperative forced expiratory volume in 1 second (FEV1) with a formula based on the premise that the total number of subsegments was 42: postop FEV1 = [1 - (b - n)/(42 - n)] (preop FEV1), where n and b are the number of obstructed subsegments and total subsegments, respectively, in the resected lobe. It was assumed that b was 6, 4, and 12 in the right upper, middle, and lower lobes, respectively, and 10 each in the left upper and the left lower lobes. The obstructed subsegments, n, were obtained from the findings on bronchography or bronchofiberscopy or both before operation. The linear regression line derived from the correlation between predicted (x) and measured (y) FEV1 was y = 0.850x + 0.286 +/- 0.296 (standard error) (N = 52; r = 0.821; p less than 0.001). We calculated the predicted postoperative FEV1 in 188 patients with primary lung cancer. The predicted values were corrected with the regression equation just mentioned and then normalized by the patient's height and sex (%FEV1(p,c). The correlation between %FEV1(p,c) and the surgical risk was studied. Postoperative respiratory complications were inversely related to %FEV1(p,c), and a significantly high incidence of complications (p less than 0.05) was observed in those whose %FEV1(p,c) was less than 60% of predicted normal. In aged patients (65 years old or more) without complications, %FEV1(p,c) was 67.3 +/- 18.0%; it was 52.2 +/- 12.8% in those with respiratory trouble and 53.3% +/- 9.6% in those with circulatory complications. The difference between groups with and without complications was significant (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)