A new approach to massive blood transfusion during pediatric liver resection

Morbidity and death during liver resection in children are due to hemorrhage and the consequences of massive transfusion. To overcome these problems, a new rapid method of blood transfusion was used in four children (8 to 35 months, 8.6 to 13 kg) undergoing extensive hepatic resection for tumor (tumor weight, 440 to 1625 gm). The rapid infusion device consisted of a roller pump and a bubble oxygenator-warmer circuit primed with washed packed red cells resuspended in fresh-frozen plasma and calcium-free balanced salt solution (Plasmalyte). The infusate was warmed, oxygenated, and buffered before it was administered. An average of 5130 ml per patient of this reconstituted blood was infused at an average rate of 122 +/- 45 ml/min, with peak infusion rates sometimes as great as 1 L/min. Cardiac output, pulmonary artery wedge pressure, body temperature, urine output, blood gases, blood chemistries, and coagulation factors remained unchanged during and after these massive transfusions. Blood transfusion at rapid rates required during pediatric liver resection can be accomplished safely if the storage lesion of the bank blood is previously corrected.     

Computerized Cardiovascular Monitoring: Method and Data

This paper describes the development of a digitized, real-time, microcomputer-based signal processing system which records the following variables: systolic and diastolic blood pressure, heart rate, pulse transit time, blood volume pulse, and R-, S-, and T-wave amplitudes of EKG signals. Forty-eight healthy subjects participated in a three-task stress response study in order to gather initial data for evaluating the reliability and validity of this monitoring system. The three tasks represented replications of earlier studies: 1) reading aloud of a monotonous neutral text (Reading Only, RO); 2) mental arithmetic without vocalization (Arithmetic Quiet, AQ); and 3) mental arithmetic with vocalization (Arithmetic Aloud, AA). The findings provided support for the reliability and validity of the new monitoring system given that few data were lost, and resting values as well as differential task responses were found to be comparable with earlier data sets derived via similar experimental protocols.     

Physiological concentrations of melatonin inhibit the nitridergic pathway in the Syrian hamster retina

In the present work, the effect of melatonin on the hamster retinal nitridergic pathway was examined. When the retinas were incubated in the presence of low concentrations (1 pM-10 nM) of melatonin for 15 min, a significant decrease of nitric oxide synthase (NOS) activity was observed. However, when crude retinal homogenates were preincubated with melatonin for 15 min, no changes in NOS activity were detected, despite the fact that under the same conditions trifluoperazine, a calmodulin inhibitor, significantly decreased enzymatic activity. Kinetic analysis showed that melatonin decreased the V(max) of retinal NOS without changes in the K(m). On the other hand, low concentrations (100 pM) of melatonin significantly reduced retinal L-arginine influx. A decrease in the V(max) of L-arginine uptake was observed in the presence of melatonin, whereas the K(m) remained unchanged. Melatonin significantly inhibited the accumulation of cyclic guanosine monophosphate (cGMP) levels induced by both L-arginine and sodium nitroprusside (SNP). In summary, the present results indicate that melatonin could be a potent inhibitor of the retinal nitridergic pathway.     

Diverticular disease of the appendix

A retrospective study of diverticular disease of the appendix was made in 3,343 consecutive instances of appendectomies. A 2 per cent incidence of diverticular disease was found. These instances were classified into four morphologic types: 1, acute diverticulitis; 2, acute appendicitis with acute diverticulitis; 3, acute appendicitis with diverticulum, and 4, appendix with diverticulum. Types 1, 2 and 3 were divided into subgroups with or without perforation. The elements of clinical behavior in each group were examined in detail. Diverticulitis of the appendix is presented as a clinically variant form of the inflamed appendix. Some followed the pattern of typical acute appendicitis. However, most were distinctive at a later age of onset, longer interval of disease, fewer or absent symptoms of the gastrointestinal tract, failure of typical abdominal pain progression, delay in surgical treatment and a remarkably high incidence of perforation. In a chi-square analysis of 56 patients with acute diverticulitis of the appendix compared with 2,503 patients with acute appendicitis, more than a fourfold incidence of perforation in acute diverticulitis was significant beyond the 0.001 level. These findings of variant behavior and high incidence of perforation are cautionary features of this frequently overlooked disease.     

Gardner’s syndrome and fibromatosis: Review of the problem and report of a case

Summary Gardner’s syndrome is inherited as an autosomal dominant trait. It is characterized by intestinal polyposis, bony exostoses, and multiple soft-tissue abnormalities. Life-threatening components of the trait are the malignant potential of the colonic polyposis and the malignant behavior of the histologically benign intraabdominal fibromatosis. Colectomy or proctocolectomy is indicated for colonic polyposis; a case illustrating the feasibility of wide resection for intra-abdominal fibromas is presented.     

Coxsackievirus B3-induced myocarditis. Autoimmunity is L3T4+ T helper cell and IL-2 independent in BALB/c mice.

Male BALB/c mice inoculated with 6 X 10(4) plaque-forming units (pfu) coxsackievirus, group B, type 3 (CVB3), develop myocarditis within 7 days. Two cytolytic T lymphocyte (CTL) populations arise in infected animals. One population belongs to the Lyt 2+ T (cytolytic/suppressor) lymphocyte subset and reacts specifically with uninfected heart cells (autoreactive CTLs, ACTLs), whereas the other belongs to the L3T4+ T (helper) lymphocyte subset and reacts with infected targets (virus-specific CTLs, VSCTLs). Although both immune T lymphocyte populations can induce cardiac inflammation in vivo, ACTLs predominantly cause tissue injury. VSCTL generation can be inhibited by either anti-Tac (antibody to the interleukin 2 [IL-2] receptor) or anti-Iad but not by anti-IAk, indicating that this response is probably both IL-2-dependent and Class II (major histocompatibility complex [MHC] antigen restricted. ACTL generation is independent of IL-2, because neither anti-Tac or cyclosporin A inhibit this response.