Adaptation of a perfused rat hemidiaphragm preparation to the study of intermediary metabolism

Glucose catabolism of a vascular perfused rat hemidiaphragm was determined at rest and during stimulation of the phrenic nerve with trains of either 5 (T5) or 15 (T15) pulses (20 msec intervals) per second. Tissues were perfused and bathed in HEPES-buffered medium containing 11 mM D-[U-14C, 5-3H]glucose, equilibrated with 100% O2. Resting glucose catabolism via the Emden-Meyerhof pathway was indicated by a 3H2O production rate per hemidiaphragm of 1.45 +/- 0.07 mumol/h, of which 47% was recovered as [14C]lactate with the remainder assumed to be metabolised by mitochondria. During the first 30 min of T5 and T15 stimulation, peak isometric tension declined from an initial value of 105 +/- 8 g by 54% and 79%, respectively. The resulting peak tensions of 48 and 22 g remained constant for the next 60 min. These tensions were associated with linear rates of 3H2O production of 2.93 +/- 0.41 and 2.84 +/- 0.25 mumol/h. Stimulation by T5 and T15 increased mitochondrial metabolism of glucose by 64% and 95%, respectively, with no significant alterations in lactate formation from either exogenous or endogenous sources. The results suggest that the initial decline in tension is due to fatigue of the fast anaerobic myofibers; whereas, the sustained force beyond 30 min is attributable to the mitochondrial-rich slow myofibers.     

Luxatio erecta: the inferior glenohumeral dislocation

Luxatio erecta, or inferior glenohumeral dislocation, is a rare shoulder dislocation usually caused by a hyperabduction injury to the arm. We have reviewed the literature consisting of 80 cases of luxatio erecta and also discuss six additional cases that we have treated. The literature shows that either a fracture of the greater tuberosity or a rotator cuff tear was associated with this injury in 80% of patients; 60% of the patients reviewed sustained some degree of neurologic compromise, most commonly to the axillary nerve. These injuries usually resolved; the time for recovery varied from 2 weeks to 1 year. Only 3.3% of the cases demonstrated significant vascular compromise, but this is the highest incidence for any shoulder dislocation. Doppler studies of the affected arm or observation of the patient overnight are recommended because of the potentially disastrous complications of vascular insufficiency. If there is any indication of a vascular problem, immediate arteriogram is indicated. Although usually fairly easily reduced by overhead traction, the lesion is so rare that few physicians are familiar with the technique of reduction. Fluoroscopy was used in our most recent cases and was helpful in obtaining a complete and safe reduction.     

Elevated sympathetic response of epicardium proximal to healed myocardial infarction

Sympathetic nerve interaction with cardiac electrophysiology was evaluated in healed myocardial infarction by monitoring the effects of sympathetic nerve stimulation on local epicardial refractoriness in cats. Single-stage distal coronary artery ligation was used to induce myocardial infarction. Regions overlying and surrounding infarcts 3 mo after healing and comparable regions in sham-operated and normal unoperated hearts were studied. Local ventricular muscle refractory periods were measured by the extrastimulus technique from 1) the epicardium overlying the infarct, 2) the area bordering the infarct, and 3) a normal area proximal to the infarct on the anterior free wall of the left ventricle. Bilateral stimulation of the ansa subclavia induced significant and disparate refractory period shortening (P less than or equal to 0.01) in hearts with healed myocardial infarction. Shortening was greatest in the normal area [-26 +/- 8 (+/-SD) ms], less in the border area (-15 +/- 6), and least in the infarct area (-7 +/- 2). In contrast, refractory periods measured in noninfarcted hearts shortened significantly (P less than or equal to 0.01) but uniformly and to a lesser extent during sympathetic stimulation. We conclude 1) the effects of sympathetic nerve stimulation are more pronounced in the areas proximal to healed infarction than in similar areas of noninfarcted hearts and 2) a marked disparity in sympathetic responsiveness occurs in hearts with healed myocardial infarction.     

Pooling of sera for human immunodeficiency virus (HIV) testing: an economical method for use in developing countries.

To determine whether donated blood samples in African countries could be pooled, then tested for the presence of human immunodeficiency virus (HIV) antibodies with a single test without loss of accuracy, a single test on five pooled samples was used, followed by individual testing of positive pools. This resulted in no loss of either sensitivity or specificity. Pooling 10 samples resulted in a loss of sensitivity for low antibody titre specimens. Pooling reduced the costs of screening by 70% and time needed for analysis. It is concluded that pooling of five samples for HIV screening may result in a substantial reduction in costs; in countries where the prevalence of HIV is higher than the 2-3% found in Zimbabwean donors, however, savings may not be as great.     

Ischemic necrosis of the femoral head. Correlation of magnetic resonance imaging and histologic sections

Magnetic resonance (MR) images were correlated with matched histologic sections of a resected ischemic necrotic femoral head and neck. Preoperative radiographs had revealed Stage 3 ischemic necrosis. Preoperative MR images disclosed foci of abnormally low signal intensity alternating with normal-appearing foci of high signal intensity. Surgical resection of the femoral head and neck was followed by MR imaging and pathologic sectioning, fixation, and staining, enabling the individual sections to be compared with the postoperative MR slices. A subchondral focus of diminished signal intensity was shown to represent saponified fat and consisted of a transudate of proteinaceous material with probable calcifications. The subjacent region of normal, high signal intensity represented "mummified" fat. The next lower stratum of diminished signal intensity was composed of fibrous and vascular tissues and histiocytic infiltrates that had extensively or completely replaced the fatty marrow.     

Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience

Abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.     

Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.