Suprasternal Doppler ultrasound for assessment of stroke distance

An assessment of a non-invasive technique for measurement of stroke distance was made using a portable Doppler ultrasound machine. The aim was to determine the measurement error of repeated stroke distance measurements (Within-observer variability) and to assess measurement agreement between two operators (between-observer variability). The measurement error (within-observer variability) for both operators was similar at approximately 2 cm. However, the measurements of the two operators (between-observer variability) did not agree well. Using the mean (SD) of three readings by each operator, the mean difference between the operators was -0.21 cm (1.96) giving a 95% confidence interval for the differences of -4.0 to +3.6 cm. There were significant positive and negative correlations between stroke distance and a variety of variables (age, height, weight, heart rate), but the relations were weak. The results indicate that the Doppler ultrasound technique for measurement of stroke distance would best be used to study trend changes in an individual patient, or subject, by a single operator.     

Contrasting effects of recombinant human granulocyte-macrophage colony- stimulating factor (CSF) and granulocyte CSF treatment on the cycling of blood elements in childhood-onset cyclic neutropenia

Recombinant human granulocyte colony-stimulating factor (G-CSF) treatment has been shown to increase average neutrophil counts substantially in patients with childhood-onset cyclic neutropenia (or "cyclic hematopoiesis"), but not to eliminate the cyclic oscillations of neutrophil counts or those of other blood elements (monocytes, platelets, eosinophils, and reticulocytes) that are characteristic of this hematopoietic disorder. Indeed, oscillations of neutrophil counts are amplified during G-CSF treatment. We have compared the effects of recombinant granulocyte-macrophage-CSF (GM-CSF) with those of G-CSF in three patients with this disease (2 men and 1 woman, 17, 30, and 32 years of age). These patients were treated with GM-CSF (2.1 micrograms/kg/day, subcutaneously) for 6 weeks, preceded and followed by 6 to 13 weeks of detailed observation to document changes in the cyclic oscillations of blood neutrophils and other blood elements; two of the patients were subsequently treated with G-CSF (5.0 micrograms/kg/d, subcutaneously) and observed for comparable periods of time. Unlike G-CSF treatment, which increased average neutrophil counts more than 20-fold, GM-CSF increased neutrophil counts only modestly, from 1.6- to 3.9-fold, although eosinophilia of varying prominence was induced in each patient. However, at the same time, GM-CSF treatment dampened or eliminated the multilineage oscillations of circulating blood elements (neutrophils, monocytes, platelets, and/or reticulocytes) in each of the patients. In contrast, G-CSF treatment of the same patients markedly amplified the oscillations of neutrophil counts and caused the cycling of other blood elements (monocytes in particular) to become more distinct. These findings support the conclusion that the distinctive cycling of blood cell production in childhood-onset cyclic neutropenia results from abnormalities in the coordinate regulation of both GM-CSF-responsive, multipotential progenitor cells and G-CSF-responsive, lineage-restricted, neutrophil progenitors.     

Glucose-6-phosphate dehydrogenase variants: reexamination of G6PD Chicago and Cornell and a new variant (G6PD Pea Ridge) resembling G6PD Chicago

Two large and unrelated families were investigated for hereditary nonspherocytic hemolytic anemia associated with deficiency of erythrocyte glucose-6-phosphate dehydrogenase (G6PD). In both families, the kinetic and electrophoretic features of the G6PD variants resembled those of G6PD Chicago. Further investigation revealed that members of one of these families previously had been characterized as having the G6PD variants Chicago and Cornell. However, it is clear that each of these terms has been applied to the same variant in this single large kindred. In the second family, we describe a newly identified variant with unique characteristics, which we have designated G6PD Pea Ridge. G6PD Pea Ridge resembles G6PD Chicago but differs in electrophoretic mobility and in a few kinetic parameters. It exhibits an unusually high Ki for NADPH and thus appears to be insensitive to product inhibition. As other cases previously considered to be the Chicago variant become more fully characterized, this probably will be shown to be a heterogeneous group of variants.     

Clinical and experimental study of antiarrhythmic and antianginal effects of quaternidine

High antiarrhythmic activity of a new Russian antiarrhythmic drug quaternidine in ventricular arrhythmia was studied in 96 coronary patients by Holter monitoring, bicycle ergometry, and echocardiography. The drug had a positive impact on local kinetics in left-ventricular ischemic myocardium and some parameters of bicycle exercise test. The preparation possesses no arrhythmogenic effect. Experiments on 30 random-bred rats showed that the drug reduced the necrotic zone under conditions of experimental coronary occlusion. Experiments on 14 intact cats demonstrated that quaternidine had no effect on coronary bloodflow.     

Mycobacterial infection in an inner city children's hospital

Childhood tuberculosis is perceived by many as a disease of the past. Experience in a children's hospital serving a deprived population suggested that tuberculosis and other mycobacterial infections were not declining in clinical practice. Fifty three tuberculous and 11 atypical mycobacterial infections were identified between 1978 and 1992. There was no decline in tuberculosis and nine of the 11 atypical infections occurred in the last five years. Altogether 40% of cases of tuberculosis were in non-Asian children; 32% had arrived in the UK or visited family overseas in the previous year; and 38% had a history of tuberculosis contact, usually a close adult relative. Nationally, the previous decline in tuberculosis in all ages has reversed. In the local health districts in London's east end, childhood tuberculosis has also stopped declining and seems to be increasing. It is regrettable that BCG vaccination has been abolished by some districts in the UK, against current recommendations. Childhood tuberculosis is still common in the practice described here, including among children who do not fall into conventionally recognised high risk groups. Inner city dwellers and junior doctors are both highly mobile populations, adding to the risk that paediatricians, particularly those in training, may encounter tuberculosis with little or no previous experience of the condition.     

Revascularization decompression of the optic nerve: a new surgery of the optic nerve in progressive glaucomatous optic neuropathy

A new operation on the optic nerve scleral canal, revascularization compression of the optic nerve, was carried out in 21 patients (21 eyes) in order to improve the visual functions and stabilize the glaucomatous process. The operation combines the advantages of decompression of the optic nerve by dissection of the posterior scleral ring with creation of an additional source of blood supply to the optic nerve from the myovascular bundle of the internal rectal muscle. Good functional effect and notable improvement of hemoperfusion of the optic nerve and retina were attained (period of observation up to 2 years). The degree of visual field extension correlated with the degree of increase in hemoperfusion values. Comparative analysis showed a higher functional efficiency of revascularization decompression of the optic nerve in comparison with optic nerve decompression, which is due to a more essential improvement of ocular hemoperfusion.     

Clinical method of the evaluation of postoperative scarring and preventive cytostatic therapy after glaucoma surgery

Lymph microcirculation in the bulbar conjunctiva at the site of surgery was studied by fluorescent lymphangiography in 217 patients with primary glaucoma before and in various periods after trabeculectomy. Lymph vessels are changed after the operation; the pattern and intensity of these changes reflect the activity of cicatrization at the site of the operation and are closely related with the hypotensive effect in remote periods postoperation. In cases with the complete compensation of ophthalmic tone without extra hypotensive therapy a moderate narrowing of the lymph vessels was observed, parallelled by a compensatory increase of their quantity and of the volumic rate of the lymph flow. If the hypotensive effect of surgery was insufficient, an essential decrease of all the lymph flow parameters was observed, the most manifest in the patients with intraocular pressure still increased after extra drug therapy. A regular lowering of the lymph flow in 2-4 years after surgery was recorded; this lowering anticipated the deterioration of the hydrodynamic parameters. Noteworthy that ophthalmic tone failed to normalize when the mean diameter of the lymph vessels decreased more than twofold vs. the preoperative value. A conclusion is made that fluorescent lymphangiography holds good promise as a method for the assessment of the intensity of cicatrization processes after antiglaucoma surgery in order to timely prescribe preventive anticicatricial therapy. Administration of cytostatics in the postoperative period helps considerably increase the number of satisfactory outcomes of surgery due to suppression of cicatrization processes at the site of intervention. A lesser rate and intensity of cicatricial deformations of the lymph vessels was recorded in the patients administered cytostatics.