Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery.

The long term recovery of a series of 27 patients who had undergone rupture and repair of an aneurysm of the anterior communicating artery was assessed using a number of neuropsychological measures. Testing took place 12 to 84 months post surgery. On the basis of the results from tests of intellect, memory, and conceptual learning, three subgroups of patients were identified: those with persuasive cognitive defects, those with evidence of residual frontal lobe damage and those who showed no evidence of dysfunction. The occurrence of cerebral vasospasm was the most consistent predictor of long term cognitive deficit.     

Treatment of refractoriness to platelet transfusion by protein A column therapy

Ten thrombocytopenic patients (platelets < 10–24 × 10(9)/L) who were refractory to platelet transfusion were investigated for their responsiveness to staphylococcal protein A column therapy. Nine patients had previously been treated with steroids, intravenous immune globulin, and/or other forms of immunosuppressive therapy without improvement in their transfusion response. All patients were receiving multiple platelet transfusions without achieving 1-hour corrected count increments (CCIs) > or = 7500. Eight patients had antibodies that reacted with platelets and were directed against HLA class I antigens, ABO antigens, and/or platelet-specific alloantigens. Plasma (500-2000 mL) from each patient was passed over a protein A silica gel column and then returned to the patient. Patients received from 1 to 14 treatments. A positive response to protein A therapy was defined as at least a doubling of the pretreatment platelet count and/or two successive 10- to 120-minute posttransfusion CCIs > or = 7500. Following plasma treatments, 6 of 10 patients responded with daily platelet counts that averaged 48 +/− 11 × 10(9) per L as compared with counts of 16 +/− 7 × 10(9) per L (p < 0.0005) before treatment. Posttransfusion CCI values determined in four of these patients averaged 2480 +/− 810 and 10,010 +/− 3540 (p < 0.005) before and after treatment, respectively. In contrast, among the four unresponsive patients, platelet counts averaged 10 +/− 9 and 13 +/− 10 × 10(9) per L (p = NS), respectively, while posttransfusion CCIs were 700 +/− 1410 and 1520 +/− 2460 (p = NS), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Perforated colorectal neoplasms: correlation of clinical, contrast enema, and CT examinations

Results of clinical, contrast enema (CE), and computed tomographic (CT) examinations in 39 patients with perforated colorectal neoplasms were retrospectively reviewed. Twenty patients were toxemic at initial presentation, but in only four patients was the diagnosis of perforated colorectal neoplasm initially suspected clinically. CE study was performed in 22 patients and enabled the diagnosis of perforated neoplasm in 11 cases, neoplasm alone in eight, and neither neoplasm nor perforation in three. CT was performed in 38 patients and enabled the diagnosis of perforated neoplasm in 36; pericolic phlegmon but no mass lesion was evident in two. In 16 patients, CT also demonstrated metastatic disease. Because of its reliability in establishing the diagnosis and staging the extent of the inflammatory and neoplastic disease, CT is indicated in cases of suspected or proved perforated colorectal neoplasm and in cases in which CE study findings are indeterminate or suggestive of perforated neoplasm.     

Synthesis of collagenous proteins by pulmonary type II epithelial cells

We have investigated the production of collagenous proteins by primary cultures of rat lung epithelial cells (type II pneumocytes). Three major bacterial collagenase-sensitive chains were synthesized and secreted into the medium between 12 and 36 h of culture. Two of the chains comigrated on sodium dodecyl sulfate-polyacrylamide slab gel electrophoresis (SDS-PAGE) with radiolabeled type IV procollagen (PC) chains isolated from adult rat lung (Mr = 185,000 and 170,000 after reduction) and were coprecipitated with monospecific antibodies to type IV collagen. Cyanogen bromide (CNBr) peptide maps of the chromatographically purified chains were identical to maps of rat lung type IV PC, and confirmed the identity of these chains as pro alpha 1(IV) and pro alpha 2(IV). Type IV PC was the major high molecular weight collagen in the cell layer, and a fraction of the newly synthesized type IV PC was selectively deposited on the substratum together with newly synthesized fibronectin. Type II cells also secreted a low molecular weight, non-disulfide-bonded, collagenase-sensitive protein (Mr = 19,000, collagen standards; Mr = 26,000, globular standards). The protein coeluted with type IV PC from DEAE-cellulose but was resolved from native type IV on CM-cellulose. The protein was not precipitated with polyclonal antibodies to type IV collagen or rat surfactant apoprotein. These studies further demonstrate the heterogeneity of collagenous macro-molecules synthesized by lung epithelial cells in vitro. We suggest that interactions between pneumocyte-derived fibronectin and type IV procollagen contribute to the formation of the epithelial basement membrane and to the attachment of these cells in normal or injured lung.