Relationship between numbers of beta adrenergic receptors in lymphocytes and disease severity in asthma

In order to assess the status of beta adrenergic receptors in bronchial asthma, binding studies using (−) [³H] dihydroalprenolol (DHA) were performed on lymphocytes of 10 control subjects and 11 stable asthmatic patients. Specific DHA binding was generally lower at all DHA concentrations in asthmatics. At 12 nM DHA concentration, specific DHA binding was 391 ± 40 fM/mg protein in controls and 263 ± 35 fM/mg protein for asthmatic subjects (p < 0.05). A highly statistically significant positive correlation between specific DHA binding (at 12 nM DHA) and FEV₁/FVC% was observed (r = 0.93, p < 0.01), with those asthmatic subjects with the more severe airway obstruction and disease severity showing lower DHA binding. The results of the study suggest that a lymphocyte beta adrenergic receptor defect may be present among some patients with asthma. The magnitude of the receptor abnormality appears to be related to disease severity and degree of airway obstruction as measured by FEV₁/FVC%. Documentation of drug consumption was made, and restriction of beta adrenergic agonists was attempted; theophylline and corticosteroids were the predominant drugs used in the study. Even with these precautions, it is possible that the differences in DHA binding observed among subjects are the results of greater drug (e.g., theophylline and corticosteroids) consumption by the clinically more severe patients. On the other hand, the lymphocyte receptor alteration noted may reflect a more general beta adrenergic receptor abnormality in bronchial asthma.     

Analysis of exercise-induced R wave amplitude changes in detection of coronary artery disease in asymptomatic men with left bundle branch block

The exercise electrocardiograms of 44 asymptomatic men with acquired left bundle branch block were analyzed for changes in R wave amplitude. Results were correlated with findings on selective coronary angiography. There were two subgroups: 7 men with significant angiographic coronary artery disease (Group I) and 37 with normal coronary angiograms (Group II). Exercise induced an increase in R wave amplitude in all seven men with coronary artery disease but in only 10 of the 37 men without significant coronary artery disease. This criterion thus had a sensitivity of 100 percent but a poor specificity of 73 percent, a predictive value of 41 percent and an accuracy rate of 77 percent for the diagnosis of coronary artery disease. The greater the increase in R wave amplitude the greater was the likelihood of some degree of left ventricular dysfunction as measured by wall motion abnormalities and elevated left ventricular end-diastolic pressure. The increase in R wave amplitude with exercise appears to be a sensitive test in identifying coronary artery disease in asymptomatic men with acquired left bundle branch block.     

Relation between high density lipoprotein cholesterol and coronary artery disease in asymptomatic men

The well established inverse relation of high density lipoprotein cholesterol (HDL) and the risk of coronary artery disease was tested in a cross-Sectional group of 572 asymptomatic aircrew members who were being screened for risk of coronary artery disease. A battery of tests was performed, including determinations of fasting serum cholesterol, HDL cholesterol and triglycerides and performance of a maximal symptomlimited exercise tolerance test. Of the 572 patients, 132 also had an abnormal S-T segment response to exercise testing or were otherwise believed to have an increased risk of organic heart disease and subsequently underwent coronary angiography. Significant coronary artery disease was found in 16 men and minimal or subcritical coronary disease in 14; coronary angiograms were normal in the remaining 102 men. The remaining 440 men, who were believed to have a 1 percent chance of having coronary artery disease by sequential testing of risk factors and treadmill testing, had a mean cholesterol level of 213 mg/100 ml, a mean HDL cholesterol of 51 mg/100 ml and a mean cholesterol/HDL ratio of 4.4. The mean values for cholesterol, HDL cholesterol and cholesterol/HDL cholesterol did not differ significantly in men with normal angiographic findings and those with subcritical coronary disease. However, 14 of 16 men with coronary artery disease had a cholesterol/HDL ratio of 6.0 or more whereas only 4 men with normal coronary arteries had a ratio of 6.0 or more. Of the classic coronary risk factors evaluated, the cholesterol/HDL ratio of 6.0 or more had the highest odds ratio (172:1). It appears that determination of HDL cholesterol level helps to identify asymptomatic persons with a greater risk of having coronary artery disease.     

Macular hole surgery with and without internal limiting membrane peeling

OBJECTIVE: To compare results of surgery for idiopathic macular hole with and without internal limiting membrane (ILM) peeling in a series of consecutive patients over a 5-year period. DESIGN: A retrospective, nonrandomized, comparative trial with concurrent control group. PARTICIPANTS: Forty-four eyes with macular holes of less than or equal to 6 months duration without ILM peeling were compared to 116 eyes with ILM peeling and the same hole duration. A third group of 65 eyes with ILM peeling and duration greater than 6 months was also evaluated. INTERVENTION: All eyes underwent pars plana vitrectomy with or without ILM peeling, intravitreous gas, and positioning face down. No adjunctive therapies were used in any group. MAIN OUTCOME MEASURES: Comparing the closure and/or reopening rate, prognosis, visual acuity, and complications for macular holes with and without ILM peeling. RESULTS: All patients had postsurgical follow-up of 18 months or greater. Primary closure was significantly improved with ILM peeling with 116 of 116 eyes (100%) showing no reopenings versus 36 of 44 holes (82%) primarily closed, 9 of which (25%) reopened without ILM peeling (P: < 0.00001) in holes less than or equal to 6 months. The 27 eyes without ILM peeling that had successful surgery displayed a mean postoperative vision of 20/40, which is the same as the successful eyes with ILM peeling (P: = 0.6). The 52 stage II eyes with ILM peeling had a mean postoperative vision of 20/30, and 48 of the 52 eyes (92%) were 20/40 or better. Stage III eyes (greater than 400-microm holes) without ILM peeling had a poor prognosis, with 6 of the 25 eyes (24%) having initial surgery fail and an additional 4 of 25 eyes (16%) reopening. Without ILM peeling, holes less than 300 microm had only one reopen, whereas holes greater than or equal to 300 microm had 16 of the 17 (94%) primary failures and/or reopenings (P: < 0.001). All 12 holes that reopened and/or primarily failed were repaired with ILM peeling with excellent visual recovery. Macular holes with a duration greater than 6 months were treated with ILM peeling, and 63 of 65 holes (97%) were closed primarily and 65% had an increase in vision by two or more Snellen lines. CONCLUSIONS: ILM peeling significantly improves visual and anatomic success in all stages of recent and chronic macular holes and reopened and failed holes, while eliminating reopening for holes greater than 300 microm.     

Influence of stimulus parameters on visual sensitivity during saccadic eye movement

Visual threshold for stroboscope test flashes was measured during saccadic eye movements over various backgrounds and compared with measures obtained during eye fixation when the same backgrounds were “saccadically” displaced. Amount and time course of threshold change in the two situations compared well, suggesting no necessity for corollary discharge or other oculomotor interference with primary visual processes during eye movement. No significant threshold rise took place during saccades in the dark. Diffuse test flashes and small well focused flashes were affected differently by specific background conditions. Diffuse flashes were perceived with more difficulty during a saccade over a contour-free background than well focused, punctate stimuli. On the other hand, contours in the background raised saccadic thresholds for small stimuli much more than for diffuse test flashes. All threshold changes occurring during saccades were accentuated by increasing the background luminance.     

Hypophysial tuberculoma with hypopituitarism

In this patient with a caseating pituitary tuberculoma the diagnosis of hypopituitarism was established antemortem by modern tests of pituitary function. Pituitary tuberculoma is rare and may resemble pituitary adenoma. Tuberculoma should be considered in patients with hypopituitarism or enlargement of the sella turcica, or both, who have or have had tuberculosis of any site. Antituberculous therapy should be instituted in such patients, especially when surgery is contemplated.     

Psychodynamics of four women with delayed cancer diagnosis

Four young women from 28 to 35 years old were referred for psychiatric evaluation because of anxiety, depression, and rage following diagnosis and treatment (radical hysterectomy in all plus radiation therapy in two) of carcinoma of the cervix. Negligence and dishonesty on the part of the laboratory that reported their Pap smears as normal when actually they had been either carelessly examined or not read at all intensified their emotional reactions of shock, panic, and fury. Feelings of injustice and victimization and fantasies about the laboratory technicians, who were women in their age group, complicated the clinical picture. The depressions that ensued in all of the women were prolonged and the working-through processes were impaired despite the fact that three have apparently been cured of their malignant disease.     

Selection of treatment in squamous carcinoma of the floor of the mouth

The incidence of papillary carcinoma in the solitary thyroid nodule has risen in the last decade partly as a result of more careful selection of patients for surgery. Eighty-two carcinomas were retrieved from a surgical population of 700 patients. No patients with papillary carcinoma of the thyroid have died. Operative treatment and postoperative care are described.     

The prediction of maximal oxygen consumption from a continuous exercise treadmill protocol

This study investigated the hypothesis than an individual's maximal oxygen consumption can be realistically predicted by the maximal time achieved in the Balke treadmill protocol. The oxygen consumption in the final minute of exercise of 1,025 normal men who performed a maximal effort in the Balke protocol were linearly regressed on their maximal treadmill time using a least-squares fit technique. In addition, the men were grouped by heart rate response, and regression equations plus (0.95, 0.95) tolerance limits were computed for each subgroup. A regression equation was also computed for an additional 127 men who had multiple bags of expired air collected approaching maximal effort. It was demonstrated that the tolerance limits are so wide that maximal oxygen consumption can be only grossly estimated by treadmill time. Thus, other factors than maximal oxygen consumption must be operating in determining treadmill performance.