Percutaneous sonographic needle aspiration biopsy of endoscopically negative gastric carcinoma

We report here the use of ultrasound-guided percutaneous fine needle aspiration gastric biopsies in three patients with endoscopically negative biopsies. Two men, ages 60 and 64, and one woman, age 64, with signs and symptoms of weight loss, abdominal pain, and early satiety, had barium contrast studies suggestive of thickened gastric walls of the antrum and cardia, yet multiple endoscopic biopsies were negative for malignancy. Using real time sector B-scan ultrasonography, percutaneous fine needle aspiration biopsy retrieved signet cell carcinomatous cytologic material in all three patients. No complications were noted. In patients with clinical and radiographic findings compatible with an infiltrative process but negative endoscopic biopsies, in whom sonography can identify a thickened stomach wall, we suggest that percutaneous fine needle aspiration biopsy be attempted.

Direct and indirect assessment of skeletal muscle blood flow in chronic congestive heart failure

In patients with chronic congestive heart failure (CHF), skeletal muscle blood flow can be measured directly by the continuous thermodilution technique and by the xenon133 clearance method. The continuous thermodilution technique requires retrograde catheterization of the femoral vein and, thus, cannot be repeated conveniently in patients during evaluation of pharmacologic interventions. The xenon133 clearance, which requires only an intramuscular injection, allows repeated determination of skeletal muscle blood flow. In patients with severe CHF, a fixed capacity of the skeletal muscle vasculature to dilate appears to limit maximal exercise performance. Moreover, the changes in peak skeletal muscle blood flow noted during long-term administration of captopril, an angiotensin-converting enzyme inhibitor, appears to correlate with the changes in aerobic capacity. In patients with CHF, resting supine deep femoral vein oxygen content can be used as an indirect measurement of resting skeletal muscle blood flow. The absence of a steady state complicates the determination of peak skeletal muscle blood flow reached during graded bicycle or treadmill exercise in patients with chronic CHF. Indirect assessments of skeletal muscle blood flow and metabolism during exercise performed at submaximal work loads are currently developed in patients with chronic CHF.

Noninvasive quantification of mitral regurgitation in dilated cardiomyopathy: correlation of two Doppler echocardiographic methods

The presence and severity of functional mitral regurgitation were quantified by Doppler echocardiography in 17 patients with dilated cardiomyopathy and no evidence of primary valvular disease. Mitral regurgitant fraction was greater than 20% in 11 of the 17 patients, and exceeded 40% in four patients. Total stroke volume, calculated from the difference between end-diastolic and end-systolic volumes obtained by two-dimensional echocardiography, correlated well with mitral valve inflow determined by Doppler echocardiography (r = 0.90, p less than 0.001). Similarly, mitral regurgitant volume, calculated as the difference between echocardiographic total stroke volume and forward aortic volume obtained by Doppler echocardiography, correlated well with regurgitant volume calculated as the difference between mitral valve inflow and forward aortic flow, both determined by Doppler echocardiography (r = 0.90, p less than 0.001). Accordingly, functional mitral regurgitation can be conveniently demonstrated in patients with dilated cardiomyopathy by two different Doppler echocardiography methods, whose results are closely correlated. Mitral regurgitant fraction is greater than 20% in two thirds of the patients with a dilated cardiomyopathy.

More effort to solve "male diseases" than female ones, MD says

Images

Isolated gastric sarcoidosis. Unique remnant of disseminated disease

Isolated granulomatous disease was identified in a gastrectomy specimen after a gastrointestinal hemorrhage in a 61-year-old white woman. She died postoperatively. No other areas of granulomatous tissue were identified at autopsy. Ten years previously, pulmonary sarcoidosis was proven on lung biopsy. Conceivable, other reported cases of unexplained "idiopathic" granulomatous disease of the stomach may represent residua of prior disseminated sarcoidosis.

Dr. Mary Fanning: caring for AIDS patients at Toronto General

Images

Computed tomography of unilateral hematometrocolpos

A 14-year-old girl presented with urinary retention and a pelvic mass. Computed tomography revealed a uterus didelphys with a unilateral right moderate hematometra and a large hematocolpos.

Sex differences in high density lipoprotein cholesterol in urban blacks

Descriptive data on high density lipoprotein (HDL) cholesterol in the black urban population of the United States are limited. We examined 119 men and 130 women aged 21-70 years who were attending a screening clinic at Cook County Hospital in Chicago, Illinois, in 1985-1986 for minor complaints; all participants were black. For men, lipid values were: total cholesterol, 209.5 +/- 50.6, HDL cholesterol, 55.2 +/- 16.5; for women, values were: total cholesterol, 215.6 +/- 47.4, HDL cholesterol, 59.2 +/- 17.2. Correlates of HDL cholesterol were different in men and women. Alcohol consumption and body mass index were significantly related to HDL cholesterol in men; however, education was the only significant factor among women. It was anticipated that the increased obesity among the women in this sample (mean body mass index, 31 kg/m2; range, 18.4-50.0 kg/m2) compared with men (mean body mass index, 27 kg/m2; range, 19.4-45.0 kg/m2) would explain part of the narrowing of the gap between the sexes in HDL cholesterol values. The association between HDL cholesterol and body mass index among women, however, was weak and nonsignificant. The increased susceptibility of black women to coronary artery disease has not been adequately explained and undoubtedly reflects a complicated interaction of epidemiologic factors.

Surgical treatment of varicocele in children

Fifty boys aged 6 to 14 years underwent surgery for left varicocele. Thirty-four patients underwent preoperative retrograde left renal venography and pressure measurements of both renal veins and inferior vena cava. In all patients an intraoperative antegrade renal venography was performed via the internal spermatic vein. The preoperative venographic studies revealed renospermatic reflux in all patients examined. The intraoperative studies demonstrated impaired renal venous drainage in 38 patients (Group A) and normal venous return in 12 patients (Group B). Manometric studies revealed increased left renal venous pressure in Group A. In view of these anatomical and functional disorders, our preferred procedure is a retroperitoneal ligation and excision of the left internal spermatic vein. The retroperitoneum was thoroughly explored and all the visible collaterals of the internal spermatic vein ligated. Forty boys were followed for 1 to 5 years; the varicocele was completely resolved in 35 of them. Five patients had recurrent varicocele; recurrence was observed only in patients with increased left renal vein pressure (Group A).

Sarcoplasmic reticulum Ca2+ transport and long chain acylcarnitines in hyperthyroidism

Male Wistar rats were treated with L-3,5,3'-triiodothyronine (T3) (500 micrograms.kg.-1.day-1) for 3 days. Cardiac sarcoplasmic reticulum (SR) was isolated at several time points during the induction of the hyperthyroid state and calcium transport and the levels of carnitine derivatives were determined. Calcium transport was augmented at all free calcium concentrations assayed (0.1-5.3 microM) 24 h following a single dose of T3; at 48 and 72 h, calcium transport was further augmented. Calcium-dependent phosphoprotein levels were increased in the SR of the 48- and 72-h T3-treated groups. Total SR carnitine was reduced after 24, 48, and 72 h of treatment. Long chain acylcarnitine (LCAC) levels were decreased in T3-treated SR at 48 and 72 h. This study shows that calcium transport is increased in T3-treated rat heart SR and that this increase may be related to a reduction in the endogenous level of LCAC in the SR membrane.

Congenital angiodysplasia of the superficial venous system of the lower extremities in children

Congenital angiodysplasia of the superficial venous system (SVS) of the lower extremities was diagnosed in 24 children 3-15 years of age. Nine patients presented with painful swelling in the affected limb. Venectasia and spongy venous masses were the main morphologic changes in the current series. Selective ascending functional phlebography and superficial phlebography were used to assess the anatomic extension of the lesions and to evaluate the functional status of the involved extremity: 14 patients had only SVS angiodysplasia, in 10 patients additional pathologic features of the deep veins (DV) were found. Venous reflux was demonstrated in 16 patients and significant venous insufficiency was detected in five patients. The patients were classified into three groups according to the severity of the disease: mild (11 patients), moderate (8 patients), and severe (5 patients). The prognostic and the long-term outcome of surgical treatment can be predicted by the depth and the extension of the angiodysplastic lesions.

Complement-mediated early clearance of Haemophilus influenzae type b from blood is independent of serum lytic activity

The role of complement-mediated serum lytic activity in the clearance of encapsulated Haemophilus influenzae type b was studied by comparing clearance of bacteria from blood in normal mice with that in congeneic C5-deficient animals and mice depleted of complement by using cobra-venom factor. The clearance of organisms from blood by C5-deficient and C5-sufficient normal animals was similar. C3 depletion and the inability to fix C3 to the surface of bacteria were, however, associated with impaired clearance of organisms during the first 24 h after intravenous bacterial challenge. These studies suggest that complement-mediated opsonization rather than bacteriolysis is important in determining early clearance of H. influenzae type b from the bloodstream.

Why there is no error in the direct theory of perception

According to Gibson's direct theory, perception is an achievement, not a process. Perceptual error, therefore, is the failure to perceive. Taken in isolation, this assertion leads to implausible consequences, but taken together with other assertions of Gibson, it may be understood, without contradiction, to mean that there is no absolute error in perception. Whether perception is successful or not is determined by the context in which the perceptual act occurs.

The effect of high-dose phenylephrine versus epinephrine on regional cerebral blood flow during CPR

Prior studies have not found the alpha agonist phenylephrine, in a dose of 0.1 mg/kg, to be as effective as 0.20 mg/kg of epinephrine in improving regional cerebral blood flow (CBF) during CPR in swine. We undertook this study to assess whether higher doses of phenylephrine might improve regional CBF. Fifteen swine were allocated to receive either epinephrine 0.2 mg/kg, phenylephrine 1.0 mg/kg, or phenylephrine 10 mg/kg. Regional CBF measurements were made during normal sinus rhythm, during CPR, and during CPR following drug administration. Epinephrine 0.2 mg/kg was significantly better in improving regional CBF to the left and right cerebral cortices, cerebellum, midbrain, and cervical cord than was phenylephrine 1.0 mg/kg. There was no significant difference in regional CBF between the animals receiving epinephrine 0.2 mg/kg and phenylephrine 10 mg/kg. The study shows that large doses of epinephrine and phenylephrine may be required during CPR to improve regional cerebral blood flow following a prolonged arrest.

Involution of the antimesometrial decidua in the mouse. An ultrastructural study

Involution of the antimesometrial decidua was analysed by electron microscopy on days 9, 10 and 11 of pregnancy in the mouse. During this period, the width of the antimesometrial decidua decreases considerably. Involution begins in the decidual cells situated closest to the embryo (internal decidua) and proceeds towards the myometrium. The cells of the internal decidua showed signs of deterioration characterized by accumulation of clumps of chromatin in the nuclei and dilation of the perinuclear cisterna and endoplasmic reticulum cisternae. Autophagosomes and heterophagosomes accumulated in the cytoplasm of these cells. Cells particularly strongly affected became spherical and were devoid of their plasma membrane. Some cells near the trophoblast as well as the mature decidual cells situated farther from the embryo showed a normal morphology. The trophoblastic cells established close contact with healthy decidual cells and engulfed fragments of disorganized decidual cells. It is suggested that the death of decidual cells is a type of programmed cell death and that it is not due to a direct lytic action by the trophoblast.

Congenital aneurysms of the deep veins of the lower extremities

This is a report of our experience with seven children with congenital aneurysms of the deep veins of the lower extremities. All the patients had various clinical features of angiodysplasia. With the use of ascending functional phlebography the patients were divided into two groups: four patients with fusiform aneurysms and three patients with saccular aneurysms. Patients in group 1 had venous reflux and a mild degree of venous insufficiency, which were surgically treated. Three patients with saccular aneurysms (group 2) showed no signs of venous insufficiency and are still being carefully followed. Anatomic and functional assessment of the deep venous system by ascending functional phlebography is essential for planning an appropriate treatment for this rare clinical entity.

Parenteral nutrition-induced anaphylaxis

A case report of a 4-yr-old child who developed an anaphylactic reaction to parenteral nutrition is presented. Dermal allergy tests demonstrated a sensitivity to Travasol solution and Armour multivitamin 2 solution. This is the first reported case known to us of such a response to elemental parenteral nutrition.