[Pathophysiology and technical prerequisites for maintaining continence]

Restoration of gastrointestinal continuity following total colectomy in patients with ulcerative colitis or familial polyposis can be achieved by construction of an ileal pouch and ileoanal anastomosis. In the development of the surgical technique three problems have emerged: a) pull-through operation; b) construction of the reservoir; c) anatomy and physiology of the sphincter system. The function of the continence organ can be evaluated by means of manometric, electromyographic and volumetric tests. The success of this complex surgical procedure also depends on the characteristics of the individual patient.

Sensitive homologous radioimmunoassay for human parathyroid hormone to diagnose hypoparathyroid conditions

A sensitive radioimmunoassay for human parathyroid hormone (hPTH) to diagnose hypoparathyroid conditions is described. The antiserum was raised in goats against extracted hPTH. Synthetic human PTH fragment (53-84) is used as a standard and 125I-Tyr52hPTH (53-84) as a tracer. After a two-step incubation (24 h + 24 h) at 4 degrees C, the bound and free fractions are separated by a mixture of second antibody and polyethylene glycol solution. The detection limit for hPTH (53-84) is 2 pmol/L hPTH (53-84) (2 mol/tube). The PTH level in 36 healthy subjects was 5-12 pmol/L. Of 14 patients with hypoparathyroidism 11 patients had PTH concentrations below normal, two patients had levels on the lower limit of the normal range (5 pmol/L). The concentration of one patient with pseudohypoparathyroidism was markedly elevated. This assay is suitable for detecting low PTH levels and for studying changes of PTH concentration within the normal range.

Gastroparesis secondary to a medulloblastoma of the posterior fossa

A patient with a 4-month history of unexplained nausea and vomiting is reported. The only abnormality found initially was severe gastroparesis found by gastric emptying scan. Subsequently, a posterior fossa tumor was found. The pathogenesis of this unusual presentation and the role of the gastric emptying scan is discussed.

Rat brain microvessel extracellular matrix modulates the phenotype of cultured rat type 1 astroglia

Astroglia from immature rat cerebral white matter which were plated on the insoluble extracellular matrix (ECM) secreted by rat cerebral microvessel endothelial cells (RCMEC) and maintained in a defined medium were induced to become stellate and to express glutamine synthetase. These effects were not elicited by RCMEC-conditioned medium. ECM secreted by rat pleural mesothelium elicited a lesser proportion of stellate astroglia and did not induce glutamine synthetase.

Recurrent psoas abscess

Recurrence of a psoas abscess in exactly the same location is very unusual--in fact, we found no other reports in the literature. Laparotomy performed after the patient presented with the second abscess revealed an impacted calculus and diverticulitis of the appendix as the cause. Computed tomography was effective in establishing the diagnosis, but the question of the best method of treatment remains. Percutaneous drainage was insufficient in this case.

Two years of intrauterine contraception with levonorgestrel and with copper: a randomized comparison of the TCu 380Ag and levonorgestrel 20 mcg/day devices

IUDs releasing 20 mcg/day of levonorgestrel (LNg20) were in randomized trial together with the Copper T, model TCu 380Ag, in seven centers involving 2244 women. Two-year (25 months) gross cumulative pregnancy rates were 0.2 +/- 0.2 and 0.9 +/- 0.3 for the levonorgestrel and copper releasing devices, respectively (P greater than 0.05). There were no ectopic pregnancies in more than 1600 woman-years of use of each device. Removal rates for bleeding and/or pain or for medical reasons other than menstrual problems did not differ significantly between devices. Oligomenorrhea or amenorrhea prompted 10.7 per hundred (gross rate, 8.4 net rate) women using the LNg 20 IUD to request removal in the two-year period, significantly above the 0.2 per hundred rate among women with the Copper IUD (P less than 0.001). At the end of two years an estimated 59.4 per 100 women were continuing use of the LNg 20 IUD, and 67.5 per 100 (P less than 0.001) with the TCu 380Ag. This difference is almost wholly ascribable to a marked reduction in bleeding episodes and days among women using the LNg 20 device with concomitant removal of device. Hemoglobin rose an average of 0.5 g/dl (P less than 0.001) for this group whereas women using the TCu 380Ag experienced a decline of 0.2 g/dl compared with baseline values (P less than 0.001).

Development and experimental application of contact probe catheter for laser angioplasty

A sapphire contact probe laser catheter was developed to increase the dimensions of tunnels created by laser angioplasty. The device consisted of a round sapphire probe (2.2 mm diameter) attached to an 8F catheter into which a 0.2 mm optical fiber was inserted with a tip maintained at 3 mm from the sapphire. The fiber was connected to a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. A saline perfusate was circulated through the catheter during laser emissions to prevent excessive heating of the fiber tip. The system was used in vitro on 16 sections of atherosclerotic calcified human cadaver aortic walls, using diluted blood as a medium, at powers ranging from 10 to 40 W and exposure times from 1 to 4 seconds. Six craters were created at each energy level. The system was also used on six human cadaver, agar-embedded, obstructed iliac and femoral arteries, using 40 W and 2 second laser emissions. Dimensions of probe-created craters were compared with those obtained using bare fibers. The shape of the probe craters was that of a truncated cone with the entry hole wider than the exit, as opposed to the cylindrical shape created with unmodified bare fibers. At 120 J (seconds X watts), areas of entry and exit probe-formed holes were greater than those created with the bare fibers (6.7 +/- 0.5 and 3.4 +/- 0.6 versus 0.2 +/- 0.01 mm2, respectively, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Incorporation of tritiated galactose into galactocerebroside by cultured rat oligodendrocytes: effects of cyclic adenosine 3',5'-monophosphate analogues

Cells dissociated from the forebrains of 21-day-old rats were enriched in oligodendroglia by Percoll gradient centrifugation, seeded on polylysine-coated surfaces, and cultured in a serum-containing medium. Incorporation by the cultures of tritium from D-[3H]galactose into the galactosyl residue of galactocerebroside (galC) increased in an almost linear fashion for 48 h with 1-8 muCi of D-[3H]galactose (30 mCi/mumol) per milliliter medium. Treatment for 2 days (day 1-3 after seeding) with 10(-4) M or 10(-3) M dibutyryl cyclic adenosine 3',5'-monophosphate (db cyclic AMP) or 10(-4) M 8-bromo cyclic AMP stimulated galC radiolabelling. Incorporation of D-[3H]galactose into galC during a terminal 48-h radiolabelling period was not stimulated when the cells were continuously treated with these cyclic AMP analogues for 8 rather than 2 days.

Esophageal tear following forceful removal of an impacted oral-gastric lavage tube

We report an unusual complication of oral-gastric lavage in a drug overdose patient. During the lavage procedure, the oral-gastric tube became impacted in the esophagus. Forceful removal of the tube resulted in an esophageal tear. The patient did well with conservative management and was discharged with no long-term sequelae.

Spontaneous rupture of the spleen in primary plasma cell leukemia. Scintigraphic-pathologic correlation

A rare case of spontaneous rupture of the spleen occurring in a patient with primary plasma cell leukemia is presented. The scintigraphic-pathologic correlation is presented together with a review of the literature.

The effect of nucleotides on the rate of spontaneous quantum bumps in Limulus ventral photoreceptors

The effect of intracellular nucleotides on the rate of spontaneous quantum bumps in Limulus ventral photoreceptors has been examined. Internal dialysis of photoreceptors with solutions lacking nucleotide leads to an elevation of the quantum bump rate that can be reversed by introduction of nucleotide. Similarly, elevation occurs after treating intact cells with the metabolic inhibitor 2-deoxyglucose. This effect can be reversed by intracellular injection of ATP. The rate of spontaneous quantum bumps in unpoisoned cells can be reduced to below normal levels by injection of ATP. These results support the hypothesis that high-energy nucleotides suppress the rate of spontaneous quantum bumps.

[Nephrolithiasis--correlation of calculus type and pathogen spectrum. Calculus analysis and microbiologic diagnosis in 173 surgically treated patients]

The microbiological findings from intraoperative swabs were correlated with the consistency of the calculi in 173 patients, who had been operated on due to nephrolithiasis. The following parameters were taken into consideration: age and sex of the patients, consistency of calculi and germ spectrum of intraoperative swabs from the upper urinary tract. Three main groups were formed corresponding to the consistency of the calculi (carriers of infection calculi, of calciumoxalate calculi and of uric acid calculi) and these were compared to one another regarding the above mentioned parameters.

Inositol uptake by cultured isolated rat Schwann cells

The uptake of radiolabeled myo-inositol by Schwann cells isolated from the sciatic nerve of 2-4 day old rats was found to occur by a saturable, sodium-dependent phlorizin-inhibited mechanism with an estimated Km of 30 microM. The system was inhibited by galactose and glucose but not by galactitol. At high concentrations of myo-inositol, a diffusion-like process appeared to be functional. The characteristics of the saturable system are very similar to those of myo-inositol uptake by the endoneural fascicle preparation of sciatic nerve.

Long-term experience with Norplant implants in international clinical trials

Norplant subdermal implants containing levonorgestrel were used for contraception and compared with the Copper T, Model T Cu 200, during 42 months of use in an open study in Chile, the Dominican Republic, and Finland. Among 324 women enrolled for the implant regimen, there were no pregnancies in the 1st 2.5 years, and 2 by the end of 42 months. 1st segment net and gross cumulative pregnancy rates were 0.7 and 1.2/100 respectively, at 3.5 years. Cumulative pregnancy rates for the T Cu 200 group were 2.9, net and 3.5/100, gross at 42 months. More than 1/2 of the implant acceptors, 51.6/100 were continuing use at 3.5 years, somewhat above the continuation rate of the T Cu acceptors, 43.5/100, but not significantly so.

Interception of lymphatic drainage by Nd: YAG laser irradiation in rat urinary bladder

Lymphatic drainage can be demonstrated by colloidal indian ink injection. A small intramural indian ink spot in the bladder dome is separated from the rest of the rat urinary bladder by encircling transmural Neodymium-YAG (Nd:YAG) laser irradiation. In untreated animals there is an ink flow via the lymphatic vessels to the regional lymph nodes within several hours. In treated animals, after laser irradiation, the indian ink remains in the bladder dome and a penetration of the irradiated area cannot be found by macroscopic and histologic examination. Indian ink will be found in the regional lymph nodes after the ninth day of absorption of the coagulation necrosis and recanalisation of the intercepted lymphatics. Evidence for the interception of the lymphatic drainage is demonstrated by the distinctly delayed ink flow and the injected ink's remaining in the irradiated area. From this, we conclude that Nd:YAG laser irradiation is especially suitable for tumor coagulation, since simultaneous interception of lymphatic drainage will inhibit the spreading of tumor cells.

[Spinal hemangioblastoma in infants with dysraphic malformation of the CNS]

Spinal hemangioblastoma in early infancy is an extreme rarity. In the case presented here such a hamartomatous tumor is combined with dysraphic malformation of the CNS in a male infant aged seven months. The morphological, epidemiological and clinical aspects are discussed with special reference to the possibility of congenital occurrence.

Heterotopic ossification heralded by a knee effusion

A knee effusion suddenly appeared in a 44-year-old woman one month after she suffered a neurological catastrophe. Heterotopic ossification (HO) subsequently developed above her knee. Because treatment of HO with disodium etidronate may be successful if started early, awareness of the association between acute arthritis and new bone formation in certain clinical settings is important.

Plasma amino acid, glucagon, and insulin concentrations in dogs with nitrosamine-induced hepatic disease

Plasma amino acids, glucagon, and insulin concentrations were determined once a week in dogs that developed acute hepatic necrosis and chronic hepatic insufficiency after treatment with dimethylnitrosamine. During the acute phase, plasma concentrations of most amino acids increased, with the changes usually correlating with increased glucagon values. Insulin correlated with changes in 10 of 21 amino acids, but the latter were not the most abundant nor the branched-chain amino acids. During the chronic phase, plasma phenylalanine tyrosine, and methionine concentrations remained increased throughout the study. Plasma values of these amino acids did not correlate with plasma concentrations of either glucagon or insulin. The values of the most abundant amino acids were less than base-line levels during the chronic phase, and 9 of 10 of these correlated positively with glucagon concentrations, but not insulin. Only proline correlated positively with insulin. Isoleucine and valine showed a negative correlation with insulin. The low concentrations of the nonaromatic amino acids increased during the time from the early to late chronic phase, during which time plasma glucagon increased and insulin remained unchanged. This study shows that a significant positive correlation existed between glucagon and the most abundant plasma amino acids during the chronic phase of hepatic insufficiency, at which time most plasma amino acid concentrations were returning toward base line. Increased glucagon values did not correlate with any evidence for deterioration of hepatic function.

Culture of purified rat astrocytes in serum-free medium supplemented with mitogen

We have obtained a highly purified astrocyte population in cultures originating from neonatal (2-5 days) rat cerebrum by use of the selection process provided by a serum-free chemically defined medium (DM). The addition of a glial growth factor isolated from bovine pituitary glands to DM induced in these astrocyte cultures both a stimulation of astrocytic proliferation and a morphological transformation of the astrocytes from flat fibroblastic form to multipolar stellate form.

Three-year experience with NORPLANT subdermal contraception

NORPLANTTM (Laboratorios Gutfol, S.A., Mexico City, Mexico) subdermal implants containing levonorgestrel were accepted by 816 women in a two-phase study initiated in 1975 and augmented in 1978. Through 3 years of first-segment use, acceptors experienced five pregnancies, a cumulative net rate of 0.7 per 100, and a gross pregnancy rate of 1.1 per 100. First-segment continuation at 3 years was at the rate of 44.6 per 100, an annual average of 76 per 100. NORPLANT users experienced irregular menstruation, with high interindividual variation, but with normal average numbers of bleeding days and of bleeding episodes. Hemoglobin levels increased moderately during implant use. The incidence of systolic blood pressure readings above 145 mm Hg or diastolic readings above 95 mm Hg was similar to that observed among users of the TCu 200 intrauterine device enrolled under the same selection criteria in the same clinics between the two phases of the NORPLANT study. Comparative data on pregnancy and other rates are also given for these intrauterine device acceptors.

Cavernous sinus syndrome due to prolactinoma: resolution with bromocriptine

Cavernous sinus syndrome due to a pituitary tumor is quite rare. Our patient had a large prolacinoma that extended superiorly, causing bitemporal visual field defects, and laterally into the right cavernous sinus, causing tearing, dysesthesia in the distribution of the fifth cranial nerve, a loss of the corneal reflex, and a sixth cranial nerve palsy. Prolactin levels ranged between 800 and 1000 ng/mL. Treatment with 7.5 mg of bromocriptine daily caused a marked reduction in the size of the tumor and resolution of her visual field defects and cranial nerve dysfunction over 6 months. We feel that bromocriptine should be considered as initial therapy for patients with prolactinomas extending into the middle or posterior cranial fossae.

Social mobility and the interpretation of social class mortality differentials

The discussion of health inequalities in Britain (e.g. in the Black Report) has been conducted largely on the basis of social class mortality differentials measured by achieved social class and not by social class of origin. It is shown in this paper that social class mortality differentials by achieved social class are not invariant to the rate of social mobility and that the use of them is likely to result in a biased measure of trends in health inequalities when the absolute rate of social mobility varies over time. It is further shown that if, as is likely, health status is a factor systematically affecting the probability for an individual of upward or downward social mobility, then an increase in the rate of social mobility may well result in constant or widening social class mortality differentials by achieved social class even if the differentials are narrowing when measured by social class of origin. It is claimed that this process may well explain why the observed social class mortality differentials, which are measured by achieved social class, have not fallen in Britain during the post-1945 period.

Effect of exercise and diet on triglyceride metabolism in rats with moderate insulin deficiency

The ability of exercise and diet to modify the effects of moderate streptozotocin-induced insulin deficiency on triglyceride metabolism has been studied in the rat. Insulin-deficient rats allowed to run spontaneously in exercise wheel cages had significantly lower (P less than 0.001) plasma glucose levels (187 +/- 19 mg/dl) than either sedentary (374 +/- 24 mg/dl) or sucrose-fed (450 +/- 13 mg/dl) diabetic rats, despite the fact that plasma insulin levels were comparable in all these groups. Plasma triglyceride (TG) levels in exercise-trained rats with diabetes (51 +/- 5 mg/dl) were actually lower than in control rats with normal glucose tolerance (90 +/- 14 mg/dl). In contrast, plasma TG levels were higher than control levels in diabetic sedentary rats (128 +/- 11 mg/dl), and severe hypertriglyceridemia developed in sucrose-fed diabetic rats (369 +/- 35 mg/dl). The ability of exercise training to attenuate diabetic hypertriglyceridemia, which was observed in both chow-fed and sucrose-fed rats, was secondary to a decrease in TG secretion, and appeared to be related to lower plasma FFA concentrations. In contrast, the accentuation of diabetic hypertriglyceridemia seen in sucrose-fed rats was related to a defect in TG catabolism. Adipose tissue lipoprotein lipase (LPL) activities were essentially identical in all diabetic rats, suggesting that the observed difference in TG kinetics could not be attributed to concomitant increases or decreases in adipose tissue LPL activity. These results emphasize the powerful impact of exercise and diet on TG metabolism in rats with moderate degrees of insulin deficiency.

Distinct lobes of Limulus ventral photoreceptors. I. Functional and anatomical properties of lobes revealed by removal of glial cells

Removing the glial cells that encase Limulus ventral photoreceptors allows direct observation of the cell surface. Light microscopy of denuded photoreceptors reveals a subdivision of the cell body into lobes. Often one lobe, but sometimes several, is relatively clear and translucent (the R lobes). The lobe adjacent to the axon (the A lobe) has a textured appearance. Scanning electron microscopy shows that microvilli cover the surface of R lobes and are absent from the surface of A lobes. When a dim spot of light is incident on the R lobe, the probability of evoking a single photon response is two to three orders of magnitude higher than when the same spot is incident on the A lobe. We conclude that the sensitivity of the cell to light is principally a function of the R lobe.

[Renal sinus lipomatosis, a pseudotumorous transformation]

A case of longstanding chronic pyelonephritis associated with severe recurrent nephrolithiasis followed by excessive lipomatosis, ureteritis cystica and xanthogranulomatous pyelonephritis is presented. In addition to the definition and morphologic description of lipomatosis its differential diagnosis is discussed. This also applies to the pathogenesis of these diseases. The special role of lipomatosis in the perpetuation of a circulus vitiosus is stressed. In special cases it seems to be justified to speak of clinical malignant lipomatosis.

[Differential diagnosis of testicular neoplasms. Tumorous and clinically tumor-like diseases of the scrotum]

The observation of a case of inguinal omental hernia with marked peritoneal carcinosis treated by operation for suspected testicular tumor leads us to discuss systematically the differential diagnosis of tumors and tumor-like conditions of the scrotal region. In order to analyse the frequency and importance 420 cases of ours were reconsidered. Of these 30 had been admitted to our hospital because of suspicion of tumors of the testis. The diagnosis on admission and after morphological analysis by the pathologist are compared.

A clinical comparison of MDP and DMAD

Tc-99m labeled dimethyl-amino-diphosphonate (DMAD) was compared with methylene diphosphonate (MDP) in five healthy volunteers and 28 patients with a variety of bony afflictions. Although the normal bone uptake of DMAD is less than MDP, the lesion-to-normal bone ratio is significantly higher with DMAD. All 71 lesions detected with MDP were also seen with DMAD. However, 10 lesions were disclosed with DMAD that were not seen with MDP. These lesions tended to have low grade concentrations of the radiopharmaceutical and were detected with DMAD by virtue of the lower normal bone uptake rather than higher lesion uptake.

[A multilocular haemangioblastoma with cerebellar and spinal involvement as a manifestation of von Hippel-Lindau syndrome]

A case of incomplete von Hippel-Lindau's disease is described. Our patient is characterized by multilocular and recurring typical hemangioblastomas in the cerebellum and the spinal cord. Moreover there are hints at familiar pre-disposition. Based on the recent literature the morphological and clinical characteristics are discussed with special consideration of modern radiological (myelography, arteriography, computertomography) and laboratory (hemoglobin levels follow-ups) investigations.

Lateral eye movements and the recall of spatial information in a familiar, large-scale environment

The relationship between cerebral asymmetry and memory for locations in a familial large-scale environment was examined. Subjects were classified as showing a preference for right or left hemisphere processing on the basis of the direction of their lateral eye movements. Knowledge of the locations of 10 landmarks in a familial large-scale space was assessed. No differences were found between right and left movers. It was concluded that memory for the location of landmarks in a familiar large-scale space is processed equally effectively by those who prefer to process information with the right or left hemisphere.

The computed tomographic spectrum of intracranial mycosis: correlation with histopathology

Four cases of intracerebral fungal infection are reviewed. The clinical course is outlined, and the computed tomographic (CT) characteristics are analyzed in light of known pathological data. The CT appearance of intracranial mycosis is dependent on the type of fungus as well as the dominant infecting form, i.e., yeast or hyphae. The hyphal form leads predominantly to a CT pattern consistent with vascular occlusion and secondary abscess formation; the yeast form generally results in noncaseating granulomas, which appear on CT scan as nodular enhancing lesions. If the patient survives the acute infective process, these fungal lesions undergo a prolonged subacute phase, and may eventually calcify.

Lipoprotein patterns in women in Santo Domingo using a levonorgestrel/estradiol contraceptive ring

Ten healthy, normally menstruating women attending a family planning clinic in Santo Domingo Participated in a study to determine the effects on plasma lipid levels of levonorgestrel and estradiol released from a contraceptive ring. A schedule of 21 days of use followed by 7 days of non-use was followed for 6 cycles. During the first two cycles of use, concentrations of cholesterol, HDL cholesterol, triglycerides and LDL cholesterol declined significantly from control levels, up to 25% for cholesterol, 28% for HDL cholesterol, 45% for friglycerides and 24% for LDL cholesterol. There were no subsequent changes with continued use. These declines are similar in direction but of lesser magnitude than those reported from clinics in other countries where pretreatment plasma levels of the same lipids are considerably higher. There was no significant change in the total cholesterol to HDL cholesterol ratio during treatment.

A multicenter study of levonorgestrel-estradiol contraceptive vaginal rings. II-Subjective and objective measures of effects. An international comparative trial

Comparative clinical trials of 2 sizes of contraceptive vaginal rings and of an oral contraceptive were undertaken at 8 investigational sites (9 clinics). More than 500 women enrolled on each of the 3 study regimens. Side effects of the rings and of Nordette, the oral contraceptive, were evaluated by noting spontaneous complaints, by recording medications taken and by physical examination. Inquiries about changes in the frequency of specific conditions were made at the end of the subjects participation in the first year of the study. The incidence of spontaneous complaints was similar among users of the 2 different-sized rings and of the pill.