Tc-99m white cell scintigraphy in suspected acute infection

The usefulness of In-111 labeled white cells in acute infection is well documented but the role of Tc-99m labeled white cell scintigraphy (WCS) has not been as clearly established. Using stannous fluoride colloid and a simple labelling procedure with 20 ml of autologous whole blood, three cases are presented in which Tc-99m WCS established unexpected diagnoses in patients who had remained undiagnosed despite extensive investigation.

End-systolic elastance as an evaluation of myocardial function in shock

The response of the heart during sepsis has been studied in human and animal models with disparate results. Because sepsis induces marked peripheral vascular changes, to accurately determine the cardiac response, one must use indices of cardiac performance that are independent of loading conditions and heart rate. The slope of the end-systolic pressure-diameter relationship (ESPDR) has been proposed to have these properties. Pigs were equipped with transducers to measure left ventricular pressure, internal short axis diameter (D), and pulmonary and coronary artery blood flows. After 7-10 days of basal observations, an endotoxin-loaded osmotic pump delivering endotoxin at 10 micrograms/kg/hr was implanted into each pig. Fourteen pigs were so treated, and 4 expired before 24 hr of endotoxin challenge. In the surviving pigs, cardiac output, heart rate, dP/dtmax, and peak systolic pressures were elevated. However, both ESPDR and % D shortening were both significantly depressed. These data suggest that the cardiac response to chronic endotoxin challenge includes a loss of inotropic state as indicated by the load-insensitive indicator, ESPDR, and confirmed by depressed % D shortening. One possible mechanism for reduced inotropic state during endotoxin challenge could be the loss of coronary perfusion. The surviving endotoxin-challenged pigs demonstrated a significant increase in coronary perfusion while stroke work remained unchanged, suggesting that depressed cardiac inotropic state during endotoxin challenge was not caused by reduced coronary blood flow. Rather, the myocardium was relatively overperfused. Another possible mechanism for the loss of cardiac inotropism during endotoxin challenge may be endotoxin-induced generation of reactive oxygen free radicals. This possibility was tested by measuring total cardiac gluthathione, a cellular component depleted by oxidant stress. Endotoxemia reduced these levels 50%. These results suggest that cardiac injury may be mediated by the generation of reactive oxygen free radicals. Further study will determine if this mechanism participates in the loss of cardiac inotropism during endotoxin challenge.

Relation between myocardial glutathione content and extent of ischemia-reperfusion injury

The relation between the extent of myocardial injury sustained during reperfusion and total glutathione (GSH) content in the ischemic myocardium was examined in anesthetized open-chest pigs subjected to coronary occlusion for 45 minutes and reperfusion for 2 hours. In pigs infused with saline during reperfusion (n = 6) there was a decrease in myocardial GSH content from 380 +/- 48 micrograms/g in normally perfused myocardium to 182 +/- 36 micrograms/g in the ischemic reperfused myocardium (p less than 0.02). Myocardial infarct size (expressed as a percentage of the ischemic area) was 12.5 +/- 0.8%. There was a delay of recovery of contractile function before returning to 60% of preocclusion value. In pigs pretreated with buthionine sulfoximine (BSO) (n = 5), an inhibitor of cellular GSH synthesis, there was reduction in GSH content to 215 +/- 25 micrograms/gm in normally perfused myocardium and to 77 +/- 8 micrograms/gm in the ischemic reperfused myocardium. The extent of injury was greater as evidenced by an increase in infarct size to 30.4 +/- 4.0% (p less than 0.001), severe destructive changes in subepicardial ultrastructure, which were absent in saline-infused pigs, and persistence of dyskinesia throughout reperfusion. In pigs infused with glutathione intravenously (0.8 gm/kg) at a rate of 6.5 mg/kg/min (n = 6), 5 minutes before and continuously during reperfusion, there was an increase in GSH content to 582 +/- 67 micrograms/g in normally perfused myocardium and to 312 +/- 80 micrograms/g in ischemic reperfused myocardium. The increase in myocardial GSH was associated with a reduction in infarct size to 7.5 +/- 1.3% (p less than 0.05, compared with saline-infused pigs) and an early recovery of contractile function of the ischemic myocardium. GSH infusion into pigs pretreated with BSO (n = 4) failed to increase myocardial GSH content and failed to reduce the extent of myocardial injury. Thus, the extent of myocardial injury sustained during reperfusion is very dependent on the effectiveness of its antioxidant defenses. Markedly increased susceptibility to injury occurs when the GSH content in the ischemic myocardium becomes depleted.

Variation in end-systolic pressure-diameter relationship using dP/dtmin or P/Dmax as a definition of end-systole in chronic endotoxemic pigs

We have reported that cardiac inotropism is reduced in various shock states, most recently during chronic endotoxemia (Lee et al.: American Journal of Physiology 254:H324-H330, 1988) [1]. We based this conclusion upon the alterations observed in the slope of the end-systolic pressure-diameter relationship (ESPDR). Recently, Dietrick and Raymond (Dietrick and Raymond: Surgical Infection Society, 7th Annual Meeting, May, 1987, p 83) [2] have reported that the slope of the end-systolic pressure-wall thickness relationship was augmented in the early stages of sepsis and depressed immediately prior to expiration. One major difference between our studies is the definition of end-systole; we used the time when the ratio of pressure-to-diameter (P/D) in the left ventricle is maximal (P/Dmax), whereas they used the time when the first derivative of pressure is minimal (dP/dtmin). In order to determine if the discrepancy between our conclusions could be explained by the differing definitions of end-systole, data from previous studies were reanalyzed, and the slope of the pressure-diameter relationship at P/Dmax and at dP/dtmin was calculated. Pigs were equipped with instruments to measure left ventricular pressure, short axis diameter, and ECG. Observations during the basal state were obtained 3-7 days after surgery. Chronic endotoxemia was induced by intravenous infusion of S. enteriditis endotoxin via an osmotic minipump at 10 micrograms/kg/hr. During the basal state, the value for the slope of ESPDR at dP/dtmin was lower than the value for the slope of ESPDR at P/Dmax, and there was a good correlation between the two values. During chronic endotoxemia, the slope of ESPDR at dP/dtmin did not change. However, the slope of ESPDR at P/Dmax decreased significantly suggesting that chronic endotoxemia reduced cardiac inotropism. This conclusion is supported by the findings that chronic endotoxemia reduced steady-state values of percentage diameter-shortening (an estimate of ejection fraction) and stable stroke work at significantly higher end-diastolic diameter. These data indicate that it is possible to calculate differing slopes of ESPDR from the same observations dependent upon the time during the cardiac cycle chosen as end-systole. More importantly, these data suggest that during chronic endotoxemia, ventricular relaxation dynamics may change so that postsystolic shortening becomes more prominent and therefore higher values for the slope of ESPDR using pressure and diameter values at dP/dtmin can be calculated.

Normalised radionuclide measures of left ventricular diastolic function

Abnormal left ventricular diastolic function is being increasingly recognised in patients with clinical heart failure and normal systolic function. A simple routine radionuclide measure of diastolic function would therefore be useful. To establish this, the relationship of peak diastolic filling rate (normalized for either end diastolic volume, stroke volume, or peak systolic emptying rate), and heart rate, age, and left ventricular ejection fraction was studied in 64 subjects with normal cardiovascular systems using routine gated heart pool studies. The peak filling rate, when normalized to end diastolic volume, correlated significantly with heart rate, age and left ventricular ejection fraction, whereas normalization to stroke volume correlated significantly to heart rate and age but not to left ventricular ejection fraction. Peak filling rate normalized for peak systolic emptying rate correlated with age only. Multiple regression equations were determined for each of the normalized peak filling rates in order to establish normal ranges for each parameter. When using peak filling rate normalized for end diastolic volume or stroke volume, appropriate allowance must be made for heart rate, age and ejection fraction. Peak filling rate normalized to peak ejection rate is a heart rate independent parameter which allows the performance of the patient's ventricle in diastole to be compared with its systolic function. It may be used in patients with normal systolic function to serially follow diastolic function or if age corrected, to screen for diastolic dysfunction.

Myocardial salvage with streptokinase combined with nitroglycerine and verapamil in acute myocardial infarction

We tested the hypothesis that preservation of left ventricular function results from treatment with intravenous streptokinase given in the first 2 hours from onset of acute transmural myocardial infarction together with nitroglycerine and verapamil. Thirty-three consecutive patients with onset of pain less than 2 hours prior to admission, received intravenous streptokinase 1.5 x 10(6) units with intravenous nitroglycerine and verapamil; 23 concurrently admitted "control" patients with pain onset 2-4 hours received intravenous nitroglycerine and verapamil only. Radionuclide ventriculographic assessment at 2 days revealed a significantly greater left ventricular ejection fraction in the streptokinase-treated patients (54.5 +/- 2.8 vs 46.1 +/- 2.9; P less than 0.05), which persisted at 28-35 days (50.1 +/- 2.3 vs 41.2 +/- 2.9; P less than 0.05). Streptokinase-treated patients had a significantly increased incidence of ischaemic events in the 35 days following infarction, but a lower incidence of death, congestive cardiac failure and non-fatal ventricular tachycardia than control group patients. Infarct-related artery patency assessed at 3-5 days was 94% in streptokinase-treated patients. We conclude that early presentation and treatment with intravenous streptokinase, nitroglycerine and verapamil is associated with a high incidence of successful thrombolysis and significant preservation of left ventricular function. Nitroglycerine and verapamil may augment the efficacy of streptokinase in this group of patients.

Cardiac function and coronary flow in chronic endotoxemic pigs

We have reported that myocardial inotropism was depressed in acute and chronic endotoxemia. One possible mechanism for this observation is that endotoxemia reduces myocardial perfusion and indeed, we observed reduced myocardial perfusion in acute endotoxemia. This study tested the hypothesis that reduced inotropism of chronic endotoxemia was accompanied by reduced coronary artery blood flow. Fifteen pigs were equipped with left atrial and ventricular catheters, circumflex coronary and pulmonary artery flow meters, left ventricular pressure transducer, and ultrasonic crystals in the anterior-posterior axis to measure internal short axis diameter by sonomicrometry. The pigs recuperated for 3 days before basal data were collected over the next 3-5 days. After at least 7 postoperative days, an osmotic pump containing Salmonella enteriditis endotoxin was implanted in 12 pigs. Endotoxin was delivered at 10 micrograms/hr/kg for 2 days, at which time the animals were sacrificed. Osmotic pumps containing sterile saline were implanted in 3 pigs. Eight of the 12 endotoxemic pigs survived; 4 died before the morning of the second day. The survivors exhibited elevated heart rate, peak left ventricular systolic pressure, and cardiac output. Inotropism was evaluated by calculating the slope of the end-systolic pressure-diameter relationship (ESPDR) and % diameter-shortening. ESPDR was significantly depressed on the second endotoxemic day, while % diameter-shortening was depressed on both endotoxemic days. Coronary artery blood flow was significantly elevated on both endotoxemic days, while cross-sectional stroke work was unchanged. Therefore, the ratio of coronary blood flow to stroke work increased on both endotoxemic days. Nonsurvivors exhibited reduced heart rate, cardiac output, peak left ventricular systolic pressure, ESPDR, and % diameter-shortening. Neither coronary artery blood flow nor flow-to-work ratios increased in this group. Sham endotoxemic pigs demonstrated no cardiac or hemodynamic changes over 3 days. These results indicate that depressed inotropism during chronic endotoxemia was not caused by reduced coronary blood flow; rather, the myocardium was relatively overperfused.

Abnormal proteins as the trigger for the induction of stress responses: heat, diamide, and sodium arsenite

Thermotolerance and synthesis of heat shock proteins are induced in cells in response to a variety of environmental stresses. We examined the suggestion of Hightower (1980) that modifications of intracellular proteins may be the triggering event that induces heat shock protein synthesis and thermotolerance. We did so by modifying cellular proteins, using diamide, a sulfhydryl oxidizing agent, and dithio-bis (succinimidyl propionate), an agent that cross-links bifunctional amino groups. Both of these agents induced heat shock proteins and thermotolerance in CHO (HA-1) cells. Furthermore, we observed cross-resistance and self-tolerance with three seemingly unrelated stimuli (diamide, heat, and sodium arsenite). This observation suggests that the induction of protective responses to these stimuli is mediated by a common mechanism. The results support the hypothesis that production of abnormal proteins by various stresses induces the stress responses as well as tolerance.

Fine structure and permeability of the metacercarial cyst wall of Clinostomum marginatum (Digenea)

Encysted metacercariae of Clinostomum marginatum (Digenea) were obtained from tissues of yellow perch, Perca flavescens. The outermost wall (host response) as seen under electron microscopy consisted of a single, fibrous tissue layer, 10-25 micron thick. The tissue contained flattened fibrocytes, small fat deposits, and vacuoles embedded between layers of collagen fibers. The cyst cavity was filled with small vesicles, crystals, and debris. No layer corresponding to the primary (parasite-produced) cyst wall secreted by most species of metacercariae was noted. To determine the permeability of the cyst wall, encysted worms were incubated under initial rate conditions with [3H] glucose, with and without the glucose transport inhibitors phlorizin and phloretin. After incubation, the worms were mechanically excysted, washed, and processed to determine glucose uptake rates. Vmax and Kt were greater than those obtained for worms excysted prior to incubation with substrate. Moreover, the presence of phlorizin or phloretin in the incubation medium had no effect on glucose uptake by encysted worms. Thus, the selective permeability of the cyst wall permits free diffusion of glucose to the cutaneous transport systems of the worm, while restricting the movements of phlorizin and phloretin.

Prenatal administration of arginine vasopressin impairs memory retrieval in adult rats

Eight pregnant female rats were chronically treated via an osmotic pump with arginine vasopressin or placebo during days 13 to 19 gestation. All offspring were tested as adults in either a discrimination task or a 25 day retention of a passive avoidance response. The results revealed that rats whose mother had been treated with vasopressin did not differ from controls on the acquisition or reversal of a brightness discrimination; however, they did require more trials to reach criterion during the ten day memory test of discrimination reversal. Further, treatment resulted in impaired memory retrieval in male rats on the 25 day memory test, while female rats were not affected. Treatment did not influence body weight. The results indicated that vasopressin administered during the prenatal period of development may have had a teratogenic effect on memory retrieval.

Determination of polyamines in digestive and reproductive tissues of adult Asterias vulgaris (Echinodermata: Asteroidea)

1. The polyamines spermine, spermidine and putrescine were extracted from tissues of Asterias vulgaris and quantitated using thin layer chromatography. 2. In the pyloric caeca, mean (+/- SE) levels of spermine, spermidine and putrescine were 138(15), 86(24) and 415(77) nmol/g wet wt tissue, respectively. In the testes, levels were 95(12), 13(6) and less than 6 nmol/g wet wt. In the ovaries, levels were 105(9), 11(0.8) and 15(8) nmol/g wet wt. 3. High levels of polyamines in the pyloric caeca may be related to secretion or excretion in this tissue. 4. We hypothesize that polyamines will be important in the regulation of cellular activity in these tissues during the annual reproductive cycle.

Lipid transfer between phosphatidylcholine vesicles and human erythrocytes: exponential decrease in rate with increasing acyl chain length

The rate of phospholipid transfer from sonicated phospholipid vesicles to human erythrocytes has been studied as a function of membrane concentration and lipid acyl chain composition. Phospholipid transfer exhibits saturable first-order kinetics with respect to both cell and vesicle membrane concentrations. This kinetic behavior is consistent either with transfer during transient contact between cell and vesicle surfaces (but only if the fraction of the cell surface susceptible to such interaction is small) or with transfer of monomers through the aqueous phase. The acyl chain composition of the transferred phospholipid affects the transfer kinetics profoundly; for homologous saturated phosphatidylcholines, the rate of transfer decreases exponentially with increasing acyl chain length. This behavior is consistent with passage of phospholipid monomers through a polar phase, which might be the bulk aqueous phase( as in the monomer transfer model) or the hydrated head-group regions of a cell-vesicle complex (transient collision model). Collisional transfer also predicts that intercell transfer of phospholipids should be slow compared to cell-vesicle transfer, as surface charge and steric effects should prevent close apposition of donor and acceptor membranes. This is not found; dilauroylphosphatidylcholine transfers rapidly between red cells. Thus, the observed relationship between acyl chain length and intermembrane phospholipid transfer rates likely reflects the energetics of monomer transfer through the aqueous phase.

Membrane bilayer balance and erythrocyte shape: a quantitative assessment

When human erythrocytes are incubated with certain phospholipids, the cells become spiculate echinocytes, resembling red cells subjected to metabolic starvation or Ca2+ loading. The present study examines (1) the mode of binding of saturated phosphatidylcholines and egg lysophosphatidylcholine to erythrocytes and (2) the quantitative relationship between phospholipid incorporation and red cell shape. We find that the phospholipids studied become intercalated into erythrocyte membranes, not simply adsorbed to the cell surface. Spin-labeling and radiolabeling data show that the incorporation of (4 +/- 1) X 10(6) molecules of exogenous phosphatidylcholine per cell converts discocytes to stage 3 echinocytes with about 35 conical spicules. This amount of lipid incorporation is estimated to expand the red cell membrane outer monolayer by 1.7% +/- 0.6%. Calculations of the inner and outer monolayer surface areas of model discocytes and stage 3 echinocytes yield an estimated difference of 0.7% +/- 0.2%.

Prevalence of mitral valve prolapse in presumably healthy Korean adults

This cross-sectional study on mitral valve prolapse (MVP) in Korean adults revealed a relatively low overall prevalence at 2.5% (5 of the 200 subjects). Three of 5 subjects with MVP were females and the majority (4 of 5 subjects) were under 30 years of age. All subjects with MVP had thoracic skeletal deformities (4 straight back syndrome and 1 pectus excavatum). All subjects with MVP did not have cardiac history and they were all asymptomatic except for one who had intermittent palpitation of mild degree.

Steroid use in idiopathic sudden sensorineural hearing loss

Few studies have investigated the effect of steroids on idiopathic sudden hearing loss (ISHL). Recently, Wilson, et al., reported a double blind study demonstrating a statistically significant improvement of hearing using steroids is ISHL. This report, fashioned after the Wilson study, confirms his findings and analyzes the relationship of several factors to the probability of hearing recovery.

Pituitary surgery: current status, including transsphenoidal surgery

Advances in CT scanning and digital subtraction angiography have improved the accuracy of preoperative diagnosis of pituitary disease. Modern radioimmunoassay techniques are able to evaluate "subdivisions" and "relatives" of the classic pituitary hormones, including monomeric and oligomeric growth hormones, somatomedin C, beta-lipotropin, and beta-endorphin, as well as the alpha subunit of follicle-stimulating hormone. Pituitary pathologic states can now be identified immunologically in patients in whom results of radiologic studies are normal. Bromocriptine, a centrally active dopamine antagonist and ergot derivative, is effective in the treatment of prolactinomas, but it is not effective in the treatment of acromegaly. Transsphenoidal surgery remains the treatment of choice in adults with pituitary-dependent Cushing's disease. The surgical advantages of the sublabial, transseptal, transsphenoidal approach include wide-field pituitary accessibility via a midline exposure.

Bacteriophage concentration from water by filter chromatography

The efficiency of an electropositive filter for membrane chromatography of viruses was examined using coliform phages T1, T4, lambda and Salmonella phage P22. Phages diluted in dechlorinated tap water were adsorbed to filters at neutral pH and eluted by 3% beef extract in 0.05 M glycine buffer at selected alkaline pH values. With exception of lambda phage, which displayed erratic adsorption behavior at any pH, all bacteriophages studied, adsorbed to filters with an efficiency of 97-100% at pH values ranging between 6.0 and 8.0. Each phage was readily eluted at alkaline pH levels. Maximal elution (86.2%) of T1 phage and lambda phage (79%) occurred at pH 10, while T4 and Salmonella phages were eluted most efficiently at pH 11 at values of 91.7 and 81.9%, respectively. The resolving power of the filter was such that individual phages within the same virus group (T1 and T4 phage) could be eluted at pHs differing by only one unit.

First branchial cleft anomalies and the facial nerve

First branchial cleft anomaly is an uncommon clinical problem that can be difficult to diagnose and treacherous to treat. It is generally believed that branchial anomalies arise from incomplete resolution of branchial cleft remnants. They may be a fistulous tract or cystic lesions, and they may be found in all age groups. This article presents three cases of first branchial cleft anomaly and offers an overview of the regional embryology and guidelines for surgical management and facial nerve preservation.

Genetic analysis of temperature-sensitive mutants which define the gene for the major herpes simplex virus type 1 DNA-binding protein

We have assigned eight temperature-sensitive mutants of herpes simplex virus type 1 to complementation group 1-1. Members of this group fail to complement mutants in herpes simplex virus type 2 complementation group 2-2. The mutation of one member of group 1-1, tsHA1 of strain mP, has been shown to map in or near the sequence which encodes the major herpes simplex virus type 1 DNA-binding protein (Conley et al., J. Virol. 37:191-206, 1981). The mutations of five other members of group 1-1 map in or near the sequence in which the tsHA1 mutation maps, a sequence which lies near the center of UL between the genes for the viral DNA polymerase and viral glycoprotein gAgB. These mutants can be divided into two groups; the mutations of one group map between coordinates 0.385 and 0.398, and the mutations of the other group map between coordinates 0.398 and 0.413. At the nonpermissive temperature mutants in group 1-1 are viral DNA negative, and mutant-infected cells fail to react with monoclonal antibody to the 130,000-dalton DNA-binding protein. Taken together, these data indicate that mutants in complementation groups 1-1 and 2-2 define the gene for the major herpes simplex virus DNA-binding protein, an early gene product required for viral DNA synthesis.

[Effect of hexosamine derivatives on mesenchymal metabolic processes of in vitro cultured fetal bone explants]

The effects of hexosamine derivatives, glucuronic acid, chondroitin sulfate, and oxyphenbutazone on growth and glycosaminoglycan metabolism of murine fetal bone explants cultured for 6 days in vitro were studied. Glucosamine hydrochloride, glucosamine hydroiodide and glucosamine sulfate (at concentrations of 100 micrograms/ml) caused a significant increase in the growth of the explants; this effect was not due to an increase in cell multiplication, as can be concluded from the DNA content of the explants, but rather to an increase in the glycosaminoglycans in the extracellular cartilage matrix. In addition, the three glucosamine salts induced an increase in the secretion of glycosaminoglycans from the surface of the explants into the culture medium. N-acetylgalactosamine, sodium glucuronide and chondroitin sulfate showed lesser or nonsignificant effects as compared to the glucosamine derivatives or the controls. Galactosamine hydrochloride (100 micrograms/ml) exerted inhibitory actions on the bone explants. Oxyphenbutazone (10 micrograms/ml), also, led to a significant inhibition of the growth and glycosaminoglycan metabolism of the explants without influencing (at this concentration) their DNA content. From the results obtained it is concluded that in the treatment of degenerative joint diseases nonsteroidal antiphlogistics acting similarly to oxyphenbutazone should be used, if at all, as cautiously as possible, whereas drugs with the type of action observed in the three glucosamine derivatives could be expected to exert a beneficial effect.