Management of infected aortoiliac aneurysms

A 30-year retrospective review identified 13 patients treated for infected aneurysms of the abdominal aorta or iliac arteries, for an overall incidence of 0.65%. A constellation of clinical findings led to the correct preoperative diagnosis in 11 (85%) of 13 patients. Treatment methods included resection and in situ replacement grafting in seven patients, resection and extra-anatomic bypass in five patients, and resection-ligation in one patient. Four (31%) of 13 patients died within 30 days of operation, three of whom died of rupture. Overall, good results were achieved in five patients (38%), while poor results were noted in the remaining eight patients (62%). The determinants of outcome were aneurysm location or rupture, the presence of established infection, and the virulence of the infecting organism. In 10 (77%) of the 13 aneurysms, Salmonella species, Bacteroides fragilis, Staphylococcus aureus, and Pseudomonas aeruginosa accounted for all deaths, ruptures, and suprarenal aneurysm infections. These data suggest that patients with primary infections of the abdominal aorta or iliac arteries continue to present with advanced infections or aneurysm rupture that result in a high mortality.

The utility of cardiac evaluation in the hemodynamically stable patient with suspected myocardial contusion

Myocardial contusion following isolated blunt thoracic trauma (BTT) remains a diagnostic and therapeutic dilemma. To identify the presence of cardiac abnormality following BTT, 123 hemodynamically stable patients were prospectively evaluated with serial electrocardiograms (ECG) and cardiac enzymes (total CPK and CPK-MB). Gated cardiac radionuclide angiography (MUGA) scans were performed within 48 hours following admission. Patients included in the study sustained significant thoracic trauma identified by physical findings or mechanism of injury. Sixty-three patients (51%) were identified with either abnormal ECG, or abnormal total CPK, CPK-MB, MUGA scan, or combination of the above. Thirty-seven patients (58.7%) manifested an ECG abnormality defined as ST-segment or T-wave abnormality. Twenty-two patients (34.9%) had total CPK value greater than or equal to 50 International Units (I.U.) or CPK-MB fractions greater than or equal to five per cent. MUGA scan was abnormal (right ventricular ejection fraction less than 40 per cent and/or wall motion abnormality) in 12 patients (19%). Eight patients with MUGA scan abnormality had normal ECG and/or normal total CPK, CPK-MB values. Evaluation of all patients up to six months revealed no mortality, malignant arrhythmias, or cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)

An evaluation of an InPouch TV culture method for diagnosing Trichomonas vaginalis infection

A new culture method for Trichomonas vaginalis, the InPouch TV test, was evaluated for its sensitivity and specificity in supporting growth of trichomonads. Five clinical isolates remained viable for periods from 41 to 131 days. A strain from the ATTC 30001 remained viable for 91 days. As few as four trichomonads/ml of culture medium could be viewed microscopically within 24 h. Doubling time for growth of trichomonad varied between 5 to 8 h. In a clinical study of 102 wet-mount negative specimens, 15 culture positive patients were observed with the InPouch TV test compared with 12 of the same patients with Hollander's fluid medium.

Characterization of Andante, a new Drosophila clock mutant, and its interactions with other clock mutants

A new clock mutant, named Andante, has been identified on the X chromosome of Drosophila melanogaster. Andante lengthens the period of the circadian eclosion and locomotor activity rhythms by 1.5-2.0 hours. The phase response curves for the eclosion and activity rhythms, indicating light-induced phase shifts, show a similar degree of lengthening. Andante also lengthens the periods of other clock mutants, including Clock, and alleles of the period locus. Analysis of locomotor activity rhythms reveals that Andante is semi-dominant, and Andante rhythms are highly temperature compensated. The sine oculis mutation, which eliminates the outer visual system, has no effect on the period of Andante. Deficiency mapping indicates that Andante is located in the 1OE1-2 to 1OF1 region of the X chromosome, close to the miniature-dusky locus. Whereas Andante flies have a dusky wing phenotype, dusky flies do not have an Andante clock phenotype.

The impact of volume on outcome in seriously injured trauma patients: two years' experience of the Chicago Trauma System

The American College of Surgeons has stated that in considering the development of trauma systems it is important to ensure an appropriate volume of seriously injured patients be seen by each trauma center in order to achieve acceptable mortality rates. Clinical data supporting this recommendation are lacking. An analysis was performed on 1,643 seriously injured trauma patients to determine the relationship between volume and mortality rates. Three separate statistical methods were used: Pearson correlation coefficients, mortality odds ratios, and direct pairwise mortality comparisons. In addition, Tobit analysis was introduced as a method to analyze the relationship between volume and mortality. Mortality rates were adjusted for the confounding variable of serious head injury. Pearson correlation coefficients for volume vs. adjusted mortality was -0.65. Mortality odds ratios comparing the low-volume (less than 140 pts) trauma centers vs. the high-volume (greater than 200 pts) trauma centers was 1.3 for adjusted mortality rates (95% CI = 1.01-1.66; p = 0.04). Categorical analysis showed significantly different mortality rates in the centers before and after adjusting for patient mix. Tobit analysis showed the relationship between volume and mortality to be significant, accounting for 30-40% of the observed variation in mortality rates. In addition, Tobit analysis allowed construction of a model to predict mortality rates, given specific volumes of patients. Our data suggest that an inverse relationship exists between volume and mortality, and support the necessity of configuring trauma systems in a manner that will ensure designated trauma centers will see a high volume of seriously injured patients.

Intraoperative autotransfusion in vascular surgery

To determine the impact of intraoperative autotransfusion on vascular surgical care, data related to 304 major vascular surgical operations performed over a 42-month period were retrospectively analyzed. Procedures included abdominal aortic aneurysmectomy (N = 152), aortobilateral femoral bypass (N = 60), thoracoabdominal aortic aneurysmectomy (N = 20), and other vascular procedures (N = 68). Fifty percent of the transfusion requirement was met by autotransfusion for the average patient. The per patient average volumes (liters) autotransfused were as follows: elective abdominal aortic aneurysmectomy, 0.87 L and nonelective, 1.45 L; elective aortobilateral femoral bypass, 0.63 L; elective thoracoabdominal aortic aneurysmectomy, 2.47 L, and nonelective, 2.15 L; and elective other, 0.53 L and nonelective, 1.30 L. Results of immediate postoperative and hospital discharge hemoglobin, hematocrit, and coagulation studies (prothrombin time, partial thromboplastin time, and platelets) did not differ from results of preoperative studies in any group. Neither mortality nor morbidity was related to intraoperative autotransfusion. These data suggest that intraoperative autotransfusion is a safe blood replacement method during major vascular surgical operations.

Effect of preslaughter experience on behaviour, plasma cortisol and muscle pH in farmed red deer

Three groups of farmed red deer were shot in the field, three groups were slaughtered on the farm and three groups were transported to commercial slaughterhouses. The behaviour of the animals was observed and peripheral plasma cortisol concentrations were measured immediately after slaughter and neck muscle pH was measured 24 hours after slaughter. The deer could be handled and herded without agitation when only one unhindered direction was open to them and nothing in the environment caused alarm. Shallow angled loading ramps were preferable. Deer shot in the field and deer penned without handling had low average plasma cortisol concentrations (less than 7 ng/ml) and a muscle pH less than 5.74 whereas deer which had been herded on the farm, or transported to a slaughterhouse, had high cortisol concentrations (greater than 20 ng/ml) and a muscle pH above 5.74. However, only four of 66 male deer transported to a slaughterhouse had a muscle pH above 6.0, the pH associated with dark cutting meat in red deer.

Ureteral complications and aortoiliac reconstruction

A 33-year experience with 58 ureteral complications in 50 of 3580 patients undergoing aortoiliac reconstruction was analyzed. Ureteral obstruction was treated before or in conjunction with aneurysm repair in six patients with aneurysmal disease. The remaining 44 patients had 46 ureteral complications after aortic reconstruction; complications included hydronephrosis (42), ureteral leak (3), and ureteral necrosis (1). A high incidence of associated graft complications was noted. Graft thrombosis developed in one of the six patients undergoing prior or simultaneous ureteral procedures, and graft infection developed in another. Thirty-six graft complications developed in 24 (55%) of the 44 patients with postoperative ureteral complications. The complications included 19 anastomotic aneurysms, eight graft limb thromboses, six graft infections, and three aortoenteric fistulas. Twenty-nine of the 44 patients with postoperative ureteral complications underwent ureteral or graft operations or both. These included five patients having ureteral operations alone, seven with a ureteral procedure and subsequent graft operation, eight requiring simultaneous ureteral and graft procedures, and nine undergoing a graft operation with ureteral observation. Six of these 29 patients (21%) died after operation, all from graft complications including aortoenteric fistulas (three), ruptured anastomotic aneurysms (two), and graft infection (one). Graft complications affected 55% of 44 patients with postoperative ureteral complications, compared to 12% of 3536 patients without ureteral complications (p less than 0.0001). Patients with postoperative ureteral complications were 4.4 times as likely to have graft complications compared to those without ureteral complications (p less than 0.0001). These data suggest that such urologic complications may be markers for recognition of or harbingers for graft complications.

Automatic generation of primary sequence patterns from sets of related protein sequences

We have developed a computer algorithm that can extract the pattern of conserved primary sequence elements common to all members of a homologous protein family. The method involves clustering the pairwise similarity scores among a set of related sequences to generate a binary dendrogram (tree). The tree is then reduced in a stepwise manner by progressively replacing the node connecting the two most similar termini by one common pattern until only a single common "root" pattern remains. A pattern is generated at a node by (i) performing a local optimal alignment on the sequence/pattern pair connected by the node with the use of an extended dynamic programming algorithm and then (ii) constructing a single common pattern from this alignment with a nested hierarchy of amino acid classes to identify the minimal inclusive amino acid class covering each paired set of elements in the alignment. Gaps within an alignment are created and/or extended using a "pay once" gap penalty rule, and gapped positions are converted into gap characters that function as 0 or 1 amino acid of any type during subsequent alignment. This method has been used to generate a library of covering patterns for homologous families in the National Biomedical Research Foundation/Protein Identification Resource protein sequence data base. We show that a covering pattern can be more diagnostic for sequence family membership than any of the individual sequences used to construct the pattern.

Toxicology screening in urban trauma patients: drug prevalence and its relationship to trauma severity and management

Although toxicology screening is often used when treating trauma patients, its utility and significance remain controversial. Data from 623 toxicology screens performed in urban trauma center patients with mental status alterations are reported. The study patients were predominantly black and male, with a mean age of 32 (+/- 22) years. Overall, 86% of screens were positive. Substances of abuse, including ethanol, were noted in 525 (84%) of urine toxicology screens. Ethanol, cannabinoids, and cocaine were the drugs most commonly found in urine, with positivity noted in 53%, 37%, and 34% of screens. Serum analysis was 44% positive, with ethanol noted in 41% of patients. In blacks, the odds ratio of illicit drug use before trauma ranged from 1.9 to 4.2 (p less than 0.005), and in those aged 17 to 40 years, the odds ratio for illicit urine drugs ranged from 4.7 to 16.8 (p less than 0.001). In patients older than 40 years, the odds of a positive serum ethanol level were 1.7 times greater than in younger patients, and a level above 300 mg% was 3.8 times more likely in this age group (p less than 0.001). When serum ethanol was detected, the odds ratio of a head injury was 1.4 relative to patients without serum ethanol (p less than 0.06), and the odds ratio for abdominal injury was 1.6 for patients with serum ethanol (p less than 0.03). The odds of a TS less than 12 were 1.8 (p less than 0.05), and the odds of a GCS less than 12 were 3.3 (p less than 0.001) with ethanol levels greater than 100 mg%.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavioral and neuroanatomical sequelae of prenatal naloxone administration in the rat

Pregnant Long-Evans hooded rats were dosed subcutaneously with 1 or 5 mg/kg/day naloxone hydrochloride, or an equal volume of vehicle, from gestational Day 4 (GD4) through GD19. Offspring were assessed for development of righting reflex, negative geotaxis, and open field activity, and for acquisition of a Warden maze; offspring sacrificed at postnatal Day (PND) 21 were assessed for several parameters of cerebellar, hippocampal, and motor cortical morphology. Five mg/kg/day naloxone accelerated development of negative geotaxis and righting reflex, while 1 mg/kg/day naloxone tended to slow development. Low dose females had significantly more errors than controls on the first day of maze learning. The high dose group had a significantly higher concentration of granule cells in the curvature of the dentate gyrus than controls; other neuroanatomical measures were unaffected by dosing. These findings confirm and extend previous work indicating that prenatal exposure to naloxone may alter neurobehavioral development in the rat.

Behavioral effects of prenatal exposure to lidocaine in the rat: effects of dosage and of gestational age at administration

Pregnant Long-Evans hooded rats were dosed via injections into the gum with 3, 6, or 9 mg/kg lidocaine, or vehicle, or were uninjected, on gestational day 4 (GD4), GD11, or GD18. Offspring (8-11 litters/group) were tested on a variety of tests of behavioral development and adult behavior. No effects of any dose at any time of administration were found upon maternal weight gain in gestation, litter size, or initial birth weight or weight gain of the pups. Administration at GD4 produced few effects; only footshock sensitivity showed a significant effect of dosing, although there were trends toward dosing effects on spontaneous alternation. For administration on GD11, lidocaine was associated with slight but significant alterations in sex ratios, and a trend toward drug effects on development of spontaneous alternation. Vehicle administration at this age reduced barbiturate sleep time in offspring and slightly altered footshock sensitivity. Lidocaine dosing on GD18 was associated with a number of significant alterations of behavior, including visual discrimination, shuttlebox avoidance, tail flick, and water maze errors; there were also both vehicle and lidocaine effects on water maze latencies. These data reinforce our previous report that lidocaine may be a behavioral teratogen, and suggest that administration in later gestation in the rat may alter a broader range of behaviors than earlier in gestation.

Depolarization changes early in the course of myocardial infarction: significance of changes in the terminal portion of the QRS complex

Studies of patients during variant angina have revealed that there are specific changes in the terminal part of the QRS complex that provide information regarding the location of the ischemia. Extending these studies to acute myocardial infarction, the electrocardiogram (ECG) obtained from 32 patients within 5 h of the onset of chest pain was analyzed to determine if similar inferences could be made. A preinfarction ECG was available from each patient for comparison and 30 patients underwent coronary arteriography within 3 weeks of the infarction. The 10 patients with anterior infarction had a decrease (p less than 0.05) in the S wave in leads V2 (0.80 +/- 0.50 mV) and V3 (0.65 +/- 0.43 mV). In 23 patients with inferior infarction an increase (p less than 0.05) in the R wave of lead III (0.47 +/- 0.35 mV), S wave of lead aVL (0.31 +/- 0.23 mV) and R wave of lead aVF (0.37 +/- 0.30 mV) occurred. A strong positive correlation between the R wave changes in leads III and aVF and the S wave in lead aVL (r = 0.94 and 0.91, respectively) suggests that the R and S wave changes in these leads are expressions of the same phenomenon and indicates that the terminal QRS complex is chiefly affected. Eight of 23 patients with inferior infarction and ST depression in the anterior precordial leads had a normal left anterior descending coronary artery. All had an increase in S wave amplitude in leads V2 and V3. Eight patients had inferior infarction, ST depression in anterior leads and severe lesions in the left anterior descending artery or anterior wall motion abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Renal insufficiency in community patients with mild asymptomatic microhematuria

Primary-care physicians often must decide when patients with asymptomatic microhematuria warrant further testing for renal parenchymal disease. Because previous data had shown a greater frequency of elevated serum creatinine concentration in a population with asymptomatic microhematuria than in control subjects without hematuria, we reviewed the records of 125 patients with isolated asymptomatic microhematuria and elevated serum creatinine (AM/EC) and 83 comparison patients with no hematuria and elevated serum creatinine (NH/EC) from a previous population-based study to determine the relationship between renal parenchymal disease and isolated asymptomatic microhematuria. Serum creatinine was often elevated transiently because of volume depletion or shock, or elevations occurred in relationship to a terminal illness. Thus, only 63 AM/EC patients and 45 NH/EC control subjects had primary renal parenchymal disease or systemic disorders that caused an elevated serum creatinine. The patients selected from the asymptomatic microhematuria population because of elevated serum creatinine most often had low-grade hematuria and were typically 75 years of age or older. No disease was consistently found more frequently in the AM/EC patients than in the NH/EC group. Intervention at the time of the detection of hematuria might have altered the prognosis in 8% and probably would not have altered the prognosis in 78%. Therefore, exhaustive diagnostic testing to detect renal parenchymal diseases cannot be advised in asymptomatic elderly patients with low-grade (grade 1) microhematuria unless more specific indications are present.

Alterations in offspring behavior induced by chronic prenatal cocaine dosing

Sperm-positive female Long-Evans hooded rats were dosed subcutaneously with 10 mg/kg/day cocaine or an equal volume of vehicle (0.9% sterile saline) from gestation day 4 (GD4) through GD18. Offspring were assessed for development of negative geotaxis, righting reflex, spontaneous alternation, and open field activity, and for adult behaviors including DRL-20 acquisition, water maze, visual discrimination, barbiturate sleep time, shuttlebox avoidance, footshock sensitivity, and tail flick latency. Cocaine dosing produced no significant effects on dam weight gain, any measure of litter size and weight, or early postnatal behavioral tests, but there were significant drug effects on development of spontaneous alternation, development of open field activity, DRL-20 acquisition, water maze performance, tail flick, and footshock sensitivity. These data suggest that chronic administration of a modest dose of cocaine during gestation in the rat alters a number of behaviors in the offspring.

Identification of new protein kinase-related genes in three herpesviruses, herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus

By using amino acid sequence patterns (motifs) diagnostic of conserved regions within the catalytic domains of protein kinases, homologous open reading frames of three herpesviruses were identified as protein kinase-related genes. The three sequences, herpes simplex virus gene UL13, varicella-zoster virus gene 47, and Epstein-Barr virus gene BGLF4, resemble serine/threonine kinases rather than tyrosine kinases.

Recurrent femoral anastomotic aneurysms. A 30-year experience

Of the 1771 patients who underwent aortofemoral bypass grafting (AFB) during the 30-year period of 1957-1986, 43 noninfected recurrent femoral anastomotic aneurysms (RFAA) developed in 28 patients. Thirty-six RFAAs were treated surgically, with one death and no amputations occurring. Seven small RFAAs (less than 2.0 cm) were treated expectantly without complications. Using univariate and multivariate analyses, clinical characteristics and other factors influencing results in patients with RFAAs were compared to two control groups: patients who had undergone AFB without the development of femoral anastomotic aneurysms (FAAs) and patients who had undergone FAA repairs but without recurrence of FAA. Comparative analyses suggested: 1) local wound complications after initial AFB or FAA repair increased risk of a RFAA (p less than 0.03); 2) development of an FAA within 4.5 years after AFB increased risk of a RFAA (p less than 0.0002); 3) following an FAA repair, risk of a RFAA was almost three times greater for women than for men (p less than 0.05); and 4) patients with arteriosclerotic heart disease (ASHD) were less likely to develop RFAA than those without ASHD (p less than 0.05). Among the 20 additional variables analyzed--including hypertension, smoking, diabetes mellitus, and etiology of primary vascular disease--no statistically significant influence on the development of RFAAs could be detected.