Repression of rearranged mu gene and translocated c-myc in mouse 3T3 cells X Burkitt lymphoma cell hybrids.

The productively rearranged immunoglobulin mu chain gene and the translocated cellular oncogene c-myc are transcribed at high levels both in human Burkitt lymphoma cells carrying the t(8;14) chromosome translocation and in mouse plasmacytoma X Burkitt lymphoma cell hybrids. In the experiments reported here these genes were found to be repressed in mouse 3T3 fibroblast X Burkitt lymphoma cell hybrids. Such repression probably occurs at the transcriptional level since no human mu- and c-myc messenger RNA's are detectable in hybrid clones carrying the corresponding genes. It is therefore concluded that the ability to express these genes requires a differential B cell environment. The results suggest that the 3T3 cell assay may not be suitable to detect oncogenes directly involved in human B cell oncogenesis, since 3T3 cells apparently are incapable of transcribing an oncogene that is highly active in malignant B cells with specific chromosomal translocations.

Synthesis and angiotensin-converting enzyme inhibitory activity of 3-(Mercaptomethyl)-2-oxo-1-pyrrolidineacetic acids and 3-(Mercaptomethyl)-2-oxo-1-piperidineacetic acids.

A number of gamma- and delta-lactam derivatives were synthesized and their in vitro angiotensin-converting enzyme (ACE) inhibitory activities were compared. The structures of these compounds were designed to include many of the important features of captopril. The synthesis involved the preparation of a variety of novel 3-methylene-2-pyrrolidinones (3-5 and 16) and 3-methylene-2-piperidinones (3a-5a, 10-12, and 17). The key intermediate 3-methylenelactams 3 and 3a were obtained from 3-(hydroxymethyl)lactams 2 and 2a by a direct dehydration with dicyclohexylcarbodiimide using cuprous iodide as a catalyst. Introduction of the sulfhydryl group was accomplished by a Michael addition of these alpha, beta-unsaturated lactams. The compound with the highest in vitro activity was 3-(mercaptomethyl)-2-oxo-1-piperidineacetic acid (7a). The activity of the 7a both in vitro and in vivo (dog) was shown to be less than that of captopril by a factor of about 100.

Pericardial drainage operations in the management of uremic pericardial effusion.

Because of frequent failures in nonoperative therapy, we have adopted early surgical drainage of the pericardium in the management of uremic pericardial effusion. This series presents the longest follow-up period of any group of patients with uremic pericardial effusion treated by surgical drainage. There have been no intraoperative deaths and no recurrences. The total hospital mortality rate was 8.3 per cent and the late mortality rate over a 72 month period was 25 per cent. Internal pericardiostomy drainage is a simple yet effective surgical solution to the life-threatening problem of uremic pericardial effusion.

Surgical significance of the endothoracic fascia. The anatomic basis for empyemectomy and other extrapleural technics.

Attention if directed to explanation of the endothoracic fascia in several operations described by pioneer thoracic surgeons. The extrapleural plane was extensively and successfully employed in a number of these operations. Re-emphasis of its use seems advisable even today when open thoracotomy is the rule rather than the exception. In selected cases the extrapleural plane can and should be dissected in the aggressive management of relatively localized empyema, with complete enucleation of the infected sac (empyemectomy). This operation can reduce morbidity and prevent prolonged external drainage. The surgical advantage of the extrapleural plane is also apparent in complete parietal pleurectomy for effective palliation of repeated fluid formation. Other instances of intrathoracic disease are mentioned for which dissection in the extrapleural plane can be a safe and time-saving method of treatment. The anatomic considerations relating to the rapid, safe, and effective dissection of the major hilar vessels are also emphasized.

Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma.

Traumatic interruption of the phrenic nerve causing diaphragmatic paralysis occurs much more commonly than realized. Patients present with symptoms referable to the respiratory, gastrointestinal, or cardiovascular systems as a result of anatomic displacement of the respective organ (eventration). Symptoms often occur shortly after the injury but may be delayed for many years; consequently, prolonged follow-up of these patients is essential. If patients are symptomatic after trauma, judicious observation is dictated, since many will experience gradual return of normal diaphragmatic function over the succeeding six to twelve months. In those who remain significantly symptomatic, thoracotomy and imbrication of the eventration is a simple and effective surgical procedure.

Progressive management of open surgical repair of achilles tendon rupture.

A 33-year-old man sustained an acute Achilles tendon rupture which was surgically repaired. Early nonweight-bearing range of motion and strengthening of the ankle and the repaired muscle unit was allowed at 4 weeks postoperatively, and closed-chain dorsiflexion was allowed at 6 weeks. Casts and/or ankle-foot orthoses were used to continue protection of the Achilles from reinjury and full body forces as the repaired muscle continued to heal. In this case, range-of-motion and strengthening exercises were initiated at an earlier stage in the treatment program without compromising the result. When indicated, this treatment will provide excellent posttraumatic function of the surgically repaired Achilles tendon in the motivated and compliant patient.

Laughter and tears: best medicine for stress.

Laughter and tears are natural resources that are often neglected in managing personal and professional stress. Facilitating patients' and families' laughter and tears is an important skill in providing emotional support, which is central to the caring role of nursing. Social stigmas, the medical model, and stressful hospital environments can distract nurses from employing these resources and other catharses in managing stress and supporting patients and families. Nurses can learn to integrate laughter and tears practically and appropriately into nursing care, thereby increasing work satisfaction and facilitating emotional healing.

Symbolic expressions of dying patients: communications, not hallucinations.

The author presents an historical and psychological framework for considering the human process of dying. An in-depth presentation is made on providing supportive emotional care to dying patients who are communicating symbolically. Many clinical examples are included.