Kinetics of protein synthesis in enucleate frog oocytes.

Kinetics of protein synthesis were measured in oocytes of Rana pipiens enucleated at various times during and following pituitary-induced maturation. These enucleated oocytes were capable of the same rate of protein synthesis as nucleated controls, even when rates were measured many hours after enucleation.

Saccular aneurysms on straight and curved vessels are subject to different hemodynamics: implications of intravascular stenting.

Our aim was to examine hemodynamic implications of intravascular stenting in the canine venous pouch (sidewall or straight-vessel) and rabbit elastase (curved-vessel) aneurysm models. Flow dynamics in stented (Wallstent) and nonstented versions were studied by using computational fluid dynamics simulations and in vitro flow visualization, with a focus on stent placement effects on aneurysmal flow stagnancy and flow impingement. Results show that sidewall and curved aneurysm models have fundamentally different hemodynamics (shear-driven versus inertia-driven) and thus stent placement outcomes.

Automated data acquisition by confocal laser scanning microscopy and image analysis of triple stained immunofluorescent leukocytes in tissue.

The aim of the study was to develop a novel system permitting automated analysis of multicolor immunofluorescence-staining of cells in solid tissues which would be comparable to the analytical capacity of flow cytometry. In the user friendly automated data acquisition and image processing system which was established, the software includes a set of pre-defined processing steps for improved object identification and can be either interactive or fully automatic. As with multi color flow cytometry, stained cells can be analyzed in a fully automated manner regardless of tissue type. The software organizes computerized sample movement, autofocus, laser readjustment, data capture and storage as well as calculation. Data are presented as histograms indicating the staining intensity and frequency of each antigen, and in dotplots with each channel plotted against the other. The calculated statistics give information about how many of the cells are single-, double- or triple-reactive and how intensely they react with the respective antibodies. Comparison of data generated by this automated fluorescence confocal laser scanning microscopy (AF-CLSM) with flow cytometry using triple stained peripheral blood lymphocytes revealed a highly significant correlation between the methods (P<0.001). A correlation was also observed when sections triple stained for anti-CD45, -CD3 and -CD8 were analyzed by AF-CLSM and the data were compared to visual/manual cell counting (P<0.01). The AF-CLSM system permits for the first time, fast (online) and reproducible analysis of immunofluorescence staining of an unlimited number of cells in tissue sections. The software, including a manual, is available for a small fee to cover the costs of printing and postage.

Intraaortic balloon counterpulsation in patients in cardiogenic shock, medically refractory left ventricular failure and/or recurrent ventricular tachycardia.

Of the 27 patients described, 23 were in cardiogenic shock, 2 had severe left ventricular failure, and 2 had medically refractory ventricular tachycardia. Utilizing intraaortic counterpulsation, adequate systemic blood pressure was initially restored in 19 patients. Nine of these were subsequently weaned from circulatory assistance, but only three were discharged from the hospital and are currently alive. The remaining 10 patients who derived initial benefit from circulatory assistance were balloon-dependent in that they could not be weaned from circulatory assistance. Eight of these patients subsequently underwent cardiac catheterization; four had inoperable disease. The remaining four patients underwent surgery for either resection of the area of infarction and/or for myocardial revascularization; only one survived to subsequently leave the hospital. Ventricular volumes were abnormal and ejection fractions were below 30 per cent in all the patients in cardiogenic shock except one who underwent cardiac catheterization and ultimately died. Ejection fractions were greater than 30 per cent in the two patients with cardiogenic shock who were weaned from balloon support and survived to leave the hospital without surgery. Both of these patients had inferior myocardial infarction. The data obtained from this experience suggest that intraaortic counterpulsation is a very useful adjunct to currently existing medical measures to treat both cardiogenic shock and medically refractory left ventricular failure but that most patients have such extensive disease that they can neither be weaned from balloon support nor undergo successful infarctectomy or myocardial revascularization.

Long-term functional results of surgery for coronary artery disease in patients with poor ventricular function.

Thirty-two patients with coronary artery disease and an ejection fraction (EF) below 0.40 had coronary bypass and/or left ventricular aneurysm (LVA) resection. Twenty-four patients had a previous infarction, 12 had congestive heart failure (CHF), and left ventricular end-diastolic pressure averaged 15 mm. Hg. Nineteen patients had three-vessel involvement and there was an average of 2.4 vessels involved per patient. Bypass was accomplished on 87 per cent of vessels; 11 patients had resection of LVA; 11 had coronary endarterectomy. There were no hospital deaths, 63 per cent of the patients were improved, and 56 per cent were able to return to work or full activity. There were five late deaths (16 per cent). There was good functional improvement in 83 per cent of the survivors, followed 1 to 4 years. We believe that patients with poor ventricular function due to severe coronary artery disease should not categorically be denied surgery, and that operation can be done with a low hospital mortality rate and good functional results.

Heparinless femoral venoarterial bypass without an oxygenator for surgery on the descending thoracic aorta.

Heparinless femoral venoarterial bypass without an oxygenator has been used for surgery in 11 patients with aortic lesions requiring cross-clamping of the descending thoracic aorta. Mixed venous blood circulates in the lower half of the body and proximal hypertension is controlled. Surgical time is not rushed, and the bleeding of heparinization is avoided. All patients are well.

Internal configuration of saphenous-coronary anastomoses as studied by the cast-injection technique.

A study of the internal configuration of saphenous vein--to--coronary artery anastomoses was undertaken to examine the effect of technical factors. One hundred fifty anastomoses were constructed in isolated swine hearts and epoxy-resin casts were made of the anastomoses by pressure-injection. The effects of interrupted sutures, continuous suture, vein tailoring, vein-to-artery size ratio, and end-to-side and side-to-side anastomoses were evaluated. We made several observations: (1) The external appearance of an anastomosis is not a reliable indicator of internal configuration. (2) Interrupted suturing consistently produces an internal configuration with minimal deformity. (3) Unless special precautions are taken with continuous suturing, severe deformities may occur. Very fine suture spacing and knotting distal corner sutures are recommended. (4) Proper vein-to-artery size ratio and "cobra-head" vein tailoring are desirable. (5) Side-to-side anastomoses are similarly significantly affected by suture techniques, vein graft size, venotomy size, and orientation. The study of the internal configuration of saphenous-coronary anastomoses is a simple and readily available method which should be useful to all coronary surgeons in assessing and perfecting their techniques.

The management of descending thoracic aortic aneurysms using heparinless femoral venoarterial bypass.

In an attempt to use the benefits of controlled circulatory bypass, while avoiding systemic heparinization and bypass circuitry placed in the operative field, we used heparinless femoral venoarterial bypass without an oxygenator for resection of aneurysms of the descending thoracic aorta. Since 1974 we have applied this technique on 29 patients with excellent results (survival 27-29, 93 percent). Using PPG tubing, mixed venous blood was drained from the right atrium by way of a long catheter inserted via the femoral vein, and returned to the femoral artery by a roller pump. Advantages include distal aortic perfusion, a safety factor in avoiding spinal cord ischemia; preload control, helpful in managing proximal aortic hypertension; avoidance of heparinization; an operative field free of bypass circuitry; and the operation can be performed in an unhurried fashion.

Myocardial protection: a comparison of cold blood and cold crystalloid cardioplegia.

Two hundred seven consecutive patients were randomized into four groups based on left ventricular end-diastolic pressure and subsequently into groups receiving crystalloid cardioplegia or blood cardioplegia. Hemodynamic data and enzymatic evidence of myocardial ischemia were examined postoperatively. We found slight but significant improvement in the blood cardioplegia group regarding left ventricular stroke work index. Similarly, the levels of creatine kinase and serum glutamic oxaloacetic transaminase were slightly but significantly better with blood cardioplegia. We believe that the technique of blood cardioplegia offers a slight but statistically significant advantage.

Omental pedicle grafting in the treatment of postcardiotomy sternotomy infection.

Postcardiotomy sternal infection occurred in 20 (2%) of 1007 patients undergoing cardiac surgery between September 1985 and December 1987, a 10-fold increase over the preceding 33 months (4 [0.24%] of 1627 patients). Cultures were sterile in 5 patients and yielded staphylococci in 12 and a variety of bowel organisms in 3. The cause for the increased occurrence of sternal wound infection is unclear after multivariate analysis, although infections have precipitously dropped subsequent to changing to cefuroxime sodium antibiotic prophylaxis. Treatment has evolved to appropriate antibiotics and early débridement of involved sternum and cartilage. Rewiring the sternum is not attempted. If gross purulence is not present, primary closure is accomplished using muscle flaps (2 patients) or omental pedicle grafts (17 patients). In the presence of gross purulence, the wound is packed open for 5 days and then closed in the above fashion. Two patients required skin grafts for primary closure. The omental pedicle flap is preferred due to simplicity and improved coverage of the sternal defect inferiorly. Nineteen patients healed primarily. A superficial wound infection was drained in 1 patient. Midline incisional hernias developed in 3 muscular patients. Omentum is now harvested through a left subcostal incision. Hospital stay was under 2 weeks in 13 patients. One death occurred due to multisystem failure prior to completion of wound closure. In our experience, early sternal débridement and omental pedicle grafting with primary closure is appropriate therapy for postcardiotomy sternotomy infections. The presence of gross purulence may require 5 days of open packing prior to omental grafting. No significant complications occurred, and mortality was low. A left subcostal incision for omental harvesting is utilized to avoid the occurrence of delayed incisional hernias.

A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery.

Following cardiac operations, 145 patients were treated with either intermittent positive-pressure breathing (IPPB), blod bottles, or an incentive spirometer in an attempt to alter the incidence of atelectasis. Pulmonary complications occurred in 30% of the patients receiving IPPB, 15% of those using an incentive spirometer, and 8% of those using blow bottles. Gastrointestinal side-effects occurred in 20% of the IPPB group and were rare in other groups. The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles. IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods.

Internal banding for palliation of truncus arteriosus in the neonate.

A method for surgically limiting pulmonary blood flow in the critically ill neonate with truncus arteriosus is described. Two recent cases utilizing this technique are presented. Comparisons are made between this and other palliative surgical procedures used in truncus arteriosus.

A technique for avoidance of hypothermia during prolonged mechanical circulatory support with centrifugal pumps.

Systemic hypothermia became a major problem in one of our patients undergoing postcardiotomy mechanical circulatory support with a centrifugal pump. We have developed a technique to prevent systemic hypothermia in this setting by applying an adapted topical cardiac cooling device to the centrifugal pump heads.

A genetic taxonomy of hyperkinesis in the dog.

Among children who have difficulty inhibiting gross motor activity and focusing on learning tasks requiring them to do this, some are helped by central nervous system stimulants such as amphetamine, while others with identical symptoms are not. Similar variations in response to pharmacological agents are seen in other syndromes, suggesting that multiple biological mechanisms are involved and that these are selectively responsive to pharmacological manipulations. Diagnosis, therefore, involves not only the identification of the condition, but knowledge of the mechanisms by means of which it can be brought about, as well as some means of identify ing these. Since such variations often have a genetic basis, their identification and characterization by genetic and pharmacogenetic approaches permit the investigator to avoid confounding biological variation with statistical error and, ultimately, to suit the treatment to the mechanism when there is no final common path permitting a single intervention specific to a given syndrome. Because such researches are difficult with human patients, we have been attempting to identify animal models with analogous symptoms to human conditions and homologous mechanisms underlying these. The present paper is one in a series describing a dog model for hyperkinesis.

Acrodermatitis and acquired zinc deficiency.

A 42-year-old woman had an acquired zinc deficiency. The patient was malnourished, secondary to chronic alcohol (ethanol) abuse and cirrhosis, with associated low serum and urinary levels of zinc. Her acrodermatitis was unresponsive to topically applied triamcinolone acetonide but cleared after oral zinc sulfate therapy.

Demodex granuloma.

A punch biopsy was done to diagnose a progressive pustular facial rash in a middle-aged woman. The biopsy specimen disclosed an intact extrafollicular Demodex folliculorum, which may be the causative organism. A review of 30 cases of granulomatous facial lesions from the Mayo Clinic indicated that this finding is uncommon.

Povidone panniculitis. Polyvinylpyrrolidone panniculitis.

Multiple subcutaneous nodules and recurrent flu-like episodes developed in a 60-year-old woman after she had received local intramuscular injections of procaine povidone for a seven-year period. A skin biopsy specimen showed distinctive gray-blue material in the histiocytes in sections stained with hematoxylin-eosin. Povidone is an inert substance that may accumulate in multiple organs, including the skin. Its presence can be verified by its affinity for special stains or by spectrophotometric analysis. In our patient, ultrastructural study showed amorphous inrahistiocytic deposits in the tissues. -revious reports have indicated that this substance may eventually accumulate in noninjected skin sites and may lead to pulmonary and arthritic symptoms in some patients, but no other patients, to our knowledge, have had complications associated with fever.

Lymphoid follicles in subcutaneous inflammatory disease.

A review of inflammatory subcutaneous disease revealed that lymphoid follicles are observed frequently in lupus panniculitis. They are found rarely in other lymphocytic inflammatory diseases involving the panniculus, such as morphea, erythema nodosum, and erythema induratum. The lymphoid follicle may be an indication of immunoreactive and connective tissue disease, and cases should be evaluated with this in mind.

Symptomatic C1-2 fusion failure due to a fracture of the lateral C-1 posterior arch in a patient with rheumatoid arthritis. Case report and review of the literature.

The authors report a case in which the lateral C-1 arch fractured in a patient with rheumatoid arthritis and an intact fusion mass; this patient had previously undergone a C1-2 Brooks-type fusion. This unique complication occurred secondary to continued resorption of the C1-2 rheumatoid pannus. Two years after occipitocervical fusion the patient has made a complete neurological recovery.

MHC-class-I expression in human breast cancer correlates with nuclear localization of the 90 kDa heat-shock-protein.

Breast cancer cells frequently exhibit a reduction in expression of major-histocompatibility-complex (MHC) class I proteins which blocks cytotoxic T-lymphocyte (CTL) mediated apoptosis. Recent studies indicate that the 90 kD heat-shock-protein (HSP90) plays a major role in the transfer of antigenic peptides to the MHC class I complex. HSP90 is a molecular chaperone which is involved in signal transduction and regulation of apoptosis. Since HSP90 is described to be elevated in breast cancer, its relationship with MHC class I expression was investigated. Using immunohistochemistry we analyzed the expression and localization of HSP90 and MHC class I in 17 human breast tumors. Positive correlation (p < 0.025) between strong nuclear staining for HSP90 and high MHC class I expression was observed. In tumors with reduced MHC class I expression, no nuclear localization of HSP90 was detectable. These findings lead to the hypothesis that tumor cells with high MHC class I expression and susceptibility to CTL action may escape apoptosis by a mechanism which involves increased nuclear HSP90.