Effect of nebulized albuterol on circulating leukocyte counts in normal subjects.

Nebulized beta 2-receptor agonists may cause neutrophil demargination and result in misleading total circulating leukocyte counts (WBCs) in patients with acute bronchospasm. Varying underlying adrenergic stimulation in these patients also makes interpretation of these data difficult. This study examined the direct effect of these agents on the measured WBCs of healthy adults without evidence of bronchospasm or illness. A prospective, blinded, randomized study of 30 healthy volunteers (aged 18-50 years) was performed in a controlled environment. Subjects were excluded if they were pregnant, had a known underlying medical disorder or have had a prior reaction to albuterol or similar medications. Participants in the study were given either a nebulized albuterol treatment or nebulized normal saline (control group). Leukocyte counts were then obtained before and after treatments. Paired data were analysed using a one-tailed t-test while considering an increase of 40% in WBCs to be significant, P = 0.05, and beta = 0.10. Mean leukocyte counts were 5.9 (+/- 1.2) before treatment as compared to 6.0 (+/- 1.3) after albuterol nebulization. Using the coefficient of variance of WBCs in normal humans as c. 50% (6000 +/- 3000 cells mm-1) we were unable to demonstrate a significant difference in variation in post-nebulized leukocyte counts between the control group and the nebulized albuterol group. While there is concern that the treatment of patients experiencing acute bronchospasm with beta 2 agonists may result in factitious elevations in peripheral leukocyte counts, were found no direct effect of these agents on measured counts in normal subjects.

Distribution of polychlorinated biphenyls in marine species from French Frigate Shoals, North Pacific Ocean.

Polychlorinated biphenyls (PCBs) were analyzed in: sediment; coral (Porites evermanni); fish (Stegastes fasciolatus, Neoniphon sammara, Acanthurus triostegus and Mulloidichthys vanicolensis); crab (Grapsus tenuicrustatus); lobster (Panulirus marginatus); and eel (Conger cinereus, Gymnothoraxflavimarginatus, G. undulatus and G. meleagris) samples collected from Tern Island and the corresponding reference samples from Disappearing Island. The two islands are part of French Frigate Shoals, a national wildlife refuge in the North Pacific Ocean. The dominant congeners 118, 138 and 153 represent 22-25, 32-34, 12-39, 37-46 and 30-55% of the sum of PCBs in the coral, sediment, fish, crab and eel, respectively. In general, high trophic species such as eels were found to highly bioaccumulate PCBs. The total average PCB concentrations were as high as 96 and 29 microg/g dry wt. in eels and damselfish, respectively, from Tern Island. The localized behavior and high bioaccumulation potential for PCBs suggest that damselfish are an excellent species for monitoring PCBs in small areas in the ocean. The high average concentrations of the sum of PCBs in different food chain levels suggest that pollution source(s) are around Tern Island and possibly around Disappearing Island. Aroclor 1254 and its analogs are suspected sources responsible for PCBs in the samples.

Comparative concentrations of metals in marine species from French Frigate Shoals, North Pacific Ocean.

Concentrations of arsenic, cadmium, chromium, copper, lead, mercury, selenium, and zinc were measured in coral, crab, eel, fish, lobster, and sediment samples collected from French Frigate Shoals, North Pacific Ocean. The sediments contained relatively high concentrations of selenium; moderate concentrations of arsenic, cadmium, copper and lead; and low concentrations of chromium and zinc. Metal concentrations were also determined in coral and crabs collected from the island of Oahu. Notably, a crab (Grapsus tenuicrustatus) and the undulated moray eel (Gymnothorax undulatus) exhibited high levels of copper and arsenic, respectively, relative to the other species studied. The concentrations of arsenic in the eel averaged 225 microg g(-1) dry wt, which was 3-12 times higher than that in all of the other species tested. The average concentration of copper in the crab was 343 microg g(-1) dry wt, 3-86 times greater than that in the other species studied. These data indicate background and comparative levels of the metals among the studied species. Lead levels in the coral (9-10 microg g(-1) dry wt) and crab (42-57 microg g(-1) dry wt) from Tern and Disappearing Islands were 23-283-fold greater than those from Oahu (0.4 and 0.2 microg g(-1) dry wt, respectively).

Role of technetium-99m sestamibi myocardial imaging in the emergency department evaluation of chest pain.

The use of technetium-99m sestamibi myocardial imaging is rapidly becoming a state of the art methodology for the emergency department evaluation of patients with chest pain. The following case report represents the first emergency department sestamibi scan ordered at the University of Mississippi Medical Center and is used to discuss the logistics and indications for such tests. A general guideline for ordering sestamibi scans has been developed for use in the emergency department.

Laparoscopic laser cholecystectomy. Results of 100 successful operations.

It would seem that laparoscopic laser cholecystectomy is a safe and reasonable procedure. We feel that it will be indicated for most patients with symptomatic gallbladder disease. The only distinct contraindications which we have noted are multiple prior upper abdominal procedures, common bile duct obstruction, or intense acute inflammation. However, as experience has widened, even some of the above problems may be manageable with laparoscopic technique. We would expect that the technique can be attempted on at least 90% of patients with proven gallbladder disease and that this percentage may increase with further experience. Our experience suggests that there is probably no increased operative risk with this operation. Any potential risks associated with pneumoperitoneum and introduction of laparoscopic instruments is more than offset by higher morbidity associated with open techniques. Besides the obvious economic benefits of shorter hospital stay and recovery time and rapid return to self-care and employment, this operation is quite rewarding for both surgeon and patient due to the decrease in post-operative pain and discomfort and a striking decrease in pulmonary problems, phlebitis and other complications of more invasive procedures. We expect this to become the standard procedure for gallbladder disease as experienced is widened.

Gastric syphilis.

A sexually transmitted disease is seldom considered in the differential diagnosis of patients with clinical gastritis. A patient with gastric syphilis is reported to alert emergency department physicians to this entity. History and physical findings of syphilis should be sought and rapid plasma reagin tests should be obtained in the patient with severe or refractory gastritis.

Expression of HC subunits from Clostridium botulinum types C and D and their evaluation as candidate vaccine antigens in mice.

Two proteins representing the heavy-chain subunits of botulinum neurotoxin types C and D were expressed in Escherichia coli, and their vaccine potential was evaluated. Mice were vaccinated with doses ranging from 0.5 to 10 microg and were challenged with 10 to 10(5) 50% lethal doses of toxin. For the type C subunit protein, C50, two doses of 2 microg were required for full protection, while, for type D subunit protein, D50, two 1- microg doses were required. A bivalent vaccine consisting of a mixture of these two proteins also provided protection against both botulinum neurotoxin type C and type D challenge. Antibody levels in serum were determined by both enzyme-linked immunosorbent assays and serum neutralization assays