Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.

A 7-year experience involving 12 cases of massive, unrelenting lower gastrointestinal hemorrhage is presented. In these patients, the bleeding could not be localized by multiple diagnostic modalities and was managed by blind subtotal colectomy. While the procedure was efficacious in arresting bleeding in all cases, a resultant mortality of four cases (33%) ensued. Morbidity among the survivors was significant. Only three patients (25%) survived without complications, which enabled an early discharge from the hospital. Diverticulosis was the most common cause (83%) of uncontrollable and preoperatively undiagnosed bleeding in this group of patients. These 12 cases of blind subtotal colectomy for massive lower gastrointestinal bleeding represent one of the larger series in the literature. These data are consistent with more recent reports that indicate that subtotal colectomy for lower gastrointestinal bleeding is an effective but a formidable procedure. This is contrary to the earlier published results.

Cardiovascular differentiation of happiness, sadness, anger, and fear following imagery and exercise.

This study examined cardiovascular patterns following happiness, sadness, anger, fear, relaxation, and control imagery in 32 subjects while they were seated and while they exercised. Affective imagery was an effective strategy for inducing reliable patterns of systolic and diastolic blood pressure and heart rate associated with particular emotional states. Anger, rather than fear, produced the greatest overall increases in cardiovascular measures and was distinctly opposite from relaxation. Anger differed from fear and all other conditions in terms of greater increases in diastolic pressure following imagery and greater increases in heart rate and slower recovery of systolic pressure following exercise. Sadness was unique in that systolic pressure and heart rate were virtually as high when subjects were still as when they were actually moving. Furthermore, sadness was the one emotional state that seemed to interfere with the cardiovascular adjustments normally associated with exercise. Implications of these findings for current biobehavioral models of emotion, including the role that specific emotions may play in the pathogenesis and treatment of cardiovascular disease, are considered.

Effect of metabolic state on phytohemagglutinin-P agglutination of normal human erythrocytes.

A reproducible quantitative assay for the lectin-mediated agglutination of human erythrocytes, depending on different rates of settling of agglutinated and nonagglutinated erythrocytes, was developed. This assay was used to study the aggregation of human erythrocytes by phytohemagglutinin-P. The aggregation of human erythrocytes by phytohemagglutinin-P was found to depend upon the metabolic state of the cells. Metabolically depleted erythrocytes agglutinated much less readily than did similar cells supplied with adenosine. This was not due to swelling and rigidity of the cells, since erythrocytes in hypotonic solution did not exhibit significantly altered phytohemagglutinin-P agglutination. Metabolically depleted erythrocytes, or erythrocytes from blood stored 8 weeks, lysed and resealed in the presence of ATP, were agglutinated by phytohemagglutinin-P to a much greater extent than control samples without ATP. The presence of Mg2+, either alone or with ATP, had little effect on the agglutinability of the resealed membranes. Low concentrations of Ca2+ (0.2 mM) had little effect on agglutinability, although high Ca2+ (5 mM) inhibited agglutinability of the resealed membranes somewhat. Both metabolically depleted erythrocytes and depleted erythrocytes, previously treated with adenosine, when treated with trypsin released similar amounts of sialic acid. The agglutinability of the trypsinized adenosine-supplemented cells increased more readily than did that of trypsinized metabolically depleted cells. The agglutination of erythrocytes was not affected by cytochalasin B (40 mug/ml). Vinblastine (0.2 mM) caused depleted erythrocytes to agglutinate similarly to adenosine-supplemented erythrocytes, but had no effect on the agglutination of adenosine-supplemented erythrocytes. It is concluded that ATP in the human erythrocyte probably participates in the modulation of phytohemagglutinin-P agglutinability. This is not a consequence of the more rigid membrane known to accompany ATP depletion in the erythrocyte, or of the effect of ATP levels on Ca2+ or Mg2+ content. It appears likely that ATP modulates human erythrocyte phytohemagglutinin-P agglutinability through interaction, direct or indirect, with a membrane-associated component, which might also be sensitivie to vinblastine.