Infective endocarditis and mitral prolapse: a comparison with other types of endocarditis.

We compared clinical features, response to therapy, and outcome of infective endocarditis in ten patients with mitral valve prolapse and 23 patients with endocarditis involving other types of left-sided valvular lesions. Signs of endocarditis were more subtle in patients with mitral valve prolapse, and antimicrobial therapy was instituted later in those patients. Nevertheless, nine of ten patients with mitral valve prolapse and endocarditis responded optimally to antimicrobials; only five of 23 patients with other types of endocarditis responded similarly. Four patients with mitral valve prolapse experienced increasing valvular dysfunction during the year after treatment of endocarditis; one died. We conclude that endocarditis in patients with mitral valve prolapse is more responsive to antimicrobial therapy even though recognition of the infection often is delayed. However, mitral valve prolapse endocarditis is not a benign infection, because progressive valvular dysfunction is a frequent sequel.

Reliability of Gleason grading system in comparing prostate biopsies with total prostatectomy specimens.

Prostate biopsy and total prostatectomy specimens from 31 patients with adenocarcinoma of the prostate were compared using the Gleason histopathologic grading system. The overall accuracy when grouping the scores into three categories (2-4, 5-7, and 8-10) was 81 per cent. The incidence of critical undergrading was 6 per cent while the incidence of critical overgrading was 13 per cent. Eighty-seven per cent of the biopsy scores were plus or minus 1 Gleason unit of the prostatectomy scores. Intraobserver variation was less than 1 Gleason unit. The mean absolute difference between the biopsy and the total prostatectomy specimen was 0.77 Gleason units. The Gleason category score of the total prostate specimen can be predicted from the biopsy tissue with reasonably good accuracy. The limitation of this grading system in predicting the presence or absence of pelvic node involvement is discussed.

Distribution and excretion of orally administered oleic acid anilide in the rat.

Oleic acid anilide [aniline-14C(U)] was administered by gastric tube to male rats in a single dose (10 mg/kg body weight). After intervals of 3, 6, 24 or 120 h the excretion of radioactivity and the distribution in different organs were studied. The radioactivity was eliminated rapidly through the urine and faeces containing 62% and 38%, respectively, after 24 h. At this time the excretion was almost complete. No radioactivity could be found in the expired air. The absorbed oleic anilide was easily deacylated as evidenced by the excretion of N-acetyl-p-aminophenol conjugate as the main urinary metabolite representing 60-70% of the urinary radioactivity. The radioactivity in faeces was due to the unchanged substance. Twenty-four hours after administration only 0.7% of the dose remained in the total organism with the highest concentrations in the red blood cells, spleen and forestomach. Even after 5 daily doses, an accumulation of radioactivity could not be found.

Effect of ethanol on the induction of lung tumours by ethyl carbamate in mice.

Groups of 25 female NMRI-mice received daily doses of 0, 18, 36, 90, or 180 mg ethyl carbamate/kg body wt either in water or in 20% ethanol by gavage for 8 weeks. Another 8 weeks later, the animals were sacrificed and lung adenomas were counted. Ethyl carbamate was found to increase the number of lung adenomas per mouse dose-dependently in all dose groups. No significant differences, however, were observed between groups receiving ethyl carbamate in water or in 20% ethanol. Thus, ethanol had no effect on ethyl carbamate induced tumourigenesis.

Induction of early lesions in the forestomach of rats by 3-tert-butyl-4-hydroxyanisole (BHA).

BHA was administered to Wistar rats at a dose level of 2% in a powdered diet for periods of 1, 2 and 4 wk. After 1 wk epithelial damage, mild hyperplasia and hyperkeratosis of the forestomach mucosa was observed. The hyperplasia and hyperkeratosis showed progression at wk 2 and 4 whereas other epithelial defects regressed. The lesions were most pronounced in the vicinity of the limiting ridge. A further 4 wk of feeding without BHA resulted in a complete regression of epithelial defects, although the hyperplastic changes were still apparent. Other rats were given 1 g BHA/kg body weight/day by gastric intubation in arachis oil for 1, 2, 4, 8, 16 or 32 days. Increased mitotic activity was observed after 1 day and mild hyperplasia after the second intubation, but inflammatory response and superficial defects were not prominent and the hyperplasia of the squamous epithelium did not appear to result from initial damage and subsequent hyper-regenerative activity. A gradual regression of the hyperplastic changes occurred after eight daily intubations. The lesions were found in the apex of the forestomach remote from the limiting ridge. It is concluded that BHA incorporated in powdered diet or given in arachis oil by oral intubation causes lesions in the rat forestomach similar to that reported for BHA given in a pelleted diet (Ito et al. J. natn. Cancer Inst. 1983, 70, 343; idem, Gann 1983, 74, 459). The hyperplastic changes in the mucosa occur rapidly and their localization is dependent on the mode of application. Following withdrawal of the BHA there was almost complete regression of the lesion, only a residual mild hyperplasia remaining after 4 wk.

Effects of BHA and related phenols on the forestomach of rats.

To determine the pathogenesis of BHA-induced forestomach lesions, the nature and time course of the early lesions in the forestomach of Wistar rats were studied. The rats were given BHA at a dose level of 2% in a powdered diet or by oral intubation of 1 g BHA/kg body weight/day in arachis oil. The hyperplastic changes in the mucosa were visible 1 day after the second application. The localization was dependent on the mode of application. Dietary exposure yielded changes in the area of the limiting ridge; oral intubation of BHA produced lesions in the apex of the forestomach. In a subchronic 90-day feeding study in rats, no recognizable effect was observed when 0.125% BHA was incorporated into the diet as a solution in arachis oil. In reversibility studies, severe forestomach lesions observed after feeding 2% BHA for 6, 12 or 15 months regressed almost completely following withdrawal of the BHA for a period of 7 months. BHA induced similar forestomach damage in NMRI mice and Syrian golden hamsters, whereas guinea-pigs, a species having no forestomach, did not show comparable lesions. Substances with similar chemical structure were tested in short-term feeding studies (tert-butylhydroquinone, 4-methoxyphenol, 1,4-dimethoxybenzene, hydroquinone, 3-methoxyphenol, 2-methoxyphenol, anisole, p-cresol, phenol and BHT). Only 4-methoxyphenol strongly affected the forestomach mucosa in a manner similar to that associated with BHA. The methoxy group in the para position seems to be important for the hyperplasiogenic activity.

Perinatal nonimmune hydrops: diagnostic ultrasonography and related aspects of management.

Nonimmune hydrops fetalis may become the commonest form of hydrops seen in Western countries during the perinatal period, and it has at least a 50% mortality. This report describes five infants with nonimmune hydrops associated with maternal hydramnios and with congenital fetal lesions or disorders, ie, mediastinal teratoma, pulmonary leiomyosarcoma, Beckwith-Weidemann syndrome with omphalocele, fetal tachycardia, and Down's syndrome. Three of the infants survived the neonatal period and two of these underwent surgery for resection of their tumors early in the neonatal period. The third had an omphalocele repaired at 6 hours of age. The literature is reviewed with respect to the pathophysiology of nonimmune hydrops. Its diagnosis and treatment are discussed, with special emphasis on the role of ultrasound in its early diagnosis and optimal prenatal and postnatal management, and on the morbidity seen in survivors.

Serum chemistry of the diamond-backed water snake (Nerodia rhombifera rhombifera) in Arkansas.

Seventeen serum chemistry analyses were performed on blood collected from captive diamond-backed water snakes. Means, standard deviations, and ranges were calculated for each assay. There was no correlation between the chemistry values and sex or size. The reported values for sodium, potassium, glucose, and total protein fell within the ranges found in the present study, but the values for chloride and blood urea nitrogen were higher, and calcium, bicarbonate, and osmolality were lower. Some snakes had unexpectedly very low serum glucose values which could not be explained by technique or methodology. There was a wide range in enzyme measurements which could be partly due to handling prior to death.

Toxicokinetics of chloroethanol in the rat after single oral administration.

The excretion and tissue distribution of 14C-labelled chloroethanol were studied in rats following single oral administration of 5 and 50 mg/kg body weight. At both dose levels, the radioactivity was rapidly eliminated, mainly in the urine. On the first day after application of 5 mg/kg body weight, 77.2% of the dose were found in the urine, 1.7% in the faeces, and 1.0% as carbon dioxide in the expired air. Only 2.8% were excreted by these routes during the following 3 days. The residual radioactivity remaining in the tissues after 4 days was almost equally distributed and amounted to about 0.4% of the dose in the liver and 3% in the whole organism. At the higher dose level, excretion rates and tissue concentrations were similar. Examination of the urine by anion exchange chromatography on DEAE-Sephadex revealed two metabolites which were identified by GC/MS analysis as thiodiacetic acid and thionyldiacetic acid. These metabolites represented almost the whole urinary radioactivity. They were excreted in approximately equal amounts at the low dose whereas the thiodiacetic acid predominated with about 70% of the urinary radioactivity at the high dose. Unchanged chloroethanol, chloroacetic acid, S-carboxymethylcysteine and sulphonyldiacetic acid were not found in the urine.

[Metabolism of 3-amino-1,2,4-triazole in rats]. / Uber den Stoffwechsel von 3-Amino-1,2,4-triazol in Ratten

3-Amino-1,2,4-triazole[5-(14)C] was administered orally to rats as a single dose of 50 mg/kg body weight. Excretion in urine and feces was followed during a period of 3 days. Within the first 24 hrs the main part of the radioactivity was found in the urine as unchanged amitrole. 3-Amino-5-mercapto-1,2,4-triazole and 3-amino-1,2,4-triazolyl-(5)-mercapturic acid were isolated from urine and identified by comparison with synthetic compounds. The total amount of these metabolites in the urine was about 6% of the dose. The metabolic pathways of amitrole and the possible relations between biotransformation and toxicity are discussed.

Coumarin mercapturic acid isolated from rat urine indicates metabolic formation of coumarin 3,4-epoxide.

A coumarin mercapturic acid, N-acetyl-S-(3-coumarinyl)cysteine, has been identified in the urine of coumarin-treated rats. [14C]Coumarin was applied by gavage as a single dose to male Wistar rats (10-150 mg/kg body weight). Twenty-four-hour urine was collected, and the deproteinized concentrate was analyzed for radiolabeled metabolites by HPLC. The new mercapturic acid metabolite is supposed to result from oxidative biotransformation of coumarin to its 3,4-epoxide and subsequent coupling with glutathione.

Primary intracranial immunoblastic lymphoma in infancy.

Primary intracranial lymphoma is uncommon in any age group, but it is especially rare in childhood. This report describes a previously healthy, 14-month-old female infant who developed a primary intracranial immunoblastic (probable B-cell) lymphoma which remained confined to the central nervous system until the time of death, 23 months after diagnosis. She appears to be the youngest patient with documentation of such a diagnosis by light and electron microscopy and by histochemical and immunoperoxidase studies. An immunological investigation was negative. Significant maternal and paternal family histories of malignancy suggest that a genetic predisposition, combined with postzygotic events such as viral infection, may be responsible for this familial cluster of tumors, and for this patient's unusual presentation.

Induction of forestomach lesions by butylhydroxyanisole and structurally related substances.

Butylated hydroxyanisole (BHA) is widely used as an antioxidant in foodstuffs, in materials which come into contact with food and also in cosmetic products. The safety of BHA was questioned, however, when it was reported that in a recent Japanese carcinogenicity study 2% BHA in a pelleted diet caused hyperplasia, papillomas and squamous cell carcinomas in the forestomach of rats. In order to clarify whether substances with a similar chemical structure would also induce forestomach lesions, BHA was compared with some related chemicals in 28 day feeding studies. For this purpose groups of 5 to 10 Wistar rats were fed diets containing 2% BHA, 2% tert.-butylhydroquinone (TBHQ), 2% 4-methoxyphenol, 2% 1,4-dimethoxybenzene, 2% hydroquinone or 1% butylated hydroxytoluene (BHT), respectively, for periods of 4 weeks. BHA treatment caused severe diffuse hyperplasia, acanthosis and hyperkeratosis in the forestomach mucosa which was most pronounced in the vicinity of the limiting ridge. In TBHQ treated animals brownish discolorations of the mucosa and mild hyperplasia with focally increased hyperplasia of basal cells were observed. In the case of p-hydroxyanisole a circular deep ulceration parallel to the limiting ridge occurred with hyperplasia and mild hyperkeratosis in the adjoining mucosa. Hydroquinone caused only mild hyperplastic and hyperkeratotic areas near the oesophageal entry in a few cases. The feeding of BHT induced no visible forestomach lesions. The strong effects of BHA and 4-methoxyphenol and the more or less inactivity of BHT and hydroquinone indicate that the methoxy group of the tested anisoles might be involved in their hyperplasiogenic activity.

Granular cell myoblastoma of the esophagus. Report of two cases.

Granular cell myoblastoma (GCM) of the esophagus is a rare, usually benign tumor, most often discovered incidentally during upper endoscopy, surgery, or autopsy. Although some reports have questioned the safety of endoscopic biopsy of granular cell tumors of the esophagus, we feel that the procedure can be performed safely and accurately. For the unwary, histological examination may lead to a misdiagnosis of squamous cell carcinoma. Although some reports of malignant esophageal tumors can be found, in general, if the histologic appearance of the tumor is benign, malignant transformation or metastasis is unusual. Surgical resection for malignant and for large symptomatic benign tumors is the treatment of choice. In, however, individuals with histologically benign tumors. who are asymptomatic or who are not considered good surgical candidates, careful observation with endoscopic follow-up can be safely done.