Conscious-sedation analgesia during craniotomy for intractable epilepsy: a review of 354 consecutive cases.

The perioperative records of 354 consecutive patients undergoing craniotomy for surgical treatment of intractable epilepsy performed with conscious-sedation analgesia were reviewed retrospectively. There was no perioperative morbidity or mortality identified which could be attributed to the anaesthetic technique. The technique was not suitable for seven patients, in whom general anaesthesia was induced. The most frequent intraoperative problems were convulsions (16 per cent) and nausea and vomiting (eight per cent). Less frequent problems included excessive sedation (three per cent), "tight brain" (1.4 per cent) and local anaesthetic toxicity (two per cent). This study confirms that conscious-sedation analgesia provides suitable conditions for craniotomies when brain mapping is required.

Diagnostic value of carcinoembryonic antigen in exudative pleural effusions.

Elevated pleural fluid (PF) and plasma (PL) carcinoembryonic antigen (CEA) levels (ng/ml) were more frequently found with malignant than benign exudative effusions, but with a low true-positive rate for malignancy in general. Adenocarcinomatous effusions differed from other malignant and benign effusions in the frequency and degree of elevation of PF and PL CEA levels. A PF > 20 had a sensitivity of 91 percent and a specificity of 92 percent as a screening test for adenocarcinomatous effusions. A PF CEA > 55 or PL CEA > 10 were present only with malignancy and 98 percent specific for adenocarcinoma.

Assessment of cerebral damage during open-heart surgery. A new experimental model.

A new experimental technique for the assessment of cerebral cellular damage during extracorporeal circulation is described. It is based upon the direct measurement of the enzyme creatine phosphokinase (CPK) and the brain-specific isoenzyme CPK-B in cerebrospinal fluid of dogs submitted to conventional techniques of cardiopulmonary bypass (CPB). Highly significant elevations occur during a 60 min period of CPB in CSF levels of total CPK and CPK-B isoenzyme. These elevated levels persist at 24 hours postoperation, despite full clinical recovery in the dogs. In a comparative study of the effects of introducing a 40 micrometer arterial line screen filter during the period of CPB, there was a highly significant reduction in total CPK and CPK-B levels in the filtered group (p < 0.005).

Ultrastructural identification of mast cells obtained from human bronchial lumens.

We have investigated the morphology of mast cells in human bronchial lavage fluid. Under light microscopy, these cells were seen to contain discrete metachromatically positive granules that were indistinguishable from those present in mast cells and basophils from other sources. With electron microscopy, the bronchial mast cells were shown to be mononucleated and to contain granules which primarily consisted of particulate materials. Complex structures such as scrolls and crystalloids were also found in the granules. In order to delineate the relationship between bronchial mast cells and mast cells from other anatomic sites, we studied the ultrastructure of tissue mast cells from bronchial, lung parenchymal, and bone marrow biopsy specimens, and that of basophils from peripheral blood. There were similarities as well as differences in these cells from different sources--in their size, shape, lobes of nuclei, nuclear chromatin distribution, and structure of special, presumably histamine-containing, cytoplasmic granules. Based on the electron microscopic data, we believe the intralumenal cells previously described in human beings can be classified as mast cells. The presence of viable, immunoreactive mast cells in the lumen of bronchi may have a significance in relation to respiratory allergic reactions, especially the immediate-type respiratory response.

Living histamine-containing cells from the bronchial lumens of humans. Description and comparison of histamine content with cells of rhesus monkeys.

Cell populations obtained by bronchial lavage from human subjects were examined for the presence of cells related to the mast cell-basophil series. Such bronchial lumen histamine-containing cells (BLHCC) were identified. The BLHCC stained with toluidine blue may be identified by bright field or dark field microscopy. The BLHCC are alive as evidenced by ability to release histamine (H) after exposure to anti-IgE or calcium ionophore. Although H release from peripheral blood leukocytes by these two agents is potentiated by the presence of D2O, H release from BLHCC of the same subjects by anti-IgE or calcium ionophore was not potentiated by D2O. In studies comparing bronchial cell populations of humans and rhesus monkeys with peripheral blood leukocyte populations of the same subjects, the histamine content of the bronchial cell population was much higher in rhesus monkeys. IgE/Alb ratios of respiratory secretions and serum of the same human subjects were of the same order of magnitude in contrast to previous comparisons done on these fluids in rhesus monkeys.

Potential of kidney cell cultures from nonhibernating thirteen-lined ground squirrels (Citellus tridecemlineatus) for virus propagation.

Kidney cells were cultured in vitro from nonhibernating thirteen-lined ground squirrels (Citellus tridecemlineatus). These primary ground squirrel kidney cultures were tested for the ability to support the replication of 13 viruses representing nine virus groups. The cultures were shown to be susceptible to every virus tested, either by an increase in infectious virus or by the cytopathic effect produced.