Motor neuron disease (ALS): evaluation of detection thresholds of cutaneous sensation.

Cutaneous touch-pressure, vibration, and thermal cooling detection thresholds were estimated on the skin of one foot for 80 patients with motor neuron disease (MND) and compared with that of more than 300 site, age, and sex-matched healthy controls. Fourteen of the patients had elevated thresholds (greater than or equal to 95th percentile): 7 showed elevated thresholds of sensitive points, 5 an increased number of insensitive grid points, and 2 a combination of these criteria. Therefore, raised vibration thresholds occur more frequently in MND patients than in controls (p less than 0.

A comparison of the protective effects of N-acetyl-cysteine and S-carboxymethylcysteine against paracetamol-induced hepatotoxicity.

The protective effect of the sulphur-containing amino acids N-acetyl-cysteine and S-carboxymethylcysteine against paracetamol-induced hepatotoxicity was evaluated in the hamster by biochemical and histological methods. Of the animals receiving paracetamol alone 25% died within 24 h following administration. All surviving animals showed acute hepatocellular injury and marked loss of cytochrome P-450 and hepatic mixed-function oxidase activities.

Mediastinal parathyroid adenomas. A cause of persistent hyperparathyroidism.

Unrecognized mediastinal parathyroid adenomas that are inaccessible via a standard cervical exploration are an important cause of persistent primary hyperparathyroidism. Of 26 patients evaluated at UCLA Medical Center for persistent primary hyperparathyroidism, six required sternotomy (5) or thoracotomy (1) for cure of their disease. Analysis of these six patients suggests that aberrant embryologic development is the most logical explanation for the ectopic location of these mediastinal adenomas.

Warm induction of cardioplegia with glutamate-enriched blood in coronary patients with cardiogenic shock who are dependent on inotropic drugs and intra-aortic balloon support.

This report reviews the initial clinical application of our experimental studies inducing cardioplegia with a warm (37 degrees C) glutamate-enriched blood solution in ischemically damaged hearts. Over 15 months, 23 consecutive coronary patients requiring preoperative intra-aortic balloon and inotropic drug support for cardiogenic shock underwent operation for left ventricular power failure. Twelve patients were given a warm glutamate-enriched blood cardioplegic solution during the first 5 minutes of aortic clamping before multidose cold (4 degrees C) glutamate blood cardioplegia was begun; 11 patients received standard multidose cold blood cardioplegia without glutamate.

Thymectomy for myasthenia gravis.

Thymectomy was performed on 249 patients with myasthenia gravis between 1957 and 1981. During a follow-up period that ranged from 2 months to 24 years (mean 7.5 years), the remission rate for the entire group was 51 percent, and an additional 36 percent had improvement (87 percent benefited).

Familial spastic paraplegia with Kallmann's syndrome.

A sibship is reported in which two males have spastic paraparesis and Kallmann's syndrome (hypogonadotrophic hypogonadism and anosmia). One of the brothers also is color blind. The association of familial spastic paraplegia and Kallmann's syndrome has not been described previously.

Surgical management of subaortic stenosis.

The two most common causes for left ventricular outflow tract obstruction are discrete fibromuscular membrane (DMS) and idiopathic hypertrophic subaortic stenosis (IHSS). From 1955 to 1980, 195 patients were seen with subaortic obstruction, 50 of whom required operation. Thirty patients had excision of a subaortic membrane; 20 had resection of the hypertrophic muscular obstruction.

The effects of splenectomy and splenic implantation on alveolar macrophage function.

The effect of splenectomy on the ability of alveolar macrophages of young and adult rats to phagocytize Pneumococci, Types 3 and 14, and Pseudomonas aeruginosa was studied. Young animals showed a significant (15%) decrease in the phagocytosis of pneumococci type 14, 4 weeks after splenectomy. This depression increased to 30% in 6 weeks' time.

Bioactive antibiotic levels in the human aorta.

A new bioassay was used to determine the level of active antibiotic within the aortic wall in 24 patients undergoing elective aortic surgery involving prosthetic grafts. The patients were divided into three groups and received either cefazolin, clindamycin, or cefoxitin intravenously at the induction of general anesthesia. Cefazolin and cefoxitin attained satisfactory tissue levels.

The value of open lung biopsy in the immunosuppressed patient.

To evaluate the impact of the open lung biopsy on diagnosis and therapy in the immunosuppressed patient, 68 such patients managed at UCLA from 1975 to 1980 were reviewed. Most had hematologic malignancies, and all were severely immunosuppressed. The rates of surgical mortality (1 operative death) and morbidity were minimal.

A newly recognized congenital myasthenic syndrome attributed to a prolonged open time of the acetylcholine-induced ion channel.

Five familial cases (in two families) and one sporadic case of a new congenital myasthenic syndrome were investigated. Symptoms arise in infancy or later life. Typically, one finds selective involvement of cervical, scapular, and finger extensor muscles, ophthalmoparesis, and variable involvement of other muscles.

Mechanical and cellular bacterial clearance in lung atelectasis.

A pig model with aerosolized pneumococcal bacteria was used to establish that bacterial clearance in a collapsed lung in the perioperative period was decreased compared with the opposite, aerated lung. Cannulation of the right lymphatic duct revealed a significant increase in both lymph flow and ratio of lymph to plasma protein, indicating the development of a high-permeability edema in the collapsed, infected lung. Only 22% of the efferent lymph and blood was positive for the infecting organism.

Persistent and recurrent hyperparathyroidism.

Twenty-six patients with persistent or recurrent primary hyperparathyroidism after an initial cervical exploration are presented. Failure of the first operation was related in part to an ectopic location of the abnormal parathyroid tissue (in 58 percent), and to a discrepancy in the histologic diagnosis between the frozen-section analysis at the time of operation and the final pathologic interpretation (in 55 percent). Before secondary operation, selective venous sampling for parathormone levels and arteriography were accurate in localizing the lesion in 88 and 71 percent of cases, respectively.

Thoracopulmonary hypogenesis with systemic artery-pulmonary vessel fistulae: report of a case.

A patient seen with recurrent hemoptysis was found to have large systemic artery-pulmonary vessel fistulae. Associated anomalies were unique, and included hypogenetic left thorax, hypoplastic unilobar left lung, and dextrocardia. Left pneumonectomy was curative.

A coded study of antitumor immunity to human lung cancer assayed by tube leukocyte adherence inhibition.

The present study was undertaken to evaluate the specificity of antitumor immunity to human lung cancer, measured by an in vitro assay--tube leukocyte adherence inhibition (LAI). We standardized and monitored the putative tumor antigen activity of the extracts by testing leukocytes from controls and patients with lung cancer in the Montreal General Hospital. A specific antitumor response to a lung cancer antigen was detected with coded leukocytes from 56% (20 out of 36) of patients with epidermoid lung cancer.

Iatrogenic false aneurysms.

Of 270 patients operated upon for aneurysm, 25 patients underwent repair for 28 iatrogenic false aneurysms. Of these, 67.9% were complications of vascular reconstructive surgery and 64.

Mediastinal teratoma causing life-threatening hemoptysis. Its occurrence in an infant.

An 8-month-old infant girl with an anterior mediastinal teratoma experienced the unusual symptom of life-threatening hemoptysis secondary to ulceration of the tumor's gastric mucosa into the lung parenchyma.

Tongue force in normals and in dysarthric patients with amyotrophic lateral sclerosis.

Tongue force, rate of syllable repetition, and judgments of articulatory defectiveness were measures obtained on 19 dysarthric adults with amyotrophic lateral sclerosis and on 125 normal adults. Anterior and lateral tongue forces were measured by means of a pressure transducer clasped between the teeth; the tongue forces were recorded on a pen-writing ECG apparatus. Audio-recorded syllable repetitions of /p lambda/, /t lambda/, and /k lambda/ also were transcribed on ECG paper and counted.

Symposium on trauma. 2. Chest trauma: current concepts.

Blunt chest trauma continues to be an important cause of death following motor vehicle accidents in Canada. Current methods of diagnosis are presented emphasizing a physiologic approach. The most important physiologic consequence of trauma associated with chest wall instability or ruptured diaphragm is pulmonary contusion.