Thrombolysis and postinfarction ventricular septal rupture.

We studied all patients with postinfarction ventricular septal rupture referred to the Oxford Heart Centre for operation over a 4 1/2-year period. Twenty one women and 8 men were admitted to the Centre, 13 of whom had received streptokinase and 16 of whom had not. The median interval between symptomatic onset of myocardial infarction and the development of septal rupture was 24 hours for those treated by early thrombolysis (all streptokinase) and six days for those who were not.

Biological monitoring of cancer chemoprevention.

A major limiting factor in the successful implementation of cancer chemoprevention trials has been the determination of endpoints to measure efficacy and success. The use of the ultimate goal of such trials, namely, cancer incidence, as an endpoint has serious feasibility problems, including the need for large numbers of participants, long follow-up periods, and high costs. The application of biological markers as intermediate endpoints to reveal responses to chemopreventive agents within a short time and to act as surrogates for cancer is an attractive concept worthy of intense investigation.

Cardiac surgery: moving away from intensive care.

Objective: To evaluate outcome in patients managed outside an intensive care unit after open heart surgery.

Background: The high cost of cardiac surgery is mainly due to the needs of traditional postoperative care. The requirements for intensive care and treatment has decreased with improvements in techniques of cardiac surgery and anaesthesia.

Oncogenes and oncoproteins as tumor markers.

A major problem in the management of patients with cancer is the lack of specific tumor markers for the early detection, the accurate prediction of biological behavior and for accurate assessment of prognosis. A new and exciting answer to this problem may now become available following the discovery of specific genes associated with malignancy. The role of such genes and their products are now being identified and their role in cancer is under intense investigation.

Combined cardiac and abdominal aortic aneurysm operations. The dual operation on cardiopulmonary bypass.

Eight patients underwent both cardiac operation and repair of abdominal aortic aneurysm. All had respiratory impairment and significant impairment of left ventricular function, whereas six patients had severe diffuse distal coronary disease. In all patients the cardiac procedure was performed first, and the patients continued to receive cardiopulmonary bypass.

Early extubation after coronary artery bypass surgery: effects on oxygen flux and haemodynamic variables.

The effect of extubation within the first postoperative hour was evaluated in 13 patients (mean +/- SD age 59 +/- 6 years) undergoing elective coronary artery bypass surgery without active systemic hypothermia. The mean cardiopulmonary bypass time was 50 +/- 14 minutes. Postoperative improvements in cardiac index and oxygen uptake (from 2.

Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation.

The systemic inflammatory response to cardiopulmonary bypass was assessed in 20 patients who underwent elective coronary artery bypass grafting with flat-sheet membrane oxygenation (group I; n = 10; age, 59 +/- 5 years) or bubble oxygenation (group II; n = 10; age, 62 +/- 8 years). The duration of cardiopulmonary bypass was 46 +/- 12 minutes in group I and 47 +/- 15 minutes in group II. Plasma interleukin-6, plasma interleukin-1 beta, transpulmonary leukocyte counts, pulmonary hemodynamic variables, and respiratory index were determined in all patients perioperatively.

Role of immune response in the prognosis of carcinoma of the uterine cervix: can in vitro analysis provide a better framework for more effective management?

Cancer of the uterine cervix is the single largest female malignancy in India and also remains a major problem facing oncologists in other parts of the world. While advances in radiation therapy and surgical techniques have made the treatment of cervical carcinoma impressive, limitations to successful management still remain. In fact, the 5-year survival rate, stage for stage, has not improved in the United States or world wide in the past 40 years.

Pathogenesis of oral submucous fibrosis. Relationship to risk factors associated with oral cancer.

Oral submucous fibrosis (OSF) is a chronic disease of the oral mucosa characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. It is a condition predominantly seen among people of Indian origin, and an epidemiologic survey done a decade ago showed no less than 250,000 cases in India, a figure that must have increased sharply. OSF is a condition with a high risk of malignant transformation; to date, no conclusive etiologic agent has been identified, although plenty of data have been generated on various aspects of the disease.

Work of adhesion of respiratory tract mucus.

A method was devised to measure the work of adhesion (WA) to a substrate of mucus, a viscoelastic gel, from the measured contact angle of glycerol on a mucus substrate and the known physical properties of a Teflon surface. Fifteen sputum samples from cystic fibrosis (CF) patients were compared with 25 mucus samples from canine tracheal pouches (CP), studied in the hydrated and partially dehydrated states. Apparent viscosity (eta A) and recoverable shear strain (SR) were measured by fluxgate magnetometry, and water content was inferred from vapor pressure osmometry.

Platelet responses to cardiopulmonary bypass. Assessment by a shear stress activation technique.

Platelet responses before and during cardiopulmonary bypass were studied using a shear stress activation technique. Whole blood was passed through a 10 microns micro-porous filter and the percentage of platelets retained was determined. Retention in control subjects (n = 20, age 62 +/- 11 years) was 65.

Aortic root replacement: modifications of technique with improvements in technology.

Potential morbidity remains substantial in aortic root replacement. The tissues are often fragile, contributing to the risk of haemorrhage and postoperative complications. In the past surgery has been directed towards minimising haemorrhage by wraparound techniques and the right atrial fistula method of Cabrol.

Oncogenesis of squamous carcinoma of the uterine cervix.

Carcinoma of the uterine cervix is the most frequent neoplasm among women in India, accounting for up to 85% of all female gynecological malignancies. In the United States, it accounts for about 48% of all female tumors and 4% of all cancer deaths of females. Epidemiological evidence suggests involvement of numerous risk factors in the etiology of cervical cancer, including sexual behavior, number of pregnancies, cigarette smoking, and venereal disease.

Stimulation of natural killer cell activity by murine retroviral infection and cocaine.

The effects of cocaine and murine AIDS on natural killer (NK) cell activity in C57BL/6 mice was studied. Cocaine may play a major role in the development and progression to AIDS in the human population. Chronic intraperitoneal injection of cocaine was shown to cause an increase in NK cell activity over those of saline-treated animals.

Cocaine immunotoxicity: abnormal cytokine production in Hispanic drug users.

Peripheral blood lymphocytes from 47 Hispanic poly-drug users with a history of cocaine abuse were analyzed for in vitro production of interleukin-1 (IL-1), interleukin-2 (IL-2), gamma-interferon (IFN) and plasma levels of soluble IL-2 receptor (SIL-2R). Cocaine use was confirmed and quantified by analysis of hair and urine samples, and subjects were grouped into 3 based on the extent of cocaine metabolites detected. No significant differences in IL-1 and IFN production were seen between the 3 groups.

Oncogene expression and prognosis in cervical cancer.

Cancer of the uterine cervix accounts for 80-85% of all female genital tract malignancies in India and also remains a major problem for oncologists in other parts of the world. A major concern regarding the disease is the lack of specific tumor markers for early detection, for accurate prediction of biological behaviour and for accurate assessment of prognosis. A new and exciting answer to this issue may now be available with the description of specific oncogenes and oncoproteins associated with this malignancy.

Immunotoxicity of poly-drug use: abnormalities in the active and high-affinity CD2 antigen (E-rosette receptor) bearing T-lymphocytes.

The E-rosetting profiles of T-cells were studied in 47 subjects with a history of poly-drug and alcohol abuse, and compared with 15 normal controls. No change was evident in numbers of total rosette-forming cells (TRFC). However, there was reduction in active and high-affinity rosette-forming cells (ARFC and HARFC).

Oncogene expression and oral cancer.

Cancer of the oral cavity remains a major problem in the United States as well as in many other countries, some of which record as much as 30% of all their cancers to be in the oral region. Despite numerous advances in the fields of epidemiology and etiology, little is known of the molecular basis of oral cancer. Advances in the field of oncogenes have produced a tool to study the different stages of carcinogenesis, including transition from premalignant to malignant stages.

Diagnostic delay and outcome in surgery for type A aortic dissection.

Twenty-two patients with acute type A aortic dissection presented to this hospital over a three-year period. The initial diagnosis was incorrect in 12 (54.5 per cent) and in 11 of these the error occurred in peripheral hospitals before referral.

Lymphocyte subset distribution after radiation therapy for cancer of the uterine cervix. Possible prognostic implications and correlation with disease course.

An analysis of lymphocyte subpopulations was done in patients with cancer of the uterine cervix before and at different intervals after the commencement of radiation therapy. A common feature was a duration of T-cell and B-cell lymphopenia after therapy. The findings relating to the T-cell subsets were interesting.

Energy state and vasomotor tone in hypoxic pig lungs.

To evaluate the role of energy state in pulmonary vascular responses to hypoxia, we exposed isolated pig lungs to decreases in inspired PO2 or increases in perfusate NaCN concentration. Lung energy state was assessed by 31P nuclear magnetic resonance spectroscopy or measurement of adenine nucleotides by high-pressure liquid chromatography in freeze-clamped biopsies. In ventilated lungs, inspired PO2 of 200 (normoxia), 50 (hypoxia), and 0 Torr (anoxia) did not change adenine nucleotides but resulted in steady-state pulmonary arterial pressure (Ppa) values of 15.