Bioactive parathyroid hormone in canine progressive renal insufficiency.

Bioactive parathyroid hormone and hormonal actions were monitored as hyperparathyroidism evolved in a model of progressive canine renal failure. Circulating levels of bioactive and immunoreactive parathyroid hormone rose as renal insufficiency worsened, but elevations, especially in bioactivity, were most marked in the final stage of uremia. By gel filtration analysis, the major circulating bioactive moiety was similar to the major glandular form of parathyroid hormone, although a smaller-molecular-weight entity was seen in the final stage of renal failure.

Use of polydimethylsiloxane subdermal implants for correcting facial deformities in Down's syndrome.

The use of polydimethylsiloxane prostheses to improve facial appearance in patients with Down's syndrome is reported. In 1 year, 50 patients were treated with 120 prostheses. A follow-up of 8 to 18 months showed that a low incidence of minor complications occurred.

Value of high-resolution computerized tomography in localizing diseased parathyroid glands.

Eighteen patients with hyperparathyroidism underwent high-resolution computerized tomography of the neck and superior mediastinum to assess the accuracy of the method in localizing diseased parathyroid glands preoperatively. The tomograms were correlated with surgical and pathological findings. Four scans were technically unsatisfactory.

Subacute endotoxemia in dogs with experimental cirrhosis and ascites: effects on kidney function.

To study the effect of low-grade continuous endotoxemia in normal and cirrhotic dogs, osmotic minipumps were filled with Escherichia coli endotoxin, implanted subcutaneously and arranged so that the endotoxin could be infused intravenously over a 7-day period in doses ranging from 2.5 to 100 micrograms/h. Observations were made at 3 and 7 days postinfusion.

The prevention of cardiac arrhythmias produced in an animal model by the topical application of a phenol preparation in common use for face peeling.

We have shown in an animal model that complex ventricular arrhythmias produced by topical application of a phenol preparation that is used in face peeling can be prevented by a brisk diuresis at the time of application or by gradual application of the phenol preparation. We recommend that continuous cardiac monitoring and recording be performed in patients having topical phenol applications in order to determine the true incidence of cardiac arrhythmias and to ascertain if they are prevented by a forced diuresis, by the gradual application of the preparation, or by a combination of both.

Single-beam radiotherapy knife. A practical theoretical model.

A feasibility study reveals that a standard linear accelerator, with only slight modification, can function in a manner similar to Leksell's multiple cobalt radiation device. A high radiation dose can be delivered to a 1-cm or 0.5-cm volume target with insignificant radiation effect on the surrounding tissue.

Spinal metastases of basal cell carcinoma.

A case of spine metastasis of basal cell carcinoma and review of the literature are presented. The treatment approach is discussed.

The triangular island skin flap for treatment of anal ectropion.

Another method for repair of anal ectropion is reported. Two triangular island flaps, deeply based, are advanced medially to cover the excised area, thus resurfacing the anal canal with normal skin. The technique is recommended because of its simplicity, reliability, and satisfactory results.

Discordant disappearance of bioactive and immunoreactive parathyroid hormone after parathyroidectomy.

The disappearance of plasma PTH after parathyroidectomy was assessed in patients with primary hyperparathyroidism and normal renal function, chronic renal failure or restored renal function (after transplantation). Plasma PTH levels were determined by renal cytochemical bioassay and by midregion and carboxyl-terminal RIAs. Baseline PTH levels were lower in each patient when assessed by bioassay than when determined by RIA, and the rate of hormone disappearance was faster when determined by bioassay than when measured by RIA.

Renal blood flow in normal dogs and in dogs with experimental liver cirrhosis following the acute continuous infusion of endotoxin.

The purpose of this study was to determine if the renal circulation of normal and cirrhotic dogs behave similarly in response to an acute endotoxin infusion. Endotoxin was administered as a slow continuous infusion (13-26 micrograms/min) to a total of 20 normal dogs through the femoral vein, portal vein, or into the left renal artery. In each case, there was an initial increment in renal blood flow, of the order of 46%, while arterial blood pressure was actually declining.

Dogs with experimental cirrhosis of the liver but without intrahepatic hypertension do not retain sodium or form ascites.

Dogs with portal cirrhosis but without portal hypertension (end-to-side portacaval anastomosis) retain sodium and expand plasma volume before ascites formation. In our study, dogs were subjected to bile duct ligation and simultaneous side-to-side portacaval anastomosis (PCA) in order to create a canine model of hepatic cirrhosis without intrahepatic or portal hypertension. The effect of normalizing intrahepatic pressures in the face of venous outflow block on sodium handling was studied.

Salvage of exposed knee prosthesis by gastrocnemius myocutaneous flap coverage.

The salvage of an exposed and infected knee prosthesis is reported. The coverage by means of a gastrocnemius myocutaneous flap resulted in good healing and prevented removal of the prosthesis, arthrodesis, and subsequent severe walking disability.

An aggressive, nonshunting approach for control of bleeding esophageal varices.

Morbidity and mortality from variceal hemorrhage can be significantly reduced. A well-defined treatment protocol which obviates delay, procrastination and excessive blood loss is essential. Early aggressive endoscopic sclerotherapy is extremely safe and effective in controlling the acute hemorrhagic event.

Renal perfusion in dogs with experimental hepatic cirrhosis: role of prostaglandins.

Increased renal production of prostaglandins are thought to be important for the maintenance of kidney blood flow in advanced cirrhosis. In alert, unanesthetized dogs with chronic cirrhosis and ascites, produced by bile duct ligation, we measured inulin and p-aminohippurate (PAH) clearance before and after the intravenous administration of 2 mg/kg indomethacin, an inhibitor of prostaglandin production. Inulin and PAH clearance declined by 42 and 43%, respectively.

Esophageal procedures to control bleeding from varices.

Portal-systemic shunting of all types has failed to improve long-term survival in patients with bleeding esophageal varices and carries a high morbidity and prohibitive mortality in the emergency setting. Direct esophageal approaches are receiving renewed attention. Sclerotherapy promises to be the simplest, safest, and most effective treatment for acute bleeding.

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction.

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

Very deep high temperature burns associated with blunt abdomino-thoracic trauma.

A 14-year-old boy with deep burns, blunt abdominal trauma and extensive muscle damage is described. The patient was operated on for a ruptured liver, developed acute tubular necrosis, had 3220 gr of necrotic tissue removed in serial tangential excisions, had an above elbow amputation of the left hand, removal of necrotic ribs and excisions of necrotic spinal processes, developed sepsis twice, empyema of right pleura, had open infected knee joints and was successfully treated until complete healing over a period of four months. The successful outcome seems to be due to early and aggressive surgical treatment, hemodialysis, total parenteral nutrition for over two months, antibiotic therapy, cryoprecipitate and devoted nursing, occupational and physiotherapy.