Necrotizing Pneumocystis carinii vasculitis associated with lung necrosis and cavitation in a patient with acquired immunodeficiency syndrome.

Pulmonary cavitation is an infrequent manifestation of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. The pathogenesis of lung cavities associated with P carinii pneumonia has not been fully elucidated by detailed morphologic studies. This article describes a patient with the acquired immunodeficiency syndrome and P carinii pneumonia who developed roentgenographically identified lung cavitation while being treated with azidothymidine.

Intravenous, deltoid, or gluteus administration of meperidine during labor?

It has been suggested, but not well verified, that drug absorption from traditional intramuscular injection sites is altered during labor. This study tested the hypothesis that absorption of meperidine from the gluteus muscle would be impeded when compared with deltoid or intravenous administration. Five patients in labor were given 50 mg intravenously, 10 were given 50 mg in the gluteus muscle, and five were given 50 mg in the deltoid muscle.

Magnetic resonance imaging of disturbances in neuronal migration: illustration of an embryologic process.

Twenty-three cases of suspected congenital anomalies involving disorders of cortical proliferation, migration or cortication were retrospectively collected over an 18 month period. Pathologic confirmation was present in five cases. The theoretical sequential stages of cortical development are discussed as keys to the interpretation of MR images of anomalies resulting from arrest of the developmental process.

Maturational changes of theophylline pharmacokinetics in preterm infants.

The pharmacokinetics of theophylline were studied at steady state by stable isotope methodology in nine individual preterm infants. Maturational variables such as postnatal age, postconceptional age, gestational age, duration of treatment, and body weight at the time of the study were analyzed for their influence on theophylline kinetics during the first 6 months of life. The strongest statistical correlations were found between the logarithm of theophylline half-life (t1/2) and the postnatal age (r = 0.

The pathologic characteristics of interstitial pneumonia cystic fibrosis. A retrospective autopsy study.

Interstitial pneumonia is a poorly understood variant of lung injury in patients with cystic fibrosis (CF). The authors identified prominent interstitial pneumonia (defined as an inflammatory reaction predominantly involving alveolar septa) in 9 of 43 autopsied patients with CF. Lungs from these nine were studied by light microscopy to determine the histopathologic features, clinicopathologic correlates, and potential causes of CF-associated interstitial pneumonia.

Arthroscopic surgery of the temporomandibular joint: report of 64 patients with long-term follow-up.

One hundred temporomandibular joints (64 patients) were examined arthroscopically. Complications from the procedure were low (4%). Eighty joints (50 patients) received superior compartment sweep and lavage.

Hepatic mitochondrial oxidative metabolism and lipid peroxidation in experimental hexachlorobenzene-induced porphyria with dietary carbonyl iron overload.

Both human porphyria cutanea tarda and experimental hexachlorobenzene-induced porphyria are associated with hepatic injury and are potentiated by excess hepatic iron. The mechanisms whereby cellular injury occurs and the synergistic role of iron overload are unknown. In the present experiments, we studied hepatic mitochondrial function and lipid peroxidation in rats with hexachlorobenzene-induced porphyria in which iron loading was achieved by dietary carbonyl iron supplementation.

A general overview of amiodarone toxicity: its prevention, detection, and management.

Although amiodarone is a highly effective antiarrhythmic agent, it has a high incidence of side effects, some of which can be serious or even lethal. With close monitoring, side effects can be found in essentially all patients, but fortunately most of these are mild and well tolerated. Furthermore, many will respond to dosage reduction in a relatively short period of time, ie, days to weeks, which is remarkable considering the long period of time amiodarone has been shown to persist in tissues.

Relationship between arterial blood gases and spirometry in acute exacerbations of chronic obstructive pulmonary disease.

Previous studies have established spirometric criteria for arterial blood gas analysis during acute asthmatic attacks. However, only general guidelines have been available regarding the need for blood gas analysis during an acute exacerbation of chronic obstructive pulmonary disease (COPD). We conducted a study to determine the relationship between arterial blood gases and spirometry in 70 emergency department patients during acute exacerbations of COPD.

The role of O6-alkylguanine DNA alkyltransferase in limiting nitrosourea-induced sister chromatid exchanges in proliferating human lymphocytes.

Although induction of sister chromatid exchanges (SCEs) following nitrosourea exposure may be greater during cell proliferation, the increase could be offset by the action of the DNA repair protein O6-alkylguanine DNA alkyltransferase (alkyltransferase). To evaluate these factors in resting and proliferating (phytohemagglutinin stimulated) human lymphocytes, we studied the effect of changes in alkyltransferase activity on 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)-induced SCEs. Phytohemagglutinin stimulation resulted in induction of alkyltransferase activity (5.

Specific binding of human C-reactive protein to human monocytes in vitro.

The precise biologic function of C-reactive protein (CRP), a major acute phase protein in man, is unknown. The abilities of CRP to bind biologic substrates and to activate the C pathway, and its localization at sites of inflammation argue for an opsonic role for this protein. Such a role has been supported by recent reports of specific binding of CRP to neutrophils.

High school athletes and the use of ergogenic aid.

To determine high school athletes' attitudes toward and use of ergogenic aids, we surveyed 295 students presenting for preparticipation examinations. In general, young athletes believed that steroids and amphetamines were not efficacious in enhancing sports performance and that their use was potentially harmful. Subjects reported minimal use of steroids (1%) and amphetamines (2%), and only a minority would consider their use.

Properties of rabbit pepsinogen granules.

Pepsinogen granules were isolated from the rabbit stomach using isoosmotic Percoll density gradients, low free calcium (10(-7) M), and conditions that minimize physical damage. These granules were enriched approximately eightfold with respect to pepsinogen and were free from contamination by mitochondria and endoplasmic reticulum. Electrophoretic examination shows pepsinogen to account for approximately 80% of the Coomassie Blue-stainable intragranular protein and the granule membrane to yield a simple spectrum of proteins similar to other granule systems.

A primer of fixator devices and configurations.

This paper gives a general introduction to the terminology, concepts, and classifications of external fixators. A clear distinction is made between characteristics typical of the three types of external fixators, simple, clamp, and ring, and those typical of the four standard frames that can be built with each of the devices. These four frames, the one-plane unilateral, two-plane unilateral, one-plane bilateral, and two-plane bilateral configurations, differ in the ease of wound access they allow and their mechanical balance, particularly toward bending moments.

Unilateral external fixation. Methods to increase and reduce frame stiffness.

Unilateral configurations with stiffness characteristics similar to those of the most rigid one- and two-plane bilateral constructs are easily built. Mechanically, most effective were two-plane unilateral frames with a short bone-rod distance. But single- and double-bar anterior unilateral frames had the best combination of clinical and mechanical features.

Histopathology and etiology of childhood pneumonia: an autopsy study of 93 patients in Bangladesh.

The causes and pathogenesis of severe childhood pneumonia in a developing country were studied in lungs removed at autopsy from 119 Bangladeshi children who presented with pneumonia and/or diarrhea. Pneumonia was observed in 93 patients. Morphologic features included acute alveolar exudate in 51% (of the 93 patients), necrotizing pneumonia in 31%, interstitial pneumonia in 22%, and caseating granulomas in 4%, while a mixed pattern occurred in 16% of patients.

Artificial ventilation by means of electrical activation of the intercostal/accessory muscles alone in anesthetized dogs.

We have previously shown that large inspired volumes can be achieved in phrenicotomized animals by intercostal/accessory muscle activation via spinal cord stimulation. In the present study, we evaluated the utility of this technique to provide complete ventilatory support for prolonged time periods (6 to 8 h, selected arbitrarily). In 10 deeply anesthetized dogs, a single electrode was introduced onto the epidural surface of the spinal cord and positioned at the T2-T3 spinal level.

Shrinking pleuritis with lobar atelectasis, a morphologic variant of "round atelectasis".

Round atelectasis (shrinking pleuritis) is typically a localized process characterized by focal pleural scarring and subjacent peripheral atelectasis. We report three patients, studied at autopsy, with an unusual variant of round atelectasis, termed shrinking pleuritis with lobar atelectasis, which is characterized by lobar atelectasis, visceral pleural fibrosis involving multiple lobes, interlobar fibrous cords, pleural effusion, and nonspecific, persistent infiltrates on chest radiogram. The possible causes of shrinking pleuritis with lobar atelectasis in our patients were multiple and included environmental dust exposure, infection, uremia, and recurrent pleural effusions.

Filariases.

It is apparent that there are many similarities among the various filariae. Besides a common life cycle, with an arthropod vector and human hosts, there are similarities in the diseases that they produce. This clinical picture takes one of two main courses: (1) characteristic disease produced by the presence of adult nematodes in their target tissue, which distinguishes typical cases for each of the filariae, and (2) the systemic hypersensitivity reactions to the circulating microfilaria, which tend to be similar.

General theory and principles of external fixation.

Starting with a review of the capabilities and main complications of external fixators, this paper shows how advances made during the past two decades have rendered the method safe, reliable, and predictable. Improved component designs, new techniques of pin care, the discovery of three basic concepts that govern the safe and effective application of pin and ring fixators, and the recognition that preoperative and long-term planning are crucial to the success of the method have made external fixation the most adaptable, versatile, and gentle method for stabilizing complex injuries of soft tissue and bone.

Efficacy of high-dose oral leucovorin and 5-fluorouracil in advanced colorectal carcinoma. Plasma and tissue pharmacokinetics.

Thirty-one evaluable patients with advanced colorectal cancer were treated with oral leucovorin (LV) 500 mg/m2, administered hourly in four divided doses weekly for 6 weeks. Six patients received intravenous 5-FU at 450 mg/m2 and the remainder at 600 mg/m2 weekly for 6 weeks. This schedule was repeated after a 2-week rest period without medication.

Effects of vitamin E deficiency on hepatic mitochondrial lipid peroxidation and oxidative metabolism in rats with chronic dietary iron overload.

Peroxidative decomposition of organelle membrane phospholipids with subsequent organelle dysfunction is a postulated mechanism of liver cell injury in parenchymal iron overload. We studied the effects of different alpha-tocopherol concentrations on hepatic mitochondrial lipid peroxidation and oxidative metabolism in rats with chronic dietary iron overload. There was no evidence of mitochondrial lipid peroxidation (conjugated dienes) or alteration in mitochondrial oxidative metabolism in alpha-tocopherol-deficient rats with normal hepatic iron levels.

A randomized controlled trial of methylprednisolone in the emergency treatment of acute exacerbations of COPD.

We conducted a randomized, controlled double-blind study to determine whether intravenous administration of methylprednisolone early in the therapy for acute exacerbations of COPD would improve pulmonary function in the Emergency Department and reduce the need for hospitalization. Ninety-six patients completed the study. All were at least 50 years of age and had no history of asthma.