Thromboembolic events in patients with malignant superior vena cava syndrome and the role of anticoagulation.

In patients with superior vena caval obstruction resulting from malignancy, the importance of vena caval thrombosis and the role of anticoagulation are incompletely understood. The authors discuss this aspect of the management of 25 patients with malignant superior vena cava syndrome. Ten patients were retrospectively reviewed after having been clinically diagnosed without venography, and treated without anticoagulation.

Effect of injection site on circulation times during cardiac arrest.

Cardiopulmonary resuscitation requires effective, prompt drug administration. In order to analyze Advanced Cardiac Life Support (ACLS) recommendations for site of drug administration, we studied dye circulation times after central, femoral, and peripheral venous injection during both closed and open chest CPR using a canine arrest model. Measurements of circulation times were made after injection of indocyanine green dye at femoral, central, and peripheral venous sites.

Aberrant arterial supply in congenital cystic adenomatoid malformation of the lung.

We report on a newborn girl with cystic adenomatoid malformation of the lungs supplied by an aberrant artery arising from the aorta at the level of the diaphragm. To the best of our knowledge, it is the first case diagnosed by prenatal ultrasound in which an arterial digital subtraction angiography (DSA) after birth showed the aberrant vessel.

Evaluation of burn discharge teaching.

In order to facilitate excellent comprehensive burn care for patients discharged from our burn center, we instituted a study to determine the quality of our discharge teaching program. As a result of high census and high acuity levels, our burn center transfers patients with smaller burns to adult and pediatric surgical floors. Thus, nurses with less expertise in burn nursing techniques provide care to these patients.

A comparison of venous blood gases during cardiac arrest.

Previous reports have advocated the use of mixed venous blood gases to estimate arterial pH and as a reflection of tissue acid-based balance. However, true mixed venous samples are difficult to obtain during cardiac arrest as they require a pulmonary artery catheter. The purpose of this study was to determine whether central or femoral venous samples could be used in place of pulmonary artery samples.

The management of localized abdominal aortic dissections.

Aortic dissections limited to the abdominal aorta occur infrequently. We have identified four cases of abdominal aortic dissection and have reviewed these in combination with 43 previously reported cases to identify factors that influence the prognosis and management of this disease. Abdominal aortic dissections are similar to thoracic dissections in their presentation, with acute shearing pain and systolic hypertension occurring commonly.

Hindsight bias: an impediment to accurate probability estimation in clinicopathologic conferences.

Although clinicopathologic conferences (CPCs) have been valued for teaching differential diagnosis, their instructional value may be compromised by hindsight bias. This bias occurs when those who know the actual diagnosis overestimate the likelihood that they would have been able to predict the correct diagnosis had they been asked to do so beforehand. Evidence for the presence of the hindsight bias was sought among 160 physicians and trainees attending four CPCs.

Effect of amrinone on diaphragm blood flow.

The purpose of the present study was to examine the effect of amrinone, a drug known to augment cardiac output and dilate peripheral vascular beds, on diaphragm blood flow. Studies were performed on 12 anesthetized mechanically ventilated dogs in which strips of left costal diaphragm were developed in situ. Strip blood flow was assessed with a drop counter attached to a catheter tied into the phrenic veins' draining strips.

Antigenic characteristics of neurofibrillary tangles in progressive supranuclear palsy.

The antigenic components of neurofibrillary tangles in the basal forebrain and brainstem were studied in 4 cases of progressive supranuclear palsy (PSP) at the light and electron microscopic levels, using antibodies to neurofilaments (in the phosphorylated and non-phosphorylated forms); the high, middle and low molecular weight neurofilament subunits; ubiquitin; the microtubule associated proteins MAP1, MAP2 and tau; isolated Alzheimer paired helical filaments and to tubulin, in the tyrosinated and detyrosinated forms. Although PSP neurofibrillary tangles appear to have most antigenic sites in common with those of Alzheimer disease, PSP tangles share epitopes with tyrosinated and detyrosinated tubulin, which has not been demonstrated in Alzheimer neurofibrillary tangles.

Biosynthetic skin substitute vs. 1% silver sulfadiazine for treatment of inpatient partial-thickness thermal burns.

When used appropriately on superficial or moderate-depth partial-thickness burns, Biobrane significantly decreased total healing time to complete reepithelialization, reduced pain, and was associated with decreased nursing time and costs when compared to 1% silver sulfadiazine cream. Care must be used in selecting wounds for Biobrane therapy. They must be fresh, noninfected, and free of eschar and debris with a moist, sensate surface that demonstrates capillary blanching and refill.

Central pontine myelinolysis in severely burned patients: relationship to serum hyperosmolality.

The rapid correction or over-correction of hyponatremia is believed by many to be the crucial factor in the causation of central pontine myelinolysis (CPM). Over a 17-year period we found CPM in 10 (7%) of the 139 burn patients examined postmortem but in only 10 (0.28%) of the 3,528 patients in the general autopsy population (p less than 0.

The effect of maternal smoking on the relationship between maternal and fetal zinc status and infant birth weight.

We have previously reported a trapping of zinc in the placenta directly related to circulating cadmium that comes from cigarette smoke. The purpose of this study was to examine in detail the effect of smoking on (a) the relationship between maternal and fetal zinc status and (b) the relationship between zinc status and birth weight. One hundred and eighteen smokers and 172 nonsmokers without any medical complications during pregnancy were studied.

A statistical evaluation of the literature regarding the associations among alcoholism, drug abuse, and antisocial personality disorder.

Prior literature suggested an association among alcoholism, drug abuse, and antisocial personality disorder. A meta-analysis of inferential studies bearing on these associations was performed on 40 studies. Results demonstrated that each diagnosis in the triad had a significant positive association with each of the other two.

Regulation of rabbit acute phase protein biosynthesis by monokines.

We defined the acute phase behaviour of a number of rabbit plasma proteins in studies (in vivo) and studied the effects of monokine preparations on their synthesis by rabbit primary hepatocyte cultures. Following turpentine injection, increased serum levels of C-reactive protein, serum amyloid A protein, haptoglobin, ceruloplasmin, and decreased concentrations of albumin were observed. In contrast to what is observed in man, concentrations of alpha 2-macroglobulin and transferrin were increased.

CT demonstration of brain infarcts due to deep venous thrombosis in systemic lupus erythematosus.

Rapid development of low density bilateral lesions in the brain due to deep venous thrombosis in Systemic Lupus Erythematosis is described. To the best of our knowledge, this type of symmetry, distribution and appearance of brain infarcts in CT due to deep venous thrombosis has not been reported previously.

Use of enzyme immunoassay for the rapid diagnosis of Chlamydia trachomatis endocervical infection in female adolescents.

Enzyme immunoassay (EIA) has been proposed as an alternative to tissue culture for the detection of Chlamydia trachomatis in cervical specimens. The diagnostic efficacy of EIA was compared to tissue culture in 113 teenaged females attending an adolescent reproductive health program. Infection was diagnosed by tissue culture in 16% of subjects.

Pathophysiological findings in a patient with Shy-Drager and alveolar hypoventilation syndromes.

This report describes the clinical, physiologic and pathologic findings in a patient with alveolar hypoventilation, acquired autonomic dysfunction, parkinsonism, and sensorimotor polyneuropathy. While there were pathologic findings in both central and peripheral nervous systems, there were no morphologic changes in the regions of the brainstem considered responsible for respiratory rhythmogenesis. A hypothesis is developed based on the assumption that the abnormalities in respiratory control which led to the patient's death are explained by abnormalities in the feedback control of respiration.

Enhanced in vivo therapy of pulmonary metastases with interferon and interleukin-2.

Interleukin-2 (IL-2) can mediate in vivo tumor regression at high doses. To enhance this efficacy, we studied the effect of adding a human hybrid recombinant interferon alpha A/D (rHuIFN-alpha-A/D) because of its known in vitro augmentation of immune-mediated tumoricidal activity. C56BL/6 mice bearing established pulmonary metastases induced by the iv injection of the methylcholanthrene-induced fibrosarcoma MCA 106 were treated for 12 days with intraperitoneal injections of (1) Hanks' balanced salt solution, (2) recombinant IL-2, (3) rHuIFN-alpha-A/D, and (4) a combination of IL-2 and HuIFN-alpha-A/D.

The statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings.

This paper presents a statistical analysis of treatment effects in 24-hour ambulatory blood pressure recordings. The statistical models account for circadian rhythms, subject effects, and the effects of treatment with drugs or relaxation therapy. In view of the heterogeneity of the subjects, we fit a separate linear model to the data of each subject, use robust statistical procedures to estimate the parameters of the linear models, and trim the data on a subject by subject basis.

Nonspecific airway hyperreactivity in nonsmoking bituminous coal miners demonstrated by quantitative methacholine inhalation challenge.

Because nonsmoking underground bituminous coal miners often have symptoms of chronic bronchitis and because a high proportion of patients with chronic bronchitis have nonspecific airway hyperreactivity, we hypothesized that coal miners would have a higher prevalence of nonspecific airway hyperreactivity than nonminer nonsmoking control subjects. By use of a quantitative methacholine provocative inhalation challenge test, we evaluated 22 underground bituminous coal miners and 41 nonminer age- and sex-matched control subjects from the same community. We found that a significantly higher proportion of miners had reactivity to inhalation of 100 mg/ml or less of methacholine, X2 = 6.

In-plane flow velocity quantification along the phase encoding axis in MRI.

In-plane flow quantification in MRI offers the potential for assessing vessel patency, and both volume flow rate and flow velocity. These techniques will have definite future impact on MR angiography. The method used in this paper employs motion artifact suppression technique (MAST) gradients to refocus spins travelling along any of the three imaging axes while encoding the velocity component along the phase encoding axis.