Duplex evaluation of venous insufficiency.

Duplex ultrasound is the most useful examination for the evaluation of venous valvular incompetence. Multi-frequency 4 to 7-MHz linear array transducers are typically used for this assessment of superficial and deep reflux. The examination is done with the patient standing and manual compression maneuvers are used to initiate reflux.

Chronic cardiac rejection masking as constrictive pericarditis.

The hemodynamic changes consistent with constrictive pericarditis are often encountered in patients who have undergone cardiac transplantation. We describe here 4 patients who underwent pericardiectomy after cardiac transplantation. All were found to have evidence of a thickened and constricting peel of pericardium at surgical exploration.

Point mutations in the DNA polymerase gene of human cytomegalovirus that result in resistance to antiviral agents.

Three independently isolated mutants of human cytomegalovirus strain AD169 were found to be resistant to ganciclovir at a 50% effective dose of 200 microM. Phosphorylation of ganciclovir was reduced 10-fold in mutant-infected cells compared with AD169-infected cells. All three mutants were also determined to be resistant to the nucleotide analogs (S)-1-[(3-hydroxy-2- phosphonylmethoxy)propyl]adenine (HPMPA) and (S)-1-[(3-hydroxy-2-phosphonylmethoxy)propyl]cytosine (HPMPC) and hypersensitive to thymine-1-D-arabinofuranoside (AraT).

Comparative interference by haemolysis in automated assays for bilirubin at multiple analyte concentrations.

The negative interference caused by haemolysis in manual bilirubin assays contrasts with the positive interference reported for some automated methods utilizing the same basic chemistry. A comparison was therefore made of the haemolysis interference associated with several automated bilirubin methodologies: multilayer film (Kodak Ektachem- total bilirubin (TBil), direct bilirubin (DBil), conjugated bilirubin (Bc), unconjugated bilirubin (Bu),; tableted reagents (Baxter Paramax- TBil, DBil); continuous flow (Technicon SMAC - TBil). Thirty serum pools were analysed (five concentrations of bilirubin, 2-229 mumol/l; six concentrations of haemoglobin, 0.

Pheochromocytoma crisis.

Of 26 patients with pheochromocytoma treated between 1974 and 1986, two presented with pheochromocytoma crisis. This unusual presentation consists of hyper- and/or hypotension, high fevers (greater than 40 degrees C), encephalopathy, and multiple organ system failure. Both patients had large tumors associated with markedly elevated levels of epinephrine.