The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2.

Human immunodeficiency virus (HIV) affects all organ systems. Infection of the heart can manifest with evidence of myocarditis, pericarditis, or cardiomyopathy. The most common gastrointestinal symptom is diarrhea, which can result from infection with a variety of bacterial, fungal, or protozoal organisms.

Evaluation of Graftskin composite grafts on full-thickness wounds on athymic mice.

We used a living bilayered cultured skin replacement to close full-thickness wound defects on the dorsum of athymic mice. The skin replacement is composed of human fibroblasts that condense a bovine collagen lattice; the lattice is then seeded with cultured human keratinocytes. The collagen lattice with fibroblasts serves as a dermal template, and the overlying human keratinocytes form the epidermal component of this composite skin replacement.

Development of anti-tumor immunity following thymidine kinase-mediated killing of experimental brain tumors.

Using the 9L experimental brain tumor model, we studied long-term tumor regression and immunologic consequences of tumor killing in a model of in vivo gene transfer of the herpes simplex virus 1 thymidine kinase (HSV-TK) gene and ganciclovir (GCV) treatments. Fibroblasts modified to produce retroviral vectors carrying the HSV-TK gene were implanted into established 9L brain tumors in Fischer 344 rats to carry out gene transfer. Animals were then treated with parenteral GCV.

Development of a temporary living skin replacement composed of human neonatal fibroblasts cultured in Biobrane, a synthetic dressing material.

Background: Preferred coverings for excised burn wounds when sufficient autograft skin is not available are fresh or cryopreserved cadaveric skin. Problems with supply, preservation, immune rejection, and potential infection transmission accompanying the use of allograft skin underscore the need for effective alternative temporary skin replacements.

Methods: We cultured human neonatal fibroblasts (HF) for 4 to 6 weeks in nylon mesh of Biobrane, a synthetic dressing consisting of a thin layer of silicone bonded to nylon mesh.

MR detection of white matter disease of the brain in patients with HIV infection: fast spin-echo vs conventional spin-echo pulse sequences.

Objective: Although fast spin-echo images and slower spin-echo images have similar contrast characteristics, the two techniques have not yet been shown to be equivalent in all aspects of brain imaging. To determine if the two sequences are equivalent, we compared detection of white matter lesions, image quality, and artifact degradation on fast spin-echo and spin-echo proton density-weighted and T2-weighted MR images of the brain in prospectively selected patients who were seropositive for HIV.

Subjects And Methods: Fast spin-echo and spin-echo MR images of the brain were obtained in 153 consecutive subjects.

Chronic pulmonary thromboembolism: detection of regional hypoperfusion with CT.

Purpose: To study the relationship of regional hypoperfusion and areas of decreased lung attenuation on computed tomographic (CT) scans of patients with chronic pulmonary thromboembolism.

Materials And Methods: Preoperative CT scans of five patients (four men and one woman, aged 29-72 years) with chronic pulmonary thromboembolism were reviewed and compared with axial single photon emission CT (SPECT) perfusion scans obtained at similar levels. Regions of varying attenuation and perfusion were scored on a three-point scale.

The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1.

The acquired immune deficiency syndrome (AIDS) was recognized as a distinct entity in 1981. It began as a medical curiosity affecting only several dozen individuals in a restricted segment of the U.S.

Integrin expression by human articular chondrocytes.

Objective: To perform a comprehensive analysis of the integrin forms expressed by normal human articular chondrocytes.

Methods: Cartilage sections and collagenase-released chondrocytes were probed with a comprehensive panel of integrin isoform-specific monoclonal antibodies (MAb), using in situ immunohistochemistry techniques, indirect immunofluorescence and flow cytometry, and immunoprecipitation/sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE).

Results: Chondrocytes in cartilage sections reacted with MAb specific for the alpha 5, alpha v, and beta 1 integrin subunits and the alpha v beta 3 and alpha v beta 5 heterodimers.

Managed care involvement by cardiovascular specialists: prevalence, attitudes and influence on practice.

Objectives: The purpose of this study was to determine the involvement in and attitudes toward managed care by cardiovascular specialists and the influence of such programs on their practices.

Background: No in-depth study has measured the impact of managed care on cardiovascular specialists. Therefore, we conducted a mail survey to determine the prevalence of managed care arrangements among cardiovascular specialists and variations among pediatric and adult cardiologists and cardiovascular surgeons; the types of managed care arrangements in which cardiovascular specialists are engaged; the reasons why those not participating in managed care have chosen not to do so; and the general attitudes among cardiovascular specialists with regard to various aspects of managed care.

Diamine oxidase is the amiloride-binding protein and is inhibited by amiloride analogues.

Diamine oxidase (histaminase), an enzyme that oxidatively deaminates putrescine and histamine, was purified from human placenta and from pig kidney. Both NH2-terminal sequences are highly homologous to the human kidney amiloride-binding protein, previously thought to be a component of the amiloride-sensitive Na+ channel. Monoclonal antibodies raised against the pig kidney amiloride-binding protein immunoprecipitate a polypeptide with the same M(r) (105,000) as that of pig kidney diamine oxidase.

Correlation of occipitofrontal circumference and crown-rump length from birth to 15 months.

This study examines the relationship between the occipito-frontal circumference (OFC) and crown-rump length (CRL) from birth to 15 months. Data where obtained from 100 male and 100 female white infants at term, 2, 4, 6, 10 and 15 months of age. The data indicate that documentation of the OFC/CRL ratio is an effective way to determine if head circumference is in the normal range for a particular child's body size.

Complexity, chaos and human physiology: the justification for non-linear neural computational analysis.

Background is presented to suggest that a great many biologic processes are chaotic. It is well known that chaotic processes can be accurately characterized by non-linear technologies. Evidence is presented that an artificial neural network, which is a known method for the application of non-linear statistics, is able to perform more accurately in identifying patients with and without myocardial infarction than either physicians or other computer paradigms.

Cystosarcoma phyllodes of the prostate: MRI findings.

Cystosarcoma phyllodes of the prostate is a rare, relatively benign sarcoma of the prostate. We describe the magnetic resonance imaging findings in an unusual case of cystosarcoma phyllodes which resulted in extensive local recurrence and sarcomatous degeneration. Although uncommon, radiologists should be aware of the existence of cystosarcoma phyllodes of the prostate.

The use of biobrane II and specialty airflow beds (FluidAir Plus and Kinair for effective coverage of extensive posterior donor site wounds.

Posterior skin graft donor sites furnish large areas of skin for wound coverage, but the sites frequently are management problems. The wounds tend to become moist and to develop excessive drainage and fluid accumulation that may interfere with adherence of dressings, including our preferred donor site dressing, Biobrane II (red label, large pore). We studied the use of specialty airflow beds for improving the outcome of posterior donor sites.

Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis.

A patient with severe interstitial pulmonary fibrosis, hypoxemia, pulmonary hypertension, and cor pulmonale was given inhaled nitric oxide (NO) followed by intravenous PGE1 to assess the reversibility of pulmonary hypertension. During NO inhalation, there was marked reduction in pulmonary vascular resistance, increased cardiac output, and dramatic improvement in arterial oxygenation. There was no effect on systemic vascular resistance.

Extraspinal abnormalities detected on MR images of the spine.

Surface-coil MR imaging of the spine is one of the most commonly performed MR imaging procedures. As the spine is the region of interest in these studies, extraspinal abnormalities may be overlooked. Such lesions can be difficult to perceive because they are out of the area of interest or distant from the surface coil.

Plasma norepinephrine variations correlate with peripheral vascular resistance in resting humans.

Plasma levels of norepinephrine (NE) vary rhythmically in humans and animals with an ultradian (shorter than 1 day) periodicity. We repeatedly measured plasma NE levels, blood pressure, cardiac output, and total peripheral resistance in nine normal resting subjects over 5 h. Plasma NE correlated with total peripheral resistance (Z = 0.

Long-term results of radical esophagogastrectomy for bleeding varices due to unshuntable extrahepatic portal hypertension.

This report describes the long-term results of one-stage total gastrectomy and distal two-thirds esophagectomy, with reconstruction by esophagojejunostomy (16 Roux-en-Y; 2 interposition), in 18 adult patients with recurrent variceal hemorrhage due to unshuntable extrahepatic portal hypertension (EHPH) from occlusion of all major tributaries of the portal venous system. The etiology of portal venous occlusion was unknown in 11 patients, abdominal trauma in 3, peritonitis in 3, and thrombotic coagulopathy in 1. Almost half of the patients had their first episode of bleeding in childhood, and 83% experienced bleeding before 40 years of age.

Reduction of bacterial translocation and intestinal structural alterations by heparin in a murine burn injury model.

Burn injury produces acute gastrointestinal (GI) derangements that may predispose the burn victim to bacterial translocation (BT). We studied the effects of heparin on gastrointestinal (GI) anatomic alterations and BT after 25% and 32% total body surface area (TBSA), full-thickness murine burn injuries. Heparin (100 U/kg) was administered with 1 mL of normal saline (NS) resuscitation solution immediately postburn and 4 hours and 18 hours postburn in volumes of 0.

Robotically assisted laparoscopic surgery. From concept to development.

The evolution of laparoscopy from a monocular view to the video screen has enabled all in the operating room to see the procedure. This has meant the surgeon must rely on an assistant to hold the scope, which has many drawbacks. Robotic enhancement technology creates a symbiotic relationship between the surgeon and robot and leads to great improvement in the performance of the case.