Management of pancreatic pain.

Treatment of pancreatic pain remains a very difficult problem. At present, when the main pancreatic duct is dilated, lateral pancreaticojejunostomy remains the treatment of choice for refractory pancreatic pain. When the disease is localized to the head or tail of the pancreas, resection of these segments has also proven to be effective in the majority of patients.

Cocaine-induced myocardial infarction: clinical observations and pathogenetic considerations.

Clinical and experimental data published to date suggest several possible mechanisms by which cocaine may result in acute myocardial infarction. In individuals with preexisting, high-grade coronary arterial narrowing, acute myocardial infarction may result from an increase in myocardial oxygen demand associated with cocaine-induced increase in rate-pressure product. In other individuals with no underlying atherosclerotic obstruction, coronary occlusion may be due to spasm, thrombus, or both.

Molecular basis of spectrin and ankyrin deficiencies in severe hereditary spherocytosis: evidence implicating a primary defect of ankyrin.

While varying degrees of spectrin deficiency have been found in the majority of patients with hereditary spherocytosis (HS), a combined severe deficiency of both spectrin and the spectrin-binding protein, ankyrin, has been reported only in two patients with severe HS. To elucidate the molecular basis of these protein deficiencies, we have studied the synthesis, assembly, and the mRNA levels of spectrin and ankyrin in peripheral blood reticulocytes in one of the previously reported probands. Pulse-labeling studies showed that in HS reticulocytes, the synthesis of alpha-spectrin was comparable with control reticulocytes while that of beta-spectrin was increased about fourfold, presumably reflecting increased erythropoietic drive.

Molecular defect of the band 3 protein in southeast Asian ovalocytosis.

Background: Southeast Asian ovalocytosis is a form of hereditary elliptocytosis in which the red cells are rigid and resistant to malaria invasion. The underlying molecular defect is unknown.

Methods And Results: We studied the red cells of 54 patients with ovalocytosis and 122 normal controls.

Sickle erythrocytes inhibit human endothelial cell DNA synthesis.

Patients with sickle cell anemia experience severe vascular occlusive phenomena including acute pain crisis and cerebral infarction. Obstruction occurs at both the microvascular and the arterial level, and the clinical presentation of vascular events is heterogeneous, suggesting a complex etiology. Interaction between sickle erythrocytes and the endothelium may contribute to vascular occlusion due to alteration of endothelial function.

Effect of hemoglobin oxidation products on the stability of red cell membrane skeletons and the associations of skeletal proteins: correlation with a release of hemin.

Oxidative injury to hemoglobin (Hb) leads to formation of methemoglobin (MetHb), reversible hemichromes (rHCRs), and irreversible hemichromes (iHCRs). iHCRs precipitate and form Heinz bodies that attach to the red cell membrane causing injury that leads to hemolysis. The molecular mechanisms of this membrane damage have not been fully elucidated.

Hodgkin's disease in the mesenteric lymph nodes in a patient with colon carcinoma.

We describe a patient in whom Hodgkin's disease affecting the mesenteric lymph nodes was discovered incidentally at laparotomy for carcinoma of the colon. The occurrence of Hodgkin's disease and colon carcinoma in the same patient is rare, as is Hodgkin's disease in the mesenteric lymph nodes. In cases in which Hodgkin's disease is discovered incidentally at laparotomy, staging is usually done by using computerized tomography and lymphangiographic studies.

Disseminated, nonmeningeal gastrointestinal cryptococcal infection in an HIV-negative patient.

Gastrointestinal cryptococcosis is extremely rare, especially in patients with no involvement of the central nervous system. We describe a 63-yr-old man undergoing prednisone therapy for chronic hepatitis and cirrhosis who presented with peritonitis, colitis, and skin lesions. Pathological studies revealed necrosis and numerous cryptococcal organisms in the colon, omentum, and skin, and cultures yielded Cryptococcus neoformans.

The brain in schizophrenia.

Schizophrenia has been the subject of intensive neuropsychologic, neuroradiologic, neuropathologic, and neurochemical investigations. The most consistent and reproducible result from all this effort has been the demonstration of a mild degree of enlargement of the cerebral ventricles. The existence of this finding is no longer a subject of controversy, and it clearly occurs independently of psychiatric treatment and chronicity of disease.

Coronary artery bypass surgery: outcome assessment.

Improvement in quality of life following coronary artery bypass surgery is a function of a number of complex variables. This outcome, based on objective medical and subjective social criteria, must be assessed to determine the success of this financially expensive surgical intervention for management of patients with coronary artery disease. The majority of patients undergoing coronary artery bypass surgery demonstrate, at least early on, an improved quality of life.

Alteration of the erythrocyte membrane skeletal ultrastructure in hereditary spherocytosis, hereditary elliptocytosis, and pyropoikilocytosis.

The membrane skeleton of normal erythrocytes is largely organized into a hexagonal lattice of junctional complexes (JC) crosslinked by spectrin tetramers, and occasional double tetramers and hexamers. To explore possible skeletal alterations in hereditary spherocytosis (HS), elliptocytosis (HE), and pyropoikilocytosis (HPP), we have studied the ultrastructure of the spread membrane skeletons from a subpopulation of HS patients with a partial spectrin deficiency ranging from 43% to 86% of normal levels, and in patients with HPP who, in addition to a mild spectrin deficiency, also carried a mutant spectrin that was dysfunctional, thus reducing the ability of spectrin dimers to assemble into tetramers. Membrane skeletons derived from Triton-treated erythrocyte ghosts were examined by negative staining electron microscopy.

Structural and functional heterogeneity of alpha spectrin mutations involving the spectrin heterodimer self-association site: relationships to hematologic expression of homozygous hereditary elliptocytosis and hereditary pyropoikilocytosis.

Defects involving alpha spectrin (Sp) are found in patients with hereditary elliptocytosis and a related disorder, hereditary pyropoikilocytosis (HPP). We have previously found that the severity of hemolysis was related to the total spectrin content of the cells and the percentage of unassembled dimeric Sp (SpD) in the membranes, which, in turn, reflected the amount of mutant Sp in the cell. However, no data are available comparing differences in the function of various alpha Sp mutations to clinical severity.

Plasmacytoma of the urethra treated with transurethral resection and radiotherapy.

Plasmacytoma, which is a localized malignant plasma cell tumor, occurs rarely and is found mostly in the upper airways of older patients. Two urethral plasmacytomas have been reported, 1 of which was a primary lesion. We describe a primary plasmacytoma of the urethra in a 23-year-old woman who had been exposed to diethylstilbestrol in utero.

Catheter-based intravascular ultrasound discriminates bicuspid from tricuspid valves in adults with calcific aortic stenosis.

A catheter-based intravascular ultrasound transducer was used to study aortic valve morphology in adults with calcific aortic stenosis. Examination of 14 postmortem specimens disclosed that intravascular ultrasound consistently identified the number of cusps or the presence of a calcified median raphe in the conjoined cusp, or both, and thereby distinguished a calcified bicuspid from a calcified tricuspid aortic valve. These postmortem findings were then employed to identify valvular morphology in 15 patients undergoing diagnostic cardiac catheterization or balloon aortic valvuloplasty, or both.

Bacteriologic status of necrotic tissue in necrotizing pancreatitis.

To confirm the accuracy of guided percutaneous aspiration (GPA) in distinguishing sterile from infected pancreatic necrosis, we have performed Brown-Brenn tissue Gram stains on pancreatic and peripancreatic necrotic tissue removed operatively in 15 patients. In eight patients judged to have sterile necrosis on the basis of negative cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery was also free of bacteria. In seven patients judged to have infected necrosis on the basis of positive cultures of pancreatic exudate obtained first preoperatively (by GPA) and then intraoperatively, necrotic tissue debrided at surgery harbored a considerable number of bacteria.

Randomized, double-blind trial of cefonicid and nafcillin in the treatment of skin and skin structure infections.

We compared treatment with one daily intravenous dose of cefonicid and multidose nafcillin in 65 patients with severe infections of the skin or skin structure. Clinical cure or improvement was achieved in 91% of the patients given cefonicid and in 87% of the patients given nafcillin (P = 0.97).

Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease.

One hundred eleven patients who had undergone surgery for benign anorectal disease under spinal anesthesia were studied retrospectively to determine the incidence of postoperative urinary retention requiring catheterization and to assess possible influences on that incidence. The age group and sex of the patients did not affect the rate of retention. However, the use of a long-acting anesthetic agent and the administration of at least 1,000 mL of intravenous fluid perioperatively each produced a significant increase in postoperative urinary retention.

Contrasting histoarchitecture of calcified leaflets from stenotic bicuspid versus stenotic tricuspid aortic valves.

Preliminary findings from clinical trials of percutaneous balloon aortic valvuloplasty and intraoperative debridement of calcific deposits in patients with aortic stenosis have suggested that calcified, congenitally bicuspid aortic valves may be less amenable to these techniques than are calcified tricuspid aortic valves. Accordingly, we evaluated the histoarchitecture of calcific deposits in 30 operatively excised aortic valves. Light microscopic sections taken through the calcified aortic valve leaflets disclosed two principal types of histoarchitecture.

Percutaneous intravascular US as adjunct to catheter-based interventions: preliminary experience in patients with peripheral vascular disease.

Catheter-based ultrasound (US) transducers may be introduced into the vascular system to record high-resolution images of the vessel wall and lumen. The potential advantages and existing liabilities of percutaneous intravascular US as an adjunct to transluminal vascular recanalization were investigated. A 6.

Atrial septal defect resulting from mitral balloon valvuloplasty: relation of defect morphology to transseptal balloon catheter delivery.

Percutaneous balloon mitral valvuloplasty has been shown to be an effective means of reducing mitral valve gradient and increasing mitral valve area in patients with mitral stenosis. Most techniques currently employed for performing this procedure involve delivery of one or two balloon valvuloplasty catheters through the interatrial septum en route to the mitral valve orifice. To determine the morphology of the resultant atrial septal defect (ASD), particularly as a function of the technique employed, we performed a series of in vitro experiments designed to simulate a variety of technical approaches.

Selective modulation of band 4.1 binding to erythrocyte membranes by protein kinase C.

We have studied the effects of band 4.1 phosphorylation on its association with red cell inside-out vesicles stripped of all peripheral proteins. Band 4.

Atherosclerotic Yucatan microswine: an animal model with high-grade, fibrocalcific, nonfatty lesions suitable for testing catheter-based interventions.

A new breed of swine, the Yucatan microswine, that was derived from repetitive inbreeding of selected, small Yucatan swine, was investigated as an animal model of advanced vascular atherosclerosis. Nineteen animals were fed an atherogenic diet for 9.9 +/- 1.