Unretrieved gallstones presenting as a Streptococcus bovis liver abscess.

We describe a case of a delayed liver abscess presenting two years after a laparoscopic cholecystectomy. At exploration, the patient was found to have an unretrieved gallstone as the nidus for the Streptococcus bovis abscess.

Extracorporeal support of oxygenation and ventilation.

The management of the patient with respiratory failure is instituted in step-wise fashion. Each successive step requires higher levels of intervention. The final level of support when all conventional means fail is the use of ECMO.

Treatment of hepatic veno-occlusive disease with low-dose tissue plasminogen activator: impact on coagulation profile.

An 18-year-old white male developed severe hepatic veno-occlusive disease (VOD) during an autologous bone marrow transplant for primary refractory nodular sclerosing Hodgkin's disease. As a result of VOD-induced hepatic dysfunction, coagulation studies revealed depression of vitamin K dependent procoagulant factor VII. Intravenous recombinant tissue plasminogen activator 20 mg over h on 4 consecutive days and continuous heparin infusion (1000 unit bolus followed by 150 units/kg/day) resulted in rapid reversal of the VOD syndrome.

Intraoperative stimulation of pedicle screws: a new method for verification of screw placement.

Pedicular fixation of the lumbosacral spine has become a popular procedure for improving fusion rates. Even in experienced hands, it can be associated with a significant rate of screw malpositioning and potential nerve root injury. In this report, we describe a technique for improving screw localization utilizing evoked electromyography responses from direct stimulation of pedicle instrumentation.

Direct cardiac massage without major thoracotomy: feasibility and systemic blood flow.

Background: Open-chest cardiac massage (OC-CM) provides higher blood pressure and flow than closed-chest compression and may improve the probability of successful resuscitation from cardiac arrest. Its clinical use has been limited by its requirement for a major thoracotomy. The present pilot study tested the technical feasibility of performing effective direct cardiac massage without a major thoracic incision, by using a simple, manually-powered plunger-like device, inserted through a small thoracic incision, to cyclically compress the cardiac ventricles.

An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy.

During a 2-year period (1988-1989), 23 cases of anterior cervical discectomy were performed with cadaveric fibular allograft instead of autologous iliac crest graft. The mean age of the patients was 35 years. There were 10 men and 13 women.

Blood-flow measurements of injured peripheral nerves by laser Doppler flowmetry.

The effects of injury on peripheral nerve blood flow were studied, using a Laserflo blood perfusion monitor. A total of 11 nerves were studied, five normal and six injured nerves in four patients. Two of the patients had lacerating brachial plexus injuries, and two other patients had compressive neuropathies of their ulnar nerves at the elbow.

Kinetics of L-glutamate influx in single barnacle muscle fibers under 0-trans conditions.

The dependence of L-glutamate influx on extracellular Na and L-glutamate concentrations was determined using internally dialyzed single muscle fibers of Balanus nubilus. Internal Na and glutamate concentrations were held at zero, and the cell membrane potential was constant. Flux activation curves for external glutamate were measured for five different external Na concentrations, and flux activation curves for external Na were measured independently for three different external glutamate concentrations.

Routine use of etomidate and temporary vessel occlusion during aneurysm surgery.

This study included 72 cases of surgically treated aneurysms, Hunt and Hess Grades 1-4, operated on within 72 hours of the ictus. All had anterior circulation aneurysms, and exposure was standard pterional approach. Once dissection had progressed to the point that the site of the aneurysm was identified, the patient was placed in burst suppression (6-8 bursts/minute), using etomidate 0.

Intraepithelial neoplasia of the lower genital tract.

The incidence of CIN, VIN, and VAIN has increased dramatically in recent years due to a true increase in disease incidence as well as improved screening methods. Associated high-risk factors in the development of intraepithelial neoplasia are known, and effective treatment modalities are available. With the use of diagnostic techniques, patient education, and selection and utilization of appropriate therapies, intraepithelial neoplasia of the lower genital tract remains a disease that should not affect long-term morbidity, social status, or mortality of female patients.

Determination of platelet adhesion to collagen and the associated formation of phosphatidic acid and calcium mobilization.

A method was developed to study the adhesion of platelets to fibrillar collagen at 37 degrees C in the absence of aggregation. Human platelets were labeled with [3H]-oleic acid, gel-filtered, and incubated with collagen in the presence of receptor antagonists to thromboxane A2, 5-hydroxytryptamine, and platelet-activating factor, as well as a fibrinogen/fibronectin inhibitor and an ADP-removing system. Those platelets that adhered to collagen were separated from those that did not by filtration through a 10-microns nylon mesh and the extent of platelet adhesion was quantitated by determination of the radioactivity retained by the mesh.

Calcium channel blockers. Progression of renal disease.

Once initiated, chronic renal disease inexorably progresses to end stage. Recent studies of various experimental renal disorders have shown that normalization of glomerular capillary flow and pressure, either by restricting protein intake or by administering converting enzyme inhibitors, slows this progression. Because the hemodynamic actions of Ca2+ channel blockers modify the angiotensin II-induced renal changes, these drugs have the potential for altering the course of renal disorders.

L-glutamate transport in internally dialyzed barnacle muscle fibers.

The transport of L-glutamate (Glu) by single muscle fibers of Balanus nubilus was studied by means of internal dialysis in an effort to obtain transport data under well-defined intracellular conditions. It is shown that the method effectively controls the sarcoplasmic amino acid composition and Glu metabolism. It was found that the classic neutral amino acid transport systems are either absent or inactive, while Glu is strongly transported by a single system.

Effect of heparin on the inhibition of the contact system enzymes.

1. One can accurately predict the contribution of each inhibitor to the total inactivation of an enzyme in plasma once its pseudo-first-order reaction rate constant and concentration are known. 2.

Proteolytic studies on the structure of bovine von Willebrand factor.

Bovine von Willebrand factor (vWF) was digested with protease I (P-I), a metalloprotease isolated from rattlesnake venom. Digestion of vWF for 24 h with P-I yielded a terminal digest consisting of an equimolar mixture of two major fragments (apparent Mr 250K and 200K). The 250-kilodalton (kDa) fragment consists of a 125-kDa chain from one subunit and a 45- and 78-kDa polypeptide chain from an adjacent subunit.

Selection of electrophysiological tests in patients with suspected multiple sclerosis.

If we accept the criteria set by McDonald and Halliday and by the Boston University WorkShop that one of the two lesions in patients with multiple sclerosis may be determined by electrophysiological tests and if we recognize that medical economics sets a limit to indiscriminate use of tests for clinical purposes, we need to pay particular attention to the selection of diagnostic tests. If we accept that certain anatomical predilections of plaques at the onset of multiple sclerosis correlate to a limited extent with long-term prognosis as suggested by Kurtzke, Rosati and Visscher, particularly with the relation to the disability and mortality, we need to pay more attention to the discovery of symptoms and signs as soon as possible utilizing clinical and laboratory data. As of now, the frequency of symptoms and signs at the onset of multiple sclerosis, with minor variations, seem to indicate that motor signs (pyramidal and cerebellar) head the list.