Laparoscopic appendectomy: a review of 95 consecutive suspected cases of appendicitis.

Objective: To assess the feasibility and efficacy of laparoscopic appendectomy.

Design: A review of a case series.

Setting: A single teaching and referral centre in Vancouver.

Multifocal uptake of Tc-99m mebrofenin in dilated liver ductules in a patient with cystic fibrosis.

A patient with cystic fibrosis and a previous cholecystectomy, underwent Tc-99m mebrofenin scintigraphy to rule out hepatobiliary disease. The scan revealed multiple focal collections of radiopharmaceutical within the liver parenchyma. This unusual pattern of multiple focal parenchymal activity may be specific for patients with cystic fibrosis.

Histologically proven pressure sore-related osteomyelitis in the setting of negative technetium bone scans. Case report.

Pressure sores are common in patients with spinal cord injury, stroke or debilitating medical illness. Contiguous osteomyelitis is a well recognized complication of pressure ulcers, but remains a challenging diagnostic and management problem. Technetium bone scan is purported to be an extremely sensitive, although nonspecific diagnostic test for osteomyelitis.

Clinical variability within Brachmann-de Lange syndrome: a proposed classification system.

Seven patients, including two sibs, with the Brachmann-de Lange syndrome (BDLS) are presented as representative of the different types of BDLS in a proposed classification system. Type I ("classic") patients have the characteristic facial and skeletal changes of BDLS using the criteria in the diagnostic index of Preus and Rex. Type I is distinguished from the other subtypes by prenatal growth deficiency (< 2.

Polyvinylchloride containers do not influence the hemodynamic response to intravenous nitroglycerin.

In-vitro evidence of sorption of nitroglycerin (NTG) to polyvinylchloride (PVC) containers suggests that these containers may deliver less nitroglycerin to the patient than glass containers. Sorption of NTG to the PVC container may result in hemodynamic changes in the patient when a fresh solution of NTG is prepared and administered from a PVC container. This study was designed as a prospective, randomized trial to measure the hemodynamic response in patients receiving NTG in glass or PVC containers, during the first hour after a container exchange.

Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment.

The objective of this article is to focus on the antihypertensive agents blocking adrenergic receptors, both alpha and beta blockers, and attempt to construct potential explanations for their effects on lipids in a mechanistic manner. The essential thesis is that adrenergic control of lipid metabolism is responsible for the effect on lipids and lipoproteins of antihypertensive agents that block adrenergic receptors. Agonists and antagonists show the opposite action on lipoprotein lipase, lecithin:cholesterol acyltransferase (LCAT) and LDL-cholesterol uptake by LDL receptors in a manner that might explain the findings of increases in triglycerides and LDL cholesterol with decreases in HDL cholesterol in patients receiving beta blockers without intrinsic sympathomimetic activity and the reverse in patients on treatment with alpha adrenergic receptor blockers.

Laparoscopic gastrointestinal anastomoses.

In a preliminary study of laparoscopic gastrointestinal anastomosis, a gastric outlet obstruction was created under laparoscopic control in six domestic pigs, weighing an average of 25 kg. A simultaneous gastroenterostomy was formed with an end-stapling device. All animals recovered clinically, and good anastomotic healing was documented 1 week postoperatively.

The opioid agonist ethylketocyclazocine accentuates epinephrine-induced cardiac arrhythmias in the rat through an action in the brain.

The purpose of this study was to determine whether the opioid receptor agonist ethylketocyclazocine (EKC) modulates the development of cardiac arrhythmias by an action within the central nervous system. Catecholamine-induced ventricular arrhythmias were produced in the rat by continuous infusion of epinephrine, at incremental doses, until the development of fatal arrhythmias that were usually ventricular fibrillation. EKC, 1 mg/kg, intravenously (IV) significantly (p < 0.

A genetic abnormality of cardiac myocytes from the blind mutant (RC) chick heart: abnormalities of cardiac structure and choline transport.

A new genetic cardiomyopathy was identified in a blind mutant avian strain. Cardiac myocytes were cultured from 7-day-old chick embryos from Rhode Island Red chickens and from another strain of this species that has been identified to have several abnormalities, the most striking of which is blindness. Cardiac myocytes were maintained in tissue culture.

Morphine and the endogenous opioid dynorphin in the brain attenuate digoxin-induced arrhythmias in guinea pigs.

The effects of the opioid receptor agonists morphine and dynorphin on digoxin-induced arrhythmias were examined in guinea pigs that had received intravenous digoxin (50 mu/kg bolus plus 500 mu/kg/hr intravenously). Animals received either morphine (50 or 100 micrograms/kg) or dynorphin A(1-13) (50 or 100 micrograms/kg) or saline (the diluent) into the lateral cerebral ventricle (intracerebroventricularly) prior to digoxin. Morphine and dynorphin produced significant (P < 0.

Fracture of the laryngeal cartilage. An incidental finding on bone scintigraphy.

A patient complaining of headaches and bone pain at multiple sites had Tc-99m MDP scintigraphy performed for possible bone trauma after a motor vehicle accident. Bone imaging revealed a small focal increase in tracer uptake in the area of the laryngeal cartilage. There was some reluctance to place a label on this abnormality because the findings were so unusual.

Bacteremic pneumonia caused by penicillin-resistant pneumococci: Case report and review with a Canadian perspective.

A Canadian adult with bacteremic pneumonia caused by a relatively penicillin-resistant (minimal inhibitory concentration 0.25 μg/mL) Streptococcus pneumoniae is reported, and the published literature regarding penicillin-resistant pneumococci in Canada reviewed. Although penicillin resistance has been reported infrequently to date, this case emphasizes the need for routine antimicrobial sensitivity testing of all pneumococci isolated from normally sterile sites, and for ongoing systematic surveillance for penicillin and other antibiotic resistance in Canada.

Craniosynostosis associated with partial duplication of 15q and deletion of 2q.

We report on an infant with multiple congenital anomalies including complex craniosynostosis associated with an unbalanced karyotype, 46,XY,-2,+der(2),t(2;15)(q37;q26)pat. The previous report of a child with cloverleaf skull and partial duplication of 15q25----qter and the Man-on-Mouse Homology map suggests that a critical segment for synostosis of sutures may be in this region.

Opioid receptor agonists D-Ala-2-Me-Phe-4-Met-(O)-ol enkephalin and ethylketocyclazocine in the brain accentuate digoxin-induced arrhythmias.

Objective: To examine the potential effects of two opioid receptor agonists in the brain on digoxin-induced cardiac arrhythmias and to explore cholinergic mechanisms in any potential effect on arrhythmias.

Methods And Results: Digoxin-induced arrhythmias were produced in guinea pigs (weighing between 280 and 350 g) that received digoxin 50 micrograms/kg intravenous bolus plus digoxin 500 micrograms/kg/h intravenously. Animals received D-Ala-2-Me-Phe-4-Met-(O)-ol enkephalin (FK 33,824) (50 or 100 micrograms/kg), ethylketocyclazocine (EKC) (50, 10 or 1 micrograms/kg) or saline (control) into the lateral cerebroventricle prior to digoxin.

The effect of intraovarian injection of oxytocin and vasopressin on ovulatory function and numbers of ovarian follicles.

Our findings support the clinical use of vasoconstrictor solution within the ovary to achieve hemostasis. This will allow the gynecologist to avoid the thermocoagulative injury to the ovary by replacing electrosurgery and laser surgery with sharp incision accompanied by vasoconstrictor injection.

The calcium antagonist diltiazem has antiarrhythmic effects which are mediated in the brain through endogenous opioids.

The purpose of this study was to examine the hypothesis that the calcium channel blocker, diltiazem, modulates catecholamine-induced arrhythmias through CNS mechanisms. Rats, that had catheters previously inserted into the lateral cerebral ventricle and femoral artery, received diltiazem, 10 or 50 micrograms/kg or the diluent, into the lateral cerebral ventricle (i.c.

Effect of dynorphin A(1-13) on cardiomyocytes in culture: modulation of the response to increased extracellular calcium, but no effect on intrinsic cardiac contractile frequency or the response to isoproterenol or increased extracellular potassium.

The purpose of this study was to determine whether the endogenous opioid peptide dynorphin A(1-13) has a direct effect on the heart or acts to modulate the cardiac chronotropic response to calcium, potassium, or beta-adrenergic receptor stimulation. Spontaneously contracting myocardial cell aggregates were prepared from 7-day-old chick embryos and were maintained in culture for 72 h before study. Dynorphin A(1-13), 10(-8) to 10(-6)M, did not alter spontaneous contractile frequency.

Cilazapril and captopril accelerate recovery from hypoxia in myocardial cell aggregates in culture.

We wished to determine whether angiotensin-converting enzyme (ACE) inhibition alters the effect of hypoxia and reoxygenation directly on the cardiac myocyte; to compare two different ACE inhibitors, one with and one without a sulfhydryl group (i.e., captopril and cilazapril), and to examine the potential interaction of these ACE inhibitors with agents that purportedly prevent the deleterious action of oxygen-derived free radicals.

Effect of antiarrhythmic drugs on choline uptake in cardiac cells in culture.

Objective: The aim was to examine the effect on choline uptake of various antiarrhythmic drugs: lignocaine, tocainide, encainide, flecainide, propafenone, procainamide, N-acetylprocainamide, bretylium, and amiodarone.

Methods: Cardiac ventricular myocytes from 7 d old chick embryos were exposed in culture to these drugs, at concentrations ranging from 10(-6) to 10(-4) M, for 24 h. Myocyte choline uptake was assessed by the addition of methyl [3H] choline to media.

The combined use of vibrostimulation and in vitro fertilization: successful pregnancy outcome from a retrograde specimen obtained from a spinal cord-injured male.

While pregnancies have been documented through the independent use of the vibrator method, from other methods of procuring ejaculate from spinal cord injured men, and from artificial insemination using a retrograde specimen, we believe that this is the first case report of a live birth resulting from a retrograde ejaculate obtained by vibration from a spinal cord-injured male whose partner underwent in vitro fertilization. Vibrostimulation may well be successful in the two-thirds of men whose spinal cord lesions are at the T10 neurological level and above, who have an intact bulbocavernosus reflex and anal tone but no pain or temperature sensation of the genitalia. Blood pressure monitoring, prevention of autonomic dysreflexia, alkalinization, dilution and infection control of urine, and retrograde specimen retrieval are all important techniques to ensure patient safety and optimal ejaculates.

Allergic and inflammatory aspects of chronic rhinosinusitis.

The pathophysiology of rhinosinusitis is complex and poorly understood. Although it is recognized that obstruction of the sinus ostia which is surgically correctable contributes to recurrent bacterial sinusitis, allergic and nonallergic inflammation may contribute to or mimic infectious rhinosinusitis. Those aspects of rhinosinusitis which are not necessarily surgically correctable require consideration and may affect surgical prognosis.

Laparoscopic appendectomy.

In October 1989 the author began a study of laparoscopic appendectomy. This paper presents the preliminary results in 21 patients. Laparoscopy was carried out for diagnosis and 12 patients underwent laparoscopic appendectomy.

Anemia after traumatic spinal cord injury.

The incidence and natural history of anemia in patients with spinal cord injuries (SCI) were investigated in a prospective study of 68 patients consecutively admitted to a regional acute SCI unit. Fifty had SCI and 18 had spine injuries (SI) without neurologic deficit. Thirty-six of 41 males (88%) and six of nine females (67%) with SCI were anemic on at least one occasion.