Aberrant PO2 values in proficiency testing.

We prospectively determined the frequency of aberrant vials of fluorocarbon/buffer used for proficiency testing of measurements of pH, PCO2, and PO2, using 20 duplicate vials from 12 lots of fluorocarbon/buffer and two arterial blood gas analyzers in eight reference laboratories. We defined aberrant vials as vials for which both duplicate measurements differed from the mean value of repeated measurements for the specific instrument (for each lot of testing materials) by > 0.04 for pH, > 10% of the mean or 3.

Hematologic effects of stem cell factor alone and in combination with G-CSF and GM-CSF in vivo and in vitro in rodents.

The intravenous injection of rrSCF causes neutrophilia and lymphocytosis as well as the appearance of immature myeloid cells and occasional blast cells in the circulation. The marrow shows a left-shifted myeloid and erythroid hyperplasia as evidenced by increases in numbers of morphologically recognizable early myeloid and erythroid precursors. A decrease in the number of mature marrow neutrophils is noted, suggesting that the release of marrow neutrophils contributes to the peripheral neutrophilia.

Surgical management of the thyroid nodule: patient selection based on the results of fine-needle aspiration cytology.

To determine whether the routine use of fine-needle aspiration (FNA) cytology reduces the rate of unnecessary surgery, the surgical pathology of 54 thyroidectomy patients who had preoperative FNA was compared to the results obtained with 24 thyroidectomy patients who did not have preoperative FNA. Twenty-nine (85.3%) of the 34 patients who had a positive FNA were confirmed by histology to have a thyroid neoplasm; in 24 patients, the neoplasm was malignant.

Inadvertent ligation of the aberrant right hepatic duct at cholecystectomy: radiologic diagnosis and therapy.

Aberrant right hepatic ducts are the most common biliary tract anomaly and are particularly susceptible to injury at cholecystectomy because of their critical location. The authors report radiologic diagnosis and therapy in five cases of inadvertent ligation of this duct at cholecystectomy. The diagnosis was unsuspected prior to the radiologic studies in each patient.

Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety.

The authors describe the technical results in 127 patients who underwent diagnostic gallbladder puncture and percutaneous cholecystostomy. The procedures were performed for a variety of indications including treatment of acute calculous or acalculous cholecystitis, drainage of obstructive jaundice or gallbladder perforation, percutaneous removal or dissolution of gallstones, diagnostic cholecystocholangiography, and gallbladder biopsy. Successful completion of the intended procedure was achieved in 125 of 127 patients (98.

Effects of lidocaine on relation between defibrillation threshold and upper limit of vulnerability in open-chest dogs.

Background: The purpose of the present study was to test the effects of lidocaine on the relation between the defibrillation threshold and the upper limit of vulnerability.

Methods And Results: The shock strength associated with a 50% probability of successful defibrillation (DFT50) and the shock strength associated with a 50% probability of reaching the upper limit of vulnerability (ULV50) were determined in 11 open-chest dogs by using the delayed up-down method before and during lidocaine (seven dogs) or normal saline (four dogs) infusion. The ventricles were paced at a cycle length of 300 msec.

A simple method to lock large mushroom-tip catheters.

Dislodgment is a major drawback with large-bore Malecot catheters. A locking mechanism with a suture affixed to the distal portion of the mushroom tip is described. In a 32-month period, 17 Malecot catheters with locking mechanisms were placed in 15 patients.

Human secretory and serum antibodies recognize environmentally induced antigens of Giardia lamblia.

The variability in duration and severity of infection with Giardia lamblia is likely to be due to trophozoite interactions with immune and nonimmune components of the small intestinal milieu. Despite its potential importance, nothing is known of the isotype or the specificity of the secretory antibody response to G. lamblia.

Magnetic resonance imaging of foot neuromas.

The authors review the entity of traumatic intermetatarsal neuroma. A thorough evaluation with the aid of magnetic resonance imaging is illustrated. This can be a beneficial modality in the initial identification, or differentiation of recurrent, pathologic lesions.

Characterization of immunodominant surface antigens of Haemophilus somnus.

An immunodominant Haemophilus somnus outer membrane protein with an apparent molecular mass of 40 kDa on Western blots (immunoblots) of gradient sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels was characterized because a monospecific antibody against this antigen was protective. This monospecific antibody was used for immunoaffinity purification of the antigen. The immunoaffinity-purified antigen reacted with a polyclonal antibody to the 40-kDa antigen but not with a monoclonal antibody (3G9) which reacted with the 40-kDa antigen in gradient gels.

A survey of nurses' knowledge, opinions, and reported uses of the Body Substance Isolation system.

The Body Substance Isolation (BSI) system was implemented at the University of California San Diego Medical Center in May 1987. About 2 years later, an evaluation was done of the long-term effects of BSI education and training on the knowledge, attitudes, and reported behaviors of nursing personnel. In June 1989, a questionnaire was sent to 600 nursing personnel, including all 100 nurses in the 20-bed surgical intensive care unit, all 66 charge nurses, and a random sample (434) of the remaining nursing staff (about 1000).

Endocrine responses to long-term administration of the antiprogesterone RU486 in patients with pelvic endometriosis.

Objective: To examine endocrine and clinical responses to long-term administration of RU486 in patients with endometriosis.

Design: Prospective open trial.

Setting: Faculty practice of the authors.

Percutaneous dissolution of gallstones.

Contact dissolution with MTBE is an effective and safe method to treat symptomatic patients with cholesterol gallstones. Personnel, time, and safety factors have limited widespread use of the procedure. With current competing methods to treat gallstones, it is likely that MTBE use will be reserved for those patients who elect percutaneous therapy due to fear of surgery or anesthesia and in those elderly patients who are compromised by underlying medical conditions.

An interesting case presentation: ultrasound diagnosis of primary atrial thrombosis associated with brain infarctions.

A premature infant with nonbacterial endocardial thrombosis and embolization of the cerebral circulation is presented. The patient was born at 32 weeks with a birthweight of 1480 g. Pregnancy was complicated by toxemia and placental infarctions.

Hodgkin's disease in children 4 years of age or younger.

The natural history of Hodgkin's disease in children younger than 4 years of age is unknown. Thirty-eight patients younger than 4 years of age at the time of diagnosis of Hodgkin's disease were treated at the member institutions of the Pediatric Oncology Group. They were found to be predominantly white and male with early-stage disease.

Epinephrine synthesis by rat arteries.

Carotid artery and aorta homogenates synthesized epinephrine (E) from norepinephrine (NE) in the presence of S-adenosylmethionine. Aorta synthesized epinine by the N-methylation of dopamine (DA) about 3 times as well as it synthesized E from NE. In contrast, adrenal homogenates which contain phenylethanolamine N-methyltransferase (PNMT) methylated DA only 1% as well as NE.

Intracoronary urokinase for intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty in acute ischemic syndromes.

Intracoronary urokinase was used to treat flow-limiting intracoronary thrombus accumulation that complicated successful percutaneous transluminal coronary angioplasty (PTCA) during acute ischemic syndromes in 48 patients who were followed up through the acute phase of their illness. The study group comprised 10 patients with unstable angina pectoris, 18 patients with an evolving acute myocardial infarction, and 20 patients with postinfarction angina. The initial mean percent coronary diameter stenosis for the entire population was 95 +/- 7% and decreased with initial PTCA to 41 +/- 20% (p less than 0.

Analysis of workload and staffing requirements for a critical-care satellite pharmacy.

A study to determine the workload and the staffing requirements of a proposed critical-care satellite pharmacy is reported. Data for all patients admitted to the adult surgical intensive-care units (SICUs) of an acute-care teaching hospital were recorded for 30 days. Both clinical and distributive data were collected, such as the number and times of patient admissions to the SICUs, the times medication orders were written and their nature, the number and types of drugs administered per patient per day, the number of medication profile reviews per day, and the number and types of interventions.

Sources of urinary catecholamines in renal denervated transplant recipients.

When a human kidney is transplanted, sympathetic nerves to that kidney are cut. We infused 3H-noradrenaline and then measured noradrenaline, dopamine and 3H-noradrenaline levels in the plasma and urine of renal transplant recipients and uninephrectomized control subjects. Less than 10% of 3H-noradrenaline cleared from the plasma appeared in the urine.

Iatrogenic injury to the bile duct. Who, how, where?

We reviewed 81 patients with bile duct injuries that occurred at cholecystectomy and/or common bile duct exploration. Thirty-two of the strictures were recurrent. The median follow-up was 9 years.

Modulation of mast cell responses to adenosine by agents that alter protein kinase C activity.

The acute incubation of mouse bone marrow-derived mast cells with low concentrations of agents known to activate protein kinase C [phorbol myristate acetate (PMA), 1,2-dioctanoyl-sn-glycerol (diC8), and 1-oleoyl-2-acetyl-glycerol (OAG)] caused an enhancement of beta-hexosaminidase release stimulated by the calcium ionophore A23187. Higher concentrations of protein kinase C activators tended to inhibit A23187- or antigen-induced preformed mediator release. All concentrations studied induced a striking mast cell hyporesponsiveness to the mediator release augmenting effect of adenosine.

Percutaneous cecostomy for Ogilvie syndrome: laboratory observations and clinical experience.

Percutaneous cecostomy (PCC) was evaluated in dogs and cadavers and by means of review of intraperitoneal contrast material-enhanced computed tomographic (CT) scans and clinical experience in five patients with Ogilvie syndrome. It was shown that PCC can be accomplished with a variety of techniques (e.g.