Growth hormone response to L-dopa and clonidine in autistic children.

Studies have shown abnormal pituitary hormone responses to neuroendocrine agonists in autistic subjects. Two probes (clonidine and L-Dopa) were used to investigate neuroendocrine responses through changes in growth hormone levels. Seven medication-free autistic subjects (ages 6.

Epidermoid cyst (monodermal teratoma) of the testis.

We report 14 patients with epidermoid cyst of the testis (monodermal teratoma). In 7 patients (5 treated within the last 5 years) the mass was excised and adjacent testicular tissue was biopsied. Seven patients underwent radical inguinal orchiectomy.

Spindle and epithelioid cell nevus (Spitz nevus). Natural history following biopsy.

A clinical follow-up study of 49 cases of spindle and epithelioid cell nevus is presented to address the question about the potential for local recurrence. Only 19 (39%) of the 49 lesions were initially excised en toto, and the remainder (30 cases) had positive margins; six of the latter spindle and epithelioid cell nevi were reexcised, and no evidence of a residual nevus was found in five of the six cases. There were no recurrences in the 49 patients during an average follow-up period of 5.

The systemic septic response: concepts of pathogenesis.

Following resuscitation from shock, the clinical phase of persistent hypermetabolism is entered from which a substantial number of patients transcend into progressive organ failure and expire. The available epidemiologic, physiologic, and metabolic data are consistent with the position that a persistent degree of microcirculatory hypoxia, although it may be present in amounts that are below the sensitivity of current detection systems, becomes an increasingly less important etiologic factor as the organ failure disease progresses. Rather, aerobic metabolism appears to be the dominant mechanism of meeting the increased work loads and energy demands.

Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study.

A total of 17 patients with intestinal urinary diversion of enterocystoplasty underwent renal transplantation between 1970 and 1988. Patient age ranged from 4 to 35 years (mean age 20 years). The patients were divided into 2 groups.

Inhibition of endogenous superoxide dismutase with diethyldithiocarbamate in acute island skin flaps.

Oxygen free radicals have been implicated in postischemic tissue damage in a variety of experimental models including the island skin flap. Previous studies have demonstrated that supplementing animals with exogenous superoxide dismutase (SOD), a free radical scavenger, improves tissue survival in island flaps. No studies to our knowledge have attempted to inhibit endogenous SOD in a skin flap model.

Deleterious effects of high magnesium diets and beneficial effects of high potassium diets in hypertensive stroke-prone rats.

The effect of varying amounts of dietary magnesium (Mg) in conjunction with potassium (K) on hypertension and stroke mortality in hypertensive stroke-prone (SHRsp) rats was studied. These results show that high K (2.1%) diets strongly protect against stroke mortality and rises of blood pressure, while high Mg (0.

Growth hormone enables effective nutrition by peripheral vein in postoperative patients: a pilot study.

The purpose of this pilot study was to investigate the metabolic effects of growth hormone (GH) (Humatrope, Eli Lilly & Co., Indianapolis, IN) administration in postoperative (PO) patients receiving peripheral vein nutrition. Seven, well-nourished, nondiabetic patients undergoing elective surgical procedures were given either no drug (n = 3), GH 30 micrograms/kg/day (n = 2), or GH 60 micrograms/kg/day (n = 2) sub-Q daily until eating, up to 7 days PO.

Patient acceptance of and satisfaction with an external negative pressure device for impotence.

Patient acceptance of and satisfaction with an external negative pressure device as a treatment for impotence were retrospectively analyzed among 100 men. The over-all satisfaction rate was 68%. Reasons for dissatisfaction with and discontinuing the use of the device included premature loss of penile tumescence and rigidity, pain or discomfort either during application of suction or during intercourse and inconvenience.

CT evaluation of atypical hepatic fatty metamorphosis.

Focal fatty metamorphosis of the liver is a well-recognized entity characteristically demonstrated by a nonspherical, low-density area without mass effect. We present a case of focal fatty metamorphosis of the liver that shows multiple areas of low attenuation within the liver with mass effect. Radionuclide liver-spleen scan shows multiple focal defects corresponding to the areas of fatty metamorphosis.

Therapeutic embolization: enhanced radiolabeled monitoring.

Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles.

Problems in the long-term renal allograft recipient.

Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients are still significant. Cardiovascular disease accounts for much of the mortality in long-term survivors; screening before the transplant procedure and adequate control of hypertension should help improve patient survival. Many of the gastrointestinal complications are due to overimmunosuppression and sepsis.

Problems related to immunosuppression. Infection and malignancy occurring after solid organ transplantation.

Renal transplantation is associated with many long-term complications caused by a combination of the patient's comorbid medical illnesses and the effects of the various maintenance immunosuppressive agents currently in use. Careful patient selection with an emphasis on adequate cardiovascular function and low maintenance doses of immunosuppression at a level compatible with graft acceptance should help to prevent significant long-term morbidity. Recurrence of the original renal disease is a common histologic finding but, except in a few diseases, rarely results in graft loss.

Pancreas transplantation.

Widespread application of pancreas transplantation in diabetic patients without secondary complications or without a demonstrated propensity to develop complications will not be possible until antirejection strategies with fewer side effects have been developed. For now, pancreas transplants are restricted to patients whose complications of diabetes are more serious than those associated with chronic immunosuppression and the drugs necessary to prevent rejection. In these individuals, however, pancreas transplantation should be considered an established therapeutic procedure.

Cardiac transplantation.

With the advent of cyclosporine and triple-drug therapy, cardiac transplantation has developed from a curiosity into an effective therapy. Optimal results require proper recipient selection, careful donor identification and preparation, and skillful surgical and postoperative care. Recent trends to expand the donor and recipient pools will result in an amplification of the problems encountered to date.

Liver transplantation.

Organ transplantation offers increased survival and improved quality of life to many patients with end-stage liver disease. Major advances in this field have included better organ acquisition and preservation as well as improved intraoperative techniques and management. An additional major factor in improved survival of transplant recipients is the elevated level of care available in intensive care units.

Renal transplantation.

Results of renal transplantation have markedly improved in the last decade. Patients previously defined as high risk (those aged greater than 50 years, infants, diabetics, and those with extra renal disease processes) can now be transplanted with excellent outcomes. Living related donors are preferred because of the improved success rates.

General principles of perioperative transplant care.

Along with the development of more specific and potent immunosuppressive agents, improvements in perioperative care of the allograft recipient have made transplantation of nonrenal organs a reality and contributed greatly to overall improvements in graft and patient survival. Thorough pretransplant evaluation, intensive care therapy and monitoring (when indicated), and meticulous postoperative care are essential to a successful outcome and to minimize the occurrence of complications.

Principles of immunosuppression.

One-year graft survival rates of 80% to 90% can now be achieved routinely for primary cadaveric transplants with a variety of CSA-containing regimens. Further improvement of these excellent results may be difficult because large numbers of patients must be evaluated to provide meaningful conclusions. On the other hand, long-term follow-up of CSA-treated patients has revealed a trend of undaunted allograft attrition with time.

The organ donor.

Vascularized organ transplantation is now a widely applied therapy for patients with end-stage diseases of the heart, lungs, liver, kidneys, and pancreas. A critical shortage of donor organs exists in the United States and, as a consequence, prospective transplant recipients die while waiting for a life-saving transplant. The apparent shortage of cadaver organs is, in large part, caused by the reluctance and failure of the physician and the public to promote cadaver organ donation.

Solid organ transplantation. Where has it been, where is it going?

Current developments in the field of clinical transplantation have led to the proliferation and expansion of the indications for various surgical procedures. Elderly patients, individuals who are at high risk of developing complications during or after the transplant procedure, and extremely ill individuals whose only chance of survival is an immediate transplant increasingly are being considered as potential recipients. The often complex nature of the underlying disease of the transplant patient, the magnitude of the transplant procedure itself, and the potential severity of ensuing complications that are often unique to this group of patients frequently lead to examination and treatment of the patient in the intensive care unit.

Is altruism enough? Required request and the donation of cadaver organs and tissues in the United States.

The lack of an adequate supply of cadaver organs and tissues for transplantation to those in need poses a major challenge to the transplant community and to those responsible for public policy. Historically, Americans have relied upon a combination of altruism and voluntarism to generate an adequate supply of cadaver organs and tissues. The ongoing shortage of organs and tissues has led, in recent years, for calls to abandon these values in favor of either a market system or a system of presumed consent.

Improved method for identifying alpha 1-antitrypsin Pi M subtypes by isoelectric focusing in agarose.

We describe an improved method for the classification of alpha 1-antitrypsin variants by isoelectric focusing in agarose. Identification of the three Pi M subtypes can now be made by using a narrow-range carrier ampholyte (pH 4.2-4.

Pseudo-intracardiac air in a heart-lung transplant patient.

Air in the heart is a serious condition and may be life-threatening. It is usually of iatrogenic origin or the result of trauma. Computed tomography of a heart-lung transplant recipient who had unilateral hydropneumothorax revealed a mediastinal gas collection that appeared to be intracardiac.