Oligoclonal T cell receptor gene rearrangements in blood lymphocytes of patients with acute Epstein-Barr virus-induced infectious mononucleosis.

Gene rearrangement studies were performed on blood lymphocytes from eight patients with acute Epstein-Barr virus-induced infectious mononucleosis. The diagnosis in each case was based on characteristic clinical, hematologic, and serologic findings. The blood lymphocytes in each patient consisted predominantly of CD8+ T cells.

Cytomegalovirus pneumonia: computed tomography findings.

Cytomegalovirus (CMV) is a frequent pathogen of the respiratory tract in immunosuppressed patients. The diagnosis of CMV pneumonia frequently requires bronchopulmonary lavage or lung biopsy because the findings on chest radiographs are nonspecific. In only three cases of pure CMV pneumonia has the computed tomography (CT) appearance been described.

A stepless needle-dilator for expedient percutaneous catheterization: technical note.

A new stepless needle-dilator is described which allows arterial puncture and dilation in a single step using a single wall puncture technique. The new needle-dilator causes significantly less arterial damage than a conventional dilator (p less than 0.05).

Cortical thickness and trabecular pattern of the femoral neck as a measure of osteopenia.

The pelvic radiographs of 312 patients aged 18 to 92 years were reviewed to determine if the Singh index was valid or not. The cortical thickness of the lower part of the femoral calcar, the stress index (body weight, physical activity, and femoral neck angle), and the Singh Index (trabecular pattern of the femoral neck) were measured in each patient and correlated with each other and with the patient's age, sex, and dominant side. It was found that the Singh index correlates well with age but not with the cortical thickness or stress index.

The effect of radiation therapy after radical prostatectomy in patients with elevated prostate specific antigen levels.

We analyzed the effects of pelvic radiation therapy given to patients who had an elevated prostate specific antigen level after radical prostatectomy. Among men who previously received adjuvant radiation therapy and had appropriately stored serum 15 had elevated prostate specific antigen levels after radical prostatectomy but before radiation therapy. After radiation therapy the prostate specific antigen level decreased by more than 50% in 80% and to female levels in 53% of the patients.

Prostate specific antigen and local recurrence after radical prostatectomy.

We evaluated the location of recurrent disease in 63 patients with carcinoma of the prostate who had abnormal levels of prostate specific antigen (greater than 0.4 ng./ml.

The role of timing of high-dose cytosine arabinoside intensification and of maintenance therapy in the treatment of children with acute nonlymphocytic leukemia.

The Children's Cancer Study Group instituted a pilot study to investigate the use of high doses of cytosine arabinoside (AraC) in the intensification phase of treatment for acute nonlymphocytic leukemia (ANLL). Patients achieving remission and not eligible for allogeneic bone marrow transplantation were treated with four doses of high-dose AraC and L-asparaginase. These drugs were repeated either on or after 28 days (q28 days), after recovery of hematologic parameters (for the first 49 patients entered onto this trial); or after 7 days (q7 days), despite dropping blood counts (for the last 53 patients enrolled).

Postnatal growth and development of the flexor tendon pulley system.

The number, type, position, and size of the pulleys of the flexor tendon sheath of preserved cadaver hands from children ranging in age from newborn to 15 years were studied by dissection, observation, direct measurement, and radiographic evaluation. These studies delineated flexor tendon pulley development and their locations in the developing hand. Pulley positions are relatively constant throughout postnatal development, with the gross anatomic characteristics correlating closely to those of the adult hand.

Management of cutaneous reactions and mechanical complications of central venous access devices in pediatric patients with cancer: algorithms for decision making.

Surgically placed central venous catheters (CVCs) facilitate the delivery of medication and nutrition support for patients with malignant disease. There is little information regarding allergic reactions to materials used for standard CVC care or about mechanical complications associated with CVC use. This study describes allergic and mechanical complications that occurred in a series of 288 CVCs implanted in 238 pediatric patients with malignant disease.

Fundamental issues in the care of homosexual youth.

The development of a homosexual identity spans the entire life cycle, but adolescence is a critical period in the lives of gay and lesbian persons. Various pre- and postnatal biologic and environmental factors are thought to determine sexual orientation early in life. An emerging homosexual identity may be reflected in youths' sexual attractions, fantasies, and cultural affiliations, as well as their behaviors.

Mechanisms of antiepileptic drug action.

Animal seizure models, in vitro preparations of cell cultures and tissue slices, and an unravelling of some of the basic mechanisms underlying epileptogenesis and epilepsy have furthered the understanding of mechanisms of action of antiepileptic drugs at the cellular and subcellular levels. Nevertheless, the mechanism of action of most antiepileptic drugs in clinical use is incompletely understood. Multiple physiologic mechanisms are altered by antiepileptic drugs.

The inferior vena cava clip. The percutaneous approach.

Pulmonary embolism in high-risk patients may be minimized by surgical inferior vena cava (IVC) clipping or by the insertion of caval filters. A percutaneous clipping technique was developed that narrows the cava while allowing caval patency. The caval clip is inserted through a percutaneous translumbar approach under fluoroscopic control.

Pharmacodynamic response to ionized calcium during acute sepsis.

Ionized Ca (Ca2+) is essential for maintaining physiologic functioning in the cardiovascular system (CVS). Sepsis affects the CVS by several mechanisms and is associated with decreased serum Ca2+. The pharmacodynamic response of the CVS to serum Ca2+ alteration was compared in acutely septic and nonseptic dogs at serum Ca2+ levels of 50%, 100%, 150% and 200% of normal baseline values.

Percutaneous balloon dilation of ureteral strictures after failed surgical repair in children.

We attempted treatment of long-standing strictures of ureterovesical or ureterosigmoid anastomosis in 6 children by percutaneous balloon dilation. The 4 girls and 2 boys were between 2 and 19 years old (mean age 9 years) at the time of dilation. Obstruction occurred at the ureterosigmoid anastomosis in 3 patients and at the ureterovesical junction in 3.

The role of radiology in the diagnosis and treatment of biliary complications after liver transplantation.

Hepatic transplantation is now an accepted therapeutic option for selected patients with terminal liver disease. Biliary complications are, however, relatively common after transplantation. We reviewed our experience with diagnostic and therapeutic biliary radiologic procedures in 151 hepatic recipients.

A useful projection for demonstrating the bifurcation of the pulmonary artery.

The demonstration of the pulmonary bifurcation is important in order to exclude pulmonary branch stenoses. The origin of the right and left pulmonary arteries can be demonstrated in the anteroposterior plane if cranial angulation is used. Depending on the course of the left pulmonary artery, the origin of the left pulmonary artery may not be seen in spite of the maximal cranial angulation.

Methods in pathology. Immunophenotype of hairy cell leukemia in paraffin sections.

The immunophenotype of hairy cell leukemia (HCL) was investigated using 20 routinely fixed paraffin-embedded tissue sections (12 bone marrows, six spleens, one liver, one lymph node) from 12 patients known to have this disease. A panel of antibodies was used, including anti-leukocyte common antigen (anti-LCA), B-lineage antibodies (LN2, MB2, L26), T-lineage reagents (MT1, UCHL1), monocytic (anti-cathepsin B) and myelomonocytic (anti-lysosyme, Mac 387) antibodies, and other less lineage-specific markers (anti-S-100, anti-alpha-1-antichymotrypsin (anti-alpha 1-ACT), anti-alpha 1-antitrypsin (anti-alpha 1-AT), anti-vimentin). Anti-LCA stained hairy cells in seven of the 12 bone marrows and consistently recognized hairy cells in the spleen, liver, and lymph nodes.

A new mechanical lithotripter for the treatment of large common bile duct stones.

A prospective uncontrolled multi-center trial of a prototype mechanical lithotripter was performed in 30 patients with common bile duct calculi. Standard endoscopic sphincterotomy had failed to remove all stones, primarily because of large size (26 patients). Stone size ranged from 13 to 35 mm.

The effect of applicator geometry on dose specification in cervical cancer.

The effect of variation of applicator geometry on classic parameters of dose specification was studied in 90 Fletcher-Suit radium applications in women with cervical cancer. Five statistically significant factors were identified by multiple linear regression analysis and quantified: mg of radium in the colpostats, mg of radium in the tandem, lateral displacement of the colpostats in the frontal plane, vertical separation between the colpostat and tandem sources, and anterior-posterior displacement of the colpostats relative to the tandem. These factors were used to predict "traditional" (i.