Biomedical subjects
Publications and source records attributed to E Thomas.
The authors present an unusual case of a highly mobile gallbladder which simulated a pancreatic mass on computed tomograms. Radiographic features of this interesting variant are illustrated.
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Effective prophylactic antimicrobial therapy for recurrent urinary tract infections depends upon the creation of minimal antimicrobial resistance in the fecal and vaginal flora. Cephalexin is known to be useful for prophylaxis clinically but substantial resistance has been reported in vaginal and rectal Escherichia coli at doses of 2 gm. per day. The effect of 250 mg. cephalexin nightly was studied in 23 women with recurrent bacteriuria who were treated for 6 months. Of the 23 patients 22 remained free of infection for 132 months of observation. Despite heavy carriage of Escherichia coli in the rectal and vaginal reservoirs during therapy, Escherichia coli resistant to 32 micrograms per ml. cephalexin did not occur. These observations explain the prophylactic effectiveness of cephalexin when used in small amounts of single nightly dosages.
Speed-accuracy trade-off characteristic of horizontal saccadic eye movements were examined in this study. Unlike limb movements, saccadic eye movements are preprogrammed, unidimensional, and do not involve target impact. Hence, they provide an optimal test of the impulse variability account of the speed-accuracy trade-off in rapid movements. Subjects were required to alternately look at two target lights as fast and as accurately as possible for a period of 10 s. Target lights subtended angles of 5, 10, 15, and 20 degrees. By restricting target distances to less than 20 degrees of arc, the speed-accuracy relation was examined for single horizontal saccadic movements of the eye. movement of the dominant eye was tracked with an infra-red eye monitoring device. Fifty saccadic movements of the eye were recorded for each target distance and used to compute the average amplitude, duration, and velocity of eye movements, as well as, movement endpoint variability. An increase in both average velocity and movement endpoint variability with increasing movement amplitude was found. This, together with the unique features of the eye movement system, support the impulse variability account of the speed-accuracy trade-off in rapid movements.
Persistent jaundice and abdominal distention were noted postoperatively in a 37-year-old white male who had undergone splenectomy and suture of a liver laceration following a motorcycle accident. Abdominal paracentesis yielded bile-stained fluid. Endoscopic retrograde cholangiography (ERC) demonstrated rupture of the hepatic duct at its bifurcation which had been missed on initial laparotomy. ERC was valuable in planning and subsequently performing a hepatojejunostomy. We found no previous report of using ERC to diagnose and locate a missed bile duct injury.
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Mice previously latently infected with the F strain of herpes simplex virus type 1 (HSV-1) can be successfully colonized with a second virus strain if HSV-2 is introduced at the same peripheral site as HSV-1. On the other hand, HSV-1 strains seemed able mutually to exclude establishment of latency with each other. Mice (3 months or 3 years after nasal infection) latently infected with HSV-1 were thus superinfected with HSV-2. The mice were sacrificed 2 days post-infection when HSV-2 replication in the ganglia was found to have commenced. Ganglia were homogenized immediately and virus was plaqued on permissive cells. HSV-1 plaques were regularly obtained among HSV-2 plaques as assessed by staining with an enzyme-linked immunosorbent using a type-specific monoclonal antibody recognizing glycoprotein C of HSV-1. DNA from this virus had identical restriction endonuclease patterns (EcoRI, BamHI and HindIII) to the F strain used to infect the animals latently. HSV-1 was not retrieved from ganglia of controls superinfected with a neuroadapted vaccinia virus or were mock-superinfected. The results suggest that it is possible to superinfect a latently infected ganglionic neuronal cell with a heterotypic HSV strain and that the subsequently introduced HSV-2 can act in trans to induce reactivation of latent HSV-1.
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Rats with a portacaval anastomosis are known to be susceptible to develop uric acid stones. The present studies were undertaken to investigate urinary Mg, Ca and oxalate excretion in such rats. We found that their Mg excretion was doubled, Ca excretion tripled, and oxaluria somewhat decreased. The Ca crystallization attributed to the increased Ca2+ in the urine is, therefore, somewhat held in check by the increased presence of Mg in the urine and by decreased oxalates.
This is a study of 34 cases of lumbar spinal stenosis operated in the University Department of Orthopaedic Surgery from August 1973 to April 1980. Eleven cases were due to degenerative stenosis, 4 due to degenerative spondylolisthesis, 1 developmental, 3 post-fenestration/laminectomy, 1 post-fusion and 14 cases were due to combined aetiology. The average length of follow-up was 2.3 years. The clinical radiological and operative diagnostic features were analysed. Decompression alone was performed in 16 cases. Discectomy was also carried out in 16 cases and primary fusion in 3 cases. Good relief of backache, sciatica and neurogenic intermittent claudication was achieved in most cases. The majority were also able to return to their previous occupation, the average time taken being 4.9 months. 77% of cases gave either excellent or good results. The complications were spinal instability in 2 cases, impotence in 1 case, intra-operative nerve root damage in 2 cases and superficial wound infection in 1 case. Further surgery (lateral gutter fusion) was performed in only 1 case.
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Pure calcium oxalate monohydrate lithiasis is rare--about 5 to 10% of total renal lithiases. The proportion is the same in men and women. Pure calcium oxalate stones are a polished dark brown color, and are very hard. They are visualized radiologically as regular and homogeneous. From a biological standpoint, this type of stone is frequently associated with normal calciuria and oxaluria. Pure calcium oxalate monohydrate stones rarely evolve.
Two successive experiments on rats confirm that a portocaval shunt leads to a substantial increase in uricosuria, which does not climax in the first week postoperatively. Clofibrate, an inductive liver enzyme, significantly reduces the uricosuria, but only after a certain timelag. Uricosuria, the degree of which varies with individual rats, leads to crystallization of uric acid, mainly in the form of ammonium urate, but polyuria secondary to portocaval shunt tends to inhibit the crystallization. A reduced water intake one day out of two facilitates the crystallization after a portocaval shunt.
Three tumor cell subpopulation lines derived from a single, spontaneously occurring BALB/cfC3H mammary tumor were evaluated for their ability to cause a leukemoid effect in mice. One of the BALB/cfC3H tumor cell lines (410.4) produced leukocytosis with neutrophilia, hypercalcemia, and thymic atrophy. A second line (66) produced none of these effects. The third line (168) was intermediate in its ability to affect neutrophil counts and splenomegaly but did not produce thymic atrophy or hypercalcemia. These studies demonstrated that the hemopoietic effect of tumor cells derived from a single tumor was variable and that a tumor cell line which caused neutrophilia also induced hypercalcemia and thymic atrophy, the same association that was reported previously in the case of murine CE mammary carcinoma. These observations will be useful in the further investigation of pathophysiology of tumor-induced leukemoid reactions, hypercalcemia, and other paraneoplastic syndromes.
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Pyridoxilate is a salt formed from glyoxylic acid and pyridoxine. It has been used therapeutically as an antianoxic drug in the treatment of various arterial complaints. Its use is based theoretically on its ability to block the conversion of glyoxylic acid into oxalic acid. The following cases suggest, however, that pyridoxilate can cause stones. Intraperitoneal injection of glyoxylate in doses of 130 mg/kg will cause oxalate stones in rats. The same effect results from injection of 427 mg/kg pyridoxilate (i.e. an equivalent dose of glyoxylate). In human subjects, intravenous injection of 200 mg of pyridoxilate results in a fourfold increase in the urinary oxalic acid content in the two hours following the injection. Thirteen cases of chronic progressive oxalate stone disease have recently been reported in patients receiving a prolonged course of pyridoxilate at 450 to 600 mg daily. Eight of these patients had no previous history of lithiasis. Oxaluria levels of 80 to 100 mg daily are observed in all cases of lithiasis in patients receiving pyridoxilate. The levels fell after cessation of the pyridoxilate treatment, and reverted to normal (30 mg/24 hours) in all but three patients. These three patients maintained levels of close to 50 mg and all three had a previous history of urolithiasis.
Piridoxilate (P) is given in cases of angina pectoris or arteritis. It is an intramolecular association of glyoxylic hemiacetal salts of pyridoxine. Glyoxylate has a membranous protective action; pyridoxine is used for the theoretical purpose of preventing oxidation of glyoxylic acid to oxalic acid. We have observed 12 patients with an active calcium oxalate lithiasis who had been taking P for many years. Hyperoxaluria was present in all patients and decreased significantly when the drug was interrupted. Significant hyperoxaluria was also observed in volunteers after ingestion of P (600 mg per day) or i.v. (200 mg). We have obtained experimental calcium oxalate urinary stones after intraperitoneal injection of P to Wistar rats. Piridoxilate represents an important lithogenic factor.