Diagnosis of cor triatriatum by two-dimensional echocardiography.
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Biomedical subjects
Publications and source records attributed to M Goldman.
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A retrospective review of 41 patients with post-mortem evidence of acute pancreatitis revealed that 19 patients (46%) showed concomitant evidence of increased intracranial pressure (ICP). A prospective analysis of five patients with increased ICP demonstrated two patients with evidence of acute pancreatitis. The pathogenesis of acute pancreatitis in these patients appears to be dependent on the following risk factors: increased intracranial pressure, steroids, hypovolemia, morphine infusion and hypothermia. These factors increase vagal stimulation, predispose to pancreatic duct obstruction and enhance cellular hypoperfusion. Acute pancreatitis occurring in Reye's Syndrome is probably a consequence of increased ICP and the therapy instituted.
The perforated irrigation needle was used to test a high-volume (20 c.c.) final flush of prepared root canals. Three solutions: TEGO 1 percent, NaOCl 5.25 percent, and REDTA were tested. The roots were split longitudinally and were prepared for examination under the scanning electron microscope immediately after preparation and final flushing. In addition, groups were prepared and flushed in the same manner, but after splitting they were soaked in the respective solutions for 3 hours and then examined. The results indicated that the smeared layer is caused by instrumentation, that it is not removed by TEGO or NaOCl, and that it is removed by REDTA. It may be that the smeared layer is a slurry of dentin filings, since REDTA does not remove soft tissue. All solutions produced a canal quite free of debris; however, none of the tested irrigants was completely satisfactory by itself.
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The potential etiologic relationship between uric acid in its microcrystalline monosodium urate form and psoriasis was examined by 1) substantiating the reported correlation between hyperuricemia and psoriasis using the phosphotungstate method; 2) examining psoriatic tissue samples for the presence of urates under a microscope using polarized light and a compensator; 3) attempting to induce psoriasis-like symptoms in laboratory animals with purine-to-uric acid metabolism by increasing serum uric acid level; and 4) observing psoriasis-hyperuricemic patients following treatment for their hyperuricemia with Allopurinol. As expected, both men and women psoriatics had higher uric acid levels than did their counterparts in a control group. Monosodium urate crystals were found in samples from psoriatic plaques by both methods used. They were clustered particularly around sweat pores and Munro abscesses, but were found only occasionally in epidermal tissue taken from nonpsoriatics. Psoriasis-like symptoms were induced in laboratory animals (the South American boa, Constrictor constrictor) when they were fed doses of uric acid. Patients with psoriasis and hyperuricemia showed marked improvement in psoriasis when treated for their hyperuricemia. Psoriasis, like gout, may be, at least partly, a result of disorder of purine metabolism and monosodium urate crystals may be responsible for the cell proliferation that is characteristic of psoriatic plaques. Monosodium urate crystals were found by the author to be strikingly segmented. This structure may result in ease of fragmentation, thus increasing the difficulty in identifying urates in any tissue.
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Intragastric intubation of 4 or 8 g/kg of body weight of ethanol per day for 12 consecutive days disrupted the normal estrous cycle in female rats as monitored by vaginal epithelial cell changes. Plasma luteinizing hormone levels were unchanged suggesting that blood ethanol in the 50--100 mg/100 ml range acted as a direct gonadal toxin and not at the hypothalamic-pituitary gland level.
Computed tomographic (CT) scans of 34 cases of abdominal fatty masses were reviewed retrospectively in order to establish criteria for distinguishing benign conditions from malignant tumors. By evaluating location, attenuation, internal consistency, and margination, it is possible not only to make this distinction but frequently to suggest a specific diagnosis. Abdominal fatty masses that are sharply marginated, homogeneous, and that show CT numbers less than or equal to the patient's normal fat can be considered benign. Malignancy should be suspected when an extrarenal abdominal fatty mass displays one or more of the following characteristics: inhomogeneity, infiltration or poor margination, CT numbers greater than the patient's normal fat, or contrast enhancement. Criteria for distinguishing between angiomyolipoma and liposarcoma are also discussed.
Abdominothoracic shape during the forced vital capacity was studied in 10 normal subjects using magnetometers to monitor anteroposterior diameters at the level of the manubrium, xiphoid, and epigastrium, lateral rib cage diameter at the xiphoid level, and vertical motion of the rib cage. Thoracic cross-sectional area change at the xiphoid level was found to lag lung volume change, due to an early paradoxical increase (or lack of change), of lower anteroposterior rib cage diameter. To the extent that the resulting rib cage deformation can influence the pleural pressure gradient, the observed shape changes provide a potential mechanism for early preferential emptying of the upper lobes and later more homogeneous emptying in forced, compared to slow, vital capacity maneuvers. Comparisons of shape changes during Valsalva and abdominal expiratory ("expulsive") maneuvers suggest that lower rib cage deformation may not simply be due to the action of rib cage muscles affecting predominantly the lateral rib cage but rather the results of diaphragmatic activity and the influence of abdominal shape on the lower rib cage.
We recorded the diaphragm electromyogram (EMG) of quadriplegic men before and during exposure of the lower torso to continuous negative pressure, which caused shortening of the inspiratory muscles by expanding the respiratory system by one tidal volume. The moving-time-averaged diaphragm EMG was larger during expansion of the respiratory system. When we repeated the experiment with subjects who breathed through a mouthpiece, we found qualitatively similar EMG changes and little or no change in tidal volume or end-tidal CO2 partial pressure. When the pressure was applied or removed rapidly, changes in EMG occurred within one or two breaths. Because end-tidal CO2 partial pressure did not increase, and because the response was rapid, we suggest that the response results from proprioceptive, rather than chemoreceptive, reflexes. As most of these men had complete spinal lesions at C6 or C7 the afferent pathways are likely to be vagal or phrenic.
The effects of diaphragm paralysis on respiratory activity were assessed in 13 anesthetized, spontaneously breathing dogs studied in the supine position. Transient diaphragmatic paralysis was induced by bilateral phrenic nerve cooling. Respiratory activity was assessed from measurements of ventilation and from the moving time averages of electrical activity recorded from the intercostal muscles and the central end of the fifth cervical root of the phrenic nerve. The degree of diaphragm paralysis was evaluated from changes in transdiaphragmatic pressure and reflected in rib cage and abdominal displacements. Animals were studied both before and after vagotomy breathing O2, 3.5% CO2 in O2, or 7% CO2 in O2. In dogs with intact vagi, both peak and rate of rise of phrenic and inspiratory intercostal electrical activity increased progressively as transdiaphragmatic pressure fell. Tidal volume decreased and breathing frequency increased as a result of a shortening in expiratory time. Inspiratory time and ventilation were unchanged by diaphragm paralysis. These findings were the same whether O2 or CO2 in O2 was breathed. After vagotomy, no significant change in phrenic or inspiratory intercostal activity occurred with diaphragm paralysis in spite of increased arterial CO2 partial pressure. Ventilation and tidal volume decreased significantly, and respiratory timing was unchanged. These results suggest that mechanisms mediated by the vagus nerves account for the compensatory increase in respiratory electrical activity during transient diaphragm paralysis. That inspiratory time is unchanged by diaphragm paralysis whereas the rate or rise of phrenic nerve activity increases suggest that reflexes other than the Hering-Breuer reflex contribute to the increased respiratory response.
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A patient with a triplet pregnancy had one infant affected by anencephalus. This pregnancy resulted from ovulation stimulation by gonadotropins. Several cases of association between anencephalus and induction of ovulation by clomiphene have been reported. The association with gonadotropins, however, has been reported only once. The event was prenatally diagnosed by ultrasound studies in the first and second trimesters. The association of anencephalus with ovulation stimulation is discussed briefly.
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A number of equations was developed to predict skeletal mass in living beagles, utilizing data from 92 dogs aged 0-3103 days. Twenty eight independent variables were utilized are predictors. These included sex, age, body weight, four external measurements and 21 measurements taken on eight individual bones. The derived predictive equations were ordered as to complexity, i.e., using minimal to maximal information. Skeletal mass could be best predicted when the beagles were divided into four age groups. The use of criteria other than the adjusted coefficient of determination (Ra(2)) was helpful in selecting the single best predictive equation from a subset offered by the computer. Average relative predictive errors could be reduced to 4--8% with maximal information as compared to 11% or more when only minimal information was (hypothetically) available. A single ratio of skeletal to body weight was shown to give poor results when used as the sole criterion for estimating skeletal weight.
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