Biomedical subjects
Publications and source records attributed to R Kaplan.
During the first 8 mo of 1978, 10 patients with fecal peritonitis were admitted to our Intensive Care Unit. An attempt was made to standardize the management of these patients, the emphasis being on intraoperative peritoneal lavage, anaerobic-sensitive antibiotics, and the early introduction of artificial ventilation (intermittent mandatory ventilation).
Previous studies of the polyamines and their biosynthetic enzyme ornithine decarboxylase (ODC) in psoriatic skin have revealed several abnormalities, including significantly elevated ODC activity. Retinoids have also been shown to modulate polyamine biosynthesis and inhibit ODC activity after different stimuli in various cell and tissue systems. The effect of etretinate has been studied on ODC activity in involved and uninvolved psoriasis skin. Increased ODC activity was found in pretreatment samples from both involved and uninvolved psoriatic skin compared with normal volunteers. Etretinate treatment significantly reduced ODC activity in both involved and uninvolved skin in psoriatics to a similar level of activity before any improvement in clinical appearance was noted. Inhibition of epidermal ODC activity in psoriasis may represent one mechanism of retinoid action on the abnormal skin psoriasis.
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Both epididymal and ejaculated spermatozoa give usable rates of fertilization of superovulated oocytes in vitro. The epididymal sperm gave higher rates, but ejaculated sperm were preferred because intra-donor variation was lower than inter-donor variation. A selected population of 14 male donors had normally distributed fertilizing capacity with a mean and standard deviation of 77 +/- 14% (2,823 eggs). Successive ejaculates usually gave similar rates of fertilization. An attempt was made to eliminate dead and agglutinated cells from the ejaculated sperm by filtration through a column of glass beads. Despite the expected marked improvement in the average motility, the eluted spermatozoa were incapable of fertilizing. We concluded that the preferred source of spermatozoa for fertilization in vitro is ejaculated sperm. In the rat, motility and cell morphology are not adequate criteria for fertilizing capacity of treated spermatozoa.
Pruritic urticarial papules and plaques of pregnancy is a self-limiting disease generally seen in the first pregnancy during the third trimester. Lesions are frequently present centrally and are intensely pruritic. Mucous membranes are usually not involved. Histology shows a normal epidermis with mild perivascular lymphohistiocytic infiltrate. Blood vessels, cutaneous appendages, and subcutaneous tissue are normal. Immunofluorescence studies are negative. A review of the reported cases suggests that there is no increased incidence of fetal mortality or congenital malformations and that recurrences do not occur in most cases. Etiology is unknown. Treatment should be directed toward symptomatic relief only.
The differential solubilities of gases permit nitrous oxide (N2O) diffusion into air-filled body cavities, increasing their size and/or pressure. An air-filled balloon-tipped catheter represents a body cavity that may be affected by the diffusion of N2O, and could account for the authors' clinical observation that more gas was aspirated than injected during insertion of Swan-Ganz (S-G) catheters in patients receiving N2O anesthesia. An accompanying increase in balloon diameter could conceivably account for difficulties in floating the tip into the pulmonary outflow tract. To help substantiate these observations, balloon volumes of three S-G catheters were measured at 0.5, 1, 2, 3, 4, 5, 10, 20, and 30 min in various N2O and oxygen mixtures, and the diameters of the balloon were compared with published diameters of pulmonary outflow tracts. The volume changes were near maximum between 5-10 min, increasing to 30 to 150 per cent depending on the N2O concentration. The increases in balloon diameter, when compared to pediatric pulmonary outflow tract diameters, could account for difficulties in passage of the catheter tip through the pulmonary outflow tract. These findings suggest that manipulation of S-G catheters under N2O anesthesia sould be done with intermittent deflation of the balloon every few minutes.
A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5-year-old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice. Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5-year-old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.
Progressive dementia, vertical ophthalmoplegia, and prominent hypothalamic dysfunction developed in one patient with documented intestinal Whipple's disease despite ongoing antibiotic therapy with intestinal remission. A clinical diagnosis of central nervous Whipple's disease was made on the basis of the patient's presentation. High-dose parenteral penicillin and chloramphenicol were administered for 4 1/2 weeks. There was no improvement in results of daily mental status examination or neuropsychologic testing. Deterioration was noted in the electroencephalographic findings after therapy. Vigorous antibiotic therapy with agents that cross the blood-brain barrier had no immediate beneficial effect. Irreversible neurologic damage or a slow, delayed response may account for this observation.
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In 30 patients having prostatectomies, 15 patients (group I) given single-injection epidural anesthesia using bupivacaine and morphine (4 mg) were compared with 15 patients (group II) given epidural bupivacaine without morphine. Patients in group I had pain relief for a mean duration of 27 hours and did not request additional analgesia. Patients receiving bupivacaine alone had pain relief for an average of 6.2 hours after surgery; all required narcotics postoperatively. It was concluded that the addition of 4 mg of morphine to the local anesthetic for epidural anesthesia in patients having prostatectomies results in excellent postoperative analgesia.
Non-lesioned, drug naive rats were administered footshock to determine whether aversive stimuli would induce rotational behavior. Circling was produced at 1, 2 and 4 mA. The direction of circling was consistent upon retest. Circling was not blocked by either haloperidol or alpha-methyl-p-tyrosine (AMPT) and the direction of circling induced by shock was independent from that exhibited spontaneously during the 24 h prior to the test. These findings suggest that aversive-stimulus-induced circling is not mediated by the nigrostriatal dopamine system.
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Leprosy is a rare disorder in the United States, yet the rheumatic features of the disease appear to be common and frequently are the primary complaint. We observed rheumatic syndromes of erythema nodosum leprosum (ENL) occurring with and without arthritis, a swollen hands syndrome, cutaneous vasculitis, or myositis in the majority (15 of 21) of our patients. These syndromes were distinctive, sometimes dramatic, and appeared to "mimic" idiopathic rheumatic diseases, substantially delaying an accurate diagnosis of leprosy in some patients. These complications were the major cause of morbidity in our 21 patients and became dominant clinical problems requiring additional chemotherapy.
Sporotrichosis is usually transmitted by cutaneous inoculation and is, therefore, most often seen on the face, extremities, and other exposed areas. We have described the case of a pilot who contracted sporotrichosis overseas and in whom the initial lesion was on the abdomen. Since the patient reported that he had been bitten by an insect at that site, the diagnosis of leishmaniasis had been strongly considered.
A study to document the utilization by house officers of the Diagnostic Radiologic Examination (DRE) in trauma patients was carried out over 2 years at Stanford University Medical Center. Physicians recorded the likelihood of a fracture being present for patients requiring DRE's to evaluate traumatic injuries. The physician's opinion and the radiologist's final interpretation of the DRE were compared for 24 anatomic regions. Preliminary findings reveal: for almost half the DRE's the officer indicated that the reason for the DRE was medicolegal; 7% of the medicolegal cases had fractures present; less than 4% of these fractures was important enough to change the medical treatment. The levels of house officer experience are suggested as possible causes of excessive DRE utilization, as well as the influence of defensive medicine. Using Green and Swets' Theory of Signal Detection, it is possible to mathematically describe an accuracy index, and a "fear" index for each physician. We plan to use this model in analysis of the study data.