Relative effects of antepartum and intrapartum maternal blood glucose levels on incidence of neonatal hypoglycemia.

OBJECTIVE: The objective of this study was to compare the relative effects of both antepartum and intrapartum maternal plasma glucose concentrations on neonatal plasma glucose levels. STUDY DESIGN: This was a prospective, nonrandomized study. Two hundred thirty-three pregnant insulin-requiring patients with diabetes received intensive diabetic treatment aimed at maintaining the 2-hour postprandial plasma glucose level < 150 mg/dl and the intrapartum plasma glucose level < 100 mg/dl. The neonatal plasma glucose level was monitored during the first 48 hours of life and the incidence of neonatal hypoglycemia was compared with the average antepartum and intrapartum maternal plasma glucose concentrations. RESULTS: The lowest incidence of neonatal hypoglycemia occurred, as expected, among infants of patients who had the lowest mean antepartum and intrapartum plasma glucose levels. However, the intrapartum plasma glucose concentration had a stronger association with decreased neonatal hypoglycemia than the antepartum plasma glucose levels. CONCLUSIONS: Even in the presence of poor antepartum diabetic control tight regulation of the intrapartum plasma glucose levels will significantly reduce the incidence of neonatal hypoglycemia.

Interpersonal needs of drug addicts: are they similar across cultures?

Needs for interpersonal resources were compared in groups of Israeli and USA drug abusers and in matched groups of normal subjects. Across cultures, drug addicts displayed a similar pattern of needs, while the patterns displayed by normal subjects were dissimilar. The results suggest that drug addicts display patterns of need that deviate from the cultural norm and approach the patterns displayed by addicts in other cultures.

The lack of relationship between hepatotoxicity and lithocholic-acid sulfation in biliary bile acids during chenodiol therapy in the National Cooperative Gallstone Study.

To test whether hepatotoxicity occurring in National Cooperative Gallstone Study patients was caused by a toxic effect of chenodiol per se or of lithocholate caused by defective sulfation, bile samples were analyzed using a new high-performance liquid chromatography method that measures the proportions of the four individual lithocholate amidates (sulfated and unsulfated lithocholylglycine and lithocholyltaurine) and all common bile acid amidates. Samples were obtained from National Cooperative Gallstone Study patients (n = 17) with abnormal light microscopic liver biopsy results or major aminotransferase elevations and from a matched control group of patients (n = 14) who received similar chenodiol doses but had no evidence of liver injury. Bile samples from 45 healthy subjects were also analyzed. The analytical method was validated by showing that the percentage of chenodiol and cholic and deoxycholic acid obtained by high-performance liquid chromatography correlated highly (r greater than 0.94) with previous gas-liquid chromatography analyses of these samples by the National Cooperative Gallstone Study Reference Laboratory. No significant differences were seen between gallstone patients with and without evidence of liver injury for percent total lithocholate amidates, percent sulfated or unsulfated lithocholate amidates or percent chenodiol amidates. Lithocholate was partially sulfated in all bile samples (52% +/- 17% [mean +/- S.D., n = 50]), but the extent of sulfation varied widely between and within patients during the course of therapy. Mean values of healthy subjects were similar and also showed a wide range in the extent of lithocholate sulfation. It is concluded that (a) liver injury caused by these doses of chenodiol could not be attributed to the accumulation of unsulfated lithocholate per se in circulating bile acids; (b) liver injury appeared to be, directly or indirectly, caused by enrichment in circulating bile acids with chenodiol or chenodiol together with lithocholate, suggesting that the hepatocytes of those patients with hepatotoxicity were injured by the change induced in bile-acid metabolism by the feeding of chenodiol; and (c) about half of lithocholate amidates in bile samples were sulfated, but the extent of sulfation was highly variable both in gallstone patients and healthy subjects.

Afferent loop obstruction presenting as acute pancreatitis and pseudocyst: case reports and review of the literature.

Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. However, chronic obstruction may begin insidiously and its symptoms may reflect other gastrointestinal diseases. Two patients are described who developed acute abdominal pain, marked hyperamylasemia, and palpable abdominal masses 5 and 15 years after Billroth II gastrectomy. The masses were initially interpreted as pancreatic pseudocysts. Both patients were found to have chronically obstructed afferent limbs, and in one the obstruction was associated with hundreds of stasis stones within the afferent limb. Surgical decompression was accomplished in each patient. Patients who have undergone Billroth II reconstruction have signs, symptoms, and laboratory findings consistent with acute pancreatitis. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.

Results of a television-advertised public screening program for colorectal cancer.

We report the results of a free, television-advertised mass screening program for colorectal cancer using stool guaiac kits. A total of 57,000 test kits were picked up and 29,619 (53%) were returned; 3.9% (1165) of the tests were positive. Ninety-three percent of persons with a positive screen sought medical evaluation after screening. Detailed follow-up was available on 744 persons. Fifty-eight persons had large-bowel carcinomas diagnosed, 80% of which were localized. One hundred sixty persons had adenomatous polyps removed. Forty percent of cancers and 58% of polyps were detected in persons with only one or two positive test slides out of a total of six. In 33% of persons with a positive screen, the diagnostic workup consisted of a repeated stool guaiac test and/or sigmoidoscopy only. A major drawback to improving the results of mass screening programs for colorectal cancer is the limited gastrointestinal workup conducted by physicians in many persons with a positive fecal occult blood test.

High pressure liquid chromatographic analysis of conjugated bile acids in human bile: simultaneous resolution of sulfated and unsulfated lithocholyl amidates and the common conjugated bile acids.

A reversed phase high pressure liquid chromatography (HPLC) system capable of simultaneously separating four lithocholyl species (sulfated and unsulfated forms of lithocholylglycine and lithocholyltaurine) as well as the eight other major conjugated bile acids present in human bile is described. The system uses a C18 octadecylsilane column and isocratic elution with methanol phosphate buffer, pH 5.35. Relative bile acid concentration is determined by absorbance at 200 nm. Retention times relative to chenodeoxycholylglycine are reported for the four lithocholic acid forms, the glycine and taurine amidate of the four major bile acids present in human bile (cholic, chenodeoxycholic, ursodeoxycholic, and deoxycholic), and for their corresponding unconjugated forms. Retention times are also reported for the glycine and taurine amidates as well as the unconjugated form of the C23 norderivatives of these bile acids. Maximal absorbance of bile acid amidates is at 200 nm and is very similar for the (unsulfated) glycine and taurine amidates. Sulfated lithocholyl amidates exhibit molar absorptivities at 200 nm which are 1.4 times greater than that of non-sulfated lithocholyl amidates. Unconjugated bile acid absorbance at 200 nm or 210 nm is 20 to 30 times less than that of corresponding peptide conjugates. The method has been applied to samples of gallbladder bile obtained from 14 healthy subjects to define the pattern of conjugated bile acids present in human bile.

Use of Indonesian non-human primate erythrocytes for measles hemagglutination inhibition serology.

The use of erythrocytes (RBC) from Presbytis cristata, P. melalophus and Macaca fascicularis for measles hemagglutination inhibition serologies is presented. These primates can provide a ready supply of RBC for diagnostic reagent use in areas of the world where the African green monkey or rhesus macaque are not available. Individuals of each species are useful but must be screened for hemagglutination ability of their erythrocytes. The animal can then be chosen that has erythrocytes which best agglutinate with the antigen being used.

Correlation of population indices of female Culex tritaeniorhynchus with Japanese encephalitis viral activity in Kapuk, Indonesia.

Nineteen consecutive monthly light trap collections of mosquitoes were made between October 1978 and April 1980 in Kapuk, Indonesia. Kapuk is a small suburb of Jakarta where pigs are raised in close proximity to rice paddies which are breeding sites for Culex tritaeniorhynchus. Japanese encephalitis (JE) virus is believed to be endemic and has been recovered from mosquitoes and pigs in the area on several occasions. A total of 18,435 female Cx. tritaeniorhynchus were allocated to 359 pools of approximately 50 per pool. Virus isolations were attempted in both Vero and BHK-21 cells and agents producing cytopathic effect were identified in a micro-neutralization test. Nineteen strains of JE were recovered from the 359 pools of Cx. tritaeniorhynchus tested. The light trap index of female Cx. tritaeniorhynchus (X) and the relative frequency of pools positive for JE (Y) for each month of the study were plotted and correlation coefficients (r) calculated after transforming the mosquito population data logarithmically and the relative frequencies of isolation by arcsine square root. The close fit of the data (p less than 0.001) to an inverse linear model (1/y = a + b log10X) suggests a close dependence of JE viral activity on the population dynamics of Cx. tritaeniorhynchus. Three additional strains of JE were recovered from other Culex spp. at the same study site. One strain each was isolated from individual pools of Cx. gelidus, Cx. vishnui and Cx. fuscocephala. Cx. tritaeniorhynchus was more frequently infected with JE than the other species tested.

Some properties of hemoglobin mobile (alpha 2 beta 2 73 Asp----Val).

A hemoglobin variant was identified as hemoglobin Mobile in which valine replaces the normal aspartic acid at beta 73. Studies of its oxygen equilibria and of its interactions in gelation when mixed with hemoglobin S were carried out. Hemoglobin Mobile had an oxygen affinity lower than that of hemoglobin A, as observed by others. However, in mixtures with hemoglobin S, hemoglobin Mobile appeared to impair gelation or increase solubility to a slightly greater extent than did hemoglobin A. Beta 73 is a known site of intermolecular interactions in polymers of hemoglobin S. Our studies suggest that the impairment of hemoglobin S polymer formation by altered intermolecular interactions is significantly less in Hb Mobile than in Hb Korle-Bu in which beta 73 is asparagine.

Comparison of the cytotoxic and mutagenic effects of selected mutagens on excision repair-sufficient and -deficient AD-3 mutants of Neurospora crassa.

The excision repair-deficient genetic marker uvs-2 was crossed into the tester strains N23 and N24 of Neurospora crassa. Comparison was made among the effects of selected mutagens on a repair-sufficient strain (N23 or N24) and a repair-deficient strain (N23 uvs-2 or N24 uvs-2) with regard to cell killing and induction of reverse mutation from adenine dependence to adenine independence. Methyl methanesulfonate (MMS), ethyl methanesulfonate (EMS), 1,2,7,8-diepoxyoctane (DEO), N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), 2,3,5,6-tetraethyleneimino-1,4-benzoquinone (TEB) and ICR-170 were found to be more toxic to the repair-deficient strains than to the repair-sufficient strains. For the induction of reverse mutations N23 uvs-2 appeared to be more sensitive than N23 to MNNG and TEB and to the high concentrations of MMS and DEO while N24 was 20 times more sensitive than N24 uvs-2 to ICR-170.

Stereomicroscopy as a diagnostic aid in evaluating the viability of island flaps: an experimental study.

This study entailed direct stereomicroscopic observations of rat abdominal island flaps and the sequence of vascular events that occurred during and after occlusion by clamping of the individual femoral vessels for varying time intervals of up to 16 hours. The vascular changes and the status of the circulation in the flap vasculature, including the timing of complete hemal stasis and resumption of flow, following the application and subsequent release of the vessel clamp were observed and correlated with flap viability and behavior. This study also included a grading system of the vascular changes observed under a stereomicroscope. From these findings, it is suggested that in vivo stereomicroscopy may serve as a new and simple clinical tool for the early diagnosis of thrombosis at the site of microvascular anastomosis of a free flap transfer and may define time limits during which the anastomosis can be successfully corrected and the flap salvaged.

Critical closing pressure, local perfusion pressure, and the failing skin flap.

A simple apparatus was devised to perfuse the rat groin flap to study the relationship between perfusion pressure and flow. Results demonstrate that a relatively high intraarterial pressure must be applied to this skin flap before blood flow will commence. Results suggest that this critical closing phenomenon is the result of surface tension, blood rheology, venous pressure, tissue pressure, and vascular smooth muscle tone. Correlating the experiments of Milton and Landis reveals that, beyond a certain distance, local perfusion pressure in a skin flap gradually decreases with increasing distance from the flap base. These observations suggest that the perfusion boundary in a skin flap forms at the point where perfusion pressure has fallen to the level of the critical closing pressure. Methods of increasing survival length of a flap by decreasing critical closing pressure are discussed. The effects of edema and pressure dressings on flap and replant survival are examined in terms of the closing pressure concept.

Resection of a giant ossifying fibroma through an intraoral approach in a 9-year-old child: immediate reconstruction and 6-year cephalometric follow-up.

An unusual opportunity was afforded to study the growth and development of the facial structures of a 9-year-old child who underwent major mandibular reconstruction. The longitudinal studies confirmed the present concepts of the factors responsible for mandibular growth as well as their repercussions on other facial structures. An intraoral subperiosteal resection of a major portion of the right hemimandible sparing the upper part of the mandibular ramus was required to eradicate a large ossifying fibroma. An iliac bone graft consisting of the outer table of cortical bone and cancellous bone was placed within the mucoperiosteal sac to repair the defect. It also was used to control the ramus remnant. The patient was followed for 6 years. The growth of the reconstructed mandible was in effect nearly symmetrical with the unaffected contralateral portion of the mandible, resulting in minimal facial asymmetry. The mucoperiosteum provided a vascular bed for the bone graft and the buccal sulcus was preserved, thus providing a retentive ridge and sulcus for a denture without the need to perform a skin or mucosal graft inlay procedure. The symmetrical growth of the mandible is attributed to the growth of the ramus by remodeling, resorption, deposition, and relocation and by the muscle-bone interface (the functional matrix).