Inhibitors of polygalacturonase in calli of Orobanche aegyptiaca.

The presence of at least three distinct polygalacturonases (PGase) in callus of Orobanche was demonstrated. The PGase activity is labile and at pH 4.5 does not require activation by cations. It can be partially purified on Biogel P 100 columns and can be resolved by PAGE into several bands. Broomrape callus tissue also contains inhibitors of PGase activity. One of these is a low M(r) compound, stable to boiling and removable by dialysis. An additional inhibitor precipitable by ammonium sulphate is also present.

Preoperative duplex venous mapping: a comparison of positional techniques in patients with and without atherosclerosis.

PURPOSE: Preoperative duplex venous mapping is the preferred modality to measure the diameter of the greater saphenous vein and its suitability as an arterial conduit for infrainguinal bypass. We wanted to determine the optimal mapping technique and maximal venous diameter in patients with and without atherosclerosis. METHODS: Three groups of patients were prospectively studied: younger control subjects (n = 20), preoperative atherosclerotic patients (n = 10), and older control subjects (n = 10). All patients underwent greater saphenous vein duplex mapping in a standardized manner. Maximal internal vein diameters were measured with the subjects in the supine position in bed, in the 20 degree reversed Trendelenburg position, sitting on the edge of the bed, standing, and in the supine position with a high-thigh, low-pressure tourniquet. Measurements were taken just beyond the saphenofemoral junction, in the distal thigh, below the knee, at midcalf, and superior to the medial malleolus. RESULTS: In younger control subjects an increasingly more erect position resulted in progressively larger measured vein diameters at all levels along the length of the leg. Both patients with atherosclerosis and older control subjects had no such increase in venous diameter with any positional change from the supine position to standing. Patients with atherosclerosis also had significantly smaller measured veins than either younger or older control subjects. A high-thigh tourniquet significantly increased vein diameters in the atherosclerotic group to the size of vein diameters in the older control group, although the absolute size differences were not large. CONCLUSIONS: The optimal position for venous mapping is with the patient in a supine position. If the internal vein diameter is below an acceptable minimum size, a high-thigh tourniquet will maximally distend the vein in patients with atherosclerosis. Vein diameter decreases with age and is less distended in patients with atherosclerosis compared with older patients without atherosclerosis.

Pulse oximetry in the evaluation of the painful hand after arteriovenous fistula creation.

Five patients with a side-to-side arteriovenous fistula complaining of pain, numbness, and cold sensation were evaluated by pulse oximetry. Low SaO2 was noticed in all five. Closure of a major proximal venous collateral vessel eliminated the steal and resulted in SaO2 correction and was followed by clinical amelioration. Pulse oximetry proved to be a helpful adjunct in the evaluation of the painful hand after creation of an arteriovenous fistula. By applying the pulse oximeter to the patient's affected limb, we were able to determine whether the pain was a result of ischemia and if the correction of the steal improved oxygenation.

Carotid endarterectomy under local anesthesia supplemented with neuroleptic analgesia.

Surgical treatment of the carotid artery is being performed increasingly under local rather than general anesthesia. The advantage of local anesthesia is that neurologic function can be continuously assessed while the carotid arteries are cross-clamped, and unnecessary shunting can, thus, be avoided, with resulting sedation, analgesia, alpha blockade and blood pressure stability. The main objection to the use of local anesthesia is the anxiety of the patient. We overcame this difficulty in a series of 42 patients by supplementing the local anesthetic with neuroleptic analgesia. The possible disadvantages of neuroleptic administration are apnea and prolonged sedation. Only one of the patients we studied required an intraluminal shunt. One patient died of cardiac disease and one suffered an early postoperative stroke, which subsequently resolved. We believe that local anesthesia, supplemented by neuroleptic sedation and analgesia to overcome patient anxiety, should be more widely used for carotid endarterectomy.

Brain abscess: a complication of oesophageal dilatations.

A 16-month-old boy underwent oesophageal dilatations following an unsuccessful attempt to locally resect a 3 cm long lye stricture. He then developed a brain abscess which was surgically drained. Subsequently, a right colon interposition was performed to bypass the stricture. Following oesophageal dilatations, bacteraemia and fever are common but the occurrence of metastatic brain abscesses is rare. This serious complication should be kept in mind when long-term treatment by repeated oesophageal dilatations is planned.

Corrosive injury to the stomach due to acid ingestion.

Ingestion of acid often causes severe damage to the stomach. Ingestion of alkali, however, usually injures the esophagus and spares the stomach. Early complications of acid ingestion, e.g., massive gastric hemorrhage or perforation, are unusual. The absence of severe symptoms in most patients soon after ingestion of acid is often misleading. Gastric outlet obstruction is a common late result and may develop following an asymptomatic interval. The authors' experience with three patients with severe complications following ingestion of acid is presented. The initial treatment, as well as the surgical management, are discussed.

Ammonia uptake by skeletal muscle in the hyperammonaemic rat.

A two-stage surgical occlusion of the portal vein was employed to produce hyperammonaemia in the rat. The procedure resulted in a significant rise of arterial blood ammonia level from 70 . 5 +/- 6 . 5 mumol/l (mean +/- SEM, n = 10) to 214 . 0 +/- 37 . 7 mumol/l and in a rise of venous blood ammonia from 65 . 0 +/- 9 . 4 mumol/l to 122 . 2 +/- 7 . 4 mumol/l during the first day following the complete vein occlusion. A marked increase of the arteriovenous difference of ammonia concentration from virtually zero in sham-operated controls to 72 +/- 9 (n = 8) mumol/l in rats 1 day after the surgical manipulation suggested uptake of ammonia by skeletal muscle. Rat muscle glutamine synthetase activity increased from 0 . 46 +/- 0 . 06 u/mg (n = 7) in controls to 2 . 7 +/- 0 . 3 u/mg (n = 7) on the fourth day following portal vein ligation, and muscle branched chain amino acids aminotransferase increased from 0 . 2 +/- 0 . 05 u/mg in controls to 0 . 96 +/- 0 . 1 u/mg (n = 7) during the first day of ligation. Glutamine dehydrogenase and aspartate aminotransferase activities were not affected by the surgical procedure. These observations suggest that ammonia trapping in skeletal muscle is coupled to glutamine formation via amination of glutamic acid. This conclusion was further supported by the finding that ammonia uptake correlated (r = 0 . 92) with enhanced release of glutamine from muscle and that treatment with methionine sulfoximine, a potent inhibitor of glutamine synthetase, changed the arteriovenous difference of glutamine from -0 . 92 +/- 0 . 01 mmol/l in ligated animals (net release) to +0 . 12 +/- 0 . 01 mmol/l (net uptake) in ligated and inhibitor-treated animals. Similarly, the inhibitor also abolished the arterio-venous difference of ammonia. Thus, the animal model of hyperammonaemia and the muscle enzyme assays reveal that skeletal muscle is involved in the regulation of blood ammonia level by conversion of ammonia, via glutamic acid, to glutamine.

The mild form of Hirschsprung's disease (short segment): fourteen-years experience in diagnosis and treatment.

From 1966 through 1980, 39 children were treated with anorectal myectomy for the mild form of Hirschsprung's disease. The mild form of Hirschsprung's disease is differentiated from the severe one mainly on clinical grounds. Of the entire group, only four patients needed a Duhamel procedure, one to three years after myectomy. One patient still uses occasional enema (11 years after operation). The remaining 34 patients are symptom-free (1--14 years after operation). Anorectal myectomy is the treatment of choice in the management of the mild form of Hirschsprung's disease.

Chronic granulocytic leukemia in pregnancy. A case report and review of the literature.

Chronic granulocytic leukemia (CGL) was diagnosed in the second trimester of pregnancy in a mother of four, who decided to terminate the pregnancy immediately. According to the literature this unusual combination is not a definite indication for abortion since CGL does not adversely affect the course of the pregnancy nor the pregnancy alter the course of the disease. Prudent treatment with busulfan or splenic irradiation, when indicated, apparently does not endanger the development of the fetus.