Microwave: practical cost-effective method for sterilizing urinary catheters in the home.

We used a standard microwave oven to sterilize red rubber catheters used for intermittent self-catheterization. Catheters were incubated for sixty minutes in a suspension of microorganisms isolated from the urine of patients with urinary tract infections. For each trial, 6 catheters were removed from their respective suspensions, placed in separate plastic freezer bags, distributed evenly in a microwave oven (avoiding cold spots), and microwaved simultaneously for twelve minutes. A control catheter was not microwaved. Two strains of each microorganism were tested. The urinary isolates were Escherichia coli, Klebsiella sp., Proteus sp., Enterobacter sp., Pseudomonas sp., Streptococcus sp., Staphylococcus sp., and Candida sp. In each experiment, all 6 catheters were sterilized. Repeat sterilization in the microwave oven did not affect the integrity of the catheters or the plastic bags. A water heat sink of constant volume was employed. A home microwave oven may be used as a method to sterilize red rubber catheters for reuse with a recommended time of twelve minutes at full power. This technique makes aseptic intermittent self-catheterization a practical possibility.

Continuous postoperative epidural analgesia in management of postoperative surgical pain.

In the last fifteen months we have used continuous postoperative epidural analgesia after open urologic surgery and herein report our experience with the first 64 patients. Incisional pain was completely eliminated in 96 percent of patients. Epidural analgesia diminished pain-related pulmonary complications without sedation. Complications were tolerable and manageable. Hypotension due to sympathetic blockade responds to intravenous fluid administration. Urinary retention is avoidable if the epidural infusion is discontinued prior to removing the urethral catheter. Itching is an undesirable consequence observed by 20 percent of patients when morphine is used.

A comparison of cefmetazole, and cefoxitin for the treatment of patients hospitalized with acute urinary tract infections.

This study evaluates the safety and efficacy of cefmetazole in comparison with cefoxitin in the parenteral treatment of patients hospitalized with acute urinary tract infections. Of the 49 evaluable patients, 27 were randomized to cefmetazole and 22 to cefoxitin. There was clinical success in 26 (96%) patients and bacteriological cure in 22 (81%) patients receiving cefmetazole. This compares with clinical success in 21 (95%) patients and bacteriological cure in 17 (77%) patients randomized to cefoxitin. There were no adverse reactions associated with either antibiotic. This study indicates that the clinical and bacteriological outcome was similar.

A multicenter randomized, placebo-controlled trial of surfactant therapy for respiratory distress syndrome.

We carried out a multicenter randomized, placebo-controlled trial to evaluate the efficacy and safety of surfactant in the treatment of respiratory distress syndrome. The study population was made up of newborn infants weighing 750 to 1750 g who were receiving assisted ventilation with 40 percent or more oxygen. The eligible infants received a single dose of either surfactant (100 mg of phospholipid per kilogram of body weight [4 ml per kilogram]) or an air placebo (4 ml per kilogram), administered into the trachea within eight hours of birth by an investigator not involved in the clinical care of the infant. When compared with the infants who received the placebo (n = 81), the infants who were treated with surfactant (n = 78) had a 0.12 greater average increase in the ratio of arterial to alveolar oxygen tension (P less than 0.0001), a 0.20 greater average decrease in the fractional inspiratory oxygen concentration (P less than 0.0001), and a 0.26-kPa greater average decrease in the mean airway pressure (P less than 0.0001) during the 72 hours after treatment. Pneumothorax was less frequent among the infants treated with surfactant than in the control group (13 percent vs. 37 percent; P = 0.0005). There were no statistically significant differences between the groups in the proportion of infants in each of five ordered clinical-status categories on day 7 (P = 0.08) or day 28 (P = 0.75) after treatment. There were also no significant differences between the groups in the frequency of bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, or periventricular-intraventricular hemorrhage. In each group, 17 percent of the infants died by day 28. We conclude that treatment with the single-dose surfactant regimen used in this study reduces the severity of respiratory distress during the 72 hours after treatment and decreases the frequency of pneumothorax, but that it does not significantly improve clinical status later in the neonatal period and does not reduce neonatal mortality. Further study of different surfactant regimens and patient-selection criteria will be required to determine whether this initial improvement can be translated into reductions in mortality or serious morbidity.

Tricholemmoma of the eyelid.

Tricholemmoma is a benign cutaneous tumor that shows differentiation characteristic of the outer hair sheath. The usual site of occurrence is the face, including the nose and eyelid. Four cases of tricholemmoma involving the eyelid margin to a variable extent are presented and the clinical and pathologic findings are reviewed. In three of the four cases, a histopathologic misdiagnosis of squamous cell carcinoma was initially made. In one case, this resulted in a greater sacrifice of normal lid tissue than was necessary, although the reconstruction yielded a good result. In the subsequent cases, the entity of tricholemmoma was well appreciated before definitive oculoplastic surgery and the referring diagnosis of squamous cell carcinoma was refuted.

Factors related to the appearance of alveolar macrophages in the developing lung.

The numbers of alveolar macrophages (AM) are known to be low in utero and to increase rapidly after birth. This study analyzed factors related to the appearance of AM in the lungs of term and preterm monkeys (Macaca nemestrina). We found that the numbers of AM were greater at birth in term than in preterm monkeys (p less than 0.01) and that they increased with postnatal age in term animals (r = 0.86) and in preterm animals without hyaline membrane disease (HMD) (r = 0.79). In contrast, the numbers of AM did not increase with postnatal age in preterm animals with HMD (r = 0.17). By multivariant analysis, AM numbers correlated most strongly with a combination of 2 variables: lavage fluid phospholipid and absence of HMD (r = 0.996). Preparations of alveolar surface-active material from newborn monkeys and to a lesser degree from adult monkeys were found to stimulate migration and polarization of monkey AM and blood monocytes in vitro. The migration-stimulating factor(s) in alveolar surface-active material had an apparent molecular weight greater than 10,000 and appeared not to be a lipoxygenase product of arachidonic acid metabolism. These data indicate a correlation between factors regulating lung pressure-volume stability and AM numbers and are consistent with a potential role for components of alveolar surface-active material in regulating the perinatal increase in AM.

Infertility in mice after unilateral vasectomy.

The effects of unilateral vasectomy upon fertility and antisperm antibody production were studied using DBA/1J mice. Thirty-six males underwent either unilateral vasectomy, unilateral orchiectomy, or sham surgery. In vivo effects upon fertility were monitored by matings. Antisperm antibody titers were measured monthly. In vitro fertilization was performed in the presence of serum obtained 4 months postoperatively, and serum testosterone levels were also determined. After 3 months, only 1 male in the vasectomy group induced a pregnancy (1 of 12), while all but 1 of the males in the two control groups induced a pregnancy (20 of 21). The geometric mean antisperm antibody titer was 1:169 in the vasectomy group, while the orchiectomy and sham surgery groups had titers of 1:4 and 1:14, respectively (P less than 0.0001). The percentage of eggs fertilized in vitro in the presence of serum from experimental mice fell from 80% in the two control groups to 40% in the unilateral vasectomy group. Unilateral vasectomy induced infertility in DBA/1J mice and an antisperm antibody response. Sera containing these antibodies inhibited in vitro fertilization. This suggests that infertility after unilateral vasectomy may be immunologically mediated by antisperm antibodies.

Antenatal glucocorticoid administration: effects on oxygen-hemoglobin affinity and hemoglobin levels in experimental hyaline membrane disease.

Dexamethasone or saline was administered in a randomized fashion to pregnant Macaca nemestrina for 3 days prior to preterm abdominal delivery. The steroid-treated animals demonstrated a greater hemoglobin concentration and a greater mean corpuscular hemoglobin concentration in cord blood. There was no difference between the groups in mean P50 in cord blood. The infants of steroid-treated animals had less frequent and less severe hyaline membrane disease. We conclude that antenatal steroid administration ameliorates postnatal respiratory distress without inducing changes in P50 and with only a small change induced in cord blood hemoglobin.

Experimental hyaline membrane disease in the premature monkey: effects of antenatal dexamethasone.

A blind, randomized trial of antenatal glucocorticoid treatment was conducted using the premature monkey (Macaca nemestrina) model of hyaline membrane disease (HMD). Twelve dams received dexamethasone (2 mg/dose) 72, 48, and 24 h before abdominal delivery at 135 +/- 1 days of gestation. Twelve control animals received saline. Infants of dexamethasone-treated dams had significantly lower incidence and severity of HMD than did infants of control animals (50 versus 92%, p less than 0.05). Improvement with treatment was markedly greater for males than for females. Differences in volume-pressure behavior of the excised lungs included greater distensibility in the infants from dexamethasone-treated dams (20.6 +/- 7.1 ml/g dry lung versus 14.7 +/- 6.1, p less than 0.05) and enhanced deflation stability with treatment. Accelerated production of surface active material (SAM) phospholipids in infants from dexamethasone-treated dams was indicated by increases in total lung phospholipid (84.5 +/- 8.1 mg/g dry lung versus 75.1 +/- 9.9, p less than 0.025), alveolar lavage fluid phospholipid (5.65 +/- 3.33 mg/g dry lung versus 3.01 +/- 1.84, p less than 0.05), and alveolar lavage fluid disaturated phosphatidylcholine (DPC) (2.47 +/- 1.84 mg/g dry lung versus 1.06 +/- 1.05, p less than 0.05). Incorporation of 14C-palmitate into lung lipid was not influenced by dexamethasone, but a significantly greater portion of the label appeared in the DPC fraction with treatment. Antenatal dexamethasone treatment was successful in reducing the incidence and severity of experimental HMD in this animal model; the beneficial effects of treatment were associated with accelerated maturation of fetal pulmonary functions, including, but not limited to, synthetic metabolism of SAM phospholipid.

Differential effect of sex in experimental hyaline membrane disease in newborn monkeys.

Data from forty-four infant monkeys of 135 to 150 days' gestation were reviewed for the existence of sex-related differences in the development of hyaline membrane disease, post-mortem lung mechanics, biochemistry, and histologic features. Severity of hyaline membrane disease was scored from 1 (severe) to 6 (none) from chest radiographic appearance and arterial PO2 determination. Female monkeys had a lower score (mean +/- 1 SD = 2.7 +/- 1.6) than males (3.8 +/- 1.6, less than 0.05). Females accounted for 70% of animals with scores of 1 or 2, and 33% of those with scores of 5 or 6 (p = 0.045). There was no difference in lung homogenate phospholipid (PL) concentration. Airway lavage PL and the ratio of lavage PL to homogenate PL were both decreased in the female. Surface activity of the lavage material was also less in the female. No significant differences between males and females were noted for mean maximal lung volume air-tissue ratio, as determined by light microscopy, or number of type II pneumocytes per alveolus. Premature female monkeys appeared to sustain a disadvantage in pulmonary adaptation to postnatal life.

The immature monkey as a model for studies of bronchopulmonary dysplasia.

The monkey is a potential model for BPD since there is considerable background information on the normal-developing lung, the prematurely delivered infant is viable, HMD can be produced, the infant is large enough to permit physiologic measurements, and it should be possible to test the effects of positive pressure, oxygen, and pharmacologic agents. Clearly further information is needed on the cellular and subcellular changes occurring during the acute and recovery stages of HMD. The monkey has already proven to be of value in this inquiry. Studies on mechanisms of altered lung repair by various injurious agents are needed, and will require an animal model as well as in vitro systems. Basic understanding of the pathogenesis of bronchopulmonary dysplasia with establishment of the relative importance of the contributing factors should help in our efforts to prevent or minimize chronic lung disease in the newborn infant.

Hereditary neonatal hyperparathyroidism.

Neonatal hyperparathyroidism usually presents as a "failure to thrive" syndrome. It may be transmitted as an autosomal dominant trait and may involve more than one offspring. We report on two brothers with neonatal primary hyperparathyroidism. One underwent a total parathyroidectomy and has lived for 14 years. Hyperparathyroidism was found in their father, suggesting autosomal dominant inheritance. The disease is fatal unless recognized early and treated. The characteristic pathological change is chief cell hyperplasia of the parathyroid glands. Near-total parathyroidectomy is the minimal operation required to control the hypercalcemia. Permanent hypoparathyroidism may be the sequel of appropriate surgical management. Treatment of the totally parathyroidectomized infant, however, is possible and can result in normal growth and development.