Melt production beneath Mt. Shasta from boron data in primitive melt inclusions.

Most arc magmas are thought to be generated by partial melting of the mantle wedge induced by infiltration of slab-derived fluids. However, partial melting of subducting oceanic crust has also been proposed to contribute to the melt generation process, especially when young and hot lithosphere is being subducted. The isotopic composition of boron measured in situ in olivine-hosted primitive melt inclusions in a basaltic andesite from Mt. Shasta, California, is characterized by large negative values that are also highly variable (delta(11)B = -21.3 to -0.9 per mil). The boron concentrations, from 0.7 to 1.6 parts per million, are lower than in most other arc lavas. The relation between concentration and isotopic composition of boron observed here supports a hypothesis that materials left after dehydration of the subducting slab may have contributed to the generation of basaltic andesite lavas at Mt. Shasta.

15-Deoxyspergualin and primate heart transplantation.

15-Deoxyspergualin is a synthetic polyamine that exhibits a novel spectrum of immunosuppressive activity in lower mammals. To define the clinical potential of this drug, we performed 25 abdominal heterotopic heart transplants in Macaca fasicularis. Donor and recipient pairs were selected from ABO-identical animals with negative erythrocyte crossmatches. All recipients received one dose of methylprednisolone sodium succinate at graft reperfusion. Five control recipients received no subsequent immunosuppression. Five recipients received high-dose 15-deoxyspergualin (7.5 mg/kg IM). Five recipients received low-dose 15-deoxyspergualin (2.0 mg/kg IM). Five recipients received cyclosporine (1.0 mg/kg IM). Five recipients received both 15-deoxyspergualin (2.0 mg/kg IM) and cyclosporine (1.0 mg/kg IM). Immunosuppressive agents were administered daily, beginning with the morning of operation, and were continued until the animal was killed or 30 days had elapsed. Graft function was assessed by daily palpation. Median graft survival among control recipients was 9 days (range, 6 to 34 days). At the dose used, cyclosporine alone did not influence either graft survival time (median survival, 13 days; range, 7 to 23 days) or rejection grade. Graft survival and rejection grade among recipients treated with low-dose 15-deoxyspergualin were not different from control recipients or those treated with cyclosporine alone (median survival, 10 days; range, 8 to 39 days). One recipient, killed on postoperative day 8, had an intraadominal abscess. In each of the recipients treated with high-dose 15-deoxyspergualin systemic toxicity developed, and the animal was killed when death appeared imminent, although graft contraction remained vigorous (median survival, 28 days; range 25 to 30 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute histologic changes in the tracheobronchial tree associated with different suction catheter insertion techniques.

Anesthetized, intubated kittens were subjected to one of two procedures: (1) insertion of a suction catheter to a predetermined distance and withdrawal with or without the application of suction or (2) insertion of the catheter until resistance was met and withdrawal with or without the application of suction. There were 5 animals in each group. All 10 of the animals in the "predetermined distance" groups had normal tissues. Of the 10 animals in the "resistance" groups, nine displayed multifocal areas of denuded epithelium and varying degrees of inflammation. One subject from the "resistance/suction" group had normal tissues. One from the "resistance/no suction" group displayed a small hemorrhage into the soft tissue. The Kruskal-Wallis rank test revealed a significant difference (p less than 0.05) between the "predetermined" and the "resistance" groups. The application of suction had no effect on the amount of damage evident.

Surgical treatment of coarctation of the aorta after balloon angioplasty.

This study was designed to assess the long-term effects of balloon angioplasty for coarctation of the aorta. Eleven asymptomatic children, aged 4 to 6 years, underwent balloon angioplasty. Mean peak gradient fell from 50.5 +/- 4.7 mm Hg before angioplasty to 21.7 +/- 3.1 immediately after angioplasty. Children were then followed up at 3 to 6 month intervals and were recatherized 5 to 14 months after balloon angioplasty. On the basis of these catheterization findings, patients were divided into three groups: group I--four patients, residual gradient less than 10 mm Hg and no anatomic abnormalities; Group II--three patients, increase of gradient to greater than 25 mm Hg, mean 34 mm Hg; Group III--four patients, aneurysmal dilatation in the area of the balloon angioplasty. The seven patients in groups II and III underwent elective resection of their coarctation at 7 to 28 months after balloon angioplasty with end-to-end anastomosis. Somatosensory evoked potentials were monitored during the operation. There were no operative deaths and no gradients between arm and leg pressures postoperatively. One patient had mild paresis of the lower extremities. Pathologic examination of the specimens revealed an absence of muscle and elastic lamella in the area of the aneurysms. This finding was present in all specimens regardless of whether there was aneurysmal dilatation. Neofibroelastic proliferation at the site of the tear was responsible for persistent gradients. Balloon angioplasty may result in aneurysmal formation and/or recurrent stenosis in the area of the tear necessitating elective surgical repair. Surgical treatment is the same as for native coarctation when done early after balloon angioplasty, but may be associated with increased risk because of the lack of collateral circulation. Continued follow-up of these lesions is necessary.

Dominantly inherited dilated cardiomyopathy.

We describe a family in which there is segregating an autosomal dominant gene determining a cardiomyopathy. The pathodynamics is that of pump failure associated with dilatation of the heart, generally having an overt clinical onset from the fourth through seventh decades. Dysrhythmia is a frequent concomitant feature. There may be an associated skeletal myopathy, either producing a very mild proximal weakness or proving detectable only upon biopsy. This family is similar to other reported cases of familial dominant "idiopathic" dilated cardiomyopathy, but the nature of the heterogeneity within this category remains to be elucidated. The roles of echocardiography, cardiac biopsy, and skeletal muscle biopsy in the presymptomatic detection of the heterozygote are noted.

Rectal fist insertion. An unusual form of sexual behavior.

Rectal fist insertion (fist fucking) is an uncommon and potentially dangerous sexual practice. This is usually a homosexual activity, but can also be a heterosexual or an autoerotic practice. One known death has been reported associated with rectal fist insertion, in which the complications of anal and colonic tears and bleeding had occurred (see Editor's note). The possibility of drug overdose is also probable, as drugs and alcohol are commonly introduced into the rectum to promote sphincter relaxation and to ease the discomfort of anal dilatation.

Oesophageal cancer in Zulu men, South Africa: a case-control study.

The high rate of oesophageal cancer amongst southern African blacks has also been recorded amongst the Zulus. Data embracing a wide spectrum of factors pertaining to socio-economic status, nutrition, exposure to carcinogens, tobacco and alcohol usage and traditional health practices were obtained from 211 hospitalized oesophageal cancer patients and compared with hospital population controls matched for age and urban-rural background. Stepwise logistic regression analysis with adjustment for age effects showed that four of the many factors could adequately model the odds of being a cancer case. They were the daily consumption of purchased maize meal (relative risk (RR) 5.7) currently smoking commercial cigarettes (RR 2.6), pipe smoking (RR 2.1), and a reduction of risk in those using butter or margarine daily (RR 0.51). Further significant differences (P less than 0.05) in 12 other factors suggest that those with rural assets but an ability to earn a modest income external to the subsistence economy are at highest risk. They represent a transitional state of Westernisation which is characterised by excessive smoking habits and a diet having a low vitamin and mineral density. These results provide further evidence for the need to combat smoking and for a program of nutrient enrichment of maize meal.

Steam quality and effective sterilization.

Faced with using steam from a commercial utility having boilers greater than 5 miles distant and being the last user on the system resulted in ineffective sterilization. A three phase testing program was established utilizing: Direct physical measurements - an Ellison model 915A portable steam calorimeter. Direct microbiology - Autoclaved feed pellets were aseptically placed in fluid thioglycolate medium and incubated at 37 degrees C. Indirect microbiology - Feces from "defined flora" mice fed the autoclaved pelleted feed were tested. Colorimetric measurements verified that the steam sometimes contained greater than 5% entrained water. During periods of wet steam it was impossible to maintain consistent sterility of the mouse pellets even using a cycle of 126 degrees C for 60 minutes. One spore-forming Gram positive rod, Clostridium perfringens type D was the predominant bacterium isolated. Lactating mice, or mice stressed experimentally came down with diarrhea within days of eating pellets treated with wet steam (calorimetric measurements) and a subsequent positive culture. These mice voided stools predominantly showing Clostridium perfringens type D.

Repair of coarctation of the aorta in children with Turner syndrome.

Increased risk of perioperative hemorrhage has been described in patients with Turner syndrome and coarctation of the aorta. We have operated on 11 patients with Turner syndrome and coarctation of the aorta, two of whom developed bleeding. One patient died. End-to-end anastomosis was performed in all patients. Histologic studies of resected specimens did not reveal any abnormalities. The risk of bleeding was not related to age at the time of repair or postoperative hypertension. Although no specific abnormality has been identified in these patients, the risk of serious hemorrhage appears increased.

Bronchial carcinoid tumors.

Forty-six patients with bronchial carcinoid tumors were operated on over a 37-year period. The results were reviewed with special reference to presenting complaint, histological diagnosis, location of the tumor, lymphatic involvement, and type of surgical resection. Age at operation ranged from 9 to 86 years (mean, 43.6 years). Presenting symptoms were hemoptysis in 21 instances, chronic cough in 17, and pneumonia in 15. The primary tumor was within the main bronchus in 17 patients. Twenty-one patients required pneumonectomy, and 20 had lobectomy or bilobectomy . Nine of the patients under-going pneumonectomy had severely damaged lung tissue distal to the lesion in the main bronchus. Six patients had metastases to hilar nodes. Four patients died of carcinoid tumor, but none with metastases died of carcinoid tumor. This series confirms the low malignancy potential of bronchial carcinoid tumors, even in the presence of lymphatic involvement. Although conservative resection is an attractive surgical option, only 10 of the 46 (22%) were potential candidates for such intervention. Standard surgical resection resulted in "cure" in 90% of the patients in the series.

Evidence for an intimate geochemical factor in the etiology of esophageal cancer.

Epidemiological data for esophageal cancer in the Butterworth District, Transkei, was used to calculate incidence contours which confirmed large variations within short distances (less than 5 km). High- and low-risk zones were demarcated, and a close relationship with underlying geology observed. The low-incidence zones in the study regions were underlain by dolerite intrusions, whereas higher-risk regions were on sedimentary strata. Analysis of rocks indicated that those from the higher-risk regions contain less copper, cobalt, and manganese. Soil samples were analyzed for boron, cobalt, copper, manganese, molybdenum, nickel, sodium, lead, vanadium, and zinc; the results also indicated a strong geochemical association with the disease. The concentrations of copper (P = 0.001), nickel (P = 0.001), and boron were markedly lower in the high-risk zones. Manganese, zinc, and molybdenum levels in soils also tended to be substantially lower in the high-risk zone.

Cryosurgery in prostatic cancer: elimination of local lesion.

From 1969 through 1976, we performed cryosurgery in 229 cases of prostatic cancer. Most of these patients had bulky, locally extensive primary tumors, and one-half had disseminated disease. Through the open perineal approach, which gives exposure for an adequate freeze, cryosurgery has been well tolerated. The primary surgical goal has been to reduce or eliminate the local lesion to minimize subsequent cancer-related lower urinary tract problems and to cure those patients with truly localized disease. In every case cryosurgery produced dramatic shrinkage of the local lesion. After four to eight weeks a local recurrence was suspected in 13 per cent, and 41 per cent eventually had some evidence of a recurrent cancer nodule or persistent cancer in the bladder neck. In a series of statistical analyses we have related these recurrences to other clinical factors. Cryosurgery has been a safe, effective way to reduce or eliminate the primary prostatic cancer, even in patients with large local lesions.

Bilateral simultaneous lung lavage utilizing membrane oxygenator for pulmonary alveolar proteinosis in an 8-month-old infant.

Pulmonary alveolar proteinosis can result in severe hypoxemia. Treatment of symptomatic patients using unilateral or lobar staged lung lavage often results in improved oxygenation and functional capacity. Lung lavage is technically difficult in infants and small children because of inability to ventilate part of the lung safely and adequately during lavage of other areas. We used extracorporeal membrane oxygenation to facilitate adequate gas exchange during lung lavage for severe respiratory failure in a 3.7 kg, 8-month-old child with pulmonary alveolar proteinosis. Oxygenation was markedly improved immediately following the procedure. Extracorporeal membrane oxygenation permits satisfactory respiratory support in the setting of severe respiratory failure and should be considered an adjunct for treatment of pulmonary alveolar proteinosis when lung lavage cannot be otherwise safely accomplished.

Nutritional status of African populations predisposed to esophageal cancer.

Nutritional status indicators were assessed chemically in blood and urine taken from 625 Transkeians drawn from three age-groups in each of two regions: one with a moderate risk for esophageal cancer and one with a very high risk. Aggregate mean values for protein, albumin, vitamin A, and phosphorus were generally acceptable, but many subjects had inadequate (though not necessarily deficient) values for nicotinic acid (74% of subjects), magnesium (60%), vitamin C (55%), carotene (53%), riboflavin (41%), calcium (35%), and zinc (27%). Groups at highest risk for esophageal cancer had markedly lower serum magnesium and carotene concentrations and mildly depressed hemoglobin and hematocrit values, but such findings are not necessarily associated with esophageal cancer etiology. Possible intestinal malabsorption in the populations at highest risk may be associated with the unusually high fiber and phytate intake of the high-risk populations as well as with exposure to necrotizing mycotoxins. Thus, while protein and energy nutriture seem generally adequate, both the high- and moderate-risk populations had high incidences of multiple micronutrient malnutrition.

Gastrointestinal bleeding and mycotic superior mesenteric aneurysm.

This is a case report of management of a delayed mycotic superior mesenteric artery aneurysm occurring in a patient 2 years after aortic valve replacement for endocarditis. A chronic ulcer history, anticoagulation therapy, episodic gastrointestinal bleeding associated with negative gastrointestinal series, and gastritis seen at endoscopy delayed the ultimate diagnosis. An episode of massive hemorrhage precipitated angiography with subsequent surgical confirmation of the diagnosis. Management included debridement and extirpation of the major part of the aneurysm, Doppler assessment of the inadequacy of collateral mesenteric arterial blood flow, and restoration of flow with a bypassing saphenous vein graft segment. Although this technique of reconstruction has been suggested, we can find no other report of such a similar case among the few reported surgical successes with superior mesenteric artery mycotic aneurysm.

Temporal bone pathology in drowning.

The temporal bones of a 2-year-old child who had drowned were examined histopathologically. The abnormalities were limited to the submucosa and lumen of the tympanomastoid space. Abnormalities included severe edema, vascular congestion, and focal ecchymosis without inflammation in the submucosa and hemorrhage into the tympanomastoid air space. To determine the incidence of tympanomastoid hemorrhage in autopsy material, 258 temporal bones were reviewed, and 11 were found to have free blood in the tympanomastoid space. When specimens from victims of skull fractures, cerebrovascular accidents, and leukemia were excluded from the 11, the only specimen remaining was found to be that from a drowning victim. Tympanomastoid hemorrhage in the absence of otitis media, head trauma, cerebrovascular accident, or a bleeding diathesis appears to be strong supporting evidence for death by drowning.

Chronic hypersensitivity pneumonitis produced in the rabbit by the adjuvant effect of inhaled muramyl dipeptide (MDP).

An established rabbit model of acute hypersensitivity pneumonitis was used to evaluate adjuvant properties of synthetic muramyl dipeptide (MDP), the minimal adjuvant-active structure of mycobacteria. The authors studied MDP as a substitute for mycobacteria in immunization and as adjuvant during repeated inhalation of antigen (ovalbumin). They found that MDP could substitute successfully for mycobacteria in sensitizing animals for acute alveolitis following subsequent inhalation of a combination of ovalbumin and MDP aerosol for 4 to 14 weeks resulted in the development of chronic granulomatous pneumonitis, characterized by alveolar wall thickening, granulomas, and infiltrations with lymphocytes and macrophages. In addition, MDP boosted systemic and local IgG and IgA antigen-specific antibodies. Inhaled MDP, itself neither antigenic nor mitogenic, acted therefore as adjuvant for continued immunologic inflammatory effector mechanisms in the rabbit lung, which are ordinarily suppressed when antigen alone is inhaled. Possible mechanisms include stimulation of effector T cells and macrophages or the failure of suppressive mechanisms, with or without participation of immune complexes. This is the first successful model of chronic granulomatous alveolitis produced by inhalation of soluble materials. Further exploration of adjuvant mechanisms in this system should help clarify the pathogenesis of immunologic lung diseases in man.

Cryosurgery in prostatic cancer: survival.

From 1969 through 1976 we performed cryosurgery in 229 cases of prostatic cancer. This article presents survival in cryosurgery and other treatment groups. In every stage, despite a preponderance of large primary tumors and poor-risk patients, cryosurgery matched total prostatectomy and compared favorably to other modalities, including radiation therapy, at our center and elsewhere. According to previous authors, and in view of the present data, eradication of the local lesion is associated with better survival even in advanced cases. Cryosurgery provides a safe, effective method.

Antibody responses to T-activated red cells in children from high- and low-risk areas of cancer of the oesophagus in Transkei.

Information is presented on the role of humoral anti-T activity in children residing in areas of Transkei where the incidence of cancer of the oesophagus ranks among the highest in the world. It is significant that children from high-risk areas produce elevated levels of antibodies to the cryptantigenic T structure of autologous cell membranes more often than those from low-risk areas (X2(1) = 32; P less than 0,0005). The extreme variations recorded in anti-T response between these two groups of children could not be related to a greater prevalence of viral infections or other susceptible childhood diseases. Available evidence suggests that the observed differences in anti-T activity may be closely related to environmental nutritive imbalances, some of which are known to be significantly correlated with the high-incidence foci of cancer of the oesophagus in Transkei.