Lupus anticoagulant masquerading as an acute abdomen with multiorgan involvement.

A 45-yr-old male patient developed acute abdominal pain, ileus, and microscopic hematuria with biochemical evidence of pancreatitis and a marked increase in liver alkaline phosphatase; CT demonstrated swelling of the pancreas, bilateral adrenal hemorrhage, and a suggestion of renal hemorrhage. ERCP was negative and renal arterial and venous blood flow normal. A coagulation profile demonstrated the presence of lupus anticoagulant, but tests for anticardiolipin antibodies and collagen vascular diseases were negative. Treatment with corticosteroids and anticoagulation resulted in improvement in clinical and all biochemical indices. Thus, lupus anticoagulant syndrome may masquerade as an acute abdominal illness with multiorgan involvement.

Maternal parenting stress in physicians' families.

The families of 16 male staff physicians and 26 male residents were studied. All spouses completed the Abidin Parenting Stress Index (PSI) prior to a well-child visit. Home interviews were conducted to identify factors contributing to stress. PSI scores were similar in both groups. The interviews suggested that physician fathers had limited time and energy for parenting. Resident fathers were twice as likely as staff fathers to participate in child care when home. Parenting stress tended to stay the same in 25% of families or increased in 50% of families after residency training.

Endothelial seeding of venous prostheses.

To evaluate the potential benefit of endothelial seeding of venous prostheses, 20 dogs were subjected to iliocaval reconstruction with expanded polytetrafluoroethylene grafts protected by an arteriovenous fistula. Grafts seeded with enzymatically derived endothelial cells were compared with control grafts that were sham seeded with culture medium and blood. Five seeded and seven sham-seeded grafts remained patient and were perfusion fixed in situ 4 to 6 weeks after operation. Specimens were examined by light, scanning, and transmission electron microscopy. No statistical difference in early patency was noted. The mean thrombus-free surface area was 80% in the seeded and 71% in the sham-seeded group. Light microscopy of these areas revealed a monocellular layer lining the lumen in all grafts. Scanning electron microscopy demonstrated a thin cellular lining covering 50% to 100% of the specimens' surface area in four of the five seeded and five of seven sham-seeded grafts. Transmission electron microscopy revealed these cells to exhibit characteristics typical of endothelial cells. The subcellular layer was equally thin in both groups. Early patency rates were not benefited by endothelial seeding of grafts placed in the venous system. Seeding of grafts with enzymatically derived endothelial cells provides a good endothelial cover with a thin subendothelial layer but not to a greater extent than does sham seeding of the venous prostheses.

Migration and granulomatous reaction after periurethral injection of polytef (Teflon).

Although patients with urinary incontinence have been treated successfully by periurethral injection of polytef paste, this study in continent animals demonstrates migration of polytef particles from the injection site. We injected polytef paste periurethrally into female dogs and male monkeys. Particles were found at 50 to 70 days in pelvic nodes in six of seven animals and lungs in four of seven (the kidneys and brain were not studied); and at 10 1/2 months in pelvic nodes, lungs, and brain in seven of seven; kidneys in four of seven; and spleen in two of seven. X-ray microanalysis confirmed that the particles were polytef. At 10 1/2 months, polytef granulomas were found at all injection sites and some sites of distant migration. Since these granulomas signify chronic foreign-body reaction, we believe that until the long-term effects in humans are known, polytef paste should not be used in children or young adults with normal life expectancy.