High incidence of cardiopulmonary complications associated with implantation of adrenal medullary tissue into the caudate nucleus in patients with advanced neurologic disease.

OBJECTIVE: The purpose of our study was to examine the cardiopulmonary complications of a group of patients who had undergone implantation of adrenal medullary tissue into the caudate nucleus for treatment of neurologic disease. DESIGN: Prospective study with partially matched historical controls. SETTING: Tertiary care community medical center. PATIENTS AND METHODS: Seven patients with advanced Parkinson's disease and three patients with progressive supranuclear palsy underwent implantation of adrenal medullary tissue into the caudate nucleus. These patients were compared with respect to their cardiopulmonary complications with a control group who had undergone craniotomy and then compared with a control group who had undergone only abdominal surgery. RESULTS: In the study group, six patients developed major postoperative complications including development of large pleural effusions, lobar atelectasis, pneumonia, upper airway obstruction, and cardiac arrest. Three patients had minor complications including development of small pleural effusions, subsegmental atelectasis, purulent bronchitis, mild congestive heart failure, and atrial flutter/fibrillation. One patient had an unremarkable postoperative course. The first control group, whose only surgery was a craniotomy, had only one major complication. The second control group, the abdominal surgery control group, had one major and five minor complications. CONCLUSION: The particular neurologic disease, its severity, and the type of surgery performed appear to be causative factors in the high incidence of complications in the study group.

Canada-Cronkhite syndrome in an 82-year-old woman.

An 82-year-old woman with the Canada-Cronkhite syndrome is described. The patient was unusual because of her age at presentation, favorable response to treatment with steroids and feeding jejunostomy, and associated hypothyroidism.

The effect of biopsy on therapy in renal disease.

In an effort to determine whether renal biopsy substantially altered patient treatment, 100 consecutive cases were reviewed. From a pathologic standpoint, 41 cases were considered "definitely" diagnostic, 36 were in the "probable" category, and the remaining 23 were "nondiagnostic." In 19 cases, a therapy change occurred on the basis of biopsy results. These patients all had significant proteinuria. No alteration in therapy took place in patients with acute or chronic renal failure or hematuria alone.

Acute effect of systemic aspirin on gastric mucosa in man.

Aspirin was administered intravenously to study its effect upon gastric mucosa at high blood levels in the therapeutic range for rheumatic diseases. Five healthy volunteers were studied twice each with intravenous aspirin (3 g over 2 hr) and isotonic saline infusion as control. In one study, gastric potential difference was measured; in the other, coded gastric biopsies were taken sequentially prior to infusion, and at the end of infusion. Duplicate biopsies were taken for light and scanning electron microscopy. Mean potential difference at the end of the intravenous aspirin infusions was -47.7 +/- 1.4 mV, compared with saline, -51.1 +/- 2.5 mV (P greater than 0.05). The percentage of cells damaged after 2 hr intravenous infusion of aspirin (3.2 +/- 0.4%) was not significantly different from that after intravenous saline (2.6 +/- 0.3%). In contrast to oral aspirin, acute administration of aspirin parenterally does not produce detectable histological damage in man, nor does it significantly alter gastric mucosal potential difference. We conclude that high blood levels of circulating salicylate do not acutely damage gastric mucosa. Thus, histologic gastric mucosal damage produced acutely after single oral doses of aspirin are due to its topical, rather than systemic, action.

Megakaryocytopoiesis in the liver of the developing opossum (Didelphis virginiana).

The development of hepatic megakaryocytes has been examined in the livers of 35 young opossums at four different stages of postnatal development. Megakaryocytopoiesis is carried out within the sinusoidals and there appears to be a close relationship between the young megakaryocytes and the sinusoid lining cells. Megakaryocytes in the opossum are relatively small and lack the degree of nuclear complexity seen in other species. Both the nucleus and the cytoplasm undergo sequential maturational changes but, in the newborn especially, these sequences are not necessarily interrelated and there is a rapid cytoplasmic differentiation to provide for early platelet release. A scheme for the maturation of the hepatic megakaryocytes is presented.