Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes.

In clinical practice, an elevated carbon monoxide (CO) transfer coefficient (KCO) and restrictive ventilatory defect are taken as features of respiratory muscle weakness (RMW). However, the authors hypothesised that both pattern and severity of RMW effect gas transfer and lung volumes. Measurements of CO transfer and lung volumes were performed in patients with isolated diaphragm weakness (n=10), inspiratory muscle weakness (n=12), combined inspiratory and expiratory muscle weakness (n=5) and healthy controls (n=6). Patients with diaphragm weakness and inspiratory muscle weakness had reduced total lung capacity (TLC) (83.6% predicted and 68.9% pred, respectively), functional residual capacity (FRC) (83.9% pred and 83.6% pred) and transfer factor of the lung for CO (TL,CO) (86.2% pred and 66.2% pred) with increased KCO (114.1% pred and 130.2% pred). Patients with combined inspiratory and expiratory muscle weakness had reduced TLC (80.9% pred) but increased FRC (109.9% pred) and RV (157.4% pred) with decreased TL,CO (58.0% pred) and KCO (85.5% pred). In patients with diaphragm weakness, the increase in carbon monoxide transfer coefficient was similar to that of normal subjects when alveolar volume was reduced. However, the increase in carbon monoxide transfer coefficient in inspiratory muscle weakness was often less than expected, while in combined inspiratory and expiratory muscle weakness, the carbon monoxide transfer coefficient was normal/reduced despite further reductions in alveolar volume, which may indicate subtle abnormalities of the lung parenchyma or pulmonary vasculature. Thus, this study demonstrates the limitations of using carbon monoxide transfer coefficient in the diagnosis of respiratory muscle weakness, particularly if no account is taken of the alveolar volume at which the carbon monoxide transfer coefficient is made.

Provision of training in chronic pain management for specialist registrars in the United Kingdom.

A study published in 1992 highlighted wide variations in the provision of training in pain management. In this survey, data were collected from both pain clinicians and Programme Directors of the Schools of Anaesthesia to see if there had been any changes in training patterns since the introduction of the Calman training scheme. There did not seem to be a uniform improvement in the provision of training in pain management for Specialist Registrars and many may reach their Certificate of Completion of Specialist Training without a basic knowledge of chronic pain. It is thought that at the present time there will be few Specialist Registrars with sufficient training to take up consultant posts in pain management unless they compete for the much sought after, and often not fully funded, pain fellowships outside their rotations.

Arabidopsis AUX1 gene: a permease-like regulator of root gravitropism.

The plant hormone auxin regulates various developmental processes including root formation, vascular development, and gravitropism. Mutations within the AUX1 gene confer an auxin-resistant root growth phenotype and abolish root gravitropic curvature. Polypeptide sequence similarity to amino acid permeases suggests that AUX1 mediates the transport of an amino acid-like signaling molecule. Indole-3-acetic acid, the major form of auxin in higher plants, is structurally similar to tryptophan and is a likely substrate for the AUX1 gene product. The cloned AUX1 gene can restore the auxin-responsiveness of transgenic aux1 roots. Spatially, AUX1 is expressed in root apical tissues that regulate root gravitropic curvature.

An alternative approach to the semi-quantitative assessment of the transplanted renal artery velocity sonogram.

There are theoretical problems with the use of resistance based indices, i.e. pulsatility index (PI) or resistive index (RI) as stand alone measures in the renal allograft. PI and RI are heart rate dependent and input pressure dependent for autoregulating organs. A new non-invasive index, termed Pz, has been proposed. Pz may be thought of as the arterial back pressure generated by the kidney representing the pressure which needs to be overcome in perfusing the glomeruli. On a theoretical basis Pz can be shown to be independent of heart rate and resistance and to allow for variations in mean systemic blood pressure. In an initial study, a group of 53 well functioning renal allografts demonstrated a significant reduction in the coefficient of variance for Pz (12.8%) when compared to PI (25.4%). A second study on recently transplanted allografts indicated that acute tubular necrosis could not be separated from rejection on the basis of Pz. Pz did however consistently perform better than PI in terms of reduced variability within pathological groups. We conclude that Pz is more useful than PI in this application.

Multiple cystic pulmonary hamartomas.

A patient with multiple cystic hamartomas presented with a pneumothorax and later developed a cystic myxomatous vaginal polyp. This and three of the cysts were resected. She remains well 13 years later. Multiple cystic hamartomas are uncommon and may be misdiagnosed as pulmonary metastases.

Is the scrotal testis normal in unilateral cryptorchidism?

Bilateral testicular biopsies were performed on 66 children undergoing orchiopexy for unilateral cryptorchidism and the tubular fertility index (TFI) recorded. The results in both the descended and undescended testes at various ages were compared with previously reported control data. There were no significant differences between the germ cell activity of the scrotal testis in cases with unilateral cryptorchidism and that of controls. By contrast, the mean TFI of the undescended testis was significantly less than that of control patients of all ages. In neither group was there evidence of a progressive loss of germ cell activity during childhood. It is concluded that there is little to be gained from very early orchiopexy, performed before the third year of life.

Histologic grade and prognosis of carcinoma of the cervix.

A histologic grading system based on tumor differentiation was applied in a study of 122 patients with stage IB and IIA squamous cell carcinoma of the uterine cervix. In general, the more dedifferentiated the primary tumor, the more bulky the primary lesion and the higher the incidence of pelvic node metastasis. Following treatment, patients with undifferentiated tumors had a higher incidence of tumor recurrence a lower 2-year survival rate than those with well or moderately differentiated lesions. These findings suggest that histologic grading is an important adjunct to the clinical evaluation of cervical cancer.

Endometrial biopsy during a cycle of conception.

Endometrial biopsies obtained from 18 infertile women during early intrauterine pregnancy were examined histologically. The cycle date on which the biopsies were obtained was determined from the day of ovulation by basal body temperature charts and prior menstrual history. The average cycle dates of the biopsies were similar for the women who delivered at term or who had first-trimester spontaneous abortions. Among the women who delivered at term, the average histologic date assigned to the specimens was significantly earlier than the average cycle date. In contrast, among the women who had early pregnancy loss, the specimens had an average histologic date significantly later than the average cycle date. A histologic date of later than 25 days or later than the cycle date of the biopsy was associated with a poor prognosis for the pregnancy.

PIP: 18 infertile women from the Milton S. Hershey Medical Center in Pennsylvania underwent endometrial biopsy during the cycle of conception. The endometrial biopsies were examined histologically and dated by 4 different examiners within 2-day interval rates. Average cycle date on which biopsies were obtained was day 25 (range 21 to 28). 13 of the 18 women delivered at term, 4 had histologically documented 1st-trimester spontaneous abortions, and 1 was lost to follow up in the 2nd trimester. Pregnancy outcome did not correlate with day of cycle on which biopsy was taken. Overall incidence of obtaining endometrial biopsy during the cycle of conception in this group of patients was 6.2%, an incidence similar to that by Wentz but greater than that observed by others (0.05% to 4.2%). Average histologic date assigned to specimens was earlier than the average cycle date on which the biopsy was taken. Pregnancy outcome correlated with the histologic dates of the endometrium, with the number of 1st trimester abortion significantly increased among those whose endometrium was dated histologically later than the cycle date of biopsy or later than day 25.

Chromosomal abnormalities associated with infertility.

From a population of 515 subfertile couples and 119 women with amenorrhea, 38 patients were karyotyped because of specific signs and symptoms suggestive of chromosomal abnormality. The indications for karyotyping included primary amenorrhea, secondary amenorrhea with gonadal failure before 35 years of age, stature of less than 147.5 cm, azoospermia with eunuchoidism, and personal or family history of more than 2 spontaneous abortions or more than 2 severely abnormal children. In addition, 19 patients from the same subfertile population were selected randomly for karyotyping to serve as controls. Using banding techniques, chromosomal abnormalities were found in 18 of the 38 specifically selected individuals, whereas no abnormality was found among those randomly selected. Three of the 18 patients had chromosomal abnormalities not previously described; their karyotypes were 46,XY/48,XY,+8,+21; 46,X,inv dup(Xq)/q26 leads to q21); and 46,XY,t(9;20)(q22;q12).

Establishment and characterization of a new endometrial cancer cell line (SCRC-1).

A new human endometrial cell line, SCRC-1, has been established from a uterine adenocarcinoma. During a period of 57 weeks in culture, the SCRC-1 cells have been passaged over 100 times. Cultures have an epitheloid morphology, high mitotic activity, and a tendency to form multiple cell layers. The cells are polygonal and are arranged in pavement-like fashion. Most have multiple nucleoli, some are multinucleated, and all have heavily vacuolated cytoplasm. Pretreatment with iododeoxyuridine did not reveal viral markers by cocultivation or immunofluorescence techniques. Karyologic studies indicate that the SCRC11 cell line is essentially diploid with a small subpopulation of tetraploid cells. Over a period of 20 weeks, 1 of 14 athymic nude mice inoculated with SCRC-1 cells developed a tumor which histologically closely resembled the original human tumor. Cells were subsequently propagated from this tumor and the resulting epitheloid-like cell line was designated SCRC-1, Tu 1.

Immunologic myopathy. Linear IgG deposition and fulminant terminal episode.

The histopathologic characteristics of a patient with progressive myopathy, renal failure, hemoptysis, and a fulminant terminal event demonstrated a diffuse vasculitis, type 2 fiber atrophy of muscle, and linear IgG staining of the basement membranes of skeletal muscle fibers and of glomerular capillary basement membranes. Interpretation of electron micrographs confirmed that there was thickening of muscle basement membranes. The data suggest the presence of an antibody to a basement membrane antigen shared by muscle and kidney.

Abnormalities in gallbladder morphology and function in patients with cholelithiasis.

Thirty-seven symptomatic cholelithiasis patients who had cholecystectomy were studied to determine the relationships between clinical manifestations, histologic findings and gallbladder absorptive capability. A clinical score was calculated from clinical data which we thought might be predictive of abnormal gallbladder histology. Histologic parameters indicative of gallbladder disease were used to calculate a histologic score. Shortcircuit current measurements, which reflect gallbladder sodium absorption,were used to assess absorptive function. Patients with very high clinical scores, indicative of pronounced clinical score was not predictive of histologic findings or absorptive function of the gallbladder is directly related to the degree of histologic abnormality, and that absorptive capability is not an all-or-none phenomenon. The data also show that visualization on oral cholecystography is an unreliable measure of gallbladder absorptive capability.