Showing papers by "Oregon Health & Science University published in 1978"

Family Medicine: Principles and Practice

Abstract: This updated and revised edition presents topics in common family medicine with a new format that features 120 short chapters on: common problems of the elderly, care of acute lacerations, care of the patient with chronic pain, ocular trauma, ischemic heart disease, cardiovascular emergencies, and much more. New and timely topics include the management and care of the HIV-infected patient, environmental and occupational diseases, substance abuse, contraception and menopause. This reference is geared to the office setting and mirrors the unique perspective of the family physician. It emphasizes practical detail and, arranged by organ system, provides clear diagnostic and treatment guidelines.

Gentamicin and tobramycin nephrotoxicity. A morphologic and functional comparison in the rat.

Abstract: Fischer 344 rats were treated with tobramycin or gentamicin, 40 mg/kg/day, for up to 10 days or with tobramycin, 120 mg/kg/day, for up to 14 days. Serum creatinine and BUN at the time of sacrifice were determined, and kidney tissues were examined by light and electron microscopy. Rats receiving gentamicin demonstrated progressive renal proximal tubular necrosis which was nearly universal at the end of 10 days. Their BUN and creatinine levels rose progressively over the same period. Even at the higher dosage, tobramycin therapy resulted in only rare foci of proximal tubular necrosis and minimal elevation of BUN and creatinine. Although they occurred later and were substantially less severe, the ultrastructural changes induced by tobramycin were the same as those seen following gentamicin administration. These results indicate that the mechanism of tobramycin-induced renal injury is probably similar to that of gentamicin and that tobramycin is significantly less nephrotoxic in this experimental model.

Initiation of sperm motility in the mammalian epididymis.

Abstract: Spermatozoa acquire the capacity for motility as they traverse the mammalian epididymis. The biochemical basis for this induction of motility is still largely unknown. Current theories are discussed and recent studies from the authors' laboratory are described which indicate that two separate processes are involved and that these act synergistically. These processes are an increase in the intrasperm content of cyclic AMP during epididymal transit combined with the binding of a specific forward-motility protein. A second increase in cyclic AMP and stimulation by calcium ion is likely involved in the expression of the acquired potential for motility at the time of ejaculation.

The arthritis of mixed connective tissue disease.

Abstract: Twenty patients with mixed connective tissue disease were followed for 5 years. Arthritis occurred in all 20 patients, being the presenting complaint in 11 patients. The joints most frequently involved were the proximal interphalangeal (PIP), metacarpophalangeal (MCP), wrists, metatarsophalangeal (MTP), and knee; the distribution tended to be symmetrical, mimicking early rheumatoid arthritis. Joint deformities occurred in 6 patients, but apart from 1 patient with arthritis mutilans, significant functional impairment was not encountered. Radiologically small punched out bone erosions, asymmetrically distributed, were the most characteristic finding; other notable changes were aseptic necrosis, tuft erosions, and periarticular calcification. Joint effusions were non-inflammatory, the cellular content was predominantly lymphocytic and the C3 level was normal. Most cases were controlled with non-steroidal anti-inflammatory agents and invariably responded to prednisone less than or equal to 7.5 mg/day.

Survival in Patients With Intraventricular Conduction Defects

Abstract: All 42,000 electrocardiograms taken at the University of Oregon Health Sciences Center from 1969 through 1971 were reviewed; 325 patients (0.77%) had left bundle-branch block (LBBB) or right bundle-branch block (RBBB) with axis deviation (AD). In December 1974, 90% were contacted or found to be dead. The five-year survival rate (actuarial technique) (mean ± SE) was 45.5 ± 2.9%. It was significantly worse than that of age- and sex-matched "controls." In most patients the cause of death could not be determined. Survival of 164 LBBB patients (40.7 ± 4.1%) at five years was not significantly worse than that of 161 RBBB and AD patients (49.5 ± 4.2%). Those with syncope did no worse in terms of survival than did those without. The five-year survival in coronary artery disease patients was 33.7 ± 4.4%; in those with primary conduction system disease (20% of patients), it was 50.6 ± 6.6%. It will be necessary to know the causes of death and of syncope in conduction disease patients before it can be determined whether or not pacemakers can prevent either. (Arch Intern Med138:30-35, 1978)

Myeloid bodies in the renal tubules of humans: relationship to gentamicin therapy.

Abstract: Ultrastructural changes in renal proximal tubule lysosomes, including the formation of myeloid bodies, occur reliably with gentamicin administration in experimental animals The present study reviewed the electron microscopic tubular morphology of renal biopsies and nephrectomies performed in our institution over a 2-year period The frequency of myeloid bodies and their relation to drug therapy and selected clinical features were determined Myeloid bodies were found in the proximal tubules of 19 of 109 cases that were judged adequate for study On review of the drug histories of these 19 patients, 15 had received gentamicin within 6 weeks of biopsy or nephrectomy None of the 90 patients without myeloid bodies had received the drug within 6 weeks of tissue examination Of 4 patients with myeloid bodies who had not received gentamicin, 1 had received chloroquin and 3 had received drugs with no known or suspected capacity to induce myeloid bodies The presence of myeloid bodies in proximal tubules did not appear to be related to the total dose of gentamicin, duration of therapy, or serum drug concentration Clinical evidence of gentamicin nephrotoxicity was present in only 1 case

Fluoroscopic guidance in femoral artery puncture

Abstract: Analysis of 100 femoral arteriograms demonstrated a consistent relationship between the course of the femoral artery and the femoral head. Fluoroscopic guidance can be of value in femoral puncture when the arterial pulse is diminished or obscured, for training purposes, and for analysis and correction of missed punctures.

Peritoneal Dialysis in the Management of Hypothermia

Abstract: PERITONEAL dialysis was introduced in 1923 as a treatment for acute and chronic renal failure. Since that time it has been useful for the management of congestive heart failure, drug intoxications, Reye's syndrome, hyaline membrane disease, hemorrhagic pancreatitis, and psoriasis. In 1967 Lash et al 1 reported its use in the treatment of hypothermia. The technique is achieving widespread acceptance as a rewarming method of choice in the treatment of patients with severe, prolonged depression of body temperature. Controversy Over Methods In conjuction with general resuscitative measures in the treatment of the hypothermic patient, a mechanism for rewarming must be instituted. 2 The potential for active external rewarming to aggravate the effect of hypothermia on core tissues has resulted in controversy over rewarming methods. The tendency for the core temperature to drop following removal of long-term cold stress may be exaggerated by peripheral vasodilation associated with external rewarming. Paradoxical central

The Glucagonoma Syndrome: A Distinctive Cutaneous Marker of Systemic Disease

Abstract: • The glucagonoma syndrome is a rare clinical condition characterized by a distinctive cutaneous eruption associated with a glucagon-secreting islet cell neoplasm of the pancreas. A 19-year-old woman manifested typical features of this condition: a polymorphous skin eruption with characteristic distribution of lesions in perioral and paragenital regions; lesions in sites of cutaneous trauma; a skin biopsy that showed epidermal cleavage; glossitis; weight loss; mild anemia; abnormal glucose tolerance test results. Plasma glucagon levels, determined by radioimmunoassay, were approximately five times normal. Angiography indicated a pancreatic tumor with liver metastases. Islet cell origin was confirmed histologically. It is hoped that wider recognition of the distinctive clinical features of this syndrome will result in earlier detection and possible surgical cure of the underlying malignancy. ( Arch Dermatol 114:224-228, 1978)

Distinct subpopulations of IgG memory B cells respond to different molecular forms of the same hapten.

Abstract: Spleen cells from mice primed with the thymus-dependent antigen trinitrophenyl keyhole limpet hemocyanin several months earlier can be cultured in vitro to give vigorous IgG antihapten PFC responses to thymus-dependent (TD) and thymus-independent (TI) forms of the same hapten. Here we show that the IgG memory precursors that respond to these two forms of the hapten constitute functionally distinct subpopulations. We have designated these subpopulations as B 1γ and B 2γ to represent secondary precursor cells responding to TI and TD antigens, respectively. Three types of evidence for these subpopulations are presented: 1) In vitro secondary IgG responses to TD and TI forms of the TNP hapten are additive when both forms are added to the same culture. 2) The precursor frequencies for the TD and TI antigens are additive, but addition is not observed between two TD or two TI antigens. 3) Each population can be selectively eliminated by BUdR and light treatment without affecting the other population. The ontogenetic relationships between these subpopulations are discussed in relation to all presently proposed subpopulations B 1µ , B 2µ , B 1γ , and B 2γ .

Transplacental gradients in the guinea pig.

Abstract: We measured plasma concentrations of Na+, K+, Mg2+, Cl-, Ca2+, HCO3-, phosphate, lactate, glucose, total amino acids, and total protein, and also the total (freezing point depression) osmolality and the colloid osmotic pressures. Conversion of chemically measured concentrations to osmolalities showed that unrecognized solute (s) were present in maternal (7 mM) and fetal (12 mM) plasma. Statistically reliable transplacental gradients existed only for calcium ion, phosphate, and amino acids, Ionic Na, K Mg, Cl, Ca, HCO3 and lactate were in electrochemical equilibrium at potential differences of -4.2 to +1.3 mV. Total plasma osmolalities were not significantly different in maternal and fetal plasmas in preparations in good condition, but fetal plasma osmolalities rose due to lactate secretion in asphyxiated fetuses. Colloid osmotic pressures were about 5 cmH2O higher in maternal plasmas before 45 days gestation and about 6 cmH2O higher in fetal plasmas after 60 days gestation. In the guinea pig, colloid osmotic pressures are at least as important as intravascular pressures in the regulation of transplacental water flow.

Hemodynamic characteristics of the composite strut ball valve prostheses (Starr-Edwards track valves) in patients on anticoagulants.

Abstract: The hemodynamic characteristics of the composite strut ball valve prostheses (Starr-Edwards Model 2400 aortic track valve and Model 6400 mitral track valve) were evaluated in anticoagulated patients. The peak systolic gradient (mean +/- SE) for the aortic valve in 16 patients was 18.1 +/- 3.9 mm Hg; the mean gradient was 17.0 +/- 2.7 mm Hg; the prosthetic valve area was 1.7 +/- 0.1 cm2; and the valve area index was 1.0 +/- 0.1 cm2/m2. In the 19 patients with the mitral valve, the mean diastolic gradient (mean +/- SE) was 5.2 +/- 0.7 mm Hg. The prosthetic valve area was 2.0 +/- 0.1 cm2, and the valve area index was 1.3 +/- 0.1 cm2/m2. These hemodynamic parameters are helpful in evaluating the catheterization findings in patients with composite strut prosthetic valves who are suspected of having prosthesis dysfunction. They also demonstrate the satisfactory in vivo hemodynamics in anticoagulated patients with these prostheses.

Aicardi's syndrome. Case report, clinical features, and electrophysiologic studies.

Abstract: • Aicardi's syndrome consists of abnormalities of the ocular fundus, myoclonic seizures, mental retardation, and congenital malformations of the brain and vertebral column in females. The pathognomonic chorioretinal lesions were noted on ophthalmologic examination of a 22-month-old girl, observed for 19 months with severe myoclonic seizures and profound mental retardation. Computerized tomography confirmed major malformation of the brain. Roentgenograms showed anterior fusion of two thoracic vertebrae. Electroretinography was normal, but visual evoked responses were abnormal. Only 72 children are known to have this syndrome; no affected siblings have been reported. The absolute sex limitation—all cases have been female—suggests that the disorder is produced by a mutation on one of the X chromosomes, and is nonviable in male conceptuses. These genetic considerations dramatically influence counseling of parents regarding likelihood of occurrence of the syndrome in subsequent offspring.

Endoscopic retrograde cholangiopancreatography in the diagnosis and management of nonalcoholic pancreatitis.

Abstract: Twenty-eight consecutive patients with idiopathic pancreatitis were studied. Endoscopic retrograde cholangiopancreatography was diagnostic in 21 of 28, while an operation was diagnostic in four of the remaining seven patients. Fifteen of 25 patients had operable disease of the gallbladder, common bile duct, ampulla of Vater or pancreatic duct. Of ten patients who had an operation on the pancreas or biliary tract, or both, for painful attacks of pancreatitis, none had a recurrence in a seven month to three year follow-up study. Two patients had reconstruction of the pancreatic duct for chronic painless steatorrhea, one of whom had marked clinical improvement. Ten of 25 patients had normal biliary tracts with normal or minimally abnormal pancreatic ducts and were treated medically. Visualization of biliary and pancreatic ducts should be attempted by endoscopic retrograde cholangiopancreatography in patients with pancreatitis of unknown cause. Operable lesions were found in 15 of 25 patients, and the postoperative results were excellent.

Percutaneous transhepatic obliteration of gastroesophageal varices: some technical aspects.

Abstract: Two cases of bleeding from gastroesophageal varices treated by variceal obliteration illustrate multiple routes of variceal supply, and alert embolizing angiographers to the presence of spontaneous portosystemic shunts which should be kept open. In one case, variceal obliteration required embolization of the left gastric vein and a transhepatic collateral originating from the left hepatic portal branch and contributing substantially to variceal filling. A second patient with a relatively large spontaneous splenorenal shunt had recurrent variceal bleeding two months after a successful embolization of the coronary vein and a short gastric vein. A repeat study revealed the recurrent varices were supplied by enlarged right gastric and gastroepiploic veins. Superior mesenteric venography was necessary for their visualization.

Lack of Functional Immunoregulatory Cells in a Patient With Mycosis Fungoides and Circulating Sezary Cells: Brief Communication

Abstract: Peripheral blood lymphocytes obtained at various intervals from normal individuals and from a patient with mycosis fungoides (MF) were cultured with phytohemagglutinin (PHA) for 3 days to activate suppressor cells. After being cultured, the PHA-treated cells were irradiated, washed, and then transferred to fresh medium with PHA. The PHA responsiveness of the cells from normal individuals was suppressed approximately 90% by autologous or normal allogeneic lymphocytes activated for 3 days with PHA, whereas the cells activated for 3 days with PHA from the patient with MF lacked the capacity to inhibit the mitogenic response of autologous or allogeneic lymphocytes. These data suggest that this patient lacked suppressor T-cells that have a specificity for helper T-cells.

Human Kidney Preservation by Flushing With Intracellular Solution and Cold Storage

Abstract: • Simple flushing and cold storage of human kidneys for transplantation has not been accepted for preservation times exceeding 24 hours. A prospective study of 25 primary cadaver kidney transplants was performed to evaluate Collins C2 solution for human kidney preservation. Cold storage time was 10 to 23 hours in 14 cases and 26 to 44.5 hours in 11 cases. Seventeen (68%) of the kidneys had immediate, sustained function. The one-month function rate was 88%. There were no significant differences between the 10-to 23-hour and the 26- to 44.5-hour groups with respect to the incidence of first-week dialysis, one-month graft function, or mean lowest serum creatinine value. Human kidney preservation time can be safely extended beyond 24 hours with Collins C2 flushing followed by simple cold storage. ( Arch Surg 113:830-832, 1978)

Synthesis of Murine Leukemia Virus Proteins Differentiating Friend Erythroleukemia Cells

Abstract: In agreement with previous observations, the Friend 745 line of virus-induced erythroleukemia cells can be induced by dimethyl sulfoxide to synthesize hemoglobin and to increase simultaneously their content of morphologically recognizable virus particles, especially in cytoplasmic vesicles. In apparent contrast to the electron microscopic results, the cellular content of the major murine leukemia virus (MuLV) proteins p30 (the major internal core protein) and gp70 (the envelope glycoprotein) were measured by radioimmunoassay and were found to be approximately the same in control and in induced cells. Control and induced cells are also approximately as active in the synthesis of the protein precursors of p30, reverse transcriptase, and gp70 in the processing of these precursors by proteolysis and glycosylation. Furthermore, the noninfectious MuLV synthesized by this cell line is released into the culture medium to the same extent by control and induced cells. Although some of the virions formed in induced Friend 745 cells bud into cytoplasmic vesicles that are absent from control cells, this intravesicular budding is not associated with a major increase in the synthesis, processing, or cellular content of virion proteins. MuLV synthesis by Friend 745 cells was compared with that of Ostertag-derived F46/K erythroleukemia cells that produce infectious virus. The synthesis and processing of MuLV-specific proteins were very similar in these independently isolated cell lines, despite the major difference in infectivity of the virus produced.

Primary cadaver kidney transplantation in older patients: survival equal to dialysis.

Abstract: In our experience, primary cadaver kidney transplantation is a reasonable alternative to dialysis in the older patient with ESRD. The probability for a transplant success is no different from that of other age groups receiving their first grafts from cadaver donors and the quality of life after transplantation is equal to or exceeds that obtained with chronic dialysis.

Left Ventricular Fistula as a Cause of Intractable Angina Pectoris: Successful Surgical Repair

Abstract: Two patients had intractable angina pectoris due to left-coronary-artery to left-ventricle fistulas. Surgical repair resulted in complete relief of symptoms. Postoperative cardiac catheterization showed obliteration of the fistulas, with preservation of ventricular function. Operative therapy is indicated in this disorder. ( JAMA 240:372-374, 1978)