Showing papers by "Rush University Medical Center published in 1984"
TL;DR: For 24 subjects of this sample, who occupied both major body positions during the evaluation night, the apnea index was found to be twice as high during the time spent sleeping on their backs as it was when they slept in the side position, suggesting sleep position adjustment may be a viable treatment for some nonobese sleep apnea patients.
Abstract: Thirty male patients evaluated sequentially for sleep apnea syndrome by all-night clinical polysomnography were compared for apnea plus hypopnea index (A + HI) during the time in the side versus time in the back sleep posture. For 24 subjects of this sample, who occupied both major body positions during the evaluation night, the apnea index was found to be twice as high during the time spent sleeping on their backs as it was when they slept in the side position. This difference is reliable and inversely related to obesity. Five patients meeting diagnostic criteria for sleep apnea on an all-night basis fell within normal limits while in the side sleep position. This suggests sleep position adjustment may be a viable treatment for some nonobese sleep apnea patients.
538 citations
Journal Article•
TL;DR: The distinct potency of MBP as a stimulus for histamine secretion from human basophils suggests that eosinophil release ofMBP may be a specific event in the augmentation of immediate hypersensitivity reactions and other disorders characterized by eos inophilia.
Abstract: Major basic protein (MBP), an arginine-rich basic polypeptide that constitutes the crystalloid core of the large specific eosinophil granule, has previously been shown to stimulate noncytolytic histamine release from human basophils and rat mast cells by an IgE-independent mechanism. Two additional basic polypeptides present in eosinophil granules, eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN), were examined for similar activity in the present study. Acid-solubilized eosinophil granules were fractionated by chromatography on a Sephadex G-50 column. Incubation of basophil-containing human mononuclear cells with the individual column fractions demonstrated that histamine release occurred only with the fractions that contained MBP. The selectivity of the basophil response for MBP was confirmed by using equimolar concentrations of purified MBP, ECP, and EDN. In contrast, both MBP and ECP, but not EDN, stimulated histamine release from purified rat peritoneal mast cells. Reduction and alkylation of the MBP molecule diminished the response of human basophils to MBP but enhanced the potency of the molecule with rat mast cells. The distinct potency of MBP as a stimulus for histamine secretion from human basophils suggests that eosinophil release of MBP may be a specific event in the augmentation of immediate hypersensitivity reactions and other disorders characterized by eosinophilia.
219 citations
TL;DR: The cumulative survival rate following second resection in 80 patients with metachronous tumors was 33% at 5 years and 20% at 10 years and data support continued aggressive surgical approach to second and third primary lung cancers.
135 citations
TL;DR: Fourteen patients were implanted with drug pumps to provide chronic epidural or intrathecal morphine to relieve pain due to cancer and the programmable device has the obvious advantage of being able to vary dose according to patient need and requires less frequent refilling.
Abstract: ✓ Fourteen patients were implanted with drug pumps to provide chronic epidural or intrathecal morphine to relieve pain due to cancer. A new programmable pump was used in seven of the patients and a constant infusion device was used in the other seven patients. Results, judged by subjective pain reports (on a 0 to 10 scale), decrease in oral narcotics, and change in activity level, were excellent in eight patients, good in five patients, and poor in one patient. The programmable device has the obvious advantage of being able to vary dose according to patient need and requires less frequent refilling. Four programmable pump failures occurred, two requiring replacement.
125 citations
TL;DR: During sinusoidal rotations of normal subjects, there was no trace of this phenomenon when subjects looked 25 degrees left and right in the dark, and the phenomenon of Alexander's law was created centrally and is not due to any mechanical properties of the orbit.
Abstract: Alexander's law refers to the phenomenon in which the spontaneous nystagmus of a patient with a vestibular lesion is more intense when the patient looks in the quick-phase than in the slow-phase direction. Alexander's law was investigated in normal subjects as well as patients with vestibular lesions. During sinusoidal rotations of normal subjects, there was no trace of this phenomenon when subjects looked 25 degrees left and right in the dark. The phenomenon of Alexander's law is therefore created centrally and is not due to any mechanical properties of the orbit. During rotation at constant velocity in the dark, normal subjects did weakly demonstrate Alexander's law because of a mild gaze-evoked nystagmus present in normal subjects in the dark. Gaze-evoked nystagmus from a cerebellar lesion involved a pronounced demonstration of Alexander's law during rotatory nystagmus. In patients with a vestibular lesion and a mild spontaneous nystagmus in the dark that obeyed Alexander's law, the nystagmus reversed upon far gaze in the slow-phase direction. We propose that in patients with a vestibular lesion, the phenomenon of Alexander's law is created by the sum of vestibular nystagmus and an abnormally large gaze-evoked nystagmus that is consequent to the vestibular lesion. This conclusion has a number of neurological implications concerning the ways in which the nervous system attempts to compensate for vestibular lesions.
121 citations
TL;DR: It is reported that unilamellar vesicles will fuse with "hydrocarbon-free" membranes subject to these same osmotic conditions, and hydrocarbon is not required for the fusion process.
Abstract: It was previously shown (Cohen, F S, J Zimmerberg, and A Finkelstein, 1980, J Gen Physiol, 75:251-270) that multilamellar phospholipid vesicles can fuse with decane-containing phospholipid bilayer membranes An essential requirement for fusion was an osmotic gradient across the planar membrane, with the vesicle-containing (cis) side hyperosmotic with respect to the opposite (trans) side We now report that unilamellar vesicles will fuse with "hydrocarbon-free" membranes subject to these same osmotic conditions Thus the same conditions that apply to fusion of multilamellar vesicles with planar bilayer membranes also apply to fusion of unilamellar vesicles with these membranes, and hydrocarbon is not required for the fusion process If the vesicles and/or planar membrane contain negatively charged lipids, divalent cation (approximately 15 mM Ca++) is required in the cis compartment (in addition to the osmotic gradient across the membrane) to obtain substantial fusion rates On the other hand, vesicles made from uncharged lipids readily fuse with planar phosphatidylethanolamine planar membranes in the near absence of divalent cation with just an osmotic gradient Vesicles fuse much more readily with phosphatidylethanolamine-containing than with phosphatidylcholine-containing planar membranes Although hydrocarbon (decane) is not required in the planar membrane for fusion, it does affect the rate of fusion and causes the fusion process to be dependent on stirring in the cis compartment
114 citations
TL;DR: Sleeve lobectomy is a safe procedure and when technically feasible can be considered the procedure of choice for bronchogenic carcinoma.
94 citations
TL;DR: The synchronous presence of squamous and exocrine features in broncho-pulmonary carcinoids indicates that they too are capable of multidirectional differentiation, which should not detract from their being regarded basically as well-differentiated neuroendocrine neoplasms.
Abstract: Twenty-five strictly defined bronchopulmonary carcinoids were studied by light microscopic immunohistochemistry by the peroxidase technique for NSE (neuronspecific enolase), serotonin, and a broad spectrum of neuropeptides. Eighteen cases were also studied by electron microscopy.Twenty-three of the twenty-five cases showed immunostaining for NSE; 24 cases displayed immuno-staining for at least two of the hormones tested for; the single case that failed to show hormonal immuno-reactivity was however positive for NSE and had granules by electron microscopy. Serotonin was the most frequently demonstrated hormone followed by bombesin, vasoactive intestinal peptide, gastrin, leuenkephalin, alphamelanocyte stimulating hormone, somatostatin, substance P, and calcitonin. In several cases, adjacent-step sections stained for different hormones strongly indicated immunoreactivity for more than one hormone in single neoplastic cells.By electron microscopy, all 18 cases studied showed generally abundant neurosecretory...
83 citations
TL;DR: Proteoglycan synthesis can be described as occurring in two stages, translation and N‐glycosylation of a coreprotein precursor which has a long half‐life in the rough endoplasmic reticulum, followed by extensive rapid modification in the Golgi complex in which the majority of glycosaminoglycan and oligosaccharide chains are added to the core protein precursor with subsequent rapid secretion into the extracellular matrix.
Abstract: Biosynthesis of cartilage proteoglycan was examined in a model system of cultured chondrocytes from a transplantable rat chondrosarcoma. Extensive modification with the addition of chondroitin sulfate glycosaminoglycan, N-linkcd oligosac-charide, and O-linked oliogosaccharide is required to convert a newly synthesized core protein precursor into a proteoglycan. Kinetic analyses revealed the presence of a large pool of core protein precursor (t1/2 ∼ 90 min) awaiting completion into proteoglycan. The large t1/2 of this pool allowed kinetic labeling experiments with a variety of radioactive precursors to distinguish between early biosynthetic events associated primarily with the rough endoplasmic reticulum from late events associated primarily with the Golgi apparatus. The results of a series of experiments indicated that the addition of N-linked oligosaccharide chains occurs early in the biosynthetic process in association with the rough endoplasmic reticulum, whereas the initiation and completion of O-linked oligosaccharides occurs much later, at about the same time as chondroitin sulfate synthesis. This also indicated that keratan sulfate chains, when present in the completed molecule, are added in the Golgi apparatus, as they are probably built on oligosaccharide primers closely related to the O-oligosaccharide chains. Furthermore, when 3H-glucose was used as the precursor, the entry of label into xylose, the linkage sugar between the core protein and the chondroitin sulfate chain, was found to occur within 5 min of the entry of label into galactose and galactosamine in the remainder of the chondroitin sulfate chain. This indicated that the initiation and completion of the chondroitin sulfate chain occurs late in the pathway probably entirely in the Golgi apparatus. Thus, proteoglycan synthesis can be described as occurring in two stages in this system, translation and N-glycosylation of a core protein precursor which has a long half-life in the rough endoplasmic reticulum, followed by extensive rapid modification in the Golgi complex in which the majority of glycosaminoglycan and oligosaccharide chains are added to the core protein precursor with subsequent rapid secretion into the extracellular matrix.
81 citations
TL;DR: Irrespective of seizure type, the epileptic patients with the most frequent seizures also had the most sleep disturbances, and sleep disorder symptoms did not increase with age in the seizure groups.
Abstract: Three groups of adult epileptic subjects with simple partial, complex partial, and generalized seizures and normal control subjects completed a brief self-report sleep questionnaire. The simple partial and complex partial groups indicated significantly more sleep disorder symptoms, especially frequent night awakenings. The generalized group was most similar to the controls. Irrespective of seizure type, the epileptic patients with the most frequent seizures also had the most sleep disturbances. Sleep disorder symptoms did not increase with age in the seizure groups. It would thus seem that epileptic patients with partial seizures and those with more frequent seizures are at risk for developing sleep disorders.
77 citations
TL;DR: The findings in this report raise the possibility that a common mechanism may underlie the renal injury in both types of pigment toxicity.
Abstract: Ten patients with myoglobinuric and hemoglobinuric acute renal failure demonstrated low fractional excretion of sodium (FENa) values (less than 1%) during the oliguric phase of their course. Acute renal failure secondary to hemoglobinuria developed in five patients, and five demonstrated acute deterioration with myoglobinuria. The mean serum creatinine level increased from 1.1 mg/dL (range, 0.6 to 1.7 mg/dL) to a maximum of 6.9 mg/dL (range, 2 to 13.1 mg/dL). Although three patients required dialysis, all individuals eventually returned or were returning toward their baseline renal function at discharge. The importance of a low FENa in the setting of myoglobinuric and hemoglobinuric renal failure is reviewed. The findings in this report raise the possibility that a common mechanism may underlie the renal injury in both types of pigment toxicity.
TL;DR: The Hilgen-reiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip is introduced to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity.
Abstract: Forty-two cases of coxa vara were retrospectively reviewed. All 42 cases were classified based on their history and roentgenographic appearance. Twenty-two cases of true congenital coxa vara were identified and are the primary focus of this review. In this study we have introduced the Hilgenreiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip. Retrospectively, this angle was measured to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity. The indication for surgery should be an HE angle of greater than 60 degrees. HE angles of less than 60 degrees and greater than 45 degrees represent a "gray zone" and should be observed. HE angles of less than 45 degrees will generally correct spontaneously without surgery.
TL;DR: Clinically, these tumors merit special attention since they are demonstrably more aggressive than true carcinoids but are distinctly less malignant than the intermediate or small cell variants of neuroendocrine carcinoma.
Abstract: We have attempted to characterize a group of bronchopulmonary neoplasms that share certain structural features with true carcinoids but appear distinctly more pleomorphic and behave far more aggressively. In reviewing our files from 1973 to 1982, 11 such neoplasms were identified; the original diagnoses were “atypical bronchial carcinoid” (3 cases), “malignant carcinoid” (1 case), “bronchial carcinoid” (3 cases), “peripheral carcinoid” (2 cases), and “peripheral oat cell carcinoma” (2 cases).Of the 11 neoplasms, 5 were central and 6 were peripherally located. At presentation, 7 patients had lymph node rnetastases and 1 had a distant metastasis. No patient had a conventionally defined hormonal syndrome; however, 2 patients had a history of episodic flushing, one of which was associated with diarrhea.All cases were studied by light microscopy and light microscopic immunohistochemistry for NSE (neuron-specific enolase), serotonin, and broad-spectrum neuropeptides. Five cases were studied by electron microsco...
TL;DR: The solitary benign schwannoma available for electron microscopic study demonstrated diffuse and abundant cytoplasmic intermediate filaments, and this tumor displayed diffuse and intense GFAP immunoreactivity.
Abstract: A spectrum of 24 benign and malignant nerve sheath tumors and 10 non-neural spindle-cell tumors were studied by light microscopy for the presence of glial fibrillary acidic protein (GFAP) immunoreactivity by the peroxidase-antiperoxidase (PAP) technique. In 8 cases, these results were compared to their electron microscopic appearances. Seventy percent (7 of 10) of benign schwannomas and 50% (4 of 8) of benign neurofibromas demonstrated focal to diffuse GFAP immunoreactivity. None of the malignant nerve sheath tumors nor any of the non-neural spindle-cell neoplasms contained demonstrable GFAP immunoreactivity. Similarly, no GFAP immunoreactivity could be detected in Schwann cells in normal peripheral nerves. The solitary benign schwannoma available for electron microscopic study demonstrated diffuse and abundant cytoplasmic intermediate filaments, and this tumor displayed diffuse and intense GFAP immunoreactivity. Two benign neurofibromas showed a more variable content of intermediate filaments ultrastructurally, and their GFAP immunoreactivity was variable. All five malignant nerve sheath tumors studied by electron microscopy displayed a variable complement of intermediate filaments; however, none of these tumors possessed GFAP immunoreactivity, suggesting that these intermediate filaments are either members of a different class of intermediate filaments or may perhaps represent "altered" GFAP not recognized by these antisera.
TL;DR: Forty patients with advanced, unresectable squamous cell carcinomas of the head and neck were entered on a prospective, randomized study comparing fast neutron radiation therapy with conventional photon radiation therapy.
Abstract: Three hundred and twenty-two patients with inoperable squamous cell carcinomas of the head and neck were entered on a randomized study comparing “mixed beam”f radiation therapy with photon radiation therapy. Patients with histologically proven tumors of T-stage T2, T3, or T4 and any N-stage originating in the oral cavity, oropharynx, supraglottic larynx, or hypopharynx were eligible. One hundred forty-five patients were randomized to photon treatment and 177 were randomized to mixed beam treatment. No significant differences could be demonstrated between the experimental and control groups for primary tumor control or overall survival, although there was an advantage for mixed beam treatment over photon treatment for patients with metastatic cervical adenopathy (69 vs. 55% complete response rate in the nods, p = .024). It is concluded that mixed beam radiation therapy does not offer a significant advantage over photon radiation therapy for patients with advanced squamous cell carcinomas of the head and neck.
TL;DR: The concept that a positive AVA test result reflects areas of delayed ventricular activation are associated with previous myocardial injury and scar tissue and serve as an anatomic basis for reentry is supported.
Abstract: The prevalence of arrhythmogenic ventricular activity (AVA) was investigated in 166 patients with coronary artery disease. Thirty patients had documented ventricular tachycardia (VT)/ventricular fibrillation (VF). Bipolar X,Y,Z leads were signalaveraged and filtered with a 40-Hz, bidirectional, high-pass digital filter. The filtered QRS signals were analyzed for the amplitude of the last 40 and 50 ms; duration of low-amplitude potentials ( μ V) in the terminal portion; and duration of the filtered QRS. A positive AVA test result was defined as the presence of 2 or more abnormal indexes. Of the 30 patients with VT/VF, 66% had positive AVA test results (AVA-positive patients). Of the 136 patients without VT/VF, 25% had positive AVA test results. The following univariate variables showed significant correlation with an AVA-positive test: age, previous myocardial infarction, previous VT/VF, left ventricular wall motion abnormalities and left ventricular ejection fraction. Multivariate stepwise discriminant function analysis revealed that the presence of previous myocardial infarction and history of sustained VT/VF were the only independent determinants of AVA. During electrophysiologic studies, sustained VT/VF could be induced in 77% of the AVA-positive patients (24 of 31) and in 30% of the AVA-negative patients (3 of 10). The survival probabilities for 6, 12 and 18 months of follow-up were 92%, 85% and 85% for the AVA-positive and 97%, 92% and 90% for the AVA-negative patients. Our findings support the concept that a positive AVA test result reflects areas of delayed ventricular activation. The areas of delayed ventricular activation are associated with previous myocardial injury and scar tissue and serve as an anatomic basis for reentry. Quantitative analysis of the high-frequency components of the terminal portion of the signalaveraged body surface QRS may be a helpful screening test for detection of patients at high risk of VT/VF.
TL;DR: Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer, and in contrast to thiotepa, myelosuppression was not the dose‐limiting effect.
Abstract: Mitomycin C 40 mg in 40 ml water was administered intravesically every week for 8 consecutive weeks to 60 patients with superficial bladder cancer. All patients had failed treatment with intravesical thiotepa and had evaluable disease. An objective response of 50% or greater reduction in measured tumor mucosal involvement was obtained in 68% of patients. Forty-two percent of the patients achieved a complete response, and this included 50% of patients with Grade III disease and 70% of patients with a T1 tumor. Median response duration in complete responders was 12.2 months with a range of 3.5 to 24.3 + months. Fifty-five percent of patients are still responding. Therapy was generally well tolerated, and in contrast to thiotepa, myelosuppression was not the dose-limiting effect. One third of all patients experienced symptoms of local irritation, and skin reactions were seen in 12% of patients.
TL;DR: From 1973 to 1979, 163 patients with biopsy proven adenocarcinoma of the prostate were treated with a curative intent utilizing megavoltage external beam irradiation at Rush‐Presbyterian‐St Luke's Medical Center or Lutheran General Hospital.
Abstract: From 1973 to 1979, 163 patients with biopsy proven adenocarcinoma of the prostate were treated with a curative intent utilizing megavoltage external beam irradiation at Rush-Presbyterian-St. Luke's Medical Center or Lutheran General Hospital. The actuarial survival at 5 years for the whole group is 78%. Survival was found to depend on initial stage and grade of disease. Local failure alone occurred in 3% of the patients, yet represented a component of failure in 7%. The effects of stage, grade, dose and field size on survival, patterns of failure and complications are discussed.
TL;DR: Improved anatomic information available from infusion CT may increase diagnostic certainty and in selected cases obviates the need for myelography for accurate diagnosis of patients with focal cervical radiculopathy.
Abstract: Two-millimeter-thick transverse axial CT scans were obtained at the 2, 3, or 4 cervical disk level in 25 patients with cervical radiculopathy. Scans were obtained before and after high dose (bolus/drip) intravenous administration of contrast medium. Clinical signs and symptoms were correlated with radiographic and surgical findings. Ventral epidural and intervertebral foraminal veins were consistently well visualized with this technique. Venous and dural enhancement provided better anatomic definition than did non-contrast CT. Visualization of posterior displacement of the enhanced epidural veins and epidural enhancement surrounding extruded disk fragments on postinfusion studies provided excellent delineation of disk extrusion and in some cases allowed demarcation of multiple discrete free disk fragments. Although noninfusion scans are usually diagnostic and sufficient, the improved anatomic information available from infusion CT may increase diagnostic certainty and in selected cases obviates the need f...
TL;DR: The process used by hospitalized chronically ill persons to defend themselves against the demands of an unpredictable and progressive disease was explored.
Abstract: The process used by hospitalized chronically ill persons to defend themselves against the demands of an unpredictable and progressive disease was explored. Intensive, unstructured interviews, constant comparative analysis, and theoretical sampling were the methods used. Vying for a winning position was conceptualized as an organizing principle to describe how patients framed the challenge their disease presented and the attitudes developed to meet that challenge. The major categories of the conceptualization included (a) how patients defined and explained their illness; (b) attitudes and behaviors developed in response to, and as a result of, the uncertainty of the disease process; and (c) the manner in which hospitalization expressed patient efforts to foster control and keep ahead of the disease.
TL;DR: An animal model for nalidixic acid photosensitivity was developed in young CF-1 female mice and showed blister formation beneath the basal lamina at the same level as that found in PCT.
TL;DR: The use of hypothenar full-thickness grafts provides an acceptable method for fingertip reconstruction, particularly in instances of palmar and lateral pulp loss in which there is insufficient tissue available for local advancement.
Abstract: Full-thickness skin grafts from the hypothenar area were used to reconstruct 25 digits in a group of 20 patients. The results were evaluated objectively and subjectively at an average of 9.5 months after operation for sensibility, durability, and appearance. Eighty-six percent of the patients had two-point discrimination of 10 mm or less, with one half of them having two-point discrimination of less than 6 mm. All patients had good protective coverage and no ulcer formation. All patients could differentiate between coarse and smooth texture, although only one third had texture discrimination equal to that of normal digits. None of the patients complained of hypersensitivity. The donor site was cosmetically acceptable in all cases. The use of hypothenar full-thickness grafts provides an acceptable method for fingertip reconstruction, particularly in instances of palmar and lateral pulp loss in which there is insufficient tissue available for local advancement.
Journal Article•
TL;DR: Evidence is presented which suggests that the crypts of the small intestine contain at least two discrete but interdependent classes of stem cells, some with discrete cell kinetic properties and some with discreet radiation responses or radiosensitivities.
Abstract: Evidence is presented which suggests that the crypts of the small intestine contain at least two discrete but interdependent classes of stem cells, some with discrete cell kinetic properties and some with discrete radiation responses or radiosensitivities. Very low doses of X rays or gamma rays, or neutrons, kill a few cells in the stem cell regions of the crypt in a sensitive dose-dependent manner. Similar doses generate several different cell kinetic responses within either the clonogenic fraction or the cells at the stem cell position within the crypt. The cell kinetic responses range from apparent recruitment of G0 clonogenic cells into cycle, to a marked shortening of the average cell cycle of the cells at the stem cell position. It is suggested that the cell kinetic changes may be the consequence of the cell destruction.
TL;DR: The acceptable state of the art for commissure electric burns of the mouth in children in the past was to advocate conservative treatment, allowing spontaneous healing to be followed by reconstructive procedures, but more recently the fabrication and use of a "dynamic microstomia prevention splint" appears to be beneficial in eliminating the need for or decreasing the degree of surgery.
TL;DR: It is concluded that mixed beam radiation therapy does not offer a significant advantage over photon radiation therapy for patients with advanced squamous cell carcinomas of the head and neck.
Abstract: Three hundred and twenty-two patients with inoperable squamous cell carcinomas of the head and neck were entered on a randomized study comparing “mixed beam”f radiation therapy with photon radiation therapy. Patients with histologically proven tumors of T-stage T2, T3, or T4 and any N-stage originating in the oral cavity, oropharynx, supraglottic larynx, or hypopharynx were eligible. One hundred forty-five patients were randomized to photon treatment and 177 were randomized to mixed beam treatment. No significant differences could be demonstrated between the experimental and control groups for primary tumor control or overall survival, although there was an advantage for mixed beam treatment over photon treatment for patients with metastatic cervical adenopathy (69 vs. 55% complete response rate in the nods, p = .024). It is concluded that mixed beam radiation therapy does not offer a significant advantage over photon radiation therapy for patients with advanced squamous cell carcinomas of the head and neck.
TL;DR: Single peeled rabbit skeletal muscle fibres, identified histochemically from their myofibrillar ATPase and oxidative staining pattterns, were characterized according to their Ca2+-activated steady-state force-generating properties at normal intracellular pH and under acidotic conditions.
Abstract: Single peeled (sarcolemma removed) rabbit skeletal muscle fibres, identified histochemically from their myofibrillar ATPase and oxidative staining pattterns, were characterized according to their Ca2+-activated steady-state force-generating properties at normal intracellular pH (7.0) and under acidotic (pH 6.5) conditions. Maximum force-generating capacity of each fibre was assessed by measuring steady-state isometric force generation at saturating Ca2+ concentration at both pH values. The Ca2+ sensitivity of each fibre was ascertained by determining the percentage of maximum force generated at each of several subsaturating Ca2+ concentrations at both pH values. Fibres were selected from soleus, tibialis anterior and adductor magnus muscles. At subsaturating Ca2+ concentrations only two functional groups of fibres were distinguishable, corresponding to the histochemical classifications type I and type II. Type I fibres were more sensitive to Ca2+ and less depressed by acidosis than type II fibres in the subsaturating range of Ca2+ concentrations. At saturating Ca2+ concentrations, the acidotic depression of maximum force was significantly less for type I fibres than type II nonoxidative fibres regardless of their muscle of origin. Type II oxidative fibre maximum force properties depended upon the muscle of origin and demonstrated subgroups of these fibres that were different from type II nonoxidative fibres and similar to type I fibres.
TL;DR: The case of a 19-yr-old woman with congenital hepatic fibrosis associated with asymptomatic familial adult-type (autosomal dominant) polycystic kidney disease is described.
TL;DR: EPS are superior to Holter findings in assessing successful management and holter findings may be concordant or discordant during EPS serial drug trials or following surgery and therefore cannot predict the success or failure of the intervention.
TL;DR: De nouveaux pacemakers asservis utilisent d'autres capteurs biologiques tels que l'espace QT, the fréquence veniilatoire, I'aciivité, les gaz et le pH sanguins et the température, which sont actuellement à l'essai and seront probablement bientôt disponibles.
Abstract: A variety of pacing techniques are available to improve cardiac performance in patients who have bradyarrhythmias. These approaches include the preservation of AV synchrony and rate responsiveness, whereby pacing rate is varied according to some physiologic marker such as the atrial rate. New rate responsive pacemakers utilize other sensors to govern pacing rate and these units may monitor QT interval duration, respiratory rate, activity, venous oxygen saturation, temperature, or pH. Additional sensors are presently being investigated and prototype stroke volume and pressure monitoring devices should be available in the near future. All of these approaches require clinical evaluation and their eventual widespread application must be preceded by thorough studies of benefit, risk, and cost.