Showing papers by "Veterans Health Administration published in 1981"
TL;DR: It is concluded that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.
Abstract: We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.
333 citations
TL;DR: There was a high correlation between low T4 levels and mortality and Hypothyroxinemia with normal thyroid-stimulating hormone levels was found in 22% of the patients.
Abstract: Thyroid function was measured in 86 patients hospitalized in an intensive care unit. Two patients were found to have primary hypothyroidism and were excluded from the study. Hypothyroxinemia with normal thyroid-stimulating hormone (TSH) levels was found in 22% of the patients and was associated with a high mortality (thyroxine [T4] levels less than 3.0 micrograms/dL, 84% mortality; T4 levels of 30 to 5.0 micrograms/dL, 50% mortality; and T4 levels greater than 5.0 micrograms/dL, 15% mortality). There was a high correlation between low T4 levels and mortality.
304 citations
TL;DR: It is suggested that this newly described toxin be designated toxin A until its primary biological activity and physical relationship to cytotoxin is determined and may play an important role in C. difficile-induced colitis.
Abstract: Clostridium difficile was shown to produce a toxin which could be biochemically separated from the previously described cytotoxin of the same organism. The two proteins differ in biological activity and physical properties. Antiserum prepared to the second toxin does not neutralize the biological activity of the cytotoxin, and immunological cross-reactivity could not be demonstrated. However, some relationship may exist between the two toxins, since the newly described toxin degrades on polyacrylamide electrophoresis into two molecules, one of which appears to migrate with the band of purified cytotoxin. We suggest that this newly described toxin be designated toxin A until its primary biological activity and physical relationship to cytotoxin is determined. This toxin is active in biological assays of enteric disease and may play an important role in C. difficile-induced colitis.
304 citations
TL;DR: This review deals with the interactions of opiates with the endocrine system in rat and man and suggests a possible local neuromodulatory role for the opioid peptides in the control of carbohydrate metabolism and reproductive processes.
Abstract: Since the isolation of the enkephalins five yr ago, there has been an explosive increase in knowledge concerning the effects of the opiates and opioid peptides. This review deals with the interactions of opiates with the endocrine system in rat and man. The opioid peptides have been demonstrated to exert a variety of effects on pituitary hormone secretion in rat and man. In the rat, opiates stimulate growth hormone, prolactin and ACTH release and inhibit the release of the glycoprotein hormones. In man, the physiologic role of the endogenous opiates appears to be involved predominantly in ACTH and gonadotrophin regulation. Opiate effects are mainly exerted at the level of the hypothalamus but further modulating effects may occur at the pituitary and at end-organs. Opiate-induced hormonal effects appear to be mediated through dopaminergic and/or serotonergic mechanisms. Recent studies have also suggested a possible local neuromodulatory role for the opioid peptides in the control of carbohydrate metabolism and reproductive processes.
286 citations
TL;DR: It is suggested that antimyelin antibody cytophilic for macrophages may be present in the central nervous system in MS and that immune ligand‐mediated phagocytosis may play a role in myelin breakdown in the disease.
Abstract: Macrophages were examined for immunoglobulin G (IgG) and albumin in actively demyelinating lesions in two patients with multiple sclerosis (MS) using the peroxidase-antiperoxidase immunocytochemical technique. In both cases, macrophages were present that stained for cytoplasmic or surface IgG or both. In one case, in which the tissue was rapidly fixed in chilled fixative, macrophages located among myelinated nerve fibers at plaque margins, but not elsewhere in the plaque, revealed surface IgG in the form of caps restricted to one or both poles of the cell. These caps were absent in sections stained for albumin. Because capping implies the presence of a multivalent ligand close to the cell surface and because cap formation was observed only in macrophages contacting myelin sheaths, we suggest that antimyelin antibody cytophilic for macrophages may be present in the central nervous system in MS, and that immune ligand-mediated phagocytosis may play a role in myelin breakdown in the disease. This study provides the first direct evidence that IgG participates locally in myelin breakdown in MS.
256 citations
TL;DR: Results could be explained by the production or release of a factor from bone to stimulate formation in response to the acute increase in resorption--a "coupling factor." Indeed, dialyzed culture medium conditioned by actively resorbing bones stimulated bone formation over controls when added to organ cultures at a 1:20 dilution.
Abstract: We have developed an in vitro system, using embryonic chicken tibiae grown in a serum-free medium, which exhibits simultaneous bone formation and resorption. Tibiae from 8-day embryos increased in mean (+/- SD) length (4.0 +/- 0.4 to 11.0 +/- 0.3 mm) and dry weight (0.30 +/- 0.04 to 0.84 +/- 0.04 mg) during 12 days in vitro. There was increased incorporation of [3H]proline into hydroxyproline (120 +/- 20 to 340 +/- 20 cpm/mg of bone per 24 hr) as a measure of collagen synthesis, as well as a 62 +/- 5% increase in total calcium and 45Ca taken up as an indication of active mineralization. A physiologic concentration (1 pM) of parathyroid hormone was found to stimulate bone resorption over control levels in this system. Parathyroid hormone stimulated the release of [3H]hydroxyproline from the bone shafts but not from the cartilage ends, indicating the specificity of the response. With 1 pM parathyroid hormone we observed an acute inhibition of bone formation, followed (after 12-16 hr) by a chronic stimulation of bone formation during the 12-day incubation. Both mineral uptake and matrix formation were enhanced at approximately the same rate during the 12-day incubation. The chronic enhancement of formation required parathyroid hormone only for the initial 8-10 hr of incubation. These results could be explained by the production or release of a factor from bone to stimulate formation in response to the acute increase in resorption--a "coupling factor." Indeed, dialyzed culture medium conditioned by actively resorbing bones stimulated bone formation over controls when added to organ cultures at a 1:20 dilution. The factor is larger than 12,000 daltons as determined by dialysis. The factor is specific for the bone shaft and did not affect the cartilage ends.
250 citations
TL;DR: The Guillain‐Barré syndrome is a distinctive neuropathy characterized pathologically by the presence of inflammatory lesions which occur scattered throughout the peripheral nervous system.
Abstract: The Guillain-Barre syndrome is a distinctive neuropathy characterized pathologically by the presence of inflammatory lesions which occur scattered throughout the peripheral nervous system. The lesions consist of circumscribed areas in which myelin is lost in the presence of lymphocytes and macrophages. Myelin damage of effected largely by macrophages, which penetrate the basement membrane around nerve fibers and strip what appears to be normal myelin away from the body of the Schwann cell and off the axon. While there is evidence that this activity is immune mediated, the precise mechanism that leads macrophages to seek out and amputate a specialized region of the Schwann cell plasma membrane remains unexplained.
249 citations
TL;DR: In this paper, the expression of 25-hydroxyvitamin D3 (25 (OH)D3) metabolizing enzymes in primary cultures of human bone cells, as well as n a human osteosarcoma cell line were reported.
227 citations
TL;DR: Dynorphin-(1–13), a recently isolated opioid peptide stimulates food ingestion in rats after intracerebroventricular administration at doses of 1 and 10 μg, and is accompanied by excessive grooming behavior.
223 citations
TL;DR: A potential role for MTFgeneration in the activation of blood coagulation in neoplasia is suggested and the possibility that inhibition of MTF generation by warfarin may be partially responsible for the decreased FPA values previously reported in anticoagulated cancer patients is suggested.
209 citations
TL;DR: The results suggest that warfarin may be useful in the treatment of SCCL and also support the hypothesis that the blood coagulation mechanism may be involved in the growth and spread of cancer in man.
Abstract: In a controlled, randomized study, survival of patients with small cell carcinoma of the lung (SCCL) was prolonged on addition of warfarin sodium to combination chemotherapy plus radiation therapy. Median survival for 25 control patients was 24 weeks and for 25 warfarin-treated patients was 50 weeks. This difference could not be accounted for by differences between groups in performance status, extent of disease, age, or sex. The survival advantage associated with warfarin administration was observed both for patients with extensive disease and for those who failed to achieve complete or partial remission. The warfarin-treated group also demonstrated a significantly increased time to first evidence of disease progression. These results suggest that warfarin may be useful in the treatment of SCCL and also support the hypothesis that the blood coagulation mechanism may be involved in the growth and spread of cancer in man. ( JAMA 1981;245:831-835)
Journal Article•
TL;DR: Analysis of fluorescence polarization at various temperatures indicated that ethanol altered the phase behavior of membrane lipids, which indicates that low, physiologically relevant concentrations of ethanol selectively fluidize the hydrophobic core of synaptic membranes.
Abstract: Synaptic plasma membranes and myelin were prepared from mouse brain and their physical properties were evaluated by using the fluorescent probe molecules 1,6-diphenyl-1,3,5-hexatriene (DPH) and 1-aminopyrene. The absorption-corrected fluorescence output and fluorescence polarization of DPH (a probe of the membrane core) were decreased when synaptic plasma membranes were exposed in vitro to low concentrations (10-20 mM) of ethanol. Fluorescence of 1-aminopyrene (a probe of the membrane surface) was affected only by high ethanol concentrations. Ethanol did not alter the excitation or emission maxima of DPH in synaptic plasma membranes, which indicates that it did not alter polarity in the vicinity of the probe. Compared with the intact synaptic plasma membranes, DPH fluorescence in myelin membranes and in lipids extracted from myelin or synaptic plasma membranes was less sensitive to the effects of ethanol. Analysis of fluorescence polarization at various temperatures indicated that ethanol altered the phase behavior of membrane lipids. These results indicate that low, physiologically relevant concentrations of ethanol selectively fluidize the hydrophobic core of synaptic membranes. The sensitivity of intact synaptic membranes is discussed in terms of lipid-protein interactions disrupted by ethanol.
TL;DR: In this paper, the authors showed that the weighted kappa statistic, employing a standard error developed by Fleiss, Cohen, and Everitt (1969), holds for a large number of k cate gories of classification (e.g., 8 < k ≤ 10).
Abstract: The results of this computer simulation study in dicate that the weighted kappa statistic, employing a standard error developed by Fleiss, Cohen, and Everitt (1969), holds for a large number of k cate gories of classification (e.g., 8 < k ≤ 10). These data are entirely consistent with an earlier study (Cicchetti & Fleiss, 1977), which showed the same results for 3 ≤ k ≤ 7. The two studies also indicate that the minimal N required for the valid ap plication of weighted kappa can be easily approxi mated by the simple formula 2k2. This produces sample sizes that vary between a low of about 20 (when k = 3) to a high of about 200 (when k = 10). Finally, the range 3 ≤ k ≤ 10 should encompass most extant clinical scales of classification.
TL;DR: A subgroup of patients with obstructive sleep apnea syndrome who benefit from medroxyprogesterone therapy by reducing obstructive apneas during sleep is characterized.
Abstract: Nine adult patients with obstructive sleep apnea syndrome were administered medroxyprogesterone acetate, 60 to 120 mg/day, and the effect of medroxyprogesterone on clinical symptoms and obstructive apneas during sleep was assessed. Four patients responded with resolution of daytime sleepiness, disappearance of pedal edema, and a decrease in the number of obstructive apneas during sleep. Cessation of therapy led to a return of daytime sleepiness in three and an increase in obstructive apneas in all four subjects. Two responders experienced side effects of alopecia or decreased libido. Before medroxyprogesterone therapy, responders were distinguished from nonresponders only by the presence of a significantly lower resting arterial oxygen tension during wakefulness. We characterize a subgroup of patients who benefit from medroxyprogesterone therapy by reducing obstructive apneas during sleep. ( JAMA 1981;245:1230-1232)
TL;DR: D dietary protein plays an important role in meal stimulated cortisol release, and ACTH was significantly increased following the 1200 hr and 1600 hr meals with the high protein diet.
Abstract: Cortisol and ACTH secretion was studied in 52 healthy subjects who were fasted of fed various diets: standard, high fat, high carbohydrate, high protein. Subjects fed high protein diet (4 gm/kg body weight) showed significant increases in cortisol both at 30 and 60 min after the 1200 hr meal and 30 min after the 1600 hr meal. Increases in cortisol, of a smaller magnitude, were also seen after both the 1200 and 1600 hr meals in each of the diets with 1 gm protein/kg body weight (standard, high fat, high carbohydrate). ACTH was significantly increased following the 1200 hr and 1600 hr meals with the high protein diet. We conclude that dietary protein plays an important role in meal stimulated cortisol release.
TL;DR: Results suggest that neurologic patients exhibit at least three different patterns of remote memory loss, including retrograde amnesia of patients with alcoholic Korsakoff's syndrome, which is characterized by a steep temporal gradient.
Abstract: • Patients with Huntington's disease (HD) were compared on three tests of remote memory with patients with alcoholic Korsakoff's syndrome (KS) and with control subjects. Though both patient groups were severely impaired in overall performance with respect to the normal control subjects on all three tests, striking differences were evident in the degree of loss for each decade interval. The patients with HD had as much difficulty identifying faces and events from the 1930s and 1940s as faces and events from the 1960s and 1970s. Thus, the pattern of their remote memory loss was "flat," that is, equal for all periods sampled. The retrograde amnesia of the patients with KS was characterized by a steep temporal gradient in which facts pertaining to the distant past were more accurately retrieved than facts concerning events that occurred just prior to the onset of their illness. Taken in conjunction with other recent studies of retrograde amnesia, these results suggest that neurologic patients exhibit at least three different patterns of remote memory loss.
TL;DR: Administration of parenteral and intracerebroventricular calcitonin resulted in suppression of stress-induced and spontaneous eating in rats and reversed calcium chloride-induced eating and reduced 45Ca2+-uptake in a hypothalamic explant system.
TL;DR: The response of circulating T-lymphocytes to phytohemagglutinin was assessed both during the episode of clinical zinc deficiency and after intravenous zinc supplementation as the sole means of nutritional intervention, showing the detrimental effect of zinc deficiency on cellular immunity.
Abstract: Two patients developed severe zinc deficiency with acrodermatitis during parenteral hyperalimentation. The response of circulating T-lymphocytes to phytohemagglutinin was assessed both during the episode of clinical zinc deficiency and after intravenous zinc supplementation as the sole means of nutritional intervention. Maximum T-cell response to phytohemagglutinin, expressed as percent of simultaneous normal control response, was 2.1% and 27.9% in Patients 1 and 2 respectively. After 20 days of intravenous zinc supplementation (12 mg/d), repeat studies showed the T-cell response of Patient 1 to be 221% of the control, and that of Patient 2 to be 139% of control. In addition, Patient 1 was anergic during the period of zinc deficiency and normally reactive after zinc supplementation. These findings agree with extensive animal studies showing the detrimental effect of zinc deficiency on cellular immunity.
TL;DR: The mechanism of the antifungal action of the imidazole antimycotics, miconazole ano clotrimazole, on Saccharomyces cerevisiae was explored and the fungistatic effect correlated with inhibition of ergosterol synthesis and elevated lanosterol/ergosterol ratios in the organisms.
TL;DR: The results indicate that males and females differ in both the direction and magnitude of their arousal response to a variety of erotic stimuli and that there is a stronger correspondence between subjective and physiological measures of sexual arousal for males than for females.
Abstract: The structural patterns of sexual arousal are examined for eight male and eight female heterosexuals. Comparisons are made in terms of physiological and subjective arousal. The results indicate (1) that males and females differ in both the direction and magnitude of their arousal response to a variety of erotic stimuli and (2) that there is a stronger correspondence between subjective and physiological measures of sexual arousal for males than for females. A social acceptability and/or unacceptability theory is suggested to account for similarities and differences between the male and female structural patterns of arousal. Several methods of assessing subjective arousal are included to represent those most frequently used in clinical research settings. It is demonstrated that each of the subjective measures discriminates between erotic conditions and that the information provided by each of the measures are comparable.
TL;DR: The satiety-inducing effect of bombesin was independent of the hyperglycemia it produces as suppression of stress-induced eating was still present in adrenalectomized animals.
Abstract: Bombesin administered both intracerebroventricularly and parenterally suppressed stress-induced eating in the rat (using the mild tail pinch model). Intraventricular administration of bombesin resulted in hyperglycemia, which was abolished by adrenalectomy. The satiety-inducing effect of bombesin was independent of the hyperglycemia it produces as suppression of stress-induced eating was still present in adrenalectomized animals.
TL;DR: The approach to these problems is illustrated through a report of seven cases, and it is emphasized that the proper management of Cushing's syndrome mandates a thorough marshalling of all the available data.
TL;DR: Results show thatosphatidate is the only membrane lipid component that acts as a functionally competent ionophore and support the suggestion that phosphatidate may serve as a link between depolarization and neurotransmitter release in the brain.
Abstract: Phosphatidate, a neuronal phospholipid, stimulated the uptake of calcium by nerve terminals isolated from the striatum of rat brain. This effect was not produced by other phospholipids or glycolipids. Phosphatidate, but not other phospholipids, evoked the release of [3H] dopamine from striatal synaptosomes. The magnitude of both effects was similar to that observed after chemical depolarization of the nerve terminals. These results show that phosphatidate is the only membrane lipid component that acts as a functionally competent ionophore and support the suggestion that phosphatidate may serve as a link between depolarization and neurotransmitter release in the brain.
TL;DR: Using bleomycin-induced pulmonary fibrosis as a model, collagen metabolism in the fibrotic process was studied using a technique based on the quantitation of the rate of release of hydroxyproline-containing peptides when lung homogenates were incubated in calcium-containing buffer, and lung collagenolytic activity was markedly diminished as a result ofBleomycin treatment.
Abstract: Using bleomycin-induced pulmonary fibrosis as a model, we have set out to study collagen metabolism in the fibrotic process As was previously shown, intratracheal administration of bleomycin in the rat caused increased deposition and net synthesis of collagen in the lung This was accompanied by marked increases in the tissue-free proline pool size and less dramatic increases in the pool's radioactivity when lung mince was pulsed with radioactive proline to measure the net collagen synthesis Using a technique based on the quantitation of the rate of release of hydroxyproline-containing peptides when lung homogenates were incubated in calcium-containing buffer, lung collagenolytic activity was markedly diminished as a result of bleomycin treatment Concomitant treatment with the steroid methylprednisolone did not affect significantly this decrease in lung collagenolytic activity Such steroid treatment, however, prevented the increase in bleomycin-induced lung collagen deposition and partially suppressed total lung collagen synthesis, without affecting the net rate of lung collagen synthesis expressed per mg of DNA Steroid treatment also inhibited the marked increase in tissue-free proline pool size and radioactivity caused by bleomycin The mechanism of amelioration of the fibrotic response by the steroid is discussed
TL;DR: This report describes 3 patients, 2 of whom had idiopathic apatite crystal deposition and 1 who had apatites related to renal failure and chronic dialysis, which were associated with erosive arthritis.
Abstract: Apatite crystals can be associated with erosive arthritis. This report describes 3 such patients, 2 of whom had idiopathic apatite crystal deposition and 1 who had apatite related to renal failure and chronic dialysis. Diagnosis was delayed for several years in 1 patient. Roentgenograms showed calcifications in all patients. Synovial fluid had non-birefringent chunks and globules suggestive of apatite. Diagnosis was established by electron microscopy in all 3 patients and verified by x-ray diffraction in 2.
Journal Article•
TL;DR: Regimen complexity was a relatively weak correlate of compliance, and the overall level of arthritis drug compliance was similar to that reported for antihypertensive drugs.
Abstract: Objective information on arthritis drug compliance in usual care settings is sparse. Of "causes" of poor compliance, regimen complexity has received special attention. We used a previously validated pharmacy-based compliance measure to study compliance in an arthritis clinic. Across drugs, mean compliance was low (64%). Wide variations were seen among drugs, ranging from 55% mean compliance (indomethacin) to over 80% (prednisone, penicillamine). Major variations by diagnosis were also found, with rheumatoid arthritis patients more compliant than others. Regimen complexity was a relatively weak correlate of compliance, and the overall level of arthritis drug compliance was similar to that reported for antihypertensive drugs.
TL;DR: Intraventricular administration of the GABA agonist, muscimol, reliably induces feeding in sated rats in a dose dependent manner over a range from 50 to 500 ng, and a model of intrahypothalamic appetite regulation is proposed.
TL;DR: No significant brain retention after single circulatory passage following arterial injection in the rat is revealed, which offers support to the lack of carrier-mediated BBB penetration of these peptides in the concentrations injected.
TL;DR: Results indicated that losses in performance increased with decreasing levels of vocabulary, and the use of corrected feedback provided a significant general improvement at all vocabulary levels but did not reduce the effects due to vocabulary levels.
Abstract: Eighty-seven elderly adults (57-87 years of age) divided into four WAIS vocabulary subgroups (<40, 40-49, 50-59, ≥60) participated in a study of comprehension and memory of an informed consent procedure. Ss in Croup 1 read the consent form and, with the information sheet still present, answered multiple choice questions covering the main points of information. Feedback and corrected answers were then provided. Ss in Group II read the consent form but did not receive the comprehension test or feedback. All Ss were tested for memory of the information 2-3 weeks later. Results indicated that losses in performance increased with decreasing levels of vocabulary. Losses associated with low vocabulary levels appeared to be comprehension-related and did not increase in later tests of memory. The use of corrected feedback provided a significant general improvement at all vocabulary levels but did not reduce the effects due to vocabulary levels.
TL;DR: The results support the idea that stratum corneum and/or malpighian layer thickening produced in early stages of tumor induction tends to protect against the detrimental effects of UV radiation.