Superiority of blood over saline resuscitation from hemorrhagic shock: a 31P magnetic resonance spectroscopy study

OBJECTIVE: To study the relation between blood and saline administration, postresuscitation hematocrit (Hct) level, and metabolic recovery after hemorrhagic shock. SUMMARY BACKGROUND DATA: It is generally believed that crystalloid can be substituted, in whole or in part, for blood during resuscitation of hemorrhagic shock. This is based on the belief that Hct can be safely reduced but should not fall below a critical level. METHODS: Male rats weighing 200 g were subjected to an isobaric hemorrhagic shock at a mean arterial pressure of 30 mmHg for 14 minutes, after which they were randomized to one of three resuscitation regimens. Control group (n = 36) were resuscitated by return of all shed blood. Mid-Hct (n = 39) and low-Hct (n = 60) groups were depleted of one third and one half of their circulating blood volumes, respectively, and were resuscitated with three times that volume of normal saline. Skeletal muscle intracellular energetics and pH were measured serially using 31P magnetic resonance spectroscopy at baseline, during shock, and after resuscitation. Arterial blood was sampled at the same time points. The number of surviving animals in each group at 24 hours was recorded. RESULTS: After resuscitation, surviving rats in the low-Hct group demonstrated a greater consumption of high-energy phosphocreatine stores than did the other groups (control = 0.479 +/- 0.003, mid-Hct = 0.465 +/- 0.004, low-Hct = 0.457 +/- 0.007, mean +/- standard error of the mean; p < 0.01 low-Hct vs. other groups by analysis of variance). The rats that received saline resuscitation developed a relative intracellular acidosis (control = 7.29 +/- 0.02, mid-Hct = 7.25 +/- 0.02, low-Hct = 7.23 +/- 0.02; p < 0.05 controls vs. other groups by analysis of variance). At 24 hours, the death rates were significantly different among the groups: control = 1 of 36 rats (2.8%), mid-Hct = 6 of 39 (15.4%), and low-Hct = 14 of 60 (23.3%) (p < 0.05 by chi square analysis). CONCLUSION: The oxygen-carrying capacity of resuscitation fluid has an important impact on intracellular metabolism and outcome.     

Database of mutations in the p53 and APC tumor suppressor genes designed to facilitate molecular epidemiological analyses

Germline and somatic mutations in the p53 and APC genes contribute to neoplasia. The patterns of these and other acquired mutations in cancers reflect environmental mutagens and endogenous factors that contribute to carcinogenesis. Herein, we describe a database of almost 2,300 mutations in the p53 and APC genes published until September 1, 1993. In addition to cataloging the mutations, multiple fields of information have been added to facilitate future molecular epidemiological analyses of human cancer. The accuracy of the database has been checked by the present authors and, by soliciting feedback from the original corresponding authors. The strengths and limitations of the primary literature are discussed.     

Pneumatic dilatation is effective long-term treatment for achalasia

Although pneumatic dilatation (PD) has been an established treatment for achalasia for decades, there is limited information on its long-term clinical efficacy. We have followed up the clinical status of patients having PD with a 30- or 35-mm balloon by one of us (D.O.C.) over a 25-year period. Of 144 patients whose initial records were available for review, 31 could not be contacted. Of the remaining 113 patients, 72 (64%) responded to a questionnaire assessing swallowing status and patient satisfaction, and this forms the basis of this report. There were 32 men and 40 women, with mean age 46 years (range: 17-78); mean length of follow-up since PD was 6.5 years (range: 10 months to 25 years). Success was primarily defined by the need for no additional therapy for achalasia other than one or two PD's. PD was effective long-term treatment in 61/72 patients (85%); only four of these required a second PD over this time interval. There was no significant difference in any of the following parameters between patients with a treatment success or failure: age, sex, size of pneumatic dilator, and duration of symptoms prior to PD. Response was significantly better (P < 0.05) in patients having no prior dilatation (43/47; 91%) than in those in whom another physician had performed prior dilatation (18/25; 72%). In response to the question of whether they would select PD again, 68 patients (94%) responded positively. In conclusion, pneumatic dilatation performed using a consistent technique by an experienced physician is effective long-term therapy for achalasia patients of all ages. Most patients require only one dilatation.     

A review of new oncotropic tracers for PET imaging

We have developed three biochemical probes to determine if they are sensitive probes of early biochemical change in a tumor. All three probes appear to have the appropriate properties for in vivo imaging, but must now be evaluated as probes for the sensitive detection of changes in early malignant disease.     

Cataract extraction rates in Olmsted County, Minnesota, 1980 through 1994

Management of Q-wave acute myocardial infarction (AMI) has been shown to differ between the United States and Canada, with more catheterization and revascularization procedures performed in the United States, but with little or no apparent difference in clinical outcomes. No previous studies have evaluated management differences for the acute coronary syndromes of unstable angina pectoris and non-Q-wave AMI. We therefore compared treatments and outcomes between 14 United States and 4 Canadian tertiary care centers participating in an observational registry of all consecutive admissions for unstable angina or non-Q-wave AMI between 1990 and 1993. A random, stratified sample was selected for detailed assessment and follow-up. There were 1,733 patients enrolled in United States centers and 642 in Canadian ones. In United States centers patients were less likely to receive intravenous nitroglycerin, heparin, beta blockers, calcium antagonists, or > or = 2 anti-ischemic agents. Coronary arteriography during index hospitalization was equally frequent in both countries (63.4% vs 66.9%, p = 0.781), but at 6 weeks and 1 year coronary arteriography was slightly less frequent in the United States patients. Revascularization by coronary angioplasty or bypass surgery was equivalent at 6 weeks and 1 year; however, there were trends toward less angioplasty and more bypass surgery in the United States than in Canada. Patients at United States centers stayed in the hospital fewer days than patients at Canadian centers (mean 8.2 vs 12.1 days, p <0.001). Death or AMI by 6 weeks was not different (4.8% vs 4.4%, p = 0.633), nor was it different at 1 year (10.0% vs 10.2%, p = 0.836). The combined outcome of death, AMI, or recurrent ischemia was more common in United States than in Canadian patients at 6 weeks (18.4% vs 13.9%, p = 0.004). Our findings indicate that United States physicians and hospitals did not consistently utilize more resources and were not more aggressive than their Canadian counterparts when treating acute coronary syndromes during this period.     

Problems associated with rabies preexposure prophylaxis

With the rabies vaccine presently available for preexposure prophylaxis, 20% of all individuals do not have seroconversion following routine immunizations, and 5% are allergic to this vaccine. Two experimental rabies vaccines of cell culture origin offering greater purity and potency were evaluated by means of a double-blind experiment. Thirty-one volunteers who did not have seroconversion or who were allergic to duck embryo rabies vaccine received rabies vaccine produced in either human diploid cell culture (WI-38), or hamster kidney-cell culture. All volunteers had seroconversion within 14 days of receiving a single injection of other experimental vaccine. Clinical side effects were only minor.     

Pinning of Austenite Grain Boundaries by

The growth behavior of austenite grains in the presence of A1N precipitates varies with the temperature and time of anneal. To study this behavior, two iron alloys, (in weight percent) a 0.1 carbon base chemistry with 0.03A1/0.01N and 0.09A1/0.04N, respectively, were annealed between 1000 °C and 1200 °C for times of up to 180 minutes. Using optical microscopy, as many as 1000 austenite grains per heat-treatment condition were measured. Conditions of sup- pressed, abnormal, and uniform grain growth were observed. Using an extraction replica tech- nique, the size, shape, and distribution of the A1N particles were determined using transmission electron microscopy (TEM). The largest grain boundary curvatures calculated, using the Hellman- Hillert pinning model, were in close agreement with independent calculations of curvatures using the grain size data. The largest grains in the lognormal size distribution of austenite grains were found to be the ones with the potential to grow to abnormally large sizes.     

Diagnostic evaluation of the juvenile offender: toward the clarification of often overlooked psychopathology

On the basis of previously reported findings that a high percentage of court-referred children suffered from serious psychopathology other than sociopathy, attention is called to some essential, though often overlooked, elements of diagnostic evaluation of delinquents. Emphasis is on a meticulous history, including careful attention to the significances of family histories of serious psychiatric and/or neurological disorders. The importance of a detailed perinatal and medical history, with emphasis on determining a possible history of significant insult to the central nervous system, is stressed. A systematic mental status evaluation is strongly recommended. Techniques for assessing the existence of significant hallucinatory and delusional experiences in children are suggested. The uses of psychological and neurological evaluations to augment the psychiatric are discussed. The poor social situation from which many delinquents come as well as the obvious intrafamilial psychodynamic factors influencing delinquent behavior are recognized as frequent impediments to the search for less obvious psychotic and/or organic vulnerabilities in the juvenile offender. Case histories of several children who had previously been dismissed as merely sociopathic, illustrate the thesis of the paper.     

UPGRADING SPENT LAYER MEAT BY MECHANICAL DEBONING AND FURTHER PROCESSING

Spent layer chickens, an underutilized, inexpensive source of animal protein in the United States, were used to produce an acceptable all chicken frank following mechanical deboning of the chicken parts without pregrinding. The franks were subjected to shear tests and compared to two well-known commercial brands of chicken franks for overall acceptability by an untrained 59 member panel. The franks produced from mechanically deboned spent layer chickens (Lab franks) had greater resistance to shear than the two commercial brands and the panelists showed significantly greater preference for one of the commercial brands. Comments of the panelists indicated the texture of the lab-prepared franks was tougher than the two commercial brands. However, 12 members of the panel stated the lab-frank texture was tender. Collagen content of the spent layer franks was no higher than for the commercial brands. It is therefore concluded that the toughness could have been due to the nature of the myofibrillar proteins. Such toughness could be modified by tenderizing enzyme treatment of the raw material to produce varying degrees of frank softness or firmness depending on consumer preference.     

CHLORINATED HYDROCARBON TISSUE RESIDUES FROM BOVINE FEED SUPPLEMENTS: APPLE POMACE AND FISH MEAL

Beef cattle were fed corn silage with or without apple pomace andlor fish meal. Trace levels of dicofol, an acaricide used on apples, were found in tissues of animals fed apple pomace. Detectable levels of p, p'-DDE were also found in tissues of these cattle since dicofol, as formulated, contains about 2.5% p, p'-DDT. The addition of fish meal containing traces of p,p'-DDE to the ration did not consistently increase p, p'-DDE concentrations since this supplement only comprised 3% of the diet. The corn silage and fish meal each contained trace concentrations of polychlorinated biphenyls (PCBs) but PCBs were not detectable in tissues of any of the cattle.