Barium enema, proctosigmoidoscopy and upper gastrointestinal series in the preoperative evaluation of the cancer patient

Charts of 566 patients admitted to the Surgery Branch, National Cancer Institute over a five year period were reviewed. Routine upper gastrointestinal series was performed in 453 patients; barium enemas in 490; and proctosigmoidoscopies in 342. Upper gastrointestinal series detected no metastases or second primary malignancies but delineated the extent of large intra-abdominal tumors. Barium enema and proctosigmoidoscopy together revealed three unsuspected primary colonic tumors (1.2% in patients over 50 years of age). Sigmoidoscopy and examination of the stool for occult blood would have detected the same patients. Barium enema may be limited to surgical cancer patients in whom the extent of local tumor invasion is to be defined and to older patients in whom colonic tumors are suspected. Neither UGIS nor barium enema appear to be of value as a routine preoperative screening test in surgical cancer patients.     

Comments on CSUN program

The somitic mesoderm of the wing level was replaced in a two-day chick embryo by quail somitic mesoderm obtained from the level of the wing, the leg or the neck. The musculature of the host's wing on the operated side was exclusively or almost exclusively constituted by quail cells, whereas the skeleton, the dermis, the tendons and the muscular envelopes were formed by chick cells. This result demonstrates that, under the present experimental conditions, the wing musculature is originated from the somitic mesoderm of any level of the cephalocaudal axis.     

Cerebral Ischemia during carotid endarterectomy with severe but reversible changes

Electroencephalographic monitoring of a patient during carotid endarterectomy demonstrated severe ipsilateral voltage suppression with preservation of rhythms when the common carotid artery was clamped. Because the atheromatous plaque extended almost to the base of the skull, it was impossible to insert a shunt. Occlusion time was 19 minutes. After carotid flow was re-established, there was a rapid recovery of voltage. The patient awoke with a profound hemiparesis, but this cleared almost completely within a week. The EEG changes indicated severe ischemia, but, though function was transiently impaired, there was no apparent cerebral necrosis. This case represents the most severe yet reversible episode of ischemia during carotid clamping reported to date. Preservation of EEG rhythms, even in the face of voltage suppression, may have been a favorable sign.     

Fixation of canine tendons to metal

For the purpose of developing a method to attach tendons directly to the prosthesis, canine supraspinatus tendons were attached in vitro to a metallic surface, using 3 different fixation devices: a spiked polyacetal washer (Synthes), a spiked soft tissue fixation plate (Synthes), and a newly designed Enhanced Tendon Anchor (ETA), which straddled the tendon with interlocking spikes oriented at a 20-degree angle. 2 methods were used: 1) the tendon was fixed directly to the metallic surface, or 2) a bone block containing the tendon insertion was fixed to the metallic surface. The specimens were tested for initial fixation strength in tension to failure; intact bone-muscle-tendon-bone units were used as controls. Bone block fixations were stronger than direct tendon fixations when the spiked washer or the ETA was used; this was not true of the fixation plate. The ETA was stronger than the other techniques in ultimate strength in both direct tendon fixation and bone block fixation. The soft tissue fixation plate was found to be weaker than the other techniques in bone block fixation.     

A further analysis of physiological changes in rats in the forced swim test

Rats were tested in the forced swim test in 35 or 20 cm of water or in an open field to evaluate the effects of different intensities of stress on blood gases, electrolytes, and metabolic indices, compared to nontested controls. Animals tested in the open field did not differ from controls on any measure. Immersion in deep water resulted in a greater mixed metabolic and respiratory acidemia (low pH, low bicarbonate, high pCO2), higher glucose and higher lactate levels than immersion in shallow water which in turn resulted in greater metabolic acidemia (low pH, low bicarbonate), and higher glucose and lactate levels than occurred in open field or control animals. In contrast to immersion in deep water, immersion in shallow water resulted in an initial hypocapnia followed by a hypercapnia. Immersion in deep water also resulted in higher potassium levels, lower bicarbonate and total carbon dioxide levels, and a higher anion gap than immersion in shallow water, testing in the open field, or in controls. In a second study, lactate infusion resulted in a metabolic alkalemia (increased pH and bicarbonate levels) and an increase in total carbon dioxide levels. These results indicate that test parameters from forced swim testing (e.g., water depth) can significantly affect the rat's physiological response to testing. The effects of forced swim testing are not simply due to general stress; and the physiological changes seen in conjunction with forced swim testing (e.g., acidemia) are not due to lactate alone.     

A live human parainfluenza type 3 virus vaccine is attenuated and immunogenic in healthy infants and children

The safety, infectivity, immunogenicity, and phenotypic stability of the cold-passaged (cp) candidate vaccine cp-45, a cold-adapted (ca), temperature-sensitive (ts) mutant of the JS strain of human parainfluenza virus type 3 (HPIV-3), was evaluated in 114 children 6 months to 10 years old in a randomized, placebo-controlled, double-blind trial. The cp-45 vaccine was well tolerated when given intranasally to parainfluenza virus type 3 (PIV-3)-seropositive and -seronegative children. With 10(4) or 10(5) TCID50 of cp-45 vaccine, 86% of seronegative vaccines were infected, 83% of whom shed virus at a mean peak titer of 10(22) pfu/mL. Virus present in respiratory specimens retained the ts phenotype, and each of 86 PIV-3 isolates tested retained both the ca and ts phenotypes. One dose of 10(5) TCID50 of vaccine induced a serum hemagglutination-inhibiting antibody response in 81% of vaccinees; the geometric mean titer was 1:32. These studies indicate that the cp-45 HPIV-3 vaccine is satisfactorily attenuated, infectious, immunogenic, and phenotypically stable and merits further evaluation in infants and young children.     

Human immunodeficiency virus type 1 evolution in vivo tracked by DNA heteroduplex mobility assays

High mutation rates and strong selective pressures imposed on human immunodeficiency viruses in vivo result in the formation of pools of genetic variants known as quasispecies. DNA heteroduplex mobility and tracking analyses were used to monitor the generation of HIV sequence diversity, to estimate quasispecies complexity, and to assess the turnover of genetic variants to approach an understanding of the relationship between viral quasispecies evolution in vivo and disease progression. Proviral DNA pools were nearly homogeneous soon after sexual transmission. The emergence and clearance of individual variants then occurred at different rates in different individuals. High quasispecies complexity was found in long-term-infected, asymptomatic individuals, while rapid CD4+ cell decline and AIDS were often, but not always, associated with lower quasispecies complexity. Proviral genetic variation was often low following in vitro culture, because of the outgrowth of one or a few variants that often became more abundant only later as proviruses in peripheral blood mononuclear cells. These studies provide insight into the dynamics of human immunodeficiency virus sequence changes in vivo and illustrate the utility of heteroduplex analysis for the study of phenomena associated with rapid genetic changes.