Anatomic correction of transposition of the great vessels

We present a new approach for anatomic correction of transposition of the great arteries. The two coronary arteries, with a piece of the aortic wall attached, are transposed to the posterior artery. The two aortic openings are closed with a patch. The aorta and pulmonary artery are transected, contraposed, ant then anastomosed. The interventricular septal defect is closed with a patch, through a right ventriculotomy approach, because the right ventricle is no longer part of the systemic circulation. Two patients, aged 3 months and 40 days weighing 4,200 and 3,700 grams, respectively, were operated upon with deep hypothermia and total circulatory arrest. There was good recovery from the operation, with normal cardiocirculatory conditions. Renal failure developed in the first patient, and she died on the third postoperative day. During this time the cardiocirculatory conditions were good. The second patient made an uneventful recovery. Hemodynamic studies 20 days after the operation showed complete correction of the malformation. Five and one-half months after the operation, he weighs 7,500 grams, and his development is very good. We believe that this operation will be reproducible by most cardiovascular septal defect and pulmonary hypertension.     

Serum triiodothyronine determination in clinical use

Two radioimmunassays for the determination of serum triiodothyronine (T3) were developed. The assay of T3 in unextracted serum had several advantages over the assay on extracted serum and was chosen for the routine determination of T3 in serum from 117 patients requiring assessment of their thyroid status. In 53 subjects considered retrospectively not to have thyroid dysfunction nor to have been on steroid contraceptives or therapy, the pooled mean serum T3 concentration was 1-92 (actual range 0-88-2-62) nmol/l. A significant inverse relationship was observed between the serum T3 level and the age of the subject. Serum total T3 levels discriminate clearly between hypo-,eu- and hyperthyroid patients and provide a rather more sensitive index of hyperthyroid function than total serum T4. In the face of normal serum T4 the T3 level was depressed in five patients with marked hypoproteinaemia and elevated in two patients taking heroin.     

Metabolic responses of White Pekin ducks to ambient temperature

Metabolic responses of unrestrained White Pekin ducks, Anas platyrhynchos, were determined at ambient temperatures of -5 degrees, 1 degrees, 10 degrees, 20 degrees, and 30 degrees C. Temperatures from the pectoralis and the subcutaneous back were monitored. Unrestrained ducks exhibited two metabolic states, a high response (540 cc. O2/kg/hr. at 20 degrees C.) and a low response (427 cc. O2/kg./hr. at 20 degrees C). Pectoralis muscle temperature did not vary greatly over the range of ambient temperatures tested and was considered to be a good representative of body temperature.     

Abnormal tryptophan metabolism in a family with a history of bladder cancer

Tryptophan metabolism was studied in a family in which a sister and brother had bladder cancer. Urinary tryptophan metabolites after administration of 2 g L-tryptophan were measured in 4 sisters and 1 brother, all free of disease when studied. One sister with and 2 without histories of bladder cancer had significantly elevated levels of kynurenine, acetylkynurenine, and 3-hydroxykynurenine. Administration of 100 mg pyridoxine hydrochloride returned the tryptophan metabolism to normal in these 3 individuals. One brother with a 1 sister without bladder cancer had normal metabolism. A repeat study 2 years later confirmed the abnormal metabolism in the 3 sisters. Two sisters with abnormal tryptophan metabolism were given 200 mg L-kynurenine sulfate orally to bypass the effects of tryptophan oxygenase activity. Both excreted elevated levels of kynurenine and 1 excreted elevated levels of 3-hydroxykynurenine.     

A histochemical investigation of catecholamines in spinal cord injury

The catecholamine hypothesis of progressive spinal cord necrosis following mechanical trauma was investigated with the histofluorometric method. Forty-four adult mongrel dog were examined as control, L1 crush-injured, and crush-injured with prior T1 total transection groups. In crush injured dogs, catecholamines were present in a 1 cm length of white matter at the crush site, with the greatest accumulation in the deep lateral and ventral funiculi. Gray matter fluorescence was not enhanced. Prior transection did not abolish the intense accumulation of catecholamines at the site of the cord injury. We propose that the catecholamines accumulating at the cord injured site are not central in origin, but represent an uptake mechanism into white matter as a reflection of cord microperfusion.     

Quantitation of maximal bactericidal capability in human neutrophils

The quantitative capacity of normal human neutrophils to ingest and kill increasing multiples of bacteria up to a level of saturation was evaluated. The in vitro system, a modification of classic bactericidal assay, employed carefully controlled ratios of bacteria per neutrophil between 1.25 and 400:1 to stress neutrophil function. Morphologic examination and measurement of bacterial survival by quantitative plate culturing indicated that at a challenge of about 100 Staphylococcus aureus per neutrophil bactericidal activity reached its peak with each average cell killing 48 bacteria. The efficiency of bactericidal function fell as the challenge was increased while ingestion capabilities kept pace with the numbers of bacteria presented to the neutrophils. Various key test parameters were evaluated from which evolved a system which provides a highly reproducible, statistically based, method for clinical assessment of subtle or partial neutrophil dysfunctions which may escape detection by the currently employed techniques of bactericidal assay.     

Discharges against medical advice from voluntary psychiatric units

About one in every six voluntary mental patients discharges himself against medical advice. But despite the high rate of AMA discharges, the authors found the literature on the subject to be sparse and of little help in explaining why patients leave the hospital against medical advice. They examine the approaches that have been used thus far to study the phenomenon. They also report the findings of their own study, which showed that patients discharged against medical advice had a poorer response to treatment than those discharged in the traditional manner. The study identified factors that contributed to the poor response and were related to the discharge.     

Aberrant left pulmonary artery presenting as a right paratracheal mass in an adult

Aberrant left pulmonary artery, or pulmonary sling, is a rare variation of the pulmonary vasculature, with only one previous report of the condition being recognized in an adult. In this report a second case recognized de novo in an adult is presented. Both of these adults were evaluated because of right paratracheal masses which required differentiation from pulmonary malignancies. The barium swallow shows a characteristic indentation of the anterior esophageal wall and the lateral tomogram demonstrates absence of the left pulmonary artery from its normal position in the left hilum. The pulmonary arteriogram is diagnostic and allows avoidance of more invasive diagnostic measures.     

Intraoral reconstruction in head and neck cancer surgery

The effect of prostaglandins (PGs) on the hepatic biotransformation of hexobarbital (Hechi) and p-chloro-N-methylaniline (PCMA) was determined in male rats. PCMA metabolism in slices was decreased by all PGs (PGA1, PGB1, PGE1, PGE2, PGF1alpha, PGF2alpha), ranging in concentration from 1 mu M to 1 mM. PGA1, at 1 mM, produced the greatest degree of inhibition, 39%. PG addition to microsomes, however, failed to alter PCMA metabolism. In contrast to PCMA biotransformation, Hechi metabolism was increased by all PGs in slices but not in liver subfractions. PGs of the E and F series were the most potent, producing a two-fold increase in Hechi metabolism at 1 mM after a 20 min preincubation. The increased effect was observed as early as 10 min and lasted for 4 hr. The relationship of PG metabolism and binding to cytochrome P-450 is presented as a possible mechanism to account for the opposite effects on Hechi and PCMA, type I and II substrates respectively, metabolism.