Internal pancreatic fistulas: pancreatic ascites and pleural effusions

Thirty-four patients seen over a 10-year period with internal pancreatic fistulas are reported. In 22 patients the fistula was into the peritoneal cavity and they presented with pancreatic ascits. In 7 patients the fistula tracked up through the mediastinum into a pleural cavity, and they presented with pancreatic pleural effusions. Five patients presented with both pancreatic ascites and pancreatic pleural effusions. Diagnosis was made by finding a markedly elevated amylase and protein content in the ascitic and pleural fluids. Serum amylase was usually, but not always, elevated. Over one half of the patients had no history of inflammatory pancreatic disease. Initial treatment was non-operative using nasogastric suction, diamox, atropine, and multiple paracenteses or thoracenteses. This was successful in 48% (12/25). If non-operative therapy failed, surgery was performed to drain or resect the internal fistula. Surgery was successful in 82% (14/17). The internal pancreatic fistula was successfully demontrated in most instances by preoperative, operative, or postmortem pancreatography, or by gross observation at the time of surgery.     

Perichondritis of the ear as a complication of acupuncture

A 54-year-old woman developed pain, tenderness, and swelling at the site where a short acupuncture needle had been placed in the helix of the pinna. Staphylococcus aureus was isolated from this LESION. Which was treated with removal of the needle and intravenously administered nafcillin. The patient recovered completely and had no scarring.     

A case of veno-occlusive disease of the liver in Britain associated with herbal tea consumption

Veno-occlusive disease of the liver with clinical and pathological features similar to those of the condition occurring in the Caribbean is described in a young woman resident in Britain. The diagnosis was made from liver biopsies and hepatic venography and was confirmed at necropsy. Small amounts of pyrroliziding alkaloids were recovered from a sample of mate (Paraguay) tea, owned by the patient, to which she was addicted. It seems probable that the consumption of large amounts of this tea over a period of years was the cause of the hepatic disease.     

Effects of hypothalamic temperature changes on the sweat rate in Macaca mulatta

The concept of cardiac reconditioning centers for the prevention and rehabilitation of coronary patients has been tremendously successful in Germany over the past 20 years. At least 40 such centers are located throughout the country. Physicians, nurses, and physical therapists work closely together in the various facets of the rehabilitation process. The financial backing for these facilities is primarily through governmental and regional insurance companies, whose officials are apparently convinced that in the long run supporting preventive measures is financially sound. Objective data supporting their convictions come from studies such as that of Brusis, who showed that such as that of 1,500 employees was diminished by nearly 70 percent during a two-year period after cardiac reconditioning, as compared to a similar time period before the rehabilitation experience. Subjective benefits, which are extremely difficult to quantitate in meaningful terms, were nonetheless expressed by nearly all the patients with whom I conversed. Perhaps they have experienced the same feelings that Mark Twain did when he observed that "all frets and worries and chafings sank to sleep in the presence of the benignant serenity of the Alps; the Great Spirit of the Mountains breathed his own peace upon their hurt minds and sore hearts and healed them."     

Characterization of a temperature-sensitive, hexon transport mutant of type 5 adenovirus

Infection of KB cells at 39.5 degrees C with H5ts147, a temperature-sensitive (ts) mutant of type 5 adenovirus, resulted in the cytoplasmic accumulation of hexon antigen; all other virion proteins measured, however, were normally transported into the nucleus. Immunofluorescence techniques were used to study the intracellular location of viral proteins. Genetic studies revealed that H5ts147 was the single member of a nonoverlapping complementation group and occupied a unique locus on the adenovirus genetic map, distinct from mutants that failed to produce immunologically reactive hexons at 39.5 degrees C ("hexon-minus" mutants). Sedimentation studies of extracts of H5ts147-infected cells cultured and labeled at 39.5 degrees C revealed the production of 12S hexon capsomers (the native, trimeric structures), which were immunoprecipitable to the same extent as hexons synthesized in wild type (WT)-infected cells. In contrast, only 3.4S polypeptide chains were found in extracts of cells infected with the class of mutants unable to produce immunologically reactive hexon protein at 39.5 degrees C. Hexons synthesized in H5ts147-infected cells at 39.5 degrees C were capable of being assembled into virions, to the same extent as hexons synthesized in WT-infected cells, when the temperature was shifted down to the permissive temperature, 32 degrees C. Infectious virus production was initiated within 2 to 6 h after shift-down to 32 degrees C; de novo protein synthesis was required to allow this increase in viral titer. If ts147-infected cells were shifted up to 39.5 degrees C late in the viral multiplication cycle, viral production was arrested within 1 to 2 h. The kinetics of shutoff was similar to that of a WT-infected culture treated with cycloheximide at the time of shift-up. The P-VI nonvirion polypeptide, the precursor to virion protein VI, was unstable at 39.5 degrees C, whereas the hexon polypeptide was not degraded during the chase. It appears that there is a structural requirement for the transport of hexons into the nucleus more stringent than the acquisition of immunological reactivity and folding into the 12S form.     

Chromosome studies in "preleukemia". III. Myelofibrosis

Cytogenetic studies were done on 18 patients with myelofibrosis or the closely related syndrome, undifferentiated myeloproliferative disorder (MPD). Clones of cells with chromosome abnormalities were demonstrated in the blood of eight individuals, including two with a history of radiation therapy and two with "acute myelofibrosis". Trisomy 8 was present in the latter two patients, but otherwise, there was no consistent cytogenetic pattern or correlation with specific hematologic findings. Sixteen of these patients have been followed for more than 1 year or until death; none has progressed to leukemia. The results indicate that chromosome abnormalities are relatively common in this disorder, but as with polycythemia vera, and unlike some other "preleukemic" states, the aberrant clones in myelofibrosis do not appear to indicate that clinical leukemia is imminent.     

Regulation of acetylcholine synthesis: does cytoplasmic acetylcholine control high affinity choline uptake?

When brain synaptosomes are obtained from animals that have been injected intravenously with [2H4]choline 1 minute before being killed, their high affinity [3H] choline uptake is correlated inversely with their acetylcholine content and directly with the rate at which they synthesize [2H4]acetylcholine. The control of such choline uptake by the cytoplasmic acetylcholine concentration is proposed as a mechanism regulating acetylcholine synthesis in cholinergic nerve terminals.     

Effect of undernutrition and amino acid deficiency on the timing of puberty in rats

Sexual maturation was examined in underfed or amino acid-deficient rats. We have demonstrated a highly significant negative linear relationship (r = -0.80, P less than 0.001) between the age at puberty and the growth rate in rats under conditions of food restriction. The weight at puberty in animals growing at different rates because of undernutrition was not constant but behaved as a quadratic function of growth rate, as predicted from the assumption that growth rate was an independent variable. Growth rate is therefore more important than arrival at a particular fixed weight in determining the timing of puberty. Feeding of low valine diets resulted in delayed sexual maturation. Both the weight at vaginal opening (182 +/- 5.9 g) and the weight at first estrus (187 +/- 6.1 g) were significantly greater in the valine-deficient group when compared with growth-matched control (139 +/- 10.7 g and 161 +/- 9.3 g, respectively, P less than 0.05). The valine-deficient group also had significantly later vaginal opening (98.8+/- 4.7 days) than growth-matched controls (76.6 +/- 6.6 days, P less than 0.02). Valine deficiency seemed to have a specific effect on the hypothalamic-pituitary-gonadal axis since puberty in valine-deficient animals was delayed more than could be accounted for by impairment of growth.     

Characterization of prostaglandin production in tissue culture of rat renal medullary cells

The purpose of our studies was to examine the role of the nervous system in arrhythmias produced by digitalis overdose and coronary artery occlusion in the cat. This was done by observing the effect of these arrhythmogenic procedures on cardiac efferent neural activity and then determining whether any observed alteration in neural activity contributed to the cardiac rhythm disturbances evoked by digitalis and coronary artery occlusion. Our data indicate that both procedures used to evoke arrhythmias activate each division of the autonomic nervous system. Activation of the sympathetic nervous system resulted in a deleterious effect on cardiac rhythm whereas activation of the parasympathetic nervous system, in general, resulted in a beneficial effect on cardiac rhythm. With coronary occlusion, the role exerted by the nervous system depended on the anatomic location of the involved myocardium. Studies directed at elucidating the mechanisms whereby the nervous system caused cardiac rhythm disturbances indicated that there may be an important difference between the antiarrhythmic efficacy of beta-adrenergic blockade and bilateral stellate ganglionectomy. The latter procedure proved to be a more effective way of removing deleterious sympathetic neural effects on the heart. In conclusion, our findings suggest that the development of new drugs for treating arrhythmias resulting from digitalis and coronary occlusion should be aimed at finding drugs that act to either depress central sympathetic outflow or enhance parasympathetic effects on the ventricle.