Comparison of factor VIII-related antigen and erythrocyte sedimentation rate in outpatient management of vasculitis

Electroimmunodiffusion (Laurell rocket) determinations of factor VIII-related antigen in plasma were ordered to determine the cost/benefit ratio for factor VIII-related antigen as a putative test for endothelial damage in suspected vasculitis. Twenty-seven consecutive patients referred for vasculitis or suspected vasculitis were identified and followed up for an average of 9.1 +/- months (range: one to thirty-three months) in a prospective, unblinded study performed in a clinic, associated with a 1054-bed inner-city university hospital. There was no difference in Westergren erythrocyte sedimentation rate (WESR) in patients with final diagnosis of systemic vasculitis (SV) (38 +/- 12 mm/hour) compared to those without vasculitis (NV) (27 +/- 7) as the final diagnosis. The mean plasma concentration of factor VIII-related antigen was significantly elevated in SV (344 +/- 100%) when compared with NV (147 +/- 39%) (P < 0.016). The factor VIII-related antigen test in this study was 2.56 times more likely (crude odds ratio) than the WESR to contribute to a change in diagnosis or therapy (P = 0.016). Positive and negative predictive values (PPV and NPV) for factor VIII-related antigen (abnormal at greater than 220% of the normal value) were both 70%. PPV and NPV for WESR were 56% and 86%, respectively. The factor VIII-related test was less cost-effective than the WESR in the follow-up period unless it was important to define complete remission or differentiate vasculitis flare from infection. The authors conclude that factor VIII-related antigen is a useful test in the initial diagnosis of vasculitis.     

Synthesis and antiplatelet, antiinflammatory, and antiallergic activities of substituted 3-chloro-5,8-dimethoxy-1,4-naphthoquinone and related compounds

2-Amino (6), 2-alkylamino (7-8), 2-methoxy (9), 2-acetamido (10), and 5,8-diacetoxy (11) derivatives of the lead compound 2,3-dichloro-5,8-dimethoxy-1,4-naphthoquinone (4) were synthesized, together with 6,7-dichloro-5,8dimethoxy-1,4-naphthoquinone (5), a positional isomer of 4. Antiplatelet, antiinflammatory, and antiallergic activities were evaluated, and most compounds were quite potent in all assays. Compounds 5 and 9-11 were especially active; however, 5 was ineffective against neutrophil superoxide formation, and 10 was ineffective against mast cell degranulation.     

Open-heart correction of tetralogy of Fallot in an acyanotic dog

Tetralogy of Fallot was diagnosed in an acyanotic 11-month-old dog. Predicted pressure gradient across the pulmonic valve, as assessed by use of continuous wave Doppler echocardiography, was 94.5 mm Hg. Bidirectional shunting was identified by means of selective angiography. Open-heart correction was performed, using a transatrial approach with limited ventriculotomy and cardiopulmonary bypass. The hypertrophied infundibulum was resected, the ventricular septal defect was closed primarily, and a transannular pericardial patch graft was applied. Pressure gradients across the pulmonic valve were 52.9 and 22.8 mm Hg 2 weeks and 4 months after surgery, respectively. Advances in cardiopulmonary bypass, anesthetic management, and use of the transatrial approach may improve the success of open-heart correction of tetralogy of Fallot in dogs.     

Spinal cord herniation after stabbing injury

The commercially available spray management valve provided consistent flow rates when used with hand-compression sprayer systems. The 15-psi spray management valve maintained a constant flow rate of 180, 150, and 155 ml/min in combination with a fine 45 degrees flat fan nozzle and Hudson. B&G, and Chapin hand-compression sprayers, respectively. The 30-psi spray management valve maintained a constant flow rate and adequate spray-on time when combined with the coarse flat fan nozzle for each of the 3 hand-compression sprayers tested.     

Acoustic reflex threshold and loudness discomfort level: relationships in children with profound hearing losses

Acoustic reflex thresholds (ART) and loudness discomfort levels (LDL) were obtained from 51 ears of 34 deaf children using broad band noise and pure tones. Both thresholds and levels were recorded using the psychophysical method of tracking. Results indicate that the relationship between ART and LDL is at variance with similar data for normal hearing individuals. Specifically, in over 39% of these deaf children LDL was obtained at a lower intensity than ART. Implications for hearing aid fitting with deaf children are discussed.     

When the patient wants facial cosmetic surgery

Cosmetic facial surgery can improve appearance but it cannot make everyone beautiful (or handsome) or solve all problems. The patient must be well motivated and must comprehend the limitations of the procedures. Procedures useful in providing a more youthful appearance include blepharoplasty, browlift and face-lift. Sometimes all three are indicated. Chemical face peeling is used for correction of fine skin lines.     

Neural control of ventilation in the lamprey

Tidal breathing of adult lampreys is produced by a single phase of excitation that compresses the branchial basket for exhalation. Inhalation is due to passive recoil. Motoneurons are located primarily in the ipsilateral motor nucleus of the vagus and exhibit periodic bursts of excitatory synaptic potentials from unidentified generator cells in the medulla. Respiratory discharges continue in the isolated brain and can be recorded from the vagal roots. The frequency of bursts increases with temperature in a manner roughly similar to that of intact animals. However, the discharges of the isolated brain are not very sensitive to altered pH or oxygen content in the bathing fluid. Mechanoreceptors in the gill can initiate "cough" responses and may modulate normal breathing.