Electrocardiographic findings in patients undergoing amitriptyline treatment

Fifteen depressed patients were treated with amitriptyline in a dosage ranging from 75 mg to 200 mg/day for a minimum of three weeks, two of which were at a fixed dosage. Plasma samples were drawn 12 to 16 hours after the bedtime dose of medication for determination of amitriptyline and its metabolite nortriptyline. Electrocardiograms were taken prior to treatment and after three weeks of drug treatment. The only abnormality noted prior to treatment was bradycardia in one patient. After treatment, two patients exhibited nonspecific T-wave abnormalities. Otherwise, the electrocardiograms were unremarkable. A significant increase in heart rate (p less than 0.001) was noted. The mean increase in rate was sixteen beats per minute. Those patients having a rate change greater than sixteen beats per minute had significantly higher amitriptyline levels (p less than 0.05), and total tricyclic antidepressant levels (p less than 0.05), than those patients having a mean rate increase less than sixteen. While tricyclic antidepressants can produce multiple cardiac effects, the risk of cardiac morbidity and mortality is relatively low in patients undergoing tricyclic antidepressant treatment with moderate dosages.     

Synovectomy and total joint arthroplasty for recurrent hemarthroses in the arthropathic joint in hemophilia

Severe hemophiliacs with intractable bleeding into one or more joints despite adequate clotting factor replacement therapy are difficult management problems. Synovectomy has controlled bleeding only in joints without significant arthritis destruction. Total joint replacements have been performed in arthropathic joints, but not when uncontrolled bleeding was a concurrent problem. This report describes a hemophiliac with uncontrolled bleeding into an arthritic knee who was successfully managed by combining synvectomy with total knee replacement.     

Fibrin regulates neutrophil migration in response to interleukin 8, leukotriene B4, tumor necrosis factor, and formyl-methionyl-leucyl-phenylalanine

We have examined the capacity of four different chemoattractants/cytokines to promote directed migration of polymorphonuclear leukocytes (PMN) through three-dimensional gels composed of extracellular matrix proteins. About 20% of PMN migrated through fibrin gels and plasma clots in response to a gradient of interleukin 8 (IL-8) or leukotriene B4 (LTB4). In contrast, < 0.3% of PMN migrated through fibrin gels in response to a gradient of tumor necrosis factor alpha (TNF) or formyl-methionyl-leucyl-phenylalanine (FMLP). All four chemoattractants stimulated PMN to migrate through gels composed of collagen IV or of basement membrane proteins (Matrigel), or through filters to which fibronectin or fibrinogen had been adsorbed. PMN stimulated with TNF or FMLP adhered and formed zones of close apposition to fibrin, as measured by the exclusion of a 10-kD rhodamine-polyethylene glycol probe from the contact zones between PMN and the underlying fibrin gel. By this measure, IL-8- or LTB4-treated PMN adhered loosely to fibrin, since 10 kD rhodamine-polyethylene glycol permeated into the contact zones between these cells and the underlying fibrin gel. PMN stimulated with FMLP and IL-8, or FMLP and LTB4, exhibited very little migration through fibrin gels, and three times as many of these cells excluded 10 kD rhodamine-polyethylene glycol from their zones of contact with fibrin as PMN stimulated with IL-8 or LTB4 alone. These results show that PMN chemotaxis is regulated by both the nature of the chemoattractant and the composition of the extracellular matrix; they suggest that certain combinations of chemoattractants and matrix proteins may limit leukocyte movements and promote their localization in specific tissues in vivo.     

Clinical utility of intraoperative frozen section diagnosis in head and neck surgery: a quality assurance perspective

The technical and professional issues that affect the clinical utility of intraoperative frozen section diagnosis in head and neck surgery are addressed from a quality assurance perspective. The most common reasons for sampling errors and interpretive errors are discussed. We offer several recommendations for head and neck surgeons and pathologists which will optimize the clinical utility of intraoperative frozen section consultation.     

Rapid detection of engraftment using T cell receptor gene polymorphism after allogeneic bone marrow transplantation in an alloimmunized child with severe aplastic anemia

A severely alloimmunized boy with aplastic anemia received an HLA-identical BMT from his brother. Despite intensive immunosuppression and large marrow dose, peripheral signs of engraftment occurred only late under G-CSF treatment. With leukocyte counts of < 0.5 x 10(9)/l, chimerism could be proven not only by oligonucleotide fingerprinting but also within 48 h by analysis of polymorphism in the TCR gene family. This rapid and sensitive method to detect engraftment before it became quantitatively evident was important for the clinical management of the patient, obviating the need to search for an alternative marrow donor.     

The effect of dyshemoglobins on pulse oximetry: Part I, Theoretical approach and Part II, Experimental results using an in vitro test system

Pulse oximeters are known to be inaccurate in the presence of elevated concentrations of carboxyhemoglobin and methemoglobin. This paper attempts to alleviate some of the confusion that exists between fractional and functional saturation, and to clarify the comparison of each with SpO2. A series of theoretical relationships between pulse oximeter reading (SpO2) and actual oxygen saturation (both fractional and functional) is derived using simple absorption theory. The theoretical relationships are checked using an experimental in vitro test system. This consists of a blood circuit containing a model finger, capable of simulating the pulsatile transmission signals through a real finger. Theoretical predictions and experimental results are compared and are found to agree well in the presence of carboxyhemoglobin, but less well with methemoglobin. Possible reasons are discussed.     

Response of Brazilian crossbred cows to varying doses of bovine somatotropin

The effect of n-methionyl bovine somatotropin (bST) on milk yield was evaluated in crossbred cows (40 1/2 Bos indicus x 1/2 Bos taurus and 18 1/4 B. indicus x 3/4 B. taurus) in Brazil. Cows were randomly assigned to treatments within stage of lactation [stage 1 = 56 to 100 d in milk (DIM); stage 2 = 101 to 199 DIM] and breed groups (1/2 vs. 1/4 B. indicus blood). Treatments were 250 or 500 mg of bST administered every 14 d. Cows in the control group did not receive bST or a placebo. Treated cows received bST injected subcutaneously in the postscapular region, alternating between the left and right sides. The 26-wk experiment consisted of 2 wk of pretreatment and 24 wk of treatment. Cows were housed in an open lot with regulated access to pasture. Cows were milked twice daily and scored for body condition at 2-wk intervals. Compared with controls, milk yield increased equally (22%) for cows receiving 250 or 500 mg of bST. Milk yield response to bST was higher and persisted longer during stage 1 of lactation than during stage 2 of lactation. No difference in response to bST was noted between cows with 1/2 or 1/4 B. indicus blood. Cows treated with 500 mg of bST tended to have more mastitis, but no other adverse health effects were observed. The potential use of 250-mg doses of bST at 14-d intervals in crossbred cattle in Brazil and other subtropical regions throughout the world is suggested, particularly before about 220 DIM.