Peutz-Jeghers polyposis with metastasizing duodenal carcinoma

A case of Peutz-Jeghers polyposis associated with duodenal carcinoma but without cutaneous pigmentation was presented. Duodenal carcinoma is the most commonly associated neoplasm. The presence of vitiligo in this patient is coincidental. Of 14 reported cases of Peutz-Jeghers syndrome associated with intestinal carcinoma, in only two was the tumor shown to originate in the polyp. In our case, too, we believe the carcinoma developed independently.     

Long-term sealing efficacy of four root surface sealing materials used in endodontic leakage studies

Fifty extracted human maxillary anterior teeth were biomechanically instrumented and divided into five equal groups, four experimental and a control. The teeth in the experimental groups had their root surface coated with one of four sealants; epoxy, casting resin, sticky wax, or nail polish. The roots of the remaining teeth were not coated and served as controls. All of the teeth were mounted in the caps of scintillation vials. Five microliters of [3H]uridine were deposited in the root canal space and disintegration counts were obtained over time periods of 1, 4, 8, 12, and 36 wk. At the conclusion of the experiment, sticky wax was demonstrated to provide a superior seal (p < 0.0001).     

Physician awareness of prescription drug costs: a missing element of drug advertising and promotion

The effects of high-dose ketamine on the c-fos protein (c-Fos) expression were investigated in rat by an immunohistochemical technique. The administration of 100 mg/kg ketamine i.p. induced seizure-like activity (limbic seizure). No c-Fos immunoreactivity was observed in hippocampus, piriform cortex and amygdala, while it was observed in neocortex and thalamus. These findings disagree with the reports that ketamine depresses the neuronal function of the neocortex and thalamus, while it stimulates the limbic system.     

Episodes of psychiatric utilization

The continued growth of outpatient psychiatric care has been accompanied by a large number of research studies concerning the determinants of psychiatric utilization. One of the major limitations of these efforts has been the inability to go beyond distributional data on the use of services. This article describes a methodology for generating episodes of psychiatric care given a data set with a small amount of routinely collected data present in many medical information systems. Both demographic and medical characteristics are significantly associated with health services resource use as defined by the number of visits in an episode. A model predicting recurrent episodes of care is also described. The general utility of this approach and the substantive implications of the specific results are discussed.     

The effect of intermittent pneumatic compression devices on intraoperative blood loss during radical prostatectomy and radical cystectomy

Intermittent pneumatic compression devices are a widely used, effective and presumed risk-free method of deep venous thrombosis prophylaxis, presumably by increasing peak venous blood velocity, and stimulating local and systemic fibrinolysis. We investigated whether intermittent pneumatic compression devices had any effect on intraoperative blood loss or transfusion during radical pelvic urological surgery. To our knowledge no previous study has addressed these issues. Records were reviewed for patients undergoing radical retropubic prostatectomy or radical cystectomy with diversion from 1985 to 1990. A total of 91 cases was reviewed: 38 radical retropubic prostatectomies and 53 radical cystectomies with diversion (34 male and 19 female patients). There were 59 patients with intermittent pneumatic compression devices (29 radical retropubic prostatectomies and 30 radical cystectomies with diversion) and 32 without intermittent pneumatic compression devices (9 radical retropubic prostatectomies and 23 radical cystectomies with diversion). Intraoperative blood loss and transfusions were calculated for each group with and without intermittent pneumatic compression devices. No clinically apparent lower extremity deep venous thrombosis or pulmonary embolus was diagnosed in any patient. For the group with intermittent pneumatic compression devices mean intraoperative blood loss was 2,541 ml. (range 700 to 8,850) versus 1,807 ml. (range 450 to 5,100) without a device, for a statistically significant difference of 734 ml. (p = 0.005). When 5 patients with excessive intraoperative blood loss (more than 5,000 ml.) were excluded the statistically significant difference was maintained. When comparing radical retropubic prostatectomy and radical cystectomy with diversion, with and without intermittent pneumatic compression devices, blood loss was greater for the group with a device for each procedure. Differences in intraoperative blood loss were independent of sex or tumor stage. Intraoperative transfusions were increased by approximately 0.6 units per patient with the device. Our study suggests that intermittent pneumatic compression devices may increase blood loss during a radical pelvic operation.     

A novel method for the extraction of sheep insulin-like growth factors-I and -II from plasma prior to radioimmunoassay

The measurement of insulin-like growth factors (IGFs) in plasma is complicated by the presence of high-affinity IGF-binding proteins (IGFBPs). Consequently, the IGFBPs need to be removed or their IGF-binding effects need to be neutralized prior to assaying samples for IGFs. It was observed that IGFs but not IGFBPs from sheep plasma bind to the size-exclusion gel Sephacryl S-100 HR at a low pH and that the IGFs can subsequently be eluted off at a neutral pH. From this observation a convenient method was developed for the extraction from plasma of ovine (o) IGF-I and -II free from detectable IGFBPs with close to 100% recovery. When assayed in homologous sheep IGF-I and -II radioimmunoassays the Sephacryl-extracted plasma samples gave dose-response curves which were parallel to purified oIGFs. Furthermore, the results obtained by Sephacryl extraction were highly correlated with those found by the established Sephadex G-75 extraction procedure.     

Atrial natriuretic peptide and bradykinin interaction on norepinephrine uptake in rat adrenal medulla

Interactions between atrial natriuretic peptide (ANP) and bradykinin (BDK) on norepinephrine (NE) uptake were demonstrated in the adrenal medulla of the rat. One hundred nM ANP and 10 nM BDK increased total NE uptake. Subthreshold concentration of ANP (1nM) or BDK (1nM) reverted the effects of thre shold concentrations of both peptides (10 nM BDK and 100 nM ANP respectively). Effective concentrations of ANP and BDK acting simultaneously did not induce additive effects on total NE uptake. Threshold concentrations of both peptides increased neuronal NE uptake only. These results suggest interactions between ANP and BDK at the neuronal uptake level. They confirm that ANP and BDK take part in the regulation of the sympathetic activity in the adrenal medulla of the rat.