Biomedical subjects
Publications and source records attributed to C Kirkpatrick.
Two patients presenting a cervical trophoblastic implantation were treated with selective uterine artery embolization associated with dilatation and curettage. This interventional radiological maneuver helped greatly in the management of the bleeding caused by the ectopic pregnancies.
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Diagnosis of probable Alzheimer disease (AD) is made by a combination of characteristic clinical findings, when normal laboratory studies reveal no structural or metabolic cause of the dementia. Definite diagnosis of AD, however, can only be made with brain tissue examination. PET scanning reveals parietotemporal decreases in cerebral blood flow (CBF) and glucose metabolism that differentiate AD from normal elderly and from multi-infarct dementia. Preliminary studies suggest that similar defects in CBF are detectable in single photon emission computed tomography (SPECT) in AD. Utilizing the iodinated ligand [123I] HIPDM ([123I] hydroxyiodobenzylpropanediamine), we studied 19 patients with probable AD of varying severity, with emphasis on mild cases, to assess the utility of SPECT as a diagnostic test in AD. Parietotemporal perfusion on SPECT was decreased unilaterally or bilaterally in 16 of 19 AD patients, similar to the defects reported with PET. The degree and extent of decreased CBF on SPECT correlated with AD severity. Strong correlations were obtained between decreases in computer-generated ratios of parietal to cerebellar activity and the level of cognitive function. SPECT was read as normal (on the radiographic film) by the nuclear medicine physician in all cases with Mini-Mental State (MMS) score greater than 24, and showed bilateral parietal perfusion deficits in only 1 of 4 patients with MMS between 22 and 24. Ten of 12 patients with MMS less than or equal to 21 had bilateral parietal abnormalities; the other 2 had unilateral perfusion defects. All patients with MMS less than 15 were bilaterally abnormal. SPECT is less expensive and more widely available than PET, and may have an adjunctive role in diagnosis of AD and other dementias if utilized under the proper circumstances.
A group of 1666 consecutive pregnant women attending our prenatal clinic was screened for gestational diabetes (GD). Patients with risk factors (155) underwent a classical 50 g OGTT, while 1511 patients without risk factors for GD were submitted at random throughout the day to a simplified OGTT, consisting of a single blood glucose determination 1 h after the glucose ingestion. In these patients, plasma glucose 1 h after the glucose load averaged 104 +/- 1 mg/dl and exceeded 135 mg/dl in 315 patients. In the latter group, retested with a standard 50 g OGTT, 48 out of 1511 patients (3.2%) finally met the criteria for GD, while 25 patients had an abnormal OGTT in the group with risk factors. The blood glucose levels after simplified 50 g glucose load were significantly higher in the third (vs. first) trimester of pregnancy (113 +/- 1 vs. 96 +/- 1 mg/dl, p less than 0.001). A significant increase in mean glucose concentrations was also observed for those patients tested after 11 a.m. (107 +/- 1 mg/dl vs. 99 +/- 1 mg/dl prior to 11 a.m. p less than 0.001) and for the women with an ideal body weight (IBW) greater than or equal to 150% at the beginning of pregnancy (124 +/- 7 mg/dl vs. 104 +/- 1 mg/dl for less than 150% IBW, p less than 0.001). These variations in glucose tolerance, related to the time of the day, the gestational age and the body weight, are of limited amplitude and should not be considered in the determination of the cut-off point of the screening test. Glucose loading at random throughout the day is a simple and useful tool for the routine detection of unsuspected GD in pregnant patients attending prenatal clinics.
A social and clinical evaluation was performed on thirty Kentucky centenarians. The majority of the subjects were women (19/30), white (27/30), either widows or widowers (26/30), and lived in long term care facilities (15/30). Only one of thirty had ever smoked cigarettes and there was an absence of excessive alcohol use. Medication use varied from 0 to 9 medications. Digitalis, diuretics, and anti-inflammatory medications were common (12; 16; 15 respectively) while major and minor tranquilizers were less frequently used (7 and 4). Hypertension was present in 48%. Although rarely functionally significant, clinically evident cardiac disease was present in 38%. Ninety-three percent lacked vibratory sensation at the ankles while ankle jerks were absent in 82%. Functionally significant diminished vision and hearing were frequent (40% and 60% respectively). Functional assessment demonstrated moderate to nearly complete independence in 57%, while the remaining 43% were significantly to nearly totally dependent on others. The primary conclusion is that for all they have in common, centenarians remain unique individuals with a tremendous variability among themselves.
A delay of more than one month between the birth of twins is an unusual occurrence presenting the obstetrician and the neonatalogist with many questions regarding the management of the case. There is the risk of prematurity for the second twin as labor has already occurred in the pregnancy. There is also a risk of infection to both mother and fetus during the interval between the two deliveries, since the stump of the first twin's cord may precipitate ascending colonization from vagina and cervix. Germs frequently recovered from the vagina e.g. Ureaplasma urealyticum, are associated with prematurity. The latter has also been responsible for lethal interstitial pneumonia in the neonate. We present a case of a patient who though she delivered twice normally, had suffered 4 first trimester abortions and one late abortion, all spontaneous. Her eighth pregnancy was a twin pregnancy. She underwent a cerclage at 14 weeks, but went into labor at 17 weeks, when she delivered the first macerated twin. She was then treated with fenoterol and ampicillin; nevertheless she delivered twin the second at 26 weeks. This 750 g baby-girl presented with severe respiratory distress. Repeated chest X rays showed perihilar infiltrates which became nodular. All cultures were negative. At the end of the first week, when her condition was considered satisfactory, she deteriorated dramatically and died in respiratory failure and DIC. Tracheal aspirates were positive for Ureaplasma urealyticum.
Ten healthy and mentally alert centenarians underwent cranial computed tomography (CT) using a fourth-generation CT scanner. The subjects ranged in age from 100 to 102 years, and included six women and four men. Two of them used alcohol on a daily basis and five had systolic blood pressures of at least 160 mmHg. The CT scans demonstrated considerable variation in the degree of cerebral atrophy, which had no relation to either sex, alcohol use, or hypertension. Three of the centenarians had evidence of mild periventricular white matter lucency. Although progressive cerebral atrophy is an integral aspect of the normal aging process in the very elderly, its exact relationship to cognitive function remains unclear.
Mucoviscidosis, the most frequently lethal genetic syndrome of Caucasian population, is a recessive disease with multiple tissue involvement. Although the major pathological changes are observed in lungs and pancreas, abnormalities have also been detected in several other exocrine glands. For many reasons, such as the ready availability of tissue material, the absence of secondary changes and the potential for prenatal diagnosis, cultured skin fibroblasts could be the tissue of choice to search for the primary defect. Several abnormalities have been reported in CF fibroblasts, suggesting that the genetic abnormality is expressed in these cells. To search for potentially mutant protein(s) we have compared the protein composition of normal and CF fibroblasts by two dimensional gel electrophoresis and double-labeling autoradiography using 35S and 75Se methionine as tracer. The results demonstrate the power of the method; however, we have not found one protein spot consistently missing in CF cells. Possible reasons for the absence of a single common identifiable defect are discussed.
The immune status of 17 healthy individuals 100-103 years of age (centenarians) was investigated. Qualitative values for immunoglobulins IgG, IgM, IgA, and IgE were within normal ranges for subjects more than 60 years of age with the exception of elevated IgM in one individual. Cell marker studies employing a panel of 27 monoclonal antibodies delineating T and B lymphocytes, monocytes, natural killer cells, granulocytes, and functional and developmental subsets of each were performed to phenotype the peripheral blood leukocytes. Although the total lymphocyte count was normal in every subject, the numbers of T4-positive helper-inducer T lymphocytes were profoundly depressed, as were responses to the mitogen phytohemagglutinin and interleukin-2 production. Activated immature T lymphocytes and the number of cells bearing the phenotype of natural killer cells were increased, but natural killer cell activity was normal. Early B lymphocytes were also increased. The relative concentration of monocytes was normal. Taken together these findings indicate that the immune system in centenarians is similar to that in younger but still elderly individuals, i.e., discriminating T-lymphoid functions are reduced in association with an apparent failure of some T, B, and natural killer cells to differentiate to functional maturity.
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The adenosine-3',5'-monophosphate (cAMP) level in human amnion has been measured in vitro during short-term incubations, with or without prostaglandin E1 (PGE1) or isoproterenol. Concentration-response and kinetic curves were obtained. Isoproterenol and PGE1 stimulated cAMP production by amnion in a time-dependent manner. The stimulating effect of isoproterenol and noradrenalin on cAMP level was abolished by the addition of propranolol. Our study, demonstrating cAMP production by amniotic membranes and its stimulation by PGE1 and beta-agonists, suggests that hormones could modulate the amniotic cell metabolism through the cAMP system.
Biparietal diameter and femoral and humeral length were measured by ultrasonography and correlated with age in 450 normal pregnancies. The resulting data may be helpful in detecting fetal limb malformation.
Serum unconjugated estriol levels were measured in 44 pregnant women treated with corticoids for the prevention of respiratory distress syndrome (RDS) in premature infants. Intravenous administration of cortisol (1 g every 6 hours for 24 hours) decreased the level of circulating unconjugated estriol to 40% of the initial value after 6 hours and to 27% after 24 hours. During the 2 succeeding days, all the results remain below the pretreatment values. On the third day, the mean value is no longer different from the control value, but in some patients recovery takes more than 3 days.
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Circulating thymic-hormone activity was assayed by measuring Thy 1-2 antigen induction on null lymphocytes from athymic mice incubated with human plasma or serum. Plasma from 19 normal children aged under 10 had inductive activity equivalent to 10-6-16-2 ng thymopoitin/ml. Plasma from 15 infants were severe combined immuno-deficiency, 2 of whom had appreciable immunoglobulin synthesis, and from 2 infants with DiGeorge syndrome had little or no inductive activity. Successful reconstitution with thymus or bone-marrow grafts and with red-cell infusions (if adenosine-deaminase deficiency is present) was followed by a rise in circulating thymic-hormone activity.
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