Biomedical subjects
Publications and source records attributed to E J Lazaro.
The monocyte plays a key role in the pathophysiology of AIDS and ARC. This preliminary report adds insight into monocyte activation associated with HIV seroconversion, by comparing recalcification times in healthy controls and HIV-positive patients.
Injury severity score and hypothermia can lead to a high level of mortality when combined clinically. In acute trauma, the presence of a coagulopathy is difficult to treat and the aim is prevention. Aliquots of whole blood from healthy human volunteers (n = 9) were added to saline (control) and saline plus endotoxin (activated). The control and activated groups were divided and subjected to 60 minutes of normothermia (24 degrees C) or hypothermia (0 degrees C). The samples were returned to 37 degrees C; then the recalcification times were determined using fibrin formation and the viscous drag as the determining factors. The activated hypothermic group showed a decreased recalcification time of 345 (+/- 48.9) seconds compared to 405 (+/- 60.8) for the activated normothermic group (P less than 0.001). When the normothermic and hypothermic groups were compared without endotoxin added, the differences were not significant. The authors conclude that the effects of endotoxin on clotting time are worsened by hypothermia in vitro and act synergistically to possibly cause the coagulopathy seen in trauma patients.
The circulating monocyte exhibits the capacity to initiate and accelerate the coagulation cascade. We have devised a simple whole blood clotting assay which quantitates the monocyte's contribution of procoagulant (a marker of monocyte activation) to the clotting process and in addition, measures the in vivo activation of the cell. Citrated whole blood is added to saline and the recalcification time (RT) determined without incubation (RT control), with two hours incubation (RT saline), or added to endotoxin with incubation (RT endotoxin). The reduction in value between RT control and RT saline is a measure of monocyte activation in vivo. The reduction in time between RT saline and RT endotoxin is a marker of monocyte activation in vitro. This simple test enables the measurement of monocyte activation and this cells contribution to the hypercoagulability described in many disease states.
In an apparently routine case, what appeared to be infected sebaceous cysts of the scalp turned out to harbour botfly larvae imported from a tropical country. Although the parasite Dermatobia hominis is not indigenous to the United States, cutaneous myiasis caused by the fly is fairly common in Central and South America, and several cases have been reported in people returning or emigrating from these regions. The authors therefore suggest that infection resulting from D. hominis invasion be considered in persons who present with furuncular lesions and give a history of travel to endemic areas.
This study was conducted to identify a relationship between anatomical trauma severity and immunologic function. Four milliliters of citrated whole blood (CWB) was obtained from 14 multiply traumatized patients and their Injury Severity Score (ISS) was calculated. Each CWB sample was divided into four 1 ml aliquots with 1 microgram of E. coli endotoxin (ECE) (Difco) being added to the first, 10 micrograms of ECE to the second, 10 micrograms of pokeweed mitogen (PWM) to the third, and 20 microliters of saline to the fourth. Following a 2 hr incubation at 37 degrees C the recalcification time (RT) was determined on a Hepcon-B10. Percent shortening was calculated as the difference in the RT between the stimulated sample and the saline control. There was a significant correlation between ISS and % shortening of the ECE stimulated samples at both concentrations (for 1 microgram ECE r = 0.59, P = 0.02, and for 10 micrograms ECE r = 0.81, P = 0.00025), and also in the PWM sample (R = 0.79, P = 0.00071). This study demonstrates a significant and direct relationship between trauma severity and the patient's monocytes' ability to generate thromboplastin following ECE or PWM stimulation.
Cod liver oil (CLO), a marine fish oil, contains approximately 20% omega-3 fatty acids (OFA). When CLO is administered to humans, inhibition of platelet aggregation, decreased platelet arachidonic acid levels, and reduced levels of endotoxin-induced thromboplastin synthesis by monocytes are observed. Since endotoxin causes both increased platelet aggregation and monocyte generation of thromboplastin with resultant microvascular compromise, the purpose of this study was to determine whether CLO is protective in murine endotoxemia. Swiss Webster mice were given CLO (1.0mg, 10.0mg, or 100mg), or 100mg triolein (an unsaturated fat containing no OFA) or saline (control) intraperitoneally (IP) three hours prior to IP administration of 0.3mg E.coli endotoxin. Survivals at 48 hours post-endotoxin administration were as follows: (A) 1.0mg CLO (4/20, 20%); (B) 10mg CLO (5/20, 25%); (C) 100.0mg CLO (11/20, 55%); (D) 100mg triolein (1/20, 5%); (E) 0.13cc saline (1/20, 5%). The significance of groups A,B,C,D verses the control group E is as follows: A vs E, p = 0.15; B vs E, p = 0.08; C vs E, p = 0.0006; D vs E, p = 0.76. This study demonstrates the beneficial effect of 100mg parenteral CLO in murine endotoxemia. This effect is probably mediated through antiplatelet and/or antimonocyte activating mechanisms.
Saline or ascorbic acid (AA), 1000 mg/kg and 1400 mg/kg was administered intraperitoneally (IP) to 3 groups of female Swiss-Webster mice after they had been anesthetized with sodium pentobarbital (SP). Both doses of AA given IP after SP anesthesia significantly prolonged sleeping time. An additional 50 mice were injected IP with 0.3 ml SP containing 6 mg/ml unlabeled SP and 0.6 ng C14 labeled SP. Immediately 25 mice received 40 mg AA in 0.4 ml saline, IP, and the remainder received saline. The serum half life of the radioactively labeled SP was more than 3 times longer in AA treated mice than in the controls.
An unusual case of traumatic hemobilia in which blood reached the bile duct through transhepatic penetration of the gallbladder is reported. The salient features of this variant of traumatic hemobilia are described: antecedent subcapsular liver injury; variant time interval to GI hemorrhage and episodic hemorrhage; and necrosis or hematoma at the bleeding site.
A case of granular cell tumor is reported and the main features of the previously reported cases are summarized. This lesion usually presents in a black woman as a small tumor obstructing the common bile duct and resulting in cholecystitis and/or obstructive jaundice. The cell of origin is still disputed. Local resection with cholecystectomy and choledochoduodenostomy appears to be the treatment of choice.
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The authors studied the lipid profile in acute pancreatitis in humans and also in dogs in which this disease had been induced experimentally. Blood samples were analysed by mass spectroscopy and gas chromatography. During the acute phase of the pancreatitis there was a significant reversal of the ratio of unsaturated fatty acids. There was a marked increase in the concentration of fatty acids in the blood with monounsaturation in both carbon-16 and carbon-18 chains and diunsaturation in the later carbon chains. These changes have not been reported in any disease state.
Since 13 cases of intrasplenic pancreatic pseudocysts have been previously described in the world literature, an additional case is reported. The mechanisms for the development of this lesion are: 1. direct extension of the pancreatic cyst into the splenic hilum; 2. digestive effects of pancreatic enzymes on splenic vasculature and parenchyma; 3. pancreatitis occurring in ectopic intrasplenic pancreatic tissue and 4. liquefaction of splenic infarcts secondary to thrombosis of the splenic vessels. Criteria for diagnosis and current available diagnostic methods are discussed. Early surgical intervention with splenectomy and possibly caudal pancreatectomy, is advocated.
Opportunity to assess changes in the management of cancer of the breast over the past 7 years was afforded by analysis of responses to questionnaires that were part of an annual questionnaire course. Comparison of responses to questionnaires conducted in 1971 and 1977 identified important features of approaches to this disease and indicated the way in which changes have occurred. Diagnostic needle aspiration increased from 24% (1971) to 54% (1977). In both surveys surgeons reported employing mammography infrequently. Use of modified radical mastectomy increased from 15% (1971) to 60% (1977). Employment of classical radical mastectomy decreased from 83% (1971) to 37% (1977). Surgeons considering biopsy of the contralateral breast to be unnecessary decreased from 47% (1971) to 14% (1977). Skin grafting, after a mastectomy, decreased from 40% (1971) to 24% (1977). Though oophorectomy is still the preferred initial treatment for premenopausal patients with advanced disease, preference for chemotherapy in postmenopausal patients increased from 5% (1971) to 23% (1977). Surgeons approving of reconstruction with implants after mastectomy for carcinoma increased from 30% (1971) to 49% (1977). Following mastectomy in patients with positive axillary nodes, 58% of our respondents employ chemotherapy with several drugs and 34% prefer irradiation.
To determine the amount of exposure to technical procedures received by students at the New Jersey Medical School, Newark, NJ, during their first surgical clerkship, a prospective study was carried out over a 3-year period. Students completing each 12-week clerkship filled in a questionnaire to indicate whether they had received exposure to a series of technical procedures. The study showed that students received relatively little experience in some important, though less commonly employed, techniques. It is therefore recommended that: (a) the instruction in technical procedures be carried out on a planned basis; (b) performance of some routine laboratory tests by students be curtailed to permit more time for technical experience in other areas; and (c) the dog laboratory be utilized for the teaching and practice of surgical procedures.
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Six cases of spigelian hernia are reported, including three unusual ones: (1) the presence of an acutely inflamed appendix in the hernial sac; (2) a patient with multiple associated hernias; and (3) a woman with a strangulated spigelian hernia occurring with endometrial carcinoma. The anatomy, etiology, clinical features and management of these hernias are discussed.