Biomedical subjects
J Greenwald
Publications and source records attributed to J Greenwald.
Prolonged rupture of membranes in the term newborn.
Of 8791 consecutive newborns, we studied 205 (2.3%) women with a history of prolonged rupture of membranes (PROM) greater than 24 hr to assess the incidence of infection, to identify the rate of clinical symptoms, and to examine the use of the white blood count (WBC) and neutrophil values as screening tools to predict infection. Blood culture and complete blood counts (CBC) were obtained in 175 (85%). Fifteen (8.2%) had positive blood cultures including group B streptococcus, streptococcus viridans, streptococcus pneumoniae, staphlococcus epidermidis, and staphlococcus aureus. In the remaining 8586 infants born to mothers without PROM, 10 had positive blood cultures for an incidence of 0.1%. In the PROM group, the six who manifested clinical symptoms had abnormal CBCs; abnormal white blood count (2), abnormal neutrophil count (5), high band/metatamyelocyte count (4), and increased immature to total neutrophil ratio (4). Of the nine asymptomatic infants, seven (78%) had abnormal CBCs, five (56%) with a high WBC, five (56%) had a high neutrophil count, two (22%) had a high band/metatamyelocyte count, and one a high immature to total neutrophil ratio. CBC values were obtained from infants with PROM and negative blood cultures. Five of these 15 controls had an abnormal CBC. In the term newborn, PROM is associated with significantly increased incidence of positive blood cultures. The sensitivity of the CBC was 86% and specificity 66%. In view of this data a conservative clinical approach utilizing blood cultures and CBC evaluations in the management of PROM is warranted.
Living wills present new challenges.
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Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass.
BACKGROUND: Heparin bonding of the cardiopulmonary bypass (CPB) pump circuit decreases complement activation and fibrinolysis. It is not known whether inflammatory cytokines produced during CPB can also be modulated by the more biocompatible heparin-coated circuit. METHODS: This initial study evaluated the impact of heparin-bonded CPB circuits on production of the cytokines interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-a), IL-6, and IL-8 in adults undergoing complex cardiac operations with prolonged CPB. Twenty patients had blood samples drawn immediately before and at hourly intervals after the start of CPB using either a conventional oxygenator and circuit (n = 14) or a covalently bonded heparin oxygenator and circuit (n = 6). Levels of IL-1, TNF-a, IL-6, and IL-8 were measured in all serum samples using a "sandwich" enzyme-linked immunosorbent assay. RESULTS: The levels of IL-6 and IL-8 increased in a time-dependent fashion in both groups, but the response was significantly less over time in the heparin-bonded group (p < 0.05) for both IL-6 and IL-8. Levels of IL-1 and TNF-a were not significantly elevated with lengthening bypass interval in either group. CONCLUSIONS: These data indicate that the use of heparin-coated bypass pump circuits results in lower serum levels of the inflammatory cytokines IL-6 and IL-8 than standard circuits. Biocompatible materials that decrease the inflammatory response to CPB may ultimately reduce the morbidity associated with cardiac operations.
A new HaeIII polymorphism at the D21S13 locus.
DNA markers in the pericentromeric region of human chromosome 21 have shown linkage to a gene for Familial Alzheimer disease (FAD; St. George Hyslop et al. 1987). The limited informativeness of probes for the loci D21S13 and D21S16 have hindered precise mapping of the FAD locus and analysis of non-allelic heterogeneity in FAD (Schellenberg et al. 1988; St. George-Hyslop et al. 1987). We recently described a new EcoRII polymorphism at the D21S13 locus that was very informative in a large FAD pedigree (Pulst et al. 1990a,b). We now report another polymorphism for the D21S13 locus that further increases the informativeness of this locus.
A new EcoRI polymorphism at the D21S13 locus.
The D21S13 locus has shown linkage to a gene for familial Alzheimer disease (FAD) on chromosome 21 (St. George-Hyslop et al. 1987). The limited informativeness of probes for this locus have hindered precise mapping of the FAD locus and analysis of nonallelic heterogeneity in FAD (Schellenberg et al. 1988; St. George-Hyslop et al. 1987). We describe a new EcoRI polymorphism at the D21S13 locus that may be useful for the further study of FAD families.
Castration-induced changes in the response of the hypothalamic-pituitary axis to alcohol in the male rat.
In an attempt to determine the direct effects of alcohol on the hypothalamic-pituitary aspect of the hypothalamic-pituitary-gonadal axis, we examined the effects of alcohol on serum luteinizing hormone (LH) levels in the normal and testosterone-depleted castrated male rat. We found that within several days after castration (2-4 days) alcohol, at low to moderate doses, was only modestly effective in suppressing serum LH levels, whereas in sham-operated controls it was maximally effective at all doses tested. Surprisingly, at very high doses (4-6 g/kg), alcohol not only did not depress serum LH levels in long-term castrated rats, but elevated them by 2- to 4-fold when compared to saline-injected controls. The loss of sensitivity of the hypothalamic-pituitary axis to alcohol observed in castrated rats appeared to be selective, inasmuch as the mortality rate at high doses of alcohol was significantly (P less than .01) greater in castrated rats, when compared to sham-operated controls, and other measures of central nervous system impairment were equivalent in both groups. At the present time, it is difficult to explain this biphasic effect of alcohol on serum LH in the castrated animal, but our results are consistent with the hypothesis that the effects of alcohol on gonadotropin release may be dependent to a significant degree on the steroid milieu at the time of the experiments.
It's not just a job: the adventure of military dentistry.
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Firms can cut retiree health benefits: court.
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Rates dropping for specific stop-loss cover.
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Stock experts are optimistic about future of public HMOs.
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Glucose: a role as a free radical scavenger in biological systems.
Recent observations indicate that OH . may be important in the microbicidal capacity of phagocytic cells, in prostaglandin metabolism, and as a mediator of inflammation. Although glucose is a weak hydroxyl scavenger, it occurs in high concentrations in biological systems. We therefore studied the capacity of glucose to scavenge OH . in biological systems known to generate this reactive oxygen species. Our experiments used a specific assay for the detection of OH .. We measured 14CO2 released during the oxidation of 14C-benzoic acid. We have previously demonstrated that benzoic acid is oxidized as a consequence of OH . in the following systems: the enzyme system xanthine-xanthine oxidase, zymosan-stimulated granulocytes, and arachidonic acid-stimulated platelets as a consequence of the lipoxygenase pathway. In all three systems the oxidation of benzoic acid was inversely proportional to the concentration of glucose in the assays. Also, platelets incubated with arachidonic acid and a high concentration of glucose increased HETE production, an effect predicted by the capacity of glucose to act as an OH . scavenger. Our results indicate that glucose acts as a scavenger of OH . in physiological concentrations and therefore may serve an antioxidant role in biological systems. In addition, the capacity of glucose to act as an OH . scavenger may explain some of the defects seen in patients with diabetes mellitus.
Those sky-high health costs.
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Comparative histological studies of the tunable dye (at 577 nm) laser and argon laser: the specific vascular effects of the dye laser.
This study compares the histological changes occurring after argon laser and dye laser (operating at 577 nm) treatment of normal human skin. The initial effect of the argon laser is a diffuse nonspecific epidermal and upper dermal necrosis with subsequent cell death and a neutrophilic response at 48 hr. These changes occur at 15 joules/cm2 and their extent closely correlates with the energy applied. In sharp contrast, the immediate effect of the dye laser is erythrocyte aggregation, vessel rupture, and hemorrhage. At 48 hr, there is a pattern of acute vasculitis in the upper dermis and a prominent perivascular neutrophilic response in the mid-dermis. Focal epidermal necrosis does occur but is relatively minimal, while skin appendages and collagen are preserved. The energy to produce these alterations is relatively small, approximately 3 J/cm2. Thus, the dye laser at 577 nm can selectively damage the cutaneous vascular plexus and may provide a basis for treatment of cutaneous vascular lesions.
The leukocyte aggregation test: immunodiagnostic applications and immunotherapeutic implications for clinical renal transplantation.
The leukocyte aggregation test (LAT) detects the in vitro adhesion of sensitized, but not nonimmune, recipient leukocytes onto donor kidney cell monolayers. The test specifically detects cell-mediated homograft immunity up to 15 days prior to the appearance of clinical signs or alteration of chemical indexes. The presence of a positive reaction always signified incipient homograft rejection, which was usually controlled by intravenously administered, high-dose methylprednisolone sodium succinate (Solu-Medrol) therapy. There was no instance in which methyl-prednisolone treatment effectively reversed rejection in the presence of a negative leukocyte aggregation test. One common form of homograft rejection may be characterized by positive LAT results, a cellular infiltrate on the renal biopsy specimen, and sensitivity to methylprednisolone therapy.
Echocardiographic mitral systolic motion in left ventricular aneurysm.
An abnormal, convex systolic anterior motion of the mitral valve, somewhat similar to that seen in idiopathic hypertrophic subaortic stenosis (hypertrophic obstructive cardiomyopathy) and occasionally in atrial septal defect, was found on the echocardiogram in 8 out of 9 patients with angiographically (7 patients) and/or clinically (2 patients) diagnosed left ventricular aneurysm secondary to myocardial infarction. The only patient whose echocardiogram failed to demonstrate convex systolic anterior motion was the only patient who had an inferior wall aneurysm; the rest of the group had anterior and/or apical aneurysms. In contrast to patients with typical idiopathic hypertrophic subaortic stenosis, the convex systolic anterior motion of the mitral valve observed in our patients tended to 'peak' rather than 'plateau'. Through the basis for this abnormal septal motion in our patients is uncertain, alterations in left vantricular configuration, plus a relatively vigorously contracting posterior left ventricular wall in the presence of abnormal interventricular septal motion, are probable contributory factors. Though non specific, in the proper clinical and echocardiographic setting convex systolic anterior motion of the mitral valve may be another sign of left ventricular aneurysm.