Intraoperative diagnosis of acute subarachnoid hemorrhage using continuous pressure monitoring via a lumbar subarachnoid catheter.
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Biomedical subjects
Publications and source records attributed to R S Glidden.
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Cyclic 3':5' adenosine monophosphate (cAMP) mediated facilitation of neuromuscular (NM) transmission was previously implicated in the mechanisms of the reversal of nondepolarizing NM relaxants by azathioprine (AZA). This interaction of d-tubocurarine (dTC) with AZA was re-examined in rats and correlated to changes in cAMP in the same muscle. Three groups of animals were studied: controls, low-dose AZA (5 mg/kg), and high-dose AZA (50 mg/kg). After AZA or saline administration, dose-response (DR) curves for inhibition of gastrocnemius twitch tension by dTC were constructed. Contralateral gastrocnemius muscle was sampled for cAMP levels. In another group of animals, the response to 5- and 50-mg/kg boluses of AZA was recorded during a steady-state twitch depression maintained with an infusion of dTC. No significant shift in the DR curve of dTC was observed following low- and high-dose AZA. During steady-state twitch depression, high-dose AZA, however, caused a transient reversal of twitch lasting 5-10 min. High-dose AZA caused a significant (P less than 0.006) elevation of cAMP levels (340 +/- 49 pmol/mg prot) compared to control (120 +/- 18) and low-dose (163 +/- 24) AZA groups. These studies, therefore, document transient reversal of twitch tension by 50 mg/kg doses of AZA during a steady-state dTC infusion. On the other hand, AZA administered prior to dTC in low (5 mg/kg) and high (50 mg/kg) doses failed to cause a significant shift in the dTC DR curve. A three-fold increase in skeletal muscle cAMP induced by high-dose AZA does not alter dTC DR curves.
A retrospective review of 55 patients with systemic lupus erythematosus (SLE) (45 girls and 10 boys) under age 18 (median age of onset; 12.2 years) seen at the Children's Hospital Medical Center (Boston, Mass.) over the past 20 years was done. Clinical presentation was similar to previous series, but atypical presentation was common. Certain unusual presentations (such as isolated hematopoietic abnormalities) often occurred and delayed diagnosis for years in some cases. The frequency of ARA clinical classification of SLE was different in children as compared to adults. We observed depression of lymphocyte count in many patients and encountered elevations of hepatic enzyme levels in others. Of the 55 patients reviewed, 9 have died and 8 have been lost to follow-up. Of the rest, 21 have mild to moderate disease and 17 have inactive or minimally active SLE, after a median length of follow-up of 8.8 years. In severe cases, using either corticosteroids and/or cytotoxic agents, a favorable prognosis was obtained. Our cumulative 5- and 10-year survival of 92 and 85%, respectively, equals or exceeds that of previous reports of childhood SLE.
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