Prolonged weakness after long-term infusion of vecuronium bromide.
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Biomedical subjects
Publications and source records attributed to S Tessler.
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The intracellular localization of basic fibroblast growth factor (bFGF) was studied in BHK-21 cells transfected with an expression vector containing the complementary DNA (cDNA) of the human bFGF gene (pbFGF). The intracellular location of bFGF was determined using indirect immunofluorescence. The antibodies used were polyclonal antibodies directed against either recombinant human bFGF or recombinant Xenopus bFGF. The nuclei of transfected cells that produce bFGF, but not the nuclei of untransfected cells, were labeled strongly by the antibodies. The nuclear staining was totally abolished when anti-bFGF antibodies preadsorbed with bFGF were used. Several types of endothelial cells known to produce bFGF were also stained in their nuclei by the antibodies. Nuclear extracts prepared from transfected cells were found to contain bFGF as determined using heparin-sepharose affinity chromatography, followed by Western blot analysis of fractions, which stimulated the proliferation BHK-21 cells. The mitogenic activity associated with the nuclei was not destroyed when isolated cell nuclei were digested by trypsin. It is therefore likely that the nucleus associated bFGF is intranuclear. These findings suggest that some biological activities of bFGF may be mediated by nuclear bFGF binding proteins or by the direct binding of bFGF to DNA.
Tracheal intubation is a commonly performed procedure generally associated with a low complication rate. A clinical sign that could lead to early detection of complications could improve management of mechanically ventilated patients. We present two instances of potentially lethal complications that were heralded by the presence of massive gastric distention. This finding should alert physicians that an abnormal communication may exist between the endotracheal tube and the gastrointestinal tract.
Coronary artery bypass grafting (CABG) is commonly performed via a median sternotomy with a reversed saphenous vein (SV) and/or an internal mammary artery (IMA) graft. Sternotomy and IMA harvesting may adversely affect postoperative respiratory function (PFTs) as disruption of the sternun may impair chest wall stability, and the decrease in intercostal muscle blood supply after removal of the IMA may reduce the force of respiration. We compared preoperative and six- to eight-week postoperative PFTs in patients undergoing CABG. The results were independent of age, sex, number of grafts, aortic cross clamp time, duration of bypass run, and postbypass fluid gradient. It was concluded that sternotomy caused a decrease in postoperative PFTs and that IMA harvesting may be accompanied by greater impairment in PFTs than when SV grafts alone were used.
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PURPOSE: Multifocal atrial tachycardia is a difficult arrhythmia to treat. Patients not showing a response to the correction of predisposing conditions present a therapeutic dilemma. To assess the efficacy of two agents reported to be effective in this condition, verapamil, metoprolol, or placebo was given intravenously in a randomized, double-blind trial. PATIENTS AND METHODS: Thirteen patients meeting inclusionary criteria were enrolled. Therapeutic response was defined as conversion to sinus rhythm, a decline in the ventricular rate of 15 percent or more [corrected], or a ventricular rate of less than 100 beats/minute. Four male and nine female patients having a mean age (+/- SD) of 81.9 +/- 14.2 years were enrolled. Automated serum chemistries, complete blood cell count with differential, arterial blood gas values, and serum digoxin and theophylline levels were determined and a 12-lead electrocardiogram was obtained at the start of the trial. Following the completion of each phase of the study, a repeat physical examination was performed, and arterial blood gas values and an electrocardiogram were obtained. The trial was designed to run for two days. RESULTS: Two of 10 (20 percent), four of nine (44 percent), and eight of nine (89 percent) showed a response to placebo, verapamil, or metoprolol, respectively. Mean slowing of ventricular rate was 3.4, 7.3, and 24.5 percent for placebo, verapamil, and metoprolol, respectively (p less than 0.01 for metoprolol versus placebo). Five patients who showed a response to metoprolol had failed to have a response to verapamil. CONCLUSION: We conclude that metoprolol appears to be more effective than verapamil in treating multifocal atrial tachycardia. However, careful patient selection is necessary in its use.
Multifocal atrial tachycardia (MAT) is a difficult arrhythmia to treat. Pharmacologic treatment is generally disappointing, and successful conversion in a predictable manner is uncommon. To assess the efficacy of metoprolol, a relatively selective beta 1-adrenergic blocking agent, we administered this agent to 11 patients (aged 71.8 +/- 8.3 yr). All patients had serious pulmonary disease. Hypoxia, hypercarbia, acidosis, and electrolyte abnormalities were corrected before the study. Nine patients were receiving theophylline derivatives and six digoxin. Serum levels for both drugs were in the therapeutic range. Four patients had received verapamil without control of MAT. Mean atrial rate before administration of metoprolol was 142.3 +/- 17.2 beat/min and mean ventricular rate was 131.4 +/- 24.3 beat/min. One to 3 h after metoprolol (25 or 50 mg orally), all patients were restored to sinus rhythm, with a mean ventricular rate of 86.9 +/- 6.8 beat/min (p less than .01). Six patients had 3 to 6 premature atrial contractions per minute. No adverse effects were noted, and arterial blood gases before and after therapy were comparable. Five patients expired from their underlying disease and four were continued on metoprolol to maintain sinus rhythm. Metoprolol is effective in the acute and chronic treatment of MAT and may be given to patients with MAT and respiratory failure without serious adverse effects.
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Asthmatics seeking emergency care for severe acute asthma may show metabolic acidosis. We sought to determine the frequency of metabolic acidosis in such patients and to assess the relative contributions of renal bicarbonate loss and lactic acid accumulation to this acidosis. Twenty-two asthmatics (21-71 yr; four males, and 18 females) who came consecutively to the emergency department with severe acute asthma were studied. Most patients reported that their asthmatic symptoms had begun to worsen greater than or equal to 2 days before the emergency department visit. Within several hours, simultaneous measurements of arterial blood gases, whole blood lactate, and serum electrolytes were made. Ten of 22 patients were found to have metabolic acidosis (base deficit greater than 2 mEq/L). All ten patients had nonanion gap acidosis, while nine of ten had whole blood lactate values in the normal range (0.33 to 2.55 mmol/L). In the one patient with an elevated whole blood lactate level, the concentration of lactate in excess of normal (0.45 mmol/L) could not account for the magnitude of the base deficit (-4.9 mEq/L). We conclude that a) nonanion gap metabolic acidosis is very common in asthmatics with acute severe asthma (prevalence 45% in our series), and b) the mechanism of the base deficit in these patients is excessive renal bicarbonate excretion. We believe that the latter occurs as a renal compensatory response to a preceding period of hypocapnia due to hyperventilation related to worsening asthma.
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Motility characteristics of epididymal sperm from tw32/+ and T/+ males of several strains were compared to those of sperm from the congenic, wild, type mice. Epididymal sperm from C57BL/6-tw32/+ (B6-tw32/+) males showed a significant decline in vigorous motility and a significant increase in adhesivity to glass during 7.5 hours in vitro, while sperm from B6-+/+ males showed no changes in these characteristics. The apparent mean velocities of epididymal sperm were: B6tw32/+, 32 micro/sec; C3H-tw32/+, 60; B6XC3H hybrids (F2*-tw32/+), 44; and C3HXB6 hybrids (F2-tw32/+), 58. Each of these values was significantly lower than that of sperm from their congenic wild-type strains: B6- +/+, 115; C3H- +/+, 177; F1*-+/+, 168 and F1-+/+, 195 micro/sec. B6-T2J/+ sperm had velocities intermediate to the congenic +/+ and tw32/+ genotypes, whereas C3HT/+ sperm velocity was not significantly different from C3H- +/+. These differences in measured sperm velocity may not reflect real differences in swimming speed, but rather may indicate a difference in the shape of swimming trajectories. Erratic and convoluted swimming trajectories were observed for the majority of sperm from tw32/+ males of all genotypes. Differences in motility patterns of sperm from tw32/+ males could play a role in the abnormally high transmission of tw32 through the male.
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A quantitative method is described for distinguishing two types of mouse sperm motility using a new parameter, the Linear Index. One hundred spermatozoa from C57BL/6-+/+ and 100 spermatozoa from C57BL/6-tw32/ + mice were used to evaluate this parameter. Spermatozoa were tracked by videomicrography, and the following calculated: net displacement velocity, Vn; curvilinear velocity of the sperm head, Vc; the "average" velocity, Va (a 5-point moving average of the track); the progressiveness ratio, (Vn/Vc); the curvilinear progressiveness ratio, (Va/Vc); and a linear index, (Vn/Va). Frequency histograms of linear index values were bimodal for both groups and each had a clear antimode at 0.5, separating two discrete subpopulations of spermatozoa. Within each group, "linear" (greater than 0.5) and "nonlinear" (less than 0.5) tracks differed in all characteristics; between groups, linear spermatozoa were similar and nonlinear spermatozoa differed only in the curvilinear velocity of the sperm head.