C. Boyd Loadholt

Predictive value of fibronectin levels in normotensive gravid women destined to become preeclamptic

The plasma fibronectin concentration was abnormally elevated (greater than 400 micrograms/ml) in 16 of 17 normotensive gravid women who subsequently developed preeclampsia. Of this group, 13 had elevated levels detectable greater than or equal to 4 weeks before the onset of hypertension. Our results indicate that plasma fibronectin levels can be abnormally increased long before the onset of clinical symptoms and that abnormalities of this glycoprotein may be an early indication of this pathologic process.

Incidence of coronary heart disease in blacks in Charleston, South Carolina

We studied a cohort of 2275 blacks and whites of both sexes in Charleston County, South Carolina, during the period of 1960-1961 to 1974-1975. There were 93 prevalent cases of coronary heart disease (CHD) at intake, and 317 new cases occurred by 1975 in persons originally free of CHD. White males had the highest incidence rates for all types of CHD and acute myocardial infarction (AMI). Black males and black females had the next highest rates. The incidence of angina pectoris in black females was double the rate in white females and five times the rate in white males. The rate of sudden death in black males was two and one-half times the rate in black females, three times the rate in white males, and four times the rate in white females. One hundred and one black males who had been selected on the basis of high socioeconomic status (SES) had AMI and CHD rates half that of other black males. None of the high SES black males experienced angina pectoris, AMI death, or sudden death during the observation period.

Evidence of accelerated platelet production and consumption in nonthrombocytopenic preeclampsia

Platelet size and the distribution of platelet sizes are both increased in preeclamptic patients with normal platelet counts. These changes suggest that accelerated platelet production and consumption are both widespread in preeclampsia.

Autoantibodies in healthy subjects of different age groups

Autoantibody determinations in 1284 healthy Caucasian subjects of various age groups were made by indirect immunofluorescence for anti-nuclear, anti-gastric, and anti-thyroglobulin antibodies. A sex-dependent relationship between age and prevalence of anti-gastric and anti-thyroglobulin antibodies was found. No association was found between age and anti-nuclear antibodies.

A Prospective Randomized Study of Membrane versus Bubble Oxygenators in Children

We studied 60 children, 2 weeks to 10 years old, prospectively by randomly assigning them to a SciMed membrane oxygenator or Harvey bubble oxygenator. Variables of cardiopulmonary bypass (CPB) were closely controlled: prime, circuit configuration, flow rate, and blood gases. Blood variables measured at eight intervals before, during, and after operation were as follows: seven plasma proteins, free hemoglobin, formed elements, and clotting functions. Preoperatively and postoperatively, we evaluated brain function (psychological testing), renal function (creatinine clearance), and pulmonary function (compliance changes and postoperative shunt function). Postoperative blood loss, fever, and length of hospitalization were also evaluated. We compared 302 variables by computer program. No difference (p greater than 0.05) between the two groups was found in any variable related to CPB or organ function (pulmonary, renal, or cerebral) or in hematological variables except free hemoglobin. After 5 and 60 minutes of CPB and the next day, it was significantly lower (p less than 0.05) in the group with a membrane oxygenator. Safety, cost, and convenience, not physiology, should be the major factors in considering membrane versus bubble oxygenators for cardiac operations in children.

A histologic evaluation of tissue response to three currently used temporary acrylic resin crowns

The subgingival placement of any one of the three types of temporary crowns placed on 28 posterior teeth of seven subjects caused no detectable change in the gingiva over a 3 week period. There is a need for further study of the influence of temporary crowns on the different types of gingival tissue.

Oral Ciramadol: A New Analgesic for Postoperative Pain

Ciramadol a new synthetic narcotic agonist‐antagonist analgesic, was compared in 30 and 60 mg doses with pentazocine 50 mg, aspirin 650 mg, and placebo in the treatment of 153 patients with postoperative pain. All drugs were administered between six and 72 hours after surgery. Analgesic efficacy was assessed for six hours after study drug administration using verbal pain intensity, analog pain intensity, and verbal pain relief scales. Significantly (P < .05) higher analgesic efficacy scores were seen with ciramadol 30 mg than with pentazocine 50 mg and placebo at most of the evaluation points. Doses of ciramadol 30 mg were significantly (P < .05) more effective than aspirin 650 mg at several time periods, and ciramadol 60 mg was better than pentazocine and placebo at several evaluation times. The 30‐mg dose of ciramadol was generally more effective than the 60‐mg dose. The mean six‐hour cumulative sum of pain intensity difference scores, total pain relief scores, and sum of pain analog intensity difference scores showed that the best analgesic response occurred in the ciramadol 30 mg group, followed by the ciramadol 60 mg, aspirin 650 mg, pentazocine 50 mg, and placebo groups. Side effects were rare and mild. There were no medically important changes in vital signs in any treatment group.

Which blood pressure

patient could have been avoided ifa rain platelet and a CT scan had been done earlier, showing the extensive intraabdominal component of the tumor. The response of hemangiomas to radiation treatment varies with the dose. Single doses of >500 rads and as high as 800 rads may speed resolution of the laemangioma? However, toxic effects of radiation during childhood, such as late skin changes, interference with epiphyseal growth, and association with later neoplasia, indicate that lower doses should be used initially. With these considerations in mind, a dose of 300 to 400 rads to the entire lesion is suggested as sufficient and of minimal hazard. Higher doses are inappropriate unless an observation period of at least 1 month documents failure to respond. ~~ It should be remembered that treatment of the hemangioma in Kasabach-Merritt syndrome is primarily directed at alleviating the coagulopathy and avoiding life-threatening hemorrhage, not at dissolution of the tumor.

119 BLOOD PRESSURE AND HUMORAL FACTORS IN CHILDREN OF HYPERTENSIVE PARENTS

Blood pressure(BP) response to exercise and levels of vasoactive substances are being investigated in normotensive(NBP) children of hypertensive(HBP) parents. Preliminary, but thus far significant, findings in 11 white(W) and 22 black(B) children (10-17 yrs)include: mothers of B children had higher (p<.002) systolic (SBP) and diastolic(DBP) pressures (p<.009) than W mothers.Although resting heart rates were lower in B (103/min) than W (122/min) children (p<.002), there were no differences between resting SBP and DBP in the children. However, at maximum exercise DBP was significantly greater in B (95mmHg) than W (88mmHg) children (p<.03). Vasoactive substance differences are listed below:Racial differences in BP and vasoactive substance measurements have been established in adults with HBP. These data suggest that similar differences already exist in resting heart rates, in exercise BP, and in vasoactive substance measurements in NBP children of B and W HBP parents.(Supported by HL 19870)