Morris R. Pudek

Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients.

Twenty-two cirrhotic patients who underwent hepatic resection from July 1989 to March 1991 at Vancouver General Hospital were analyzed prospectively in order to determine whether there was any preoperative evaluation of liver function that would help identify those patients who would not survive hepatic resection. Patients were analyzed on the basis of age, type of resection, and a variety of so-called standard liver function tests. In addition, all patients were evaluated preoperatively with an indocyanine green (ICG) clearance test, a relatively new test that we attempted to evaluate in terms of its role in hepatic resection in cirrhotic patients. Parametric statistical evaluation used included Students t-test and multivariate regression, as well as discriminate analysis. The nonparametric evaluation used was the Wilcoxon rank sum test. Overall, the 30-day mortality rate was 18%, with those patients who did not survive resection having a significantly lower ICG clearance than those who underwent successful resection (p less than 0.0001). No other liver function test was useful in determining the outcome of resection. Similarly, neither age nor type of resection appeared to influence outcome. Use of discriminate analysis (p = 0.0029) allowed the identification of a cutoff point for ICG clearance below which hepatic resection should not be attempted.

Perinatal Changes in a Digoxin-like Immunoreactive Substance

ABSTRACT. An endogenous digoxinlike immunoreactive substance(s) (DLIS) exists in the serum of premature and full term infants not receiving digoxin. We followed serum changes in DLIS concentration sequentially over the first 14 postnatal days in 24 premature neonates who did not receive digoxin in the intensive care nursery. All infants had measurable levels (>0.6 ng/ml) of DLIS in their serum. There was a distinct peak in DLIS concentration in 19 of 24 infants occurring at 4 ± 1.6 (SD) days after birth (range, 1–8 days). No peak was found in five infants. The peak serum level of DLIS obtained in the first 8 days of life was negatively correlated with gestational age and birth weight.DLIS levels in amniotic fluid remained constant from 16 to 33 weeks of gestation but rose from 33 wk to term. DLIS concentrations in umbilical artery, umbilical vein, and maternal serum at normal full term delivery suggested that DLIS was of fetal origin. DLIS and digoxin concentrations are additive when present in the same serum sample if measured by standard radioimmunoassay methods.

A Study into the Nature and Organ Source of Digoxin-Like Immunoreactive Substance(s) in the Perinatal Period

Digoxin-like immunoreactive substance(s) (DLIS) was isolated from sera and autopsy-derived tissue obtained from premature and full-term neonates. The highest tissue level of DLIS was in the small bowel followed by the adrenal, gallbladder and liver. Of the fluids examined, meconium had the highest level of DLIS. Preparative high performance liquid chromatography fractionation of cord blood generated at least six different fractions which not only contained DLIS material but also inhibited canine kidney Na+/K+-ATPase activity. Recovery/inhibition studies indicated that 72% of the canine kidney Na+/K+-ATPase inhibition within one fraction could be accounted for on the basis of progesterone content of the fraction.

GONADOTROPHIN-SECRETING PITUITARY TUMOUR: REPORT AND REVIEW

A 34‐year‐old male with a pituitary adenoma was investigated and demonstrated to have hypersecretion of both gonadotrophins in the basal state. Immunocytochemical staining and electron microscopic examination were positive for tumour cells secreting FSH and LH. Presenting symptoms included visual disturbances, loss of libido, impotence, cold intolerance, frontal headaches, change in skin pigmentation and excessive weight gain. The patient denied alteration in hair distribution, had no acral features, galactorrhoea or gynaecomastia. Surgical extirpation resulted in complete amelioration of his symptoms over a three year follow‐up period. Basal and stimulated pituitary function testing results returned to normal post‐operatively. A review of the literature documents six other cases of pituitary tumour secreting both LH and FSH in the basal state. More commonly, the pituitary adenoma secretes FSH only. The literature is reviewed with regard to both types of tumour.

Beta2-microglobulin levels in cerebrospinal fluid of children with leukemia and lymphoma

Abstract Beta 2 -microglobulin levels were determined in the cerebrospinal fluid (CSF) of 119 children (ages 1 1/2 to 18 years) with malignant conditions; 87 with acute lymphoblastic leukemia, 9 with acute myeloblastic leukemia, 15 with lymphoma, and 8 with solid tumours. A total of 491 CSF specimens and 202 serum specimens were analyzed over a 12-month period. The mean CSF β 2 -Microglobulin and serum β 2 -microglobulin were 1.11 ± 0.58 mg/L and 1.5 ± 0.64 mg/L respectively and were not different from the mean CSF (1.20 ± 0.45 mg/L) and serum β 2 -Microglobulin levels (1.70 ± 0.45 mg/L) found in control patients. Meningeal leukemia was diagnosed on the basis of cytology in 7 patients. No elevation of CSF β 2 -microglobulin was found in any specimen at the time of CNS disease. Eleven other patients showed a transient rise in CSF β 2 -microglobulin above the reference range (>2.1 mg/L). No evidence of CNS involvement was found in any of these patients. Five of these patients had received a combination of intrathecal methotrexate and irradiation therapy within the previous 4 months. A transient rise in CSF β 2 -Microglobulin (2–3-fold increase over baseline CSF levels), which did not exceed the upper limit of the reference range was seen in 5 of 7 other children receiving the above therapy. Our study fails to demonstrate the usefulness of CSF β 2 -Microglobulin for the diagnosis of CNS metastases but suggests that a transient elevation of CSF β 2 -microglobulin may occur after intrathecal methotrexate and irradiation therapy.

Antibody interference with biochemical tests and its clinical significance.

Antibody interference with routine biochemical tests is becoming increasingly recognized as a cause of spurious results. It is important to recognize these interferences because inappropriate investigation may be instituted in response to the abnormal test result. The present review deals with the various biochemical tests in which antibody interference occurs. The tests include measurement of enzymes, hormones, immunoglobulins, vitamin B12, and a variety of other molecules and ions.

Cardiovascular and Metabolic Effects of Medroxyprogesterone Acetate versus Conjugated Equine Estrogen After Premenopausal Hysterectomy with Bilateral Ovariectomy

Study Objective. To compare the cardiovascular and metabolic effects of medroxyprogesterone acetate (MPA) with those of conjugated equine estrogen (CEE) as single‐hormone therapies in women who underwent hysterectomy with bilateral ovariectomy.

Progesterone therapy increases free thyroxine levels--data from a randomized placebo-controlled 12-week hot flush trial.

Thyroid hormones and progesterone both influence core temperature, metabolism and are crucial during pregnancy. Our objective was to discover whether progesterone therapy caused changes in thyroid physiology compared with placebo.

Effect of general and peridural anesthesia on the concentrations of prolactin and cortisol in maternal plasma

Abstract Comparison of the effect of general. and peridural anaesthesla on matemalprolactin cortisol concentrations in response stress of cesarean section near term revealed that surgery under general anesthesia resulted in significant augmentation of mean maternal plasma prolactin and cortisol concentrations. By contrast, surgery under peridural anaesthesia resulted in no significant increase in mean maternal plasma prolactin levels and significant but delayed increment in mean cortisol concentrations. During pregnancy near term. the prolactin and cortisol responses to surgical stress intact but modified by the type of anesthetic administered: (Am. Oestet. GYnecol. 141:483, 1981.)

Comparison of vancomycin concentrations in blood and interstitial fluid: a possible model for less invasive therapeutic drug monitoring

1 Faculty of Pharmaceutical Sciences , The University of British Columbia, Vancouver, BC , Canada 2 Child and Family Research Institute , Vancouver, BC , Canada 3 Department of Pharmacy , Children ’ s and Women ’ s Health Centre of British Columbia, Vancouver, BC , Canada 4 Departments of Mechanical and Electrical and Computer Engineering , The University of British Columbia, Vancouver, BC , Canada 5 Animal Care Centre , The University of British Columbia, Vancouver, BC , Canada 6 Vancouver General Hospital , Vancouver, BC , Canada