Cardiac Ischemia. Part II—Reperfusion and Treatment

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. The Director of Conferences is William M. Pardridge, MD, Professor of Medicine.     

New Advances in Bone Research

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine, UCLA School of Medicine, Los Angeles. William M. Pardridge, MD, Associate Professor of Medicine, is Director of Conferences.     

Transferase-deficiency galactosemia: Immunochemical studies of the Duarte and Los Angeles variants

Summary Rabbit antibodies to purified human placental galactose-l-phosphate uridyltransferase (EC 2.7.7.12) were used to establish immunologic cross-reactivity patterns for the enzyme in hemolysates, prepared from red cells of a normal individual, a homozygous Duarte variant, and a heterozygous Los Angeles variant. The antibody immunoprecipitated all three forms of the enzyme. The amount of antibody absorbed by each hemolysate was related to the different levels of activity, and examination of hemolysate/antibody reaction mixtures by starch gel electrophoresis revealed that the antibody quantitatively precipitated all of the isoenzyme forms that characterize these three genetic variants.This research was supported in part by a United States Public Health Service Grant, HD 06576, from the National Institute of Child Health and Human Development.     

Glutethimide,a new nonbarbiturate hypnotic

A new anticonvulsant, nonbarbiturate compound, Doriden (ethyl-a-phenyl-glutarimide) was studied for clinical activity as a hypnotic drug in mildly disturbed patients on the acute Psychiatric Service of Los Angeles County General Hospital. It was found to have approximately the same hypnotic activity as pentobarbital in the dosages recommended (1 gm. Doriden=200 mg. pentobarbital).     

GLUTETHIMIDE—A New Nonbarbiturate Hypnotic

A new anticonvulsant, nonbarbiturate compound, Doriden (ethyl-a-phenyl-glutarimide) was studied for clinical activity as a hypnotic drug in mildly disturbed patients on the acute Psychiatric Service of Los Angeles County General Hospital. It was found to have approximately the same hypnotic activity as pentobarbital in the dosages recommended (1 gm. Doriden=200 mg. pentobarbital).     

El Nuevo Mundo: The Landscape of Latino Los Angeles

El Nuevo Mundo: The Landscape of Latino Los Angeles. Photographs by Camilo José Vergara. National Building Museum, Washington, D.C., December 3, 1998-March 19, 1999; Cooper-Hewitt National Design Museum, New York City, June 25-September 5, 1999; Natural History Museum of Los Angeles County, Los Angeles, January 29–July 16, 2000 (review venue); Graham Foundation, Chicago, November 15,2000–January 25,2001.
ElNuevo Mundo: The Landscape of Latino Los Angeles. Photographs by Camilo José Vergara. Gustavo Leclerc. Michael J. Dear. and J. Dallas Dishman. eds. Los Angeles: Southern California Studies Center, 2000.48 pp.     

Facilitation of Hb S polymerization by the substitution of Glu for Gln at beta 121

In an effort to clarify the role of Glu-beta 121 of Hb S molecules in polymerization, we studied the solubility and kinetics of polymerization of various mixtures of deoxyhemoglobins S (Glu-beta 6----Val) and D Los Angeles (Glu-beta 121----Gln). It is known that patients with Hb S-D Los Angeles have a relatively severe clinical course. Mixtures of Hb S and Hb D Los Angeles polymerized after a distinct delay time, the length of which depended on the initial hemoglobin concentration and the fraction of Hb S in the mixture. There was a linear relationship between the logarithmic plot of delay time and initial hemoglobin concentration. The line for a 1:1 mixture of Hb S and Hb D Los Angeles shifted to the right of that for deoxy-Hb S by 0.08. This shift is much smaller than the shift of 0.32 for 1:1 AS mixtures. From these data, the probability factor for nucleation of S-D Los Angeles hybrid hemoglobin was calculated to be 1.16, which is higher than that of Hb S (1.0) and AS hybrid hemoglobin (0.5). The degree of co-polymerization of Hb D Los Angeles in S-D Los Angeles mixtures was similar to that of Hb A in AS mixtures. The critical concentration for the polymerization of Hb D Los Angeles was between that of Hb A and Hb Machida, which has the same amino acid substitution (Glu----Gln) at the beta 6 position. These results suggest that the protein interaction of Hb S molecules during nucleation involves at least two steps. First, the Val-beta 6 of a Hb S molecule interacts hydrophobically with the Phe-beta 85 and the Leu-beta 88 of an adjacent Hb S molecule. In the second step, Glu-beta 121 weakens the interaction with His-beta 116 and Pro-alpha 114. The substitution of Glu-beta 121----Gln may strengthen this second reaction and facilitate nucleation as well as polymerization.     

Cerebral palsy; an approach to the problem

A program for the cerebral palsied child has been developed in California which has been made possible through the cooperation of the state and local departments of education, the state and local departments of health, the Children's Hospital and Orthopedic Hospital at Los Angeles and the University of California School of Medicine in San Francisco. An attempt is being made to deal with not only the medical and educational needs of the cerebral palsied but also the social and emotional aspects.     

CEREBRAL PALSY—An Approach to the Problem

A program for the cerebral palsied child has been developed in California which has been made possible through the cooperation of the state and local departments of education, the state and local departments of health, the Children''s Hospital and Orthopedic Hospital at Los Angeles and the University of California School of Medicine in San Francisco. An attempt is being made to deal with not only the medical and educational needs of the cerebral palsied but also the social and emotional aspects.     

Brain Cellular Injury and Recovery—Horizons for Improving Medical Therapies in Stroke and Trauma

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. The Director of Conferences is William M. Pardridge, MD, Professor of Medicine.After ischemic and traumatic brain injury, many cells may be rendered dysfunctional but are not irreversibly damaged or disrupted. The brain tissue may become metabolically deranged, and neurons, while still alive, are paralyzed and cannot create an action potential or conduct an electrical impulse. This injured brain tissue is in a precarious state of increased vulnerability. If the milieu of the favorable, they may recover; if it is slightly unfavorable, they may die. There is now evidence that reversibly injured brain tissue will die from an ischemic or hypoxic insult ordinarily tolerated by the normal brain. The major challenge of modern research in stroke and trauma is to define the chemical and metabolic milieu in which the injured brain exists and to define an ideal milieu for healing.     

Renal Dialysis Center Operational Plans

The Southern California region has available a Renal-Dialysis Center at the University of Southern California School of Medicine and the Los Angeles County General Hospital. The center is prepared to carry out dialysis, transplantation, research and education in nephrology.Patient selection for dialysis will be randomized among optimum candidates.The high cost of dialysis per patient might be reduced through home dialysis and by successful homotransplantation. The center plans to arrange transplantation of cadaver kidneys matched by tissue typing to a recipient undergoing hemodialysis. Such an approach will keep a constant turnover of patients and will help in research efforts toward better understanding of problems in nephrology.     

ALCOHOLISM—Medical Team Approach to Treatment

Various approaches to the treatment of alcoholism have been evaluated by the Los Angeles Rehabilitation Clinic since it began operating more than four years ago. A team approach similar to that used in the outpatient treatment of other chronic disabling diseases has been formulated. With the permission of the California State Department of Public Health (Division of Alcoholic Rehabilitation) preliminary figures of the follow-up study conducted by this department are presented and would tend to support the conclusion that alcoholism can be successfully treated on an outpatient basis.     

Issue Information

Front Cover: Skeleton of a Columbian mammoth (Mammuthus columbi) assembled from bones recovered at the La Brea Tar Pits in Los Angeles, California. Original photograph taken by Jonathan Drury. Reproduced by permission of David A. Gold, Department of Ecology and Evolutionary Biology, University of California, Los Angeles, CA.     

Improved technique for electrophoresis of human galactose-1-P uridyl transferase (EC 2.7.7.12)

Summary A newly developed electrophoretic technique for human galactose-1-phosphate uridyl transferase confirms the multiple band patterns for the Duarte and Los Angeles variants. This represents the first confirmation for the Los Angeles variant. The observed frequencies of N, D, and LA types are similar to earlier reports for these variants.     

Complications of Gastroesophageal Reflux

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. The Director of Conferences is William M. Pardridge, MD, Professor of Medicine.Several specialists have recently recognized that gastrointestinal reflux causes complications resulting in significant disease. It causes discomfort, indigestion, esophagitis, Barrett''s esophagus, and carcinoma of the esophagus. Pediatricians attribute many early pulmonary problems, and even some sudden deaths in infants, to the reflux of gastric contents. Otolaryngologists now recognize that many cases of nonbacterial, nonspecific pharyngitis and laryngitis are due to the reflux of gastrc acid secretions. Contact granuloma and cancer of the larynx may, in some instances, be secondary to nocturnal reflux. Thoracic surgeons and pulmonologists believe chronic tracheobronchitis and some cases of pulmonary disease are attributable to recurrent bathing of the respiratory epithelium by aspirated gastric contents. An awareness of the many complications of gastrointestinal reflux should lead to a multidisciplined attack on the factors responsible for these diseases.     

Plague surveillance by serological testing of coyotes (Canis latrans) in Los Angeles County, California.

Sera from 19 (5.6%) of 338 coyotes (Canis latrans) collected in Los Angeles County, California between 1986 and 1990 had antibodies against Yersinia pestis using the passive hemagglutination test. Coyotes were excellent sentinels of plague activity in Los Angeles County. Enzootic plague declined dramatically in the county during the 5-yr period.     

From Cyanotic Infant to Acyanotic Adult—The Odyssey of Blue Babies

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. Director of Conferences: William M. Pardridge, MD, Associate Professor of Medicine.In the past two decades we have witnessed the maturing of diagnostic and surgical skills in the management of congenital heart disease. Although longevity and quality of life have improved, cures are few; varying degrees of postoperative medical supervision are therefore needed. This new patient population of adults requiring long-term medical care continues to increase. Proper management of such patients can be taxing, requiring knowledge not only of the preoperative disease but also of the nature and effects of surgical intervention and of the presence, type and extent of late postoperative residua and sequelae. The tetralogy of Fallot is taken as a model because it is well known in both pediatric and adult medicine, because intracardiac repair includes a wide range of techniques and because postoperative residua and sequelae comprise a broad spectrum of patient care concerns.     

Acute Rheumatic Fever in Los Angeles County

There was a general downward trend in the reported incidence of acute rheumatic fever in Los Angeles County during the years 1954-1963. A survey of hospital records in five large hospitals in 1962 revealed 100 cases diagnosed, 39 of which were reported. Diagnoses in the charts reviewed conformed to the Modified Jones Criteria. Most of the patients were born in Los Angeles County.Mortality rates for acute rheumatic fever during the same period were greatly in excess of those expected from the reported morbidity. The mean crude mortality rate for the period concerned was higher than for New York City, although not as high as for Boston.Acute rheumatic fever appears to constitute a health problem in need of review in Los Angeles County.     

Outpatient cleft lip repair

The emphasis on cost reduction and increased efficiency in health care delivery has prompted an increase in outpatient (ambulatory) surgical procedures. A retrospective review of the perioperative management of patients undergoing cleft lip repair at two urban tertiary pediatric hospitals was performed to assess the safety of outpatient cleft lip repair. The hospital database at Childrens Hospital Los Angeles was searched to find all patients who had been operated on for cleft lip repair during calendar years 1999 and 2000. Two groups were identified from Childrens Hospital Los Angeles: the outpatient cleft lip repair group (patients discharged the same day as the operation; n = 91) and the inpatient cleft lip repair group (n = 14). A data set was acquired from the Royal Children's Hospital in Melbourne, Australia, using the same criteria, for fiscal years 1998 to 2000 (n = 50). All patients from Royal Children's Hospital had operations as inpatients. Parameters considered for each group were age, sex, race, ethnicity, length of hospital stay, preexisting medical conditions or diagnoses, complications, and readmissions or presentation to the emergency department within 4 weeks of operation. The Childrens Hospital Los Angeles outpatient group had three readmissions that were considered to be complications of the operation. The Childrens Hospital Los Angeles inpatient group had one readmission attributable to a complication. The Royal Children's Hospital group also had one readmission for a complication. There was no significant difference in the complication rate of the Childrens Hospital Los Angeles outpatient group and the Royal Children's Hospital group (p > 0.05). There was also no significant difference in the complication rate of both of the Childrens Hospital Los Angeles groups compared with the Royal Children's Hospital group (p > 0.05). This study indicates that cleft lip repair performed in an outpatient setting may be a safe alternative to the inpatient operation. Certain preexisting medical conditions, however, may dictate the need for inpatient hospitalization after repair.