Cubic phases in hydrated 1:1 and 1:2 dipalmitoylphosphatidylcholine-dipalmitoylglycerol mixtures.

The structures of fully hydrated 1:1 and 1:2 (mol/mol) dipalmitoylphosphatidylcholine (DPPC)-dipalmitoylglycerol (DPG) mixtures were studied by means of small-angle x-ray diffraction. The x-ray diffraction pattern of the 1:1 (mol/mol) DPPC-DPG mixture at 65 degrees C contains three reflections with spacings in the ratio of 1:1/ square root of 2:1/ square root of 3 in addition to reflections of an inverted hexagonal (H11) phase. A possible interpretation of this result is that a cubic phase of the body-centered space group lm3m, with a lattice constant of 23.1 +/- 0.6 nm, is formed. This cubic phase appears at intermediate temperatures between the lamellar and the H11 phases. The 1:2 (mol/mol) DPPC-DPG mixture gives an x-ray diffraction pattern at temperatures higher than the lamellar-to-H11 transition containing a number of reflections that index a cubic phase structure. The space group of the cubic phase was assigned a face-centered group Fd3m with a lattice constant of 16.3 +/- 0.1 nm at 82 degrees C. The possible role of cubic phases in membrane phenomena such as transmembrane signal transduction and fusion is discussed.     

Bleeding varices: 1. Emergency management.

The aim of the emergency management of bleeding varices is to stop the hemorrhage nonoperatively if possible, avoiding emergency shunt surgery, an operation that has a higher mortality than elective shunt surgery. Patients with an upper gastrointestinal hemorrhage should undergo endoscopy immediately to verify the diagnosis of bleeding varices. They can then be categorized according to whether they stop bleeding spontaneously (group 1), continue to bleed slowly (group 2) or continue to bleed rapidly (group 3). Group 1 patients are discussed in the second part of this two-part series. Group 2 patients are initially treated with vasopressin given intravenously; those who fail to respond should undergo emergency angiography and receive vasopressin intra-arterially. If this fails, patients at low surgical risk should undergo urgent shunt surgery; those at high risk do better with endoscopic sclerotherapy. Group 3 patients are also given an intravenous infusion of vasopressin. Patients at low surgical risk who continue to bleed then receive tamponade with a Sengstaken--Blakemore tube. If this fails, they undergo emergency creation of an H-shaped mesocaval shunt. Patients at high surgical risk who fail to respond to vasopressin given intravenously are next treated intra-arterially. If this fails they are given either endoscopic or transhepatic sclerotherapy.