Endemic Kaposi's Sarcoma Vs. Kaposi's Sarcoma in AIDS: A Brief Communication

Five cases of Kaposi's Sarcoma are presented to highlight the clinical course of the African or Endemic Kaposi's Sarcoma and point out the differences against the Epidemic form of Kaposi's Sarcoma common in AIDS patients in the United States and Europe. Groups at risk of developing the Epidemic form of Kaposi's Sarcoma are well identified in the United States whereas there is no special group at risk of developing the Endemic form in Africa. Genital Kaposi's Sarcoma of the Endemic form, a rare site for the disease is also presented. Three clinical and histological types of the endemic form are described

An Analysis of Cardiopulmonary Hemodynamics During Hemorrhagic Shock in Dogs

Utilizing the standard Wiggers' method, hemorrhagic shock was induced in ten anesthetized dogs by bleeding to a mean arterial pressure (MAP) of 50 mmHg for 2 hr and then to 30 mmHg for 1 hr, followed by reinfusion of the shed blood. The experimental protocol was designed to evaluate the effect of hemorrhagic shock on sequential pulmonary hemodynamic changes in relation to those of cardiac and systemic circulation. All selected cardiopulmonary hemodynamic parameters were recorded throughout the experiment on a multi-channel poly-oscillograph monitor. Total pulmonary resistance (TPuR) started rising early in hemorrhagic shock and was found to rise to a level that was 10-fold greater than pulmonary arteriolar resistance (PAR). This meant that, 90% of TPuR came from the venous side of the pulmonary vascular bed. Persistently raised TPuR even after reinfusion was linked to early death of the experimental animals. Myocardial contractility (max dp/dt mmHg/sec) which is one of the indices for cardiac performance was found to be severely depressed at terminal stage (p<0.001). Both total pulmonary and peripheral resistances were found to have an inverse relationship to ventricular performance which was measured by left ventricular stroke work (LVSW) and right ventricular stroke work (RVSW). There is a high suspicion that reinfusion or resuscitation following prolonged hypovolemic shock may aggrevate the hemorrhagic shock effects by facilitating the distribution of accumulated blood-borne toxic substances to various target organs and that, this has been linked with the early and sustained pulmonary hemodynamic disturbance found in these experiments

Three-Dimensional Vascular Architecture of the Dog Heart as Revealed by Injection Replica Scanning Electron Microscopy

The three-dimensional vascular architecture of the dog myocardium was investigated by means of injection replica scanning electron microscopy. Coronary arteries entered into myocardial wall at almost right angle. They repeated bicornal divisions and run toward endocardium. The arterioles and precapillary arterioles branched in bicornal, tricornal or multicornal fashions. These branches were arranged usually in a plane in short distances. Capillaries were arranged parallel to the myocardial cells and had many anastomotic channels. The branching of the capillaries was usually Y-, T-, H- or K-shape, and Y-shape was the most common. Many anastomotic channels between precapillary arterioles were recognized just under the endocardiurn, while same connections were very difficult to identify in the myocardial wall. Numerous venous capillaries joined together with postcapillary venules and collecting venules almost exclusively in a plane parallel to the capillary sheets. Junctional architecture of these capillaries and venules was usually fan-shaped, finger-shaped or feather-shaped in appearance. The postcapillary venules and collecting venules were oriented usually perpendicular to the muscle fiber or capillary direction. The orifices of Thebesian veins, arterio-luminal vessels and arterio-sinusoidal vessels were observed between ventricular trabeculae as small masses of injected resin. The number of these orifices were more abundant in the right ventricular wall than in the left

Blood Sugar in Relation to Endocrine Hormones During Hemorrhagic Shock in Dogs

Wiggers' standard method was used to induce hemorrhagic shock in eighteen anesthetized dogs by bleeding to a mean arterial pressure (MAP) of 50 mmHg for 2 hr and then to 30 mmHg for 1 hr, followed by reinfusion of the shed blood. The experimental protocol was designed to determine the sequence of changes in blood sugar during hemorrhagic shock and its relationship to variations in the underlying endocrine hormones, in particular the levels of insulin, catecholamines and cortisol. Venous blood samples were drawn from all experimental animals at specific regular time intervals for sugar and endocrine hormones determination. In early stages of hemorrhagic shock, blood sugar, catecholamines and cortisol were shown to be raised while insulin levels were not influenced by fluctuations in sugar levels. This suggested that, the effect of catecholamine inhibition on the synthesis of insulin is greater than the blood sugar stimulus on the secretion of insulin. Moreover pancreatic islet cells were shown to be intact at terminal stage by Electron microscopy. Corresponding elevated blood levels of sugar, catecholamines and cortisol were found to have a common goal towards increasing plasma osmolality to effect plasma refill. Persistent hypoglycemia in late stages of hemorrhagic shock was shown to be a major sign of failing neuroendocrine compensatory mechanisms against a shock insult. Electron microscopy revealed severe damage of the pituitary gland at the terminal stage

Experience with Subfascial Ligation for Varicose Veins in Tanzania : A Brief Communication

From January 1987 through December 1989, ten patients with varicose veins complicated by postphlebitic ulcers were treated at Muhimbili Medical Center, Tanzania, by subfascial ligation of perforating veins. The technique employed was a posterior subfascial approach which avoids making the skin incision through the ulcer itself. The follow up periods ranged from one to three years and there was no recurrence of the ulcer in any of the patients in the study. The major indication for performing the procedure was the presence of a varicose stasis ulcer.　　 Before surgery, all patients had a complete peripheral vascular examination to exclude deep venous thrombosis. Healing of varicose ulcers and elimination of stasis eczema had to be achieved four weeks before surgery.　　 The authors maintain that patients who present with varicose veins of the lower leg and a postphlebitic stasis ulceration invariably have incompetence of the valves in the perforating veins and should be treated by subfascial ligation of the perforating veins

Impending Gastric Rupture in a Neonate with Gastric Outlet Obstruction due to Malrotation

This is a case report of a neonate with impending gastric rupture due to malrotation with gastric outlet obstruction. A preoperative plain abdominal X-ray showed expansion of the gastric bubble. A barium meal demonstrated an unusual bulging of the gastric wall extending from the fundus to the body of the stomach on the greater curvature side and malrotation of the duodenal loop. At operation a malrotation with volvulus and a rupture of the seromuscular layer with bulging of the mucosa in the stomach was found. We think that this unusual bulging of the gastric wall in the barium meal is an important radiological sign of impending gastric rupture