Although low-flow CPB resulted in a marked decrease in CBF compared with prebypass and full-flow bypass, phenylephrine administered to double arterial pressure during low-flow bypass produced a proportional increase in CBF.

To investigate the role of mast cells and cellmediated immunity in the pathogenesis of scleroderma, we studied wheal size after skin testing with compound 48/80, a liberator of mast cell histamine, and demonstrated increased mast cell releasability in skin that appeared normal, adjacent to involved skin. Immunofluorescent staining for HLA-DR showed dermal positivity in 12 of 13 involved-and 9 of 13 uninvolved-skin biopsy specimens from scleroderma patients, compared with only 1 of 10 controls. By immunoperoxidase staining, most of the DR positivity was found in fibroblastlike cells. These findings further support the notion of immunologic dysfunction in scleroderma.Systemic sclerosis (SSc) is a multisystem disease characterized by varying degrees of proliferative changes in small arteries and arterioles, obliterative microvascular lesions, and fibrosis in the skin and internal organs. Although the etiology of the disease is unclear, there is evidence that immunologic mechanisms may be important in its pathogenesis. The

We present the case of a patient who had rheumatoid nodules of the vertebrae, which had resulted in bony destruction of the spine at 3 levels. Although there have been only 3 previous reports of such findings with confirmation by histologic analysis, we believe the condition is more common than has been thought. From a review of the literature, we found that similar clinical and radiographic features, as well as descriptions of rheumatoid granulation tissue invading the disc spaces, have been described in several subjects, Rheumatoid nodules are found in approximately 20% of patients with rheumatoid arthritis (RA). These nodules occur most commonly on the extensor surface of the forearm, on the Achilles tendon, and in the olecranon bursa (1). Less commonly, they have been found in the lungs, heart, spinal cord, meninges, and on the vocal cords. Standard rheumatology texts, however, make no mention of rheumatoid nodule involvement on body structures (2,3). Autopsy studies have demonstrated that rheumatoid nodules were the cause of vertebral body destruction in 3 subjects with RA (4-6). We report another case of vertebral destruc- tion at multiple levels of the spine. This case is unique in that, during spinal surgery, rheumatoid nodules were found to have caused the vertebral destruction.Case report. The patient, a 65-year-old American Indian woman, had a 17-year history of seropositive nodular RA and a 9-year history of insulindependent diabetes mellitus. The arthritis had been treated with prednisone for most of the 17 years, and D-penicillamine had recently been added to the regimen. Her arthritis was well controlled with these medications until November 1984, when she noted the onset of dull, nonradiating pain in her lower back.The pain progressed, and in April 1985, roentgenograms were made of the patient's spine; these showed destruction of the L3-L4 disc space. A bane scan was also performed, and it showed diffuse uptake in this same area. Needle aspiration of the disc space was performed. Cytologic results and acid-fast bacilli (AFB) staining were negative, as were bacterial and tuberculosis (TB) cultures. It was believed, however, that the radiographic results were most compatible with a diagnosis of TB of the spine, and she was started on a regimen of isoniazid and rifampin.The pain worsened, and by June 1985, the patient became unable to walk. Roentgenograms of her spine (July 1985) showed progressive destruction of the L3-L4 disc space, with right sacroiliac (SI) joint destruction. A computed tomography scan demonstrated marked destruction of the L4 vertebral body. Needle aspiration of the right SI joint gave negative results on cytologic study, AFB staining, and bacterial and TB cultures. At that time, the patient was referred to the University of Colorado Health Sciences Center for further evaluation.At the time of admission, she was taking the

Introduction. The purpose of the study was to determine the hemodynamic effects and conditions of ventilation and tracheal intubation after paralysis with either rocuronium (R) or vecuronium (V) during induction of anesthesia with moderate dose fentanyl. Patients and Methods. After IRB approval and written consent, 20 patients undergoing coronary artery surgery were randomized to receive, in a blinded fashion, ILI mg/kg (n= IlL or V, 015 mg/kg (n = 9). Premedication was with Iorazepam. Anesthesia was induced with an infusion of fentanyl, 0. I ug/kg/min, followed by a bolus of 15 ug/kg. The muscle relaxant was given 90 sec after the fentanyl induction, and the trachea was intubated 90 sec later. Ease of bag-mask ventilation was evaluated every 15 seconds before and after the relaxant. Tracheal intubating conditions were evaluated according to jaw relaxation, status of vocal cords, and cough/buck response. Train of four monitoring of the facial nerve-orbicularis oculis muscle was done. Data were compared between groups with Student's t test and the Cochran-ManteI-Haenzel test. A p value < 0.05 was considered significant. Results. Demographics and hemodynamics were similar between groups. Compared with V, patients receiving R were easier to ventilate, had faster loss of TOF, and better overall intubating conditions (Table) Discussion. During conditions of the study, R produced similar hemodynamics and better conditions for bag-mask ventilation and tracheal intubation compared with V.