Airway obstruction due to massive lingual oedema following cleft palate surgery

The Pierre Robin syndrome consists of micrognathia, pseudo-macroglossia, glossoptosis and a high arched or cleft palate. Difficult intubation of the trachea and associated abnormalities such as congenital heart disease are well known complications of this syndrome. Intraoral surgery (such as cleft palate repair and palatoplasty) can also be technically difficult for the surgeon resulting in prolonged retraction on the tongue with a mouth gag to provide adequate surgical exposure. We report a case where massive lingual oedema following a cleft palate repair resulted in life-threatening airway obstruction.     

Pulmonary response of rats exposed to titanium dioxide (TiO2) by inhalation for two years

Rats were exposed to TiO2 by inhalation exposure to concentrations of 0, 10, 50, and 250 mg/m3 for 6 hr/day, 5 days/week for 2 years. There were no abnormal clinical signs, body weight changes, or excess mortality in any exposed group. Exposed groups showed slight increases in the incidence of pneumonia, tracheitis, and rhinitis with squamous metaplasia in the anterior nasal cavity. The pulmonary response at 10 mg/m3 satisfied the biological criteria for a "nuisance dust." The lung reaction was characterized by dust-laden macrophage (dust cell) infiltration in the alveolar ducts and adjoining alveoli with hyperplasia of Type II pneumocytes. Rats at 50 and 250 mg/m3 exposure concentrations revealed a dose-dependent dust cell accumulation, a foamy macrophage response, Type II pneumocyte hyperplasia, alveolar proteinosis, alveolar bronchiolarization, cholesterol granulomas, focal pleurisy, and dust deposition in the tracheobronchial lymph nodes. Minute collagenized fibrosis occurred in the alveolar walls enclosing large dust cell aggregates. The pulmonary lesions with massive dust accumulation appeared to be the result of an overwhelmed lung clearance mechanism at 250 mg/m3 exposure. Bronchioloalveolar adenomas and cystic keratinizing squamous cell carcinomas occurred at 250 mg/m3 exposure, while no compound-related lung tumors were found in rats exposed to either 10 or 50 mg/m3. In addition to excessive dust loading in the lungs of rats exposed chronically at 250 mg/m3, the lung tumors were different from common human lung cancers in terms of tumor type, anatomic location, tumorigenesis, and were devoid of tumor metastasis. Therefore, the biological relevance of these lung tumors and other pulmonary lesions for man is negligible.     

Comparison of arsenic-induced cell transformation, cytotoxicity, mutation and cytogenetic effects in Syrian hamster embryo cells in culture

Sodium arsenite and sodium arsenate were observed to inducemorphological transformation of Syrian hamster embryo cellsin a dose-dependent manner. A linear dose-dependence with aslope of 1 was observed with both compounds when the data wereplotted on a log-log graph. The trivalent sodium arsenite was> 10-fold more potent than the pentavalent sodium arsenate.The compounds also exhibited toxicity; however, transformationwas observed at non-toxic as well as toxic doses. At low doses,enhanced colony-forming efficiency of the cells was observed.To understand the mechanism of arsenic-induced transformation,the genetic effects of the two arsenicals were examined overthe same doses that induced transformation. No arsenic-inducedgene mutations were detected at two genetic loci. However, celltransformation and cytogenetic effects, including endoreduplication,chromosome aberrations, and sister chromatid exchanges wereinduced by the arsenicals with similar dose-responses. Theseresults support a possible role for chromosomal changes in arsenic-inducedtransformation.     

Inhibition of lens-aldose reductase activity by brazilin and haematoxylin

Brazilin and haematoxylin, plant pigments, were examined for their effects on the Bovine-Lens aldose reductase (LAR)-activity. About 50% inhibition was observed in a concentration of 10 (-4) M-brazilin and 10 (-4) M-haematoxylin, and above 95% inhibition was observed in a concentration of 10 (-3) M-brazilin and 10 (-3)M-haematoxylin. In order to determine the type of inhibition, kinetic studies were also conducted with brazilin and haematoxylin, in which both were found to be noncompetitive inhibitors.     

Dysplasia in Barrett's esophagus. A clinicopathologic study of six patients

To evaluate the consequences of dysplasia in Barrett's esophagus, six patients with esophageal mucosal biopsies showing dysplastic Barrett's mucosa in the absence of clinically evident esophageal carcinoma were identified and their clinicopathologic features reviewed. The patients, four men and two women, averaged 60 years and had long histories of gastroesophageal reflux. Four patients had high-grade dysplasia; two had low-grade. Dysplastic Barrett's mucosa appeared to arise most commonly from specialized-type Barrett's mucosa. After a mean follow-up of 29 months, four patients, all with high-grade dysplasia, had esophageal resections. Three of the four were found to have invasive adenocarcinoma, which extended through the esophageal wall in two patients. The fourth patient had a noninvasive adenomatous polyp ("Barrett's adenoma"), an infrequently described form of dysplasia in Barrett's esophagus. The two patients with low-grade dysplasia had developed no clinical indications of carcinoma. The results confirm that dysplastic Barrett's mucosa, particularly the high grade, is a morphologic marker for adenocarcinoma. Biopsy surveillance of patients with Barrett's esophagus is histologically feasible, but prospective studies are required to prove its effectiveness.     

Chronic empyema: key-point and results of our one-step operation

A new operative method named as "Extraperiosteal air plombage" against chronic empyema were performed to 80 patients and its cure rate by the first operation was 93.8% which is a good and high rate. Know-how to perform the operation without failure is (1) to complete the excoriation of the pleural debris, (2) to seal completely the leakage such as bronchiolar fistula, (3) to perform the extraperiosteal abbration rather over much to attach the lung to the muscle layer, (4) to close the chest wall completely, and (5) to wash out thoroughly the extraperiosteal cavity with brush and enough saline solution and to use the effective antibiotica.     

An explanation of renal hemodynamics in acute renal failure based on sequential CT in patients with Korean hemorrhagic fever

The pattern of renal enhancement and washout of contrast medium was observed on sequential follow-up CT in 12 patients with Korean hemorrhagic fever, in which acute renal failure is one of the most important clinical features. Renal contrast enhancement and contrast medium washout were delayed longer in patients with severe oliguric renal failure. The delayed washout peaked at 4-5 days and did not return to normal until 8-9 days in the patients with severe oliguria; in the patients without severe oliguria the times were 1-2 days and 3-4 days, respectively. A characteristic "cart-wheel" pattern was observed during the washout stage in patients without severe oliguria. This "cart-wheel" pattern of washout is thought to result from relief of vasoconstriction and repair of tubular function. Multifocal "wedge-shaped" nonenhanced areas of the kidney, seen on the 2 week follow-up postcontrast CT, are thought to be ischemic zones due to persistent vasoconstriction. On the 6 week follow-up postcontrast CT in one patient, scarring of the kidney was detected in the same area that did not enhance on the 2 week CT. This scarring is thought to be a result of permanent vasoconstriction.     

Changes in central serotoninergic transmission affect clonidine analgesia in monkeys

Summary 1. The effects of changes in central serotoninergic transmission on clonidine analgesia were assessed in monkeys. The minimum electrical current required for producing jaw opening is referred to as the pain threshold. Pain was induced by electrical stimulation of tooth pulp afferents. 2. In the first series of studies, intracerebroventricular administration of clonidine (5–30 g) produced dose-dependent analgesia in monkeys. The clonidine-induced analgesia was abolished or attenuated by prior injection of the animals with p-chlorophenylalanine or 5,7-dihydroxytryptamine into the third cerebral ventricle. On the other hand, pretreatment of the animals by injecting 5-HT or its precursor 5-hydroxytryptophan into the cerebral ventricle potentiated the clonidine-induced analgesia in monkeys. 3. In the second series of experiments, administration of clonidine (1–10 g) into the diencephalic periventricular gray (of the anterior hypothalamic portion), the periaqueductal gray, or the dorsal raphe nuclei also produced dose-dependent analgesia in monkeys. The analgesia induced by clonidine injection into the diencephalic periventricular gray or the periaqueductal gray was effectively antagonized by pretreatment of the animals by injecting two 5-HT receptor antagonists (such as ketanserine and methysergide) into the diencephalic periventricular gray or the periaqueductal gray. The clonidine-induced analgesia in monkeys was not affected by pretreatment of the animals with injections of either ketanserine or methysergide into the dorsal raphe nuclei. 4. The results suggest that the functional activity of central 5-HT neurons correlate well with the analgesic sensitivity of clonidine microinjected centrally. In addition, the analgesia induced by clonidine microinjected into the diencephalic periventricular gray or the periaqueductal gray was mediated by the 5-HT receptors at the site of injection.This study was supported by grants from the National Science Council of the Republic of China and the Student Summer Fellowship of National Cheng Kung University Medical College (1986) Send offprint requests to Mao-Tsun Lin at the above address     

Expressions of resistance and cross-resistance in teniposide-resistant L1210 cells

Summary Resistance to teniposide (VM-26) by VM-26 selected resistant L1210 cells in culture was attributed to alterations in the flux of VM-26 across the plasma membrane and to functions of homogeneously staining regions that appeared on one or more chromosomes. In the present study, electrophoresis of membrane-cytosol fractions of these resistant sublines demonstrated a protein band, M_r 22 kd, that was not evident in similar fractions of drugsensitive L1210 cells or three revertant sublines. The distribution of this protein among various cellular fractions could be altered by manipulation of the concentration of calcium ions. A representative subline, LIa5 M, was observed to have vesicles that reacted with Sudan black B stain, an indication of altered lipid metabolism. The LIa5 M subline was cross-resistant to etoposide, vincristine, doxorubicin, amsacrine, and actinomycin D. Concentrations of VM-26 that inhibited cell division to the same extent caused an accumulation of fewer cells in the G₂ stage of cell division in LIa5 M cultures than in L1210 cultures. These observations indicate that the LIa5 M subline expressed multiple drug resistance, as well as changes in the expression of cytotoxicity to VM-26.This investigation was supported by Research Project Grant CA 35319, by Cancer Center Support (CORE) Grant CA 21765 from the National Cancer Institute, and by the American Lebanese Syrian Associated Charities.Recipient of research support from a training grant, American Cancer Society Grant IN-85-06, to the University of Tennessee Center for the Health Sciences