Clinical trial of a new lightwand device (Trachlight) to intubate the trachea

BACKGROUND: Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique. A newly designed lightwand (Trachlight) incorporates modifications to improve the brightness of the light source as well as flexibility. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients. METHODS: Healthy surgical patients were studied. Patients with known or potential problems with intubation were excluded. During general anesthesia, the tracheas were intubated randomly using either the Trachlight or the laryngoscope. Failure to intubate was defined as lack of successful intubation after three attempts. The duration of each attempt was recorded as the time from insertion of the device into the oropharynx to the time of its removal. The total time to intubation (TTI), an overall measure of the ease of intubation, was defined as the sum of the durations of all (as many as three) intubation attempts. Complications, such as mucosal bleeding, lacerations, dental injury, and sore throat, were recorded. RESULTS: Nine hundred fifty patients (479 in the Trachlight group and 471 in the laryngoscope group) were studied. There was a 1% failure rate with the Trachlight, and 92% of intubations were successful on the first attempt, compared with a 3% failure rate and an 89% success rate on the first attempt with the laryngoscope (P not significant). All failures were followed by successful intubation using the alternate device. The TTI was significantly less with the Trachlight compared with the laryngoscope (15.7 +/- 10.8 vs. 19.6 +/- 23.7 s). For laryngoscopic intubation, the TTI was longer for patients with limited mandibular protrusion and mentohyoid distance, with a larger circumference of the neck, and with a high classification according to Mallampatti et al. However, there was no relation between the TTI and any of the airway parameters for Trachlight. There were significantly fewer traumatic events in the Trachlight group than in the laryngoscope group (10 vs. 37). More patients complained of sore throat in the laryngoscope group than in the Trachlight group (25.3% vs. 17.1%). CONCLUSIONS: In contrast to laryngoscopy, the ease of intubation using the Trachlight does not appear to be influenced by anatomic variations of the upper airway. Intubation occasionally failed with the Trachlight but in all cases was resolved with direct laryngoscopy. The failures of direct laryngoscopy were resolved with Trachlight. Thus the combined technique was 100% successful in intubating the tracheas of all patients.     

The Streamtest cup: a new uroflow device

OBJECTIVES: To create an inexpensive, simple, accurate, and noninvasive device to evaluate the character of a male's urinary stream. METHODS: The results of a formal in-office uroflow study performed on 50 symptomatic men were compared with those of the same men using the Streamtest cup. RESULTS: All men with a urine flow of 12 mL/s or greater reached or exceeded the red line on the Streamtest cup. No patient whose stream was less than 11 mL/s was able to reach the red line. CONCLUSIONS: Uroflowmetry is an excellent study in diagnosing, managing, and monitoring the treatment of urinary obstructive disease secondary to benign prostatic hyperplasia. The Streamtest cup can provide both the patient and the physician with a clinically accurate visual assessment of an individual's urine flow at a significant cost savings over other testing means. The Streamtest cup when compared with a formal in-office uroflow study provided clinically similar results in separating obstructive uropathy from a normal urinary flow.     

Water-jet dissection in renal surgery: experimental study of a new device in the pig

The pig model was used for experiments with a new type of water-jet dissector, which produces high-pressure water by application of a gas and maintains the water fully sterile in a single-use delivery apparatus. The experiment was conducted ex vivo (14 kidneys) and in vivo to compare electric cautery section with water-jet dissection (5 vs 11 partial nephrectomies). Ex vivo study confirmed sparing of blood vessels and pelvicaliceal system. In vivo study did not show significant differences in blood loss but, the water-jet allowed precise dissection and tight closure of the excretory system. More frequent haemorrhages were noted on histological examination of the WJ group, but no coagulation necrosis. These are preliminary findings and further studies of long-term results may confirm the benefits of the absence of parenchymal necrosis and the definite advantage of precise closure of the pelvicaliceal system, as morbidity of partial nephrectomy is often related to secondary haemorrhages and urinary fistulae.     

铝电解质初晶温度测定装置及初晶点数模的研究

电解质初晶温度是铝电解生产过程中的一个重要参数,本文研究了直接测定铝电解质初晶温度的装置。整套装置由进样系统、高温炉、炉温控制系统、计算机测控系统组成。采用新装置可以在线实时读取数据并自动绘制温度曲线,获取结果方便准确,减少了人为误差。同时采用均匀设计法进行试验设计,考察了Na3AlF6-Al2O3-MgF2-CaF2-LiF五元体系的初晶温度,并由此建立了该体系初晶温度的数学模型。由此模型得出的预报值与实测值之间的绝对误差在±5℃以内。     

Glial tumourettes (glial microtumours): their clinical and histopathological manifestations

This study represents our experience with eight cases (males: 4; females: 4; 13-47 years old, average age 28.5 years) of a "glial tumourette" (minute glioma), which measured less than 15 mm in diameter on an MRI. Four tumours were located in the frontal lobe, one in the rostrum of the corpus callosum, two in the midbrain, and one in the thalamus. The symptoms and signs lasted from two days to 15 months prior to diagnosis, and they consisted of epileptic seizures in five patients and increased intracranial pressure due to hydrocephalus resulting from aqueductal stenosis in three. All patients had a CT scan and an MRI as a part of their initial neuroimaging evaluations. While the CT findings failed to show the lesion in four patients, MRI demonstrated it in all cases. Five tumours were either totally or subtotally removed while the remaining three were biopsied. Histological examinations revealed six tumours to be low-grade gliomas (fibrillary astrocytoma: 4; oligoastrocytoma: 2) and two to be high-grade gliomas (anaplastic astrocytoma: 1; anaplastic oligodendroglioma: 1). Regarding adjuvant therapy, three patients received radiation and/or chemotherapy. One of the patients with midbrain fibrillary astrocytoma died of the disease 38 months after the operation, however, no evidence of progression in the remaining seven has been observed in the follow-up period ranging from five to 65 months after the operation (average: 25.4 months). The histogenesis of benign and malignant gliomas and the importance of surgical exploration in the management of such patients with minute intracerebral tumours are also discussed.     

Melanin-containing hydrogel intraocular lenses: a histopathological study in animal eyes

Poly(2-hydroxyethyl methacrylate) hydrogel intraocular lenses, containing adrenochrome-melanin, were manufactured and implanted in animal eyes in order to assess the effect of melanin upon (a) biocompatibility of implants with the eye tissues, and (b) fibrous proliferation of lens epithelium responsible for the opacification of the posterior capsular membrane. An equal number of control lenses were also implanted. The animals were followed up for durations up to two years, and a detailed histopathological examination of the eyes was performed subsequent to their enucleation. The postoperative complications were minor and probably caused by surgical trauma. The study failed to give any indication of the postulated antiproliferative activity of adrenochrome-melanin since minimal capsular opacification occurred in the operated eyes, regardless of the presence of melanin.     

Response of normal aorta to endovascular grafting: a serial histopathological study

The initial data on the effect of ruthenium red on mature human type-1 VDAC are presented. Highly enriched human type-1 porin in planar lipid bilayers shows lowered voltage-dependence whenever a commercially available ruthenium red preparation is applied. The hexavalent polycationic dye ruthenium red affects different functions in varying cell compartments. Concerning the plasma membrane of cells the actual data, together with our former measurements on the interaction of VDAC and the polycationic synthetic polyamine Compound 48/80, refer to a second VDAC opener, which is relevant for studies on the stimulation of exocytotic processes of different cell types.     

Phaeohyphomycosis due to Alternaria spp. and Phaeosclera dematioides: a histopathological study

A case of phaeohyphomycosis caused by strains of both Alternaria spp. and Phaeosclera dematioides is presented. The biopsy material was studied using histological, immunohistochemical and transmission electron microscopy techniques. The agent's dematiaceous mycelia are composed of thick-walled hyphae, branched and unbranched, with terminal vesicular formations. All the described structures occur alone or in chains within multinuclear giant foreign body-type cells or invading an abscess. Also present are budding forms. Immunostaining of histiocytic inflammatory cells in either. diffuse or granulomatous infiltrates revealed cytoplasmic positivity for lysozyme and Ki-MIP antibody. The lymphocytic infiltrates of the upper corium show predominantly small T lymphocytes (CD3 and CD45RO positive) and absence of CD20-positive B cells. Plasma cells occurring within the infiltrates of the deeper parts show polyclonal expression of both Ig light chains.     

Blood preservation and air transport: study of physical constraints (temperature and pressure)

We study physical compulsions of packed red cells during air transport. We found important variations of pressure and temperatures in blood transport box. These variations explain the biological alterations found in the first part. New rules for blood air transport are proposed.     

Comparison of a new anti-glutamic acid decarboxylase (GAD) enzyme-linked immunosorbent assay (ELISA) with radioimmunoassay methods: a multicenter study

Several methods are available for the measurement of antibodies to glutamic acid decarboxylase (anti GAD). These antibodies are valuable tools for the immunodiagnosis of insulin-dependent (type 1) diabetes mellitus (IDDM) and for the assessment of risk for the future development of IDDM. We here describe a new enzyme-linked immunosorbent assay (ELISA) for the detection of anti-GAD which was tested in a multicenter study. The results of the new anti-GAD ELISA correlate well with those obtained by radioimmunoassays (RIA) and they have a higher sensitivity (69%) and specificity (98%) compared to other anti-GAD enzyme immunoassays as determined in the IDW Proficiency Test Program for the detection of GAD antibodies. The new ELISA is simple and easy to perform, with convenient handling of the reagents. Quantitative and reproducible test results are available within approximately four hours. The new anti-GAD ELISA can be used for large scale population screening to indicate a prediabetic state as well as to diagnose autoimmune diabetes in adults (LADA) and the risk for IDDM in pregnant women with gestational diabetes.     

The glottic aperture seal airway: a new ventilatory device

BACKGROUND: None of the presently used airway devices are ideal regarding ease of insertion, alignment with the laryngeal inlet, and provision of a high-pressure seal from the environment. The purpose of this study was to determine, in awake volunteers, the performance of a new ventilatory device, the glottic aperture seal airway, regarding ease of insertion, alignment with the laryngeal inlet, and forced exhalation seal pressure (PFES). METHODS: The glottic aperture seal airway consists of a curved tubular component that ends in the middle of an elliptical foam cushion glottic component. The posterior surface of the foam has a curved flexible plastic backing, which imparts a 60 degree angle between the proximal half and the distal half of the foam cushion. When the glottic aperture seal airway is properly in situ in a supine patient, the proximal half of the foam cushion is opposite the laryngeal inlet. The posterior surface of the plastic backing has a balloon attached to it. Inflation of the balloon presses the ventilation hole and foam cushion up against the laryngeal inlet, thereby creating a seal from the environment. Using the laryngeal mask airway as a control device, the glottic aperture seal airway was tested for time and ease of insertion, fiberoptic alignment with the laryngeal inlet, and PFES in 18 lightly sedated and locally anesthetized volunteers. RESULTS: The glottic aperture seal and laryngeal mask airways were inserted with equal ease and speed. The fiberoptic alignment with the larynx was excellent for both the glottic aperture seal and laryngeal mask airways. In all volunteers, the mean +/- SD PFES values at 0-, 10-, 20-, 30-, and 40-ml balloon inflation volumes of the glottic aperture seal airway were 23.4 +/- 11.8, 29.6 +/- 12.4, 42.7 +/- 12.5, 56.9 +/- 5.6, and 60 +/- 0 cm H2O, respectively; the PFES at > or = 20 ml balloon inflation volume of the glottic aperture seal airway was significantly greater than with the laryngeal mask airway (19.4 +/- 6.7 cm H2O, P < 0.01). A PFES of > or =60 cm H2O was achieved with the glottic aperture seal airway in all volunteers (n = 2 at 10 ml, n = 3 at 20 ml, n = 9 at 30 ml, and n = 4 at 40 ml). The glottic aperture seal airway did not cause any trauma. CONCLUSION: In awake volunteers, the glottic aperture seal and laryngeal mask airways were equally easy to insert and position. The glottic aperture seal airway was capable of achieving a higher PFES than the laryngeal mask airway.     

Recurrence of hepatitis D (delta) in liver transplants: histopathological aspects

BACKGROUND: The viral/pathological correlates of recurrent hepatitis delta virus (HDV) disease in orthotoptic liver transplants are reported. METHODS: We examined the histological features of recurrent HDV disease in nine patients with transplants for terminal HDV cirrhosis were examined; intrahepatic HDV and hepatitis B virus (HBV) antigens were detected by immunoperoxidase techniques. Sera were tested for the battery of HDV and HBV markers. RESULTS: In four patients, HDV reinfection was accompanied by the recurrence of an HBV infection with features of active viral replication. In the other five, HDV reinfection was accompanied by an atypical recurrence of HBV infection without evidence of active HBV replication (no expression of intrahepatic hepatitis B core antigen). In four of the latter patients, the atypical HBV pattern changed during the follow-up into a pattern of active viral replication accompanied by chronic necroinflammation detected during histology. CONCLUSION: The pattern of recurrent HBV infection can influence the pathological aspects of the relapses of HDV disease in liver grafts.     

Human defunctionalized colon: a histopathological and pharmacological study of muscularis propria in resection specimens

Despite the regression of "diversion colitis," temporary functional disorders after bowel continuity restoration could be caused by changes in the smooth muscle of excluded segments; however, studies on the muscularis propria have yielded contradictory results. This study was aimed at evaluating possible histopathological changes in muscular layers and motility of the defunctionalized human colon. Ten patients with defunctionalized colorectum (group A) and 10 controls (group B) underwent restorative or primary resection surgery. Strips were taken proximal to the colostomy (specimens A1) and the defunctionalized segment (specimens A2), and from the proximal (specimens B1) and distal extremity (specimens B2) of resected colons. Measurements of the thickness of the muscularis propria and of the volume density of the myenteric plexus, as well as of spontaneous motility and responses to electrical and pharmacological stimulation were taken. The muscularis propria was thicker in A2 than in A1 specimens (P = 0.004) and in B2 than in B1 specimens (P = 0.007). No differences were recorded either in the myenteric plexus volume density or in colonic motility. No differences were recorded in intergroup comparisons. As no structural or functional changes related to defunctionalization were found, clinical disorders after colorectal restoration could rather result from underlying colonic pathology and/or incomplete distal colon resection.     

The effect of PTA on cerebral vessels in experimental vasospasm: a histopathological study

Although the percutaneous transluminal angioplasty (PTA) is an useful procedure for the treatment of symptomatic vasospasm after subarachnoid hemorrhage, the morphological changes in spastic intracranial vessels after PTA are not yet clear. The purpose of this study was to evaluate the effects of PTA angiographically and histologically. Chronic cerebral vasospasm was induced by producing a blood clot in the subarachnoid space around the top of internal carotid siphon in Japanese monkey. After angiographic recognition of vasospasm, PTA was carried out with silicone microballoon at 1 atmosphere, 3 times for 10 seconds. Angiography after PTA disclosed significant dilatation at the site of PTA, without any significant dilatation of distal spastic vessels. Papaverine hydrochloride was then infused intra-arterially, which resulted in significant dilatation of distal spastic vessels. Upon histological examination, deformation and some denudation of endothelial cells were noted in the intimal layer. At the site of denudation, attachment of platelets was observed despite generalized heparinization. Internal elastic lamina and the media were also stretched and myocytes were deformed and arranged irregularly. These changes were not uniform all over the vascular walls. We conclude that the prolonged effect of PTA may be caused by mechanical damage of endothelial cells and myocytes, and the nonuniformity of histological changes in vascular wall may be a leading cause of its rupture during PTA.     

Evaluation of a new ambulatory blood pressure device

We assessed the OSCILL-IT ambulatory blood pressure (BP) recorder (FIGI sr1, Rome, Italy) according to the performance criteria set out by the British Hypertension Society (BHS) protocol. The OSCILL-IT is a portable, noninvasive recorder that uses a process that correlates systolic, mean, and diastolic areas, identified on the oscillations, to the cuff absolute pressure. According to the recommendations of BHS, a large heterogeneous population (100 subjects: 52 men aged from 19 to 79--median 44 and 48 women from 19 to 74--median 54) was recruited in order to assess accuracy and to analyze, in addition, the effects of observer agreement and BP level on the observer-device differences. With reference to BP level, we suggest also a new graphic approach. Four sets of sequential, same arm, comparative BP measurements were obtained, performed by the OSCILL-IT recorder and two skilled clinicians using a mercury column, for each subject. We used a linear combination for the statistical evaluations. We confirmed the observer agreement through the frequency distribution of BP as a function of the observer and through the differences between observers. We compared OSCILL-IT with sphygmomanometric readings: the differences were not significant. A visual inspection, with the addition of regression lines, showed that there were no variations in differences at the changing of BP level. The difference between observers and OSCILL-IT was 0.2 +/- 5.3 mm Hg and 0.2 +/- 5.8 mm Hg both for systolic BP (SBP) and diastolic BP (DBP). The level of agreement, according to BHS criteria, showed that 64% of all systolic and 70% of all diastolic readings obtained by the OSCILL-IT were within 5 mm Hg of the sphygmomanometric determinations. Therefore, the grade is C for SBP, even if 93% of SBP and 95% of DBP obtained by the OSCILL-IT were within 10 mm Hg of the sphygmomanometric determinations. These analyses demonstrate that the OSCILL-IT satisfies the accuracy parameters and the additional linear regression yields graphics more immediate.     

Monobloc distraction osteogenesis during infancy: report of a case and presentation of a new device

Adrenomedullin(AM) is a potent hypotensive peptide originally isolated from human pheochromocytoma. AM exerts various biological actions such as vasodilation, bronchodilation and natriuresis, by stimulating cAMP production and increasing free Ca2+ levels through the specific receptors. Although an orphan receptor cloned from rat lung, which contained seven transmembrane domains, was proved to be one of the AM receptors, it is now considered by many studies that other receptor subtypes should be present. The precise signal transduction mechanism for the AM receptor is not fully elucidated yet, but it is supposed that AM acts against proliferative changes of vascular and mesangial cells as seen in hypertensive states, at least partly by inhibiting the MAP kinase pathway. Further studies on the AM receptor subtypes and their intracellular signaling mechanisms are needed to clarify the role of AM in various pathophysiological conditions.