Pleomorphic adenoma of the trachea--a case report

An unusual tracheal tumor was found in a 50 year old male who was admitted due to mild dyspnea on exertion. Simple chest X-ray showed an abnormal mass shadow in the trachea and computerized chest tomogram revealed a tumor in the mid 1/3 of the trachea obstructing 80% of the lumen. Through a right thoracotomy incision, resection of a 2.5 cm segment of the trachea with end-to-end anastomosis was done and microscopic findings showed many cystic spaces with myxomatous hyalinous stroma. It was diagnosed as a pleomorphic adenoma of the trachea.

Soft tissue changes after superior repositioning of the maxilla with Le Fort I osteotomy: 5-year follow-up

Long-term changes in soft tissue landmark positions were examined in 49 patients following superior repositioning of the maxilla by Le Fort I osteotomy. From presurgery to 1 year, on average the upper lip moved up one third the distance that the upper incisor and point A did, but there was considerable variability. In 25% of the patients the upper lip moved up more than 2 mm, and in 6% it moved up more than 4 mm. As the mandible rotated upward and forward in response to the maxillary movement, soft tissue movements paralleled the adjacent hard tissue movements almost exactly in the absence of genioplasty. From 1 to 5 years postsurgery, in 25% of the patients the maxilla moved downward more than 2 mm, and the mandible rotated down and back, often without relapse of occlusal relationships. In both jaws, long-term changes in soft tissue landmarks exceeded hard tissue changes, meaning soft tissue points tended to move downward even if hard tissue points were stable and moved down more than the corresponding hard tissue points when skeletal changes occurred.

Calcipotriol (MC 903), a synthetic derivative of vitamin D3 stimulates differentiation of squamous carcinoma cell line in the raft culture

We investigated whether calcipotriol, a synthetic derivative of vitamin D3 has the ability to correct defects in the control of proliferation and differentiation of human squamous carcinoma cells using the raft culture of SCC 13 cell line. Calcipotriol treatment at concentrations of 10(-8)-10(-6) M considerably enhanced terminal differentiation of SCC 13 cells, as shown by the appearance of enucleated-eosinophilic cells as well as granular cells in their upper cell layers. Immunohistochemical staining showed marked increases in the differentiation of marker proteins such as keratin 1, involucrin, or filaggrin expressing cells in their upper layers. The elevated expression at protein level was confirmed by immunoblotting analysis. Furthermore, calcipotriol also stimulated basal cell marker proteins such as keratin 14 and EGF receptor. However, the numbers of basal marker expressing cells within the architecture of SCC 13 raft culture were markedly reduced upon calcipotriol treatment, and their localization was mainly restricted in the innermost cell layer. In addition, calcipotriol stimulated EGF receptor biosynthesis for the first 16 hours post treatment and subsequently inhibited [3H]-thymidine incorporation of SCC 13 cells at 24 hours. In this study, we have clearly demonstrated that the long term application of calcipotriol considerably improves the complex defects in the regulation of proliferation and differentiation of SCC 13 cells, as supported by morphological and biochemical observations. This provides an evidence that calcipotriol can be applied clinically as a potent differentiation inducer in the treatment of human squamous cell carcinoma.

Dysphagia due to mediastinal tuberculous lymphadenitis presenting as an esophageal submucosal tumor: a case report

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.

Effects of preinterview suggestion on counselor memory, clinical impression, and confidence in judgments

This study examined the effects of schematic preinterview suggestion on counselors' (a) recognition memory of the information presented by the client; (b) clinical impression rating of the client; and (c) confidence in rating clinical impression. Fifty-two Master's-level counselor-trainees were assigned randomly to two conditions of preinterview suggestion about the status of the client (i.e., depression and no depression). After subjects had received appropriate preinterview information (i.e., depression or no-depression content) and had viewed a videotaped counseling interview, information was gathered from them. The results indicated that the preinterview suggestion (a) did not affect counselor-trainees' clinical impression rating of the client; (b) did not affect confidence of rating; and (c) yielded a weak, but significant, confirmatory memory. Implications for the interview setting are discussed.

Effect of intracoronary ultrasound imaging on clinical decision making

The aim of this study was to determine the effect of intravascular ultrasound (IVUS) imaging on decision making in the performance of coronary interventions. One hundred lesions were assessed in 87 patients undergoing balloon or laser angioplasty, atherectomy, stent placement, and additional diagnostic examination. Angiographically acceptable results were deemed inadequate by IVUS in 29% of angioplasties and 30% of stent deployments, and planned procedures subsequently were altered. Abnormalities commonly identified by IVUS and not by angiography were 13 coronary dissections after the procedure and 14 significant stenoses in apparently normal angiograms and significant stenoses were excluded in 7 patients with ambiguous angiograms. The apparent contribution of coronary IVUS imaging led to its significantly increased use over a 1-year period, as coronary interventional decisions on the basis of IVUS findings increased from 4 (17%) of 19 to 60 (74%) of 81. These data suggest that IVUS is a useful adjunct to angiography in selected patients for (1) identification or exclusion of dissection, (2) assessment of the adequacy of balloon angioplasty, (3) identification or exclusion of thrombus, (4) measurement of the depth of tissue removal, (5) determination of stent size and the result of stent deployment, and (6) assessment of the severity of stenoses, especially at ostial sites.

Use of a low profile Doppler angioplasty guidewire to evaluate the effect of percutaneous coronary angioplasty on coronary artery flow velocity

BACKGROUND

The intracoronary Doppler flow velocity measurement is widely used. The Doppler flow catheter, used in many studies, still cannot always measure distal portions of coronary artery stenosis. However, three years ago, a low profile Doppler angioplasty guide wire (0.018-inch) was started by apply for measurement of changes in proximal and distal flow velocity during coronary angioplasty.

METHODS

Blood flow velocity and diastolic/systolic velocity ratio (DSVR) on both proximal and distal portions of the coronary artery were measured with a low profile Doppler angioplasty guide wire in 13 patients with stenosis of the left anterior descending artery (LAD) during coronary angioplasty.

RESULTS

Non-significant improvement in maximal peak velocity was noted in the distal portion of the coronary artery immediately after angioplasty (before, 36 +/- 12 cm/s; after, 41 +/- 12 cm/s; p > 0.05); but significant improvement was found after removal of the balloon (from 41 +/- 12 cm/s to 49.5 +/- 15 cm/s, p < 0.01). Increases in proximal maximal peak velocity after angioplasty were less remarkable (before, 38.5 +/- 15 cm/s; after, 45 +/- 13 cm/s; p > 0.05), and there was a significant increase of DSVR on the distal portion of the left anterior descending artery after angioplasty (before, 2.18 +/- 0.51; after, 2.98 +/- 0.44; p < 0.05). However, there was no significant increase of DSVR on the proximal portion of LAD (before, 2.19 +/- 0.16; after, 2.44 +/- 0.1; p > 0.05). The coronary flow reserve ratio showed no significant increase on the distal portion of the LAD (before, 1.03 +/- 0.3; after, 1.02 +/- 0.3) and proximal portion of LAD (before, 1.05 +/- 0.2; after, 1.03 +/- 0.3).

CONCLUSIONS

Increase in peak velocity and DSVR of the distal portion of the coronary artery after angioplasty was more significant after removal of the balloon catheter than as if it were assessed immediately, without removing the balloon catheter. No significant increase in flow velocity of the proximal portion of the coronary artery after angioplasty was observed. No significant increase of the coronary flow reserve of the distal and proximal portion of the coronary artery occurred after successful angioplasty.

Erythema induratum with pulmonary tuberculosis: report of three cases

Three cases of erythema induratum which occurred in the patients with pulmonary tuberculosis are described. The cutaneous lesions were violaceous, indurated nodules on both lower legs above the malleoli. Histologically, tuberculoid granuloma with caseation necrosis was found in one case; necrotizing vasculitis was the prominent finding in other two cases. The erythema induratum promptly responded to antituberculous therapy. We believe that, in light of these cases, the association between erythema induratum and infection with tubercle bacilli should be re-emphasized.

Regression of left ventricular aneurysm after delayed percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction

Two weeks after acute myocardial infarction (AMI), 23 patients received delayed percutaneous transluminal coronary angioplasty (PTCA) and 14 consecutive randomized selected patients received conservative treatment as a control group. Follow up intravenous and/or intraventricular left cine-ventriculography, as well as radionuclide ejection fraction were performed 6-24 months (mean 11.2 months) after the acute phase. The results showed no significant statistical differences between the two groups for age, sex, Killip class, left ventricular end-diastolic pressure, and medication. The PTCA group showed a significant increase in radionuclide left ventricular ejection fraction, when compared to the control group (20.4 +/- 0.3 vs. 2.05 +/- 1.2; P < 0.05), as well as in the cine-global ejection fraction (32.1 +/- 0.4 vs. 3.44 +/- 1.1; P < 0.05). The dyskinetic area and volume were found also to have greater reduction in the PTCA group than in the control group (-84.7 +/- 1.2 vs. -10.5 +/- 1.1 and -86.1 +/- 1.1 vs. -15.4 +/- 0.9; P < 0.05). There were no significant changes in diastolic or systolic circumferences for both group. In conclusion, delayed PTCA after AMI can reduce the left ventricular dyskinetic area, and improve cine-global ejection fraction. Intravenous first pass left ventriculography is a safe, simple, and reproducible method for evaluating left ventricular remodeling after acute myocardial infarction.

Fractionation of fulvic acids: characteristics and complexation with copper

Two fulvic acid samples isolated from Suwannee river (International Humic Substance Society) and Feeitsuey reservoir were subjected to gel filtration chromatography (GFC) for molecular size fractionation. The GFC-eluted samples were separated into three groups corresponding to the molecular weight ranges: < 220, 220-1000, and 1000-4000. Fluorescence quenching techniques were employed for determining the conditional stability coefficient and kinetic parameters of copper complexation with the three fractions of fulvic acids. Experimental conditions were pH 6, 5 x 10(-5)m total copper and 5 mg C litre(-1) of fulvic acids. The conditional stability coefficients of the fulvic acid fractions were in the order of 0.9-3.3 x 10(5)m(-1), and the forward and reverse rate constants were in the order of 6.9-12.4 x 10(3)m(-1) s(-1) and 3.5-8.0 x 10(-2) s(-1). Information could be useful in modelling copper transport in the hydrosphere.

High intensity, low frequency catheter-delivered ultrasound dissolution of occlusive coronary artery thrombi: an in vitro and in vivo study

OBJECTIVES

This study assessed the efficacy of a new high intensity, low frequency therapeutic coronary ultrasound catheter for thrombus dissolution in vitro and in vivo in canine coronary arteries.

BACKGROUND

Therapeutic ultrasound has been shown to dissolve thrombi in vitro and in peripheral arteries in vivo. There have been no previous studies on in vivo coronary thrombus dissolution by ultrasound.

METHODS

In vitro, we exposed 1- to 4-h old human blood clots for 3 min to pulsed-wave ultrasound. Clot dissolution under various conditions was evaluated. In vivo occlusive coronary thrombi were induced in 18 dogs.

RESULTS

In vitro irrigation alone (10 ml/min of normal saline solution) and ultrasound alone each contributed to a reduction of clot weight by 47.1 +/- 11.4 mg and 84.6 +/- 25.6 mg, respectively, after 3 min (p < 0.001). Ultrasound plus irrigation resulted in a reduction of clot weight by 216.5 +/- 31.5 mg after 3 min (p < 0.001). The magnitude of clot dissolution was considerably amplified when ultrasound energy was combined with irrigation, probably because of cavitational effects. In vivo, in three dogs mechanical passage of the unactivated probe failed to recanalize the artery, and the arteries remained thrombotically occluded. After passage of the activated ultrasound probe, angiography revealed widely patent coronary arteries in 13 of 15 dogs and partial recanalization with filling defects indicative of residual thrombus in 2 of 15 dogs. Three of 15 coronary arteries were histologically free of residual thrombi. Mural thrombi extending to < or = 10% of the vessel circumference were seen in 10 of 15 dogs. Residual thrombi > or = 50% of the vessel circumference were found in two cases. There was no histologic evidence of ultrasound-mediated vessel damage.

CONCLUSIONS

Catheter-delivered therapeutic ultrasound effectively dissolves clots in vitro and in canine coronary arteries in vivo. Thus, therapeutic catheter-delivered ultrasound has the potential to serve as an adjunct or alternative treatment for thrombus-mediated coronary ischemic syndromes or myocardial infarction.

Acquired vitamin D-resistant rickets caused by aggressive osteoblastoma in the pelvis: a case report with ten years' follow-up and review of the literature

Rickets or osteomalacia secondary to tumor in either bone or soft tissue is rare and interesting in that it can be cured after removal of the tumor. The majority of the reported cases occurred in adults older than 30 years, and the most commonly associated types were vascular and fibrous tumors. We present a new case of aggressive osteoblastoma in the ilium, which induced vitamin D-resistant rickets in an 8-year, 9-month-old boy. Radiographs and blood chemistry findings on admission showed typical features of active hypophosphatemic ricketts. He underwent three local excisions of the tumor. At 10-year follow-up, the patient was symptom free but short. When a child has symptoms of rickets that develop relatively later than ordinary vitamin D-resistant rickets, every effort should be made to search out a tumorous lesion before attributing it to a renal origin.

Alteration in insulin-like growth factor-binding proteins (IGFBPs) and IGFBP-3 protease activity in serum and urine from acute and chronic renal failure

The insulin-like growth factors, IGF-I and IGF-II, are proteins that promote cellular growth and differentiation of various organs, including the kidney. These peptides interact with high affinity cell surface receptors and bind to a family of IGF-binding proteins (IGFBPs). Altered serum and urinary IGFBP patterns in children with chronic renal failure have been previously described. In this study, we evaluated serum and urinary IGFBP profiles in acute renal failure patients (ARF; n = 10) and chronic renal failure patients (n = 10), using Western ligand blots. Most patients with acute or chronic renal failure showed decreased intact serum IGFBP-3 and increased serum IGFBP-2. Both groups displayed marked urinary IGFBP alterations, including increased urinary IGFBP-1 and totally absent urinary IGFBP-3, as detected by Western ligand blot. To evaluate altered IGFBP profiles, we performed IGFBP-3 protease assays with sera and urine from renal failure patients and normal controls. Although control urine had only minor protease activity (defined by the ability to degrade [125I]IGFBP-3), significant protease activity was found in urine from renal failure patients. The proteolytic pattern and susceptibility to protease inhibitors in most renal failure urine samples were the same as those seen in normal urine and with plasmin. Protease activity was completely inhibited by serine protease inhibitors. We speculate that urinary protease activity is mediated primarily by a serine protease(s), which may be involved in the modulation of renal IGF activity in health and disease.

Development of an instrument to assess clinicians' recognition memory using a videotaped stimulus interview

This study represents the development of an instrument to assess clinicians' memory using a videotaped counseling interview. The instrument, called the Recognition Checklist (RC), consists of 60 items of information based on the content presented by the client on the stimulus tape. Initial findings indicated that this instrument has promising reliability and validity and warrants further development and application to the study of clinicians' memory of the interview process and interviewing skill training.

Chest wall implantation of carcinoma after fine needle aspiration biopsy

Implantation of malignant cells along the needle aspiration tract in patients with lung cancer is a rare but potential complication following percutaneous fine needle aspiration biopsy. Dissemination of cancer cells by aspiration biopsy can change resectable, potentially curable lung cancer to unresectable cancer. We report a 55 year male patient who underwent completion pneumonectomy due to squamous cell carcinoma and one cycle of chemotherapy. He developed outgrowing chest wall tumor at the site of needle aspiration biopsy performed prior to completion pneumonectomy and was pathologically diagnosed as metastatic squamous cell carcinoma. The lesion was successfully treated by radical full-thickness resection of the chest wall and reconstruction with latissimus dorsi musculocutaneous island flap.

Clinical implications of the erroneous use of the Verhoeff Stereopter: a case report

BACKGROUND

The Verhoeff Stereopter test is currently used by some branches of the military to evaluate depth perception for career placement. A 22-year-old male presented for consultation after failing the Verhoeff stereopter test during an examination for Marine flight training school.

METHODS

A complete vision examination was conducted. Stereopsis was evaluated using the Verhoeff Stereopter, Randot Stereotest and the Multi-stereo test.

RESULTS

A complete visual analysis revealed a mild refractive error, no ocular pathology, and normal binocularity. Stereopsis testing with the Verhoeff stereopter, Randot stereotest, and Multi-Stereo tests were normal. Subsequent investigation revealed that the original military tester did not follow proper testing protocol. When the erroneous testing condition was analyzed, we found that the stimulus horizontal disparity was eliminated. This lack of horizontal disparity makes it impossible to pass the test. We confirmed our findings by presenting the correct testing conditions and the erroneous testing conditions to five subjects with normal stereopsis. All subjects passed the Verhoeff test under standard protocols but failed under the erroneous condition. The critical factor that causes the elimination of horizontal disparity is identified.

CONCLUSION

Although this instrument is not popular among vision care practitioners, it is being utilized by various organizations. An understanding of the theoretical basis for the instrument would therefore be beneficial.

Surgical treatment of stage III lung cancer after chemotherapy and radiotherapy

We have experienced eight patients with advanced bronchogenic carcinomas who underwent resectional surgery after receiving preoperative adjuvant chemotherapy and radiotherapy during the period March, 1990, to February, 1992. Four patients were in stage IIIA and four in stage IIIB, of which six had epidermoid carcinomas and two small cell carcinomas. All patients were male with ages ranging from 48 to 73 (mean 56.7) years. The induction chemotherapy for six patients consisted of cisplatin and VP-16 (Etoposide) only, and two patients were given fluorouracil/cyclophosphamide and cyclophosphamide/adriamycin/cisplatin in addition to cisplatin/VP-16, respectively. All patients also received four to six weeks of radiotherapy following chemotherapy and were re-evaluated for the possibility of surgery after four weeks of observation. All patients underwent pneumonectomies. Postoperative histological staging revealed complete responses in two patients, partial responses in three and no response in three. Patients were followed-up for seven to 33 (mean 21.5) months after the diagnosis of lung cancer. Six patients died 1, 2, 3, 10, 14 and 26 months postoperatively and two patients are alive, revealing no evidence of tumor recurrence 24 months postoperatively. Induction therapy may induce a better resectability by the conversion of the lung cancer to a lower clinical stage by the time of surgery.

Cockayne syndrome: a case with hyperinsulinemia and growth hormone deficiency

Cockayne syndrome is a rare autosomal recessive disorder of childhood characterized by cachectic dwarfism with senile-like appearance, mental retardation, photosensitive dermatitis, loss of adipose tissue, pigmentary degeneration of retina, microcephaly, deafness, skeletal and neurologic abnormalities. We describe here an 18 year old boy with Cockayne syndrome who had, in addition to the typical features of the disorder, fasting hyperinsulinemia and growth hormone deficiency.

[Prophylactic effects of trimethoprim-sulfamethoxazole in Toxoplasma-infected mice]

This study was performed to evaluate the prophylactic effects of trimethoprim-sulfamethoxazole (TMP-SMZ) in mice experimentally infected with virulent RH strain and avirulent Beverley strain of T. gondii. The mice infected with 1 x 10(5) tachyzoites were used in the measurement of mean survival days, and the mice infected with 10 cysts were used in the titrations of specific antibodies and enumeration of brain cysts. Mean survival days of mice were significantly increased in mice treated with TMP-SMZ as compared with spiramycin-treated and untreated control group. Mean survival days and survival rates of mice were increased according to the increment of dosages, and TMP-SMZ protected 100% of mice after fifteen daily dose of 24 mg/mouse or more administered orally. Toxoplasma-specific serum IgG and IgM antibody titers were significantly lower in mice treated with TMP-SMZ than those of spiramycin-treated and untreated control group. Toxoplasma cysts were not found in mice treated with TMP-SMZ at a dose of 24 mg/mouse or more per day, but the group of spiramycin treatment and untreated controls were found in the brain from 20 days after infection. The present results revealed that TMP-SMZ can be used as a prophylactic agent against murine toxoplasmosis after intraperitoneally challenges with the virulent or avirulent strain of T. gondii.

Pulmonary leiomyoma--a case report

A 56 year old female patient was found to have a lung mass in the right upper lobe lobe during evaluation for cough and sputum. The mass had grown slightly over the past 6 months when she was admitted for an operation. Preoperative studies revealed the benign nature of the tumor, and a thoracoscopic right upper lobectomy was performed. Postoperatively, the diagnosis was histologically proven to be pulmonary leiomyoma which is a rare type of benign lung tumor.

Effect of tibial lengthening on the gastrocnemius muscle. A histopathologic and morphometric study in rabbits

We observed the changes of the gastrocnemius muscle in relation to the percentage of lengthening of the rabbit's tibia by callotasis. 75 rabbits were separated into 3 lengthening groups, 10, 20, and 30 percent lengthening, respectively. Histopathologic observations, based on the fiber size variation, internalization of the nuclei, degeneration, regeneration, and endomysial fibrosis of muscle fibers, revealed that substantial changes occurred in the latter groups. Histomorphometrically, the decrease in the mean size of Types I and II muscle fibers was observed in all lengthening groups, but there was no significant change in the proportion of the muscle fiber types in any of the lengthening groups.