Anesthesia in a patient with acute respiratory insufficiency due to relapsing polychondritis

We report on a male patient with advanced relapsing polychondritis (RP), who was hospitalized for an ophthalmologic intervention. He had to undergo a tracheostomy with general anesthesia due to respiratory decompensation. RP is a rare systemic, inflammatory, and destructive disease of the cartilaginous structures leading to multiple functional disorders in the affected organs. Involvement of the tracheobronchial tract may cause severe respiratory problems and even life-threatening respiratory insufficiency. Treatment consists of corticoids, chemotherapy, antirheumatics, and surgical intervention. Anesthesiologic management requires careful preoperative evaluation of vital organ functions, in particular respiration, so that the anesthetic approach can be tailored to the individual needs of each patient.

[Proliferative myositis--a little-known pseudomalignant lesion]

The leading symptom of proliferative myositis is a rapidly growing hard tumor in the muscle. The disease is rare and therefore widely unknown. We observed a case of proliferative myositis in a 54-year-old female. We initially interpreted the hard tumor in the left musculus sternocleidomastoideus and its rapid growth as a malignant disease. The histological findings finally led to the correct diagnosis. In the light of the literature of 78 reported cases, a presumptive diagnosis can already be suspected from the clinical examination. The addition of CT scan and fine needle aspiration is highly diagnostic.

[Polychlorinated biphenyls as a cause of sterility in women?]

A total of 59 female infertile patients were investigated for the concentration of polychlorinated biphenyls (PCB) in their blood serum and follicular fluid. The average concentration of PCB in 66 related samples of follicular fluid and blood serum was 1.6 and 1.8 ng/ml, respectively. A splitting of the patients into two collectives, one with explained infertility, the other with unexplained infertility, showed no evidence of a higher PCB concentration in unexplained infertility patients. These results may exclude PCB as a primary reason for unexplained infertility.

The infratemporal fossa approach for adenoid cystic carcinoma of the skull base and nasopharynx

The infratemporal fossa approach to the skull base is an established method of treating neoplasms of this region. The type C variation has proved an effective means of removing adenoid cystic carcinoma invading the infratemporal fossa and skull base from the nasopharynx. A classification of these tumors is proposed, the surgical technique is described, and the results are given in this article.

Open laparoscopy for laparoscopic cholecystectomy

This report deals with the first 350 laparoscopic cholecystectomies performed at Creighton University, beginning in October 1989, by one of the authors (R.J.F., Jr.). An open technique was used for initial access to the abdominal cavity in 343 patients (98%). Patients included 274 females and 76 males, with an average age of 45.5 years. Weight ranged from 72 to 316 pounds (32-142.2 kg). The laparoscopic procedure was successfully completed in 338 (96.6%). Operative cholangiography was performed in 113 (32.3%), and 52 (14.7%) had acute cholecystitis as determined by the final pathological report. Median operating time was 80 min. There was no operative mortality. Bile duct injury was not seen. Postoperative complications occurred in 21 patients (6%), only two of which were directly related to the open technique (cellulitis of the umbilical wound requiring antibiotics). A third patient (0.3% of 343 successful laparoscopies) required reoperation on postoperative day 4 for a small bowel perforation; the exact cause could not be determined, but conceivably it was related to the umbilical minilaparotomy. We conclude that the open technique is safe and effective method for initial peritoneal access prior to laparoscopic cholecystectomy.

Radical mastoido-epitympanectomy with tympanoplasty and partial obliteration: a new surgical procedure?

The modern concept of an open cavity is to combine a safe with a dry, self cleansing ear. The prerequisites to achieve this goal are: the radical exenteration of the mastoid, antrum and epitympanum, the maximal reduction of the volume of the cavity by extensive lateral removal of bone and the adequate shaping of the cavity walls by obliteration of the bone pockets. To perform correctly a radical mastoido-epitympanectomy with tympanoplasty and partial obliteration is difficult and requires a perfect anatomical knowledge of the deepest regions of the temporal bone, particularly of the supralabyrinthine space. Using the technique exposed in this article, 75 out of 79 ears (95% of our revision cases) achieved a dry and self cleansing cavity at three years follow-up.

Candida endophthalmitis: clinical presentation, treatment and outcome in 23 patients

The presumptive diagnosis of Candida endophthalmitis was made in 11 intravenous (i.v.) drug addicts, seven surgical patients and five individuals with no established risk factors. It was based on the clinical symptoms with partial to total visual loss and the findings of a retinohyalitic lesion eventually affecting the entire eye. Empiric antimycotic treatment consisted of i.v. amphotericin B (average cumulative dose 1,580 mg) and i.v. or oral flucytosine (mean cumulative dose 231 g). This treatment resulted in a significant mean improvement of visual acuity from 0.15 to 0.275 during treatment and 0.55 after completion of therapy. Long-term results showed stable scar healing of the inflammatory lesions and stable to improved visual acuity. Transient side effects of treatment included anemia, thrombocytopenia and a rise of serum creatinine. Empiric antimycotic treatment of presumptive Candida endophthalmitis favourably influences the course of this infection. Regular ophthalmological examination of these patients is mandatory.

[Obstructive sleep apnea syndrome in a child with trisomy 21]

Pulmonary hypertension without any cardiovascular malformation was diagnosed by heart catheterization in a 4 year old girl with trisomy 21. A suspected obstructive sleep apnea syndrome was confirmed by polysomnography which revealed numerous obstructive apneas and hypopneas (apnea-index 23/h) with marked oxygen desaturation and a disturbed sleep pattern. Three months after adenotonsillectomy the mother reported her daughter having a quiet sleep without snoring. Polysomnography did not show any apnea nor any oxygen desaturation below 90%. A decrease of the pulmonary artery pressure was documented. Facial dysmorphias and muscle hypotonia predispose patients with trisomy 21 to obstructive sleep apnea, especially if hypertrophy of tonsills and adenoids coexist. Frequent arousals and hypoxia during sleep can result in failure to thrive and pulmonary hypertension. These consequences can be prevented by early diagnosis and treatment.

Feasibility of cellular microencapsulation technology for evaluation of anti-human immunodeficiency virus drugs in vivo

We investigated the feasibility of micro-encapsulation technology for the evaluation of anti-human immunodeficiency virus (HIV) drugs in vivo. The ability to place human cells in microcapsules with semipermeable membranes for implantation into test animals led to the development of this assay. The anti-HIV activity assay involves microencapsulating human T-lymphoblastoid cells sensitive to the cytopathic effects of HIV; the encapsulated cells are then implanted into athymic nude mice and recovered after drug treatment in vivo. A positive antiviral effect of the test substance is indicated by growth or survival of the virus-infected cells in the microcapsules. Several HIV-sensitive cell lines of T-lymphocyte, monocyte, and nonlymphocyte origin were examined for growth in microcapsules in vitro and in vivo. Light and electron microscopic analysis of the capsules and the human cells contained therein revealed the invasion of mouse immune cells and other adverse effects that could not be overcome by any of numerous technical modifications attempted. We conclude that cellular microencapsulation technology is not feasible for in vivo drug-testing protocols because of immunogenic reactions.

Differentiation of Al3+ and Al species in environmental samples by isotachophoresis

An isotachophoretic method for the determination of free [Al(H2O)6]3+ ions in different aluminium salt solutions was developed. The electrolyte system consists of 0.01 M sodium acetate (leading system) and 0.01 M tris(hydroxymethyl)amino-methane (terminating system). Separation was effected with a precapillary tube (diameter 0.05 cm) followed by a main capillary tube of length 20 cm and of smaller cross-section. The detection limit for [Al(H2O)6]3+ ions was 0.05 mg/l. The method was applied to the determination of free Al3+ ions ([Al(H2O)6]3+) in soil leachates and aqueous soil extracts.

Acidification of endosome subpopulations in wild-type Chinese hamster ovary cells and temperature-sensitive acidification-defective mutants

During endocytosis in Chinese hamster ovary (CHO) cells, Semliki Forest virus (SFV) passes through two distinct subpopulations of endosomes before reaching lysosomes. One subpopulation, defined by cell fractionation using free flow electrophoresis as "early endosomes," constitutes the major site of membrane and receptor recycling; while "late endosomes," an electrophoretically distinct endosome subpopulation, are involved in the delivery of endosomal content to lysosomes. In this paper, the pH-sensitive conformational changes of the SFV E1 spike glycoprotein were used to study the acidification of these defined endosome subpopulations in intact wild-type and acidification-defective CHO cells. Different virus strains were used to measure the kinetics at which internalized SFV was delivered to endosomes of pH less than or equal to 6.2 (the pH at which wild-type E1 becomes resistant to trypsin digestion) vs. endosomes of pH less than or equal to 5.3 (the threshold pH for E1 of the SFV mutant fus-1). By correlating the kinetics of acquisition of E1 trypsin resistance with the transfer of SFV among distinct endosome subpopulations defined by cell fractionation, we found that after a brief residence in vesicles of relatively neutral pH, internalized virus encountered pH less than or equal to 6.2 in early endosomes with a t1/2 of 5 min. Although a fraction of the virus reached a pH of less than or equal to 5.3 in early endosomes, most fus-1 SFV did not exhibit the acid-induced conformational change until arrival in late endosomes (t1/2 = 8-10 min). Thus, acidification of both endosome subpopulations was heterogeneous. However, passage of SFV through a less acidic early endosome subpopulation always preceded arrival in the more acidic late endosome subpopulation. In mutant CHO cells with temperature-sensitive defects in endosome acidification in vitro, acidification of both early and late endosomes was found to be impaired at the restrictive temperature (41 degrees C). The acidification defect was also found to be partially penetrant at the permissive temperature, resulting in the inability of any early endosomes in these cells to attain pH less than or equal to 5.3. In vitro studies of endosomes isolated from mutant cells suggested that the acidification defect is most likely in the proton pump itself. In one mutant, this defect resulted in increased sensitivity of the electrogenic H+ pump to fluctuations in the endosomal membrane potential.

A possible role for Na+,K+-ATPase in regulating ATP-dependent endosome acidification

Endosomes maintain a slightly acidic internal pH, which is directly responsible for their ability to ensure proper sorting of incoming receptors and ligands during endocytosis. At least two distinct subpopulations of endosomes can be distinguished, designated "early" and "late" on the basis of their kinetics of labeling with endocytic tracers. The subpopulations differ not only in their functions (rapid receptor recycling and transport to lysosomes, respectively) but also in their capacities for acidification in intact cells and in vitro. To investigate the possible basis for pH regulation in endosomes, we have studied the transport properties and ion permeabilities of early and late endosomes isolated from Chinese hamster ovary cells. Using endosomes selectively labeled with pH-sensitive endocytic tracers, we found that ATP-dependent acidification is electrogenic, being accompanied by the generation of an interior-positive membrane potential which opposes further acidification. While membrane potential and, consequently, acidification was controlled by the influx of permeant anions and efflux of protons and alkali cations, acidification was further modulated in Na+ and K+-containing buffers by the ouabain- and vanadate-sensitive Na+,K+-ATPase, which appears to be a functional component of the endosomal membrane. The data suggest that electrogenic Na+ transport due to Na+,K+-ATPase activity contributes to the interior-positive membrane potential, thereby reducing ATP-dependent H+ transport. Importantly, inhibition of acidification by Na+,K+-ATPase activity was found only in early endosomes, consistent with their limited acidification capacity relative to late endosomes and lysosomes.

Histology of synthetic ossicular prostheses

Thirty-three synthetic middle ear prostheses removed after two to 99 months of implantation were examined histologically. All prostheses were infiltrated by fibroblasts, capillaries, collagen fibrils, and multinucleate foreign body giant cells. Although some of the giant cells contained tiny particles of the prosthetic material, there was no evidence of erosion or engulfment of larger particles of the prosthesis or structural dissolution of the prosthesis. New histologic findings were aseptic necrosis and focal calcification in the interior of some of the prostheses.

[Histological study of the binding of Polycel and Ceravital implants to the stapes footplate in rabbits]

Five Polycel and five Ceravital implants were interposed between the stapedial footplate and the tympanic membrane in 10 rabbits. Four to 7 months later the connection of the prostheses to the stapes was histologically examined by temporal bone sections. The union of both types of prostheses to the stapedial footplate was achieved by remnants of crura, middle ear mucosa and connective tissue. Histology revealed a more stable connection of the Polycel prosthesis to the stapedial footplate.

Rapid analytical and preparative isolation of functional endosomes by free flow electrophoresis

Endosomes are prelysosomal organelles that serve as an intracellular site for the sorting, distribution, and processing of receptors, ligands, fluid phase components, and membrane proteins internalized by endocytosis. Whereas the overall functions of endosomes are increasingly understood, little is known about endosome structure, composition, or biogenesis. In this paper, we describe a rapid procedure that permits analytical and preparative isolation of endosomes from a variety of tissue culture cells. The procedure relies on a combination of density gradient centrifugation and free flow electrophoresis. It yields a fraction of highly purified, functionally intact organelles. As markers for endosomes in Chinese hamster ovary cells, we used endocytosed horseradish peroxidase, FITC-conjugated dextran, and [35S]methionine-labeled Semliki Forest virus. Total postnuclear supernatants, crude microsomal pellets, or partially purified Golgi fractions were subjected to free flow electrophoresis. Endosomes and lysosomes migrated together as a single anodally deflected peak separated from most other organelles (plasma membrane, mitochondria, endoplasmic reticulum, and Golgi). The endosomes and lysosomes were then resolved by centrifugation in Percoll density gradients. Endosomes prepared in this way were enriched up to 70-fold relative to the initial homogenate and were still capable of ATP-dependent acidification. By electron microscopy, the isolated organelles were found to consist of electron lucent vacuoles and tubules, many of which could be shown to contain an endocytic tracer (e.g., horseradish peroxidase). SDS PAGE analysis of integral and peripheral membrane proteins (separated from each other by condensation in Triton X-114) revealed a unique and restricted subset of proteins when compared with lysosomes, the unshifted free flow electrophoresis peak, and total cell protein. Altogether, the purification procedure takes 5-6 h and yields amounts of endosomes (150-200 micrograms protein) sufficient for biochemical, immunological, and functional analysis.

[Computerized tomography in the classification of hypopharyngeal and laryngeal cancers]

CT scans of 26 patients with laryngeal or hypopharyngeal carcinoma were compared with macrosections and histological slices obtained from laryngectomy specimens in order to assess the role of CT scanning in the staging of hypopharyngolaryngeal carcinoma. Of the 26 cases six could not be staged correctly without CT. Computed tomography proved particularly useful in staging medium sized carcinomas (T2/3) of the supraglottic and piriform sinus region.