Quantitative impact of pediatric sinus surgery on facial growth

OBJECTIVE/HYPOTHESIS

To quantitatively evaluate the long-term impact of sinus surgery on paranasal sinus development in the pediatric patient.

STUDY DESIGN

Longitudinal review of eight pediatric patients treated with unilateral sinus surgery for periorbital or orbital cellulitis with an average follow-up of 6.9 years. Control subjects consisted of two groups, 9 normal adult patients with no computed tomographic evidence of sinusitis and 10 adult patients with scans consistent with sinusitis and a history of sinus-related symptoms extending to childhood.

METHODS

Application of computed tomography (CT) volumetrics, a technique allowing for precise calculation of volumes using thinly cut CT images, to the study and control groups.

RESULTS

Paired Student t test analyses of side-to-side volume comparisons in the normal patients, patients with sinusitis, and patients who had surgery revealed no statistically significant differences. Comparisons between the orbital volumes of patients who did and did not have surgery revealed a statistically significant increase in orbital volume in patients who had surgery.

CONCLUSIONS

Only minimal changes in facial volume measurements have been found, confirming clinical impressions that sinus surgery in children is safe and without significant cosmetic sequelae.

Enhanced stability of laccase in the presence of phenolic compounds

The storage stability of laccase (EC 1.10.3.2) from the white-rot basidomycete Trametes versicolor in potassium-citrate buffer was enhanced by various phenolic compounds as well as by lignin sulfonate. The highest storage stability was obtained with phenolics, e.g. phloroglucin and 3,5-dihydroxybenzoic acid; these represent substrates of laccase which are oxidized slowly because of their relatively high redox potential and which did not precipitate from the solution within the tested period of time. Sterilization enhanced the stability of laccase but additional stabilization by phenolics was observed both under sterile and non-sterile conditions. We thus concluded that stabilization occurred not only through prevention of microbial degradation.

Chemoenzymatical grafting of acrylamide onto lignin

Laccase (E.C.1.10.3.2.) from white-rot basidiomycete Trametes versicolor and dioxane peroxides were essential in the copolymerization of acrylamide and a derivative with lignin in a dioxane-H(2)O (7:3) mixture. Both a solubility test and an elemental analysis of the eluted and separated fractions provided evidence of grafting. Gel permeation chromatography on Sephadex G-100 showed that the side chain and the lignin backbone migrate as one unit through the column. Copolymers obtained were characterized by UV-VIS-spectroscopy as well as FT-IR, and 13C-CPMAS-NMR spectroscopy. Freeze-dried copolymers of lignin and acrylamide appeared as homogeneous fibril-like particulate. The mechanism of the enzymatical grafting is discussed.

Phototherapeutic keratectomy combined with photorefractive keratectomy for treatment of myopia with corneal scars

To evaluate the effect of phototherapeutic keratectomy combined with photorefractive keratectomy in the treatment of myopia with corneal scars, corneal epithelium was removed with laser plus scraping. Corneal scars were removed with PTK, followed by PRK for myopia. Healon was used to make corneal surface smoother during operation. 30 eyes of 24 cases of myopia with corneal scars were followed up for one year. Mean corrected vision was 0.51 and myopic degree was -6.42 D +/- 4.26 D before operation. After operation, corneal scars of 21 eyes (70.0%) were removed in operative zone. The vision of 27 operated eyes (90.0%) was equal to or better than best corrected vision. Mean postoperative visual acuity was 0.72. Corneal surface was smoother and astigmatism was reduced after the surgery. Our study showed that PTK combined with PRK is a safe and effective treatment for myopia with corneal scars.

Selectivity of ferric enterobactin binding and cooperativity of transport in gram-negative bacteria

The ligand-gated outer membrane porin FepA serves Escherichia coli as the receptor for the siderophore ferric enterobactin. We characterized the ability of seven analogs of enterobactin to supply iron via FepA by quantitatively measuring the binding and transport of their 59Fe complexes. The experiments refuted the idea that chirality of the iron complex affects its recognition by FepA and demonstrated the necessity of an unsubstituted catecholate coordination center for binding to the outer membrane protein. Among the compounds we tested, only ferric enantioenterobactin, the synthetic, left-handed isomer of natural enterobactin, and ferric TRENCAM, which substitutes a tertiary amine for the macrocyclic lactone ring of ferric enterobactin but maintains an unsubstituted catecholate iron complex, were recognized by FepA (Kd approximately 20 nM). Ferric complexes of other analogs (TRENCAM-3,2-HOPO; TREN-Me-3,2-HOPO; MeMEEtTAM; MeME-Me-3,2-HOPO; K3MECAMS; agrobactin A) with alterations to the chelating groups and different net charge on the iron center neither adsorbed to nor transported through FepA. We also compared the binding and uptake of ferric enterobactin by homologs of FepA from Bordetella bronchisepticus, Pseudomonas aeruginosa, and Salmonella typhimurium in the native organisms and as plasmid-mediated clones expressed in E. coli. All the transport proteins bound ferric enterobactin with high affinity (Kd </= 100 nM) and transported it at comparable rates (>/=50 pmol/min/10(9) cells) in their own particular membrane environments. However, the FepA and IroN proteins of S. typhimurium failed to efficiently function in E. coli. For E. coli, S. typhimurium, and P. aeruginosa, the rate of ferric enterobactin uptake was a sigmoidal function of its concentration, indicating a cooperative transport reaction involving multiple interacting binding sites on FepA.

An analysis of 1,001 blinding patients with corneal disease in 1960-1989

PURPOSE

To investigate the condition and change of corneal blindness (CB) in the past 30 years.

METHODS

1,001 blinding patients of corneal disease were clinically analysed from 1960 to 1989, including etiology, sex, age, occupation, difference between the urban and rural areas etc.

RESULTS

The male predominated. Infection stood the first cause of blinding corneal diseases, followed by trauma, malnutrition and the others. HSV-1 keratitis was the most frequent infection in 1980s. The highest incidence of CB was 20-40 year-old. The number of CB caused by occupational trauma was more than that by ordinary trauma in 1960s, but from 1970s, the latter was more than the former. The number of CB in rural area was more than that in the urban in 1960s, but from 1970s, there was no significant difference between the two areas. The percentage of bilateral CB was gradually decreased.

CONCLUSION

We should try to find more effective strategies to prevent and treat CB caused by HSV-1 keratitis, pay special attention to preschool blindness caused by perforation injuries and avoid infection after corneal injuries of foreign bodies.

[Surgical therapy of esophageal perforation. A determination of current status based on 4 personal cases and the literature]

We present four cases of esophageal rupture (three iatrogenic, one Boerhaave syndrome) to demonstrate the difficulty in diagnosis and therapy. The current literature is discussed and conclusions are drawn as regards the modus operandi. All our patients were operated on. The site of esophageal rupture was always closed with a primary suture and substantial irrigation and drainage were performed. In two cases the suture line was in addition covered with fibrin glue or by an omentum flap, respectively. All patients survived and recovered was unremarkable. Our own results and a subsequent analysis of literature allow the following conclusions. At an early stage of esophageal rupture surgical intervention is indicated. The method of choice is primary closure of the rupture site by suture, possibly combined with a muscle or omentum flap. In cases of delayed diagnosis with advanced mediastinitis, suture of the rupture site should also be striven for. Additional coverage is advisable in these cases. Resection procedures with or without reconstruction should be done only in exceptional cases before of the high surgical risk.

[A study on histochemistry and electron microscopy of corneal nerves in experimental diabetic rabbits]

OBJECTIVE

To observe the changes of corneal nerves in diabetes mellitus.

METHODS

Alloxan-induced diabetes in rabbits was used as the experimental model. Histochemical techniques and electron microscopy were applied to examine the corneal nerves.

RESULTS

In the diabetic rabbits, from 6 weeks, the density of nerve plexus became markedly sparser, the fibers thinner and the activity of nerves lower than those of the control group. Ultrastructural changes showed swelling of axons, irregular distribution of fibril and degeneration of mitochondria of varying degree; with the progress of disease the above changes became more marked gradually.

CONCLUSION

The abnormal corneal nerve changes might be a pathologic basis for the reduction in corneal sensitivity in diabetes.

[A study on the course of corneal epithelial healing in diabetic rabbits]

OBJECTIVE

In order to approach the course of corneal epithelial healing of diabetes mellitus.

METHODS

The experimental rabbit diabetes models were produced by the injection of alloxan. The corneal epithelium of each rabbit was removed by freezing with a 6 mm diameter brass probe cooled in liquid nitrogen. The rate of corneal epithelial healing following freezing in the normal rabbit was compared to that in the diabetic one. Contrasted with the normal rabbits, the ultrastructural changes of the epithelium with and without freezing were also observed in the diabetic rabbits.

RESULTS

It is shown that there is no statistical significant difference in the overall rate of epithelial healing between the normal and diabetic rabbit. In contrast with the normal rabbit, the epithelial basement membrane of the diabetic rabbit without freezing revealed markedly thickened, and the mitochondria and glycogen particles in the epithelial cell increased. In the diabetic rabbit with freezing, the epithelial basement membrane appeared absent or discontinuous. After complete healing, the corneal epithelium was edematous in diabetic rabbit.

CONCLUSION

The abnormal basemenet membrane and edematous epithelial cell were responsible for the diabetic corneal epithelial poor healing and recurrent erosion.

Intraoperative use of mitomycin in trabeculectomy

Mitomycin (0.2 mg/ml) was applied intraoperatively to 26 glaucomatous patients (33 eyes) during conventional trabeculectomy procedure. Most of them were considered to be at high risk of surgical failure. The conjunctival flap was fornix-based in 9 patients (11 eyes). The success rate was 84.8% without any serious side effect.

Increased carbon dioxide production in two patients with malignant hyperpyrexia and its control by dantolene

Two patients with successfully treated malignant hyperpyrexia are reported. Carbon dioxide output, calculated from the respiratory minute volume and PaCO2, was found to be greatly increased in both patients. In the patient who received dantolene 7.5 mg kg-1 the carbon dioxide output decreased rapidly to normal values, whereas in the other patient carbon dioxide output remained increased for several hours.