Endoscopic mandibular angle surgery: a swine model

The improvement of endoscopic technology has revolutionized surgery, and endoscopy has become a trend in recent years. In plastic surgery, endoscopic release of the carpal tunnel and endoscopic face-lifting have been used clinically. However, no report has been noted that deals with the bone of the face. Using pigs as the animal model, endoscopic resection of the mandibular angles was undertaken. The result was satisfactory; it appears that it can also be effective in humans.

Pericardiocentesis and drainage by a silicon rubber line without echocardiographic guidance. Experience in 55 consecutive patients

Pericardiocentesis and drainage with a silicon rubber line were performed safely in 55 patients via the subxiphoid (80 times) or apical (1 time) approach at the bedside without echocardiographic guidance. The subxiphoid approach, which is close to the posterior of the sternum or the costal cartilage with a small acute-angle (15-30 degrees) to the parietal pericardium in front of the right ventricle, can avoid injuring the heart, liver and lungs. A line with sideholes near the distal end, which provides convenient drainage and has better histocompatibility, can be kept in place for a long period of time (1-82 days). It was also convenient to inject air, drugs or fluid through the line. There were no procedure-related serious complications or deaths. Emergency drainage with the Seldinger technique, especially for small to moderate effusions, is safe and simple.

Chromosome investigation in in vitro fertilization failure

PURPOSE

A chromosomal complement of 227 human oocytes was studied to provide information on the frequency and type of chromosomal abnormalities in oocytes failing in vitro fertilization.

RESULTS

Normal haploid chromosome complement was found in 54.6%; chromosomal abnormalities consisting of diploid sets were identified in 16.7% and aneuploidy was observed in 26%. Premature condensation of sperm chromosomes of the GI-phase was observed in 22.9% oocytes. Male infertility was correlated with an increase in the rate of aneuploidy when compared with tubal infertility. The rate of chromosome abnormalities for the oocytes recovered from women who had no fertilized oocytes was significantly higher compared to those with at least one oocyte fertilized.

CONCLUSION

A high frequency of chromosome abnormalities in unfertilized oocytes suggests that natural selection against chromosome abnormalities may occur even prior to fertilization.

Surgical treatment of axillary osmidrosis: an analysis of 343 cases

From July of 1986 to July of 1992, 343 patients have received surgery for axillary osmidrosis by partially removing skin and cellular tissue en bloc and removing the subcutaneous cellular tissue of the adjacent area. A total of 102 patients were followed for 4 months to 6 years, with an average of 32 months. The total satisfaction rate was 91 percent (93 of 102). The wound complication rate was 6.715 percent (46 of 685). There were no scar contractures or limitations of arm abduction. In this paper we emphasize three merits of our procedure. One is that partially removing the skin promises definite excision of more than half the eccrine glands which were located in the dermis of the operative field. The second merit is good exploration for undermining and defatting of the under-surface of the adjacent area. The third merit is a low wound complication rate because the width of the skin excision is less than 3 cm. Therefore, partial removal of skin and cellular tissue en bloc and the subcutaneous cellular tissue of the adjacent area is the choice for surgical treatment for axillary osmidrosis.

Conformation of CD4-derived cyclic hexapeptides by NMR and molecular dynamics

Two cyclic hexapeptides, cyclo[Ala1-D-Ala2-Ser3-Phe4-Gly5-Ser6] and cyclo[Ala1-Gly2-Ser3-Phe4-Gly5-Ser6], derived from the loop portion of the C'C" ridge of CD4, were characterized by high-resolution nmr spectroscopy and simulated annealing studies. In DMSO-d6 both of these peptides display a single conformer on the nmr time scale with two intramolecular H-bond (1<--4) stabilized beta-turns at positions 2-3 and 5-6. The nmr derived distance constraints were used in simulated annealing calculations to generate the solution structures. These structures adopt energetically comparable conformational substates that are not resolvable on the nmr time scale. In aqueous solution, the H-bond stabilized beta-turn conformation for cyclo[Ala-D-Ala-Ser-Phe-Gly-Ser] is no longer the predominant structural form. Structures generated using molecular dynamics simulations with no experimental constraints were compared with those from nmr analysis. The correlation between these two sets of structures allows the use of molecular simulations as a predictive tool for the conformational analysis of small peptides.

[Effects of phenytoin and cabamazepine on sex hormones in male patients with epilepsy: a controlled study]

We measured the levels of estradiol (E2), total testosterone (TT) and free testosterone (FT) in 24 male patients with epilepsy receiving phenytoin (DPH), 21 male patients with epilepsy receiving cabamazepine (CBZ), 23 male epileptics receiving no treatment, and in 10 healthy age-matched male controls. The FT and TT levels of the DPH group were significantly lower and higher than those of the normal control group, respectively. The E2, FT and TT of the CBZ group were all lower than those of the normal controls. The results showed the difference between DPH and CBZ in the mechanism of affecting the levels of sex hormones; therefore, the treatments should not be the same.

[Molecular cytogenetic study of Turner's syndrome with the 45, X/46,X,r(?) karyotype]

Two small marker chromosomes were identified as X-derived ring chromosomes by using the high-resolution banding technique and in situ hybridization with a radioactively labelled human X-chromosome-specific satellite DNA probe. This procedure clearly determined the origin of the marker chromosome, which had been impossible using conventional cytogenetic techniques. The clinical significance of this work is briefly discussed.

Increased renal 25-hydroxyvitamin D3-24-hydroxylase messenger ribonucleic acid and immunoreactive protein in phosphate-deprived Hyp mice: a mechanism for accelerated 1,25-dihydroxyvitamin D3 catabolism in X-linked hypophosphatemic rickets

X-Linked Hyp mice exhibit rachitic bone disease, hypophosphatemia, impaired renal phosphate reabsorption, and abnormal regulation of renal 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] metabolism. We demonstrated that phosphate deprivation of Hyp mice, but not normal littermates, elicits a dramatic fall in serum 1,25-(OH)2D levels and an increase in renal 1,25-(OH)2D3 catabolism that can be ascribed to an increase in the activity of renal mitochondrial 25-hydroxyvitamin D3-24-hydroxylase (24-hydroxylase), the first enzyme in the C-24 oxidation pathway. The present study was undertaken to elucidate the mechanism for the increase in renal 24-hydroxylase activity in phosphate-deprived Hyp mice. Phosphate deprivation of Hyp mice resulted in a 3-fold increase in the maximum velocity for 24-hydroxylase (n = 5; P < 0.001) accompanied by an increase in 24-hydroxylase immunoreactive protein relative to the level of ornithine aminotransferase. Phosphate deprivation of Hyp mice also elicited a 3-fold increase in renal 24-hydroxylase mRNA abundance relative to that of beta-actin mRNA (n = 7; P < 0.001). The increase in 24-hydroxylase mRNA was specific to the kidney and was evident as early as 1 day of the low phosphate diet. Phosphate deprivation had no effect on renal 24-hydroxylase immunoreactive protein or mRNA in normal littermates. In contrast to the abnormal 24-hydroxylase response to dietary phosphate, Hyp mice exhibited an appropriate increase in renal 24-hydroxylase mRNA and catalytic activity in response to increasing doses of 1,25-(OH)2D3. The present results demonstrate that elevated renal 24-hydroxylase activity in phosphate-deprived Hyp mice can be ascribed to an increase in the abundance of 24-hydroxylase mRNA and protein and suggest that inappropriate regulation of 1,25-(OH)2D3 catabolism in Hyp mice occurs at the pretranslational level.

Studies of anti-cataract drugs from natural sources. I. Effects of a methanolic extract and the alkaloidal components from Corydalis tuber on in vitro aldose reductase activity

The inhibitory of Corydalis tuber (Corydalis turtschaninovii Besser forma yanhusuo Y. H. Chou et C. C. Hsu) was tested on crude rat lens aldose reductase, an enzyme involved in the complications of diabetes. The methanolic extract (CM-ext) inhibited aldose reductase, while the aqueous extract (CA-ext) was ineffective. Only dehydrocorydaline, of the seven alkaloidal components isolated from CM-ext, inhibited aldose reductase. It is suggested that the inhibitory effect of CM-ext on aldose reductase may be partially attributed to dehydrocorydaline.

Renal Na(+)-phosphate cotransport in murine X-linked hypophosphatemic rickets. Molecular characterization

The X-linked Hyp mouse is characterized by a specific defect in proximal tubular phosphate (Pi) reabsorption that is associated with a decrease in Vmax of the high affinity Na(+)-Pi cotransport system in the renal brush border membrane. To understand the mechanism for Vmax reduction, we examined the effect of the Hyp mutation on renal expression of Na(+)-Pi cotransporter mRNA and protein. Northern hybridization of renal RNA with a rat, renal-specific Na(+)-Pi cotransporter cDNA probe (NaPi-2) (Magagnin et al. 1993. Proc. Natl. Acad. Sci. USA. 90:5979-5983.) demonstrated a reduction in a 2.6-kb transcript in kidneys of Hyp mice relative to normal littermates (NaPi-2/beta-actin mRNA = 57 +/- 6% of normal in Hyp mice, n = 6, P < 0.01). Na(+)-Pi cotransport, but not Na(+)-sulfate cotransport, was approximately 50% lower in Xenopus oocytes injected with renal mRNA extracted from Hyp mice when compared with that from normal mice. Hybrid depletion experiments documented that the mRNA-dependent expression of Na(+)-Pi cotransport in oocytes was related to NaPi-2. Western analysis demonstrated that NaPi-2 protein is also significantly reduced in brush border membranes of Hyp mice when compared to normals. The present data demonstrate that the specific reduction in renal Na(+)-Pi cotransport in brush border membranes of Hyp mice can be ascribed to a proportionate decrease in the abundance of Na(+)-Pi cotransporter mRNA and protein.

Anti-inflammatory activities of methanolic extract and alkaloidal components from Corydalis tuber

A methanolic extract (CM-ext) from Corydalis tuber (Corydalis turtschaninovii Besser forma yanhusuo Y. H. Chou et C. C. Hsu) has been screened for activity in experimental models of inflammation. CM-ext (200 or 500 mg/kg, p.o.) inhibited an increase in vascular permeability in mice induced by acetic acid, and reduced acute paw edema in rats induced by compound 48/80 or carrageenin. CM-ext suppressed the development of adjuvant-induced edema in arthritic rats. CM-ext and its alkaloidal components, dehydrocorydaline, d-glaucine and l-tetrahydrocoptisine inhibited compound 48/80-induced histamine release from peritoneal mast cells of rats. Since these substances from C. tuber were found to be effective in both the acute and chronic phases of inflammation, the crude drug C. tuber can be considered to exert anti-inflammatory activity.

Phalloplasty for female transsexuals with sensate free forearm flap

One of the primary goals of phalloplasty on female to male transsexuals is to void while standing. However, achieving competence of the neourethra, sensation, and rigidity of the neophallus still present a challenge. Over a 5 year period (1988-1993), 56 phalloplasties using sensate free forearm flaps were performed for 56 primary female transsexuals. The urethrocutaneous fistula rate was 38/56 and one flap totally necrosed. However, when the flap was prefabricated with a tubed graft of vaginal mucosa for the 28 cases (the later part of the series), there were less complications and a lower fistula rate within this portion of the neourethra. Although the whole procedure was time consuming, it was worthwhile and patient satisfaction was high.

[Severe acute pancreatitis and ARDS]

A survey was done in 28 cases of severe acute pancreatitis with main interest on their respiratory appearance. It was noticed that at the early stage of the disease process the patients did develop some degree respiratory disorders but they were mild in severity. Only after successful resuscitation of septic shock and its accompanying diffuse body tissue injury, then followed severe clinical respiratory failure symptom which is now known as acute respiratory distress syndrome (ARDS). ARDS in this disease usually had two phases, one immediately after the early resuscitation, which was usually 2-3 days after the disease and followed by a period of recovery of respiratory syndrome and the second ARDS phase with fulminante clinical respiratory failure usually developed 10-14 days after the disease. The reburning phase of ARDS, was clinically very serious and went together with pulmonary infections in all cases. A discussion was made in this retrospective study about all the clinical findings, the risk factors and their reasonable treatments.

Crystal structures of two cyclic pseudopentapeptides containing psi[CH2S] and psi[CH2SO] backbone surrogates

The solid state conformations of cyclo [Gly-Pro psi[CH2S] Gly-D-Phe-Pro] and cyclo [Gly-Pro psi[CH2-(S)-SO]Gly-D-Phe-Pro] have been characterized by X-ray diffraction analysis. Crystals of the sulfide trihydrate are orthorhombic, P2(1)2(1)2(1), with a = 10.156(3) A, b = 11.704(3) A, c = 21.913(4) A, and Z = 4. Crystals of the sulfoxide are monoclinic, P2(1) with a = 10.662(1) A, b = 8.552(3) A, c = 12.947(2) A, beta = 94.28(2), and Z = 2. Unlike their all-amide parent, which adopts an all-trans backbone conformation and a type II beta-turn encompassing Gly-Pro-Gly-D-Phe, both of these peptides contain a cis Gly1-Pro2 bond and form a novel turn structure, i.e., a type II' beta-turn consisting of Gly-D-Phe-Pro-Gly. The turn structure in each of these peptides is stabilized by an intramolecular H bond between the carbonyl oxygen of Gly1 and the amide proton of D-Phe4. In the cyclic sulfoxide, the sulfinyl group is not involved in H bonding despite its strong potential as a hydrogen-bond acceptor. The crystal structure made it possible to establish the absolute configuration of the sulfinyl group in this peptide. The two crystal structures also helped identify a type II' beta-turn in the DMSO-d6 solution conformers of these peptides.

Iatrogenic bilateral femoral mycotic aneurysms: a case report following burns

Haemodynamic monitoring is important in severely burned patients and repeated catheterization of the arteries of these victims seems to be inevitable. We present a 46-year-old female with 54 per cent TBSA burns who suffered from bilateral femoral mycotic aneurysms due to repeated arterial punctures.

Conformations of psi [CH2NH] pseudopeptides. Cyclo[Gly-Pro psi [CH2NH]Gly-D-Phe-Pro]-TFA and cyclo[Gly-Pro psi [CH2NH]Gly-D-Phe-Pro]

The cyclic pseudopentapeptide cyclo[Gly-Pro psi [CH2NH]Gly-D-Phe-Pro] and its TFA salt were synthesized by solution methods, and their conformations were studied by NMR spectroscopy in both DMSO-d6 and CDCl3. While intramolecular hydrogen bonding is observed with some conformers, the nature of the solvent and the presence of TFA affects the relative structural rigidities of the compounds. No evidence was found for the psi [CH2NH] or psi [CH2NH2+] units acting as H donors in this series.

[Rapid screening of the Duchenne muscular dystrophy gene deletion by two multiplex PCR]

Duchenne muscular dystrophy (DMD) is one of the most common lethal X-linked disorders. Partial intragenic deletions account for up to 60% of DMD deletions, and approximately one-third of all cases arise via new mutations. In this paper, two sets of primers were used for two multiplex PCR screenings of DMD gene deletions. The first set consists of 5 pairs of primers which amplify 5 exons with higher deletion frequencies, and the second set includes other 4 pairs of primers. Fifty-one DMD samples were screened by the first set, and then those not found to have deletions were screened by the second set. In total, 25 deletions were identified in the Fifty-one DMD samples: That is, about 49% of all cases studied were found to have deletions.

Hypotensive and bradycardiac responses to reflex sympathetic inhibition produced by nitroglycerin in rats with sinoaortic deafferentation

Nitroglycerin (NTG) may cause paradoxical bradycardia and occasional life-threatening hypotension. The mechanism is unclear. In this study, we compared the cardiovascular responses of sodium nitroprusside (SNP) with that of NTG in rats with sinoaortic deafferentation (SAD). Intravenous (i.v.) injection of SNP and NTG produced dose-dependent decreases in mean arterial pressure (MAP). SNP was more effective than NTG in increasing heart rate (HR). After SAD, tachycardiac responses to i.v. SNP were abolished, but i.v. NTG caused bradycardia. SAD enhanced the hypotensive responses of both NTG or SNP after i.v. administration. The bradycardic and hypotensive effects of NTG were attenuated by either bilateral vagotomy or intracisternal (i.c.) pretreatment with 20 nmol rauwolscine, but the responses were not altered by i.v. atropine methylbromide (M-atropine), 0.6 mumol. In contrast, cardiovascular responses to i.v. SNP after SAD were not altered by these pretreatments. Tachycardiac responses to intracerebroventricular (i.c.v.) injection of NTG were reduced by SAD, but SAD did not alter bradycardic responses to i.c. injection of NTG. These results suggest that NTG induces inhibitory reflexes that may contribute to its complex cardiovascular responses in rats. The drug may stimulate peripheral sensory receptors with vagal afferents to the medulla, which then triggers an alpha 2-adrenoceptor-mediated sympathoinhibition.

Initiation of bone regeneration in adult baboons by osteogenin, a bone morphogenetic protein

Osteogenin, and related bone morphogenetic proteins, induce endochondral bone differentiation through a cascade of events which include formation of cartilage, hypertrophy and calcification of the cartilage, vascular invasion, differentiation of osteoblasts, and formation of bone. These events have been studied in a postnatal model of bone development in rodents. Information concerning the morphogenetic potential of osteogenin in primates is a prerequisite for potential clinical application in man. The efficacy of allogeneic osteogenin in primates was investigated in both extraskeletal and skeletal sites in 19-Chacma baboons (Papio ursinus). Osteogenin was isolated from demineralized baboon bone matrix and purified by chromatography on heparin-Sepharose, hydroxyapatite, and Sephacryl S-200. Protein fractions with a molecular mass range of 26-42 kDa induced cartilage and bone differentiation in the subcutaneous space of rats. Final purification to homogeneity was obtained by electroendosmotic elution from a preparative sodium dodecyl sulphate (SDS) polyacrylamide gel, resulting in a single band on a SDS-polyacrylamide gel with an apparent molecular mass of 30-34 kDa, with biological activity in rats. The osteoinductive potential of osteogenin in primates was tested first in intramuscular sites in baboons and found to be active. The bone regeneration potential was investigated in nonhealing calvarial defects surgically prepared in adult male baboons. Baboon osteogenin induced complete regeneration of the cranial wound. These findings in adult primates establish a primary role for osteogenin in initiation and promotion of osteogenesis, and imply a potential therapeutic application based on cell biology of extracellular matrix-cell interactions.

The critical role of geometry of porous hydroxyapatite delivery system in induction of bone by osteogenin, a bone morphogenetic protein

The collagenous extracellular matrix of bone obtained after dissociative extraction with 4 M guanidine-HCl is an optimal substratum for bone induction by osteogenin, a bone morphogenetic protein. As a proteinaceous substratum, this matrix and other collagen-based materials may be immunogenic. Thus, the search and discovery of a non-immunogenic substratum is a necessary prerequisite for the therapeutic application of the principle of bone induction to skeletal repair. Bovine osteogenin, purified greater than 50,000-fold and with an apparent molecular mass of 28-42 kilodaltons, was delivered into nonresorbable porous hydroxyapatite in granular and disc configuration. A total of 328 preparations were bioassayed for osteogenic activity by subcutaneous implantation into 164 Long-Evans rats. Specimens were harvested at day 7, 11 and 21 after implantation and subjected to alkaline phosphatase activity determination and histologic analysis. Osteogenin combined with discs of porous hydroxyapatite induced in vivo differentiation of the osteogenic phenotype in mesenchymal cells invading the three-dimensional porous space of the inorganic substratum. The geometry of the substratum had a profound influence on bone induction, since the expression of the osteogenic phenotype was solely confined in porous hydroxyapatite with disc configuration. Osteogenin did not induce bone differentiation when combined with granules of porous hydroxyapatite with identical pore dimensions. The finding that the biological activity of osteogenin can be restored and delivered by a substratum with defined geometry other than the insoluble collagenous matrix may form the basis of the potential therapeutic application of bone morphogenetic proteins.

Further studies on central actions of nitroglycerin and lack of evidence for nitroglycerin interacting on [3H]clonidine binding sites in cortex membranes

Decerebration and transection of the spinal cord totally abolished the hypotensive and tachycardiac responses to i.c.v injection of nitroglycerin (NTG) and reduced the tachycardia induced by i.v. injection of the drug. The hypotensive responses to i.v. injection of sodium nitroprusside were not altered by decerebration. Microinjection of NTG (0.1-1.0 nmol) into anterior hypothalamic medial preoptic area (AH/POA) produced dose-dependent decreases in mean arterial pressure and heart rate, but minimal responses were induced when the same doses of NTG were injected into the rostral ventrolateral medulla. Pretreatment with rauwolscine (2.5 nmol), injected into the AH/POAs, antagonized the depressor responses to NTG when it was administered into the areas or given i.v. However, rauwolscine did not alter the depressor responses induced by i.v. sodium nitroprusside. Prazosin (1.5 nmol) in the AH/POA did not alter the bradycardic effects induced by microinjection of NTG into the areas. (minus)-Epinephrine significantly interacted with alpha-2 adrenoceptor binding sites, but serotonin and NTG did not interact with [3H] clonidine binding sites in cortex membranes. Results suggest that cardiovascular responses after i.v. injection of NTG involve central and peripheral component. AH/POA is one of the central sites involved in the depressor effects of NTG. NTG-induced modulation of noradrenergic transmission appears to stimulate alpha-2 adrenoceptors in the central nervous system, but the drug does not involve direct interaction with alpha-2 adrenoceptors. Hypotensive effects of sodium nitroprusside result from its action at peripheral sites.