Spontaneous resolution of an intratracheal mass: report of one case

A 14 year-old boy was investigated for a slowly resolving right upper lobe consolidation persisting for 3 months after a pneumonic episode. A flexible bronchoscopy showed a polypoid mass in the carina with extension to the right proximal bronchus. The bronchial washings study for fungus, acid-fast bacilli and polymerase chain reaction for mycobacterium were negative. A reported bronchoscopic examination 8 months later revealed no tracheal mass or subsequent stenosis. A tracheal mass in an asymptomatic and non-progressive child may be managed alternatively by repeated bronchoscopic examinations at intervals instead of immediate bronchoscopic excision or thoracotomy.

Swyer James syndrome following Mycoplasma pneumoniae pneumonia: report of one case

A previous healthy 5 year-old girl developed a right hyperlucent lung following Mycoplasma pneumoniae pneumonia 14 months before admission. Serial chest radiographs revealed a persistent right upper lobe atelectasis and gradual development of the right hyperlucent lung associated with frequent bouts of wheezing and exertional dyspnea. Physical examination showed markedly decreased breathing sounds in the right hemithorax with fine inspiratory crackles and expiratory wheezes. A diagnosis of Swyer James syndrome was confirmed by the exclusion of other causes of unilateral hyperlucent lung using computed tomographic scans of chest, fiberoptic bronchoscopy and lung perfusion scintigraphy. She has been followed up at our hospital using anti-asthmatic medication.

Middle cerebral artery occlusion after recent Mycoplasma pneumoniae infection

Stroke is a rare complication of Mycoplasma pneumoniae infection although recent studies suggest that infection may be a risk factor of acute ischemic stroke. We report a 5-year-old girl who had a stroke 10 days after M. pneumoniae infection. This is the first case of documented middle cerebral artery occlusion after Mycoplasma infection in children. In this article, we review other published reports on this topic and discuss the possible underlying mechanisms of the middle cerebral artery occlusion.

Origin of third-order optical nonlinearity in Au:SiO(2) composite films on femtosecond and picosecond time scales

Three sorts of probe laser, which have pulse durations of 200 fs, 35 ps, and 70 ps, were employed in the measurement of the third-order nonlinear optical susceptibility x((3)) in Au:SiO(2) composite films in a degenerate four-wave mixing scheme. We found that the composite films at their absorption peak (~550 nm) had a maximum x((3)) , which depends strongly on the pulse width of the probe laser. The value of x((3)) measured with a 70-ps laser was ~30 times larger than that measured with a 200-fs laser. The time-resolved measurements revealed that the optical nonlinearity on the femtosecond time scale is attributable mainly to contributions from the interband electric-dipole transition (especially at low concentrations) and partly to those from hot electrons rather than being dominated by hot-electron excitation in the picosecond regime.

Intracranial stenosis in Chinese patients with acute stroke

We studied 100 consecutive acute stroke patients in a Chinese population with transcranial Doppler and CT. Twenty patients had intracerebral hemorrhage and 14 patients did not have adequate temporal windows for transcranial Doppler examination. Among the remaining 66 patients, 22 patients (33%) had intracranial occlusive diseases and 3 (6%) had extracranial carotid stenosis. Our data showed that intracranial occlusive disease is the most commonly found vascular lesion in our acute stroke patients.

Hemoptysis in children

BACKGROUND

Hemoptysis is rare in children, yet is one of the most frightening manifestations of cardiopulmonary disease. A wide spectrum of diseases has been reported to cause hemoptysis in children, but the search for a specific cause can be tedious and unrewarding. Early diagnosis and interventions of hemoptysis are extremely important for the successful management of this potentially lethal process in children.

METHODS

From July 1994 to June 1996, 15 pediatric patients ranging from 1 month to 15 years of age were admitted to the Pulmonology division for the investigation of hemoptysis. We retrospectively reviewed the clinical records and diagnostic evaluations of these patients.

RESULTS

Six (40%) of the patients investigated were infectious in origin, only one patient had tuberculous infection. Three patients had a traumatic cause and 2 patients had foreign bodies in the airway. Two cases had no obvious contributing cause of hemoptysis despite extensive investigations. One patient had hematemesis because bleeding from esophageal ulcerations was misinterpreted as hemoptysis. One patient had varicosed tracheal and bronchial collaterals causing massive hemoptysis due to portal vein obstruction and hypertension.

CONCLUSION

Pulmonary infection was the leading cause of hemoptysis in the 15 children we studied, but Mycobacterium tuberculosis is an uncommon causative agent. Bronchoscopy is an extremely useful tool for the diagnosis and localization of hemoptysis. Hematemesis may be misinterpreted as hemoptysis, particularly when an accurate history is not possible in children, therefore, bleeding from the upper aerodigestive tract should be studied meticulously and excluded adequately using endoscopy.

Demonstration of tracheal bronchus associated with tracheal stenosis using direct coronal computed tomography

A 2-year-old boy presented with chronic wheezes and was refractory to medical treatment. A high carina with bilateral bronchial stenosis was erroneously diagnosed by bronchoscopic examination. Serial direct coronal computed tomographic scans showed a displaced right upper lobe tracheal bronchus associated with tracheal stenosis below the abnormal bronchus. A direct coronal computed tomographic scan of the tracheobronchial tree is a useful imaging technique for the delineation of airway configuration when the bronchoscope fails to pass beyond a stenotic region. A coronal computed tomographic scan may make invasive tracheobronchography unnecessary.

Dichotomizing stroke outcomes based on self-reported dependency

Patients participating in a clinical trial of stroke therapy were assessed 3 months after randomization using the Barthel Index, the Modified Rankin Scale, questions on activities of daily living, and extent of recovery. Those who needed help in performing the activities of daily living and had not recovered completely were classified as dependent. Self-reported dependency had a sensitivity of 94% and specificity of 80% against the Barthel Index dichotomized at 16 or below, or a sensitivity of 85% and specificity of 87% against the Modified Rankin Scale dichotomized at 2 or above.

Perforated leiomyosarcoma of Meckel's diverticulum

Two cases of perforated leiomyosarcoma of Meckel's diverticulum are presented. There are only 59 cases reported in current literature, including 4 perforations. Although the condition is rare, leiomyosarcoma is the commonest tumour of Meckel's diverticulum. Its clinical presentation include abdominal pain, intestinal bleeding, abdominal mass, intestinal obstruction and less commonly, acute perforations. Both our cases presented with perforations which is unusual. Despite this late presentations both were resectable and both had no distant or local metastasis. One of our patients was 89 years old at presentation and has been disease-free 3 years after resection. The other patient was 69 years old and has also been disease-free.

Fatal Haemophilus influenzae pneumonia: two cases report

Haemophilus influenzae is a common cause of acute childhood pneumonia. Most Haemophilus pneumonia generally follow a benign course with occasional complications of pleural effusion, pneumothorax or pneumatocele. Deaths following invasive Haemophilus pneumonia have rarely been reported in children older than 3 years of age. We report 2 deaths in children presenting with fulminant pneumonia, complicated by sepsis and adult respiratory distress syndrome despite vigorous antibiotic therapy and full resuscitative measures.

Efficient visible femtosecond optical parametric generator and amplifier using tilted pulse-front pumping

Using pulses with tilted pulse fronts to compensate for the group-velocity mismatch in three-wave interactions, we constructed an efficient 400-nm pumped femtosecond collinear typeI phase-matched beta -barium borate optical parametric generator and amplifier. The signal and idler outputs are tunable from 470nm to 2.7 microm and have pulse widths in the range of 100170fs at a 1-kHz repetition rate. A maximum output energy of 6.5 microJ and a total conversion efficiency of more than 15% were achieved.

Kilohertz femtosecond UV-pumped visible beta-barium borate and lithium triborate optical parametric generator and amplifier

We demonstrate optical parametric generation and amplification of femtosecond pulses in the entire visible range using type-I phase-matched beta-barium borate and lithium triborate crystals pumped by the frequency-doubled output of a Ti:sapphire regenerative amplifier at 395 nm. The output is tunable from 470 to 770 nm with a pulse width of ~170 fs at a repetition rate of 1 kHz and a maximum output energy of ~1.1 muJ/pulse. The visible optical parametric amplifier output was then frequency doubled and sum frequency mixed with the fundamental output of Ti:sapphire at 790 nm to produce UV pulses with a conversion efficiency of greater than 25%. The second harmonic generated UV pulses are tunable from 240 to 380 nm with a maximum pulse energy of ~260 nJ/pulse.

Early echo-guided percutaneous aspiration of peripheral lung abscesses in children: report of two cases

A 9 year-old boy and a 7 year-old girl suffered from fever and chest pains before they were brought to Chang Gung Children's Hospital. Chest radiographs and computed tomography scans showed lung abscesses with pleural attachment, and using echo-guidance, percutaneous aspirations were done which confirmed the growth of Fusobacterium sp, and Veillonella parvula respectively, both of which are susceptible to penicillin G. The fever and chest pains subsided within 24 hours after the procedure. We suggest using early percutaneous aspiration of peripheral located lung abscesses soon after admission, rather than after a 10-14 day trial of antibiotic therapy: it can be a safe and cost-effective procedure to shorten the duration of the parenteral antibiotic treatment and hospitalization.

Vascular lesions in Chinese patients with transient ischemic attacks

We studied 96 Chinese patients with TIAs using transcranial Doppler and duplex ultrasonography. We found intracranial stenosis or occlusion in 51% of cases and extracranial disease in 19% of cases. The most common intracranial lesion was stenosis of the terminal internal carotid artery or proximal middle cerebral artery, whereas the most common extracranial lesion was stenosis of the carotid bifurcation.

Sodium salicylate decreases intracellular ATP, induces both heat shock factor binding and chromosomal puffing, but does not induce hsp 70 gene transcription in Drosophila

Sodium salicylate has long been known to be an inducer of the heat shock puffs and presumably heat shock gene transcription in the polytene chromosomes of Drosophila salivary gland cells. Stress-induced transcription of the heat shock genes is mediated by the transcription factor known as Heat Shock Factor (HSF). In yeast, sodium salicylate has been reported to induce the DNA binding of HSF but not heat shock gene transcription itself, and similar findings have been reported in human cells. This apparent discrepancy in the induction of certain aspects of the heat shock response between these organisms prompted us to carefully reexamine the induction of the heat shock response in Drosophila salivary gland cells of third instar larvae and Drosophila tissue culture (SL2) cells. Sodium salicylate (3-30 mM) decreases intracellular ATP levels in SL2 cells and induces HSF binding activity in SL2 and salivary gland cells in a dose-dependent manner. Despite the induction of HSF binding and heat shock puffs in polytene chromosomes, we found no evidence for increased hsp 70 gene transcription suggesting that chromosomal puffing and gene transcription may be separable events. Salicylate did not induce the HSF hyperphosphorylation that is normally associated with HSF activation. Furthermore, salicylate (30 mM) prevented heat-induced hyperphosphorylation of HSF and hsp 70 gene transcription indicating that salicylate's inhibitory effect on hsp 70 transcription may be independent of its effect on HSF binding activity. We propose that the reduction in intracellular ATP caused by the addition of salicylate likely plays a role in the activation of HSF binding and the inhibition of both HSF hyperphosphorylation and hsp 70 gene transcription.

Bacterial tracheitis: a case report

An 18-month-old girl was brought to the emergency room of Chang Gung Children's Hospital with inspiratory stridor, suprasternal retractions and imminent respiratory failure. Despite orotracheal intubation, persistent poor air-entry was noted. Flexible bronchoscopy via the endotracheal tube showed a copious amount of mucopurulent secretions in the tracheobronchial tree without any foreign bodies. With vigorous suctioning and antibiotic treatment, she had a rapid recovery. Tracheal aspirates showed a growth of Haemophilus influenzae. Cefamandole was used with good response. In conclusion, although bacterial tracheitis is an uncommon obstructive upper airway disease in children, using a bronchoscope to diagnose and to guide specific therapy can decrease the morbidity and mortality.

Termination of second trimester pregnancy with gemeprost and misoprostol: a randomized double-blind placebo-controlled trial

A prospective randomized double-blind placebo-controlled trial was conducted in 70 subjects to determine whether pre-treatment with misoprostol could facilitate termination of second trimester pregnancy by gemeprost. The women received either 400 micrograms oral misoprostol or placebo tablets 12 hours before the administration of vaginal pessary of gemeprost 1 mg every 3 hours. There were no significant differences in induction-abortion interval and the amount of gemeprost required between the misoprostol and the placebo group. There was no significant difference in the incidence of side effects or analgesic requirement between the two groups. We conclude that oral misoprostol is not useful in facilitating termination of second trimester pregnancy by gemeprost.

Variability of magnetic resonance angiography and computed tomography angiography in grading middle cerebral artery stenosis

BACKGROUND AND PURPOSE

Magnetic resonance angiography and computed tomography angiography are new, noninvasive methods to provide images of the cerebral vasculature. The reliability of magnetic resonance angiography and computed tomography angiography when used to grade middle cerebral artery stenosis remains to be established. We sought to study the interobserver and intraobserver variabilities of magnetic resonance angiography and computed tomography angiography in grading middle cerebral artery stenosis.

METHODS

A total of 50 middle cerebral arteries in 25 patients were studied with magnetic resonance angiography and computed tomography angiography. All patients had a history of ischemic stroke. The films were read independently by two observers on separate occasions. Films were shown again to the same observer 4 weeks after the first reading. The degree of middle cerebral artery stenosis was categorized into four grades: normal/mild, moderate, severe, and occluded. The interobserver and intraobserver variabilities were calculated by the kappa statistic method.

RESULTS

Interobserver variability for grading middle cerebral artery stenosis was good (kappa = 0.78) for magnetic resonance angiography and moderate (kappa = 0.51) for computed tomography angiography. There was perfect agreement between two observers in 86% of the vessels shown in magnetic resonance angiography and in 76% of the vessels shown in computed tomography angiography. Intraobserver variability for both imaging methods was good, with the kappa value in the range of 0.70 to 0.76.

CONCLUSIONS

Our results suggest that according to our protocol, magnetic resonance angiography is more reliable than computed tomography angiography in grading middle cerebral artery stenosis.

Congenital anomalies following maternal varicella infection during early pregnancy

We report a typical case of congenital varicella syndrome following a maternal varicella infection during the 10th week of pregnancy. The presenting symptoms in the small gestational age baby were: cicatricial skin lesion, Horner's syndrome,dysphagia with resulting aspiration pneumonia and delayed developmental milestones. Serologic studies revealed persistence of varicella zoster virus IgG for at least 10 months. Although congenital varicella syndrome is rare, it should be kept in mind when counseling families where maternal varicella infection has occurred during the first 20 weeks of gestation. A maternal history of varicella infection, typical manifestations and serologic proof are crucial in the diagnosis of congenital varicella syndrome.

Evaluation of chronic atelectasis in children using chest computed tomography and bronchoscopy

A heterogeneous group of 11 children with atelectasis persisting longer than one month were investigated for the causes using chest computed tomography and fiberoptic bronchoscope. Four young infants had right upper lobe (RUL) posterior segmental atelectasis simulating RUL lobar collapse in plain chest films; all had only two visible segmental bronchi by bronchoscopic examination. Intraluminal obstruction in the central airway was not a common cause of pediatric chronic atelectasis in this small series of patients. Only one obstructive atelectasis caused by dilated pulmonary arteries was detected in this study. Two patients with pre-existing neuromuscular diseases showed multiple atelectasis. The atelectatic lobes do not spontaneously re-inflate following flexible bronchoscopy. Investigations involving a larger number of cases are needed to substantiate the etiologies and to guide specific therapy for those children with chronic atelectasis.

Femtosecond time-resolved Z-scan investigations of optical nonlinearities in ZnSe

Degenerate (single-color) and nondegenerate (two-color) time-resolved Z-scan techniques, with femtosecond time resolution,have been implemented to measure the magnitude and dynamical processes of the optical nonlinearities of ZnSe. In the time-resolved Z-scan spectra a reversal of sign in the refractive-index change Deltan as a function of time delay was observed. A bound electronic contribution with a resolution limited response s,200 fs) gave rise to a positive Deltan at zero time delay, whereas a free-carrier contribution resulted in a negative Deltan at longer time delays. The free-carrier contribution to Deltan has two initial rapid relaxation components with time constants of a few picoseconds and a few tens of picoseconds, respectively. The longlived carriers also contributed to a slow relaxation component in Deltan on a nanosecond time scale.

Low-molecular-weight heparin for the treatment of acute ischemic stroke

BACKGROUND

Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months.

RESULTS

A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high-dose group, 53 patients (52 percent) in the low-dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days.

CONCLUSIONS

For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.

Congenital tracheal stenosis: report of six cases

We experienced six cases of congenital tracheal stenosis during a 3 years' period from October 1991 to September 1994 in Chang Gung Children's Hospital, Taiwan. The presenting symptoms of congenital tracheal stenosis varied from acute obstructive upper respiratory episodes in young childhood, stridor and wheezing since birth, recurrent bronchiolitis, difficult to intubate with endotracheal tube. Although bronchoscopy was diagnostic, but further imaging studies without anesthesia were equivocal. In spite of pericardial patch-tracheoplasties, the two cases undergoing surgery expired. During follow-ups, the remaining four patients suffered from persisting noisy respiration by conservative management.

Spiral computed tomography angiography in the assessment of middle cerebral artery occlusive disease

There has been no report on the use of spiral computed tomography angiography (CTA) in the investigation of intracranial cerebral artery stenosis. A prospective pilot study was conducted to investigate the feasibility of CTA in the diagnosis of intracranial occlusive disease and its correlation with transcranial Doppler. With transcranial Doppler, 10 patients with acute ischaemic stroke with middle cerebral artery stenosis or occlusion were identified. There were seven middle cerebral artery stenoses and five middle cerebral artery occlusions. The CTA confirmed all diagnoses by transcranial Doppler except in one patient with middle cerebral artery occlusion in whom the embolus had probably propagated. The results showed that CTA is feasible and potentially useful in the diagnosis of middle cerebral artery occlusive disease. Further studies are required to assess its validity, sensitivity, and specificity in the diagnosis of middle cerebral artery occlusive disease.

Pediatric flexible bronchoscopy: a three-year experience

One hundred and forty-one flexible fiberoptic bronchoscopies were performed in 124 pediatric patients in Chang Gung Children's Hospital between October 1991 and September 1994. Eleven of these patients were younger than 1 month old; 52 patients were younger than 1 year old; 94 patients were younger than 6 years old. The bronchoscope used was Olympus BF 3C20; with a 3.5 mm outer diameter, it also has a build-in 1.2 mm working channel. Most of the procedures were done in the pediatric intensive care unit. Oral chloral hydrate and parenteral benadryl were given as pre-sedation medication 30 minutes before the procedures; for most cases intravenous midazolam and meperidine hydrochloride were given immediately before the examination. The most common diagnoses were laryngomalacia, airway foreign bodies, subglottic stenosis or tracheal stenosis. Six episodes of transient hypoxemia and one brief episode of apnea were encountered. It was concluded that flexible fiberoptic bronchoscopy, very useful and safe in pediatric patients, has been underused in Taiwan.

Prevalence of migraine and other headaches in Hong Kong

From July 1992 to March 1993, we conducted a community-based prevalence survey of migraine and other types of recurrent headache by a telephone interview of 2,240 households with 7,356 persons aged 15 and above. 311 patients with recurrent headache were successfully interviewed. Of these, 101 were clinically validated. The overall prevalence rates were 1% for migraine, 2% for tension-type headache and 1% for unclassified headache. Adjusted for misclassification and non-response, the estimated prevalence rates for the three categories were 1.5, 3 and 0.4%, respectively. Agreement between clinical method and questionnaire interview was good for migraine, fair for tension-type headache and poor for unclassified headache. For all three types of recurrent headache, there was a female preponderance with a peak in the 25-44 age group. The prevalence of migraine was much lower than in Western communities but higher than that found in mainland China [1-8]. Common predisposing and aggravating factors for all three types of headaches as reported by the patients were mental stress, physical exertion and menstruation among females. Despite the low prevalence, the overall socioeconomic impact to a populous community is considerable.

Response to thymectomy in Chinese patients with myasthenia gravis

Myasthenia gravis was diagnosed in 48 patients between 1985 and 1991 in this Chinese community. Thymectomy was performed on 36 patients and the mean postoperative follow-up period was 49 months. Significant improvement was seen in 72% of the thymectomised patients, with 33% achieving complete remission. Patients with mild generalised myasthenia at presentation or those found to have thymic hyperplasia had the best prognosis. Patients with more severe symptoms or those with an underlying thymoma also responded favourably. Only patients with ocular myasthenia or those with a normal or atrophic thymus gland had no more than an even chance of gaining significant improvement. Although previous reports suggested a high prevalence of ocular myasthenia and of thymoma among Chinese myasthenic patients, the present study has found no evidence that they respond differently to thymectomy than their Western counterparts.

Cyclosporin hypertension in the Wistar rat: role of uninephrectomy

1. The effects of cyclosporin A (CyA) solution (1-50 mg/kg per day), CyA powder (5-20 mg/kg per day) and vehicle, and the effects of renal mass reduction on CyA induced hypertension, were examined in conscious Wistar rats. 2. CyA solution consistently increased blood pressure at 5-20 mg/kg per day and the powder at 10-20 mg/kg per day. The vehicle had no consistent effect. 3. Both CyA solution and powder inhibited gain in bodyweight. There was no consistent effect on food intake, water intake or urine volume. Plasma sodium (Na+), and Na+ and potassium (K+) excretion were reduced by CyA 20 mg/kg per day. 4. Renal function was impaired by CyA powder at 20 mg/kg per day and plasma renin activity (PRA) was increased by all doses of CyA powder. 5. Thus, uninephrectomy did not potentiate CyA solution (5 mg/kg per day) induced increases in blood pressure and the effects of CyA do not appear to be a consequence of nephrotoxicity in Wistar rats.

Pilot study of low-molecular-weight heparin in the treatment of acute ischemic stroke

BACKGROUND

Our purpose was to assess the feasibility and risk of performing a double-blind placebo-controlled study of low-molecular-weight heparin in the treatment of acute ischemic stroke.

SUMMARY OF REPORT

Fifty-five patients were treated within 48 hours of stroke onset. Pretreatment computed tomography was performed to rule out cerebral hemorrhage. Fraxiparine (6000 IU per day) was given subcutaneously for 7 days. No adverse reaction was encountered during the treatment period. At 3 months, 26 patients were independent, 21 moderately disabled, 4 severely disabled, and 4 dead.

CONCLUSIONS

It would be safe and practical to conduct a clinical trial on the use of Fraxiparine in the treatment of acute ischemic stroke.

Adrenocorticotrophin-induced hypertension in rats. Role of progesterone and digoxin-like substances

Adrenocorticotrophin (ACTH) administration raises blood pressure in humans, sheep, and the rat. ACTH hypertension can be reproduced in sheep by combined infusion of aldosterone, 17 alpha-OH-progesterone, and 17 alpha,20 alpha-OH-progesterone, and in humans by cortisol. In the rat, ACTH hypertension is probably due to corticosterone. Progesterone treatment can prevent ACTH-induced hypertension in sheep. This study examined the ability of progesterone to antagonize the onset and development of ACTH-induced hypertension in Sprague-Dawley rats (n = 44). We also investigated the relationship of plasma digoxin-like substances (DLS) to ACTH hypertension. ACTH (0.5 mg/kg/day) significantly increased blood pressure (+24 +/- 5 mm Hg, P < .001) in association with an increase of water intake, urine output, and plasma sodium concentration, and a decrease of body weight and plasma potassium concentration. ACTH increased plasma DLS (+132 +/- 18 pg/mL, P < .01), and there was a positive correlation between DLS and blood pressure (r = 0.68, n = 22, P < .001). Progesterone (50 mg/kg/day) did not block the development of ACTH-induced hypertension in the rat. Although progesterone prevented the ACTH-induced rise in plasma sodium and glucose concentration, it did not prevent the decrease in plasma potassium concentration. The failure of progesterone to prevent ACTH-induced hypertension in the rat argues against a common "hypertensinogenic" mechanism for ACTH hypertension in sheep and rat. DLS may play a role in ACTH-induced hypertension in the rat.

Isoelectric focusing and selectivity index in IgA nephrotic syndrome

Proteinuria in 13 patients with IgA nephritis with nephrotic syndrome (IgANS) was analysed by isoelectric focusing (IEF) and compared with 12 patients with minimal change nephrotic syndrome (MCNS) (n = 8) or focal global sclerosis nephrotic syndrome (FGS) (n = 4) to determine the pattern of proteinuria on IEF and to assess the value of IEF and protein selectivity index (SI) as predictors of response to therapy with predisolone or cyclophosphamide. Steroid/cyclophosphamide responsive patients with IgANS had SC:UA (cationic serum albumin with anionic urine albumin) or SA:UC (anionic serum albumin with cationic urine albumin) IEF patterns and steroid/cyclophosphamide unresponsive patients with IgANS had an SC:UC (cationic serum albumin with cationic urine albumin) IEF pattern. The majority of patients with MCNS or FGS who had an SA:UC IEF pattern were steroid responsive. SI was a better predictor of steroid/cyclophosphamide responsiveness in patients with IgANS (r = 0.78, p < 0.002 compared to IEF, r = 0.64, p < 0.02).

7-S-glutathionyl-tryptamine-4,5-dione: a possible aberrant metabolite of serotonin

Tryptamine-4,5-dione (Compound 1) is an in vitro oxidation product of 5-hydroxytryptamine (5-HT). Recent evidence has suggested that aberrant oxidations of 5-HT occur in the central nervous system of individuals with Alzheimer's disease (AD). In the event that Compound 1 is formed as a result of oxidation of 5-HT within serotonergic nerve terminals or axons, it would be expected to be rapidly conjugated by intraneuronal glutathione (GSH) to give 7-S-glutathionyl-tryptamine-4,5-dione (Compound 2). When injected into the brains of laboratory mice, Compound 2 was lethal (LD50 = 21 micrograms) and evoked hyperactivity for the first 30 min following drug administration. Particularly during this hyperactive phase Compound 2 caused a statistically significant decrease in whole brain levels of norepinephrine and 5-HT. Levels of dopamine were also decreased while whole brain concentrations of its metabolites, 3,4-dihydroxyphenylacetic acid and homovanillic acid, were increased significantly. In the presence of GSH, NADPH and ascorbic acid, Compound 2 redox cycled in reactions that catalyzed the oxidation of these cellular reductants by molecular oxygen and formed H2O2 as a byproduct. Compound 2 also reacted with molar excesses of GSH to form more structurally complex glutathionyl conjugates. Several of these conjugates have been isolated and their structures determined using spectroscopic methods. It is conceivable that one or more of these conjugates might serve as analytical markers in a search for evidence in support of the hypothesis that aberrant oxidations of 5-HT occur in the Alzheimer brain. The redox cycling properties of Compound 2 and its facile reactions with cellular nucleophiles such as GSH may represent mechanisms that contribute to the toxicity of this drug.

Influence of somatostatin analogue (SMS 201-995, octreotide) on blood pressure in adrenocorticotrophin (ACTH) treated rats: role of hyperinsulinaemia in ACTH hypertension

1. The hypothesis that adrenocorticotrophin (ACTH)-induced hypertension is a consequence of steroid-induced hyperinsulinaemia was tested using the somatostatin analogue (sandostatin, octreotide) to inhibit insulin release in Sprague-Dawley (SD) rats (n = 41). 2. Octreotide (20 micrograms, twice daily) did not modify blood pressure, plasma glucose, bodyweight, water and electrolyte balance, or organ weights but inhibited insulin secretion in the SD rat. 3. Compared with sham injection, ACTH-treated (0.5 mg/kg per day) SD rats showed an increase in blood pressure (sham 111 +/- 4 mmHg; ACTH 140 +/- 5 mmHg on treatment day 10 (P < 0.01), organ weights, water intake, urine volume, plasma glucose, insulin and sodium concentrations, and decrease of bodyweight and plasma potassium concentration. 4. Systolic blood pressure in rats treated with combined octreotide and ACTH was similar to that in rats on ACTH alone. Plasma insulin concentration was lower in octreotide + ACTH treated rats than with ACTH treatment alone. There were no differences in body or organ weights, plasma glucose, water or electrolyte balance. 5. Octreotide lowered plasma insulin concentration to the normal range but did not modify ACTH-induced hypertension in SD rats. These data do not support the notion that insulin-mediated alterations in blood pressure are a major mechanism for ACTH-induced hypertension in the rat.

Acute mesenteroaxial gastric volvulus in an infant: a case report

Only 52 cases of gastric volvulus have been reported in children and infants. The pathophysiology of the condition relates to an abnormal rotation of the stomach. The authors report a case of an 11-month-old infant who presented with an 8-hour history of retching and obtundation. Abdominal distension and left upper-quadrant tenderness were the predominant physical findings. A diagnosis of mesenteroaxial gastric volvulus with eventration of the left hemidiaphram was made by means of plain-films and an upper gastrointestinal series. The child underwent laparotomy and gastrostomy, made a smooth recovery and was well 36 months postoperatively.

Effects of cortisol on blood pressure and salt preference in normal humans

1. Adrenocorticotrophic hormone (ACTH) and corticosteroids stimulate salt appetite in laboratory animals. The hypothesis tested was that cortisol administration increases salt preference in humans. 2. Sodium taste studies (detection and recognition thresholds, taste intensity and preference tests) were conducted before, during and after cortisol administration (200 mg/day for 5 days) in normal men on a free diet. 3. Cortisol significantly increased systolic blood pressure (SBP), 113 +/- 3 - 130 +/- 4 mmHg, P < 0.05; diastolic blood pressure (DBP), 65 +/- 3 - 81 +/- 2 mmHg, P < 0.05; mean arterial pressure (MAP), 81 +/- 2 - 97 +/- 3 mmHg, P < 0.05; and bodyweight, 72.9 +/- 3.0 - 75.4 +/- 3.3 kg, P < 0.05. 4. Salt detection and recognition thresholds, taste intensity and preference for sodium chloride were unchanged following cortisol.

Time-resolved optical tomography

We have obtained transaxial slice images of a cylindrical object containing a highly scattering, low-absorbing solution by using picosecond pulses of visible light. Embedded in the solution was an assortment of six glass tubes containing different concentrations of absorbing dye. We reconstructed images tomographically from projections generated by using light transmitted through the object with theshortest flight times.

Progressive hemifacial atrophy (Romberg's disease): skeletal involvement and treatment

Progressive hemifacial atrophy (Romberg's disease) manifests variable involvement of the skin, soft tissue and underlying cranio-facial skeleton. Significant bony deformation has been identified in those patients with early onset disease, the result of factors both intrinsic to the disease process and secondary to the abnormal environment in which the skeleton develops (functional matrix). Treatment demands combined osteotomy and augmentation of the skeleton in concert with conventional approaches to soft tissue correction.

Tracheal rupture from incorrect positioning of endotracheal tube

Significant ischaemic tracheal damage from endotracheal intubation is uncommon when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. This is facilitated by the modern endotracheal tubes with high-volume-low-pressure cuffs. We report a case of tracheal rupture due to an incorrectly positioned softcuffed tube. The need to review tube position radiologically and to make immediate adjustment cannot be overemphasised.

Time resolved imaging through a highly scattering medium

Transmission images through a highly scattering medium have been obtained using picosecond pulses of visible light. The imaging method involves recording and discriminating between the times-of-flight of photons that penetrate th medium and using a fraction of the light with the shortest travel times to construct an image. The technique is being developed as a possible alternative method of screening for breast cancer without using potentially harmful x-rays. One- and two-dimensional images are presented of objects whose optical thicknesses are comparable with those of the human breast at visible wavelengths.

Necrotizing perianal infection in children: report of two cases

Two girls aged 1 9/12 years and 5 months were treated for necrotizing perianal infection. In both patients, the necrotizing ulcers around the anus developed following an episode of diarrhea. A poor nutritional status with low body weight (25th percentile) and hypoalbuminemia (2.5 g/L) in the elder patient, as well as a hypogammaglobulinemia in the younger one, may predispose them to bacterial infection and subsequent perianal lesions. Anorectal trauma was denied. The necrotizing infection was confined to the skin and the subcutaneous tissue layer, and both patients had a benign clinical course. We report it and briefly discuss the etiology and treatment of this rare disorder.

[Idiopathic scoliosis and pneumonia complicated with cor pulmonale. Report of one case]

A 10-year-old boy with idiopathic scoliosis presented with exertional dyspnea, lower leg edema since two weeks prior to admission. Physical examination revealed neck venous engorgement, moist rales, mild hepatomegaly, ascites and lower leg edema in addition to the scoliosis. Chest x-ray films showed cardiomegaly, pulmonary congestion and pneumonic infiltration of both lower lobes with bilateral pleural effusion. Electrocardiograms showed right axis deviation and right atrial hypertrophy. Two-dimensional echocardiography revealed dilatation of the right heart chambers and pulmonary artery. He was treated initially with mechanical ventilation, antibiotics, bronchodilators, diuretics, vasodilators, and digoxin with improvement. Unfortunately the patient became comatose after an episode of cardiopulmonary arrest. He did not recover from this tragedy and was discharged against medical advice in comatose state. Scoliosis may be complicated with pneumonia and cor pulmonale in children. Early surgical correction of the scoliosis may prevent the development of cor pulmonale. Combined medical and surgical managements should be carried out aiming at scoliotic heart disease.

[Anesthetic considerations in complete obstruction of major veins of upper trunk--report of two cases]

This article presents two cases about complete obstruction of major veins of upper trunk. One was a 45 year-old woman who suffered from complete obstruction of superior vena cava due to bronchogenic carcinoma. Venous bypass grafting from left innominate vein to right atrium was performed. The other was a 41 year-old man. Both of his right and left, internal and external jugular veins were completely obstructed after radical laryngectomy and radiotherapy due to hypopharyngeal carcinoma. Venous bypass grafting from cerebral transverse sinus to right atrium was performed. In both cases, general anesthesia with neurosurgical anesthetic concepts were performed with continuous blood pressure monitoring, CVP monitoring, pulse oximetry, end-tidal CO2 monitoring, blood gas analysis, urine output and EKG monitoring. The outcome was satisfactory in both cases.

Comparative double-blinded study between mupirocin and tetracycline ointments for treating skin infections

A double-blinded study was conducted to compare the effects of mupirocin and tetracycline ointments in the treatment of skin infections. 111 patients were available for clinical assessment, of which 53 were treated with mupirocin and 58 treated with tetracycline. Clinically, both groups were improved, and there was no significant difference. Bacteriological assessment however revealed a better response to mupirocin. Staphylococcus aureus and Streptococcus pyogenes were the most common organisms isolated. 99% of Staphylococci were sensitive to mupirocin compared with 61% to tetracycline and 29% to penicillin G. 57% of Group A beta haemolytic Streptococci were resistant to tetracycline compared to 14% to mupirocin. Gram-negative organisms were mostly resistant to both preparations. No side effects were observed in both treatment groups. This study suggests that mupirocin is a safe and effective topical preparation for treating most of our common skin infections.