Solid-cystic papillary tumor of the pancreas in children

Solid-cystic papillary tumor (SCPT) of the pancreas is a rare neoplasm in children. The current study attempted to estimate the incidence and possible pathological origin of the tumor. Clinicopathologic features of the children under the age of 16 years with pancreatic tumors managed in a single institution between January 1993 and November 1999 were reviewed. Representative blocks of SCPT specimens were immunostained for neuron-specific enolase (NSE) chromogrannin, synaptophysin, insulin, glucagon, somatostatin, and gastrin. There were three SCPTs, two pancreatic endocrine tumors, and one acinar cell carcinoma during the study period. The estimated yearly incidence in the referral area of 2 million population is about 0.01 pediatric SCPT per year per 100,000 population. The children underwent surgical removal of the tumors. Postoperatively, they were followed up for 6 months to 4 years and were well. Immunostaining for NSE, chromogranin, synaptophysin, insulin, somatostatin, and gastrin was negative in all cases. SCPT may thus be the most common pancreatic tumor in the Asian pediatric population. The pathological origin of the tumor remains unclear and requires further investigations.

H-type tracheo-oesophageal fistula: appearance on three-dimensional computed tomography and virtual bronchoscopy

H-type tracheo-oesophageal fistula (TOF) is a rare type of fistula without oesophageal atresia. The symptoms are usually present at birth, but the diagnosis is often delayed. Traditionally, contrast oesophagography and/or fiberoptic bronchoscopy are used to confirm the diagnosis. We describe the imaging features of a case of H-type TOF seen on three-dimensional computed tomography and virtual bronchoscopy and the usefulness of these techniques in pre-operative evaluation.

A multi-resolution wireless force sensing system based upon a passive SAW device

Referring to the technology of SAW wireless identification systems, a multi-resolution wireless force sensing system, including a passive time-delay SAW device and a specific interrogation unit, is introduced in this paper. Using an IDT, which connects with an antenna, as the force sensing element is a design to transduce the electromagnetic wave into surface acoustic wave and vice versa. Several reflectors are designed to get multi-resolution. Sample/hold devices are used instead of high-speed A/D converter to construct a low-cost interrogation system. Properties of the sensing system are theoretically predicted and experimentally verified.

Twenty-year comparison of tissue and mechanical valve replacement

OBJECTIVE

We sought to compare outcomes with tissue and St Jude Medical mechanical valves over a 20-year period.

METHODS

Valve-related events and overall survival were analyzed in 2533 patients 18 years of age or older undergoing initial aortic, mitral, or combined aortic and mitral (double) valve replacement with a tissue valve (Hancock, Carpentier-Edwards porcine, or Carpentier-Edwards pericardial) or a St Jude Medical mechanical valve. Total follow-up was 13,390 patient-years. There were 666 St Jude Medical aortic valve replacements, 723 tissue aortic valve replacements, 513 St Jude Medical mitral valve replacements, 402 tissue mitral valve replacements, 161 St Jude Medical double valve replacements, and 68 tissue double valve replacements. The mean age was 68 +/- 13.3 years (St Jude Medical valve, 64.5 +/- 12.9; tissue valve, 72.0 +/- 12.6).

RESULTS

There were no overall differences in survival between tissue and mechanical valves. Multivariable analysis indicated that the type of valve did not affect survival. Analysis by age less than 65 years or 65 years or older and presence or absence of coronary disease revealed similar long-term survival in all subgroups. The risk of hemorrhage was lower in patients receiving tissue aortic valve replacements but was not significantly different in patients receiving mitral valve or double valve replacements. Thromboembolism rates were similar for tissue and mechanical valve recipients. However, reoperation rates were significantly higher in patients receiving both aortic and mitral tissue valves. The reoperation hazard increased progressively with time both in patients receiving aortic and in those receiving mitral tissue valves. Overall valve complications were initially higher with mechanical aortic valves but not with mechanical mitral valves. However, valve complication rates later crossed over, with higher rates in tissue valve recipients after 7 years in patients undergoing mitral valve replacement and 10 years in those undergoing aortic valve replacement.

CONCLUSIONS

Tissue and mechanical valve recipients have similar survival over 20 years of follow-up. The primary tradeoff is an increased risk of hemorrhage in patients receiving mechanical aortic valve replacements and an increased risk of late reoperation in all patients receiving tissue valve replacements. The risk of tissue valve reoperation increases progressively with time.

E. coli Rep oligomers are required to initiate DNA unwinding in vitro

E. coli Rep protein is a 3' to 5' SF1 superfamily DNA helicase which is monomeric in the absence of DNA, but can dimerize upon binding either single-stranded or duplex DNA. A variety of biochemical studies have led to proposals that Rep dimerization is important for its helicase activity; however, recent structural studies of Bacillus stearothermophilus PcrA have led to suggestions that SF1 helicases, such as E. coli Rep and E. coli UvrD, function as monomeric helicases. We have examined the question of whether Rep oligomerization is important for its DNA helicase activity using pre-steady state stopped-flow and chemical quenched-flow kinetic studies of Rep-catalyzed DNA unwinding. The results from four independent experiments demonstrate that Rep oligomerization is required for initiation of DNA helicase activity in vitro. No DNA unwinding is observed when only a Rep monomer is bound to the DNA substrate, even when fluorescent DNA substrates are used that can detect partial unwinding of the first few base-pairs at the ss-ds-DNA junction. In fact, under these conditions, ATP hydrolysis causes dissociation of the Rep monomer from the DNA, rather than DNA unwinding. These studies demonstrate that wild-type Rep monomers are unable to initiate DNA unwinding in vitro, and that oligomerization is required.

[An experimental study of effects of injection of pingyangmycin on activities of enzyme of endothelial cells]

OBJECTIVE

The objective of this study is to investigate the mechanism of acute trauma of endothelium after injection of Pingyangmycin.

METHODS

A total of 42 adult Wistar rats were divided randomly into experimental groups (24), positive control groups (12) and normal control group (6), and the rats in the experimental or the positive control groups were injected with Pingyangmycin or sodium morrhuate into the mesenteric veins respectively, and then the enzyme activity of hepatic endothelial cells and hepatocytes was examined histochemically 0.5, 1, 2, 4, 8 and 24 hours after injection.

RESULTS

After injection, the activity of 5'-nucleinase(5'-N) in hepatic endothelial cells and that of lactic dehydrogenase (LDH) and succinodehydrogenase (SDH) in hepatocytes decreased gradually, but that injected Pingyangmycin was less than that injected sodium morrhuate.

CONCLUSION

The trauma caused by Pingyangmycin is less than that caused by sodium morrhuate, but the reaction of trauma caused by both is nonspecific.

Radiation-induced progressive decreasing in the expression of reverse transcriptase gene of hEST2 and telomerase activity

OBJECTIVES

In order to identify the relationship between telomerase and the biological effect of radiation injury, and investigate the role of human telomerase catalytic subunit gene (hEST2) reverse transcriptase(RT) segment in the expression of telomerase activity.

METHODS

Tumor HeLa cells, KB cells and A431 cells were employed to measure the change in telomerase activity after 60Co-ray irradiation at RNA level and protein level. Quantitative PCR and Northern blotting were used to determine the expression of hEST2 RT segment that encodes seven motifs of the human telomeres, a PCR-based telomeric repeat amplification protocol (TRAP) was used to assay telomerase activity after exposure to radiation.

RESULTS

Both of telomerase activity and the expression hEST2 RT segment were decreased with increasing dosage of radiation. In addition, testing the expression of motifs domain is similar to the measurement of telomerase activity.

CONCLUSION

The detection of the hEST2 RT segment by Northern blotting and quantitative PCR are new methods for testing telomerase activity. Furthermore, radiation can cause a dose-dependent decrease in telomerase activity. The effect of radiation on telomerase is one possible reason for the death of cancer cells after irradiation.

Enteric nervous system, interstitial cells of cajal, and smooth muscle vacuolization in segmental dilatation of jejunum

BACKGROUND/PURPOSE

The etiology of congenital segmental dilatation (CSD) of bowel remains elusive. Intestitial cell of Cajal plays a role in the pace making of the intestine. Its abnormality has been documented in a variety of conditions of abnormal intestinal motility. The current study attempts to evaluate the roles of intestitial cells of Cajal, enteric nervous system, and smooth muscle in segmental dilatation of small bowel.

METHODS

Resected specimen from a neonate with segmental dilatation of jejunum was stained with H&E, Alcian blue, Periodic Acid-Schiff (PAS), and immunostained with S100, Ret, MAP5, and c-kit antibodies using the standard immunohistochemical process.

RESULTS

The immunostaining of S100, Ret, MAP5 and c-kit of CSD specimen were positive. Localized vacuolization was, however, detected in the circular smooth muscle of the jejunum. The Alcian blue and PAS staining of the vacuolization were negative.

CONCLUSIONS

CSD shows no abnormality in the enteric nervous system and pace makers. Localized vacuolization suggests myopathy to be a contributing factor to the disease. J Pediatr Surg 36:930-935.

Radial artery harvesting for coronary bypass operations: neurologic complications and their potential mechanisms

OBJECTIVES

We sought to determine the incidence of self-reported neurologic hand complications after radial artery harvest for coronary artery bypass grafting.

METHODS

Between February 20, 1996, and December 31, 1999, 615 patients underwent coronary bypass operations with radial arteries. A scripted telephone interview was performed, collecting data on perceived thumb weakness and sensation abnormalities in the distribution of the radial nerve in 560 patients. The average time to follow-up interview was 14.5 +/- 9 months.

RESULTS

Neurologic complications were reported in 30.1%, decreased thumb strength in 5.5%, and any sensation abnormality in 18.1% of patients. There was a high rate of symptom improvement over an average of 8.7 +/- 7.5 months, such that only 12.1% of patients reported symptoms without any improvement. Associations between thumb weakness and sensory abnormalities imply median nerve damage in some patients. There were statistically significant associations between neurologic complications and diabetes, peripheral vascular disease, elevated creatinine levels, smoking, and number and site of radial artery harvest.

CONCLUSIONS

The overall rate of self-reported neurologic complications after radial artery harvest was higher than previously reported. These symptoms may be attributable to radial and median nerve injury caused by trauma and devascularization. These data have important implications not only in attempting to improve harvesting techniques but also in guiding informed consent before coronary artery bypass grafting.

[Treatment of lumbar intervertebral disk prolapse by estradural injection of mailuoning and its influence on dynorphin A in cerebrospinal fluid]

OBJECTIVE

To explore the modulating effects of extradural injection of Mailuoning on analgesic function.

METHODS

Twenty patients of lumbar intervertebral disk prolapse were treated by extradural injection of Mailuoning, the spontaneous release of dynorphin A (Dyn-A) in cerebrospinal fluid (CSF) before and after treatment were measured and compared with that of the 20 cases in the control group to determine the therapeutic effect of Mailuoning.

RESULTS

After treatment, the concentration of Dyn-A in CSF in the treated group increased remarkably, but displayed no significant difference to normal healthy group (P > 0.05), while that in the control group there was significant difference between them (P < 0.01).

CONCLUSION

Mailuoning has the modulatory effect on analgesia function and lumbar intervertral disk prolapse was treated by means of its Dyn-A elevating action.

Ultrasound assessment of scald scars in Asian children receiving pressure garment therapy

BACKGROUND/PURPOSE

Scar formation after scald injury in children is managed commonly by application of pressure garment. The duration of the treatment depends on clinical assessment. The objective of the study was to evaluate the efficacy of the pressure garment therapy and to correlate the clinical assessment scar thickness with ultrasound measurement.

METHODS

Prospective study of children with hypertrophic scars receiving pressure garment therapy was carried out between 1993 and 1998. The scars were mapped with paper cutting. Representative scar sites were scored clinically according to Vancouver General Hospital Burn Assessment Scale (pigmentation, vascularity, pliability, height, pain, itchiness). Blind to the clinical results, 2 radiologists measured the scar thickness of the same sites with ultrasonography (5 to 10 MHz transducer, General Electric LOGIQ 500). The correlation between the clinical scores and ultrasound measurement of scar thickness were analysed using analysis of variance (ANOVA).

RESULTS

The median age of 58 children with scald injury (M:F = 36:22) was 2.8 years (0.5 to 15.8 years). The mean percentage of scald was 8.8% (24% had scald area >10%). In addition, there were 5 children with burn from naked flame and 9 children with keloid secondary to surgical incisions. With pressure garment therapy, the scar thickness reached a plateau 1 (1/2) years after the injury and began to decline gradually thereafter. The clinical estimation of scar thickness correlated well with the ultrasound measurement (ANOVA, P =.003, Adjusted R square = 0.99). The accuracy rate of clinical thickness estimation was 67%. Overestimation and underestimation accounted for 15% and 18%, respectively. There also was good correlation between total clinical score and the ultrasound measurement (ANOVA, P <.001).

CONCLUSIONS

In children with scald injury, the pressure garment needs to be continued for a minimum of 1 year. Ultrasound measurement correlates well with overall score of the Vancouver General Hospital Burn Assessment Scale but not individual components of the scoring system except wound height.

Hirschsprung's disease: a more generalised neuropathy?

BACKGROUND/PURPOSE

Aberrant neural crest migration is implicated in the pathogenesis of hindgut aganglionosis in Hirschsprung's disease (HSCR). Neural crest progenitors also give rise to a variety of cell types outside the gut, including nerves of the inner ear and peripheral nervous system. This study aims to determine whether such nerves are also affected in HSCR.

METHODS

Pure tone audiometry and oto-acoustic emission tests were performed on 53 patients with Hirschsprung's disease and 28 age-matched controls. Forty-two children with Hirschsprung's disease and 30 age-matched controls also underwent neurologic evaluation, including quantitative peripheral tests of sensory function.

RESULTS

Moderate to severe sensorineural hearing loss (1 profound [Waardenburg syndrome] and 3 high frequency) was detected in 4 children (8%) from the Hirschsprung's group. Abnormal (absent or reduced) oto-acoustic emission was detected in 77 of 102 ears (41 of 51 patients) in the HSCR group and 8 out of 48 ears (6 of 24 children) in the control group (75% v 17%; P<.0001). Two HSCR children had marked abnormalities on tests of peripheral nerve function. Significantly higher thresholds for vibration sensation were detected in HSCR versus controls (P<.05).

CONCLUSION

Hirschsprung's disease may have a more generalised neuropathy than just that involving the affected bowel.

Glycine preserves function and decreases necrosis in skeletal muscle undergoing ischemia and reperfusion injury

BACKGROUND

Glycine (GLY) is a neutral amino acid that has been shown to be cytoprotective in the kidneys of dogs and rabbits undergoing ischemia-reperfusion injury. To investigate whether GLY exhibits a protective effect on skeletal muscle subjected to ischemia and reperfusion injury, we used a well-described gracilis muscle model in canines.

METHODS

Twelve adult mongrel dogs were subjected to 6 hours of ischemia in 1 randomly selected side. The dogs were randomized into 2 groups: group 1 (6 animals) underwent 15 minutes of perfusion with 2.2% GLY, and group 2 (6 animals) underwent 15 minutes of perfusion with normal saline solution (NS) only. Both groups had normothermic reperfusion for 1 hour along with the corresponding perfusate. Muscle biopsy specimens were taken, frozen in liquid nitrogen, and stored at -70 degrees C. Muscle injury was evaluated at 48 hours by measuring weight gain (edema), maximal contractile force, and percent of muscle necrosis. Adenosine triphosphate (ATP) and phosphocreatine (Pcr) (an energy store for ATP synthesis) levels were determined by using high performance liquid chromatography.

RESULTS

In group 1, the average weight gain was 57% +/- 11.27% while in group 2 it was 100% +/- 12.48%. Maximal muscle contractile force was 712.5 +/- 68 g for group 1 and 511 +/- 27.91 g for group 2. The amount of muscle necrosis was 30 +/- 3.7% in group 1, as opposed to 63 +/- 10% in group 2. The ATP content was 0.07 +/- 0.03 nmol/mg wet tissue weight (post-ischemia with NS) and 0.21 +/- 0.08 nmol/mg wet tissue weight (post-ischemia with GLY). Pcr content was 0.19 +/- 0.04 mmol/mg wet tissue weight (post-ischemia with NS) and 0.27 +/- 0.04 micromol/mg wet tissue (post-ischemia and infused with GLY) (P <.05).

CONCLUSIONS

These data show that GLY preserves muscle function, decreases edema and the amount of muscle necrosis and preserves energy stores in this canine model. Because GLY can be safely given systemically in human beings in higher concentrations than that given in our model, as it is given in parenteral nutrition, its mechanism of action should be further investigated for its potential use in the clinical setting of ischemia and reperfusion injury.

Effects of intrinsic and extrinsic factors on the haemocyte profile of the prawn, Macrobrachium rosenbergii

The giant freshwater prawn Macrobrachium rosenbergii was investigated for its total haemocyte count (THC) based on season, sex, size and feeding rate. The THC, when the prawns were subjected to injections of foreign materials was also investigated. The prawns displayed the highest and lowest THC in autumn and winter respectively, with no significant difference between male and female, or among animals with a body weight range of 7-115 g. The prawns displayed the lowest THC at D3 stage, and the highest in C stage. The prawns displayed the lowest THC when they were fed at 0.1% feeding rate among feeding rates of 0.1%, 0.5%, 1.0% and 1.5% body weight x day(-1). Prawns injected with carbon powder and Enterococcus showed increased THC during the first 6 h. Prawns injected with saline and carbon powder had the lowest THC after 30 h, and recovered to the normal value after 54 h. Prawns injected with Enterococcus showed the lowest THC after 42 h, and showed delayed recovery.

Single strand conformation polymorphism analysis of K-ras gene mutations by capillary electrophoresis with laser-induced fluorescence (LIF) detector

Mutations of K-ras gene play an important role in neoplastic progression. The capillary electrophoresis-single strand conformation polymorphism (CE-SSCP) technique is available for the detection of gene mutations. Using an automated capillary electrophoresis with short-chain linear polyacrylamide, after denaturation of PCR products, injections were performed at reverse polarity of 5 kV for 15 s and the separations were carried out under a constant voltage of 8 kV. Of 16 specimens of lung cancer tissue, two specimens were found to have abnormal peaks in the electrophoretogram. CE-SSCP is rapid, automated, and has high performance.

Gastric electrical activity normalises in the first decade of life

AIM

Electrogastrography (EGG) is emerging as a non-invasive modality for clinical investigation, especially in children. Yet the results of EGG are influenced by many factors, including age. The objective of this study was to establish the relationship between EGG parameters and age.

METHODS

Fasting surface EGG (Digitrapper, Synectics) was recorded on 24 healthy boys. The data were analyzed using ANOVA, taking p < 0.05 as being statistically significant.

RESULTS

The age of the boys studied ranged from 1.0 to 11 years (mean = 6.0 years). The percentage of bradygastria was high, accounting for 34% of the recording. Normal rhythm increased (p = 0.013) and the bradygastria decreased with age (p = 0.026). The dominant frequency instability coefficient also decreased to a certain extent with age (p = 0.065).

CONCLUSION

Compared to the adult population, bradygastria is common in children. The EGG progressively approaches adult pattern as the enteric development matures in the first decade of life. This justifies the conservative approach in managing conditions like gastro-oesophageal reflux in young children.

Ultrasound-guided hydrostatic reduction of childhood intussusception: technique and demonstration

The authors review the technique of ultrasound-guided hydrostatic reduction of childhood intussusception and illustrate, in real-time fashion, the treatment of three cases with this technique. Two cases of successful reduction of ileocolic intussusception are demonstrated. The third case is an example of the complex fronded appearance of ileo-ileocolic intussusception and failed reduction. This technique is recommended as an alternative method for the treatment of childhood intussusception, as it does not involve ionizing radiation and is a simple and safe procedure.

Cytotoxic chemotherapy has minimal direct effect on gastric myoelectric activity in children with 5HT(3) antagonist prophylaxis

BACKGROUND

Cancer patients receiving cytotoxic chemotherapy frequently develop nausea and vomiting. The direct effect of chemotherapy on gastric pacemaker is not clear. The objective of this study was to assess the direct interference of gastric electrical activity by chemotherapeutic agents as a possible cause of vomiting using electrogastrography (EGG).

PROCEDURE

Fasting surface EGGs were recorded in 24 children with malignancy and 24 age-matched controls. All oncology patients received the intravenous prophylatic ondansetron. According to the known emetic potential of the medications they received, the children were divided into mild, moderate, and severe groups. The EGG recordings of oncology patients were segmented into prechemotherapy period, chemotherapy period, and emetic period. The EGG data from each period were collected and analyzed (paired t-test and Mann-Whitney U test).

RESULTS

There were 24 children (M:F ratio: 14:10), with a mean age of 9.6 years. Eight children vomited during the course of recording (0/3 from the mild group, 2/6 from the moderate group, and 6/15 from the severe group). The average duration of intravenous medication infusion was 7.8 hr (range 2 min to 24 hr). There was no difference between the EGG of normal control and the prechemotherapy EGG of the oncology patients. No difference was detected between the EGG data from the prechemotherapy period and the chemotherapy period. A statistically significant increase in tachygastria was detected in emetic periods (28 episodes, mean duration 5 min; P = 0.01).

CONCLUSIONS

Insignificant EGG changes during chemotherapy suggest that chemotherapy has a minimal direct effect on gastric pacemaker. Tachygastria seemed to be a secondary effect of vomiting rather than the cause of it. These preliminary findings suggest that efforts to modify gastric electrical rhythm as a means of management of chemotherapy-induced vomiting may be futile. Further studies to identify factors responsible for vomiting are warranted.

Esophageal atresia and tracheal stenosis: use of three-dimensional CT and virtual bronchoscopy in neonates, infants, and children

OBJECTIVE

The objective of this study was to evaluate the use of three-dimensional CT and virtual bronchoscopy in the treatment of neonates, infants, and children with esophageal atresia and tracheal stenosis.

CONCLUSION

Long-gap (n = 1) and short-gap (n = 5) esophageal atresia, long-segment stenosis (n = 2), patent poststenting trachea (n = 1), normal trachea without fistula (n = 1), and tracheal bronchus (n = 1) were studied. Fistulas between the lower esophagus and carina were noted in all six cases of esophageal atresia. All CT findings correlated with operative or bronchoscopy findings. Sensitivity and specificity were 100%. Three-dimensional CT and virtual bronchoscopy are accurate and useful techniques in the preoperative assessment of esophageal atresia and tracheal stenosis in neonates, infants, and children.

[Role of P53, nm23 proteins and vascular endothelial growth factor in angiogenesis and metastasis of laryngeal cancer]

OBJECTIVE

To elucidate the role of P53, nm23 proteins and vascular endothelial growth factor (VEGF) on angiogenesis and metastasis of laryngeal cancer.

METHODS

Specimens of 42 laryngeal carcinomas were studied by immunohistochemical staining for P53 protein, nm23 protein, VEGF and CD34 antibody.

RESULTS

Positive expressions of P53 protein, nm23 protein and VEGF were found in 47.6%, 57.1% and 71.42% of laryngeal cancer specimens respectively. There was a positive relationship between P53 and VEGF expression. The microvessel density (MVD) in P53- or VEGF--positive tumors was significantly higher in patients with cervical lymph node metastases than those without metastases. No correlation was identified between nm23 and VEGF staining. The MVD in nm23-negative and VEGF--positive tumors was significantly high. These phenomena were more easily found in patients with cervical lymph node metastases than in patients without metastases.

CONCLUSION

P53 gene play roles in the metastasis of laryngeal cancer through regulating VEGF expression and reacting MVD in tumor; and nm23 gene reacts through approaches other than regulating VEGF expression.

[Partial laryngectomy plus radiotherapy versus partial laryngectomy alone for laryngeal carcinoma]

OBJECTIVE

To investigate the effect of radiotherapy in the combined treatment of laryngeal cancer with partial laryngectomy.

METHODS

One hundred and seventy-one cases of laryngeal cancer were randomly separated into three groups of partial laryngectomy, partial laryngectomy with preoperative radiotherapy (dose 40-50Gy) and partial laryngectomy with postoperative radiotherapy(dose 51-70 Gy). The surgical procedures included cordectomy, vertical partial laryngectomy, horizontal partial laryngectomy and near total laryngectomy.

RESULTS

The overall 5-year survival rate was 82% (123/150). The 5-year survival rates for surgery alone group (56 cases), surgery with preoperative radiotherapy group(65 cases) and surgery with postoperative radiotherapy group(50 cases) were 85.7%, 80.7% and 79.5% respectively. There was no significant difference among the groups(chi 2 = 0.703, P = 0.704). Analysis of survival rates revealed a significant difference among the different stages(chi 2 = 12.248, P = 0.007). All 171 cases except 3 that had near total laryngectomy achieved satisfactory phonation.

CONCLUSION

Neither preoperative radiotherapy nor postoperative radiotherapy can improve the 5-year survival rate of laryngeal cancer with partial laryngectomy. All patients with partial laryngectomy got satisfactory phonation.

Regression of hypertrophy after Carpentier-Edwards pericardial aortic valve replacement

BACKGROUND

The purpose of this study was to determine whether significant regression of left ventricular hypertrophy is seen after implantation of small sizes (19 to 23 mm) of the Carpentier-Edwards (CE) pericardial valve, a stented pericardial valve.

METHODS

Echocardiograms and electrocardiograms (ECGs) were performed at least 1 year after surgery (mean 18 months) in patients with 19-, 21-, and 23-mm CE pericardial aortic valves and compared with preoperative echocardiograms and ECGs.

RESULTS

A total of 41 patients, mean age 79 +/- 9 years (range 46 to 93 years), were studied, including 7 19-mm, 22 21-mm, and 12 23-mm patients. The mean postoperative gradient was 22 +/- 7 mm Hg for 19-mm valves, 18 +/- 5 mm Hg for 21-mm valves, and 16 +/- 4 mm Hg for 23-mm valves. The postoperative valve areas were 1.1 +/- 0.3 cm2 for the 19-mm, 1.3 +/- 0.3 cm2 for the 21-mm, and 1.5 +/- 0.4 cm2 for the 23-mm valves. Left ventricular end diastolic diameter, end systolic diameter, septal thickness, and posterior wall thickness all decreased significantly (p <0.05) postoperatively. The proportion of patients with significant left ventricular hypertrophy on ECG decreased from 63% to 47% (p = 0.001). Left ventricular mass decreased significantly by echocardiography from 265 g preoperatively to 208 g postoperatively (p = 0.004). Left ventricular mass decreased for each valve size, and the greatest absolute reduction in mass occurred in the 19-mm valve recipients.

CONCLUSIONS

Implantation of the 19-, 21-, and 23-mm CE pericardial valves results in significant reductions in left ventricular mass. These findings suggest that stented pericardial valves can be used in the small aortic root without the need for aortic root enlargement procedures.

Apoptosis in murine duodenum during embryonic development

Duodenum is thought to go through a solid-core stage followed by recanalization during its development. This study investigates the role of apoptosis in normal duodenal development, especially during widening of the lumen, and hence, the possible role of apoptosis in duodenal atresia (DA). Twenty-four time-mated Sprague-Dawley rats were killed from day 13 to day 20 of gestation. Duodenums of 3 fetuses were chosen randomly from each rat and processed. Apoptosis was determined by the terminal deoxytransferase-mediated biotin dUTP nick-end labeling (TUNEL) technique (ApopTag). Apoptosis count and cross-sectional areas were measured with an image analyzer (MetaMorph). The number of apoptotic cells per unit area duodenum peaked on day 15 for the mucosal/submucosal layer and on day 14 for the muscular/mesenchymal layer. The maximal number of apoptotic cells per cross-section of duodenum was between 7 and 8. The cross-sectional areas of the duodenal wall and lumen increased exponentially between day 17 and day 19 while duodenal-wall thickness remained relatively constant throughout duodenal development. The localization, timing, and intensity of apoptosis do not suggest that apoptosis is responsible for the widening of the duodenal lumen; enlargement of the lumen is related to the increase in duodenal circumference. Apoptosis thus may not be involved in the pathogenesis of DA.

Differences in induction of p53, p21WAF1 and apoptosis in relation to cell cycle phase of MCF-7 cells treated with camptothecin

The DNA topoisomerase I (topI) inhibitor camptothecin (CPT), stabilizes so-called cleavable complexes which consist of topI covalently attached to 3' OH ends of DNA nicks. Collisions between the progressing DNA replication forks (occurring in S phase cells) or between the transcription driven RNA polymerase molecules (occurring in G1, S and G2 cells) and these complexes convert the latter into secondary DNA lesions which are unrepairable and lethal to the cell. Changes induced by CPT in the level of the tumor suppressor p53, cyclin-dependent kinase inhibitor p21WAF1 and proapoptotic protein Bax (all detected immunocytochemically), were measured separately in the nucleus and cytoplasm of individual human breast carcinoma MCF-7 cells by laser scanning cytometry (LSC) in relation to cell cycle position and induction of apoptosis. The initial transient cell arrest at the G1 checkpoint seen at 8-16 h of treatment with 0.15 microM CPT was accompanied by the rapid accumulation of p53 (preventable by cycloheximide) in the nucleus; the rise (>20-fold) in p53 was maximal for S phase cells. The magnitude of the nuclear p53 increase induced by CPT, at maximum, was 2-fold higher than that induced by the proteasome inhibitor N-acetyl-Leu-Leu-norleucinal (LLnL). While the accumulation of p53 was seen in all phases of the cycle, only G1 cells responded by induction ( approximately 60-fold increase) of p21WAF1. Inhibition of DNA replication by aphidicolin prevented the accumulation of p53 in S and G2/M but had no effect on its induction in G1 cells. Perturbation of cell progression through S phase was seen between 24-72 h of treatment, and it coincided with induction of Bax and apoptosis (both maximal in S phase cells). Thus, the changes observed in S phase cells (nuclear accumulation of p53 preventable by aphidicolin, induction of Bax, apoptosis), triggered by the collisions of DNA replication forks with the CPT-induced lesions, were distinct from the changes in G1 (nuclear p53 accumulation unaffected by aphidicolin, induction of p21WAF1) presumably triggered by collisions of RNA polymerase with the CPT-lesions. Great heterogeneity in expression of p53 and p21WAF1 of the G1 cell population in response to CPT was observed, which may reflect the intercellular variability in the rate of transcription (i.e., frequencies of collisions of RNA polymerase with the lesions). Thus, differences in the transcriptional activity of G1 cells may play a role in their sensitivity to CPT and similar topI inhibitors.

Foreign-body ingestion in children: experience with 1,265 cases

BACKGROUND/PURPOSE

This study aims to elucidate the clinical presentation, the effectiveness of investigations, and treatment of foreign body ingestion in children and to formulate an algorithm of management.

METHODS

The records of children admitted to a single institution who had a history of foreign body ingestion over 33 years were reviewed. Symptoms, radiological findings, and endoscopic findings were assessed.

RESULTS

Foreign bodies were detected in 552 (43%) of the 1,265 children admitted. The age of the children ranged from 6 months to 16 years (mean, 5.2 years). The preschool toddlers (mean age, 3.8 years) were most prone to ingest inanimate objects. The most common objects were coins (49%) and nonmetallic sharp objects (NMSO; 31%). Although x-rays could detect all the metallic objects and 86% of glass objects, the sensitivity of fish bone detection is only 26%. Absence of symptoms was common (50% in metallic group and 29% in NMSO group). Forty-one percent of coins and 95% of NMSO were lodged at sites suitable for removal by direct laryngoscopy alone with success rates of 86% and 77%, respectively. There were 3 disease-related complications and 1 mortality. Two of these children were mentally retarded and presented late.

CONCLUSIONS

Efforts for prevention of ingestion of inanimate foreign body should focus on the preschool toddler group. Particular attention should be paid to mentally retarded children with vague gastrointestinal symptoms. Absence of symptoms does not preclude presence of foreign body in children. Children with history of NMSO ingestion should undergo direct laryngoscopy despite negative radiological finding, both as a screening procedure or treatment.

Residual bladder dysfunction 2 to 10 years after acute transverse myelitis

OBJECTIVE

Acute transverse myelitis (ATM) is a relatively rare condition in children. The recovery rate is reported to be generally complete. In the current study, the long-term urological outcome of children with ATM was assessed.

METHODOLOGY

The medical records of children with ATM admitted to Queen Mary Hospital, Hong Kong, over the last 15 years, were reviewed.

RESULTS

The median age of the five children with ATM at the time of onset was 6 years (range = 2-12 years). The median length of follow up was 5 years (2-10 years). Four children recovered completely from paraparesis; two had no urinary symptoms with normal micturition. However, video-urodynamic studies 3 years after the acute onset revealed that four out of the five children, including one without any urinary symptom, suffered from residual bladder dysfunction - two from contractile neurogenic bladder and two from intermediate type of neurogenic bladder.

CONCLUSION

Residual bladder dysfunction is common in children suffering from ATM despite improvement of paraparesis and apparent lack of urological symptoms. Long-term follow up of urological function in these patients is recommended.

CT appearance of midgut volvulus with malrotation in a young infant

Computed tomography (CT) appearances of small bowel malrotation and midgut volvulus (MGV) have rarely been described in paediatric patients. We present spiral CT images of a surgically proven case in a young infant. The literature on imaging techniques to diagnose these conditions is reviewed. Radiation doses of upper gastrointestinal series (UGI) and spiral CT are estimated and compared.

Discountinuous lung sounds and hysteresis in control and Tween 20-rinsed excised rat lungs

In the past, the relationship between pulmonary hysteresis and a model of the recruitment-derecruitment of lung units has been explored (Cheng, W., DeLong, D.S., Franz, G.N., Petsonk, E.L., Frazer, D.G., 1995, Resp. Physiol. 102, 205-215). The recruitment process is characterized by a sequence of events which represents discrete configurational changes in lung structure. It is assumed that energy released during the opening of lung units is associated with the formation of discontinuous lung sounds. The goal of this study was to record tracheal sounds for lungs inflated from different end-expiratory pressures and to relate the sound power to the normalized hysteresis of individual pressure-volume (PL-VL) loops. PL-VL curves and lung sounds were recorded for control lungs and lungs rinsed with Tween 20 in order to estimate the role of alveolar surfactant on the recruitment-derecruitment process. Results indicate that there may be two populations of lung units, one which is altered by Tween 20 and another which is not. The population not affected by Tween 20 appears to be responsible for producing discrete lung sounds and may represent the opening of larger conducting airways. The second population, possibly within the respiratory zone, is affected by alterations in surface tension and contributes to pulmonary hysteresis, but, apparently, does not contribute significantly to lung sound power measured at the trachea.

Characterization of a soluble ternary complex formed between human interferon-beta-1a and its receptor chains

The extracellular portions of the chains that comprise the human type I interferon receptor, IFNAR1 and IFNAR2, have been expressed and purified as recombinant soluble His-tagged proteins, and their interactions with each other and with human interferon-beta-1a (IFN-beta-1a) were studied by gel filtration and by cross-linking. By gel filtration, no stable binary complexes between IFN-beta-1a and IFNAR1, or between IFNAR1 and IFNAR2 were detected. However, a stable binary complex formed between IFN-beta-1a and IFNAR2. Analysis of binary complex formation using various molar excesses of IFN-beta-1a and IFNAR2 indicated that the complex had a 1:1 stoichiometry, and reducing SDS-PAGE of the binary complex treated with the cross-linking reagent dissucinimidyl glutarate (DSG) indicated that the major cross-linked species had an apparent Mr consistent with the sum of its two individual components. Gel filtration of a mixture of IFNAR1 and the IFN-beta-1a/IFNAR2 complex indicated that the three proteins formed a stable ternary complex. Analysis of ternary complex formation using various molar excesses of IFNAR1 and the IFN-beta-1a/IFNAR2 complex indicated that the ternary complex had a 1:1:1 stoichiometry, and reducing SDS-PAGE of the ternary complex treated with DSG indicated that the major cross-linked species had an apparent Mr consistent with the sum of its three individual components. We conclude that the ternary complex forms by the sequential association of IFN-beta-1a with IFNAR2, followed by the association of IFNAR1 with the preformed binary complex. The ability to produce the IFN-beta-1a/IFNAR2 and IFN-beta-1a/IFNAR1/IFNAR2 complexes make them attractive candidates for X-ray crystallography studies aimed at determining the molecular interactions between IFN-beta-1a and its receptor.

Electrogastrographic changes in children who undergo day-surgery anesthesia

BACKGROUND/PURPOSE

Postoperative nausea and vomiting is common after general anesthesia. The timing of resuming oral input is arbitrary. This study aims to estimate the duration of emetic effects of general anesthesia after day surgery in children with electrogastrography (EGG).

METHODS

Children between the age of 3 and 12 years undergoing elective nonabdominal surgery were recruited. The standard anesthesia protocol of thiopentone (5 mg/kg), O2 (30%), N2O (70%), and isoflurane (1.5%) was adopted. Caudal block was applied to the patients. A laryngeal mask was used. A mobile electrogastrogram (EGG) machine (Synectic; International Medtronic Synectics, Stockholm, Sweden) was attached to the epigastrium of the patient at least 1 hour before the operation and the recording continued through the operation and for a further 2 hours after the operation. The first half hour of preoperative recording was taken as normal control period. The results were analyzed using paired t test.

RESULTS

Twenty patients who underwent circumcision under general anesthesia were studied. The mean age was 6.6 years. The mean anesthetic duration was 33.2 min. The tachygastria component (associated with nausea and vomiting) became prominent immediately after induction and returned to normal 1 half hour after cessation of general anesthesia. The dominant frequency instability coefficient of EGG (DFIC) and the dominant power instability coefficient (DPIC) peaked during the first half hour period postoperatively and returned to baseline 1 hour postoperatively (DPIC, P>.05). Bradygastria became prominent during the periods 1 half-hour before and 1 half-hour after the general anesthesia and returned to baseline 1 hour postoperatively (P<.05).

CONCLUSIONS

Significant EGG changes occur during day-surgery general anesthesia for children undergoing nonabdominal surgery. These changes return to baseline 1 hour after reversal of anesthesia. It is probably safe to restart feeding 1 hour later after day-surgery general anesthesia without causing nausea and vomiting.

[Changes of placental nitric oxide synthase in patients with pregnancy induced hypertension]

The objective of this study was to determine whether the expression of placental endothelial nitric oxide synthase (eNOS) and/or inducible nitric oxide synthase (iNOS) are changed in pregnancy induced hypertension (PIH). The placentas of 32 patients with PIH and 32 normal pregnancies were studied by immunohistochemistry (Avidin-Biotin-Complex method). The results showed there were eNOS and iNOS antigens in placental tissues from PIH and normal pregnancy. They were all localized in placental villi and syncytiotrophoblast cells. The expression of placenta eNOS decreased significantly in patients with PIH as compared with that of normal pregnancy. The expression of placenta eNOS in mild PIH was higher than that of moderate or severe PIH (P < 0.025, P < 0.005, respectively). There was a negative correlation between blood pressure and the expression of eNOS in placenta (P < 0.0005). There was no significant difference between the expression of iNOS in placenta with PIH and that in normal pregnancy. Also, there was no significant difference of the expression of iNOS in placenta between the mild and moderate PIH, or the mild and severe PIH. Furthermore, there was no correlation between blood pressure and the expression of iNOS in placenta with PIH. It is concluded that the decrease of the expression of eNOS in placenta may be associated with the pathogenesis of PIH.

[The effect of Xuezhikang on oxidation of low-density lipoproteins in vitro]

OBJECTIVE

To study the effect of Xuezhikang on oxidation of human low-density lipoprotein.

METHODS

In vitro experiment was used to study the effect of Xuezhikang on the change of human low-density lipoprotein. Relative electrophoresis movement rate after oxidation of low-density lipoprotein mediated by addition of copper ion was observed.

RESULTS

Oxidation of low-density lipoprotein mediated by copper ion was accelerated as the time of action prolonged and the process was accompanied by increased relative electrophoresis movement rate. Oxidation of low-density lipoprotein by copper ion was inhibited significantly in the presence of Xue zhikang as compared with absence of XuezhiKang at all time points. A greater reduction of reactive electrophoresis movement rate up to 33.5%, (P < 0.05) was noted. With increase of Xuezhikang concentration, the extent of reduction increased.

CONCLUSION

It is shown that human low-density lipoprotein can be oxidized by mediation of copper ion and XuezhiKang may inhibit the extent of oxidation of low-density lipoprotein by copper ion.

Video-assisted thoracoscopic surgery for patent ductus arteriosus in low birth weight neonates and infants

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) has been assuming an expanded role in the management of cardiothoracic disease. As instrumentation and experience increase, VATS is being applied to treat smaller patients. We report our experience with 34 low birth weight infants undergoing VATS interruption of patent ductus arteriosus (PDA).

METHODS

VATS allows PDA interruption without the muscle cutting or rib spreading of a standard thoracotomy. Four small, 3-mm incisions are made along the line of a potential thoracotomy incision. Ports placed through these incisions admit endoscopic instruments, a camera, and a vascular clip applier.

RESULTS

Median age at surgery was 15.5 days (range: 1-44 days). Median weight at surgery was 930 g (range: 575-2500 g). Twenty patients weighed <1 kg, and 13 weighed <750 g. All patients had congestive heart failure and had either failed indomethacin therapy or had contraindications to indomethacin. Median surgical time was 60 minutes (range: 31-171 minutes). Echocardiography documented elimination of ductal flow in all patients. Operative mortality was zero. Four patients (4/34 = 12%) required conversion to open thoracotomy: 1 because of difficult exposure, 1 because of pulmonary dysfunction and anasarca, 1 because of a large 1-cm duct, and 1 because of coagulopathy and poor pulmonary compliance. Two patients died before discharge: 1 patient (surgical weight: 605 g) died on postoperative day 2 because of intracranial hemorrhage, and 1 patient (surgical weight: 1725 g) died on postoperative day 88 because of multiple system organ failure. Follow-up has demonstrated no PDA murmur in any patient, but echocardiography revealed trace ductal flow in 2 patients.

CONCLUSIONS

VATS offers a minimally traumatic, safe, and effective technique for PDA interruption in low birth weight neonates and infants.

Selenium-dependent cellular glutathione peroxidase protects mice against a pro-oxidant-induced oxidation of NADPH, NADH, lipids, and protein

Since our prior work indicated that Se-dependent cellular glutathione peroxidase (GPX1) was necessary for protection against paraquat lethality, the present studies were to elucidate the biochemical mechanisms related to that protection. Four groups of mice [Se-deficient or -adequate GPX1 knockout and wild-type (WT)] were injected (i.p.) with 50 mg paraquat/kg body weight and tissues were collected 0, 0.5, 1, 2, 3, or 4 h after the injection. Whereas the ratios of NADPH/NADP and NADH/NAD in lung were reduced by 50-70% only 0.5 h after the injection in all groups, these two ratios in liver of the Se-adequate WT were significantly higher than those of the three GPX1 knockout or deficient groups 2-4 h after the injection. The paraquat-induced pulmonary lipid peroxidation and hepatic protein oxidation, measured as F(2)-isoprostanes and carbonyl contents, respectively, peaked at 1 h in these three groups. No such oxidative events were shown in any tissue of the Se-adequate WT throughout the time course. Whereas the F(2)-isoprostane formation was accelerated by both GPX1 knockout and Se deficiency in liver, it was not significantly elevated by the paraquat treatment in brain of any group. The paraquat injection also resulted in temporal changes in lung GPX activity and GPX1 protein in the Se-adequate WT, and significant reductions in lung total SOD activity in the GPX1 knockout or deficient groups. In conclusion, GPX1 plays a critical role in maintaining the redox status of mice under acute oxidative stress, and protects against paraquat-induced oxidative destruction of lipids and protein in vivo. These protections of GPX1 seem to be inducible and coordinated with those of other antioxidant enzymes.

A null mutation in murine CD36 reveals an important role in fatty acid and lipoprotein metabolism

A null mutation in the scavenger receptor gene CD36 was created in mice by targeted homologous recombination. These mice produced no detectable CD36 protein, were viable, and bred normally. A significant decrease in binding and uptake of oxidized low density lipoprotein was observed in peritoneal macrophages of null mice as compared with those from control mice. CD36 null animals had a significant increase in fasting levels of cholesterol, nonesterified free fatty acids, and triacylglycerol. The increase in cholesterol was mainly within the high density lipoprotein fraction, while the increase in triacylglycerol was within the very low density lipoprotein fraction. Null animals had lower fasting serum glucose levels when compared with wild type controls. Uptake of 3H-labeled oleate was significantly reduced in adipocytes from null mice. However, the decrease was limited to the low ratios of fatty acid:bovine serum albumin, suggesting that CD36 was necessary for the high affinity component of the uptake process. The data provide evidence for a functional role for CD36 in lipoprotein/fatty acid metabolism that was previously underappreciated.

[Determination of serum and erythrocyte iron, serum ferritin, MCH and MCHC related with aged hypertension and coronary heart disease]

Using AAS method, we detected serum and erythrocyte iron, serum ferritin (SF), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) in the elders with hypertension and coronary heart disease. The results showed that the levels of serum iron, erythrocyte iron and SF were significantly higher than those in the healthy control (P < 0.01). It is concluded that iron metabolic abnormality may be one of the factors resulting in hypertension and coronary heart disease.

High affinity binding of fluorescein isothiocyanate to eosinophils detected by laser scanning cytometry: a potential source of error in analysis of blood samples utilizing fluorescein-conjugated reagents in flow cytometry

BACKGROUND

In samples of peripheral blood cells processed using the commercial kits for detection of apoptosis based on DNA strand break labeling, a subpopulation of cells characterized by high green fluorescence, similar in intensity to that of apoptotic cells but more uniform, was consistently observed by flow cytometry. The labeled cells had no other features of apoptosis. The labeling was observed regardless of the fixative used and was evident in control samples lacking terminal deoxynucleotidyltransferase. Common to all the kits that generated this labeling pattern was the presence of fluorescein (f) conjugated reagents, f-dUTP, f-avidin, or f-antibody.

METHODS

Laser scanning cytometry was used to identify the labeled cells and study the mechanism of labeling. Because it was suspected that the traces of unconjugated f-isothiocyanate (FITC) that may contaminate the reagents were responsible for the labeling, FITC binding affinity to white blood cells was studied. Gel electrophoresis was used to detect the presence of unconjugated FITC in the reagents.

RESULTS

After staining with Giemsa, the strongly fluorescent objects were identified as eosinophils with normal morphology and no evidence of apoptosis. The fluorescence was localized exclusively within the cytoplasmic granules. Labeling of eosinophils was observed at 2 nM concentration of FITC, which was over three orders of magnitude lower than that needed to label neutrophils, monocytes, or lymphocytes. Gel electrophoresis of the f-conjugated reagents revealed only minor contamination with FITC.

CONCLUSIONS

(1) Trace amounts of unconjugated FITC contaminating the reagents are adequate to strongly label eosinophils thereby introducing experimental bias in analysis of apoptosis and in other studies on blood cells utilizing f-labeled antibodies, e.g., in detecting cytokines. (2) FITC at concentration 2-500 nM can be used as a marker of eosinophiles; (3) Because of high affinity to FITC, eosinophiles (or the protein from these cells) may serve as a means of removing traces of unconjugated FITC from the reagents during their manufacture or prior to use.

Apoptosis and myocardial infarction

Myocardial infarction was produced in rats and the contribution of apoptotic and necrotic myocyte cell death was measured quantitatively. Myocyte cell death by apoptosis involved 2.8 million cells at 2 hours after coronary artery occlusion and necrosis only 90,000 cells. Myocyte apoptosis continued to represent the major form of cell death, affecting 6.6 million cells at 4.5 hours, whereas myocyte necrosis peaked at 1 day, including 1.1 million cells. Apoptotic myocyte cell death was also present in the surviving portion of the wall adjacent to and remote from the infarcted myocardium where it peaked at 1-2 days. At this interval, 700/10(6) and 110/10(6) myocyte nuclei were undergoing apoptosis in the non-infarcted tissue bordering on and away from the ischemic area, respectively. Myocyte necrosis was absent in the viable myocardium after infarction. Since mechanical forces produced by pathologic loads may activate apoptosis, papillary muscles were exposed to high levels of resting tension in vitro and the magnitude of cell death in these samples was determined. Overstretching resulted in a 21-fold increase in apoptotic myocyte cell death which was coupled with the formation of reactive oxygen species, side-to-side slippage of myocytes, and depressed tension generation of the myocardium. In conclusion, apoptotic myocyte cell death plays a major role in ventricular remodeling after infarction, but whether physical forces, oxidant stress, architectural rearrangement of myocytes, and impaired force development of the myocardium in vivo are causaly related requires further investigation.