Plunging ranula: a report of three cases and review of the literature

Three cases of plunging ranula are reported and the literature reviewed. Extravasation of saliva from the sublingual gland due to trauma or obstruction of its ducts appears to be the most likely cause of plunging ranula. Available data suggest that the submandibular gland is usually not involved, although at the time of surgery it may be extremely difficult to exclude a submandibular origin of the cyst in the neck. Communication between the oral and cervical components of the plunging ranula probably occur via a hiatus in the mylohyoid muscle. Such communication passing directly into the submandibular compartment may simulate submandibular gland involvement. Since 1910, 139 procedures in 89 patients with plunging ranula have been reported in the English literature. The recurrence rate was 70 per cent after incision and drainage of the cyst, 53 per cent after marsupialization, 85 per cent after excision of the cyst in the neck and 2 per cent after excision of the sublingual gland via the cervical or intra-oral route. This review suggests that excision of the sublingual gland with intra-oral drainage of the cervical swelling appears to be the treatment of choice for the plunging ranula.

Infantile spasms. Comparative trial of nitrazepam and corticotropin

Fifty-two patients were enrolled in a four-week randomized multicenter study comparing nitrazepam and corticotropin in the treatment of infantile spasms. The drugs' efficacy was evaluated in 48 patients, all less than 2 years of age. Both treatments resulted in a statistically significant reduction in spasm frequency from that at baseline, but the difference between treatments was not significant. The number of patients who experienced side effects was similar in the two treatment groups, but the adverse effects encountered among the patients treated with corticotropin were qualitatively more severe and required the discontinuation of treatment in six patients.

Improved methods for venous access: the Port-A-Cath, a totally implanted catheter system

We prospectively evaluated the performance and rate of long-term complications with the Port-A-Cath (PAC), a totally implanted vascular access system. Two catheter styles were evaluated, a small-bore (SB) catheter (0.51-mm diameter) and a large-bore (LB) catheter (1.02-mm diameter), in conjunction with the use of a strict catheter care protocol. The PAC performed well, and with both SB and LB systems, no significant extravasation, skin necrosis, hematoma, septum damage or leakage, or subcutaneous portal infections occurred after 7,240 days of implantation and 1,435 days of use. Complications with the PAC system consisted of catheter occlusion (seven patients, 21.5%) and one instance of possible catheter infection (3.1%). Occlusions were limited to patients implanted with the SB catheter (seven of 16, 43.8%), and five of the seven (71.4%) occurred in patients receiving continuous infusion chemotherapy and/or total parenteral nutrition. Patency of the PAC system was maintained using a regular flushing schedule once every 30 days, a significant advantage compared with the daily maintenance schedule required with externally placed venous catheters. The results of this study suggest that the PAC system can provide a safe and reliable method for venous access in patients requiring intermittent or prolonged intravenous therapy.

Clinical pharmacokinetics of high-dose metoclopramide in cancer patients receiving cisplatin therapy

Using a sensitive and specific high-pressure liquid chromatographic (HPLC) assay, we measured serum levels of metoclopramide in 18 cancer patients receiving high-dose intravenous (IV) therapy to prevent cisplatin-induced emesis. Ten patients were treated with one or more courses with metoclopramide alone (1.0 to 3.0 mg/kg) in an open-label study, and eight patients were treated with a fixed 2.0 mg/kg dose of metoclopramide with or without adjunct dexamethasone (20 mg) using a randomized, crossover design. The pharmacokinetics of metoclopramide were determined, and the relationship between serum levels and clinical response was evaluated. The pharmacokinetic parameters of high-dose metoclopramide were found to be similar to those reported for standard promotility doses, and no dose dependency was demonstrated over the range of doses studied. No clear correlation between serum metoclopramide levels and prevention of cisplatin-induced emesis was observed. The addition of dexamethasone resulted in clinical improvement in two of eight patients, but had no effect on serum metoclopramide levels or kinetic parameters. Results in this study population do not show metoclopramide levels to be related to antiemetic effect following IV cisplatin therapy.

Factors related to delay for legal abortions performed at a gestational age of 20 weeks or more

Between 1981 and 1982 the Royal College of Obstetricians and Gynaecologists undertook a national survey of late abortion practice in England and Wales. The study was based on a confidential enquiry, specifically authorized by the Chief Medical Officers of the DHSS and the Welsh Office, which used the notification system as the means of identifying cases. All abortions notified as carried out at 20 weeks gestational age or more were selected during the year, together with varying proportions of cases from other gestational groups. Data on avoidable and unavoidable causes of delay were obtained by questionnaire from notifying doctors, and a comparison was made of the subjectively attributed delay with any that was found through objective measures derived from both questionnaire and notification data. This paper presents results on delay associated specifically with abortions carried out at a gestational age of 20 weeks or more to residents of the United Kingdom only.

Interstitial implant with interstitial hyperthermia

A Phase I Pilot Study combining interstitial or intracavitary irradiation using 192Ir or 137Cs and interstitial hyperthermia in advanced or recurrent tumors is underway at the City of Hope National Medical Center. Hyperthermia is performed using 0.5 megahertz RF (500 kilohertz) radiofrequency localized current fields. In the implanted volume, a temperature of 41 degrees to 45 degrees C is maintained for 30 to 40 minutes. Hyperthermia is performed prior to irradiation in all patients. All patients had either failed previous conventional treatments, including surgery, chemotherapy and/or radiation therapy, or had advanced malignant tumors which were not felt to be controllable by conventional means. Sixteen lesions were implanted in 15 patients. Of the 16 lesions, 11/16 (68%) achieved complete response, and three had no response or recurred locally. The six patients (100%) receiving interstitial implant and hyperthermia as the primary therapy achieved complete response. Normal tissue complications were minimal. Range of response was three to 13 months. Interstitial thermoradiotherapy appears to be a safe and promising mode of therapy in advanced or recurrent accessible malignant tumors.

Kinetics of the absorption of amino acids by the rat intestine in vivo

The kinetics of L-phenylalanine and L-lysine absorption by the rat small intestine in vivo have been studied by perfusing intestinal segments and monitoring simultaneously the uptake of the substrate into the intestinal tissue and its disappearance from the perfusate. The rate of phenylalanine disappearance is a linear function of the substrate concentration. Its uptake into the tissue is rapid and obeys saturation kinetics, but is not concentrative. Both tissue uptake and disappearance rate can be inhibited by leucine or methionine, but are not influenced by hydrophilic neutral or dibasic amino acids. Lysine disappearance from the perfusate and its uptake into the tissue both display saturation kinetics. Lysine transport is quantitatively smaller than that of phenylalanine. Both uptake and disappearance are inhibited by arginine and leucine, but are unaffected by other neutral amino acids or sugars. To analyse the kinetic results, integrated equations were developed to express the final concentration in the perfusate in terms of the original concentration. The disappearance rate was considered as a mixed process (saturable and non-saturable in parallel) in a one-compartment system, and the uptake by the tissue was treated as a two-compartment system in which the amino acid entered the cells by a mixed process but left them by a pure non-saturable mechanism. The results concerning disappearance from the lumen are compatible with the one-compartment model. Phenylalanine absorption can be described by a major non-saturable component and a minor saturable one, while lysine absorption occurs almost entirely by a saturable process. The two-compartment model does not adequately describe the tissue uptake results.

Levodopa in Parkinson disease: a long-term appraisal of mortality

Mortality rates for a group of patients in a collaborative multicenter study of levodopa (Larodopa) in the treatment of parkinsonism were compared with corresponding mortality rates in the general population adjusted for age and sex distribution in accordance with that of the parkinsonian patients under study. The death rate, conservatively adjusted for dropouts among parkinsonian patients, is estimated to be approximately 33% greater than that for the general population. This is in contrast to an earlier study of Hoehn and Yahr, prior to the advent of levodopa treatment, wherein the mortality rate for parkinsonian patients was shown to be in excess of that in the general population by a factor of 2.9, or nearly 200%.