Modeling of the Permeate Flux during Microfiltration of BSA-Adsorbed Microspheres in a Stirred Cell

A study on the variation of the permeate flux was performed in a stirred cell charged with microspheres, to investigate the effects of the stirrer speeds (300, 400, and 600 rpm) and the BSA concentration (0.1, 0.2, 0.4, and 0.8 g/L) under constant pressure. The permeate flux increased over time before the saturation point, but it began to decrease after that point. An increase of the BSA concentration and the stirrer speed resulted in the rapid increase of the permeate flux. This is contrary to the observation of the conventional filtration experiments using a stirred cell. A resistance-in-series model was employed for the modeling of the permeate flux. The cake resistance (R(c), induced by the concentration polarization of microspheres) and the fouling resistance (R(f), induced by the adsorption of BSA inside the membrane pore) must be considered simultaneously for the modeling. These modeling results were in good agreement with the experimental data. These can be applied to the special system considering both R(c) and R(f) as well as the general filtration systems using a stirred cell. Copyright 2000 Academic Press.

Purification and characterization of a novel heparinase from Bacteroides stercoris HJ-15

A novel type of heparinase (heparin lyase, no EC number) has been purified from Bacteroides stercoris HJ-15, isolated from human intestine, which produces three kinds of heparinases. The enzyme was purified to apparent homogeneity by a combination of QAE-cellulose, DEAE-cellulose, CM-Sephadex C-50, hydroxyapatite, and HiTrap SP chromatographies with a final specific activity of 19.5 mmol/min/mg. It showed optimal activity at pH 7.2 and 45 degrees C and the presence of 300 mM KCl greatly enhanced its activity. The purified enzyme activity was inhibited by Cu(2+), Pb(2+), and some agents that modify histidine and cysteine residues, and activated by reducing agents such as dithiothreitol and 2-mercaptoethanol. This purified Bacteroides heparinase is an eliminase that shows its greatest activity on bovine intestinal heparan sulfate, and to a lesser extent on porcine intestinal heparan sulfate and heparin. This enzyme does not act on acharan sulfate but de-O-sulfated acharan sulfate and N-sulfoacharan sulfate were found to be poor substrates. The substrate specificity of this enzyme is similar to that of Flavobacterial heparinase II. However, an internal amino acid sequence of the purified Bacteroides heparinase shows significant (73%) homology to Flavobacterial heparinase III and only 43% homology to Flavobacterial heparinase II. These findings suggest that the Bacteroidal heparinase is a novel enzyme degrading GAGs.

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.

Glucose transporter 1 (GLUT1) expression is associated with intestinal type of gastric carcinoma

Increased expression of glucose transporter1 (GLUT1) has been reported in many human cancers. We hypothesized that the degree of GLUT1 might provide a useful biological information in gastric adenocarcinoma. RT-PCR and immunostaining were used to analyze GLUT1 expression in gastric cancer. RT-PCR showed GLUT1 expression was not largely detected in normal gastric tissue but was detected in cancerous gastric tissue of counterpart. By immunohistochemistry, GLUT1 protein was absent in normal gastric epithelium and intestinal metaplasia. 11 of 65 patients with gastric adenocarcinoma had specific GLUT1 immunostaining in a plasma membrane pattern with varied intensities. GLUT1 protein did not show any significant correlation with tumor stage and nodal metastasis (p>0.05 by Mann-Whitney test). However, the positive immunostaining for GLUT1 is associated with intestinal differentiation (p=0.003). Our results suggest that GLUT1 protein is associated with intestinal type of gastric cancer.

A comparative study of two methods of quantifying the soft tissue profile

One of the most important components of orthodontic diagnosis is the evaluation of the patient's soft tissue profile. There have been many attempts to quantify the soft tissue profile based on the lateral cephalogram. Yet, the methodology used to evaluate the profile varies widely among studies, and there has been no consistency in the way straight lines are constructed in the analysis of the soft tissue contours. The purpose of the current study was to compare the values obtained by 2 drawing methods (tangent line and anatomic points) of constructing angles, and to assess the intraobserver and interobserver reproducibility for both methods. There were statistically significant differences between the 2 methods for 9 of the 10 measurements evaluated. In the comparison of reproducibility assessed by Pearson correlation analysis, both methods showed statistically significant correlations between repeated measurements. The anatomic point method, however, showed greater reproducibility by means of a paired t-test. In the analysis of intraobserver reproducibility, 2 measurements showed significant differences with the anatomic point method and 4 measurements demonstrated significant differences when the tangent line method was used. In the analysis of interobserver reproducibility, 5 measurements showed significant differences in the anatomic point method, while 6 measurements represented significant differences in the tangent line method. Our results indicate that a precise description of the methodology used in the analysis of the soft tissue must be provided because of the differences between methods. In the analysis of soft tissue contours, the construction of lines with the anatomic point method is more reproducible than the tangent line method.

Effect of an additional 1-hour T-piece trial on weaning outcome at minimal pressure support

PURPOSE

The purpose of this article was to investigate the effect of an additional 1-hour T-piece trial at the level of minimum pressure support (PSmin) on weaning outcome.

MATERIALS AND METHODS

Open, randomized, prospective study of 44 patients who had received mechanical ventilation for more than 3 days.Thirty-six patients satisfied the protocol. There were 42 weaning trials. The patients were randomized into an intervention group (additional 1-hour period of T-piece trial) and a control group (extubation directly) at PSmin. Blood gas analysis and estimation of respiratory and hemodynamic variables were performed at the 15 cm H2O level of pressure support. Measurements were repeated at PSmin and during weaning process (in intervention group).

RESULTS

Mean PSmin level was 7.6 (+/- 1.9) cm H2O. There were no differences in total ventilation time (TVT), acute physiology and chronic health evaluation (APACHE) II score, nutritional indices, and respiratory mechanics on PSmin between the two groups. The weaning success rate and the reintubation rate were similar for the intervention group (55% and 18%, respectively) and control group (70% and 20%, respectively). Work of breathing, pressure time product, and tidal volume significantly worsened after a 1-hour T-piece trial when compared with those values measured at PSmin in the intervention group (P < .05). For the combined patient sample, TVT and tidal volume at PSmin were significantly different between the patients with weaning success (246 +/- 195 hours, 0.43 +/- 0.11 L) and those with weaning failure (407 +/- 248 hours, 0.35 +/- 0.10 L) (P < .05 in each).

CONCLUSION

There were no advantages in weaning outcome by the addition of a 1-hour T-piece trial compared with prompt extubation at PSmin.

Closing volume influences the postural effect on oxygenation in unilateral lung disease

In normal adults, both blood flow and ventilation are distributed preferentially to the dependent lung zones. In adults with unilateral lung disease, arterial oxygenation improves when they are positioned with their good lung down because of improved matching of ventilation and perfusion. When the closing volume is increased, dependent airways are closed during tidal breathing, so that reduced ventilation-perfusion ratio and hypoxia develops and ventilation is preferentially distributed to the upper lung zones. We undertook an observational study on the effects of lateral recumbency on arterial oxygenation in adult patients with unilateral lung disease and tested the hypothesis that oxygenation in lateral recumbency might be influenced by an increase in closing volume. Arterial blood gases were analyzed in the supine, right and left lateral decubitus positions and the AaPO(2) was calculated in 44 randomly selected patients 49.9 +/- 18.7 yr of age with unilateral pneumonia (23 cases) or pulmonary tuberculosis (21 cases). In 26 patients, individual Pa(O(2)) with the normal lung in the dependent position was higher than that with the diseased lung; the opposite was true for 18 patients. The difference in Pa(O(2)) and AaPO(2) between the two positions was statistically significant in both groups. In 16 patients (10 men and six women 49.2 +/- 18.2 yr of age), we measured closing volume and determined the fractional ventilation to each lung by (133)Xe lung scan in the three positions. In these 16 patients, the difference in Pa(O(2)) between the normal and the diseased lung in the dependent position was related significantly to the difference in the fractional ventilation going to the normal lung between the dependent and the supine position (r = 0.642, p = 0. 007). The latter was related significantly to the % predicted closing volume (CV/VC) (r = -0.597, p = 0.015). This study has shown that closing volume, as well as posture, might be involved in determining oxygenation in lateral recumbency in patients with unilateral lung disease.

Congenital intrahepatic portohepatic venous shunt: treatment with coil embolisation

Congenital abnormalities of the portal venous system are rare. There are few radiological descriptions of intrahepatic portosystemic venous shunt detected in the perinatal period. We report a congenital portosystemic shunt that was detected by US and treated with coil embolisation in the neonatal period.

Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane

PURPOSE

To identify the potential antiangiogenic and antiinflammatory proteins expressed in human amniotic membrane tissue.

METHODS

Human amniotic epithelial and mesenchymal cells were isolated from human amniotic membranes by sequential trypsin and collagenase digestion. Total RNAs were harvested from freshly obtained human amniotic epithelial and mesenchymal cells. Antiangiogenic and antiinflammatory proteins were detected by the reverse transcriptase-polymerase chain reaction (RT-PCR) technique and further confirmed by DNA sequencing of PCR-amplified transcripts. The distribution of tissue inhibitors of metalloproteinase (TIMPs) were studied further by immunohistochemistry performed on paraffin-embedded amniotic membrane tissue.

RESULTS

RT-PCR results showed that both human amniotic epithelial and mesenchymal cells express interleukin-1 receptor antagonist, all four TIMPs, collagen XVIII, and interleukin-10. Thrombospondin-1 was expressed in all of the epithelial cell specimens and in one out of five mesenchymal cell specimens. Furthermore, immunohistochemistry studies performed on freshly prepared amniotic membrane confirmed that all members of the TIMP family were present in epithelial and mesenchymal cells as well as in the compact layer of the amniotic stroma. In cryopreserved amniotic membranes, positive staining was seen in residual amniotic cells and stroma.

CONCLUSIONS

Human amniotic membrane epithelial and mesenchymal cells express various antiangiogenic and antiinflammatory proteins. Some of those proteins also were found in amniotic membrane stroma. These findings may explain in part the antiangiogenic and antiinflammatory effects of amniotic membrane transplantation.

US in the diagnosis of pediatric chest diseases

Most pediatric chest diseases are adequately evaluated with chest radiography. However, when chest radiography does not allow identification of the location and nature of an area of increased opacity, ultrasonography (US) can help establish the diagnosis. US may be helpful in evaluation of persistent or unusual areas of increased opacity in the peripheral lung, pleural abnormalities, and mediastinal widening; US is particularly useful in patients with complete opacification of a hemithorax at radiography. In cases of pulmonary parenchymal lesions, identification of air or fluid bronchograms at US and of pulmonary vessels at color flow imaging is useful for differentiating pulmonary consolidation or atelectasis from lung masses and pleural lesions. US allows characterization of pleural fluid collections as simple, complicated, or fibroadhesive, which is important information for planning thoracentesis or thoracotomy. Computed tomography and magnetic resonance imaging are superior to US in evaluation of the mediastinum, but US is a reasonable alternative in certain situations (eg, to avoid unnecessary investigation of a normal thymus simulating a mediastinal mass). In cases of chest wall lesions, US may enable localization of the site of origin to soft tissues or an extrapleural intrathoracic location. Osseous involvement, particularly rib involvement, is easily evaluated with US.

Microsatellite instability(MSI) in non-small cell lung cancer(NSCLC) is highly associated with transforming growth factor-beta type II receptor(TGF-beta RII) frameshift mutation

BACKGROUND

TGF-beta type II receptor (TGF-beta RII) mutations associated with microsatellite instability(MSI) are characteristically frameshift mutations within a 10 bp poly-A tract. These frameshift mutations have been reported to be common in colorectal and gastric cancers with MSI, though, rarely reported in non-small cell lung cancer (NSCLC).

MATERIALS AND METHOD

In this study, we analysed MSI and TGF-beta RII frameshift mutations in 7 NSCLC cell lines and 21 surgically resected NSCLC tissues. Determination of MSI in NSCLC was performed using primer sets for BAT-25, BAT-26 and BAT-40. In order to examine the presence of the frameshift mutations of TGF-beta RII in samples with MSI, sequencing for TGF-beta RII poly-A tract was performed.

RESULTS

MSI was observed in 5 out of 7 NSCLC cell lines and 3 out of 21 NSCLC tissues. Six out of 8 samples with MSI(75%) showed frameshift mutations in TGF-beta RII poly-A tract.

CONCLUSION

These results suggest that MSI is highly associated with TGF-beta RII frameshift mutations in NSCLC and further support the hypothesis that TGF-beta RII plays an important role in NSCLC carcinogenesis.

A tetrodotoxin-producing Vibrio strain, LM-1, from the puffer fish Fugu vermicularis radiatus

Identification of tetrodotoxin (TTX) and its derivatives produced from a Vibrio strain in the intestine of the puffer fish Fugu vermicularis radiatus was performed by thin-layer chromatography, electrophoresis, high-performance liquid chromatography, and gas chromatography-mass spectrometry, together with a mouse bioassay for toxicity. It was demonstrated that the isolated bacterium produced TTX, 4-epi-TTX, and anhTTX during cultivation, suggesting that Vibrio strains are responsible for the toxification of the puffer fish.

Transperineal ultrasonography in imperforate anus: identification of the internal fistula

The purpose of this study was to assess the usefulness of transperineal ultrasonography in identifying the internal fistula in cases of imperforate anus. Transperineal ultrasonography was performed in 19 infants (13 neonates and 6 older infants; 13 were male and 6 were female) with imperforate anus to identify the internal fistula. Sagittal plane images were obtained through the anal dimple, and the internal connection of the rectal fistula was traced. The ultrasonographically traced internal fistula was compared with that observed on distal loopography after colostomy or with surgical findings. The internal fistula was identified as a hypoechoic linear tract, containing linear echogenicity in some cases. Of 19 patients, internal fistulas were correctly identified in 16 patients; these were rectourethral (n = 12), rectovaginal (n = 1), rectovestibular (n = 1), rectovesical (n = 1), and rectocloacal (n = 1). In three patients, internal fistulas were incorrectly defined; these cases consisted of rectovestibular (n = 2) and rectovaginal (n = 1) fistulas. Internal fistulas were correctly identified in all of the 13 male patients and in 3 of 6 female patients. Transperineal ultrasonography is an excellent diagnostic modality to define the type of the internal fistula in imperforate anus.

Microsurgical anatomy of the perigeniculate ganglion area as seen from a translabyrinthine approach

Detailed anatomic knowledge of the microsurgical anatomy of the perigeniculate ganglion area is essential to probing adjacent to the facial nerve by a translabyrinthine approach. This study was designed to investigate the surgical anatomy of the perigeniculate ganglion area of the facial nerve from a translabyrinthine point of view. We dissected 15 human temporal bones under a microscope, measured the lengths of the tympanic segment and the labyrinthine segment by a middle cranial fossa approach, and measured the angle between the tympanic and labyrinthine segments by a translabyrinthine approach. The distance of the facial nerve from the cochleariform process to the geniculate ganglion was 3.8+/-0.7 mm. The length of the labyrinthine segment of the facial nerve was 4 +/-0.8 mm. The angle between the tympanic and labyrinthine segments from a translabyrinthine point of view was 26 degrees +/-5 degrees. Precise knowledge about the microsurgical anatomy of the perigeniculate ganglion area of the facial nerve from a translabyrinthine viewpoint is imperative for facial nerve decompression by a translabyrinthine approach.

Late abnormal findings on high-resolution computed tomography after Mycoplasma pneumonia

BACKGROUND

The clinical course of Mycoplasma pneumonia is typically mild and self-limited. There are, however, several case reports of severe complication following this illness with considerable morbidity and mortality.

OBJECTIVES

This study was conducted to investigate, using high-resolution computed tomography (HRCT), the long-term pulmonary structural abnormalities after Mycoplasma pneumonia and to identify risk factors (chest radiograph findings, antibody titers, and host factors) that might increase the likelihood of developing the sequelae.

METHODS

Thirty-eight children requiring hospitalization attributable to Mycoplasma pneumonia were recruited by the retrospective examination of hospital records. They underwent HRCT after an interval of 1.0 to 2. 2 years. A control group of 17 children with the history of Mycoplasma upper respiratory infection was also studied after a similar interval.

RESULTS

Abnormal HRCT findings were present in 37% (14/38) of the pneumonia group, compared with 12% (2/17) of the control group. The abnormalities in the pneumonia group, which appeared alone or in combination, included mosaic perfusion (n = 12), bronchiectasis (n = 8), bronchial wall thickening (n = 4), decreased vascularity (n = 1), and air trapping on expiratory scan (9 of 29 tested). The area affected by these abnormalities, usually involving 2 or more lobes, corresponded in all cases to the location of the infiltrate on chest radiograph at the time of pneumonia. Between subjects with abnormal HRCT (n = 14) and normal HRCT (n = 24) in the pneumonia group, significant differences were observed in age at the time of pneumonia (mean +/- standard deviation: 5.3 +/- 2. 0 years vs 7.7 +/- 3.4 years) and peak antimycoplasma antibody titer (geometric mean [range of 1 standard deviation]; 1:7943 [3126-19 953] vs 1:3093 [832-11 482]).

CONCLUSIONS

We conclude that a considerable proportion of children with history of Mycoplasma pneumonia have abnormal findings on HRCT, suggestive of small airway obstruction and that younger age and higher antibody titer at the time of pneumonia may be risk factors for these sequelae.

Survival of Pseudomonas fluorescens and Salmonella typhimurium after electron beam and gamma irradiation of refrigerated beef

The radurization effects of gamma ray and electron beam irradiation at 1.5 and 3.0 kGy on beef steaks inoculated with Salmonella Typhimurium and Pseudomonas fluorescens were investigated during 8 days of storage at 5 degrees C. Total bacterial counts and numbers of Salmonella Typhimurium and P. fluorescens were analyzed at 2-day intervals. Total bacterial counts of samples irradiated by both gamma rays and electron beam were significantly (P < 0.05) reduced by 3.8 to 5.3 log CFU/g. Salmonella Typhimurium was not detectable during the experimental period. P. fluorescens counts of beef samples irradiated by gamma rays at both 1.5 and 3.0 kGy were not detected; however, P. fluorescens in samples irradiated by electron beam at 1.5 and 3.0 kGy was recovered after 2 days, and bacterial counts reached 7.8 and 6.9 log CFU/g, respectively. Both gamma ray and electron beam irradiation reduced total bacterial counts initially, possibly extending shelf life. Irradiation was very effective in destroying Salmonella Typhimurium; however, P. fluorescens was not completely eliminated by electron beam irradiation. Consequently, gamma ray irradiation was more effective than electron beam irradiation in the destruction of P. fluorescens.

An optimal dose of perfluorocarbon for respiratory mechanics in partial liquid ventilation for dependent lung-dominant acute lung injury

BACKGROUND

Despite increasing knowledge about partial liquid ventilation (PLV), the optimal dose of perfluorocarbon (PFC) is not yet established. Because there exist normal regions in the lung with ARDS and because PLV in the normal lung results in worsened gas exchange, we postulated that the optimal dose of PFC for PLV may be less than the functional residual capacity (FRC) dose in the lung with limited disease.

DESIGN AND SETTING

Animal study at the Asan Institute for Life Sciences, Seoul, Korea.

SUBJECTS

Twelve rabbits in which dependent lung-dominant lung injury was created by a modified saline solution lavage.

INTERVENTIONS

PLV performed at six different doses of perfluorodecalin in sequence (3, 6, 9, 12, 15, and 18 mL/kg every 15 min).

MEASUREMENTS AND RESULTS

Our modified saline solution lavage induced atelectasis and hemorrhage confined to the dependent lung with severe hypoxia (PaO(2)/fraction of inspired oxygen = 37 +/- 6 mm Hg). Peak airway pressure (Ppeak) and inspiratory pause pressure (Ppause) with PLV were lower at doses of 3 to 15 mL/kg (all p < 0.05), but not different at a dose of 18 mL/kg, when compared with gas ventilation. Ppeak increased at doses of 12, 15, and 18 mL/kg, when each was compared with the preceding PFC dose. At increasing PFC doses, the change in the elastic component of airway pressure (Ppause after minus Ppause before) was negative until the dose of 9 mL/kg, but was positive at doses of 12 mL/kg and above. The change in the resistive component ([Ppeak minus Ppause] after minus [Ppeak minus Ppause] before) was negative until the dose of 6 mL/kg, but was positive at the dose > or = 9 mL/kg.

CONCLUSION

Respiratory mechanics during PLV for dependent lung-dominant lung injury were optimal at a PFC dose less than the FRC.

Disseminated BCG infection in a patient with severe combined immunodeficiency

Disseminated mycobacterial infection after bacillus Calmette-Guerin (BCG) vaccination is a very rare disorder, occurring mostly in patients with immunologic deficiency. We report a case of disseminated BCG infection in a 16-month-old girl with severe combined immunodeficiency. Plain radiographs showed multiple osteolytic lesions in the femora, tibiae, humerus, and phalanges. Abdominal sonography and CT scanning revealed multiple nodules in the spleen, and portocaval lymphadenopathy.

Tracheobronchial strictures: treatment with a polyurethane-covered retrievable expandable nitinol stent--initial experience

A polyurethane-covered retrievable expandable stent was placed in 13 patients with tracheobronchial strictures. In four patients with benign strictures, the stent was removed with use of a retrieval hook 2-6 months after placement. After stent removal, three of the four patients did not need further treatment. The retrievable stent warrants further investigation in the treatment of tracheobronchial strictures.

Heat shock response decreases endotoxin-induced acute lung injury in rats

OBJECTIVE

Transient whole-body hyperthermia was reported to reduce lung damage in a rat with intra-abdominal sepsis produced by caecal perforation.

METHODOLOGY

In order to determine the effect of heat shock response on acute lung injury induced by endotoxin, which plays a central role in the pathogenesis of sepsis, we instilled either saline or lipopolysaccharide (LPS) intravenously with and without heat pretreatment in rats. The heated rats had their rectal temperature raised to more than 40 degrees C for 13 min 18 h before intravenous administration of saline or LPS.

RESULTS

We found that the lung leak was significantly increased among the rats given LPS intravenously with (median, 0.17; range, 0.15-0.22; n = 10) and without heat pretreatment (0.23; 0.17-0.30; n = 10) compared with those of saline-treated rats (0.13; 0.10-0.14; n = 10) (P < 0.05 in each). However, rats given LPS after heat pretreatment had significantly decreased lung leak index compared with those of LPS-treated rats without heat pretreatment (P < 0.05). Rats administered LPS intravenously showed increased myeloperoxidase activity without heat pretreatment (19.01; 9.34-28.00 U/g; n = 10) compared with that of saline-treated rats (7.09; 4.49-10.56 U/g; n = 5) (P < 0.05) (Fig. 2). Myeloperoxidase activity of the rats treated with LPS with heat pretreatment (5.57; 2.87-8.96 U/g; n = 10) was significantly decreased to the level of normal control compared with that of LPS-treated rats without heat pretreatment (P < 0.05). The levels of heat shock proteins (HSP72) in lung tissue, which were examined by western blot analysis, were increased over baseline levels at 23 h after hyperthermic stress.

CONCLUSIONS

These observations show that brief heat shock response is associated with the induction of HSP72 protein synthesis and attenuated neutrophil recruitment and acute lung leak is induced by endotoxin in rats.

The effect of varying inspiratory to expiratory ratio on gas exchange in partial liquid ventilation

BACKGROUND

In partial liquid ventilation (PLV), the nondependent lung was observed to be inflated first and the dependent lung later. The inflational time difference between the lung regions can lead to maldistribution of tidal gas and inefficient gas bubbling in the slow-inflating region during PLV. In this situation, increasing the inspiratory to expiratory (I:E) ratio of the mechanical ventilator would lessen the heterogeneity of regional ventilation and improve gas exchange possibly to a greater degree than in gas ventilation (GV).

DESIGN AND SETTING

Animal study at the Asan Institute for Life Sciences, Seoul, Korea Subjects: Eighteen rabbits (2.6 +/- 0.5 kg) with acute lung injury by saline solution lavage.

INTERVENTIONS

Three I:E ratios were tried in GV and then in PLV. I:E ratios were changed by adjusting pause (1:2, 1:1, and 2:1; group 1) or by adjusting inspiratory flow rate (1:3, 1:1, and 2:1; group 2).

MEASUREMENTS AND RESULTS

With increasing I:E ratio in all animals, PaO(2)/FIO(2) increased (80 +/- 24, 143 +/- 74, and 147 +/- 88 mm Hg; p = 0.001), and PaCO(2) decreased (74 +/- 15, 66 +/- 16, and 66 +/- 15 mm Hg; p = 0.006). The increases of PaO(2)/FIO(2) from 1:2/1:3 to 1:1 (p = 0.006) and from 1:1 to 2:1 (p = 0.036) were both greater in group 1 than in group 2. PaCO(2) decreased with increasing I:E ratio in group 1, but not in group 2. The change of PaO(2)/FIO(2) by varying the I:E ratio was 49 +/- 65% in PLV and 14 +/- 14% in GV (p = 0.003).

CONCLUSIONS

Extending the I:E ratio, especially by adding pause, improved gas exchange in PLV. Oxygenation in PLV was affected by the I:E ratio to a greater degree than in GV.

The direct effect of intraorbital pressure on orbital growth in the anophthalmic piglet

Tissue expanders placed within the orbit can have a positive effect on orbital and ipsilateral midfacial growth. To date, there is no precise method for controlling and monitoring expansion to induce normal growth in the developing facial skeleton. The present study was undertaken to determine the optimal physiologic pressure required to stimulate normal orbital growth and to determine whether above-normal growth could be achieved with higher intraorbital pressures. Using a neonatal swine model, an accurate method of monitoring intraorbital pressure, precisely controlling intraorbital expansion, and achieving normal orbital growth was explored. Sixteen male, 3-week-old Yorkshire piglets were randomly divided into three surgical groups. In each group, the left orbit was the experimental side, and the contralateral right orbit served as an untreated control. Group 1 (n = 6) underwent enucleation only. Group 2 (n = 5) underwent enucleation and orbital expansion at a near-normal physiologic pressure of 20 mmHg. Group 3 (n = 5) underwent enucleation and orbital expansion at a supernormal pressure of 60 mmHg. Spherical tissue expanders (10 cc) with a separate injection port were utilized as the orbital expanders. Pressure was monitored by an electronic manometer that was calibrated daily. Morphology of the orbits was documented by photography, the dimensions of the orbits were quantitated by three-dimensional mechanical digitization, and orbital volumes were calculated. In the unexpanded, anophthalmic control group, a significant reduction in radial growth after evisceration was seen. In group 2, the orbit stimulated with a consistent pressure of 20 mmHg, just above the physiologic normal pressure of 17 mmHg, showed an increase in radial dimension of 8 percent compared with the unoperated side. In the high-pressure group of 60 mmHg, an increase of 16 percent in the radius was observed over the 4-week period. This led to a corresponding increase in orbital volumes with increased pressure. Utilizing a paired t test, these differences in the radial and volumetric growth of the orbit were statistically significant (p < 0.005). The results obtained demonstrated a direct relationship between intraorbital pressure and the growth of the bony orbit in the radial dimension. On the basis of this study, we concluded that orbital expansion maintained at normal physiologic pressure can stimulate normal orbital growth in the neonatal facial skeleton. In addition, application of above-normal pressures for expansion can induce accelerated orbital growth.

Abdominal-wall myositis secondary to intra-arterial chemotherapy for femoral osteosarcoma

With the increasing application of intra-arterial chemotherapy (IAC), new side-effects are encountered. We describe two children with proximal femoral osteosarcoma who developed focal myositis of the abdominal wall musculature after IAC. In both cases, myositis presented as abdominal pain and mimicked acute abdomen. US demonstrated asymmetrical thickening of abdominal-wall musculature in the right lower abdomen. This diagnosis should be considered when evaluating the patient with unexplained abdominal pain and a history of IAC.

Shark liver oil-induced lipoid pneumonia in pigs: correlation of thin-section CT and histopathologic findings

PURPOSE

To evaluate sequential changes in thin-section computed tomographic (CT) findings after inducement of lipoid pneumonia and provide the histopathologic bases of these findings.

MATERIALS AND METHODS

Shark liver oil was administered to 12 sites in seven pigs. Thin-section CT scans were obtained within 1 hour and at 1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after oil administration. Scans were assessed for opacity, distribution, location at the lobular level, extent, and volume of the lesions. The CT number in consolidation areas also was measured. Findings at CT were correlated with those in the histopathologic specimens.

RESULTS

Diffuse ground-glass opacity was noted on all immediately obtained scans. The opacity of the lesions was highest at 1 week; then it decreased gradually to an area of ground-glass opacity. The extent and volume of the lesions decreased at follow-up CT. Histopathologically, the lesions showed a lobular distribution sharply demarcated from the normal lungs. The lobules of decreased volume showed residual thickening of the alveolar walls with bronchiolectasis and mild collagen deposition of the interlobular septa. Pathologic examination of the low-attenuating consolidation area at CT revealed evidence of partial aeration.

CONCLUSION

Thin-section CT findings of lipoid pneumonia include ground-glass opacity and airspace consolidation, followed by complete or incomplete resolution with volume loss and septal thickening. Low-attenuating consolidation at CT does not always indicate the presence of fat.

Distribution of carcinoembryonic antigen and biologic behavior in colorectal carcinoma

PURPOSE

Carcinoembryonic antigen is assumed from the results of several experiments to be associated with invasion of colorectal carcinoma by adhesion or contact inhibition. The patterns and the intensity of carcinoembryonic antigen distribution in colorectal carcinoma were assessed to verify whether they were correlated with malignant potential from those biologic characteristics.

METHODS

Carcinoembryonic antigen distribution was tested in the archival samples of 149 colorectal carcinomas by immunohistochemistry, using three characterized anti-carcinoembryonic antigen monoclonal antibodies: T84.66, PR1A3, and PR3B10. The distribution patterns in neoplastic tissue were categorized into unstained, apicoluminal, and diffuse cytoplasmic patterns. Tumor, invasive tumor margin, and tissue surrounding the tumor were examined.

RESULTS

Although all three antibodies revealed a positive correlation, T84.66 showed better discrimination than the others. Although none of the negative staining of the tumor or invasive tumor margin showed recurrence, the apicoluminal pattern showed recurrence, and the diffuse pattern showed the most frequent recurrence (P < 0.01). Recurrence was also associated with staining intensity in the apicoluminal pattern in both the tumor and invasive tumor margin (P < 0.05). Infiltrative tumor growth and lymph node metastasis were more frequent in cases of positive staining in tissue surrounding the tumor. Patients with the apicoluminal pattern achieved longer survival than patients with the diffuse-cytoplasmic pattern in the invasive tumor margin (P = 0.024) by a multivariate analysis including tumor stage and histologic differentiation.

CONCLUSION

The distribution of carcinoembryonic antigen in tumors and surrounding tissue seems to be closely correlated with invasiveness and metastatic behavior in colorectal carcinoma. Carcinoembryonic antigen immune staining can be considered as an efficient tool to determine groups with risk of recurrence.