Round window membrane rupture following blunt force trauma

Round window rupture following barotrauma such as diving and air travel is well documented. However, we describe a case of round window rupture following a slap to the ear, which has not been described previously. A 12-year-old boy was slapped by his teacher in rural Nepal over his left ear and immediately noted hearing loss. There was no dizziness or tinnitus. He presented to our unit 21 days after the trauma and examination showed a perforation of the tympanic membrane in the anterior inferior quadrant with an otherwise normal ear examination and no nystagmus seen. Audiogram showed a left profound hearing loss, which was supported by auditory brainstem response test. Exploratory tympanotomy showed active perilymph leakage from the round window niche as demonstrated in the video attached. The round window was packed with cartilage and fascia to address the perilymph leakage. The patient was discharged the following day without any complications. This is an unusual cause for round window membrane rupture where the patient presented with hearing loss as his only symptom. Tympanotomy is recommended for patients with hearing loss following trauma with normal computed tomography imaging to exclude perilymph leak secondary to inner ear barotrauma.

Prognosticating patients with necrotising otitis externa based on response to treatment

INTRODUCTION

Necrotising otitis externa (NOE) is a severe infection of the temporal bone. The traditional severity based staging system does not fully prognosticate all patients with NOE. We hypothesise that a patient response staging system would more accurately capture the disease process and guide prognosis.

METHODS

We carried out a retrospective notes review of patients diagnosed with NOE from January 2017 to December 2018 in a regional tertiary referral centre. Patient outcomes from our proposed patient response staging system were compared to a modified previously published severity based Gleeson staging system with patients requiring prolonged treatment classified as having a poor outcome.

RESULTS

A total of 34 patients were treated for NOE. The majority were male (n=24) and had diabetes (n=25). Patients with the most severe Gleeson staging did not have the worst outcome. Daily delay in resolution of otorrhoea was associated with an increased need for more than six weeks of treatment. Rapid responders are patients who had resolution of otalgia, otorrhoea and C-reactive protein normalisation within 14 days, and all were cured following standard 6 weeks of treatment.

CONCLUSIONS

The Gleeson staging system was valuable in assessing the extent of disease and all early Gleeson staged patients had good outcomes. However, patients with higher severity staging on the Gleeson system did not necessarily require prolonged treatment. There is a role for a joint approach in staging patients based on both modified Gleeson and treatment response, which would subsequently guide prognosis, duration of treatment and early diagnosis of potential fungal NOE.

Prophylactic Antiplatelet Medication in Endovascular Treatment of Intracranial Aneurysms: Low-Dose Prasugrel versus Clopidogrel

BACKGROUND AND PURPOSE

Prophylactic antiplatelet medication is beneficial in decreasing thromboembolic complications during endovascular treatment of unruptured intracranial aneurysms. The efficacy may be limited by variability of individual response to antiplatelet medication, especially clopidogrel. We compared the efficacy of 2 antiplatelet medications, low-dose prasugrel and clopidogrel, in patients undergoing endovascular treatment of unruptured aneurysms.

MATERIALS AND METHODS

From November 2014 to July 2015, 194 patients with a total of 222 unruptured aneurysms underwent endovascular treatment at a single institution. Laboratory and clinical data from the prospectively maintained registry were used in this study. Antiplatelet medication was given the day before endovascular treatment (prasugrel 20 mg or 30 mg or clopidogrel 300 mg). Response to the antiplatelet medication was measured by the VerifyNow system. Periprocedural adverse event rates between the 2 groups were compared.

RESULTS

There were no significant differences in the baseline characteristics of patients and aneurysms between the 2 groups. The P2Y12 reaction unit values were lower (clopidogrel group versus prasugrel group, 242.7 ± 69.8 vs 125.7 ± 79.4; P < .0001) and percentage inhibition values were higher (22.1% ± 19.7% vs 60.2 ± 24.7%; P < .0001) in the prasugrel group. There were no thromboembolic events, but there was 1 procedural bleed in each group, without any clinical consequences.

CONCLUSIONS

The prasugrel group showed more effective and consistent platelet inhibition. We may omit the antiplatelet response assay with the low-dose prasugrel premedication before the endovascular treatment of patients with unruptured aneurysms. Further study is required to determine whether there is benefit of this strategy regarding clinical outcome.

Do Contrast-Fill Patterns Immediately After Coil Embolization of Small Saccular Aneurysms Impact Long-Term Results?

PURPOSE

It is generally accepted that filling of a saccular aneurysm with contrast immediately after coil embolization predisposes to later recanalization. However, not all such scenarios evolve similarly over time. We investigated outcomes of small (≤ 7 mm) aneurysms with contrast-filled sacs immediately after coil embolization, evaluating the impact of pattern and degree of filling on subsequent recanalization.

METHODS

Between January, 2008 and December, 2010, 186 small (≤ 7 mm) saccular aneurysms that retained contrast after coil embolization accrued for this study. Lesions were categorized by pattern (eccentric vs. concentric) and degree of filling on working projections. Clinical and morphologic factors were also analyzed to assess impact on subsequent recanalization. Morphologic outcomes at 6 months or more were assessed.

RESULTS

In 93.5 % (174/186) of aneurysms with visible contrast retention, complete occlusion was evident on follow-up imaging studies at 6 months. Multiple logistic regression analysis indicated that eccentric (vs. concentric) contrast filling carried greater risk of subsequent recanalization (p = 0.020). Stent placement and progressive occlusion were also linked, falling short of statistical significance (p = 0.089). Of 166 progressively occluded aneurysms followed for more than 12 months (mean, 30.8 ± 7.3 months), 158 (95.2 %) exhibited stable occlusion.

CONCLUSION

Small (≤ 7 mm) aneurysms that retain contrast immediately after coil embolization are more likely to become completely occluded over time through progressive thrombosis. However, an eccentric fill pattern may predispose to recanalization.

Injury to the blood-testis barrier after low-dose-rate chronic radiation exposure in mice

Exposure to ionising radiation induces male infertility, accompanied by increasing permeability of the blood-testis barrier. However, the effect on male fertility by low-dose-rate chronic radiation has not been investigated. In this study, the effects of low-dose-rate chronic radiation on male mice were investigated by measuring the levels of tight-junction-associated proteins (ZO-1 and occludin-1), Niemann-Pick disease type 2 protein (NPC-2) and antisperm antibody (AsAb) in serum. BALB/c mice were exposed to low-dose-rate radiation (3.49 mGy h(-1)) for total exposures of 0.02 (6 h), 0.17 (2 d) and 1.7 Gy (21 d). Based on histological examination, the diameter and epithelial depth of seminiferous tubules were significantly decreased in 1.7-Gy-irradiated mice. Compared with those of the non-irradiated group, 1.7-Gy-irradiated mice showed significantly decreased ZO-1, occludin-1 and NPC-2 protein levels, accompanied with increased serum AsAb levels. These results suggest potential blood-testis barrier injury and immune infertility in male mice exposed to low-dose-rate chronic radiation.

Data Build-up for the Construction of Korean Specific Greenhouse Gas Emission Inventory in Livestock Categories

Many studies on methane (CH₄) and nitrous oxide (N₂O) emissions from livestock industries have revealed that livestock production directly contributes to greenhouse gas (GHG) emissions through enteric fermentation and manure management, which causes negative impacts on animal environment sustainability. In the present study, three essential values for GHG emission were measured; i.e., i) maximum CH₄ producing capacity at mesophilic temperature (37°C) from anaerobically stored manure in livestock category (B_0,KM, Korean livestock manure for B₀), ii) EF_3(s) value representing an emission factor for direct N₂O emissions from manure management system S in the country, kg N₂O-N kg N⁻¹, at mesophilic (37°C) and thermophilic (55°C) temperatures, and iii) N_ex(T) emissions showing annual N excretion for livestock category T, kg N animal⁻¹ yr⁻¹, from different livestock manure. Static incubation with and without aeration was performed to obtain the N₂O and CH₄ emissions from each sample, respectively. Chemical compositions of pre- and post-incubated manure were analyzed. Contents of total solids (% TS) and volatile solid (% VS), and the ratio of carbon to nitrogen (C/N) decrease significantly in all the samples by C-containing biogas generation, whereas moisture content (%) and pH increased after incubation. A big difference of total nitrogen content was not observed in pre- and post-incubation during CH₄ and N₂O emissions. CH₄ emissions (g CH₄ kg VS⁻¹) from all the three manures (sows, layers and Korean cattle) were different and high C/N ratio resulted in high CH₄ emission. Similarly, N₂O emission was found to be affected by % VS, pH, and temperature. The B_0,KM values for sows, layers, and Korean cattle obtained at 37°C are 0.0579, 0.0006, and 0.0828 m³ CH₄ kg VS⁻¹, respectively, which are much less than the default values in IPCC guideline (GL) except the value from Korean cattle. For sows and Korean cattle, N_ex(T) values of 7.67 and 28.19 kg N yr⁻¹, respectively, are 2.5 fold less than those values in IPCC GL as well. However, N_ex(T) value of layers 0.63 kg N yr⁻¹ is very similar to the default value of 0.6 kg N yr⁻¹ in IPCC GLs for National greenhouse gas inventories for countries such as South Korea/Asia. The EF_3(s) value obtained at 37°C and 55°C were found to be far less than the default value.

Thymic teratoma masquerading as a thyroid lump

Teratomas are germ cell tumours commonly found in the sacrococcygeal region, ovary, testicle or, infrequently, the mediastinum. In very rare circumstances, these tumours are found in the neck. This case represents a thymic teratoma presenting as what appeared to be an intrathyroid lesion. This has not been described previously and demonstrates an unusual presentation of a neck lump necessitating two operations and a multidisciplinary approach for management. We would also like to highlight that while patients undergo imaging to guide surgery, the surgeon must always be prepared for the unexpected and recognise situations where the operation should be converted to an exploratory procedure instead of full resection. Often, combined surgical care is the best option for difficult congenital cases.

Remodelling of nasal mucosa in mild and severe persistent allergic rhinitis with special reference to the distribution of collagen, proteoglycans, and lymphatic vessels

BACKGROUND

Small leucine-rich repeat proteoglycans (decorin, biglycan, and lumican), collagen, and lymphangiogenesis are involved in tissue remodelling of various organs with inflammatory diseases.

OBJECTIVE

We determined the expression level and the distribution pattern of small leucine-rich repeat proteoglycans (decorin, biglycan, and lumican), collagen and lymphatic vessels in healthy, mild, and severe persistent allergic nasal mucosa.

METHODS

The distribution pattern of collagen, proteoglycans, and lymphatic vessels in healthy, mild, and severe persistent allergic nasal mucosa was evaluated by the van Gieson staining, immunohistochemistry, RT-PCR, and Western blotting. Quantitative analyses of collagen deposition were calculated as the median of the total percentage area in the tissue specimen. For the evaluation of proteoglycans, the percentage area stained and median optical density were measured for each image. Lymphatic vessels were identified by D2-40 antibody and calculated using the lymphatic vessel density and endothelial length density in tissue specimens. The expression of MMP 2 and 9, TIMP1 and 2 was evaluated with RT-PCR and Western blotting.

RESULTS

In mild and severe persistent allergic nasal mucosa, compared with healthy nasal mucosa, collagen showed more intense staining in the superficial and submucosal layer. In healthy and allergic nasal mucosa, decorin was lightly stained without significant differences in the percentage area and optical density of staining. However, lumican and biglycan showed strong immunoreactivity in mild and severe persistent allergic nasal mucosa, which was verified by Western blotting. The number and endothelial length density of lymphatic vessels were increased in mild and severe persistent allergic nasal mucosa compared with healthy nasal mucosa. The expression of MMP 9 was increased in severe persistent allergic rhinitis.

CONCLUSION AND CLINICAL RELEVANCE

These results suggest that the altered distribution pattern of collagen, proteoglycans, and lymphatic vessels could potentially modulate the remodelling of nasal mucosa in mild and severe persistent allergic nasal mucosa.

Expression of mRNA encoding interleukin (IL)-10, IL-12p35 and IL-12p40 in lungs from pigs experimentally infected with Actinobacillus pleuropneumoniae

The expression of mRNA encoding interleukin (IL)-10, IL-12p35 and IL-12p40 was studied, by reverse transcription-polymerase chain reaction and by in situ hybridization with a non-radioactive digoxigenin-labelled cDNA probe, in formalin-fixed, paraffin-wax-embedded lung tissue from pigs experimentally infected with Actinobacillus pleuropneumoniae. Forty-eight 7-week-old colostrum-deprived pigs were randomly allocated to infected (n = 24) or control (n = 24) groups. Three pigs from each group were euthanized at 3, 6, 9, 12, 24, 36, 48 and 60 h post inoculation (hpi). IL-10 mRNA was detected in the lung at 3 hpi, numbers of cells positive for IL-10 increasing at 36 hpi. IL-12p35 mRNA was detected in the lung at 3 hpi, numbers of cells positive for IL-12p35 increasing at 36 and 48 hpi and rapidly decreasing thereafter whereas IL-12p40 mRNA was constitutively expressed at low levels during the experiment. Hybridization signals for IL-10, IL-12p35 and IL-12p40 were always associated with inflammation, in particular with macrophages and neutrophils within alveolar spaces. Expression of these cytokines was minimal in non-lesional lung of A. pleuropneumoniae-infected pigs and in normal lung from control pigs. In situ hybridization of A. pleuropneumoniae and these cytokines in serial sections of lung tissues indicated close co-localization of A. pleuropneumoniae and these cytokines in pleuropneumonia. The results suggest that the expression of IL-10 and IL-12 play a role in pathogenesis of A. pleuropneumoniae infection.

Expression of inflammatory cytokines (TNF-alpha, IL-1, IL-6 and IL-8) in colon of pigs naturally infected with Salmonella typhimurium and S. choleraesuis

The expression of mRNA encoding tumour necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), IL-6 and IL-8 was studied, by in situ hybridization with a non-radioactive digoxigenin-labelled probe, in formalin-fixed, paraffin wax-embedded colonic tissue from pigs naturally infected with Salmonella typhimurium and S. choleraesuis. By in situ hybridization, a distinct positive signal for TNF-alpha, IL-1, IL-6 and IL-8 was detected in colon from all 12 infected pigs. Hybridization signals for all four inflammatory cytokines were detected primarily inflammatory cells infiltrating the lamina propria and submucosa. In comparison, expression of all four inflammatory cytokines was minimal in non-lesional colon of infected pigs and in normal colon from control pigs. The results suggest that these cytokines play an important role in the pathophysiological processes in porcine salmonellosis.

Expression of cyclooxygenase-2 in swine naturally infected with Actinobacillus pleuropneumoniae

Cyclooxygenase-2 (COX-2) was detected and localized in 15 pigs with naturally occurring pleuropneumonia using a 437-base pair digoxigenin-labeled cDNA probe in an in situ hybridization protocol. Histopathologic changes in the acute stage were characterized by coagulative necrosis of lung parenchyma, hemorrhage, vascular thrombosis, edema, fibrin deposition, and infiltration of lung parenchyma by neutrophils and alveolar macrophages in nine pigs. In chronic lesions, a thick layer of granulation tissue surrounded foci of pulmonary necrosis in six pigs. All 15 pigs infected with Actinobacillus pleuropneumoniae, confirmed by bacterial isolation, had distinct positive hybridization signals for COX-2 in bronchial, bronchiolar epithelial cells, alveolar macrophages, neutrophils, and type I pneumocytes. COX-2 expression was detected primarily in neutrophils from pigs with acute lesions and primarily in alveolar macrophages from pigs with chronic lesions. The results suggest that a prostanoid product of COX-2 is an important component of the inflammatory response to acute and chronic A. pleuropneumoniae infection.

Anti-microbial susceptibility for east1 + Escherichia coli isolated from diarrheic pigs in Korea

The in vitro susceptibilities of 128 isolates of east1 + Escherichia coli from pre-weaned and post-weaned pigs with diarrhoea were tested with nine commonly used anti-microbial agents by an agar dilution minimal inhibitory concentration (MIC) procedure according to National Committee for Clinical Laboratory Standards guidelines. For the isolates from preweaned and post-weaned pigs, most of them were susceptible to low concentrations (MIC90) of tetracycline (4 and 2 microg/ml), ceftiofur (2 and 2 microg/ml), and colistin (4 and 2 microg/ml). Marked resistance was found in others.

Genotypic prevalence of the fimbrial adhesins (F4, F5, F6, F41 and F18) and toxins (LT, STa, STb and STx2e) in Escherichia coli isolated from postweaning pigs with diarrhoea or oedema disease in Korea

A PCR was used to determine the genotypic prevalence of five fimbrial adhesins (F4, F5, F6, F41 and F18), two heat-stable enterotoxins (STa and STb), the heat-labile enterotoxin (LT), and the shiga toxin 2e (Stx2e) in 230 isolates of Escherichia coli from postweaning pigs with diarrhoea or oedema disease. Ninety-four (40.9 per cent) of the isolates carried genes for at least one of the fimbrial adhesins or toxins. Genes for the F18 fimbrial adhesin were detected in 18.3 per cent, and genes for F4, F6, F5 and F41 were detected in 10.0 per cent, 4.3 per cent, 1.7 per cent and 0.8 per cent of the isolates, respectively. Genes for STa, STb and LT were detected in 25.7 per cent, 15.2 per cent and 8.7 per cent of the isolates, respectively. Genes for Stx2e were detected in 36 (15.6 per cent) of the isolates, and among them 24 also contained the gene for F18ab and four also contained the gene for F18ac.

Expression of nitric oxide synthase 2 and tumor necrosis factor alpha in swine naturally infected with Actinobacillus pleuropneumoniae

Nitric oxide synthase 2 (NOS2) and tumor necrosis factor alpha (TNF-alpha) were detected and localized in 15 pigs with naturally occurring pleuropneumonia by use of in situ hybridization with a nonradioactive digoxigenin-labeled cDNA probe. Two cDNA probes 491 and 219 base pairs for NOS2 and TNF-alpha, respectively, were generated by reverse transcription polymerase chain reaction. All 15 pigs infected with Actinobacillus pleuropneumoniae had distinct positive hybridization signals for NOS2 and TNF-alpha. Strong hybridization signals for both NOS2 and TNF-alpha were evident in degenerate alveolar leukocytes bordering zones of coagulative necrosis and in alveolar spaces. NOS2 nucleic acids were detected in neutrophils and macrophages. In situ hybridization of serial sections of lung tissue revealed numerous cells positive for NOS2 and TNF-alpha, suggesting that NOS2 and TNF-alpha expression may play a role in the pathophysiology of pleuropneumonia.

The numerical modelling and process simulation for the fault diagnosis of rotary kiln incinerator

The numerical modelling and process simulation for the fault diagnosis of rotary kiln incinerator were accomplished. In the numerical modelling, two models applied to the modelling within the kiln are the combustion chamber model including the mass and energy balance equations for two combustion chambers and 3D thermal model. The combustion chamber model predicts temperature within the kiln, flue gas composition, flux and heat of combustion. Using the combustion chamber model and 3D thermal model, the production-rules for the process simulation can be obtained through interrelation analysis between control and operation variables. The process simulation of the kiln is operated with the production-rules for automatic operation. The process simulation aims to provide fundamental solutions to the problems in incineration process by introducing an online expert control system to provide an integrity in process control and management. Knowledge-based expert control systems use symbolic logic and heuristic rules to find solutions for various types of problems. It was implemented to be a hybrid intelligent expert control system by mutually connecting with the process control systems which has the capability of process diagnosis, analysis and control.

Prevalence, capsular type and antimicrobial susceptibility of Streptococcus suis isolated from slaughter pigs in Korea

This study was undertaken to determine the prevalence, capsular serotype, and antimicrobial susceptibility of Streptococcus suis isolated from slaughter pigs. Capsular serotype and antimicrobial susceptibility were determined by coagglutination test and agar dilution minimum inhibitory concentration, respectively. Streptococcus suis was isolated from 55 of the 406 palatine tonsillar samples tested (13.8%) and 14 of the 29 sampled herds (48.3%). Of the 55 isolates recovered from slaughter pigs, 26 (47.3%) were untypeable. Of the remaining 29 isolates, capsular serotypes 9 (9 isolates) and 16 (4 isolates) were the most common, followed by capsular serotypes 4 (3 isolates) and 7 (3 isolates). Every capsulated isolate was typeable and no palatine tonsillar sample yielded more than one serotype. Most of isolates were susceptible to low concentrations (MIC90) of amoxicillin (2 microg/mL), ceftiofur (1 microg/mL), and penicillin (1 microg/mL). No correlation was found between antimicrobial susceptibility and capsular serotype.

Expression of the apxIV gene in pigs naturally infected with Actinobacillus pleuropneumoniae

The apxIV gene was detected, by in-situ hybridization with a non-radioactive digoxigenin-labelled probe, in formalin-fixed, paraffin wax-embedded samples of lung tissue from 10 pigs naturally infected with Actinobacillus pleuropneumoniae. A 442 base pair DNA probe of the apxIV gene from A. pleuropneumoniae serotype 2 was generated by the polymerase chain reaction. All 10 pigs infected with A. pleuropneumoniae serotypes 2, 5, 6, or an untypable strain showed a distinct, positive signal in the degenerate alveolar leucocytes in alveolar spaces, and in the dense zone of degenerated cells in granulation tissue surrounding the necrotic areas. Thus, the study demonstrated the presence of the apxIV gene in pleuropneumonic lesions caused by A. pleuropneumoniae.

Genotypic prevalence of apx1V in Actinobacillus pleuropneumoniae field isolates

A total of 90 Actinobacillus pleuropneumoniae field strains from pigs were serotyped by slide agglutination and analyzed for the presence of the apxIV gene by polymerase chain reaction. Of the 90 isolates serotyped, serotypes 2 (47 isolates) and 5 (25 isolates) were the most common, followed by serotype 6 (10 isolates). Three isolates belonged to serotype 7, and 5 isolates could not be typed. All 90 A. pleuropneumoniae field isolates tested carried the apxIV gene. This gene is species specific rather than serotype specific. Therefore, the ApxIV toxin has potential value for use both in vaccines and in diagnostic tests.

Antimicrobial susceptibility of Actinobacillus pleuropneumoniae isolated from pigs in Korea using new standardized procedures

The in vitro susceptibilities of 76 isolates of Actinobacillus pleuropneumoniae collected from pigs with pleuropneumonia were tested with 12 commonly used antimicrobial drugs by an agar dilution minimal inhibitory concentration procedure according to National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Field isolates had low MICs for ceftiofur, danofloxacin and penicillin. No correlation of antimicrobial resistance was related to serotype.

Immunohistochemistry and polymerase chain reaction for the detection of Lawsonia intracellularis in porcine intestinal tissues with proliferative enteropathy

Detection method of Lawsonia intracellularis was studied in formalin-fixed paraffin-embedded intestinal tissues from 5 naturally infected pigs by immunohistochemistry with a monoclonal antibody against outer membrane protein of L. intracellularis. Warthin-Starry silver stain revealed clusters of argyrophilic, slightly curved rod-shaped organisms in the apical cytoplasm of enterocytes. Immunohistochemical staining with a L. intracellularis-specific monoclonal antibody confirmed the presence of the organism in the apical cytoplasm of hyperplastic enterocytes. The presence of L. intracellularis in the ileum of pig with proliferative enteropathy was confirmed by polymerase chain reaction (PCR) further on the basis of amplification of 319 base pair products specific for porcine L. intracellularis chromosomal DNA. Immunohistochemistry and PCR may be a complementary method to confirm the diagnosis of L. intracellularis infection in pigs.

Hybrid origin of Japanese mice "Mus musculus molossinus": evidence from restriction analysis of mitochondrial DNA

The Japanese mouse, Mus musculus molossinus, has long been considered an independent subspecies of the house mouse. A survey of restriction-site haplotypes of mitochondrial DNA (mtDNA) showed that Japanese mice have two main maternal lineages. The most common haplotype is closely related to the mtDNA of the European subspecies M. m. musculus. The other common haplotype and two minor ones are closely related to each other and to the mtDNA of an Asiatic subspecies, M. m. castaneus. Two other rare variants are probably the result of recent contamination by European M. m. domesticus. The musculus type of mtDNA is found in the southern two-thirds of Japan, whereas the common castaneus type is found in the northern third and the minor variants are found sporadically throughout Japan. The castaneus mtDNA lineage had a few minor variants, whereas the musculus lineage was completely monomorphic. By contrast, the native population of M. m. castaneus and the Chinese and Korean musculus populations were highly polymorphic. These results suggest that M. m. molossinus is a hybrid between ancestral colonies, possibly very small, of M. m. musculus and M. m. castaneus, rather than an independent subspecies.

Endoscopic extraction of a perforating wire from the stomach

A Report on the succesful endoscopic removal of a wire 3.8 cm long which perforated the gastric wall.

Percutaneous endoscopic gastrostomy for enteral nutrition

From January to October, 1986, at Wonkwang University Hospital in Iri, percutaneous endoscopic gastrostomy(PEG) was attempted in 26 patients and was successful in 24. This study was designed to review the technique and to evaluate the efficacy of PEG. The mean operation time was 22 minutes (range: 14 to 42 minutes). After feeding started, early positive nitrogen balance was achieved in all patients. All gastrostomies functioned well throughout the patient’s survival with the longest functioning at 10 month. There were no procedure-related deaths, and morbidity was lower and less severe as compared with large-bore nasogastric tube feeding. Complications included minor wound infection in two patients, stomal growth in one patient, leaks around the tube in two patients, and intraperitoneal leak in one patient. No patient developed aspiration pneumonia or required laparotomy for complications from PEG. The gastrostomy tube was easily removed endoscopically when treatment was completed. Feeding via a large-bore tube increased the risk of aspiration pneumonia (72%) and the feeding cost via a small-bore tube with elemental diet exceeded that of PEG by more than tenfold. This author’s experience with these 26 patients has led to the conclusion that PEG is safe, easy to perform, and effective means of creating feeding gastrostomy without laparotomy or general anesthesia. The authors suggest that PEG be the preferred route of alimentation in those patients who are unable to swallow for prolonged periods of time.

Characterization of newly isolated monoclonal antibodies against MHC of a Japanese wild mouse

We have already developed nine B10.MOL congenic strains carrying H-2 haplotypes derived from Japanese wild mice, Mus musculus molossinus, with the C57BL/10 genetic background. To obtain monoclonal antibodies against the H-2 antigen of the Japanese wild mouse, we carried out cell fusion using spleen cells from the animal immunized with one of the B10.MOL strains, B10.MOL-SGR (H-2wm7). As a result, 19 hybridomas producing monoclonal antibodies were produced. Analysis with the intra-H-2 recombinants derived from B10.MOL-SGR indicated that 8 of them reacted with the class I and 11 with the class II molecule. The class I antibodies were tested for their cross-reactivities on wild mice and on the panels of standard inbred and B10.MOL strains. Most of the antibodies reacted with both the Japanese wild mice and the other subspecies, including standard inbred, while two antibodies highly specific for the donor H-2K region reacted with only three wild-derived mice, two M. m. molossinus from Anjo and Shizuoka, Japan, and one M. m. domesticus from Pigeon, Canada. In addition, all of the other four antibodies reactive with the K antigen of B10.MOL-SGR also reacted with the same three wild mice. The wild mice belonging to different subspecies might share very similar H-2K antigenic determinants in spite of their genetic and geographical remoteness.

Allelic constitution of the hemoglobin beta chain in wild populations of the house mouse, Mus musculus

We studied the allelic frequency of the hemoglobin beta chain (Hbb) of wild mice, Mus musculus, collected from 46 localities, mostly in Asia and surrounding areas. The wild populations in the northern part of China, Korea, and the central part of Japan exhibited an almost monomorphic distribution of Hbbp. In the southern part of Asia, the frequency of Hbbp decreased and Hbbd was predominant. Although Hbbs and Hbbd are generally found in Europe, the Hbbp allele was present in Southeastern Europe (Bulgaria). In the light of these results, the Hbbp allele might have originated in mice of northern Asia.