Injection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children. The effect of pretreatment with alfentanil 10 (Alf10), 15 (Alf15) or 20 (Alf20) micrograms.kg-1 on reducing injection pain caused by propofol was compared with lignocaine 10 mg mixed with propofol (Lign). This double-blind, double-dummy and randomized study included 100 children with a mean age of 4.3 +/- 0.6 years, 25 children in each group, undergoing minor otolaryngological surgery. The children were premedicated orally with midazolam 0.5 mg.kg-1 and atropine 0.03 mg.kg-1. Injection pain occurred in 4% in the Lign group. The corresponding figures were 40, 16 and 20% in the Alf10, Alf15 and Alf20 groups, respectively. Both 1% lignocaine 10 mg and alfentanil 15 micrograms.kg-1 reduced injection pain significantly compared with alfentanil 10 micrograms.kg-1. Pretreatment with alfentanil significantly diminished haemodynamic responses to tracheal intubation. Furthermore, the concomitant use of alfentanil and propofol caused transient severe bradycardia and a significant decrease in heart rate after laryngoscopy.


Changes in ventilatory pattern and arterial oxygen saturation during spinal anaesthesia in man. Using a respiratory inductive plethysmograph and a pulse oximeter, we investigated the changes in the respiratory pattern and peripheral oxygen saturation (SpO2) of the finger before and during spinal anaesthesia in 20 surgical patients. The rib cage contribution to the tidal volume (%RC) increased significantly from before (20.4 +/- 4.3%) to during spinal anaesthesia (30.4 +/- 4.8%). However, in those patients who fell asleep 60 min after subarachnoid injection of a local anaesthetic, %RC returned to the preanaesthetic value (23.0 +/- 5.9%). Finger SpO2 increased significantly during spinal anaesthesia, but the femoral arterial oxygen saturation did not change. The authors conclude that spinal anaesthesia increases %RC in conscious patients. However, the increment of %RC does not cause a major change in arterial oxygen saturation.


Heat and moisture exchangers with bacterial filters: a laboratory evaluation. Six commercially available heat-moisture exchanger (HME) humidifiers with built-in bacterial filtration were evaluated by laboratory tests. Physical characteristics, humidification efficiency, resistance to flow and filtration capability were investigated. The resistance was comparable for all units and did not change notably with exposure to humidity. Deadspace values were in the range 55-92 ml and weight values between 34-55 g. The humidification efficiency of two units (Group 1) was clearly less (54%-63% at 11 tidal volume), than for the other four devices (Group 2) (77%-82%). This corresponds to an average humidification output of 22.0 g/m3 for Group 1 as compared to an output of 29.9 g/m3 for Group 2. The average filtration capability of Group 1 was 99.9998%, which is somewhat higher than the 99.9973% obtained for Group 2. There are significant differences between the humidification efficiency and deadspace of different units, with the Pall Conserve device having the least satisfactory performance. All units exhibit good filtering properties, with the Pall Conserve device performing best in this respect.


Serum potassium, catecholamine levels and ECG during field block for inguinal hernia surgery. The purpose of this study was to find out whether hypokalaemia and associated ECG changes occur as a result of field block for hernial repair, alone or in combination with surgery. We recorded the ECG and measured the serum potassium and the plasma catecholamine concentrations at 10-min intervals in three groups of patients. In Group 1 (n = 7) and in Group 2 (n = 7), the blockade was instituted with prilocaine 0.5% and adrenaline 1:250,000, while in Group 3 plain prilocaine 0.5% was used. In Group 1 surgery was withheld for 40 min, while in Groups 2 and 3 surgery started as soon as the blockade became effective. There was a prolonged 4 to 5-fold elevation of the plasma adrenaline level from the adrenaline-containing solutions, the peak being 2.44 +/- 0.48 nmol/l (mean +/- s.d.) 10 min after the blockade had been instituted. The S-K level was unchanged in Group 1, while in Group 2 it decreased from 4.14 +/- 0.33 mmol/l to 3.91 +/- 0.29 at 60 min (P less than 0.05). An ECG pattern consistent with hypokalaemia did not develop. In Group 3, with plain prilocaine, there was a significant increase in the S-K level from 3.86 +/- 0.21 mmol/l to 4.08 +/- 0.36 at 40 min (P less than 0.05).


Alfentanil inhibits muscle fasciculations caused by suxamethonium in children and in young adults. The effect of alfentanil on suxamethonium-induced muscle fasciculations was studied in a double-blind study in 34 children (mean age 6.8 years) and in 30 adults (mean age 20 years). After pretreatment with either alfentanil 50 micrograms kg-1 or saline, each patient was anaesthetized with a sleep dose of thiopental followed by suxamethonium 1.5 mg kg-1 for endotracheal intubation. Compared to the control groups, alfentanil significantly decreased the intensity of visible muscle fasciculations caused by suxamethonium. In children, the duration of muscle fasciculations was shorter in the alfentanil than in the control group. In adults, the intensity rather than the duration of fasciculations was attenuated by alfentanil. The inhibition of fasciculations caused by alfentanil was also demonstrated in children in the surface electromyogram recorded on the biceps. There was no circulatory response to endotracheal intubation in the groups pretreated with alfentanil.


Intramuscular low-dose ketamine versus pethidine for postoperative pain treatment after thoracic surgery. In a double-blind prospective study the effects of low-dose intramuscular ketamine (1 mg/kg) were compared to pethidine (1 mg/kg) in the treatment of pain after pulmonary surgery. Thirty patients were admitted to the study and postoperatively randomized to either a ketamine or a pethidine group. The analgesic effect was evaluated using a scale ranging from 0 to 10, where 0 denoted no pain and 10 severe pain. We did not find any significant difference between the analgesic effect of ketamine and pethidine; however, the duration of action of ketamine appeared to be slightly longer. Throughout the study PaCO2 was significantly lower in the ketamine group. PaO2 increased through the study in both groups and was significantly higher after 2 h. Heart rates increased significantly only in the pethidine group. Mean arterial pressures remained unchanged and the respiratory frequencies were similar in the two groups. The incidence of adverse reactions was low and not significantly different between the groups. The findings indicate that low-dose intramuscular ketamine is a potent analgesic for postoperative analgesia following thoracic surgery and that it has no respiratory depressive effect.


Oxygen consumption after flumazenil reversal. The effect of flumazenil reversal of midazolam-induced anesthesia on whole body oxygen uptake (VO2) was investigated in a double-blind trial in 48 patients (ASA, 1 or 2) undergoing elective surgery under general anesthesia. VO2 was measured in spontaneously breathing patients during recovery from anaesthesia induced with midazolam 0.25 mg.kg-1 and maintained with nitrous oxide 60% in oxygen and halothane. The level of sedation was evaluated by a subjective score. To reverse midazolam-induced anesthesia, patients were randomly allocated to receive placebo or flumazenil (6 micrograms.kg-1). No significant changes in VO2 (160 +/- 53 vs 150 +/- 39 ml.min-1.m-2 or sedation score (2.5 +/- 1.0 vs 2.1 +/- 0.9) were observed in the placebo group. After flumazenil administration, the sedation score significantly (P less than 0.05) improved (2.9 +/- 1.0 vs 1.3 +/- 0.8) whereas no significant change in VO2 was observed (158 +/- 67 vs 157 +/- 61 ml O2.min-1.m-2). These data show that reversal of benzodiazepine effects with flumazenil resulted in no significant change in oxygen uptake.


Adenosine infusion during isoflurane-nitrous oxide anaesthesia: indications of perioperative analgesic effect. Adenosine, an endogenous compound with a known antinociceptive effect when administered into the CNS, was applied in nine patients (21-65 years) by the peripheral intravenous route (70-130 micrograms.kg-1.min-1) as a replacement for peroperative opioids during inhalation anaesthesia for surgical procedures not requiring muscle relaxation. Lorazepam was given as premedication, thiopentone was used for induction, and succinylcholine facilitated intubation of the trachea. Anaesthesia was maintained with isoflurane [initial surgery endtidal concentration (ET) 0.88% (range 0.7-1%)] and nitrous oxide (60-70%) in oxygen. Adenosine infusion was initiated 5-10 min prior to surgery, and stopped close to or when isoflurane was terminated at the end of surgery. The duration of anaesthesia, adenosine infusion, and surgery were 120 min (range 80-165), 90 min (range 70-145), and 90 min (range 60-135), respectively. Spontaneous unassisted ventilation was maintained in all patients. Mean heart rate increased 10 beats.min-1 (range 0-35) upon induction of surgery, while systolic blood pressure was unaffected at 105 mmHg (range 85-120) (14 kPa (range 11.3-16.0)). Spo2 and ETCO2 were in the normal range. The isoflurane concentration was gradually reduced in most cases [mid-surgery ET 0.63% (range 0.5-0.8) and end-surgery ET 0.57% (range 0.3-0.8)]. Extubation and verbal communication were rapidly achieved after anaesthesia. The mean postoperative (24 h) opioid requirement was 4 mg (range 0-10 mg). These pilot cases suggest that systemic adenosine infusion may replace opioids during inhalation anaesthesia, and that adequate spontaneous ventilation can be achieved.


Morphometric and stereological study of the seminal vesicle of the guinea pig. The seminal vesicle of the guinea pig has been widely used as a model for the study of hormonal action on the male accessory sex organ, but there have been few attempts to quantify their cellular and tissue components. In the present study, the seminal vesicle of the guinea pig was described in the form of a morphometric model. Tissue samples were taken from the distal, middle and proximal regions of the gland and processed for light microscopy. Using a combination of a stereological point-counting technique and direct measurement, the relative volumes of different components (lumen, epithelium, lamina propria and fibromuscular layer) were determined. The relative numbers of the secretory cells and basal cells were also estimated. Following the estimation of the average size of the seminal vesicle, the relative volume of different components and the relative number of secretory cells were transformed into absolute data on a per average seminal vesicle basis. Similarly, the average sizes of the secretory cells and nuclei were also determined. The quantitative data generated from the present study will serve as a baseline for further studies of the seminal vesicle of the guinea pig. The techniques used in the present study are easy to apply, and data generated were objective and reproducible.


Nonresponsiveness of the thyroid gland to goitrogen in the early neonatal period in the rat: light- and electron-microscopic observations. The thyroid response of fetal and neonatal rats to propylthiouracil (PTU) as a goitrogen was studied with observation of the thyroid glands by light and electron microscopy. On day 19 of gestation and on days 1, 3, 5 and 8 after birth, fetal and neonatal rats were given a subcutaneous injection of PTU and were autopsied 2 days later. PTU induced conspicuous goiters in fetal rats but did not in neonatal rats aged up to day 5 after birth. Beyond that age, PTU again induced goiters. Histologically, the follicular cell height in goitrous thyroid glands was significantly increased. Ultrastructurally, follicular cells in goitrous thyroid glands often had colloid droplets and lysosomes. It seems that nonresponsiveness of the thyroid glands in early neonatal rats to goitrogen is due to a temporary decline of the pituitary activity of thyrotropin secretion. About 5 days or more after birth, the pituitary-thyroid system begins to operate again in response to goitrogen.


Morphometric variations of the lumbar vertebrae between Chinese and Indian adults. A morphometric study of the lumbar vertebrae of 126 adult skeletons, 90 Chinese and 36 Indian, of both sexes without marginal osteophytes were performed. In each lumbar vertebra, the cephalad and caudad midsagittal diameters, the interpedicular diameter of the spinal canal as well as the midsagittal and transverse diameters and the height of the vertebral body were measured. The results showed that the midsagittal and transverse diameters, the heights of the lumbar vertebral bodies and the interpedicular diameters of the lumbar spinal canals increased progressively from L1 to L5, while the midsagittal diameters of the lumbar spinal canals decreased progressively from L1 to L5 in both Chinese and Indian adult skeletons. The lowest mean values of the cephalad and caudad midsagittal and the interpedicular diameters of the spinal canals in Chinese were found to be 5.04 +/- 0.15 mm at L5, 4.67 +/- 0.09 mm at L5 and 25.92 +/- 0.20 mm at L2, respectively, while in Indians they were found to be 4.54 +/- 0.18 mm at L5, 4.25 +/- 0.10 mm at L5 and 25.42 +/- 0.22 mm at L1, respectively. In addition, the mean diameters of the spinal canal and the vertebral body (except the height of the vertebral body) were significantly greater in the Chinese than in the Indian skeletons. The above findings indicate that the mean diameters of both the lumbar spinal canal and the vertebral body vary greatly between Chinese and Indian adults, i.e. there are no mean values of the vertebral dimensions that are valid for all populations.(ABSTRACT TRUNCATED AT 250 WORDS)


[Biomechanics of the joints of the large toe. Shape and movement of the first tarsometatarsal joint and of the medial cuneonavicular joint]. 90% of the first (hallucal) tarsometatarsal joints are screw-shaped; the axis is directed upwards to the front touching the lateral edge of the joint. Thus the plantar flexion is inevitably accompanied by an adduction and a pronation, and vice versa a dorsiflexion is consequently accompanied by an abduction and a supination, when the articular surfaces exactly slide along each other. 10% of these joints, however, are ellipsoid-shaped; in this case the distal articular surface of the medial cuneiform bone has the form of an ovoid head, and a strong ligament situated next to the lateral edge of the joint effects the same kind of motion described above. The medial cuneonavicular joint is always ellipsoid-shaped, the head of which is made up by the medial facet of the distal articular surface of the navicular bone. Each of the two joints mentioned has a considerable range of mobility.


Tight junctions of human uterine epithelial cells change during the menstrual cycle: a morphometric study. Tight junctions between luminal epithelial cells of the human uterus were studied by freeze-fracture electron microscopy. It was found that junctional complexity decreased during the menstrual cycle, and we explore how this finding may contribute to the role of the uterus in facilitating implantation.


Light-microscopic demonstration of methylene blue accumulation sites in mouse brain after supravital staining. Mouse brains were stained supravitally with methylene blue and studied in paraffin sections by light microscopy. In the perikarya, the dye was found to bind primarily to the nuclei; only slight staining of the cytoplasm was observed. Dye accumulations within nerve fibers were found in the nodes of Ranvier and in the varicosities of the unmyelinated endings. Specific dye binding in dendrites corresponded mainly to beads and spines. The accumulation sites in terminal neuronal processes appeared to be closely related to the plasma membrane. These morphological data would explain the neurophysiologically proven interaction of the dye with calcium-binding sites in membranes.


Liver development in rats during the embryonic period (Carnegie stages 11-14). The hepatic structures appearing during Carnegie stages 11-14 were analyzed in a series of 61 OFA rat embryos. The group of embryos (crown-rump length 2-7 mm, 10th-12th days after coitus) was composed of 52 specimens of the somite period (stages 11 and 12) and of 9 specimens of the postsomite period (stages 13 and 14). The embryos were submitted to serial histological sectioning with graphic reconstruction. Stage 11 was characterized by the development of the hepatic diverticulum induced by differential growth of the endodermal plate and fixed contact between the entoderm and endothelium lining the heart. Stage 12 presented obvious signs of cellular differentiation, the septum transversum giving the liver stroma and the hepatic diverticulum the epithelial trabecula. At stage 13 the epithelial cords enmeshed the stromal capillaries, while hepatocardiac veins drained the hepatic flow into the sinus venosus. Stage 14 was recognized by the presence and development of the hepatic lobes and the enlargement of vascular channels. The cystic bud was never observed. The identification of these features permits to precise the hepatic developmental staging in rats and to obtain accurate criteria for the characterization of the end of the somite period and the beginning of the postsomite period.


Long-term effects of alloxan-induced diabetes on the nucleus ventralis posterolateralis in the thalamus of the rat. The present paper describes the long-term ultrastructural changes in the nucleus ventralis posterolateralis of the thalamus of male Wistar rats after alloxan-induced diabetes. Degenerating dendrites were characterized by an electron-dense cytoplasm with scattered endoplasmic reticulum and ribosomes. Degenerating axon terminals were characterized by an electron-dense cytoplasm and clustering of small spherical agranular vesicles. Degenerating axon terminals formed axosomatic synapses with seemingly normal cell bodies and axodendritic synapses with normal as well as degenerating dendrites. Degenerating axons (both myelinated and unmyelinated) were readily encountered in the neuropil. Activated microglial and astrocytic cells in the neuropil were in the process of phagocytosis or had residua in their cytoplasm.


A comparison of the immunohistochemical localization of type I and type II collagens in craniofacial cartilages of the rat. The immunohistochemical localization of types I and II collagen was examined in the following 4 cartilaginous tissues of the rat craniofacial region: the nasal septal cartilage and the spheno-occipital synchondrosis (primary cartilages), and the mandibular condylar cartilage and the cartilage at the intermaxillary suture (secondary cartilages). In both primary cartilages, type II collagen was present in the extracellular matrix (ECM) of the whole cartilaginous area, but type I collagen was completely absent from the ECM. In the secondary cartilages, type I collagen was present throughout the cartilaginous cell layers, and type II collagen was restricted to the ECM of the mature and hypertrophic cell layers. These observations indicate differences in the ECM components between primary and secondary craniofacial cartilages, and that these differences may contribute to their modes of chondrogenesis.


[The posterior intervertebral spaces of the craniovertebral joint]. Closing of the posterior intervertebral spaces of the craniovertebral joint is not performed by the classical posterior atlanto-occipital and atlantoaxial membranes. In the atlanto-occipital space, the connective laminae come from the occipital periosteum and from the anterior fascia of the rectus capitis posterior minor muscle, and pass round the anterior side of the posterior arch of the atlas to reach the spinal dura mater. In the atlantoaxial space, the anterior fasciae of the rectus capitis posterior major muscle and of the inferior oblique muscle, as well as the periosteum of the posterior arch of the atlas, extend to reach the spinal dura mater. Thus, the epidural space is sealed posteriorly by the connective laminae of the atlantoaxial space, and lets above a superior recessus containing the ganglia of the spinal nerves C1 and C2 and in which the vertebral artery transits.


The pretectal complex of the rabbit: distribution of acetylcholinesterase and reduced nicotinamide adenine dinucleotide diaphorase activities. The chemoarchitecture of the pretectal complex of the rabbit was examined in sections stained by acetylcholinesterase (AChE) and reduced nicotinamide adenine dinucleotide (NADH) diaphorase in the coronal, horizontal and sagittal plane. Twelve different subdivisions can be identified in the rabbit pretectum on the basis of the distribution of both histochemical markers. According to the standard terminology, the pretectal complex of the rabbit consists of: the nucleus of the optic tract; the anterior, posterior, olivary and medial pretectal nuclei; the nucleus of the posterior commissure; the periventricular subcommissural gray; the suprageniculate and internal suprageniculate nuclei, and the dorsal, lateral and medial terminal nuclei of the accessory optic system. The combined use of several sectioning planes and the histochemical mapping of AChE and NADH diaphorase have been of value in resolving the structural limits within transitional regions of the pretectum.


Elbow extensor muscles of the horse: postural and dynamic implications. Based on histochemical and immunohistochemical evidence, horse elbow extensor muscles are composed of two morphologically distinct muscle groups. The long and lateral heads of the triceps brachii are large, predominantly type II (presumed fast) muscles. The long and lateral heads of the triceps together account for 96% of the weight of the elbow extensors (long head of triceps is 81%). The long and lateral heads contain three histochemical fiber types: types I, IIa and IIb. Type I muscle fibers account for approximately 18 and 27% of the fibers in the long and lateral heads of the triceps, respectively. In the lateral head, type IIa and IIb fibers account equally for the remaining 70%, while in the long head of the triceps type IIb fibers predominate (50%) over type IIa fibers (32%). In contrast, the much smaller medial head of the triceps (2% of triceps mass) and the anconeus (2% of mass) contain almost exclusively type I muscle fibers. It is hypothesized that the medial head and anconeus, with their slow fibers, contribute to the postural maintenance of the forelimb by preventing flexion at the elbow joint during passive stance. The larger long and lateral heads, with their generally fast fiber populations, are most likely important during dynamic activity.


Distribution of oxytocin and vasopressin neurons in the diencephalon of the Japanese horseshoe bat, Rhinolophus ferrumequinum. An immunohistochemical study. The distribution of oxytocin (OXT) and vasopressin (VP) neurons in the diencephalon of the hibernating Japanese horseshoe bat, Rhinolophus ferrumequinum, was immunohistochemically investigated by the avidin-biotin complex method. Magnocellular OXT and VP neurons were localized mainly in the paraventricular nucleus and the supraoptic nucleus. In addition to these main nuclei, both kinds of magnocellular neurons were also found in the periventricular nucleus, perifornical area and lateral hypothalamic area. Extensively distributed parvocellular neurons containing only VP were observed in the rostral and middle portions of the suprachiasmatic nucleus. The size of OXT and VP magnocellular neurons was almost equal in the paraventricular and ventromedial supraoptic nuclei, whereas VP neurons were significantly larger than OXT neurons in the dorsolateral supraoptic nucleus. The OXT and VP cells in the ventral supraoptic nucleus showed a distinctive elliptical shape. Both OXT and VP fibers were distributed in the lateral habenular nucleus, stria medullaris thalami, lateral preoptic area, stria terminalis, and medial and supracapsular part of the bed nucleus of the stria terminalis. Moreover, OXT fibers were found in the substantia nigra, and VP fibers were noted in the nucleus reunions and the paraventricular nucleus of the thalamus.


Failure to detect a second-generation effect in female mice after neonatal treatment with an estrogen (diethylstilbestrol). Inbred female mice of the NMRI strain were treated subcutaneously with 5 micrograms diethylstilbestrol (DES) in olive oil or vehicle only for the first 5 days after birth. One group of DES-treated females was killed at the age of 8-12 weeks, and the uterine cervix and adjacent parts of the vagina and uterine horns prepared for histological studies. In all preparations, the cervical epithelial lining contained regions with heterotopic columnar epithelium (HCE) along 69-100% of the length of the common cervical canal. Ovaries from neonatally DES-treated females were grafted to 8-week-old ovariectomized control hosts and these hosts were mated to control males 2 weeks later. The hosts gave birth to normal-sized litters. The female offspring from these litters had a normal cervical epithelial lining and, in turn, gave birth to normal-sized litters. These results indicate that treatment of neonatal female mice with DES does not affect the female germ cells as far as concerns factors associated with the development of HCE or reduced fertility in the next generation.


The suprascapular nerve as re-interpreted by its communication with the phrenic nerve. A particular nerve bundle which may be called phrenicosuprascapular communication is, although only rarely, met with in various forms in man. By teasing, fibres of this communication are revealed to belong to the most anterior components of the brachial plexus, being closely associated with anterior nerves such as the phrenic, accessory phrenic, subclavius and even pectoralis. It is, therefore, obvious that the nervus suprascapularis conveys anterior fibres. It may be interpreted that the anteriormost nerve fibres may be separated from the main cord(s) and form an irregular network or plexus for themselves. It should be stressed that the n. suprascapularis consists of all the anterior components of the brachial plexus and that this is an anterior nerve.


Effects of alcohol and caffeine on cultured whole rat embryos. The direct effects of ethanol and caffeine on embryogenesis were investigated using the whole rat embryo culture system. Compared to control embryos, the crown-rump length, number of somites, branchial bars, and morphological score were significantly reduced in embryos exposed to ethanol, caffeine, or both substances. Development of the craniofacial region, cardiac primordium and forelimb was delayed following ethanol treatment. Compared to the controls, the anterior neuropore lagged in development following caffeine treatment; closure of the posterior neuropore was significantly delayed in each of the treatment groups. The optic and olfactory primordia were not affected. The results indicate that alcohol and caffeine independently affect the embryo, but when combined their effects were not potentiated.


[Nasal cavities and paranasal sinuses in newborns and children]. The paranasal or accessory nasal sinuses begin their development as evaginations of the mucosa during the 3rd and 4th fetal months, but undergo their major expansion after birth according to the development of the facial cranium and the teeth. While in the newborn the sphenoidal and frontal sinuses are still only predispositioned, the ethmoidal labyrinth and particularly the maxillary sinus are of appreciable size. In the 4-year-old the frontal and sphenoidal sinuses are already developed and in the 12-year-old the paranasal sinuses reach their final form and a size equivalent to the adult.


Relationship between morphological signs of cell injury in myocardial ischaemia. Morphological signs of severe ischaemic injury are well known. However, we still lack knowledge about how indices of milder injuries are related on a cellular level. In a previous study we have reported on the sequence of alterations across the border zone in cat hearts subjected to 3 h of coronary occlusion. In the present study, which elaborates that study, we have examined the relationship between morphological variables in serial sections of 220 myocytes within the border zone. In cells with intact sarcolemma and no chromatin changes, the fractional volume of cytoplasm has a bimodal distribution indicating cells with and without oedema. Whereas cells with focal disruptions of the sarcolemma have a moderate oedema, usually localized submembranously, cells with extensive sarcolemmal fragmentation have an extensive oedema. A mild oedema is seen before other signs of severe cell injury, even though more extensive oedema is closely associated with sarcolemmal fragmentation. The fractional volume of mitochondria was smaller, whereas the fractional volume of lipid droplets was larger in cells with oedema than in cells without oedema.


[The pedicled transposition of the digastric and stylohyoid muscles in the treatment of velopharyngeal incompetence. Anatomic basis and clinical application]. The anatomical basis for the application of neurovascular pedicled muscle transfers of the digastric and stylohyoid muscles in the treatment of velopharynx incompetence is described. The fact that the neurovascular pedicle is located in the cranial third of the muscle bellies provides the safety of the operative procedure. The muscles have to be dissected with respect to that. The direction in which the transferred muscles pull is described. The muscle transposition is combined with the classic Wardill-Kilner operation to lengthen the soft palate. The transferred muscles have to avoid scar contraction and shortening of the soft palate and to gain a muscular function of the soft palate. The clinical use is justified in rare cases as demonstrated in one case.


Morphological study of fetal nasopharyngeal epithelium in man. In 30 human fetuses between 8 and 13 weeks of intrauterine life the lateral wall of the nasopharynx was examined by light microscopy and transmission and scanning electron microscopy. In the subjects between 8 and 9 weeks in utero the mucosa displays still an immature appearance, being mono- or bistratified and lacking the characteristic structures of the respiratory epithelium. Nevertheless, signs of differentiation are to be noticed, with the presence of two distinct cellular types that, in the later periods, will give rise to ciliated cells and microvillus-provided cells. An almost complete differentiation will be reached at 12-13 weeks in utero, even if goblet cells are still lacking in the examined zone during the considered period. Nonrespiratory types of epithelium, such as transitional or squamous, were never found in the studied subjects.


Postnatal development of the dentate gyrus: a karyometric and topographic study. We have analysed the postnatal development of the nuclear sizes of the granular cells of the dentate gyrus in 5- to 190-day-old male mice. The study was performed in three topographic levels: rostral, intermediate and caudal. Three subdivisions were analysed in each level: suprapyramidal blade, infrapyramidal blade and the transition between them, the angular zone. Additionally, each of these subdivisions was measured in its external and internal layer, separately. Three gradients of postnatal karyometric development can be described: external-to-internal, suprapyramidal-to-infrapyramidal, and caudal-to-rostral, indicating that the external, suprapyramidal and caudal cells show higher karyometric sizes than the other subdivisions. These gradients are related to the ontogenetic gradients of these neurons.


Differential localization of G proteins, Gi and Go, in the olfactory epithelium and the main olfactory bulb of the rat. The immunohistochemical localization of proteins Gi1 (plus Gi3). Gi2 and Go was studied in the olfactory epithelium and the main olfactory bulb of rats, using purified antibodies to the respective alpha subunits and beta gamma subunits of these G proteins. In the olfactory epithelium, only a restricted population of olfactory cells was immunopositive for Gi2 alpha, but others were not. The immunoreactivity for Gi1 alpha/Gi3 alpha was not observed. The olfactory epithelium was immunopositive for both Go alpha and beta gamma, but its apical surface was immunopositive only for beta gamma. In the main olfactory bulb, all layers were intensely immunopositive for Go alpha and beta gamma but weakly for Gi2 alpha. In contrast to the negative or weak immunostainings in the olfactory nerve fiber layer and glomeruli, the molecular and the internal granular layers were intensely immunopositive for Gi1 alpha/Gi3 alpha. These findings suggest the functional difference among Gi1/Gi3, Gi2 and Go in the signal transduction in the olfactory system.


Studies on the microvascularization of the digestive tract by scanning electron microscopy of vascular corrosion casts. 2. Bile duct in guinea pigs. The microvascularization of the bile duct was studied in 20 adult guinea pigs (Cavia porcellus) using microvascular corrosion casts in the scanning electron microscope. The main supplying and draining vessels are located in the adventitial layer; from there they form the subepithelial capillary network. The microangioarchitecture of the common bile duct is reminiscent of that of the cystic and hepatic ducts. The diameter of these ducts is 1,000 microns on average. The microvascular arrangement in the bile duct suggests a probable involvement of the capillaries in the absorption of bile hormones.


Computer 3-dimensional reconstruction of intraglandular lymph vessels and ductal systems of the human submandibular gland. Computer three-dimensional reconstruction of serial sections is currently an active area of research. In this paper we combine computer graphics, image processing and biomedical techniques to reconstruct a stereo model of intraglandular lymphatic vessels, veins, arteries and ducts from serial microsections of the human submandibular gland.


Electron-microscopic localization of baboon acrosomal antigens using antisperm monoclonal antibody. A sperm antigen corresponding to baboon sperm monoclonal antibody 1A9 was localized in the testis and ejaculated sperm in this animal, using the immunofluorescence technique and immunogold labelling. Immunohistochemical studies of the baboon testis showed that the antigenic determinant was localized in the late spermatid cells and spermatozoa close to the seminiferous tubules. Immunofluorescence studies indicate that the protein was localized on the acrosome region of ejaculated baboon sperm. At the electron-microscopic level, gold particles indicative of the presence of this determinant recognized by 1A9 monoclonal antibody were detected on the inner acrosomal region of ejaculated baboon sperm.


Stereological studies of the parathyroid gland of phosphate-treated golden hamsters subjected to a hypergravity environment. The ultrastructure of the parathyroid glands of phosphate-treated golden hamsters exposed to a 5-G environment was studied. In the phosphate-treated animals exposed to a hypergravity environment, the Golgi complexes associated with numerous prosecretory granules, and the enlarged intercellular spaces containing floccular or finely particulate material showed a significant increase compared to those of the control, centrifuged, and phosphate-treated groups, and the cisternae of the granular endoplasmic reticulum showed a significant increase compared to those of the control and phosphate-treated groups. In addition, numerous secretory granules were situated close to the plasma membrane of chief cells in the phosphate-treated animals exposed to a hypergravity environment. These findings suggest that the synthesis, and to a greater extent the release of secretory granules may be markedly stimulated, in the parathyroid glands of phosphate-treated animals exposed to a hypergravity environment.


Evidence of the occurrence of calcitonin cells in the ultimobranchial follicle of the rat postnatal thyroid. A study on thyroid glands of Wistar rats of ages ranging from 1 to 120 days was carried out. The glands were serially sectioned and stained for calcitonin using the peroxidase antiperoxidase method. All the thyroids contained ultimobranchial follicles (UBF) located partially embedded among the usual follicles but in a 5-day-old rat this structure showed an unusual position in the interstitium of connective tissue between the cartilage of the trachea and the thyroid gland. We have observed in the wall of that UBF the presence not only of resting C cells but also mitotic figures of C cells. Furthermore, on the opposite side of the same UBF an active area of formation of thyroid follicles was found. These observations provided the first evidence of the contribution of the UBF in the formation of C cells during the postnatal life of the rat. Furthermore, it is suggested that some C cells may share a common origin with ultimobranchially derived follicular cells.


Functional construction of the sacroiliac ligamentous apparatus. The sacroiliac ligamentous apparatus was examined as a part of a biomechanical pelvis-lower extremities system. The ligamentous apparatus of two pelves was freed, and the findings concerning the ligaments and their direction were drawn by a modular constructed, three-dimensional calculator model of the pelvic region. The ligamentous apparatus of the sacroiliac joint belongs to a functional system. Its task is to minimize every movement in this amphiarthrosis. The ligamentous apparatus shows an adaptation to strong or long-time-acting stresses. The junction between the os sacrum, pelvis and the ligamentous apparatus of the sacroiliac joint can be described as self-tightening. Local stresses are also reduced by the ligaments. A loosening in this system, which has to fix the os sacrum to the pelvic girdle, leads to a static insufficiency. The consequence is pain due to an irritation of the lumbosacral trunk. The exact description of the structure allows a representation according to the laws of similarity mechanics. With such a representation one can build up a computer-aided biomechanical model of the pelvis-lower extremities region. Examples for such a model are biomechanical finite-element models. By observing the laws of similarity mechanics (an exact description of geometric, physical and functional conditions) an efficient biomechanical model can be constructed that also takes into consideration the complex functional circumstances, in contrast to previous models. In order to construct such a model, one has to feed the findings of the examination into a data bank, which has to be demanded.


Connections between the supratemporal and its rostral areas, and the posterior thalamic region in the monkey: a retrograde HRP study. Connections between the anterior half of the superior temporal gyrus (Ts) and the supratemporal plane (STP) in the Sylvian fissure, and the posterior thalamic region in the monkey were studied after retrograde transport of horseradish peroxidase (HRP). HRP injections into the Ts resulted in labeled cells in the posterodorsal division of the principal medial geniculate complex (GMpd), the suprageniculate and limitans nuclei, and the medial part of the medial nucleus of the pulvinar complex. HRP injections into the rostral Ts led to labeling in the posterior extremity of the GMpd, whereas injections into the caudal Ts resulted in labeling in the rostral GMpd. HRP injections into the area of transition between the Ts and STP led to labeling in the ventral part of the ventral division of the principal medial geniculate complex (GMv) and in the GMpd. HRP injections into the rostral STP led to labeling in the lateral part of the GMv, the anterodorsal division of the principal medial geniculate complex (GMad), and the lateral division of the posterior nucleus (Pol). HRP injections into the more caudal part of the STP yielded labeling in the more dorsomedial part of the GMv, Pol, and GMad. HRP injections into the lip of the STP yielded labeling in the GMv, Pol, GMad, and GMpd.


[An aberrant muscular nerve to the latissimus dorsi muscle from the posterior cutaneous nerve of the arm]. In the 1987 student course on gross anatomy dissection of cadavers at Iwate Medical University School of Medicine, an aberrant muscular nerve to the latissimus dorsi muscle arising from the posterior cutaneous nerve of the arm was found bilaterally in a 65-year-old female who had died of acute pneumonia. The case was investigated anatomically. The posterior cutaneous nerve of the arm arose from the radial nerve approximately at the lateral axial border as the first branch independently on the right, and by forming a trunk with the nerve to the long head of the triceps brachii muscle on the left. The aberrant muscular nerve originated from the posterior cutaneous nerve of the arm about 3 cm distally to the point of the branching of the cutaneous nerve from the radial nerve. This aberrant nerve entered the latissimus dorsi muscle near the transitional area from the muscular part to the tendinous part while dividing into three on the right, and without dividing on the left. The side into which the aberrant nerve entered was just the reverse of the side into which the thoracodorsal nerve and artery supplied. The muscular part innervated by the aberrant nerve was bounded by a tendinous intersection for the most part of the latissimus dorsi muscle innervated by the thoracodorsal nerve. The intramuscular nerve distribution of the aberrant nerve was investigated under a binocular dissecting microscope. It was revealed that there was no communication between the ramification of the aberrant nerve and that of the thoracodorsal nerve.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of the right aortic arch with the left subclavian artery as its last branch]. A case of the right aortic arch with the left subclavian artery as its last branch was found in an 80-year-old Japanese female cadaver during the 1990 dissection for students. The main findings were as follows. The ascending aorta arose from the left ventricle and ran right and upward to the level of the intervertebral disc between the 2nd and 3rd thoracic vertebrae. It then curved right and backward to form the aortic arch. The aortic arch joined the thoracic aorta that descended along the right side of the vertebral column and crossed obliquely the vertebral column at the level of the 8th thoracic vertebra. Finally it entered the abdomen through the aortic hiatus behind the esophagus. Four branches were given off from the aortic arch in the following order from left to right: the left common carotid, the right common carotid, and the right subclavian and the left subclavian arteries. The left subclavian artery, which had an aortic diverticulum at the origin of the aortic arch, ran left and upward behind the esophagus. The ligamentum arteriosum connected the left pulmonary artery with the aortic diverticulum of the left subclavian artery. The left common carotid artery, which normally had no branches before entering the cranium, gave off an accessory esophageal branch about 20 mm distally from its origin. The right and left vertebral arteries entered the transverse foramen of the 6th cervical vertebra. The left recurrent laryngeal nerve hooked around from the left dorsal to the right ventral part of the ligamentum arteriosum.(ABSTRACT TRUNCATED AT 250 WORDS)


Appearance of monocytes and macrophages in the embryonic thymus of the mouse: light and electron microscopic studies. Development of the embryonic thymus was studied by light and electron microscopy, particularly with reference to the appearance of macrophages. The thymus anlage appeared at 12 days of gestation. Then, at 14 days, the anlage was invaginated by mesenchymal septa carrying small blood vessels. In the embryonic thymus, macrophages and monocytes were present as early as 15 days of gestation. Monocytes as well as macrophages laden with phagocytic inclusions first appeared in the perivascular space or very close to blood vessels at the cortico-medullary junction. The perivascular space was continuous with the mesenchyme surrounding the thymus. From 15 to 17 days, monocytes could often be seen in the perivascular space. The origin of thymus macrophages was discussed in relation to a route for movement of macrophage precursors into the embryonic thymus.


[Bilateral absence of the quadrangular space of the axilla]. In the 1988 student course on gross anatomy dissection of cadavers at Iwate Medical University School of Medicine, two cases of the absence of the quadrangular space of the axilla were found bilaterally in a 92-year-old female who had died of heart failure. The cases were investigated anatomically. The tendons of insertion of the latissimus dorsi and the teres major muscles and the tendon of origin of the long head of the triceps brachii muscle were united, forming a conjoint tendon that attached to the infraglenoid tubercle of the scapula and the lower part of the anatomical neck of the humerus adhering to the articular capsule of the shoulder joint. The subscapularis muscle was normal except that a muscular bundle arose from the conjoint tendon and inserted to the lesser tubercle of the humerus and the crest continuing down from the tubercle. A part of the conjoint tendon was covered by the insertion of the subscapularis muscle, and there was no space between the conjoint tendon and the insertion of the subscapularis muscle. The teres major muscle was poorly developed, but the area of origin was rather wide and arose from both the dorsal and costal surfaces of the scapula. The anatomical features of the latissimus dorsi and the long head of the triceps brachii muscles were normal except for the insertion of the former and the origin of the latter. The triangular space of the axilla was found to be surrounded by the conjoint tendon, teres major muscle, and the lateral border of the scapula covered by the subscapularis and the teres minor muscles.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of anomalous courses of the brachiocephalic artery, trachea, and esophagus]. A case was described in which the brachiocephalic artery ran transversely in front of the fourth tracheal ring. The abnormal course of this artery may present a possible hazard in the event of a tracheotomy. In this case the anomalous artery was accompanied by a shift of the trachea to the right and of the esophagus to the left. As a consequence, the left recurrent laryngeal nerve ascended in front of the esophagus. The anomalous nerve course may present the possibility of injury to the nerve in the event of a curative operation for esophageal cancer.


[Three-dimensional reconstruction of cytoskeletons in rat salivary glands using confocal fluorescence microscopy and volume-rendering computer graphics]. A new reconstruction technique for the demonstration of three-dimensional architectural details from biological fluorescent specimens was used to determine the precise spacial organization of F-actin in rat sublingual glands. F-actin was stained with NBD-phallacidin in thick (20-30 microns) frozen sections and observed with a confocal laser scanning microscope to obtain thin (-1 micron) optically sectioned images. A series of optical sections taken successively at different focal levels in steps of 1 micron was then reconstructed with volume-rendering computer graphics. The rendered images viewed from several angles (e.g. top, bottom, sides) clearly revealed the presence of F-actin fluorescence along the hexagonal framework of the junctional complex within the acini and in the cytoplasm of star-shaped myoepithelial cells encircling the acini. The detailed structures and the topographical relations between the junctional complex and myoepithelial cells were more impressively observed when the rendered images were displayed by motion picture. These images are free from any artifacts caused by the mechanical sectioning and revealed well the delicate and complicated profiles of cellular structures that previously have been almost impossible to demonstrate by conventional reconstruction techniques. We expect that the combination of confocal microscopy and volume rendering will permit the dynamic observation of previously unseen phenomena in three dimensions, such as the behavior of biologically active molecules in living cells.


The whale (Odontoceti) spleen: a type of primitive mammalian spleen. Three spleens from two Odontoceti species were studied histo-anatomically. These spleens consisted of lymphatic nodules, the red pulp (broad sense), and the trabeculo-capsular system composed of the elasto-fibroleiomyocytic tissue. The periarterial lymphatic sheath (PALS) was unclear. Two layers, the intermediate zone and perivenous layer, were distinguishable in the red pulp (broad sense). The perivenous layer was narrow in width and consisted of venules and the intervascular reticular tissue rich in myeloid cells. The collecting and drainage veins were enclosed in this layer. The perivenous layer corresponds to the red pulp (narrow sense) of the common mammalian spleen and may be under involution in a process that probably relates to the remodelling of the intrasplenic vein. The pattern of the arteriovenous communication seemed to be closed, and no ellipsoids were noted around arterial terminals. The Odontoceti spleen has two venous drainage routes (hilar and capsular systems), suggesting a primitive state of evolution, and may be an additional example of the primitive mammalian spleen.


[The innervation of deep muscles of the human forearm extensors]. The innervation of four deep muscles of the human forearm extensors (the abductor pollicis longus, the extensor pollicis brevis, the extensor pollicis longus, and the extensor indicis muscles) were investigated in 24 bodies (48 sides) from those used in the 1989 and 1990 student courses in gross anatomy dissection at the Iwate Medical University School of Medicine. The forearm extensor muscles and the deep branch of the radial nerve were dissected intensively in the student courses in gross anatomy and were removed afterwards. The four deep muscles of the human forearm extensors and the nerves innervating the muscles were observed while they were immersed in the water and with use of a stereomicroscope--with the assistance of which they were drawn. In six sides the intramuscular nerve supply was also examined carefully and drawn. The results were as follows. 1. The nerves to the four deep muscles of the forearm extensors arose usually from the deep branch of the radial nerve after emerging the supinator muscle and sending branches to superficial forearm extensors. In some cases a nerve or nerves to the superficial forearm extensors were observed arising from the deep branch of the radial nerve after sending one or more branches to the deep forearm extensor muscles, or from the branches to the deep muscles themselves. However they were split easily from the deep branch of the radial nerve and from the branches to the four deep forearm extensors proximally near to the emerging of the deep branch from the supinator muscle. Therefore, it was considered to be constant that the nerves to the four deep forearm extensors arose from the deep branch of the radial nerve after branching to the superficial forearm extensors. 2. The radial group of the deep forearm extensors (the abductor pollicis longus and the extensor pollicis brevis muscles) was innervated usually by one branch that arose from the deep branch of the radial nerve just after emerging from the supinator and giving off branches to the superficial forearm extensors. This branch ran on the dorsal (extensor) surface of the abductor pollicis longus muscle distally, sending many twigs to this muscle, and entered into the muscle at various distances from the origin (Figs. 1-6). The abductor pollicis brevis muscle was innervated by some twigs that ran usually inside but occasionally outside of the abductor pollicis longus muscle (Figs. 7-10).(ABSTRACT TRUNCATED AT 400 WORDS)


Factors of importance for changes in dental caries among adults. A follow-up study of Oslo citizens from the age of 35 to 50 years. Eighty-one 35-year-old Oslo citizens examined in 1973 were reexamined after 15 years, to monitor changes in their caries situation expressed as carious surfaces (DS + DFS). Factors considered to be of importance for a change in the number of carious surfaces over this 15-year period were arranged under four items: environment, behavior, human biology, and health care organization. The results showed a slight but not statistically significant increase in the overall caries experience expressed as DMFS. A statistically significant reduction in DS + DFS from the age of 35 to 50 years was demonstrated. Despite this reduction 23% of the 50-year-olds had more carious surfaces than at age 35. The results indicate that the improvement in the number of untreated carious surfaces reported from many Western societies is also valid for adult Norwegians. However, this improvement is not shared by all. Multivariate analyses showed that behavioral factors had the greatest impact on the observed changes in dental health.


Numerical density and distributional pattern of dentin tubules. By a new method the numerical density and distributional pattern of transversely cut dentin tubules and the diameters of their peritubular dentin walls were measured in sections near the dentin-enamel junction (DEJ), midway to the pulp, and near the pulp wall in human premolars. For each section the mean and standard deviation of these variables were expressed. At all three levels the measurements comprised the same bundle of tubules from the DEJ to pulp in the coronal dentin. The number of tubules per square millimeter increased more than three times, and the diameters of peritubular dentin decreased one-tenth, whereas central distances between tubules were halved from DEJ to pulp. Thus the pulpward reduction of intertubular dentin is quantified. The distribution of the tubules is not regularly hexagonal, but the distances between them at each given depth are still very uniform in all directions. The pattern of cross-cut tubules often showed distinct short curved rows. The quantitative method might be used to determine taxonomic affinities.


Effect of experimental traumatic occlusion on periodontal and pulpal blood flow. Fluorescent microspheres (FM) were used to visualize and semi-quantify flood flow in the periodontal ligament (PDL) and dental pulp during experimental traumatic occlusion of the maxillary and mandibular molar teeth in young rats. At different observation points FM were injected systemically, and the number of FM was counted in serial sections from the jaws in the PDL and pulp of the molar teeth in a fluorescent microscope. Blood flow was related to the number of FM in the tissues and in a reference blood sample. In the early stages an increase in blood flow in the PDL and dental pulp was found on the experimental side compared with the contralateral side. Furthermore, there was an increase in blood flow on both sides of the jaws compared with an unoperated control material. The study thus indicates that a local unilateral occlusal trauma initiates blood flow responses in the total molar dentition in rats.


Initial studies on the behavior of salivary proteins at liquid/air interfaces. The mode of adsorption of salivary proteins at air/liquid interfaces was studied by using the drop volume technique to measure the kinetics of surface tension decay of aqueous salivary solutions. Adsorption of salivary proteins from whole saliva was fast, with a plateau value of the surface tension of 43 (+/- 2) mNm-1. As the concentration of saliva was reduced, the plateau value of surface tension increased and was achieved more slowly. The reduction in surface tension of aqueous solutions was larger for salivary proteins than for many other proteins reported.


A clinical evaluation of the Optec inlay system. To evaluate the clinical quality of ceramic (Optec) inlays, the inlay production of 10 dentists, served by 3 dental laboratories, was examined independently by 2 calibrated examiners. A total of 57 patients with 205 inlays (mean age, 8.1 months) were examined 1 to 32 months after placement by means of using a slightly modified form of the California Dental Association criteria. Periodontal variables such as plaque index, gingival index, and margin index were also recorded. Eight patients reported postoperative but not persistent hypersensitivity in relation to the Optec therapy. No differences between Optec proximal surfaces and homologous control surfaces were seen with regard to plaque or bleeding on probing. The examination using the CDA criteria showed that 59% of the inlays had a slight color mismatch. Slightly roughened surfaces were most common (86%). As to anatomic form and margin integrity, 24% and 67%, respectively, of the inlays were rated excellent. A difference between the dentist with regard to the clinical quality of the inlay treatment procedure was seen. The present results cannot allow a definitive judgement with regard to the long-term clinical quality of the Optec inlay system but will serve as a base for further studies.


Relation of glenoid fossa morphology to mandibulofacial asymmetry, studied in dry human Lapp skulls. Asymmetry in the shape and location of the temporomandibular joint and its associations with mandibulofacial asymmetry were studied in 40 Lapp skulls by a method in which the configuration of the fossa is clearly defined. The results show a general directional temporomandibular asymmetry. The glenoid fossa on the right was on average more laterally and distally placed than on the left when studied in the axial view. The mandible was more often longer on the left than on the right in the frontal view. The temporomandibular asymmetry found here was associated with skull base characteristics and left-right differences in mandibular length. The basic reason for the asymmetric relationships may lie in the reciprocal interaction between the developmental aspects of the skull base and impaired directional function.


Swedish dentists' perceptions of their patients. Swedish dentists' perceptions of patient behavior problems, levels of stress experienced by the dentists in relation to such behavior, and general problem areas in their occupational situation were investigated by means of a self-administered questionnaire mailed to a sample of 485 Swedish dentists. The questionnaire assessed 16 different patient behavior problems and an additional number of other occupationally related problem areas. A total of 342 replies (71.4%) were analyzed. The relationship between the occurrence of behavior problems and the resulting level of stress was inversely proportional. This implies that Swedish dentists feel confident in dealing with behavior problems in their patients. Furthermore, this study shows that most dentists (93%) feel positive about their work and believe that their work is highly appreciated by their patients (96%) and colleagues (84%).


Acute myelofibrosis terminating in acute lymphoblastic leukemia: report of one case. A four-year-old boy suffered from acute myelofibrosis which became acute lymphoblastic leukemia during the course of the disease. Histologic and immunophenotypic studies revealed that the leukemic cells were lymphoblasts. Immunophenotypic examination also excluded the possibility of acute megakaryoblastic, monocytic and myeloid leukemia. Thus terminal leukemic transformation, in some cases of acute myelofibrosis, may be of a lymphoid nature.


Congenital Horner's syndrome: report of one case. Congenital Horner's syndrome is an infrequent illness caused by a lesion of the cervical sympathetic nerve fiber. It's clinical features are facial anhidrosis, ptosis, miosis, and hypochromia iridis of the affected side. The subject of this report, a full-term male newborn, had had a smooth birth process but was found on the second day of life to have narrowing of the palpebral fissure and absence of facial flushing on the right side when he cried. Ophthalmologic examination revealed a smaller right pupil. The above abnormalities proved to result from a post-ganglionic lesion, after pharmacologic test. Roentgenograms of the skull, chest and cervical spine were normal, and a computed tomography scan of the cervical spine showed no abnormalities. The diagnosis was of congenital Horner's syndrome. Since no congenital Horner's syndrome to the newborn period could be found in previous literature, this report is presented.


Enzyme inhibitory assay using monoclonal antibody against acid alpha-D-glucosidase in prenatal diagnosis to identify homozygotes of Pompe's disease. From January 1985 to January 1990, measurements of acid alpha-D-glucosidase activity in amniocytes or chorionic villus samplings were done for 24 pregnant mothers who were carriers of Pompe's disease. 6 women had two subsequent pregnancies. Amniotic fluid was obtained by transabdominal amniocentesis performed on 10 of them, while chorionic villus samplings were obtained in the other 20. The results showed that 7 (23.3%) cases were homozygotes, 16 (53.4%) cases were heterozygotes, and 7 (23.3%) cases were normal. Pregnancies were terminated in the homozygotic group. Final diagnosis was confirmed by either skin fibroblast culture or clinical course. However, we found that there was overlap in the acid alpha-D-glucosidase activity of amniocytes between homozygotes and heterozygotes due to residual activity of neutral alpha-D-glucosidase. In an attempt to identify heterozygotes for Pompe's disease, we established an enzyme inhibitory assay using monoclonal antibody (mAb) against acid alpha-D-glucosidase. Comparing the differences in alpha-D-glucosidase activity before and after mAb treatment the homozygotes were significantly lower than heterozygotes (P less than 0.001). There was no more overlap in the difference of acid alpha-D-glucosidase activity before and after mAb treatment between heterozygotes and homozygotes in amniocytes. This modified enzyme inhibitory assay should facilitate homozygote detection. Comparing acid alpha-D-glucosidase activity between CVS and amniocytes, the enzyme activity in CVS is about 5 times higher than in amniocytes. There was no overlap in the acid alpha-D-glucosidase activity between homozygotes and heterozygotes. Therefore, CVS is better than amniocentesis in the prenatal diagnosis of Pompe's disease.


An analysis of prognostic factors for submersion accidents in children. The case histories of 47 consecutive pediatric submersion victims admitted to the Changhua Christian Hospital from 1983 to 1990 were retrospectively reviewed for patient status on arrival and eventual outcome. Age, sex, season, location, estimated submersion time, cardiopulmonary resuscitation (CPR) at the scene, vital signs on arrival, Orlowski score, modified physiologic stability index (PSI) scoring system were analyzed. Patient outcome, based on the status at discharge, was categorized as (1) 22 patients survived intact, with normal findings on neurologic examination; (2) 10 patients had neurologic insults, with abnormal neurologic findings including mental retardation; (3) 15 patients died. The results clearly demonstrated that there were no differences among these three groups in the variables of estimated submersion time, CPR at the scene, referral from local medical clinics. The prominent characteristics of pediatric submersion were male (74%), age below three years (64%), summer season (45%) and fishpool (60%). The favorable prognostic factors were a body temperature greater than thirty-five centigrade, detectable heart beat and respiration on arrival, Orlowski score below two and PSI below seven.


[Percutaneous catheterization of internal jugular vein]. Percutaneous catheterization of internal jugular vein has been recognized as a valuable procedure during special conditions which need either a central venous pressure monitoring or a route for intravenous infusion either on a long term or short term basis. In our hospital we had 27 patients who had undergone 32 percutaneous internal jugular vein catheterizations over a period of 19 months. Patients' age ranged from 10 days to 13 year-old. Among these 27 patients, 20 were less than 1 year-old. Overall successful punctures were achieved in 87.5% of attempts. There was no case complicated with pneumothorax, hematoma, air embolization, pericardial tamponade or Horner's syndrome following the procedure. 68.7% of the procedure were done under emergency situation when peripheral venous route were inaccessible. In our experience, this procedure is a highly useful method of obtaining venous line in patient with inaccessible peripheral venous route.


Chemotherapy-related side effects in children with acute lymphocytic leukemia in Taiwan: a nursing perspective. The purpose of this study was to understand the pattern of side effects experienced by children with acute lymphocytic leukemia (ALL) who were receiving the induction and consolidation phases of a specific chemotherapy regimen. One hundred and one children with ALL in treatment centers throughout Taiwan in June 1990 through June 1991 served as the sample for this study. Children had been divided into two groups, a standard risk group (SR) and a high risk group (HR), which received different therapeutic regimens. Of 101 children, 52 in SR and 27 in HR completed the induction and consolidation phases of treatment. Among sources of data for the study were nurses' prospective close observations in the natural care setting of each child. Chemotherapy-related side effects are multifaceted and intrusive, including changes in hematopoietic function, body function and body appearance. The most common side effects with regard to body function were elevation of body temperature, ulceration of oral mucous membrane, poor appetite, nausea and vomiting, ulceration of anus, diarrhea, impaired mobility. Side effects were greatest during the first through third weeks of the chemotherapy regimen. Twenty percent of the children developed infection. The findings stressed that nurses should be aware of such patterns of side effects so that they can provide optimal care to patients receiving chemotherapy.


Electroencephalographic and clinical features of typical absence seizures in children. From July 1986 to July 1991, seventeen typical absence seizures, in patients aged 3 to 12 years (mean: 7 years 1 month), were collected for clinical and electroencephalographic (EEG) analysis. All were first-evaluated patients at the Pediatric Neurology Clinic, National Taiwan University Hospital with thorough EEG examination (including waking and natural sleep records) and detailed medical records. All had no history of any brain insult, except for one who had had febrile convulsion before. There were nine female and eight male patients. All had regular bilaterally synchronous and symmetric 3 Hz spike-and-wave discharges and absences. Nine of the 17 cases had interictal focal spike discharges, located over centro-temporal area in 4 cases, fronto-central area in 2 cases and parietooccipital area in the other 2 cases. Another patient was found to have 3 Hz posterior slow waves. Four of the 17 cases had automatisms. Only one case had photo-paroxysmal response. Hyperventilation could induce clinical spells and typical EEG findings in all 17. Normal interictal background activity on the EEG was also found in all cases.


[Neonatal bowel perforation successfully treated by conservative treatment: report of two cases]. Neonatal bowel perforation is a potentially lethal disease whose etiology and pathophysiology remain unclear. An aggressive approach with surgical intervention has been favored by some authors; otherwise, a high mortality rate was reported. In recent time, peritoneal drainage under local anesthesia for critically-ill premature infants with complicating perforation of necrotizing enterocolitis has had good results. Two cases of such perforation are reported. Case 1, a full-term baby was delivered by spontaneous delivery. Bowel perforation was found on the second day after birth. Case 2, a 27-week gestational age, premature baby, was delivered by emergent Cesarean section because of maternal placenta previa with massive vaginal bleeding. Bowel perforation was found, after feeding, on the seventh day after birth. Both sets of parents refused any surgical procedure, but the infants survived under medically conservative treatment, and the use of peritoneal drainage. This technique may be considered for neonates with bowel perforation if a surgical procedure is unsuitable or unacceptable.


Sinus node dysfunction in children.

Sinus node dysfunction in children. Seven out of 829 pediatric cardiac patients (0.84%) were found to have sinus node dysfunction (SND) over the past seven years. Of the seven patients, three had structurally normal hearts. One of these three patients had long QT syndrome. In four patients, structural heart disease was noted. In three of these four patients the sinus node dysfunction was attributed to cardiac surgery. The age of onset of SND ranged from four months to eight years. Presenting symptoms and signs included syncope, near-syncope, seizure and congestive heart failure. Two patients were asymptomatic. Five patients had episodic sinus pause. Sinus or junctional bradycardia was noted in four patients. Three had tachy-bradycardia. High grade atrioventricular block was noted in one patient. Treadmill exercise test revealed a nonsustained ventricular tachycardia in two patients. All seven patients were found to have prolonged maximal corrected sinus node recovery time. Prolonged intra-atrial conduction time was found in three, prolonged AV nodal conduction time in one, and prolonged His-Purkinje conduction time in one patient during the electrophysiologic study. All seven patients showed abnormal results in intrinsic heart rate study. Anti-arrhythmic drugs were prescribed. During the follow-up study, no patient died, but two patients received a pacemaker implantation. Because of the extent of their conduction system diseases, it is recommended that patients with SND should be thoroughly investigated.


A survey of more than 90 commercially available luminometers and imaging devices for low-light measurements of chemiluminescence and bioluminescence, including instruments for manual, automatic and specialized operation, for HPLC, LC, GLC and microtitre plates. Part 2: Photographs. Part 1 of this survey comprised a description of the luminometers (J. Biolumin. Chemilumin. 7, 77-108 (1992)) and was compiled in January and February 1992 from information available in public domain literature requested by and supplied to the author by numerous companies in the previous two months. This part includes photographs of around 40 of these instruments. It is intended that updates to this review will be published at least annually in this journal and suppliers are invited to provide full technical details of new luminometric equipment to the author.


Measurement of urinary orotic acid by gas chromatography-mass spectrometry. Urinary excretion of orotic acid is increased in many inborn errors of ureagenesis and some other diseases. Urine orotic acid is found to be accurately measured by gas chromatography-mass spectrometry (GC-MASS) under the conditions for organic acids analysis. Therefore, GC-MASS analysis of urine is also helpful in the diagnosis of urea cycle disorders in patients with hyperammonemia. Specific tests for orotic acid measurement are not necessary if urine organic acids analysis is available.


Atypical Kawasaki disease: report of two cases. Two cases of atypical Kawasaki disease are reported. Case 1 was a five-month-old male infant admitted to this hospital with a 10-day's history of high fever. On examination, he appeared ill-looking and only hepatomegaly was noted. Laboratory studies showed leukocytosis, thrombocytosis, elevated ESR and pleocytosis in CSF. He was treated as sepsis with meningitis. Sudden death occurred on the eighth day of admission, and left coronary artery aneurysm with thrombosis was noted at autopsy. Case 2 was a four-month-old male infant referred to our hospital with fever and cervical lymphadenopathy of 11 day's duration, and unresponsive to antibiotics. Skin rash had developed after oxacillin injection. Echocardiogram, performed on the third day of admission, disclosed a 5-8 mm aneurysm of the left coronary artery and a 4 mm aneurysm of the right coronary artery. Before a specific diagnostic test for Kawasaki disease becomes available, we suggest that a possible diagnosis of Kawasaki disease and echocardiographic evaluation should be considered in case of (1) presence of partial criteria of Kawasaki disease with thrombocytosis; and/or (2) young infants with prolonged unexplained fever.


Marinesco-Sjögren syndrome: report of one case. A three-year-old Taiwanese boy with Marinesco-Sjögren syndrome is reported. Psychomotor retardation had been noticed since early infancy with hypotonia, muscle weakness, delayed motor milestones and imbalance in sitting and standing. Bilateral visual impairment proved to be congenital cataract. Speech was limited to a few words. The parents were consanguineous, and there are two similarly affected siblings. The brain computed tomography revealed cerebellar atrophy. The evoked potential studies indicated a central origin or brainstem lesion. The histopathologic study of the muscle showed variation in fiber size and regenerating fibers. The patient received intraocular lens implantation and was discharged under a home rehabilitation program.


[Ultrasonic detection of ectopic ureterocele]. Ten cases of duplex kidney with ectopic ureterocele were detected by ultrasound in the recent four years. There were eight girls and two boys. One case was found to have bilateral ectopic ureterocele, the others were unilateral. Urinary tract infection was found in five cases, urinary dribbling was told in one case, and the other four cases were asymptomatic. The age distribution ranged from newborn to 15 years. Six cases received surgery, and the other four cases were followup at O.P.D. In these cases, the sonography could identify the hydronephrotic nature of the upper pole moiety. Dilatation of the upper pole ureter could be demonstrated. A sonolucent intravesical cystic mass also could be outlined. In this series, five cases with residual parenchyma were assessed by ultrasonography, and two cases with pus formation in the upper pole collecting system were detected. On intravenous urogram, the affected upper pole moiety was not or poorly visualized in these cases, thus produced some diagnostic challenges. Ultrasonic examination is an excellent method to identify a fluid-filled cystic structure, and can provide a simple and non-invasive technique for confirmation of ectopic ureterocele, which is independent of renal function. Therefore, it has become an important modality in the detection, diagnosis and followup of this anomaly.


The neonatal morbidity and mortality of low birth weight neonates. During the period between January 1, 1987 and March 31, 1991, a total of 454 low birth weight neonates, classified if below 2,500 grams, admitted to this hospital, 450 of them could be evaluated retrospectively. Among the 450 cases, 41 (9.1%) were transferred from outside hospitals within 24 hours of birth; and 409 were original hospital inpatients. The sex distribution was quite even (M/F = 227/223), but more than half of them were small-for-date (56.4%). Multiple pregnancy accounted for 22.9%, and toxemic mother, for 11.6%. Neonatal mortality rates were 23.9% for those with birth weight below 1,500, and 45.5% for those with birth weight below 1,000 grams, respectively. Respiratory distress syndrome occurred in 15.9% of the low birth weight neonates, and the incidence increased stepwise as birth weight decreased. Symptomatic patent ductus arteriosus could be detected in 11%. Fundoscopical evaluation, a routine for all with birth weight below 1,500 grams or below 2,000 grams with prolonged ventilator support, demonstrated retinopathy of prematurity in 5.6% of all cases or 50% in those below 1,000 grams. Routine brain echo done in all those below 2,000 grams within the first three days of age, and at least once every week thereafter, revealed intracranial hemorrhage in 10.2%, but only 2.4% belonged to grade III-IV. Respiratory distress syndrome and outborn were the two major determinants affecting the severity and occurrence of intraventricular hemorrhage significantly.(ABSTRACT TRUNCATED AT 250 WORDS)


Light-induced biophotonic emission from plant tissues. The emission of biophotons in the visible range, following a delay time of 2-200 seconds after exposure to light, has been measured in germinating seeds, roots, flowers, leaves, and cells. It was found that the biophotonic signals are reproducible and light-induced. The observed signals from germinating seeds of Phaseolus aures and decaying leaves of Eucalyptus are presented to show that the signals have characteristic kinetics and intensity. The kinetics of the signal was found to be independent of the stage of growth or decay, though its intensity varied with biological factors. The kinetics in the first minute is characterized by a single exponential decay term while that in the region t less than or equal to 200 s is characterized by two exponentials. The variation in the intensity of the signal with mass, state of hydration, and growth, and the effect of inhibitors in various systems (e.g. leaves, lichen, Chlorella) are reported.


Comparison of properties of commercially available crystalline native and recombinant firefly luciferases. Commercially available crystalline native and recombinant firefly luciferases were compared. The two types of luciferase had indistinguishable responses to variation in ATP and luciferin concentrations and to omission of reaction components. The time courses of light production, the responses to nucleotide analogues, and the stability of the enzymes under several storage conditions were identical. The native enzyme had a slightly greater specific activity and was more sensitive to trypsin degradation. These differences are probably attributable to differences in conformation.


Liveborn trisomy 22: report of one case. A case of trisomy 22 liveborn female baby with multiple congenital anomalies is described. Physical manifestations included failure to thrive, hypotonia, pre-auricular sinus, low set ears, hypertelorism, posterior low hair line, micrognathia, cleft palate, congenital heart disease, imperforated anus with anovulvar fistula, contracted pelvis and bilateral rocker-bottom feet. The infant died at two months of age. Cases of trisomy 22 usually present with many severe malformations, and they rarely survive to term. A review of the literature is presented to delineate this chromosome disorder.


G syndrome: report of two cases.

G syndrome: report of two cases. This report concerns two cases of G syndrome in male neonates with hypertelorism, hypospadias and hoarse/voiceless cry. Case 1 had a positive family history; all similarly affected relatives have apparent hypertelorism. Case 2 seemed to represent a new mutation, since the parents are apparently normal, and the family history was non-contributory. The clinical expression of Case 1 was relatively severe and needed further surgical management, such as imperforate anus, hypospadias, and vesicoureteral reflux. Case 2 had two manifestations not previously reported: hypoplasia of cerebellum and web neck.


Intracerebral arteriovenous fistula: report of one case. Intracranial arteriovenous fistula (AVF) is rare. Of the 320 arteriovenous malformations (AVMs) treated by Halbach over the past ten years, only five (1.6%) had a single arteriovenous connection. In the present study, a male infant developed focal seizure and intracranial hemorrhage without cardiac decompensation at the age of 42 days. When he was 3 years and 4 months old, status epileptics occurred, and AVF was discovered via CT scan and cerebral angiographic examination. The AVF was fed by a middle cerebral artery and drained into a huge cortical vein over the left parietooccipital area. Endovascular therapy and/or surgery were suggested, but the family refused. Though seizures occurred occasionally, the patient's consciousness level had become more clear, and he was discharged after three weeks' hospitalization. The patient was noted to be lethargic and only could roll over partially at the age of 3 year and 8 months, in the latest follow-up.


Immunological study in three families of juvenile ankylosing spondylitis. Three patients, all exhibiting symptoms before 15 years of age, were diagnosed as juvenile ankylosing spondylitis (JAS) by stigma of JAS. The families of these three patients--a total of fifteen first-degree relatives--had clinical, radiologic and laboratory examinations. All three patients and four family members (26%) had positive HLA-B27 and ankylosing spondylitis (AS). Five (33%) of these three family members had positive HLA-B27 but were asymptomatic; six members(40%) were HLA-B27 negative and symptom-free. A high positive rate of HLA-B27 was found among the patients (100%) and the family members (60%). The rheumatoid factor, antinuclear antibody, and anti-native DNA antibody were negative for all patients and family members. Significant elevation of IgG, IgA, and C3 were noted in the AS group. The CD3 cell was lower, and the ratio of CD4/CD8 was decreased in the AS group. Lympho-proliferative responses to phytomitogens (Con A, LPS and PHA) were also done in our study. There was no significant difference in Con A and LPS stimulation index among the AS group, symptom-free family members and normal controls.


[Infantile bilateral necrosis of the striatum of corpus: report of four cases]. The designation of "Infantile Bilateral Striatal Necrosis" (IBSN) was first given by Friede in 1975. However, this unusual condition was first described by Paterson and Carmichael in 1924. The disease is rare with uncertain etiology. The clinical picture includes choreoathetosis, abnormal eye movements, seizures and mental dullness. These circumstances often follow symptoms such as fever, vomiting and impaired consciousness. The final diagnosis is confirmed by pathological examination, which reveals symmetrical degeneration of bilateral basal ganglia. With present technology IBSN can be well demonstrated in the brain Ct scans or MRI scans nowadays. This article reports four cases with clinical manifestations which had appeared before the age of one year. Three cases had prodromal upper respiratory tract infection symptoms with vomiting, while seizure and impaired consciousness ensued. One case had several bouts of pneumonitis followed by seizures, impaired consciousness and abnormal eye movement. Brain sonogram of one of these cases showed hyper-echoic basal ganglia, while CT scans or MRI scans revealed symmetrical hypodensity or signal change over bilateral basal ganglia, respectively. All of these led to a bedridden life. These four cases are reported based on their clinical presentations and brain imaging findings, in spite of the absence of pathological confirmation. Some of the literature are also reviewed. To sum up, IBSN should be kept in mind in the differential diagnosis of symmetrical bilateral basal ganglia lesion after the exclusion of other disorders such as neurometabolic disorders, central nervous system infection, carbon monoxide intoxication, hypoxic-ischemic encephalopathy, tumors and cerebrovascular disorders etc.


CSF drainage in patients with posterior fossa tumours. The management of hydrocephalus secondary to a posterior fossa tumour is controversial. We audited recent practice with a retrospective analysis of 287 consecutive patients undergoing posterior fossa exploration for tumour. 85 shunts and 112 external ventricular drains (EVD) were placed. The overall CNS infection rate in the series was 6%. There was a significantly higher (p less than 0.01) infection rate in patients who had a drainage procedure, and a trend towards higher infection rates in patients with two drainage procedures. Early infection rates with EVDs and shunts were the same (7%). One third of patients with hydrocephalus had pre-operative drainage, a third had per-operative drainage but only a quarter required a permanent shunt. The majority of patients will not require a permanent shunt and where temporary CSF diversion is required EVD is reasonable.


Does the shunt opening pressure influence the effect of shunt surgery in normal pressure hydrocephalus? Thirteen patients with normal pressure hydrocephalus were operated upon with an externally maneuverable shunt system (Sophy SU8) in order to investigate its influence on clinical outcome, intracranial pressure and cranial CT parameters. The opening pressure was set at high at surgery and lowered stepwise at intervals of three months to medium and low. The clinical condition, intracranial pressure and cranial CT parameters were examined at the end of the 3 months interval on each pressure level. The patients improved within the first 3 months inspite of an unchanged mean intracranial pressure and remained in a stable clinical condition during the rest of the study period. The intracranial pressure was significantly reduced at 9 months. The ventricular index, Evans index, temporal horn and third ventricle width were reduced 3 months post-operatively and did not change significantly during the rest of the study. The pre-operative third ventricle width was correlated to high psychometric test results after shunt surgery. Reduction in ventricular index, Evans index and third ventricle width after surgery correlated to improvement in psychometric scoring. The clinical improvement after shunt surgery for normal pressure hydrocephalus is seen within 3 months and is independent of the adjusted valve pressure.


Management of giant serpentine aneurysms of the middle cerebral artery--review of literature and report of a case successfully treated by STA-MCA anastomosis only. Thirty-eight cases of giant serpentine aneurysms (GSA), including 17 GSA of the middle cerebral artery (MCA), were reviewed in the literature. The treatment possibilities of GSA of the MCA are discussed together with our own case who was a 39-year-old male with a GSA of the right MCA and was treated only by STA-MCA anastomosis. The pathogenetic mechanism of progressive enlargement of the aneurysm is also discussed.


Histopathological evaluation of polymethyl methacrylate as an embolic agent. Polymethyl methacrylate (PMMA) microspheres were used as an embolic agent to reduce the vascularity in eight patients with intracranial vascular tumours. Post embolization angiograms showed 30-60% reduction in the vascularity of the tumours. No patient developed any neurological complications in the immediate post-embolization period. These eight patients subsequently underwent surgery for the removal of their tumours. During surgery there was minimal blood loss and a good plane of cleavage was obtained between the tumour and the adjacent brain. The surgical specimens were examined histopathologically for the effects of PMMA. PMMA microspheres, in contrast to other cyanoacrylates--isobutyl-2-cyanoacrylate (IBCA)--did not elicit either inflammatory reaction or mural angionecrosis within the wall of the embolised vessels. The histopathological studies suggest that PMMA microspheres are an inert material and can be used as an adjunct in the management of intracranial vascular tumours.


ICP dependent changes of CSF outflow resistance. CSF outflow resistance was studied in cats using the lumbar infusion tests. Different infusion rates were applied from 0.012 to 1.8 ml/min. ICP level obtained during infusions varied from 8.9 +/- 3.0 to 144.0 +/- 25.7 mmHg. The calculated resistance (R) values were within 75.2 +/- 14.4 to 255.6 +/- 71.2. mm Hg/ml/min. The relation between ICP and R are characterized by a curve which can be divided into three parts. First R rises until an ICP level of about 20 mmHg is reached, then R decreases fast until the ICP value is about 50 mmHg, a further drop is much slower and the ICP/R curve becomes almost parallel to the ICP axis. The possible reasons for the ICP dependent changes of R as well as the clinical importance of the results obtained are discussed.


The course of vasospasm following subarachnoid haemorrhage in rats. A vertebrobasilar angiographic study. The course of vasospasm following subarachnoid haemorrhage in rats was studied using vertebrobasilar angiography. Wistar and Sprague Dawley rats were compared with respect to vasospastic response after bleeding. A more pronounced vasospasm was found in Sprague Dawley rats. In order to avoid a possible toxic effect on the contrast medium, only one angiogram per animal was initially performed. However, a comparison with the results obtained in a separate series of non-challenged animals demonstrated a difficulty due to high variability in basilar artery size in the latter group. Therefore, vasospasm can be more readily shown if multiple angiograms are used in the same animal so that the vasospasm can be expressed as a percentage of the initial diameter of the basilar artery. It was found that multiple angiograms are well tolerated when non-ionic contrast media are used.


Collagen vicryl--a new dural prosthesis. No ideal dural grafting material is currently available. Many materials have been evaluated in this role, and for many neurosurgeons cadaveric human lyophilized dura has been popular. Recently this material has been putatively associated with Creutzfeldt-Jakob disease. In this study we compared three degradable materials, collagen vicryl (Bovine collagen coated vicryl mesh), Zenoderm (Porcine dermis) and Lyodura (Lyophilized human cadaveric dura) as dural substitutes. In an experimental model using the New Zealand White Rabbit the materials were implanted into dural defects of dimensions 1.7 cm by 1 cm. In the control group the dura was not repaired. In total 47 animals were used and sacrificed at time intervals of 2, 4, 8, 12, and 24 weeks. On gross examination the collagen vicryl produced few adhesions to the cerebral cortex and was replaced by a neomembrane which showed good union with the host dura. In the control group no new layer was formed and there were severe cortical adhesions. Zenoderm and Lyodura remained undegraded and produced more adherence to the cerebral cortex than the collagen vicryl implant. The histological examination showed collagen vicryl to support ingrowth of fibroblasts and the production of a new collagen layer which by 3 months resembled the original host dura. The inflammatory response to the implant did not persist after 3 months. The other substitutes were revitalized by host cells but remained undegraded at 6 months with ingrowth of woven bone and persistence of inflammatory and foreign body response. The results show collagen vicryl to be a suitable dural substitute with potential advantages over other currently used degradable materials, and should be evaluated more fully, both in laboratory studies and clinically.


Intra-operative monitoring of the facial nerve with an air inflated balloon. Technical note. A simple, reliable and cheap device for intra-operative monitoring of the facial nerve during surgery for cerebellopontine angle tumours is presented. It consists of a single use tracheostomy tube with a low pressure air inflatable cuff placed in the mouth of the patient on the side of the tumour, connected by a pressure transducer to a monitoring unit. It records any pressure changes in the patient's mouth induced by muscular contractions as a result of excitation of the inferior parts of the facial nerve.


A ring electrode to record extraocular muscle activities during skull base surgery. A ring-shaped electrode was developed and used in 20 patients to record evoked electromyographic responses directly from the extraocular muscles during skull base surgery. Intra-operative monitoring with this electrode helps the surgeon to localize the nerves that innervate the extraocular muscles precisely and to refrain from disturbing important neural structures during operations. Such monitoring also provides some insight into the pathophysiology of the dysfunction of these nerves resulting from skull base lesions.


Slit ventricle syndrome in children: clinical presentation and treatment. Symptomatic ventricular coaptation, or the slit ventricle syndrome, is frequently described and recognized as a clinical entity in the pediatric population. It is characterized by symptoms of shunt failure (i.e., ataxia, obtundation, nausea, vomiting, lethargy, irritability, and complaints of headache) and the CT findings of ventricular coaptation (slit-like ventricles). This study of twenty-two children with this syndrome reflects the variety of possible clinical presentations, and the variety of available treatment modalities. Multiple therapeutic approaches were required in seven of the patients. This illustrates not only an evolving treatment regimen, but also that a single treatment modality is not universally effective. Six patients needed only occasional symptomatic support. Blockage and/or removal of the shunt system was the definitive therapy in six patients, pressure augmentation in nine patients, and subtemporal craniectomy in one. This article outlines the theoretical pathophysiology, and a scheme for the management of patients with this syndrome.


Abscess formation in Rathke's cleft cyst. Two patients are discussed who presented at our Institute with endocrine dysfunction and sellar enlargement. CT scans revealed intra and suprasellar expanding lesions with ring enhancement. The postoperative histological examination showed remnants of Rathke's cleft cyst together with signs of inflammation. CT and MRI pictures, and possible mechanisms of abscess formation in this region are discussed.


A pineal tumour with features of "pineal anlage tumour". A primitive tumour of the pineal region in a 9 month-old boy caused hydrocephalus, ataxic gait and paraplegia leading to death after 9 months of evolution. Histological and histochemical examination revealed a pinealoblastoma with melanotic cells as well as cartilaginous formations. The leptomeningeal seeding of the tumour showed neuroblastic and neuronal differentiation. A diagnosis of pineoblastoma with neuroepithelial and ectomesenchymal differentiation was made. This tumour belongs to a recently defined category of pineal tumours, called pineal anlage tumours.


The amniotic fluid compartment: the fetal habitat. This study begins with a phylogenetic overview of the fetal membranes in terrestrial vertebrates. It is, of course, well known that the human amnion differs very little from that of other recent members of the phylum, although during evolution the development of the placenta has brought about extensive changes in the chorion. Much of the structure and many of the functions of both the amnion and chorion laeve can be interpreted from a comparative point of view (e.g., production of lipids). The next section deals with the ontogeny of the human amniotic sac, and the histogenesis and functional structure of the fetal membranes. It concludes with a structural analysis of the single layers of the fetal membranes at the end of pregnancy. Light and electron microscopy and histochemical examination are combined with experimental investigations; the striking differences and departure from any possible "norm", however, made the interpretation of morphological findings particularly difficult. Explanations for these differences are put forward: the texture of the connective tissue elements is only approximately determined and therefore gives rise to many irregularities; differences in the structure of cells depend upon their functional state; and the cells exist in groups which reciprocally exchange functional activity with each other. It is emphasized that the amniotic epithelium produces lipids which then appear in the same composition in the amniotic fluid. The fibroblasts in the amniotic connective tissue may, when necessary, be transformed into phagocytes (the so-called Hofbauer cells). Within the fetal membranes one can also observe glucose metabolism which, apart from the supply of local energy and the storage of glycogen, is concerned with production of phospholipids, triglycerides, glycoproteins, proteoglycans, and collagen (types I, III, and IV). A similar process of glucose metabolism is found in the trophoblast, especially the building-up of an extracellular matrix (the so-called fibrinoid), which seems to play a part in the formation of an immune barrier. An attempt is made to correlate the various differentiated cells of the trophoblast with particular functions. The vacuolated cells obviously store glucose. Others, as lectin-binding investigations have shown, are concerned with production of the extracellular matrix. They produce a three-dimensional latticework between the cells, and reach out as far as the borders of the chorionic connective tissue. In this regard, the microtexture of the amniotic and chorionic connective tissue provides a basis for a more precise understanding of their mechanical stability.(ABSTRACT TRUNCATED AT 400 WORDS)


Therapies for hepatitis B virus: current status and future possibilities. Alpha-interferon is the first agent with proven therapeutic efficacy in humans with chronic HBV infection. Obviously, further research is needed to clarify and expand the role of interferon in this setting. In addition, an overall response rate of less than 50% illustrates the need for continuing innovation in the treatment of HBV infection especially in patients with predictors of poor outcome. Despite the advent of effective vaccines against HBV, this pathogen is likely to remain a source of serious human morbidity and mortality for the foreseeable future. Continuing efforts must be directed towards finding more effective therapies against HBV. A recent preliminary report suggests that thymosin. like interferon on immune modulator, may also be efficacious in the treatment of chronic HBV and deserves further study.