The anesthetic agent as an extra-integumentary foreign body in the respiratory tract. A new theory of general anesthesia

Two cases are cited of patients who sometimes exhibited a condition of temporary unconsciousness which proceeded to spontaneous recovery without harmful sequelae. This type of cerebral arrest is frequently called general anesthesia: however, these patients had not received any drugs. What they did have was an irritant in the respiratory passages as shown by coughing. Three cases of general anesthesia are described wherein the duration of the phenomenon appeared to be partly due to the presence of an extra-integumentary foreign body, confined to the respiratory passages. In this trio there was evidence that the drugs did not affect the patients in any unusual way, whatever their effects on whichever side of the alveolar walls. Many anesthetic agents act like unabsorbable foreign bodies, in that they enter and leave the body umchanged, despite the fact that they do pierce the integument. Of course, almost everything, except inspirable and expirable air, but including anesthetic agents, is a foreign body in the respiratory tract. On the basis of these considerations, I suggest that one way, in which general anesthetic agents work, is as extra-integumentary foreign bodies, causing Reflex Coma by irritating or stimulating the trigger points in the walls of the respiratory tract, thereby arresting the cerebrum.     

Ear foreign bodies: observations on the clinical profile in Sokoto, Nigeria

BACKGROUND/OBJECTIVES: Ear foreign bodies are common otorhinolaryngological emergencies which must be removed otherwise they may present with various complications. This paper reviews cases of ear foreign bodies seen over a seven year period from January 1995 to December 2001 in the Ear, Nose and Throat (ENT) department of Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. METHOD: This is a retrospective study of all case folders of patients who presented with ear foreign bodies whose clinical features and management modalities were analyzed. RESULTS: The total number of patients reviewed were 207. There were 126 males (60%) and 81 females (40%) with a male to female ratio of 1.5:1. Their ages ranged from 1 to 65 years with 61.8% being children under 10 years old. Agricultural seed was the commonest documented foreign body (15%). Deliberate insertion by patients accounted for 70% of the cases while accidental insertion accounted for 30%. Ear foreign bodies became complicated in 41 patients (19.8%) at presentation one of them requiring a major surgical operation (posterior tympanotomy) to remove the foreign body. About 99.5% of the foreign bodies were removed through the per meatal approach with 79.8% being carried out by the nurses and doctors who had received basic training to do so. CONCLUSION: Ear foreign bodies may become complicated and so needs to be removed using standard methods which should be carried out by those specially trained to do so.     

Insomnia-coma and auto-electrocution complicating general anesthesia. Incidental factors which also cause cerebral, respiratory and cardiac arrest.

Whatever induces general anesthesia, i.e. cerebral arrest, tends to cause respiratory and cardiac arrest also. However, general anesthesia does not necessarily exclude nor block all other mechanisms which can provoke one or more of these three phenomena. Amongst many such more or less equipotent factors are intracranial, intrapleural, intra-abdominal and intratracheal pressures. These mechanical factors occurring but unrecognized in surgical patients cause puzzling complications including, insomnia, coma and unexpected sudden death.     

A rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum

A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child''s parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally.On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum.The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy.The child recovered well and was discharged from hospital on day 55.     

The entry of the prothymocyte into the thymus after lethal irradiation and bone marrow transplantation. II. Time of entry

The time of entry of prothymocytes into the thymus after lethal irradiation and bone marrow transplantation (BMT) was determined by exposing the thymus only or the whole body with the thymus shielded to a second irradiation after different intervals. The repopulation of the thymus by donor type cells was determined by a thymus repopulation assay using donor specific markers. Reirradiation of the thymus kills the prothymocytes that have entered the thymus during the interval. It was found that reirradiation of the thymus from 48 hours after BMT onwards increasingly delayed thymus regeneration. This shows that donor prothymocytes do not enter the thymus until about 2 days after BMT and that they continue to do so during at least three subsequent days. In the second reirradiation protocol thymus regeneration occurred earlier in the shielded thymus than in thymuses of whole body irradiated mice. Earlier thymus regeneration was not seen in mice that were reirradiated at 24 hours after BMT, but occurred only when irradiation took place at 48 hours and later. These data are consistent with those obtained in the first protocol. The results are in contradiction with results of direct homing experiments, which showed entrance of donor cells within 3 hours after BMT. Our functional assay demonstrated that the early appearing cells cannot be prothymocytes. In retransplantation experiments it was shown that the bone marrow (BM) may indeed be the initial homing site of prothymocytes.     

The development of asthma after tracheobronchial aspiration of a foreign body

To evaluate whether a tracheobronchial foreign body (TBFB) itself or its removal by bronchoscopy with the patient under general anesthesia predisposed children to asthma, we surveyed 58 children who had a TBFB removed at the Mayo Clinic between 1970 and 1978. A control group included children who had undergone tonsillectomy or adenoidectomy. Asthma developed in four children in each group. Children with a TBFB do not seem to be predisposed to the development of asthma.     

The spherule cells of Holothuria polii Delle Chiaie, 1823 (Aspidochirota, Holothuroidea) during brown body formation: an ultrastructural study

Spherule cells are specific types of coelomocytes found in both the coelomic fluids and the connective tissues of many echinoderm groups and are characterised by large membrane-bound inclusions which completely fill their cytoplasm. In holothurians they are present in massive number in the coelomic fluids and are employed in brown body formation. Brown bodies are products of encapsulation and mainly consist of phagocytic amoebocytes and spherule cells: they surround foreign particles too large to be ingested by circulating phagocytes. During brown body formation, phagocytic amoebocytes flatten out over the surface of foreign particles to form unpigmented nodules which eventually aggregate into a single brown body in which many spherule cells are entrapped. Morphological modifications of spherule cells were studied in Holothuria polii following the induction of brown body formation by intracoelomic injection of sheep erythrocytes. Our ultrastructural observations provide evidence that the granules undergo typical exocytosis after previous disorganisation of their content and suggest a specific secretory activity for the spherule cells. The possible functional role of the secreted vacuolar material in brown body formation is discussed.     

Spatial and temporal response patterns on the eight-arm radial maze

Six maze-experienced hooded rats were timed during five trials on which they collected water from all arms of an eight-arm radial maze, then made five more choices. All subjects frequently exhibited a "task-completion pause:" The subjects rarely spent more than 1 sec in the center of the maze between choices until they had entered all eight arms, then stopped in the center of the maze. In contrast, the time spent in each arm gradually increased until all of the water had been obtained, then decreased slightly. Four subjects began every trial by choosing eight consecutive adjacent arms. The task-completion pause indicates that these subjects recognized when all of the arms had been entered, without having to repeat one. Therefore, even extreme degrees of response stereotypy do not imply a fundamental dependence on response strategies.     

Age, sex and socioeconomic correlates of fat patterning among adults from the Chandigarh zone of northwest India

Fat patterns were derived from principal-component analysis of skinfolds and circumferences of 651 northwest Indian adults 18-49 years of age of high and low socioeconomic class. All measurements were corrected for absolute size prior to the analysis. As described in other ethnic groups, two patterns emerged: trunk/extremity and upper/lower body, based upon skinfolds and circumferences respectively. There was a general trend towards increases with age in upper body trunk fatness, somewhat more pronounced in upper than lower SES subsamples. Sexual dimorphism was greater in upper SES individuals due to an intensification of those patterns associated with each sex. Not only do lower SES females have less body fat than their upper SES counterparts, they have relatively less on their lower bodies (hips and thighs), which, in females, may serve as sites of energy storage.     

麻醉机快速充氧连接气管镜在小儿气管异物取出术中的应用

目的总结麻醉机快速充氧连接气管镜在小儿气管异物取出术中应用的经验。方法15例行气管异物取出的患儿经快速诱导面罩加压通气经口腔于声门置入气管镜用麻醉机高频喷射充氧控制通气，氯安酮或丙泊酚复合肌松荆维持麻醉，术中严密监测SPO2。术毕停滴麻醉药，病人洁醒后拔管。结果14例取出异物，1例未取出；无一例发生屏气、呛咳。患儿均于停麻醉药30min内清醒。睁眼，吞咽反射、自主呼吸恢复良好，吸空气时SPO2维持在93％以上，拔管后均未发生喉痉挛及喉头水肿，术后也未发生缺氧。结论经快速诱导面罩加压通气后置入气管镜用麻醉机高频喷射充气控制通气用于气道异物取出术，声门暴露良好便于气管镜的插入，术中不发生屏气、呛咳，病人苏醒快。术后并发症少。不失为一种比较实用的方法，但术中及术后均需加强监测，尤其是SPO2。     

Light and electron microscopical studies on specific cells of the marginal zone in the developing rat cerebral cortex

Summary The development of specific cells in the marginal layer of the occipital cortex of the rat was studied both light and electron microscopically. These cells are the first cells of the cerebral cortex to begin differentiation on embryonal day 13 when they enter the stage of beginning ramification. The maturation of these cells proceeds rapidly; on day 17 of gestation they are in the stage of accumulation of ergastoplasm, on day 19 most of them have reached the stage of orientation of ergastoplasm. 1 to 2 days before birth the majority of these horizontally oriented cells exhibit large Nissl bodies in their cytoplasm which often surround the whole nucleus and extend into both processes. The ultrastructure of the horizontal processes of these cells cannot readily be compared with that of conventional protoplasmic processes, buth they rather appear more like extensions of the perikaryal cytoplasm, the structure of which is retained along the course of the processes.These specific cells which are limited to and specific for the marginal zone of the cerebral cortex thus are the first cells of the cerebral cortex to reach cytological maturity—even before birth—and therefore do not fit into the concept of an inside-out gradient of neurogenesis and differentiation in the development of the cerebral cortex as proposed by a number of authors, because the deeper situated preneurons of the other cortical layers have at this time only just begun differentiation from the stage of ventricular cells. Their functional role as a fetal cell in the morphogenesis of the cerebral cortex and their identity with the horizontal cells of Cajal-Retzius is discussed.     

Identification of a new mechanism for bacterial uptake at mucosal surfaces,which is mediated by dendritic cells

Dendritic cells are potent activators of the immune response. They reside in tissues which interface the external environment, but we shall see that they do not perform only a passive role by monitoring microorganisms that have entered the body. Rather, DC can actively participate to microbial entry across mucosal surfaces by creeping between epithelial cells and by internalizing bacteria via their dendrites.     

Localization of CO2 sensor related to the inhibition of the bullfrog respiration.

CO2 sensitivity in the airways and the general skin surface of the bullfrog under urethane anesthesia or without anesthesia was investigated. Pressure in the buccal cavity as well as blood pressure in the sciatic artery were measured with a differential or a straingauge transducer. Air containing 2--14% CO2 was introduced into the regions as given below. (1) The nose and the body surface, both regions were separated from each other and independently exposed to CO2. (2) The larynx-lungs, the buccal cavity-lungs, the naso-buccal cavity separated from the airways at the glottis, and the internal or external nares, respectively. By analyzing the CO2 sensitivity of the respective regions mentioned above, both the nasal mucosa and the skin surface were found to be responsible for the respiratory inhibition by CO2. Sectioning both the olfactory and the trigeminal nerves abolished the CO2-induced inhibition mediated by the nasal mucosa and electrical stimulation of the proximal cut end of these nerves inhibited respiration. These findings suggested the existence of afferent reflex pathways from the nasal mucosa by these cranial nerves. Significance of this CO2-induced reflex was discussed.     

Vagal innervation of the air sacs in a songbird, Taenopygia guttata

The air sacs of birds are thin-walled chambers connected to the lung that act as bellows in the ventilatory mechanism. Physiological evidence exists to suggest that they may contain receptors that are innervated by the vagus nerve, but no morphological study has examined the vagal innervation of these putative structures. To do this, we injected the cervical vagus nerve with choleragenoid and examined the innervation of the air sacs using light and confocal microscopy. We identified vagally innervated structures in the air sac wall that resemble the neuroepithelial bodies (NEBs) described in the airways of many vertebrates. Although NEBs have been proposed to have a dual chemoreceptive and mechanoreceptive role, their specific function in the air sacs of birds remains unclear.     

Post-translational protein modifications in antigen recognition and autoimmunity

It is estimated that 50-90% of the proteins in the human body are post-translationally modified. In the proper context, these modifications are necessary for the biological functions of a vast array of proteins and the effector functions of the cells in which they reside. However, it is now clear that some post-translational modifications can create new self antigens (Ags) or even mask Ags normally recognized by the immune system. In either case, they profoundly affect the recognition of Ag by bone marrow-derived cells, as well as their effector functions. How do post-translational protein modifications affect the processing of foreign and self Ags and what is their role in the origin of autoimmune responses?     

Features of foreign proteins affecting their retrograde transport in axons of the visual system

Summary The retrograde axoplasmic transport of foreign proteins in the rat visual system shows certain specificities. The molecular features of these proteins which may underlie their entry into the retrograde phase have been examined using biochemical and morphologic techniques. Of the isoenzymes of horseradish peroxidase (HRP), the basic isoenzyme C is strongly transported, while the acidic isoenzymes A and A are transported weakly and not at all, respectively. Decreasing the isoelectric point (pI) of isoenzyme C from 8.2 to 4.4 decreases its transport, but a basic pI is not the sole requisite for transportability since two other basic peroxidases (turnip isoenzyme P₇ and lactoperoxidase) are not transported in retrograde. The sugar component as a whole of isoenzyme C does not appear to be required for determining transport. Isoenzyme C and the other proteins which are transported enter multivesicular bodies in axons and axon terminals, as well as synaptic and coated vesicles and fine tubules in axon terminals. The non-transported proteins enter only the vesicular organelles thought to be involved in neurotransmitter recycling in axon terminals and do not enter multivesicular bodies. Thus the two systems of axonal membraneous compartments involved in local synaptic recycling versus the retrograde phase of transport do not show the same specificity of uptake of extracellular tracers and can be dissociated by the experimental use of these peroxidases.     

Angiogenesis in the mouse lung

When pulmonary arterial blood flow is obstructed in all mammals studied, there is a compensatory growth of the bronchial vasculature. This angiogenesis normally occurs through a proliferation of the systemic circulation to the intraparenchymal airways. It is an important pathophysiological process, not only in pulmonary vascular disease, but also in lung cancer, because the blood flow that supplies primary lung tumors arises from the systemic circulation. In the mouse, however, the systemic blood vessels that supply the trachea and mainstem bronchi do not penetrate into the intraparenchymal airways, as they do in all other larger species. In this study, we attempted to generate a new functional bronchial circulation in the mouse by permanently obstructing 40% of the pulmonary circulation. We quantified the systemic blood flow to the lung with fluorescent microspheres for 3 months after left pulmonary artery ligation. Results demonstrated that a substantial systemic blood flow to the lung that can eventually supply up to 15% of the normal pulmonary flow can be generated beginning 5–6 days after ligation. These new angiogenic vessels do not arise from the extraparenchymal bronchial circulation. Rather they enter the lung directly via a totally new vasculature that develops between the visceral and parietal pleuras, supplied by several intercostal arteries. This unique model of angiogenesis occurs in the absence of any hypoxic stimulus and mimics the vascular source of many lung tumors.     

Diagnosis and management of an intra-articular foreign body in the foot

We describe a case of a small intra-articular foreign body in the foot presenting 48 hours following injury, which at operation showed early evidence of septic arthritis. It is essential to accurately localise periarticular foreign bodies in the foot and proceed to arthrotomy and debridement in all cases where there is radiological or clinical evidence to suggest intra-articular retention of a foreign body.     

Mitotic arrest of female germ cells during prenatal oogenesis. A colcemid-like, non-apoptotic cell death

The sequence of events and a possible reason for germ cell death during oogenesis in the prenatal ovary were studied in rat and mouse embryos. ED 14–22 rat and ED 14–16 mouse embryos were studied using semithin sections for light microscopy and serial ultrathin sections for electron microscopy. In addition, the rat material was 3H-thymidine labelled for historadioautography and cytospin preparations of freshly obtained gonads were immunohistochemically analysed. During the transition from the proliferating oogonial stage to the meiotic prophase about 16% of the postmitotic oocytes do not pass the initial meiotic checkpoint on ED 18/19 in the rat (ED 15/16 in the mouse). These germ cells first show structural signs of mitosis; the diploid number of ’super-condensed’ chromosomes are globally formed and are concentrated in the center of the cell. Although the germ cells show all morphological signs of living cells they never have mitotic spindles; the micro-tubulus-organisation-centres (MTOCs) are found peripherally and become concentrated, forming a single centrosomal body (acentriolar MTOC) as detected by immunohistochemistry for the centrosomal protein MPM2 and γ-tubulin. EM studies show 25 nm tubule-like profiles within the MTOC bodies. The centrioles frequently lie separate from the MTOC material or are not present at all; the germ cells are apparently arrested in a prophase- or metaphase-like stage when they have reached the postmitotic G2/preleptotenal transition and are unable to enter meiosis. Forty-eight to 72 h after the first mitotically arrested germ cells are found, degeneration is seen in these germ cells. This second event, the germ cell death proper, shows neither criteria of apoptosis (cell shrinkage, marginal condensation of chromatin, DNA fragmentation) nor signs of necrosis (cell swelling, pycnosis, inflammation). Both arrested pro- and metaphase-like stages are found with signs of cell death and phagocytosis. The morphological signs of phagocytosis are found in neighbouring pregranulosa cells. The final heterocytotic bodies contain the remnants of the centrosomal (MTOC) material and DAPI-positive DNA material. The pregranulosa cells are mitotically silent during the phase when mitotic arrest and germ cell degeneration is found. The results suggest the presence of a hypothetical ’anti-spindle’ factor, which under normal conditions is necessary for induction of meiotic prophase. The structural events of ’arrested mitosis’ is reminiscent of those induced by the antimitotic, tubule-degrading drug colcemid. This type of arrest may inhibit meiosis of more than 33% prenatal germ cells and induce their cell death. Accepted: 30 July 2001