Local versus general anaesthetic in the management of the fractured nose

Displaced fractured noses are usually manipulated under general anesthetic. The appearances of fractured noses were assessed and the airways measured by rhinomanometry before and after nasal manipulation in 29 patients. Seventeen received a local anaesthetic (LA) and 12 a general anaesthetic (GA) for the manipulation. Patients were generally pleased with the outcome and there were no significant differences between results in the 2 groups. Bony manipulation did not affect the nasal airway. Local anaesthesia was acceptable to all but one patient. The benefits, including those of cost and safety, of local anaesthetic for manipulation of almost all fractured noses are discussed.     

An immunocytochemical analysis of TGFα expression in benign and malignant prostatic tumors

Transforming growth factor alpha (TGFα) expression was analyzed immunocytochemically on formalin-fixed wax-embedded sections obtained from 24 benign prostatic hyperplasia (BPH) specimens and 76 prostatic carcinoma tissues, 3 human prostatic tumor xenografts, normal kidney, and salivary gland. Low amounts of TGFα immunopositivity were encountered in the epithelium of BPH glandular tissues, whereas in the prostatic adenocarcinoma samples, a greater heterogeneity and intensity of TGFα immunostaining was observed. The most intense staining was exhibited by the least differentiated tumors, although a few of these were weakly stained. Statistical analysis of the relationship of histopathological grade of tumor with TGFα expression in the carcinomas showed a significant correlation of these parameters, 0.01 > P > 0.001. The expression of the proliferation markers Ki-67 and PCNA was also analyzed in the carcinoma specimens, and the relationship of these to TGFα expression indicated that there was no significant correlation in this series of tumors between increased growth activity and TGFα expression (p ? 0.25 with both markers). The prostatic carcinoma xenografts TEN 12 and TEN 15 contained low levels of immunoreactive TGFα, which was uniformly distributed, whilst heterogeneous immunostaining was observed in the uroepithelial xenograft TEN 16. In the normal human kidney, TGFα was concentrated in the epithelium of the distal convoluted tubules (DCT) and the collecting tubules (CT), and lower amounts were identified in the proximal convoluted tubules (PCT). As in the prostatic carcinomas, the immunostaining was eliminated by prior absorption of the antibody with pure TGFα and not with human or mouse EGF. No crossreactivity of the TGFα antibody with salivary EGF was demonstrated. This study concludes that, in prostate carcinoma, the least differentiated tumors more often expressed greater amounts of immunoreactive TGFα; however, no relationship between TGFα expression and cellular proliferation markers was found. © 1993 Wiley-Liss, Inc.     

Lorazepam and pentobarbital discrimination: interactions with CGS 8216 and caffeine

Baboons and rats were trained under a two-lever, food-reinforced drug discrimination procedure. The training drug was either lorazepam (1.0 mg/kg) or pentobarbital (5.6 mg/kg in baboons, 10.0 mg/kg in rats). Under test conditions, a range of training drug doses occasioned 100% drug lever responding. CGS 8216 (3.2-10.0 mg/kg) combined with lorazepam produced a complete shift to the no-drug lever in both species; this shift was surmountable with higher doses of lorazepam. CGS 8216 (32.0 mg/kg) combined with pentobarbital produced a statistically significant decrease in drug-lever responding in rats, and in baboons CGS 8216 initially, but not subsequently, produced a complete shift to the no-drug lever. Caffeine (0.32-10.0 mg/kg) combined with lorazepam inconsistently decreased drug-lever responding across multiple determinations in baboons and significantly decreased drug lever responding in rats. Caffeine combined with pentobarbital also yielded an inconsistent decrease in drug lever responding in baboons but there was no effect in rats. Thus the most reliable and complete antagonism across species was obtained with the CGS 8216/lorazepam combinations.     

Growth studies of subcutaneous rat tumours: comparison of 31P-NMR spectroscopy, acid extracts and histology

31P-NMP, surface coil spectra of three subcutaneously implanted rat tumours (Morris hepatoma 7777, GH3 prolactinoma, Walker carcinosarcoma) and an N-methyl-N-nitrosourea induced rat mammary adenocarcinoma at different stages of growth were obtained and compared with histological sections taken immediately after NMR acquisitions. Metabolite ratios (phosphocreatine (PCr)/beta nucleoside triphosphate (beta NTP), PCr/Pi, beta NTP/Pi) calculated from the NMR spectra were compared with ratios obtained from acid extracts of tumours of similar size. Measurements of creatine and ADP were also made. Three of the tumours showed positive correlations between increasing tumour size and decreasing metabolite ratios measured both by NMR and in extracts, whereas the Walker carcinosarcoma showed no correlation between size and any parameters measured. Phosphorus metabolite ratios, measured in extracts of skin overlying the tumours, indicated a fall in high energy phosphate when there was histological evidence of skin invasion by the tumour. Surface coil 31P-NMR spectra of subcutaneously grown or induced tumours in the rat represent a slowly changing steady state as the tumour increases in size. We conclude that increasing numbers of hypoxic tumour cells, rather than large areas of necrotic tissue, contribute largely to the NMR spectrum.     

Effects of cigarette rod length on puff volume and carbon monoxide delivery in cigarette smokers

As part of a continuing series of studies to investigate the variables controlling various topographical aspects of cigarette smoking, the present study examined the extent to which cigarette rod length influenced smoking. Cigarette smoking was examined under conditions in which subjects smoked cigarettes they could not see. Both puff volume and puff duration varied as a direct function of rod length, although they were not highly correlated. Peak flow rate was not affected by rod length. Other results suggest that visual stimulus control and satiation did not affect puff volume. Comparison of puffing whole cigarettes versus short cigarette rods suggests that puff volume, but not puff duration, may be decreased in response to increased pharmacological delivery as a result of particulate build-up during smoking of a whole cigarette. Carbon monoxide (CO) exposure was substantially greater after puffing full length cigarette rods than after short cigarette rods. Comparison of these human CO data with CO delivery from syringe-simulated puffing of full length and short cigarette rods indicates that knowledge of puff volume and duration during human smoking is insufficient for accurately predicting biological (CO) exposure.     

Age changes in the dorsal and ventral lumbar nerve roots of dogs

Dorsal and ventral nerve roots from clinically normal dogs aged 3 months to 13 years have been examined. The L6, L7 roots were selected and samples removed from the roots within the sub-arachnoid space and within the root sleeves. Routine light microscopy, electron microscopy and single fibre studies have been made. The single teased fibre results have been analysed statistically for the correlation of internodal length and diameter. With increasing age there was marked evidence of demyelination and remyelination. Paranodal and segmental demyelination were present and there were numerous fibres showing a marked variation in internodal length. In younger animals these features were not seen. Wallerian type degeneration was uncommon. In older animals myelin balloons, similar to those described proximal to neuromas, were commonly found. These were present in both dorsal and ventral roots. The ballooning appeared to result from a splitting of the myelin sheath. The intervening space was non-staining but sometimes contained myelin debris. No evidence of neuromas was present in these roots or peripheral nerves. These studies suggest that both the ballooning and demyelination and remyelination are age related.     

Long term follow-up in cutaneous malignant melanoma: the relationship of maximal tumour thickness to disease free survival, disease recurrence and death

284 patients with invasive cutaneous malignant melanoma and known maximal tumour thickness (MTT) were followed up for 10 to 16 years (or to earlier death) following conventional wide margin excision of the primary tumour. Of these 26 (9%) presented with clinical Stage II disease (enlarged regional lymph nodes). The 10 year disease free survival was 45% for clinical Stage I disease, with 5/26 patients with Stage II disease alive 10 years after tumour excision combined with lymph node dissection. Ninety per cent of first tumour recurrences (lymph node or local skin recurrence) occurred within 5 years of primary surgical treatment for clinical Stage I disease, whilst only 63% of deaths from melanoma occurred within this 5 year period. Although maximal tumour thickness is a valuable prognostic guide, cutaneous malignant melanoma remains an unpredictable disease.     

Burn injury in the aged patient

It is a tragedy when an aged patient dies after sustaining a minor burn. Although many reported series illustrate the poor prognosis of burn injury in the elderly, the number of patients studied is often small. In a 10-year-period, 276 patients aged over 60 years were admitted to the Wessex Regional Burn Centre following acute burn injury. These patients represented 16 per cent of all acute burn admissions, and were studied in a retrospective review. Various data on mortality and burn size incidence are presented for this traditionally regarded high risk group.