Speaking jejunum after laryngopharyngectomy with neoglottic and neopharyngeal reconstruction

Total laryngopharyngectomy results in a considerable degree of morbidity. Although many advances have been made over the past 10 years, the restoration of speech remains an unsolved problem. Herein, we present three patients who underwent both neoglottic and neopharyngeal reconstruction using a free vascularized segment of jejunum. All three patients were able to swallow and two were able to speak. We believe that this method of reconstruction restores speech after total laryngopharyngectomy.     

Effects of bis-chloronitrosourea (BCNU) on pulmonary and serum angiotensin converting enzyme activity in rats

The anticancer drug bis-chloronitrosourea (BCNU) causes potentially life-threatening lung injury in a high percentage of patients. Because changes in the activities of pulmonary and serum angiotensin converting enzyme (ACE) have been reported previously to reflect toxic pulmonary damage by certain agents, we have investigated the effects of BCNU on pulmonary and serum ACE of rats. In vitro, BCNU had a direct inhibitory effect on both serum ACE and pulmonary ACE. In vivo, a large single dose of BCNU (80 mg/kg, i.p.) did not alter pulmonary ACE nor cause histologically observable acute lung damage. However, serum ACE dropped by 25% within 1 hr after drug. A multi-dose regimen, consisting of 5 mg BCNU/kg once per week for 6 weeks, caused marked pulmonary injury, which continued to develop in severity over several weeks following the completion of dosing. Lung ACE after four doses (total of 20 mg BCNU/kg) was depressed by 40% and remained low until dosing was completed. Following the final dose, lung ACE returned to control within 2 weeks. However, after an additional 2 weeks both lung and serum ACE had decreased by 35 and 25% respectively. It appears that ACE may provide a useful biochemical monitor for BCNU-induced pulmonary toxicity, but careful attention must be given to the time-course of changes in the enzyme activity.     

Senile disciform macular degeneration and smoking

We studied the smoking habits of 114 patients with senile disciform degeneration of the macula. The mean age at onset of blindness in the first eye was 64 years in those currently smoking; this was significantly less than the mean age in those who had never smoked (71 years). We advise all patients with disciform degeneration to stop smoking.     

Effect of transfused reticulocytes on iron exchange

A animal model was developed whereby reticulocyte-rich blood was introduced into normal rats by exchange transfusion. Measurements of plasma iron turnover was made at similar plasma iron concentrations before and after exchange transfusions. High reticulocyte blood obtained from animals rendered iron deficient by diet or by treatment with phenylhydrazine resulted in a mean increase of 86% in internal iron exchange, while the plasma iron turnover was unaffected by exchange with normal red cells. Since iron input from reticuloendothelial cells could have increased due to breakdown of transfused cells, iron absorption was also measured. Within 1 hr and for a least 6 hr after exchange with high reticulocyte blood, mean absorption in six groups of animals was increased over control animals by 50%-130%. The increased plasma iron turnover and absorption was not mediated by a decrease in plasma iron or an increase in unsaturated iron-binding capacity. Indeed, a higher plasma iron and transferrin saturation augmented the movement of iron into the plasma from iron- donating tissues. It is proposed that the donation of iron by transferrin in some way immediately facilitates the procurement of more iron by transferrin.