Modified method for epicardial constriction: the electric-Waffle procedure

Residual epicardial constriction after pericardiectomy prevents good results. The Waffle procedure, incising the fibrotic epicardium in a crosshatched manner, is frequently used to release the epicardial constriction. In this report, we describe a modification of the Waffle procedure, which uses the electrocautery unit and watching the standard monitoring equipment for arrhythmia, to perform multiple epicardial incisions.     

Rosai-Dorfman disease manifesting as relapsing uveitis and subconjunctival masses

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy, SHML) is a rare, non-hereditary, benign histiocytic proliferative disorder mainly affecting young people with common clinical characteristics such as painless bilateral cervical lymphadenopathy, fever, leukocytosis and polyclonal gammopathy. Extranodal manifestations have been reported in 28-43% of cases. Eye involvement is relatively uncommon (8.5%), and most of cases have presented as lymphoproliferation in the soft tissues of the orbit and eyelids. Uveitis is an even more rare presentation as a review of all the literature. We describe a 63-year-old man with SHML with unusual ophthalmic manifestations of relapsing uveitis and bilateral subconjunctival masses. The results of biopsies were compatible with the characteristic histopathological findings of SHML: focal aggregations of S100-positive foamy histiocytes and the existence of lymphocytophagocytosis. During the clinical course, the patient relapsed but the relapse was relatively benign and the patient showed fair response to topical as well as systemic corticosteroid treatment. Here we describe this unusual presentation of SHML to inform physicians of the possibility for this systemic granulomatous disease to contribute to relapsing uveitis.     

Neonatal hepatitis: a follow-up study

Fifty-six patients with moderate to severe neonatal hepatitis were followed for 12 to 78 months. Two died from causes other than hepatitis itself and were free from liver disease at the time of death. Of the remaining 54 patients, seven died of hepatitis, two are living with chronic liver disease and psychomotor retardation, and 45 are living without liver disease. High peak bilirubin levels and liver histologic findings of periportal fibrosis, moderate to severe portal inflammation, and/or diffuse giant cell transformation appear to be major factors predictive for poor outcome. Cytomegalovirus (CMV) infection was a common associated infection. Evidence of CMV infection was found in 22 (49%) of the 45 patients studied. Three of them died, and one is still living with cirrhosis of the liver. Metabolic disorders such as alpha-1-antitrypsin deficiency, galactosemia, and aminoaciduria and/or aminoacidemia were carefully screened but were not found in these cases. A fatal case had a sibling who had died of a similar disease course. Chinese infants may have metabolic and familial cholestasis diseases requiring further investigation.     

Normal childhood developmental patterns in skull bone marrow by MR imaging

To establish the normal developmental pattern of skull bone marrow in children by MR imaging, sagittal T1-weighted MR skull images of 324 normal children (newborn to 18 years) were reviewed. Bone marrow intensity was assigned four gradations as compared with that of muscle and fat on the same image. Bone marrow became isointense with fat (yellow marrow) at a mean age ±S.E.M. (in years) of 8.5±0.24 in sphenoid, 9.1±0.29 in mandible, 9.3±0.28 in hard palate, 9.7±0.26 in frontal, 11.0±0.26 in squamous occiput, 11.5±0.28 in parietal, and 11.9±0.24 in basiocciput. There is a strong correlation between age and marrow intensity by Spearman analysis (p<0.001): hard palate 0.64, mandible 0.61, parietal 0.42, sphenoid 0.70, cervical spine 0.50, basi-occiput 0.58 and occiput 0.52. Two consistent overall patterns of red-yellow marrow conversion were observed. Bone marrow became isointense with fat prior to pneumatization of the paranasal sinuses. Marrow conversion in the bones of the face occurred before those of the calvarium in a specific pattern. There was no significant sex difference in the pattern or rate of marrow conversion. These normative data are necessary to evaluate the immature skull by MR imaging in disease states.     

Striatal homogenates from animals chronically treated with haloperidol stimulate dopamine and GABA uptake in cultures of rostral mesencephalic tegmentum

The effect of pharmacologic denervation of striatal tissue on the production of growth promoting factors was examined in a cell culture system. Relative to saline-treated controls, rats were rendered behaviorally hypersensitive to a subsequent apomorphine challenge by 2 months of chronic treatment with haloperidol. Four days following chronic treatment, the animals were killed and the striata and cerebella were homogenized in Hank's Balanced Salt solution. The supernatants of these crude homogenates were then added to E-13 rostral mesencephalic tegmentum cultures for 6 days. Within 24 h, the haloperidol-treated striatal supernatants induced an overt increase in culture growth relative to all other supernatants. After 6 days, cultures incubated with haloperidol-treated striatal supernatants exhibited a significant increase in dopamine and GABA uptake relative to cultures incubated with all other supernatants. This effect was observed in the presence and absence of glia. The relative degree of this increased uptake was dependent upon the amount of haloperidol-treated striatal supernatant added. Boiling the supernatant removed the growth promoting effect. These results suggest that pharmacologic denervation of striatal tissue leads to a "target-specific" increase in growth promoting activity that may play a role in the pharmacologic and behavioral effects of haloperidol.     

Modulatory effect of blood cells on hypoxic vasoconstriction response and nitric oxide release in rat lungs.

In this study, we investigated the modulatory effects of different types of blood cells on hypoxic pulmonary vasoconstrictive (HPV) response and nitric oxide (NO) release in isolated rat lungs. The lungs were perfused at a constant flow with physiologic saline solution (PSS). The changes in pulmonary arterial pressure (PAP) and NO release were observed. Two hypoxic challenges with a 5% CO2-95% N2 gas mixture were carried out in each experiment. Hypoxia induced pulmonary vasoconstriction, as reflected by an increase in PAP (0.88 +/- 0.22 cmH2O). At the same time, NO (342.9 +/- 78.3 mv) release from the lungs was also increased. Addition of white blood cells (WBCs, 0.70 to 0.88 x 10(5)/mL), platelets (1.48 to 1.96 x 10(5)/mL), or red blood cells (RBCs, 4.6 to 6.6 x 10(5)/mL) into the perfusate produced different effects on PAP and NO changes. WBCs decreased the pulmonary vasoconstriction response and this was accompanied by an increase in NO release. Platelets had no significant effects on either PAP or NO. RBCs significantly potentiated the PAP increase and attenuated the NO release. The results indicate that NO release during hypoxia tends to offset pulmonary vasoconstriction and that NO release and HPV response are modulated by different cell elements.