Analysis of an in vivo model to study the interaction of host factors with Candida albicans.

Conditions were established under which membrane diffusion chambers surgically implanted into mice could be used to study interactions between host defense factors and Candida albicans within the chambers. Depending on the size of membrane pores, soluble host substances and phagocytic cells entered the chambers during the first 24 h after chamber implantation. By 7 days in vivo, the membranes of chambers appeared impermeable to these host factors. Mouse phagocytic cells were found to be functional within the in vivo chambers whether the cells emigrated to the chambers on their own accord or were placed there before chamber implantation. Opsonic factors such as antibody and complement appeared to be biologically functional within the in vivo chambers. Conditions suitable for harvesting C. albicans from the chambers also were determined.     

Paget disease of the anterior tibial tubercle

A study was done of 13 cases of biopsy-proved Paget disease in which the disease involved the anterior tibial tubercle with extension into the metaphysis and diaphysis, but without apparent involvement of the proximal tibial epiphysis. Case data were obtained from archives containing more than 350 cases of Paget disease. Age, sex, symptoms, serum alkaline phosphatase level, and histologic and radiographic appearance of the lesions were evaluated. Patients were young at clinical presentation, averaging 36 years of age. In five of six patients the serum alkaline phosphatase level was normal. The proximal extent of the disease was the anterior tibial tubercle rather than the proximal epiphysis. Radiographic patterns ranged from predominantly lytic to mixed lytic and blastic to predominantly blastic, and the lesion was marginated by a flame-shaped configuration. The radiographic appearance of Paget disease of the anterior tibial tubercle is characteristic and should be sufficient to suggest the diagnosis and preclude biopsy.     

Generation and characterization of three murine monoclonal nucleotide binding anti-ssDNA autoantibodies

Three murine monoclonal anti-ssDNA autoantibodies have been produced by fusion of spleen cells from NZB/NZW F1 hybrid mice with Sp 2/0-Ag 14 murine myeloma cells. Specificity studies characterizing monoclonal anti-ssDNA autoantibodies revealed binding patterns for nucleotides. Clone E-4-1 showed preferential binding with mono-, di- and polyguanosine. Clones E-4-4 and E-11-1 specifically bound mono-, di- and polythymidine. Results of inhibition studies indicated an order of reactivity for each monoclonal autoantibody: polynucleotide greater than dinucleotide greater than mononucleotide. In a fluorescence immune assay, using aminonaphthyl derivatives of nucleotides, all three monoclonal antibodies exhibited a low affinity (5 x 10(4)-10(5) M-1) for the homologous mononucleotides. The affinity of clone E-4-1 increased approximately 10-fold when a dinucleotide derivative was used relative to a mononucleotide fluorescent ligand.     

Use of laryngeal mask airway in children with upper respiratory tract infection,compared with face mask: Randomized,single blind,clinical trial

ObjectiveThe incidence of postoperative cough (primary outcome) and adverse respiratory events (secondary outcome) in children who received anesthesia by laryngeal mask airway (LMA) with children who received anesthesia by face mask (FM) was compared in a blind randomized trial with uncomplicated upper respiratory track infection (URI) undergoing general anesthesia. Previous studies of pediatric patients with URI receiving anesthesia by endotracheal tube have reported a greater number of anesthetic complications; however reports concerning adverse effects in pediatric patients with URI receiving anesthesia by LMA or FM are scanty.MethodFor the present trial, 150 children with uncomplicated URI and requiring general anesthesia for ophthalmic procedures were enrolled. Once the severity of preoperative URI symptoms was stratified, the children were randomized to receive general anesthesia by FM or LMA. Anesthesia was induced with sevoflurane and nitrous oxide in oxygen (N₂O in O₂). Respiratory adverse events were evaluated peri- and post-operatively.ResultsThe two groups did not differ in age, weight, American Society of Anesthesiologists (ASA) physical status, sex, duration of surgery or severity of URI symptoms. The incidences of cough (19% in LMA vs. 42% in FM), vomiting (4% in LMA vs. 12% in FM) and intervention to maintain the patency of the airway were statistically higher in the FM group (p < 0.05). There were no differences between the two groups with respect to the incidences of apnea, laryngospasm, desaturation, bronchospasm, readmission and sore throat.ConclusionIn children with uncomplicated URI, the administration of inhalation anesthetics in general anesthesia by LMA is likely to cause fewer adverse events than the use of FM.     

World Health Organization Group III pulmonary hypertension

Pulmonary hypertension in the setting of parenchymal lung disease and conditions associated with chronic hypoxemia is commonly encountered in clinical practice and may adversely affect patients’ function and mortality. Diagnosis of this subgroup of pulmonary hypertension has evolved but still requires right heart catheterization for confirmation. The primary treatment goal is optimization of the underlying parenchymal lung or hypoxemia-associated condition prior to consideration of pharmacologic therapy. Limited published experience with pulmonary hypertension-specific medications for treatment of WHO Group 3 pulmonary hypertension suggests symptomatic and functional benefit in selected individuals. The potential for worsening ventilation–perfusion matching must be considered in these cases, however, since there is a paucity of data regarding the optimal approach to treatment selection. Ongoing medication trials and further investigation of mechanisms of hypoxic pulmonary vasoconstriction provide hope for these patients who in the past often had only lung transplantation as a potential treatment option.