The use of pericardium for the management of recurrent tracheoesophageal fistula

Correction of congenital esophageal atresia and tracheoesophageal fistula (TEF) with either a primary or staged repair may result in recurrence of the TEF, most often at the site of esophageal anastomosis. Definitive operative repair of a recurrent TEF involves isolation and resection of the fistula with closure of the tracheal and esophageal defects. A technique is described, whereby mobilization of a vascularized pedicle of pericardium allows further enhancement of the standard repair of a recurrent TEF. The vascularized pedicle of pericardium serves to isolate the tracheal and esophageal suture lines from each other, as well as aid in sealing leaks at either or both suture lines. This may dramatically reduce the incidence of second recurrences and lower the overall operative mortality, reportedly as high as 59%.     

Impaired insulin receptor binding and postbinding defects of adipocytes from normal and diabetic pregnant women

To evaluate the relative contribution of insulin binding and postbinding defects of glucose utilization in peripheral tissue during normal and diabetic pregnancy, we have studied the in vitro insulin action of isolated adipocytes from eight nondiabetic pregnant women and nine pregnant women with insulin-dependent diabetes mellitus who were undergoing cesarian section. The pregnant women were compared with a matched group of normal nonpregnant women undergoing gynecologic surgery. Insulin binding to adipocytes measured at tracer insulin concentration was reduced by 45% (P less than 0.01) in normal pregnant women and by 30% (P less than 0.02) in pregnant women with diabetes. In contrast, no changes were found between the three groups in insulin binding to pure monocytes and erythrocytes. The glucose transport system in fat cells from both groups of pregnant women was characterized by impaired maximal (P less than 0.05) and half-maximal (P less than 0.05) response to insulin. When fat cell glucose metabolism was studied, pregnant diabetic women exhibited decreased basal lipogenesis (P less than 0.05) and decreased maximal responses of lipogenesis and glucose oxidation to insulin stimulation (P less than 0.05). Similar but less pronounced abnormalities were seen in glucose metabolism of adipocytes from nondiabetic pregnant women. In conclusion, both in late normal and diabetic pregnancy, insulin binding to adipocytes is significantly reduced and accompanied by decreased insulin sensitivity and reduced maximal insulin responsiveness of glucose transport and by impaired basal and maximally insulin-stimulated glucose metabolism.     

Ovarian and omental ependymomas in peritoneal washings: cytologic and immunocytochemical features

The cytologic findings in peritoneal washings of two women, one of whom had an ovarian ependymoma and the other a primary omental ependymoma, are reported. The ependymomas were characterized by the presence of numerous, isolated, spindle and stellate cells as well as groups of cells forming true rosettes. The tumor cells displayed slightly pleomorphic, round-to-oval eccentric nuclei and abundant fibrillary cytoplasm with tapering cytoplasmic processes. In addition, one of the patients had numerous papillae and cell clusters with associated psammoma bodies indistinguishable from those found in low-grade serous carcinoma. The demonstration of glial fibrillary acidic protein (GFAP) in both cases by immunocytochemical procedures indicates the usefulness of this method in cytologic preparations to confirm the diagnosis of these uncommon neoplasms.     

The reaction of skin to primers used in the "single-step" bonding systems

A large number of direct bonding systems have been introduced for use by dentists and dental hygienists. Although these agents are used for direct bonding of brackets to enamel, contact with skin, oral mucosa, and gingiva is not uncommon. These products have wide clinical use, but their biocompatibility characteristics have not been extensively investigated. The present study was undertaken to determine the effects of the primer component of Mono-Lok (Rocky Mountain) and the primer component of Control (Lancer Pacific) on skin. Three adult Macaca mulatta monkeys were used in the study. The skin on their backs was shaved and the primer component of Control, primer component of Mono-Lok, and saline solution were applied at different sites every 3 days for up to four applications. The skin was examined clinically and, 5 days after the last application, a biopsy was performed for histologic evaluation. The skin in contact with the primer component of Mono-Lok exhibited pronounced inflammatory changes and was characterized by swelling, vesiculation, and ulceration. Histologic observations confirmed these findings by showing a marked inflammatory cellular response characterized by eosinophils. In contrast to these findings, the skin in contact with the primer component of Control or saline solution exhibited normal architecture. Histologic observations supported this appearance and showed minimal inflammatory cell infiltration. These results show that there are differences in the biocompatibility of direct bonding systems and that further studies are needed to clarify their long-term effects on patients and dental personnel.