Successful treatment of tracheomalacia associated with esophageal atresia without a tracheoesophageal fistula by aortopexy: Report of a case

Tracheomalacia (TM) is well known as a complication associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF); however, the occurrence of TM requiring surgical treatment in a patient having EA without a tracheoesophageal fistula has never been reported. We describe herein a rare case of TM associated with EA without TEF. Respiratory distress was caused by compression of the trachea by a severely dilated upper esophageal pouch with weakness of the tracheal wall. Aortopexy was performed, and an excellent postoperative result was achieved.     

Spontaneous pneumothorax without any detectable pulmonary metastases in a patient with osteosarcoma

An 11-year-old girl with osteosarcoma in the left distal femur, developed unilateral spontaneous pneumothorax. Pneumothorax was found at the initial presentation, but chest CT failed to reveal pulmonary metastases, bullae or blebs.

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Résumé  Une fillette de 11 ans présentant un ostéosarcome de la région distale du fémur, chez qui est apparu un pneumothorax spontané. Le pneumothorax a été constatéà la première visite, mais la tomographie par reconstruction d’image n’a permis de révéler ni métastases pulmonaires, ni bulles pulmonaires ou sous-pleurales.

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Accepted: 7 October 1999     

Efficacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear

Although magnetic resonance imaging (MRI) has improved the diagnostic accuracy of meniscal pathology, the authors believe that physical examination remains essential to the evaluation of knee pathology. In this study, the diagnostic accuracy of five clinical tests for meniscal pathology was prospectively evaluated in 160 patients, who thereafter underwent arthroscopy. 69% (109 knees) of the knees tested had associated ACL deficiency. There were 144 meniscal lesions in 130 of the 160 knees which were examined. The sensitivity of the tests was lower than the specificity. Conventional tests such as McMurray and Apley tests showed a low accuracy rate of 45% and 28% respectively. The diagnostic value of the axially loaded pivot shift test was significantly higher, indicating that this remains a useful diagnostic aid.     

Effects of aging on fluorescein leakage in the iris and angle in normal subjects.

PURPOSE: To determine the presence of fluorescein leakage from the iris and angle in normal subjects, and how it is affected by aging. METHODS: The subjects were 92 normal volunteers and patients with senile cataract who ranged in age from 20 to 93 years and were free from any systemic or ocular diseases. Fluorescein iris and angle photography and color iris and angle photography were performed using a goniolens and a photo slit lamp. RESULTS: Radial ciliary body vessels were found in 22 eyes (24%), radial iris vessels or trabecular vessels in 7 eyes (8%), and circular ciliary band vessels were seen in 4 eyes (4%). Goniovessels were found in 8 of 30 eyes (27%) of those under 50 years of age. No significant difference in the incidence of goniovessels was found between those over and under age 50 (P < .01). In the pupillary margin, fluorescein leakage was seen in 1 of 30 eyes (3%) in the age group under 50 years, whereas leakage was found in 30 of 62 eyes (48%) in the age group over 50 years. In the anterior chamber angle, leakage was seen in 4 of 30 eyes (13%) under age 50 years, and in 38 of 62 eyes (61%) over age 50 years (P < .05). CONCLUSIONS: These findings suggested that the incidence of leakage of fluorescein from the pupillary margin and anterior chamber angle tends to increase with age. Thus, when leakage of fluorescein in angle and iris is observed, it is important to consider the physiological changes resulting from aging.     

An ultraviolet absorbing pigment causes a narrow-band violet receptor and a single-peaked green receptor in the eye of the butterfly Papilio

The distal photoreceptors in the tiered retina of Papilio exhibit different spectral sensitivities. There are at least two types of short-wavelength sensitive receptors: an ultraviolet receptor with a normal spectral shape and a violet receptor with a very narrow spectral bandwidth. Furthermore, a blue receptor, a double-peaked green receptor and a single-peaked green receptor exist. The violet receptor and single-peaked green receptor are only found in ommatidia that fluoresce under ultraviolet illumination. About 28% of the ommatidia in the ventral half of the retina exhibit the UV-induced fluorescence. The fluorescence originates from an ultraviolet-absorbing pigment, located in the most distal 70 microns of the ommatidium, that acts as an absorption filter, both for a UV visual pigment, causing the narrow spectral sensitivity of the violet receptor, and for a green visual pigment, causing a single-peaked green receptor.     

Stresgenin B, an inhibitor of heat-induced heat shock protein gene expression, produced by Streptomyces sp. AS-9

Stresgenin B was isolated as an inhibitor of heat-induced heat shock protein (HSP) gene expression from a culture broth of Streptomyces sp. AS-9 by silica gel chromatography and HPLC. The molecular formula of the novel compound was determined as C11H13NO5 by high resolution FAB-MS analysis, and the structure was determined by UV, 1H NMR, 13C NMR, HMQC, HMBC, and NOESY spectra. Stresgenin B inhibited heat-induced luciferase reporter-gene expression directed by the human hsp70B promoter in Chinese hamster ovary (CHO) cells at concentrations lower than the concentrations for inhibition of dexamethasone-induced luciferase reporter-gene expression directed by the mouse mammary tumor virus (MMTV)-LTR promoter. The inhibition of heat-induced reporter gene expression was evident even when cells were exposed to stresgenin B only during heat stress treatment. Moreover, the compound inhibited heat-induced syntheses of hsp72/73, hsp90, and hsp110 and thereby suppressed the induction of thermotolerance. Stresgenin B showed moderate cytotoxic activities against several neoplastic cell lines and also showed antibacterial activities against Micrococcus luteus, Bacillus subtilis and Staphylococcus aureus strains.     

Synthesis of 2,8-disubstituted imidazo[1,5-a]pyrimidines with potent antitumor activity

Seventeen 1,2,3,4-tetrahydroimidazo[1,5-a]pyrimidine derivatives bearing electron-withdrawing substituents were designed and synthesized by novel ring closure as potential antitumor agents. They were screened for their activities against mouse leukemia L1210 and human oral epidermoid carcinoma KB cell lines, and relationships of structure and antitumor activity in vitro are discussed. It was found that 8-thiocarbamoyl-1,2,3,4-tetrahydroimidazo[1, 5-a]pyrimidin-2(1H)-thione (8c) exhibited activity comparable to that of 5-fluorouracil against both L1210 and KB cells. The existence of both 2-thioxo and 8-substituent with a thioxo group in the molecule is crucial for the cytotoxicity against L1210 and KB cells. A novel procedure for introduction of a double bond between C-3 and C-4 in 8c was developed. Introduction of the 3,4-double bond increased the activity against L1210, but against KB cells the activity decreased by 4-fold. Cytotoxicity of compounds 8c and 8-thiocarbamoyl-1,2-dihydroimidazo[1,5-a]pyrimidin-2(1H)-thione (11c) against human solid tumor and leukemia cell lines was further evaluated. The saturation of the 3,4-double bond led to a significant increase in cytotoxicity against tumor cell lines tested.     

Nocturnal eating/drinking syndrome and neuroleptic-induced restless legs syndrome

Nocturnal eating/drinking syndrome secondary to neuroleptic-induced restless legs syndrome (RLS) occurred under treatment with low-dose haloperidol in a 51-year-old female schizophrenic patient. Polysomnographic investigation showed a low level of sleep efficacy, periodic leg movements, and a strict relationship between nocturnal eating episodes and non-rapid eye movement sleep. Her nocturnal eating and RLS were completely inhibited by clonazepam treatment. To our knowledge, this is the first published case of nocturnal eating/drinking syndrome secondary to neuroleptic-induced RLS.     

An immunohistochemical and immunoelectron microscopic study of adhesion molecules in synovial pannus formation in rheumatoid arthritis

To investigate the mechanism of synovial pannus formation in rheumatoid arthritis, immunohistochemical and immunoelectron microscopic studies with monoclonal antibodies against the adhesion molecules, CD54 (ICAM-1), CD 11a (LFA-1), CDw49a (VLA-1), CDw49b (VLA-2), CDw49c (VLA-3), Cdw49d (VLA-4) and CDw49e (VLA-5), were carried out to determine the pattern of distribution of these molecules at the rheumatoid synovial cartilage junction. Treatment with anti-ICAM-1 resulted in membrane staining of most of the macrophages and fibroblasts infiltrating the synovial tissue and bordering the pannus-cartilage junction, suggesting the possibility that ICAM-1 may function to facilitate the adhesion of synovial type A cells bearing ICAM-1 to type B cells of the pannus. ICAM-1-positive macrophages and fibroblasts were often found to be in contact with lymphoid cells, suggesting also that a cellular immune reaction occurs in the formation of the pannus. In addition, VLA-3, VLA-4 and, particularly, VLA-5 were the predominant1 integrins expressed by rheumatoid synovial pannus. Since these three integrins all function as fibronectin receptors, it is possible that the fibronectin-rich environment of the rheumatoid cartilage surface effectively traps pannus cells expressing high levels of these molecules. The VLA-5 molecule was found in a pericellular and interterritorial matrix distribution in the present study, strongly suggesting that a recepfor-ligand interaction between VLA-5 and cartilage matrix may occur at the early stage of pannus formation. Furthermore, an increase in1 integrin may be necessary for the growth of the pannus and also for the upregulation of the VLA molecules, leading secondarily to increased attachment.     

Akinesia and axial rigidity without limb rigidity: an intermediate form between progressive supranuclear palsy and pure akinesia of Imai and Narabayashi

We report five patients with atypical parkinsonism characterized by freezing phenomenon, akinesia and axial rigidity without limb rigidity or tremor. These patients were selected from 252 patients with parkinsonism who were referred to our clinic from 1986 to 1993. They have common clinical features consisting of freezing phenomena involving all four extremities, especially in the initiation of walking, and marked axial rigidity; otherwise, neither supranuclear ophthalmoparesis nor nuchal dystonia was noted. Their clinical features did not change over several years except in one patient who later developed typical manifestations of progressive supranuclear palsy (PSP). Levodopa was of no effect on their symptoms. After excluding other possibilities, it is our conclusion that they represent an atypical form of PSP lying between the pure akinesia of Imai and Narabayashi and the typical form of PSP.