Early Prenatal Echocardiographic Diagnosis of Cantrell Pentology with Hypoplastic Right Heart Syndrome

Pentology of Cantrell is a complex syndrome involving the thoracic and abdominal walls, the diaphragm, and the heart. We report a case of that syndrome diagnosed early in pregnancy (16 weeks gestation) by fetal echocardiogram. The fetus had a severe form of hypoplastic right heart syndrome. Early diagnosis of such complex cardiac anatomy together with other severe anatomical malformations is important in planning the surgical intervention. It also shows the intimate relationship between the developmental anatomy and physiology of the fetal heart.     

Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.     

DETECTION OF T LYMPHOCYTES AND T LYMPHOCYTE SUBSETS IN LICHEN PLANUS: IN SITU AND IN PERIPHERAL BLOOD

Background. Abnormal immune mechanisms are thought to be important in the pathogenesis of lichen planus (LP). This is a study to clarify the changes that occur in T lymphocytes and T lymphocyte subsets, both in situ and in peripheral blood. Methods. A group of 100 patients with LP were included in this study. T lymphocytes and T lymphocyte subsets were detected in lesional skin by immunoperoxidase cell surface staining using monoclonal antibodies. Peripheral T lymphocytes and T lymphocyte subsets were also detected by indirect immunofluorescence using monoclonal antibodies. A group of 10 normal healthy subjects were used as controls. Results. The study of the lesional T lymphocytes and T lymphocyte subsets demonstrated that helper T cells was the predominant subset in LP lesions in most of the patients. This predominance was evident irrespective of the duration of the disease and was more evident in late than in early lesions. The percentage of both total T lymphocytes and helper T cells in peripheral blood was decreased significantly in patients compared with controls. A significant decrease in helper T cells and the helper/cytotoxic T cell ratio was detected in patients with a longer duration of the disease. Conclusion. Activation of helper T lymphocytes that were found to be the predominant subsets in LP lesions may be responsible for epidermotropic cellular infiltrates leading to damage and destruction of epidermal cells.     

Characterization of the receptor binding profile of (3H)-dermorphin in the rat brain

Amphibian skin synthesizes a variety of biologically active peptides. Of these, dermorphin (Tyr-d -Ala-Phe-Gly-Tyr-Pro-Ser-NH₂) is an extraordinarily potent opioid peptide up to 1000 times more active than morphine in inducing analgesia after intracerebroventricular administration. Dermorphin has little in common with the sequence of all hitherto known mammalian opioid peptides and is unique in having a d -amino acid residue in position 2. Specific binding properties of tritium labeled dermorphin were characterized in the rat brain. Scatchard or Hill analysis of equilibrium measurements performed over a large range of concentrations revealed a single population of dermorphin binding sites with a Kd value of 0.46 nM. Dermorphin and the selective μ-receptor ligand (d -Ala², MePhe⁴, Gly⁵-ol)- enkephalin (DAGO) had similar high potencies in competing with (³H)-dermorphin binding, whereas the inverse holds for the prototypical delta receptor ligand (d -Pen²,d -Pen⁵)-enkephalin (DPDPE), which exhibited a potency three orders of magnitude lower. Dermorphin was tested for its relative affinity to μ and delta binding sites by determining its potency in displacing (³H)-DAGO and (³H)-DPDPE from rat brain membrane preparations. Based on these comparisons, dermorphin exhibited a selectivity ratio Ki(DPDPE)/Ki(DA-GO) = 100, a value almost identical to that of DAGO, this ligand being considered as the protypical μ-receptor probe. The high affinity and selectivity of (³H)-dermorphin together with its very low nonspecific binding make this peptide a useful tool for dissecting the role(s) of the μ-receptor(s).     

Tooth contact patterns and contractile activity of the elevator jaw muscles during mastication of two different types of food

The pattern of molar and canine contacts and the contractile activity of the masseter and anterior temporal muscle were studied, through integrated electromyography, during right-sided mastication of banana and apple in ten healthy male subjects. Tooth contacts occurred on both the chewing and the non-chewing side. This study does not support the clinical concept that non-chewing side contacts are necessarily detrimental to the jaw muscles and the temporomandibular joints. The activity of the elevator jaw muscles and the tooth contact patterns suggest that the mandible tilted around a sagittal axis, and rotated around a vertical axis, during the phase of elevation of a masticatory cycle.     

Mechanism of Chloroform Formation by Chlorine and Its Inhibition by Chlorine Dioxide

Mechanism of Chloroform Formation by Chlorine and Its Inhibitionby Chlorine Dioxide. SUH, D. H., and ABDEL-RAHMAN, M. S. (1985).Fundam. Appl. Toxicol. 5, 305–313. Chlorination of drinkingwaters leads to the formation of trihalomethanes arising fromthe reaction of chlorine and organic substances. Therefore,chlorine dioxide (ClO₂) which does not produce trihalomethanesis being considered as an alternative disinfectant. It has beenreported that rat blood chloroform levels were significantlydecreased after treatment with ClO₂. Studies were conductedto investigate the mechanisms of chloroform formation by chlorine(HOCl) and its inhibition by ClO₂ (5 mg/liter) in the presenceof HOCl (5, 10, 20 mg/liter) using sodium citrate (1 mM) asan organic substance. When citrate was reacted with HOCl, ß-ketoglutaricacid, monochloroacetone, dichloroacetone, and trichloroacetonewere produced as reaction intermediates and chloroform as afinal product. There was a linear relationship between the concentrationsof HOCl and the formation of chloroform. When ClO₂ was substitutedfor HOCl, neither chloroform was formed nor citrate concentrationwas changed. Further, chloroform formation was inhibited byClO₂ in the presence of HOCl and citrate and the degree of inhibitiondepends on the ratio of ClO₂7sol;HOCl. Gas chromatograph/massspectrometer analysis indicates that this inhibition is relatedto the reaction of ClO₂ with ß-ketoglutaric acid toform malonic acid. Chlorine dioxide also oxidizes other intermediatessuch as monochloroacetone and dichloroacetone to acetic acid.These studies indicate that ClO₂ inhibits chloroform formationfrom citrate and HOCl by the oxidation of the intermediateswhich were involved in the reaction of chloroform formation.     

THE ROLE OF URINARY POTASSIUM IN THE PATHOGENESIS AND DIAGNOSIS OF INTERSTITIAL CYSTITIS

Purpose

We determined whether intravesical potassium absorption in normal bladders correlates with increased sensory urgency, and corroborated the hypothesis that mucus is important in the regulation of epithelial permeability. We compared sensory nerve provocative ability of sodium versus potassium, and determined whether intravesical potassium sensitivity discriminates patients with interstitial cystitis from normal subjects and those with other sensory disorders of the bladder.

Materials and Methods

A total of 231 patients with interstitial cystitis and 41 normal subjects underwent intravesical challenge with 40 ml. water and then 40 ml. of 40 mEq./100 ml. potassium chloride. Subjective responses of urgency or pain stimulation were recorded on a scale of 0 to 5. In 19 normal subjects potassium absorption was measured at baseline, after injury of the bladder mucus with protamine, after heparin treatment to reverse mucus damage and then for a final time. These subjects simultaneously recorded the symptoms of sensory urgency and pain at baseline, after protamine and after heparin. Another group of normal volunteers underwent a challenge with sodium versus potassium to determine which cation was more provocative. Patients with bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), detrusor instability, and acute and chronic urinary tract infection but no current infection were also evaluated for potassium sensitivity.

Results

Neither normal subjects nor patients with interstitial cystitis reacted to water administered intravesically. There was marked sensitivity to intravesical potassium in 75% of patients with interstitial cystitis versus 4% of controls (p <0.01). Only 1 patient with BPH responded to potassium and none of the 5 with chronic urinary tract infection responded. All 4 patients (100%) with a current acute urinary tract infection reacted positively to the potassium challenge. Of 16 patients with detrusor instability 25% responded. Normal subjects had minimal sensitivity to potassium before (11%) and markedly increased sensitivity after (79%) protamine treatment, and these symptoms were reversed by heparin in 42%. Potassium absorption directly correlated with symptoms (0.4, 3.0 and 1.3 mEq. before and after protamine, and after heparin reversal, respectively). In regard to sodium versus potassium provocation, potassium was far more provocative for causing urgency after protamine (10 versus 90%). Neither group underwent provocation before protamine.

Conclusions

Chronic diffusion of urinary potassium into the bladder interstitium may induce sensory symptoms, damage tissue and be a major toxic factor in the pathogenesis of interstitial cystitis. Intravesical potassium sensitivity is a reliable method for detecting abnormal epithelial permeability. It discriminates between patients with interstitial cystitis and normal subjects with intact epithelial function, and it is a useful diagnostic test for interstitial cystitis. Potassium sensitivity correlates with increased potassium absorption in normal subjects, and potassium is far more provocative than sodium. Potassium sensitivity is also present in acute urinary tract infection and occasionally detrusor instability but not in BPH or chronic urinary tract infections.     

Absence of Delayed Neurotoxicity and Increased Plasma Butyrylcholinesterase Activity in Triallate-Treated Hens

Absence of Delayed Neurotoxicity and Increased Plasma ButyrylcholinesteraseActivity in Triallate-Treated Hens. LAPADULA, D. M, JOHANNSEN,F., AND ABOU-DONIA, M. B. (1990). Fundam. Appl. Toxicol. 14,191–198. Triallate (S-2,3,3-trichloroalryl diisopropylthiocarba-mate)was tested for the potential to produce delayed neurotoxicity.Hens were given single oral doses ranging from 312.5 to 2500mg/kg of triallate, 750 mg/kg tri-o-cresyl phosphate (TOCP),or empty gelatin capsules on Days 1 and 21 and were killed onDay 42. In a second experiment, animals were administered dailyoral doses of 25-300 mg/kg triallate or 10 mg/kg TOCP for 90days. In a third experiment, animals were given single oraldoses of 2500 mg/kg triallate, 750 mg/kg TOCP, or empty gelatincapsules and killed after 24 hr. Delayed neurotoxicity was observedonly in TOCP-treated animals. Animals given daily doses of 300mg/kg triallate became moribund after 30 days; however, histologicalexamination revealed no lesions characteristic of organophosphorus-induceddelayed neurotoxicity. Neurotoxic esterase was not significantlyaltered in triallate-treated animals while it was 95% inhibitedin TOCP-treated animals. Plasma butyrylcholinesterase increasedsignificantly 24 hr after treatment with triallate in a dose-dependentmanner. In summary, triallate, a thiocarbamate, did not produceneurotoxicity which has been previously reported for some dithiocarbamates.