Treatment of xerostomia following radiotherapy: does age matter?

The goals of this work were to investigate the effect of a mucin-containing spray on chronic xerostomia after radiotherapy in the head and neck region and to lean about the influence of age on the results of this treatment. A total of 73 patients with xerostomia following radiotherapy for various malignant disease in the head and neck region tested a bottle of the mucin spray (SALIVA-medac) and filled ina questionnaire about xerostomia. In all, 59 questionnaires were completed and returned. All patients had had some form of prior treatment for xerostomia, which was applied an average (mean) of 16 times per day (median 15 times per day). The mucin spray had to be used less frequently, i.e. 11 times daily (median 5 times per day) (P<0.001, Wilcoxon rank test). Also, the patients reported sleeping significantly better when using the mucin spray [2.9 against 3.9 (P<0.00 I by Wilcoxon rank test) in the German school marking system, where 1=very good and 6=poor]. As far as the frequency of saliva substitute use is concerned, on average older patients had a benefit from using the spray. However, older patients had a clear benefit seen in the individual improvement in the reported quality of sleep when using the mucin spray. The slope of improvement in sleep quality (school-type points) over age (years) was 0.3 points/10 years. In this explorative study the mucin spray was found to be useful against xerostomia in irradiated patients. Older patients seem to derive especial benefit from its use.     

Successful treatment of methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis in a heart transplant recipient

We report on the first case of successfully treated severe methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis after heart transplantation. The therapy consisted of wrapping of the heart with the transposed greater omentum, 4-week local irrigation and prolonged aggressive antibiotic therapy with vancomycin and linezolid.     

Vibratory stimulation increases and decreases the regional cerebral blood flow and oxidative metabolism: a positron emission tomography (PET) study

The aim of this study was to examine the hypothesis, if the activation of some cerebral structures due to physiological stimulation is accompanied by deactivations of other structures elsewhere in the brain. A vibratory stimulus was applied to the right hand palm of healthy volunteers and the regional cerebral blood flow (rCBF) and regional cerebral oxygen metabolism (rCMRO2) were measured with positron emission tomography (PET). Regional analysis and voxel-by-voxel plots indicated that the stimulation induced increases and decreases of the rCBF were coupled to increases and decreases of the rCMRO2. The increases were localized in the left primary somatosensory area (SI), the left secondary somatosensory area (SII), the left retroinsular field (RI), the left anterior parietal cortex, the left primary motor area (MI), and the left supplementary motor area (SMA). The decreases occurred bilaterally in the superior parietal cortex, in paralimbic association areas, and the left globus pallidus. The increases and decreases of the rCBF and rCMRO2 were balanced in such a way that the mean global CBF and CMRO2 did not change compared with rest. We conclude that the decreases of the cerebral oxidative metabolism indicated regional depressions of synaptic activity.     

Mediators of antigen-induced gastrin release: role of antigen-antibody complexes and the complement system

That orally administered antigen was shown to induce gastrin release in immunized animals was a new aspect of gastrointestinal physiology. The mediators responsible for this immunological effect are still unclear. In an attempt to discover more about the mechanisms regarding antigen-induced gastrin release, we developed an in vitro system where fragments of rat antral mucosa were challenged. This makes it possible to determine the role of antigen-antibody complexes and the complement system in the mechanism of antigen-induced gastrin release. Wistar rats were immunized in vivo with NIP-OVA and mucosal fragments were challenged in vitro with NIP-HGG. Gastrin was determined after a preincubation and a challenged incubation period without supernatants. After antigenic challenge, supernatants were used for in vitro challenge in order to rule out the presence of a soluble mediator and activation of complement. In a second group of experiments Wistar rats were used to study in vitro the release of specific antibodies after antigenic challenge. With this experimental design we were able to show increased gastrin secretion after antigenic challenge in vitro in the presence of intact tissue. It is shown that the increased gastrin release is most probably mediated by activation of the complement system in the presence of antigen-antibody complexes. These are built up by specific anti-NIP antibodies and NIP-HGG used for the challenge. The complement system might be the final pathway of the observed in-creased gastrin release.     

Neurosonographic features of Aicardi's syndrome

Aicardi's syndrome occurs in females and is associated with profound mental retardation, agenesis of the corpus callosum, chorioretinal lacunae, and infantile spasms. We report a distinctive combination of abnormalities which was observed on real-time cranial ultrasound scans of two infants with Aicardi's syndrome. These abnormalities include bilateral prominent cysts in the choroid plexus in conjunction with agenesis of the corpus callosum. Recognition of these radiologic findings may suggest the diagnosis of Aicardi's syndrome in early infancy even prior to the onset of seizures or visualization of chorioretinal lacunae.     

Ultrasound biometry of the fetal heart]

We report on biometric measurements of the fetal heart with the TM-technique; these measurements were carried out between the 20th and 40th gestational week. The right and left endsystolic atrial and ventricular diameters were, measured, as well as the diameters of the large vessels, i.e. aorta and pulmonary artery; finally, the septal thickness was determined. Our measurements show a linear progression of the diameters in question, the right-left ratio of the atria and ventricles was close to one, so was the ratio between aorta and pulmonary artery. Our results are compared, as far as possible, to the literature.     

Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s)

In the absence of distant disease, the pathologic diagnosis of malignancy in pheochromocytoma or paraganglioma is impossible. In an effort to establish the true incidence of recurrence in this disease, we have analyzed long-term follow-up (average, 15.8 years) of 98 patients who underwent complete resection of localized, noninvasive, histologically-benign pheochromocytomas and paragangliomas at our institution between 1960 and 1976. Eighty-eight patients had nonfamilial, sporadic pheochromoctyoma/ paraganglioma. Nine had multiple endocrine neoplasia (MEN) type 2 (2A: 7, 2B: 2), and 1 had familial pheochromocytoma. Seventy-nine patients had single pheochromocytomas; 10 had single extraadrenal tumors (paragangliomas); and 9 had multicentric or bilateral adrenal tumors. Six patients (6.5%) developed recurrent pheochromocytoma after documentation of normal postoperative urinary catecholamine levels. One of these patients had MEN 2A. The recurrences developed at intervals from 5 to 13 years following initial resection. These were distant in 3 patients, local in 2, and both local and distant in a single patient. None of the recurrences occurred in the 13 patients who, on pathologic rereview, had either local or vascular invasion. No paraganglioma recurred. Life-long follow-up of all patients who have had pheochromocytomas or paragangliomas resected is mandatory.

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Resumen En ausencia de metástasis distantes, el diagnóstico histopatológico de malignidad en un feocromocitoma o en un paraganglioma es imposible. Con el objeto de establecer la verdadera incidencia de recurrencia de esta enfermedad, hemos analizado el seguimiento a largo plazo (promedio, 15.8 años) de 98 pacientes sometidos a resección completa de feocromocitomas y paragangliomas localizados, no invasivos e histológicamente benignos en nuestra institución entre los años 1960 y 1976.Ochenta y ocho pacientes tenían feocromocitoma/paraganglioma no familiar, de tipo esporádico. Nueve tenían el síndrome de neoplasia endocrina múltiple (NEM) tipo 2 (2A: 7, 2B: 2) y uno feocromocitoma familiar. Setenta y nueve pacientes tenían feocromocitoma único; 10 tenían tumores extra adrenales (paragangliomas) y 9 tumores adrenales multicéntricos o bilaterales.Seis pacientes (6.5%) desarrollaron feocromocitoma recurrente después de haberse documentado niveles postoperatorios normales de catecolaminas; uno de ellos tenía el síndrome NEM 2A. Las recurrencias se desarrollaron a intervalos de 5 a 13 años después de la resección inicial, distantes en 3 pacientes, locales en 2, y locales y distantes en sólo un paciente. Ninguna de las recurrencias ocurrió en los 13 pacientes que en la revisión histopatológica presentaban invasión local o vascular. Ningún paraganglioma exhibió recurrencia.El seguimiento de por vida en pacientes que hayan tenido feocromocitomas o paragangliomas es mandatorio.

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Résumé En l'absence de lésions pathologiques à distance, le diagnostic de malignité en matière de phéochromocytome ou de paraganglion est impossible. Pour déterminer la fréquence vraie de récidive nous avons analysé le suivi à long terme (moyenne, 15.8 ans) de 98 patients ayant eu une résection complète de phéochromocytome et de paraganglions bénins localisés et non invasifs opérés à la Clinique Mayo entre 1960 et 1976.Quatre-vingt-huit patients avaient un phéochromocytome ou paraganglion sporadique, non familial. Neuf patients avaient une MEN de type 2 (2A: 7, 2B: 2), et un patient avait un phéochromocytome familial. Soixante-neuf patients avaient un phéochromocytome simple; 10 avaient une tumeur extrasurrénalienne simple (paraganglion); et 9 avaient des tumeurs surrénales bilatérales ou multicentriques.Six patients (6.5%) ont eu une récidive de leur phéochromocytome après normalisation des catécholamines urinaires en postopératoire. Un de ces patients avait une MEN 2A. La récidive s'est manifestée entre 5 et 13 ans après la résection. Elle était à distance chez 3 patients, locale chez 2 patients, et à la fois locale et à distance chez un. Il n'y avait aucune récidive chez les 13 patients qui avaient soit une invasion locale ou vasculaire lorsque les coupes histologiques ont été revues. Il n'y avait aucune récidive de paraganglion.La surveillance permanente de tout patient ayant un phéochromocytome ou un paraganglion semble s'imposer.

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Presented at the International Association of Endocrine Surgeons in Toronto, Ontario, Canada, September, 1989     

ANCA-assoziierte Vaskulitiden

Ohne Zusammenfassung     

Synaptic terminals in the ventroposterolateral nucleus of the thalamus from neurons in the dorsal column and lateral cervical nuclei: an electron microscopic study in the cat

Summary The afferent fibres to the ventroposterolateral nucleus (VPL) of the contralateral thalamus from neurons in the dorsal column nuclei (DCN) and the lateral cervical nucleus (LCN) were labelled by anterograde transport of wheat germ agglutinin-horseradish peroxidase conjugate and subsequent histochemical processing with tetramethyl benzidine. In accordance with the results of previous light microscopical studies using the degeneration method or autoradiographic tracing technique, the distribution of the afferents from the DCN and LCN in the VPL differed considerably. Thus the DCN terminals, which were calculated to constitute about 7–8% of the total number of boutons in the VPL, were found throughout the entire VPL, whereas the LCN terminals were mainly located in its dorsal and dorsolateral parts, where they made up about 1% of the total number of boutons. However, the morphology and synaptic organization of the terminals from the DCN and LCN were virtually identical. Thus the synaptic terminals of the two afferent pathways seemed to be represented by large boutons of a similar type, which had large, slightly oval and loosely packed synaptic vesicles and contained numerous mitochondria. Both DCN and LCN terminals synapsed preferentially on medium-sized to large dendrites, but were also presynaptic to other vesicle-containing profiles, probably of internuncial origin, which in turn were in synaptic contact with the same dendrites as the labelled ones.It is suggested that the differences in physiological properties between the somatosensory information that is transmitted to the somatosensory cortex via the dorsal column-medial lemniscus pathway and the spino-cervico-thalamic tract do not seem to have a counterpart in differences in the synaptic organization of their relay in the VPL.