Antitoxin's effect on tetanus toxin induced sphincter pupillae paralysis in the rabbit

Summary The effectiveness of antitoxin in preventing tetanus toxin's blockage of acetylcholine release from the cholinergic nerves of the rabbit iris was tested by injecting purified tetanus toxin into the anterior chamber, and by injecting horse antitoxin at various time intervals either into the anterior chamber, intravenously, or into the anterior chamber and intramuscularly.The results indicate that antitoxin is ineffective in preventing the development of sphincter pupillae paralysis once it is induced by tetanus toxin, prior to appearance of the symptoms.The efficacy of antitoxin treatment depends on the administration of an optimal therapeutic dose.Neither the rate of development, nor the rate of recovery from the maximal pupillary paralysis are altered by antitoxin treatment.The severity, the duration, and the time of complete recovery from the paralysis are directly related to the time antitoxin treatment begins.     

Periphere Nervenlähmungen nach Shuntoperationen bei chronischen Dialysepatienten

Zusammenfassung 25 chronisch niereninsuffiziente Patienten, bei denen zur Durchführung einer chronisch intermittierenden Hämodialysebehandlung Shuntoperationen zwischen Arteria radialis und Vena cephalica antebrachii bzw. Arteria ulnaris und Vena basilica oder Vorlagerungen der Arteria femoralis bzw. Vorlagerungen der Arteria femoralis und Anastomosierung mit der Vena saphena magna durchgeführt worden waren, wurden in einem Zeitraum von 3 Wochen bis zu 4 1/2 Jahren nach den Operationen gezielt mit der Frage nach operationsbedingten Ausfällen peripherer Nerven nachuntersucht. Nach 28 Unterarmshuntoperationen fanden sich noch 8mal Oberflächensensibilitätsstörungen im Versorgungsgebiet des Ramus superficialis des N. radialis sowie nach 8 Femoralisvorlagerungen 6mal Ausfälle des N. saphenus. Unter Berücksichtigung der Operationstechniken und der anatomischen Gegebenheiten, die individuell variieren können, werden die Ursachen für Ausmaß und Schweregrad der neurologischen Ausfälle diskutiert.

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Peripheral nerve damage following surgical creation of shunts in patients on chronic dialysis

Summary 25 patients on chronic hemodialysis, who had either subcutaneous fistulas between the radial artery and the cephalic vein or the ulnar artery and the basilic vein or subcutaneous fixation of the femoral artery and anastomoses between the great saphenous vein and the subcuticularized femoral artery, were evaluated neurologically for peripheral nerve damage 3 months to 4 1/2 years after surgery. Of 28 patients with subcutaneous av. fistulas in the forearm, 8 had impairment of the superficial sensitivity in the area innervated by the ramus superficialis of the n. radialis. In 6 of 8 patients with subcutaneous fixation of the femoral artery this was found in the cutaneous area of the saphenous nerve. The causes of distribution and severity of the neurological disorders are discussed, with reference to the surgical procedures and the individual anatomical findings.

     

Interaction of heart and arterial system

We have studied the interrelation of left ventricle and arterial system in the anesthetized open-thorax cat. The ventricle was characterized by its pump function graph, relating mean ventricular pressure ( ) and mean aortic flow ( ). The pump function graph was determined by means of an artificial periphery and on a beat-to-beat basis. The periphery was characterized by relating mean aortic pressure ( ) and mean flow. Mean aortic and mean left ventricular pressure could be related over a wide range of values by a proportionality factor . In a series of five separate experiments a value of a=1.72±0.14 (mean±SD) was found. This simplified relation allows direct comparison of apparent source resistance (i.e., slope of pump function graph), (R_s), and peripheral resistance (R_p). It was also found experimentally that total external power ( ) could be calculated from mean aortic pressure and mean flow as well as from mean left ventricular pressure and mean flow (thus from the pump function graph) by . The value of c=1.16±0.12 (mean±SD, n=4). Maximum external power was predicted for . In six different cats R_p/R_s ratio in the working point (i.e., mean left ventricular pressure and mean flow when the normal periphery loaded the heart) was found to be R_p/R_s=2.63±0.92. This value could not be shown to differ from that in the point where maximal external power was found, i.e., R_p/R_s=1.81±0.08 (n=6).     

Lymphocyte induced macrophage cytotoxicity: characterization of the macrophage cytotoxicity-inducing lymphocyte

The phenotype of lymphocytes, obtained from mice immunized with allogeneic tumor cells, with the capacity to induce macrophage cytotoxicity was determined. Macrophage cytotoxicity was induced, either by incubating the macrophages with Macrophage Arming Factor (MAF) containing supernatants of cultures of sensitized lymphocytes and tumor cells (arming) or by incubating the macrophages directly with sensitized lymphocytes and tumor cells (activation). The MAF producing or activating capacity of the lymphocytes was not only "triggered" by the sensitizing tumor cells but also by normal cells and other tumor cells bearing the H-2 determinants of the sensitizing tumor cell. The capacity to render macrophages cytotoxic was not reduced after treatment of the lymphocytes with mitomycin-C or treatment with anti-murine Ig and complement. This capacity of the lymphocytes was abrogated after treatment with anti-T-cell serum or anti-Thy 1.2 serum and complement. After treatment with anti-Lyt 1 or anti-Lyt 2 serum and complement, the activating capacity was significantly reduced and the MAF producing capacity of the lymphocytes abrogated. Mixing the Lyt 1 depleted and Lyt 2 depleted lymphocytes or addition of normal lymphocytes to the Lyt 1 depleted or Lyt 2 depleted populations did not restore the MAF producing and activating capacities. This indicated that the lymphocytes inducing macrophage cytotoxicity in this allogeneic system are Lyt-1+2+ T-lymphocytes, which do not need to divide prior to perform their action.     

An association between human papillomavirus 16/18 deoxyribonucleic acid in peripheral blood with p16 protein expression in neoplastic cervical lesions

BACKGROUND: Human papillomavirus (HPV) infection plays a crucial role in cervical carcinogenesis. Apart from the detection of p16 protein in cervical tissues, the feasibility of the presence of HPV DNA in peripheral blood being an auxiliary marker of cervical lesions was examined. METHODS: Peripheral blood samples and cervical tissues, from 36 cervical tissues from high-grade squamous intraepithelial lesions (HSIL) and 31 early invasive cervical cancers (EICC), were analyzed for HPV 16/18 DNA and HPV 16/18 E7 mRNA expression, as well as the in situ expressions of p16 and pRb to investigate the in-between associations. RESULTS: The prevalence of HPV 16/18 DNA in patients with EICC was relatively higher than those of HSIL, in both of cervical tissues and peripheral blood. The presence of HPV 16/18 DNA in peripheral blood was positively correlated with that in cervical tissue, as well as with p16 overexpression in cervical tissues together with a significant correlation between E7 mRNA and pRb and p16 protein expressions. DISCUSSION: A positive correlation between the presence of HPV 16 or 18 DNA in peripheral blood and p16 overexpression in tissues of patients with cervical lesions was confirmed. Together with p16 immunostaining in cervical tissues, the detection of high-risk HPV 16 or 18 DNA in peripheral blood may act as an auxiliary biomarker for HPV-associated neoplastic cervical lesions.     

Cytomegalovirus interstitial pneumonitis following allogeneic peripheral blood stem cell transplantation

Objective： To explore the risk factors and prophylaxis and treatment of cytomegalovirus interstitial pneumonitis （CMV-IP） after allogeneic peripheral blood stem cell transplantation （allo-PBSCT）. Methods： 43 patients who received allo-PBSCT were allocated to either a Gancyclovir（GCV）-prophylaxis group （n=19） or a non-GCV prophylaxis group （n=24）. A comparison was made of the incidence of CMV-IP in patients given or not given prophylactic gancyclovir. Results： 9 patients in non-GCV prophylaxis group developed late CMV-IP （P〈0.05）. Graft-versus-host-disease （GVHD） may be associated with a high risk of CMV-IP. 5 cases of CMV-IP were successfully treated with GCV, but 3 cases died of CMV-IP. The most common adverse event of GCV was neutropenia, but was reversible. Conclusion： CMV infection was a major cause of interstitial pneumonitis after allo-PBSCT, which correlated strongly with the severity of GVHD. Gancyclovir was shown to be effective in both prophylaxis and treatment of CMV-IP.     

Conservative parotidectomy for the treatment of parotid cancers

A conservative parotidectomy is defined as any procedure that is less than a classic superficial parotidectomy, and where less than a full facial nerve is dissected. The aim of this study was to evaluate the oncologic effects of a conservative parotidectomy in a series of patients with malignant tumors of the parotid gland.

The medical records of 43 patients treated at Severance Hospital from 1992 to 2002 who had been diagnosed with parotid cancers confined to the superficial lobe, and had also undergone conservative parotidectomies were reviewed. There were 16 males and 27 females, ranging in age from 8 to 84 years. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers. Twenty-four patients underwent neck dissection simultaneously with the primary lesion. Surgical treatment was followed by radiotherapy in 10 patients. The follow-up period ranged from 8 to 130 months, with a mean duration of time at 57.7 months.

The overall survival rate and the disease-free rate at five years were 88% and 79%, respectively. Univariate analyses showed histologic tumor grade (p = 0.003) and pathologic neck node metastasis (p < 0.001) to be significant variables. Based on multivariate analysis, only the presence of pathologically positive lymph nodes proved to be significant (p = 0.001). Occult metastases rates was 25% (3 of 12 cases) for high-grade tumors and none of the low-grade tumors had microscopic metastases. Recurrences developed in eight cases (19%). Four cases (9%) had a local or locoregional failure. Of these cases, two cases were high-grade tumors (13%, 2 of 16) and the other two cases were low-grade tumors (7%, 2 of 27). The six cases (14%) of which four cases were high-grade (25%) and two cases were low-grade (7%) had positive surgical margin but showed no evidence of local recurrence after additional postoperative radiotherapy. The incidence of postoperative facial nerve paralysis (HB > 1) was 12% (5 outof 43) for a temporary deficit, but there was no permanent paralysis.

Conservative parotidectomy with appropriate postoperative radiotherapy may be an acceptable procedure without potential morbidity, such as postoperative facial palsy, in the treatment of low-grade parotid cancers confined to the superficial lobe if the facial nerve is sufficiently distant from the tumor.     

Recurrent pleomorphic adenoma of the parotid gland

BACKGROUND: Surgery of recurrent pleomorphic adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. METHODS: A series of 33 patients with first recurrence of pleomorphic adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. RESULTS: Multifocal recurrence and carcinoma in pleomorphic adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. CONCLUSIONS: The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.     

Magnetic resonance signal alterations in the acute onset of heterotopic ossification in patients with spinal cord injury

The purpose of our study was to evaluate magnetic resonance (MR) signal characteristics of acutely forming heterotopic ossification (HO) in paralyzed patients. Fourteen patients with spinal cord injury (female n=2, male n=12, mean age 38.3 years) and acute onset of radiographically proven HO had contrast-enhanced 1.5-T MRI within 13.4±18.3 days of clinical onset of symptoms. MR signal alterations of affected muscles, fascia, subcutaneous tissue, skin and adjacent bone were evaluated. A diffuse T2-hyperintense signal of multiple muscle groups was seen in all patients (bilateral in 12) involving quadriceps (n=13, 93%), adductors (n=13, 93%) and iliopsoas (n=12, 86%) with contrast enhancement in n=11 (79%), n=8 (57%) and n=8 (57%) patients. All patients had nonenhancing areas (mean size 2×3.5×5.8 cm) within diffusely enhancing muscles. HO formation occurred around these nonenhancing areas in four patients with computed tomography follow-up. Other MR findings included fascial edema (n=14, 100%), fascial enhancement (n=13, 93%), subcutaneous edema (n=13, 93%), subcutaneous enhancement (n=12, 86%), bone marrow edema (n=5, 36%), and joint effusion (n=12, 86%). MRI reveals mostly bilateral edema and enhancement of muscles, fascia and subcutaneous tissue during acute onset of HO. HO develops in the periphery of well-defined areas of no enhancement.     

Trigeminal neuralgia and facial nerve paralysis

The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves.