Tetraparesis resembling acute transverse myelitis in a captive chimpanzee (Pan troglodytes): long-term care and recovery.

BACKGROUND: A 24-year-old, male chimpanzee (Pan troglodytes) developed acute tetraparesis. Magnetic resonance imaging showed a diffuse T2-weighted hyperintensive lesion, indicating inflammation at the C1-2 level. All infective, autoimmune, and vascular investigations were unremarkable. RESULTS AND CONCLUSIONS: The chimpanzee's condition most resembled acute transverse myelitis (ATM) in humans. The chimpanzee was in severe incapacitated neurological condition with bedridden status and required 24-hour attention for 2 months followed by special care for over a year. Initially, corticosteroid therapy was performed, and his neurological symptoms improved to some extent; however, the general condition of the chimpanzee deteriorated in the first 6 months after onset. Pressure ulcers had developed at various areas on the animal's body, as the bedridden status was protracted. Supportive therapy was continued, and the general condition, appetite, mobility, and pressure ulcers have slowly but synergistically recovered over the course of 2 years.

The grand biopsy for the "cold" thyroid nodule.

A lobe and isthmusectomy is our standard surgical management for the cold nodule of the thyroid. Experience indicates that the great majority of cold nodules prove benign. It is manifest that the attendant morbidity for this surgery be extremely low. Our experience reviewing thyroid surgery for only benign disease indicates that complications are indeed uncommon. Our surgical management of the cold nodule includes resection of a lobe and isthmus with exploration and palpation of the opposite side. The nerve is routinely identified and preserved. In the past 18 months, we have experienced two minor postoperative complications in 36 consecutive cases of the lobe and isthmus resection for benign disease.

Microbiology of wound infection after head and neck cancer surgery.

Specimens of pus were obtained from 24 patients who developed postoperative wound infection after head and neck cancer surgery. Aerobic bacteria only were isolated in two instances (8%), anaerobic bacteria only in one (4%), and mixed aerobic and anaerobic bacteria in 21 (88%). A total of 146 isolates were recovered (66 aerobic and 80 anaerobic), an average of six isolates per specimen (2.7 aerobic and 3.3 anaerobic). The most frequently recovered isolates were Peptostreptococcus sp, Staphylococcus aureus, Bacteroides sp, Fusobacterium, and enteric gram-negative rods. Twenty-two isolates recovered from 17 wounds (71%) produced beta-lactamase. These included all five isolates of S aureus and nine of 17 (53%) of the Bacteroides melaninogenicus group. The polymicrobial aerobic/anaerobic nature of postoperative wound infections after head and neck cancer surgery and the presence of beta-lactamase-producing bacteria may have important implications for the management of these infections.

Video nasopharyngoscopy: a comparison of fiberscopic, telescopic, and microscopic documentation.

Video nasopharyngoscopy is a most valuable method of documenting the anatomy and pathophysiology of the nasopharynx. Such a permanent record is useful for diagnosis, patient counselling, resident teaching, and the monitoring of therapy in nasopharyngeal disorders. To evaluate the various techniques for assessment of the nasopharynx, the authors have attempted to systematically compare flexible and rigid endoscopes and mirror examination during video recording. The pros and cons of 1) transnasal fiberscopic, 2) transnasal telescopic, 3) transoral telescopic, and 4) transoral microscopic mirror examination methods for video nasopharyngoscopy are discussed.

Management of the thyroid nodule.

Lobectomy-isthmectomy is part of our standard diagnostic approach for the solitary "cold" nodule of the thyroid. Although the majority of these prove to be benign, there is no noninvasive technique that can rule out malignant disease. It is necessary that the attendant morbidity for diagnostic surgery be extremely low. In our experience thyroid surgery for benign disease carries minimal risk. Resection of a lobe and isthmus with exploration and palpation of the opposite side constitutes our routine surgical management of the "cold" nodule. The nerve is always identified and preserved. In the past 18 months two minor complications have occurred postoperatively in 36 consecutive cases in which the lobe and isthmus were resected for benign disease.

Strut fracture of Björk-Shiley convexo-concave valve in Japan--risk of small valve size--.

BACKGROUND: The Björk-Shiley convexo-concave (BSCC) prosthetic valve was introduced in 1979. Between 1979 and 1986, approximately 86,000 BSCC valves were implanted. By December 31, 1994, 564 complete strut fractures had been reported to the manufacture. We experienced a case of an outlet strut fracture and investigated the risk of BSCC prosthetic valve fractures in Japan. METHODS AND RESULTS: To investigate the risk factor of a strut fracture in Japan, we investigated published cases of strut fractures. Between 1979 and 1986, 2021 BSCC valves were implanted in Japan. By January 31, 2000, 11 complete strut fractures of 60-degree BSCC valves including our case had occurred. The patients were eight males and three females. The average age at valve replacement was 42.4+/-8.1 years, and nine of eleven (81.8%) were patients < 50 years-old. The average age of the patients when the BSCC valve fractured was 47.7+/-6.4 years, and eight of eleven (72.7%) were patients <= 50 years old. All patients were implanted in the mitral position. The sizes of the BSCC valve were 27 mm (n=5) (45.5%), 29 mm (n=3) (27.2%), and 31 mm (n=3) (27.2%). Four patients died and seven patients survived. CONCLUSIONS: Although only 11 BSCC valve struts fractured and statistical analysis could not be performed, our findings suggest that the high risk group for a strut fracture in Japan is young male patients with a mitral valve, >= 27 mm in size with BSCC models manufactured before March 1982. When following-up patients with BSCC models manufactured before March 1982, the possibility of a strut fracture in all BSCC valve sizes should be kept in mind.

Effects of docarpamine on hemodynamics after open heart surgery in children.

Docarpamine is a dopamine prodrug which has been selected from a large number of dopamine derivatives in order to develop an orally effective dopamine. The pharmacokinetics after oral administration of docarpamine have not yet been studied in children undergoing open heart surgery. This study examined the effects of docarpamine on hemodynamics and evaluated its safety in 11 children undergoing open heart surgery for congenital heart disease. This study began when the patientOs postoperative condition was stabilized by continuous dopamine infusion into the vein at a rate of 5 micro g/kg/min. The patients were administered 40 mg/kg of docarpamine every 8 hours, and hemodynamics were measured every 4 hours for 16 hours after the initial docarpamine administration. Immediately after the initial docarpamine administration, the dose of dopamine was reduced to 3 micro g/kg/min. Infusion of dopamine was stopped 8 hours after the initial docarpamine administration. Systemic systolic and diastolic blood pressure and heart rate showed no significant changes. Mean right atrial pressure decreased 4 hours after docarpamine administration. Mixed venous oxygen saturation and mean velocity of circumferential fiber shortening increased significantly after docarpamine administration. No significant changes were observed in urine volume. All patients could be weaned from dopamine within 8 hours. No changes were observed in ECG, and no arrhythmia-inducing action was noted. Our study indicates that 40 mg/kg oral doses of docarpamine produce plasma dopamine concentration equivalent to those of a 3 to 5 micro g/kg/min dopamine infusion. Our data suggest that docarpamine is a safe and effective drug for children who have undergone open heart surgery.

Treatment of patients with a history of recurrent tonsillitis due to group A beta-hemolytic streptococci. A prospective randomized study comparing penicillin, erythromycin, and clindamycin.

Forty-five patients with a history of recurrent tonsillitis associated with Group A beta-hemolytic streptococcal (GABHS) infection participated in a prospective, randomized study comparing penicillin, erythromycin, or clindamycin therapy. Surface tonsillar cultures were obtained before therapy, 10 days after termination of therapy, and once a month for a period of 12 to 18 months. The specimens were processed for aerobic and anaerobic bacteria. Beta lactamase-producing aerobic and anaerobic bacteria were present in 43 of the 45 (96%) tonsillar cultures. GABHS colonization was eradicated in two of 15 patients treated with penicillin, in six of 15 treated with erythromycin, and in 14 of the 15 treated with clindamycin. In long-term follow-up, 12 of 14 patients treated with penicillin, eight of 14 treated with erythromycin, and one of 15 treated with clindamycin (p less than 0.0001 when compared to penicillin and p = 0.002 when compared to erythromycin) continued to suffer from recurrent tonsillitis.

[Squamous cell type lung cancer that produced granulocyte colony-stimulating factor].

A 73-year-old man was hospitalized because of weight loss and fever. Laboratory data showed marked leukocytosis (21,200/mm3), granulocytosis (89.7%), thrombocytosis (47.8 x 10(4)/mm3), increased CRP (15.8 mg/dl), and increased SCC (5.0 ng/ml). Chest X-ray films demonstrated a mass shadow in the right upper lung field. Chest computed tomographic scans revealed a mass shadow 58 mm in diameter with mediastinal pleural invasion in the right S1. Right upper lobectomy and dissection of regional lymph nodes was performed under a diagnosis of lung cancer (squamous cell carcinoma, T3 N0 M0 stage IIB) with concomitant infection. Serum G-CSF was 234 pg/ml pre-operatively and 68.8 pg/ml postoperatively. The cytoplasm of tumor cells stained positively with anti-recombinant human G-CSF monoclonal antibody. No general bacteria or mycobacteria were detected within the specimen. Postoperatively, the patient's white blood cell count, platelet count, and CRP level soon decreased, and the fever disappeared. We diagnosed the disease as G-CSF-producing squamous cell type lung cancer.

Caged compounds of a 2-deoxyglucose: facile synthesis and their photoreactivity.

An o-nitrobenzyl and an o-nitrophenethyl derivatized 2-deoxyglucose (caged 2-deoxyglucoses) were synthesized from 3,4,6-tri-O-acetyl-D-glucal in only two steps in moderate to good yields as isomeric mixtures, which were irradiated at 350 nm to afford a 2-deoxyglucose. Decomposition of the o-nitrophenethyl derivative upon photolysis proceeded more efficiently than that of the o-nitrobenzyl derivative.