Can fetal pulmonary artery Doppler indices predict neonatal respiratory distress syndrome?

OBJECTIVE: To study whether fetal main pulmonary artery (MPA) Doppler indices can predict the development of neonatal respiratory distress syndrome (RDS). STUDY DESIGN: This prospective cross-sectional study included pregnant women between 34 and 38+6 weeks gestation. The diagnostic accuracy of MPA Doppler measurements (systolic/diastolic (S/D) ratio, peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI) and acceleration time/ejection time (At/Et)) for diagnosis of neonatal RDS was tested. RESULT: Of the 698 eligible fetuses, 55 (7.87%) developed neonatal RDS. PSV, PI, RI and At/Et were positively correlated with gestational age. The strongest correlation was found with At/Et (r=0.602, P<0.001). PI and RI were significantly higher, whereas At/Et and PSV were significantly lower in fetuses that developed RDS. A cutoff value of 0.305 for At/Et predicted the development of RDS (sensitivity: 76.4%; specificity: 91.6%). CONCLUSION: Development of neonatal RDS can be predicted using the MPA At/Et with high sensitivity and specificity.

Dystocia in Friesian cows and its effects on postpartum reproductive performance and milk production.

A total of 1,243 records for 585 dairy Friesian cows from 1997-2004 were used to study the factors affecting dystocia and its effects on reproductive performance and milk production. The overall incidence of dystocia was 6.9%. The percentage of dystocia decreased with increasing live body weight, age, and parity of cows (P < 0.05); however, it increased with increasing birth weight of calves (P < 0.05). The highest percentage of dystocia was detected in winter season, but the least percentage was in summer season (P < 0.05). The percentage of incidence of dystocia was significantly (P < 0.05) higher with winter feeding compared to summer ration (8.2% vs. 5.1%). The percentage of incidence of dystocia was significantly (P < 0.05) higher with twinning than single calving (15.5% vs. 6.5%), while not significantly affected by the sex of born calves. Incidence of dystocia had adverse effects on reproductive performance and milk yield. The service interval, service period, days open, and calving interval were significantly (P < 0.05) longer in cows afflicted with dystocia compared to normal cows. The conception rate was lower (P < 0.05), but the number of service per conception was higher (P < 0.05) in cows afflicted with dystocia compared to normal cows (60.5% vs. 73.0% and 3.4 vs. 2.7, respectively). Average daily milk yield was lower (P < 0.05) by 1 kg for cows with incidence of dystocia compared to normal cows.

Laryngotracheal augmentation using titanium mesh.

BACKGROUND: The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment. STUDY DESIGN: Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken. RESULTS: Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted). CONCLUSION: Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.

Segmental tracheal replacement in mongrel dogs.

OBJECTIVE: To evaluate the use of alcohol- and detergent-preserved tracheal allografts in dogs. MATERIAL AND METHODS: Experimental segmental tracheal replacement was performed in 18 adult mongrel dogs. Three different techniques were tried in three groups of dogs. In the first group, a four-ring cervical tracheal segment was dissected out and implanted in the trachea of another dog. In the second group, the procedure was performed using a tracheal allograft that had been preserved in 70% ethyl alcohol for 20 days. In the third group, tracheal grafts were previously impregnated in 10% povidone iodine for 72 h before being implanted. Allografts were harvested 60 days after transplantation and assessed both histologically and in terms of the percentage patency. Dogs that died within 60 days were also included in the analysis. RESULTS: The best results were found in the group in which the tracheal allograft had been preserved in ethyl alcohol and this was explained by the reduced antigenicity of the graft in this group. CONCLUSIONS: The use of alcohol-preserved allografts is a practical method of tracheal transplantation, and the alcohol-preservation technique markedly reduces the immunogenicity of the grafts.

Frontal sinus outflow tract "anatomic study".

Meticulous anatomical knowledge is mandatory to approach endoscopically the frontal sinus area safely and manage its diseases successfully. The aim of this study was to identify the various drainage patterns of the frontal sinus. To illustrate these patterns we performed anatomical dissections of the outflow tract of the frontal sinus in 30 cadaver half heads. We found that the frontal sinus drained anterior to the uncinate process in 23.3% of specimens and posterior to it in 63.3%, while it drained medial to the semilunar hiatus in 6.6%. Our study, however, represents an exclusive assortment of linear and angular measurements of important landmarks around the frontal recess region. Although these measurements were made in embalmed tissue, we believe they will provide reference points in endoscopic sinus surgery.

Experimental intravenous inoculation of Klebsiella rhinoscleromatis bacilli in albino rats: a histopathological and bacteriological study.

Scleroma, chronic specific granuloma of the nose and upper respiratory tract, is endemic in Egypt and many other countries. The exact pathogenesis of the disease as regards the aetiological role of Klebsiella rhinoscleromatis is contradictory. This work investigated the effect of experimental intravenous injection of K. rhinoscleromatis in albino rats to demonstrate that the micro-organism can fulfil Koch's postulates. Micro-organisms were isolated from biopsy specimens taken from nasal lesions of 10 patients in the granulomatous stage of scleroma. Specimens were subjected to bacteriological and histopathological examinations to confirm the diagnosis. A 100 microl volume of freshly prepared bacterial inoculum containing 10(8) cfu/ml was injected weekly in the tail vein of each of 30 albino rats for 5 consecutive weeks. Biopsy specimens were taken from sacrificed animals and subjected to bacteriological and histopathological examinations. Positive histopathological diagnosis of scleroma was reported in the nose of 66.7% of rats, the larynx of 46.7%, the lungs of 26.7% and liver of 20% of rats. Bacteriological techniques were successful in revealing K. rhinoscleromatis from the nose of 36.7% of rats, the larynx of 30% and the lungs of 20% of rats. Various techniques were carried out to demonstrate the micro-organisms in tissue sections. Two histochemical stains for bacteria were employed: silver and Periodic Acid Schiff (PAS) stains. Immunoperoxidase technique using Klebsiella capsular type 3 antiserum was applied. It gave positive results in 66.7% of the 6 stained liver sections in spite of negative bacteriological cultures. The histiocytic nature of the Mikulicz cells was confirmed using alpha-1 antitrypsin, an immunohistochemical marker of histiocytes, and by studying the ultrastructural features of Mikulicz cells using the transmission electron microscope.

Nasal endoscopy and CT study of Pharaonic and Roman mummies.

In ancient Egypt mummifications were first carried out around 3000 BC. The visceral organs (lungs, stomach, liver and bowel) were removed from the body, cleansed, desiccated and placed in four canopic jars. The brain was removed from the body but was not preserved. Exactly how removal of the brain was accomplished is not clear. This study investigated the route of brain removal during mummification. Nasal endoscopy was carried out on 20 Pharaonic and Roman mummies. CT examination was performed on 2 mummy heads. In all mummies a communication between the cranial and nasal cavities was found passing through the posterior ethmoids and cribriform plates. The cranial cavity was empty. Our results demonstrate that brain removal during mummification was performed endonasally by trained personnel with a good knowledge of anatomy, using special instruments capable of creating a clean-cut endonasal craniotomy.

The vomeronasal (Jacobson's) organ in adult humans: frequency of occurrence and enzymatic study.

The vomeronasal system in adult humans has commonly been regarded as absent or vestigial, but recently it was found to be more common than previously reported. In this study, a search for the frequency of occurrence of the vomeronasal organ (VNO) was performed by examining the nasal septae of 200 adult patients. The frequency of occurrence was found to vary according to the method of examination. By anterior rhinoscopy, large pits and even deep grooves lined by glistening mucosa were visible in 16% of the people examined. Using nasal endoscopes this ratio increased to 76%. After receiving informed, written consent, from 13 patients undergoing endonasal surgery under general anaesthesia, one VNO was dissected out. Specimens were examined histologically and histochemically for succinic dehydrogenase and alkaline phosphatase enzymes. One specimen was processed for transmission electron microscopy. Two morphologically distinct cell types were differentiated. One cell type was previously suggested to have some of the features associated with nerve cells and could have a sensory function. A possible function for the VNO is postulated.

The effect of ammonia on olfactory epithelium and vomeronasal organ neuroepithelium of rabbits. A histological and histochemical study.

In recent studies, the vomeronasal organ (VNO), although vestigial and with unknown function in humans, was reported to be present in almost every person examined. In rabbits, it is a well-developed organ, one lying on each side of the nasal septum. Histologically it was found to contain neuroepithelium which is considered an accessory olfactory system taking charge of an olfactory discrimination different from that of olfactory epithelium. Experimental removal of the VNO in male animals reduces reproductive performance and aggression. In this study, the effects of prolonged exposure to ammonia vapor on the histological pattern and enzymatic activity of the olfactory epithelium and the VNO neuroepithelium of 30 adult male rabbits were investigated and compared with a control group. In the exposed animals, the supporting cells in both types of epithelia showed hyperplasia which was more marked in the olfactory epithelium. Manifestations of cytotoxicity were found more in the bipolar cells of the olfactory epithelium than in the VNO neuroepithelium. The enzymatic activity in the exposed group supported the histological results. The presence of the VNO neuroepithelium of the rabbit in a narrow duct with a minute nasal orifice could have some protective effects on the cells.

The effect of ammonia on the respiratory nasal mucosa of mice. A histological and histochemical study.

The effects of prolonged exposure to ammonia vapour on the histological pattern and enzymatic activity of the respiratory nasal mucosa of 75 adult male mice were investigated and compared with a control group. In the exposed animals, the nasal epithelial cells showed patches of squamous metaplasia, dysplasia, and even malignant changes in the nose of 2 animals. As regards the histochemical changes, the apical border of epithelial cells showed increased succinic dehydrogenase activity denoting increased energy production. The acid phosphatase activity was also higher, and this seemed to be a constant feature in metaplastic and neoplastic transformation. The alkaline phosphatase activity was detected only in the basal parts of epithelial and goblet cells, which was attributed to an increased activity of basal cells to form a thicker basement membrane. The periodic acid Schiff's reaction was weak in the cilia due to their partial degeneration. Prolonged exposure to ammonia interfered with the normal physiological mucociliary action resulting in accumulation of particulate matter initiating or promoting a neoplastic process.

Scleroma of the upper respiratory passages: a CT study.

Scleroma is a chronic specific granulomatous disease endemic in Egypt. The nasal cavities were all affected in the 37 patients examined. The paranasal sinuses and nasopharynx were involved in 17 patients, while the larynx and upper trachea were affected in five patients, four of whom were females. Twenty-three patients were in the granulomatous stage; the rest of the patients were in the atrophic and fibrotic stages. The main nasal and nasopharyngeal CT findings were soft tissue masses of variable sizes. The lesions were characteristically homogenous, non-enhancing and had distinct edge definition; adjacent fascial planes were not invaded. The subglottic area was involved in laryngeal and tracheal scleroma. The lesions were mainly in the form of concentric irregular narrowing of the airway. In the trachea, crypt-like irregularities were diagnostic of scleroma. Intra-orbital, intra-cranial and infratemporal parapharyngeal scleromatous masses were detected in one patient.

Cytopathology in cancer of larynx.

The results of brush cytological smears were compared with the microscopical examination of punch biopsies obtained from 60 patients with suspected cancer of the larynx. The bronchofibroscope 'Olympus BF B3' was used to obtain the brush specimens. The results of cytology and pathology specimens were found identical in 93.3% of cases. Comparison between our results and previous similar work is presented.

Flexible endoscopy and radiologic evaluation of the eustachian tube in adults with eustachian tube dysfunction.

This study was conducted on 20 adult patients presenting with eustachian tube dysfunction of about 6 months' duration. It included endoscopy of the pharyngeal end of the eustachian tube and contrast radiologic study. Both methods are now available because of technical progress and practical improvements. By these methods, physiologic movements of the soft palate, tubal torus, and tubal orifice can be observed and studied and anatomic variations and pathologic abnormalities can be detected. This study shows that eustachian tube dysfunction may be caused by salpingitis (acute or chronic) or adenoid or nasopharyngeal carcinoma. Scleroma affecting the lumen of the eustachian tube was reported in one case.

Skin affection in rhinoscleroma. A clinical, histological and electron microscopic study on four patients.

Clinical, histological and electron microscopic studies were performed on 4 rhinoscleroma patients with concomitant skin lesions in the upper lip, dorsum of the nose and nasolacrymal sac area. The skin lesions were treated locally. One of the patients was followed up to 16 years. Histologically, the skin lesions showed downward prolongation of the rete pegs. Deep in the dermis, vacuolated Mikulicz cells surrounded by lymphocytes and plasma cells were found. By electron microscopy, numerous small vacuoles containing fine granular material were seen inside Mikulicz cells. A limited number of bacilli were found inside and outside these cells. Two clinical entities of rhinoscleroma are observed in Egypt, an active granulomatous type with possible extranasal extension, and a less active intranasal type with limited mucosal lesions. The skin lesions in rhinoscleroma were found to have an unpredictable course.

Experimental inoculation of Klebsiella rhinoscleromatis bacilli in albino mice.

72 albino mice were intranasally inoculated with Klebsiella rhinoscleromatis suspension with or without the addition of hog mucin. Scleroma-like lesions developed in their lungs more frequently with hog mucin. A liver affection was detected only in 1 animal. K. rhinoscleromatis organisms were recovered from the lung lesions. A possible potentiating effect of hog mucin is discussed.

The effect of streptomycin and irradiation on rhinoscleroma (electron microscopic study).

Irradiation of scleromatous lesions produces its effect by destroying the organisms, whereas Streptomycin improves the mucosal defence mechanisms. A combination of both lines of treatment seems to be indicated for the arrest of the pathological process.

Toxofactor associated with Toxoplasma gondii infection is toxic and teratogenic to mice.

A toxin associated with Toxoplasma gondii infection was obtained from the trophozoites and culture medium used to propagate the parasite in cell cultures. The toxin, named Toxofactor (TF), administered parenterally or nonparenterally in adult mice, produces transient symptoms of lethargy, ruffled fur, and body weight loss. Organ changes which accompanied the outward symptoms included hepatosplenomegaly and involuted thymus. TF activity was detected in extracts of the blood, peritoneal fluid, liver, and spleen of infected mice. Severe damage to embryonal and fetal development was induced when TF was administered during pregnancy. Resorption, abortion, and congenital abnormalities were produced, dependent upon the stage of development at the time of exposure. Adult mice which had reacted to and recovered from an initial intraperitoneal injection to TF were protected against a secondary challenge from TF. Fetal development was also protected from damage when TF was used to challenge adults previously exposed to TF. Mouse and rabbit anti-TF sera neutralized TF activity in the adult. In no instance did control mice show any deleterious effect when exposed to soluble cell lysate from the uninfected cell line (BHK-21) used to propagate the organism plus the used medium from these same uninfected cells. TF activity was not attributed to bacterial, myocoplasmal, or viral contamination. TF toxic activity is labile to elevated temperature and high or low pH, which also destroy its protective properties. TF activity was sensitive to trypsin and was obtained in the elution fraction (alpha-methyl-D-mannoside) from affinity chromatography (concanavalin A-Sepharose 4B). Ultrafiltration indicated the molecular weight to be between 50,000 and 100,000. TF, apparently a glycoprotein, was quantitated for activity by a weight loss assay. A unit of activity was defined as the minimum quantity of TF (highest dilution) which produced at least a 10% average body weight loss in adult Nya:NYLAR female mice between days 7 and 12 post-intraperitoneal injection.

Endoscopy of lower respiratory tract scleroma.

Eleven cases of scleroma with lower respiratory tract affection were examined by the flexible and rigid bronchoscopes. The patterns of laryngeal, tracheal and bronchial scleroma as seen through the flexible scope are presented. In the larynx, diffuse and localized forms are found. The trachea was affected by granular or atrophic lesions. Stenosis of the main bronchi was seen in two patients. The present-day treatment of lower respiratory tract scleroma is discussed.