Prosthetic valve endocarditis due to Cardiobacterium hominis occurring after upper gastrointestinal endoscopy.

Bacterial endocarditis secondary to endoscopic procedures has been convincingly documented in only four cases. We describe a case of prosthetic valve endocarditis due to Cardiobacterium hominis that developed after upper gastrointestinal endoscopy. Because of this, we recommend subacute bacterial endocarditis prophylaxis in patients who have a prior history of endocarditis or valve replacement.

Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases.

The investigators report the clinical and pathologic features of 19 cases of intraepithelial neoplasia occurring in the anal canal mucosa of routinely excised hemorrhoidal tissue, a condition that has been infrequently described. The patients were 12 women and seven men having an age range of 21 to 74 years (mean, 48 years). Two patients had coexistent anogenital condylomata acuminata. Leukoplakia of the hemorrhoidal surface was noted in two patients. Intraepithelial neoplasia arose in the transition zone of the anal canal of 11 cases, in the squamous zone of three cases, and in both sites of five cases. All were high-grade intraepithelial neoplasms; one was classified moderate to severe dysplasia, 17 exhibited severe dysplasia/carcinoma in situ, and one contained microinvasive carcinoma. Both keratinizing and cloacogenic type neoplasms were observed. Associated koilocytotic atypia was identified in 16 cases (84%). In situ hybridization for human papillomavirus (HPV) messenger RNA demonstrated HPV RNA sequences in seven of nine neoplasms (78%) studied by that technique (five HPV type 16, one HPV type 18, and one coinfection with HPV types 6 and 18). Eighteen patients had no clinically evident recurrent or progressive disease at mean follow-up of 6.6 years. Residual/recurrent intraepithelial neoplasia was noted in one patient at 1, 2, 5, and 49 months posthemorrhoidectomy. Our data indicate that incidentally discovered high-grade intraepithelial neoplasia present in hemorroidal tissue is a clinically nonaggressive lesion frequently associated with HPV infection. Hemorrhoidectomy alone is curative in most cases.

Analysis of perfluorochemical elimination from the respiratory system.

We describe a simple apparatus for analysis of perfluorochemicals (PFC) in expired gas and thus a means for determining PFC vapor and liquid elimination from the respiratory system. The apparatus and data analysis are based on thermal conduction and mass transfer principles of gases. In vitro studies were conducted with the PFC vapor analyzer to determine calibration curves for output voltage as a function of individual respiratory gases, respiratory gases saturated with PFC vapor, and volume percent standards for percent PFC saturation (%PFC-Sat) in air. Voltage-concentration data for %PFC-Sat of the vapor from the in vitro tests were accurate to within 2.0% from 0 to 100% PFC-Sat, linear (r = 0.99, P < 0.001), and highly reproducible. Calculated volume loss of PFC liquid over time correlated well with actual loss by weight (r = 0.99, P < 0. 001). In vivo studies with neonatal lambs demonstrated that PFC volume loss and evaporation rates decreased nonlinearly as a function of time. These relationships were modulated by changes in PFC physical properties, minute ventilation, and postural repositioning. The results of this study demonstrate the sensitivity and accuracy of an on-line method for PFC analysis of expired gas and describe how it may be useful in liquid-assisted ventilation procedures for determining PFC volume loss, evaporation rate, and optimum dosing and ventilation strategy.

Roles of computed tomography and magnetic resonance imaging diagnoses in the treatment of head and neck cancer.

This article has provided an overview of the current imaging techniques for evaluating head and neck cancer. Advantages, disadvantages, and complementary roles of CT and MRI have been described.

Extradural lymphoma presenting as an acute surgical emergency.

Extradural lymphoma can present as an acute neurosurgical emergency. The clinical presentation and radiological appearance may suggest epidural hematoma or meningioma. Lymphoma should be considered as a rare but possible diagnosis before operation. High resolution computed tomography using direct coronal imaging with and without contrast enhancement may aid in suggesting the correct preoperative diagnosis.

Liquid assisted ventilation: an alternative ventilatory strategy for acute meconium aspiration injury.

Evidence of surfactant inactivation by meconium has led to the use of exogenous surfactant therapy in the management of meconium aspiration syndrome (MAS). Liquid assisted ventilation has been shown to improve the cardiopulmonary function in lungs with high surface tension. We compared exogenous surfactant therapy with liquid assisted ventilation in the management of experimental acute meconium aspiration injury. Thirty-two newborn lambs were ventilated at peak inspiratory pressures of 13-16 cm H2O, positive end expiratory pressure of 3-4 cm H2O, fractional inspired oxygen concentration (FiO2) of 1.0, and a respiratory frequency range between 30 and 35 breaths/min. Baseline arterial blood gases, pulmonary function, and arterial blood pressure measurements were taken. All lambs were given 2-3 ml/kg of an unfiltered 25% meconium solution. Lambs were then randomized into either gas-ventilated meconium control, or one of three treatment groups: 1) surfactant; 2) partial liquid ventilation (PLV); or 3) total liquid ventilation (TLV) for 4 hours after meconium injury. All treated groups demonstrated a significant increase in arterial oxygenation (P < 0.05); surfactant and PLV-treated lambs demonstrated significantly decreased arterial PCO2 (P < 0.05). Compliance in all groups increased compared with injury values; compliance of the TLV group increased more than in all other treatment groups (P < 0.05). In addition, lung histology of the TLV group demonstrated clear, intact alveolar epithelium and homogeneously expanded alveoli, while no such improvement was evident in the other groups. These data suggest roles for both exogenous surfactant therapy and liquid assisted ventilation techniques in the management of MAS.

Detection of peroxynitrite in biological fluids.

Peroxynitrite (ONOO(-)) is both an oxidant and a nitrating agent (1-3). However, unlike other strong oxidants, peroxynitrite reacts selectively with biological targets. This selectivity is derived in part from the different second-order rate constants (vary from 10(3)-10(6) M (-1) s(-1)) by which ONOO(-) reacts with biological targets. Competing for peroxynitrite-mediated oxidation of biological targets are two pathways. One is the protonation to form peroxynitrous acid and the second is the reaction with CO(2). Peroxynitrous acid is also an oxidant but it readily isomerizes to nitrate. The reaction with CO(2) results in the formation of the ONO(O)CO(2) (-) adduct that is a more potent nitrating agent but a weaker oxidant than peroxynitrite. Peroxynitrite can diffuse through biological membranes before it encounters and reacts with biological targets. This observation implies that diffusion can effectively compete with the isomerization to nitrate or the reaction with CO(2).

Meconium aspiration injury: Uncoupling between the in vivo physiologic and in vitro inflammatory responses.

OBJECTIVE: To correlate the in vivo physiologic changes that occur with meconium aspiration injury to an associated in vitro cellular response to meconium. DESIGN: Experimental, prospective, randomized, controlled study. SETTING: University research laboratory. SUBJECTS: Eighteen adult Sprague-Dawley rats with meconium aspiration injury. INTERVENTIONS: Rats were given 3 mL/kg of a 25% meconium solution and were treated with conventional gas ventilation; nine rats were given exogenous surfactant therapy (Survanta, 4 mL/kg), and nine rats were not treated (control). Bronchoalveolar lavages were collected for total cell counts. Histologic samples also were taken for analysis. In addition, the in vitro effect of meconium on granulocytic elastase release from human neutrophils was determined. MEASUREMENTS AND MAIN RESULTS: Meconium caused significant morbidity in vivo, including poor oxygenation, elevated Paco(2), diminished compliance, and elevated white cell count in the bronchial lavages. Lung white cell count was significantly less in the surfactant group (p <.01). Meconium did not cause elastase release from human neutrophils in vitro. CONCLUSIONS: This study demonstrated uncoupling between in vivo physiologic responses to meconium injury in rats and the in vitro effect of meconium on human neutrophils. Surfactant therapy alleviated some of the perturbations associated with meconium injury, including a reduction in the inflammatory cell count in lung lavages. The absence of direct neutrophil activation by meconium suggests the requirement of an intermediary in the pathogenesis of meconium aspiration injury.

Fine needle aspiration cytology of liposarcoma of the breast. A case report.

Aspiration cytology has become an accepted procedure in the evaluation of breast abnormalities. Encountering unusual findings in cytologic material, therefore, may become more frequent. We describe a primary liposarcoma of the breast diagnosed by fine needle aspiration cytology and review the cytologic features of liposarcoma in general. The differential diagnosis is considered, and the previous literature regarding liposarcomas of the breast is reviewed.

Infection of a pancreatic pseudocyst due to Candida albicans.

A 40-year-old man with diabetes mellitus, congestive heart failure, alcoholic cirrhosis, and chronic pancreatitis had an exacerbation of pancreatitis due to alcohol abuse. His condition deteriorated rapidly with development of apparent sepsis; cultures were negative. He slowly improved with multiple antibiotic therapy and total parenteral nutrition. Serial imaging of the pancreas revealed edematous pancreatitis that evolved initially into a phlegmon and later into multiple pseudocysts. Intermittent fever prompted computed-tomography-directed percutaneous aspiration of the largest pancreatic fluid collection, yielding purulent material that grew only Candida albicans. Subsequently, disseminated candidiasis developed. Despite therapy with amphotericin B and aggressive supportive care, the patient died from multiple organ system failure.

Computed tomography of gliomatosis cerebri.

Gliomatosis cerebri, a rare diffusely infiltrating astrocytoma, was discovered on the postmortem examination of a 22-year-old woman with a 13 year history of seizures. Computed tomography of the brain revealed bifrontal white matter low density changes that were most consistent with a demyelinating or dysmyelinating disorder.

Comparison of natural surfactant and brief liquid ventilation rescue treatment in very immature lambs. Clinical and physiological correlates.

We studied the effect of rescue therapy with modified porcine surfactant (Curosurf) or brief perfluorocarbon liquid ventilation on pulmonary gas exchange, mechanics and structure in very immature lambs. Both rescue strategies produced an improvement in arterial oxygenation and were able to support CO2 elimination. Histology showed unevenly inflated lungs in all but tidal-liquid-ventilated lambs. We speculate that due to immature lung architecture and relatively high permeability, previous exposure to gas ventilation impeded full effectiveness of both rescue modalities, perhaps prophylactic surfactant or liquid ventilation could be a better alternative.

Isolated aspartate aminotransferase elevation due to macroenzyme formation with liver biopsy correlation.

Serum aspartate aminotransferase (AST) has rarely been reported to complex with immunoglobulins, resulting in abnormally elevated serum activity. A similar phenomenon occurs with serum amylase, resulting in the more common entity of macroamylasemia. AST macroenzyme formation can occur in the presence or absence of liver disease and, at times, can lead to a false suspicion of liver disease. We describe the abnormal liver histology found in a healthy patient with isolated AST elevation due to AST macroenzyme formation.

Nyquil-associated liver injury.

Acetaminophen, a commonly used medication, is present in many over-the-counter remedies. In recent years, its potential to cause severe liver injury has been increasingly appreciated. Chronic abusers of alcohol may be particularly susceptible to hepatotoxicity from acetaminophen. We report two cases of unintentional liver injury associated with ingestion of Nyquil, a liquid cold remedy containing acetaminophen and 25% alcohol.

Three-dimensional human pattern visual evoked potentials. II. Multiple sclerosis patients.

Pattern visual evoked potentials were obtained from 46 patients with definite relapsing/remitting multiple sclerosis, using both a conventional 5-channel occipital array and a 3-D recording technique consisting of three bipolar derivations approximating the three dimensions of space. These three orthogonal wave forms were displayed as a 3-D Lissajous trajectory for each subject. Two of the 15 patients with completely normal conventional pattern VEPs had abnormalities of the orientation of the B-C curvilinear segment of the 3-D pattern VEPs. Delays in the first major occipital positive component (P100) were evident using both techniques; the correlation between P100 latency and the latency of the corresponding trajectory apex was r = 0.99 (P less than 0.01). Post-chiasmal MRI abnormalities were associated with 3-D VEP orientation abnormalities. Three-dimensional pattern VEPs are moderately more sensitive than conventional pattern VEPs at detecting dysfunction posterior to the optic chiasm in demyelinating disease and do not require the use of eccentric fixation to do so.

The use of two new coagulation probes for control of hemorrhage in laparoscopic liver biopsy.

Two new prototype probes, BICAP and Heater, were assessed to determine their effectiveness in controlling post-biopsy bleeding during laparoscopy. A total of 88 patients with a wide spectrum of liver diseases were studied. Both probes were equally effective in stopping bleeding in all patients. We recommend the use of either of these devices in controlling post-biopsy bleeding.

Technique for using microencapsulated terpenes in lepidopteran artificial diets.

We have developed and tested a technique to microencapsulate terpene compounds by forming gelatin-walled microcapsules around the terpene essential oils. Eight terpenes that are common constituents of Douglas fir (Pseudotsuga menziesii) oleoresin were encapsulated, including five monoterpenes (α-pinene,ß-pinene, camphene, myrcene, and limonene) and three oxygenated monoterpenes (bornyl acetate, linalool, andß-citronellol). The encapsulated terpenes were mixed into artificial diets to determine the effects they had on western spruce budworm (Choristoneura occidentalis) survival and reproduction, using a three-generation bioassay. We describe the technique and present data from preliminary bioassays with seven of the terpenes to demonstrate thatC. occidentalis larvae would consume diets fortified with microencapsulated terpenes. The technique is useful because it helps to reduce the rate at which terpenes volatilize from the diets and it "packages" the terpenes in a manner more closely resembling the way they are present in the resin canals of plant foliage. Many scientists investigating the biological importance of terpenes in mediating plant-herbivore interactions may find that microencapsulated terpenes are useful in both laboratory diet studies and field and greenhouse experiments with plant material.