Comparison of no airway device, the Guedel-type airway and the Cuffed Oropharyngeal Airway with mask ventilation during manual in-line stabilization.

STUDY OBJECTIVE: To compare two different types of oropharyngeal airway: the Guedel-type oral airway and the Cuffed Oropharyngeal Airway (COPA), with respect to the effectiveness of positive-pressure ventilation (PPV) through a face mask in patients with in-line stabilization of the head and neck. DESIGN: Prospective, randomized, crossover study. SETTING: University hospital. PATIENTS: 30 ASA physical status I and II patients undergoing elective surgery. INTERVENTIONS: General anesthesia was induced with propofol and muscle relaxation was produced with vecuronium. In a random sequence, no airway device, the Guedel-type airway, and the COPA were used in each patient while applying a face mask and lifting the jaw forward. MEASUREMENTS AND MAIN RESULTS: Tidal volumes were measured during PPV in each option. The position of the distal tip of each airway was assessed using a fiberscope, and the resulting views were graded and compared. When the Guedel-type airway was used, tidal volumes (V(T)s; means +/- SD) were significantly greater (12.3 +/- 4.5 mL/kg) than those with no airway device (8.5 +/- 4.5 mL/kg) (p < 0.001). When the COPA was used, V(T)s (14.6 +/- 4.4 mL/kg) were significantly greater than those with the Guedel-type airway (p < 0.05). The grade of the fiberscopic view through the distal tip was significantly better with the COPA than with the Guedel-type airway (p < 0.05). CONCLUSIONS: Although clinical differences often appear trivial, the COPA is more effective on mask ventilation than the Guedel-type airway when used in patients with manual in-line stabilization.

Bond-specific chemical cleavages of peptides and proteins with perfluoric acid vapors: novel peptide bond cleavages of glycyl-threonine, the amino side of serine residues and the carboxyl side of aspartic acid residues.

Peptide bond cleavages by vapors composed of various from aqueous solutions of perfluoric acid were studied using synthetic peptides and proteins, and specific conditions were established for peptide bond cleavages including a novel cleavage of the glycyl-threonine bond. The peptide bonds on the aminosides of serine residues were cleaved by exposure to a vapor of 75% aqueous heptafluorobutyric acid at 30 or 50 degrees C for 24 h. Glycyl-threonine peptide bonds were cleaved with vapors of various concentrations (5, 75, and 90%) of heptafluorobutyric acid at 30-40 degrees C for 24 h. The peptide bonds on the carboxylsides of aspartic acid residues were cleaved by exposure to a vapor of 0.2% heptafluorobutyric acid at 90 degrees C for 4 to 24 h. The same vapor cleaved aspartyl-proline bonds under milder conditions such as at 60 degrees C for 16 h, under which the other aspartyl bonds were uncleaved. These specific chemical cleavages were applied to several proteins including newly characterized proteins.

Vocal cord abductor paralysis (VCAP) in Parkinson's disease: difference from VCAP in multiple system atrophy.

Vocal cord abductor paralysis (VCAP) is rare in Parkinson's disease (PD), while it is frequent in multiple system atrophy (MSA). Although VCAP is a life-threatening complication it has not yet been clarified whether there is any difference in the mechanism of VCAP between PD and MSA. Examining 3 autopsy-proven PD patients who developed severe VCAP requiring tracheostomy, we found the following differences in the mechanism of VCAP between MSA and PD: (1) clinical and laryngofiberscopic examination showed that VCAP in PD was not exacerbated during sleep, unlike in MSA; (2) On histological examination of the intrinsic laryngeal muscles, the posterior cricoarytenoid muscle demonstrated no abnormalities in PD, while the muscle showed characteristic neurogenic atrophy in MSA. There seemed to be two types of VCAP, namely the nonparalytic type observed in PD, and the paralytic type observed in MSA. Severe dysphagia requiring tube-feeding was common among PD patients who presented with VCAP. Although the relationship between VCAP and dysphagia is unknown, one should be aware of the possibility of fatal VCAP in PD patients with severe dysphagia.

Carboxy-terminal degradation of peptides using perfluoroacyl anhydrides. A C-terminal sequencing method.

An accurate carboxy-terminal sequencing method has long been sought to complement the Edman degradation procedure for amino-terminal amino acid sequence analysis. The method presented here is a unique and simple method to partly fulfill the needs. Exposure of a polypeptide to perfluoroacyl anhydride vapor at -20 degrees C for 0.5-1 h causes sequential chemical degradation of the molecule from the C-terminus. Fast-atom-bombardment mass spectrometric analysis of the resultant mixture of C-terminally truncated molecules permits the determination of the C-terminal sequence by simple calculation of the mass differences in molecular ions. Experiments suggested that this C-terminal degradation proceeds by active intermediates such as oxazolone at the C-terminal carboxyl residues.

[Neuroleptic malignant syndrome associated with the syndrome of inappropriate secretion of antidiuretic hormone].

We reported a case of neuroleptic malignant syndrome (NMS) associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 71-year-old woman, who had been diagnosed as hypertension and multiple cerebral infarction, was given sulpiride 150 mg daily for depressive state. Three days after started sulpiride, she developed fever, sweating, difficulty of movement and was admitted to the hospital. The white blood cell count rose to 16,300/mm3 and serum creatine kinase (CK) to 3,063 IU/L. Two days later CK rose to 20,050 IU/L regardless of stopping the drug, so she was transferred to our hospital for further investigation. On admission, it was the 6th day from the onset, she was mute and akinetic accompanied by muscle pain and rigidity in extremities. Serum CK was 1,831 IU/L, Na 122 mEq/L, osmolality 244 mOsm/kg, plasma antidiuretic hormone (ADH) level 6.5 pg/ml and urine Na was 101 mEq/L, osmolality 467 mOsm/kg. Renal and adrenal functions, plasma renin activity were normal. From the history, course and these data, diagnosis of NMS associated with SIADH was made. Intravenous sodium (130-200 mEq/day) and fluids (1,000-1,200 ml/day) were carefully infused. She became active, muscle pain disappeared and rigidity, akinesia decreased. CK, serum Na and osmolality gradually improved to normal. About the transient increase in ADH secretion, we considered that hypothalamic disturbance in NMS might induce leakage of stored ADH from neuroendocrine neurons in it.

Acoustic schwannoma presenting as subarachnoid hemorrhage due to ruptured contact aneurysm.

The authors report a rare combination of aneurysm and acoustic schwannoma in a 66-year-old housewife, who developed subarachnoid hemorrhage from a ruptured aneurysm arising from an arterial branch of the posterior inferior cerebellar artery on the tumor capsule. Association of aneurysm and cerebellopontine angle schwannoma is extremely rare, and there has been no report of subarachnoid hemorrhage due to ruptured contact aneurysm, although previous reports indicated a small number of acoustic schwannomas accompanying hematomas in and around tumors.

A genetic variant of Emery-Dreifuss disease. Muscular dystrophy with humeropelvic distribution, early joint contracture, and permanent atrial paralysis.

A 38-year-old woman, a product of consanguineous parents, had been observed to have limited neck flexion and elbow joints contracture since early childhood. In addition, she experienced humeropelvic muscular weakness and atrophy, so that she was unable to walk by age 27. At 34 years of age, she required a permanent pacemaker to treat complete atrioventricular block with ventricular bradycardia. A myocardial biopsy confirmed cardiomyopathy. The clinical features of the present case are similar to those of the Emery-Dreifuss syndrome; however, this case may be inherited through an autosomal recessive trait.

[Arteriovenous malformation associated with congenital heart disease, with a remark on accompanying cardiopulmonary dysfunction (author's transl)].

A 10 years old school boy, who had been known to have a small ventricular septal defect from 2 months after birth, was admitted to us with a diagnosis of subarachnoid hemorrhage on October 24, 1978. On admission, neurological examination revealed mild right hemiparesis and miotic pupils in semicomatose state, and thrilling, that was equivalent to Levine III, pansystolic murmur and cyanosis of nails were noticed. By CT scan, intraventricular hemorrhage originated from hemorrhage in the basal ganglia was shown and the left CAG revealed an arteriovenous malformation in the left basal ganglia. Electrocardiogram showed mild cardiac failure and chest x-ray showed pulmonary congestion. Neurological symptoms and abnormal cardiopulmonary changes made well manageable after bilateral ventricular drainage. Twenty four cases of arteriovenous malformation associated with congenital heart disease were reviewed in the reported literature, and 20 cases were found to combine with Galenic aneurysm with congenital heart disease. All of those cases had been in a little pause after the birth and the most of congenital heart diseases were of patient ductus arteriosus. The rest of cases including our present case were 4 cases, who had rather small arteriovenous malformation, and the severity of the congenital heart disease was attributable to the patients mortality. In all of the report at present only our case was the single survival. Embryological investigation on arteriovenous malformation of the brain and congenital heart disease indicated that association of both conditions could be attributable to the vascular malformation in a very limited gestational stage, and that the incidence should be much less than reported. Our case showed the intracranial hypertension was found to create serious cardio-pulmonary dysfunction when congenital heart disease being accompanied, and it was presumably relating to the relatively higher incidence of Galenic aneurysm associated with ductus arteriosus.

[Actinomycotic brain abscess -case report- (author's transl)].

Actinomycosis of the central nervous system is rare. There has been considerable discussion as to whether it can be primary, but several cases have been reported occasionally. Authors presented a case of cerebral actinomycosis involving primarily the right frontal lobe through an obsolete stick wound. Patient is a 18-year-old man and when he was 8 years of age, he received right frontal penetrating injury due to fall on wire about 3 mm in diameter. Wound had healed sustaining any abnormal effect to note. Eleven years later, he was admitted to our institution because seizure attack characterized by automatism, and plain skull X-ray showed intracranial frontal calcification. EEG, angiography, RI scan and CT scan were performed. At operation, a granuloma was found and total removal was performed. The histological examination showed actinomycotic brain absess. Patient was treated with antibiotics and he returned to the previous occupation. Primary actinomycosis of the central nervous system was discussed with previously reported cases in the literature.