Fibrosarcoma of the trachea in a child: case report and review of the literature.

We present a case of nearly total obstruction of the trachea in a 15-month-old boy suffering from tracheal fibrosarcoma. The diagnosis was confirmed on histological examination of a removed part of the tumor, with subsequent successful complete resection of tracheal fibrosarcoma. Follow-up to the age of 13 years showed complete recovery with normalization of respiratory functions. The diagnostic and therapeutic aspects of this case are discussed.

The influence of acid on astringency of alum and phenolic compounds.

Astringency of aqueous solutions of phenolic compounds (grape seed tannins, tannic acid, catechin and gallic acid) increased upon addition of citric acid, whereas the astringency of alum was reduced. Astringency of alum was decreased equivalently by addition of equi-sour levels of lactic acid, citric acid or hydrochloric acid. The difference between alum and the phenolic compounds is speculated to result from chemical modifications affecting binding of the astringents with oral proteins rather than cognitive differences. Chelation of the aluminum ion in alum by acids reduces its availability for interacting with salivary proteins or epithelial proteins. In contrast, the increased astringency produced upon acidification of phenolic compounds is speculated to result from the pH driven increase in the affinity of the phenols for binding with proteins. These results suggest that alum cannot be used interchangeably with phenolic astringents in psychophysical studies.

Perceptual properties of benzoic acid derivatives.

Sensory properties of equimolar concentrations of benzoic acid derivatives were examined using time-intensity procedures. Significant differences in maximum intensities (P < 0.005) were found for astringency, bitterness, prickling, sourness and sweetness. Although these compounds differed only in the number and position of the hydroxy groups, they exhibited quite different profiles. Gentisic acid had the highest sourness and bitterness maximum intensity, salicylic and gentisic acids were highest in astringency, and m-hydroxybenzoic acid was the sweetest sample. Benzoic acid had the highest intensity of prickling feeling which lasted 20 s longer than salicylic acid and 40 s longer than the other samples which elicited lowest intensity of prickling sensation.

Nitric oxide and prostanoids protect the renal outer medulla from radiocontrast toxicity in the rat.

Human radiocontrast nephrotoxicity is predicted by the presence of multiple risk factors, often associated with compromised renal circulation. To produce a simple model of radiocontrast nephropathy, rats were pretreated with indomethacin and N omega-nitro-L-arginine methyl ester (L-NAME, to inhibit nitric oxide synthesis) before the administration of iothalamate. Acute renal failure consistently developed, with a decline in creatinine clearance from 1.05 +/- 0.10 to 0.27 +/- 0.05 ml/min (P < 0.001) associated with selective necrosis of 49 +/- 9% of medullary thick ascending limbs. Hemodynamic studies using laser-Doppler probes revealed that when injected alone, iothalamate increased outer medullary blood flow to 196 +/- 25% of baseline (P < 0.001). Pretreatment by L-NAME or indomethacin both reduced basal medullary blood flow and transformed the medullary vasodilator response to radiocontrast into vasoconstriction, with a prolonged reduction of medullary blood flow to less then half of baseline. Combined administration of indomethacin, L-NAME, and iothalamate lowered medullary blood flow to 12 +/- 4% of baseline. We conclude that prostanoids and nitric oxide have an important protective role in the renal response to radiocontrast material. Reduced synthesis of these vasoactive substances in renal/vascular diseases may predispose patients to radiocontrast nephropathy.

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel.

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.

[Primary left lower lobe tuberculosis and diabetes mellitus].

A 31-year-old man presented with fever, cough and hemoptysis. Primary pulmonary tuberculosis of the left lower lobe was diagnosed. Concurrently he developed severe insulin-dependent diabetes. This case stresses the special connection between primary atypical pulmonary tuberculosis affecting the lower lobes and diabetes mellitus.

Bone and joint infections due to Pseudomonas aeruginosa: clinical aspects and treatment.

The occurrence of nine cases of Pseudomonas septic arthritis and osteomyelitis within a 12-month period may be considered an uncommon experience even in a large, tertiary referral center. These cases are reported here and the various clinical patterns and therapeutic implications associated with Pseudomonas bone infections are discussed. Epidemiologic serotyping of the isolated strains indicated that they do not represent a single nosocomial outbreak.

[Delayed diagnosis of esophageal perforation].

Esophageal perforation is a rare complication of endotracheal intubation. Usually clinical symptoms are manifested shortly after the injury. Delayed diagnosis and treatment are associated with high morbidity and mortality. In a 38-year-old woman esophageal perforation was diagnosed 31 days after its occurrence, but prompt treatment, including surgery, led to a successful outcome. It is recommended that all available means be used to diagnose suspected cases of this fatal complication as early as possible.

The rabbit as an experimental animal for tracheal surgery.

The circumferential resection of the trachea with end-to-end anastomosis is a well-established clinical procedure. Still, some problems remain to be solved, such as the choice of optimal suture material. Dogs are primarily used for experimental work in this field, but are difficult to obtain. This operation was performed on nine rabbits, eight of whom survived to the preplanned date of sacrifice. Two of the survivors were found to have severe stricture at the anastomosis. This study indicates that the rabbit is a suitable experimental animal for circumferential resection and anastomosis of the trachea.

Human lung tumors: SPECT quantitation of differences in Co-57 bleomycin uptake.

A newly developed single photon emission computed tomography (SPECT) method was used to measure noninvasively the concentration of labeled drugs in human lung tumors. The validity of the method was established by the high correlation (r = .92) between in vivo SPECT measurement of the concentration of glucoheptonate labeled with technetium-99m and in vitro measurement of the concentration of the drug in specimens of nine of the same tumors obtained at surgery. The in vivo concentration of intravenously injected bleomycin labeled with cobalt-57 was measured over time in 14 human lung tumors. Significant differences were found in the uptake of bleomycin by the tumors, even those with the same histologic characteristics, when the concentration over time, the tumor/blood ratio at 30 minutes, and the tumor cumulative concentration were measured in vivo. Since the drug concentration in the blood was not related to the concentration in the tumor (r = .54), uptake of chemotherapeutic drugs should be measured in each patient individually.

Computed tomography in diagnosis of broncholithiasis.

A case of broncholithiasis detected by computed tomography is presented. The entity of broncholithiasis and its imaging modalities are briefly reviewed.

Prognosis after resection of non-small cell lung cancer of the right middle lobe.

In a previous study at Roswell Park Memorial Institute, it was noted that in patients whose resected non-small-cell lung cancer had originated in the right middle lobe, the prognosis was much worse than when it had originated in any other lobe. A review of a longer period and exclusion of patients who might introduce a bias resulted in a group of 18 patients whose fate was compared to the findings reported in other comparable series. Three out of those are alive at 8-96 months after operation. Five-year survival was 22% (30% counting only survivors of the operations). These findings indicate that the results of surgery for non-small-cell carcinoma of the right middle lobe fall within the lower range of lung cancer generally.

The contribution of anterior mediastinotomy in the diagnosis and evaluation of diseases of the mediastinum and lung.

Our experience with 62 consecutive patients who underwent anterior mediastinotomy is presented. A wide range of histological diagnoses was achieved. The highest yield was achieved for mediastinal masses. The overall diagnostic specificity was 64.5% and the diagnostic sensitivity was 98%. However, patient morbidity and mortality were 16.1% and 1.6%, respectively. Therefore, specific guidelines for the procedure are presented.

An experimental comparison of suture materials for tracheal and bronchial anastomoses.

Tracheal anastomosis, after circumferential resection, and bronchial anastomosis, after sleeve resection, have become widely accepted procedures. Nevertheless, there appears to be no agreement as to the optimal suture material for these anastomoses. Fifty-two rabbits were operated on, and 10 cervical tracheal rings were resected in each animal. End-to-end anastomosis was performed using 5/0 silk, chronic catgut, Teflon-coated polyester, coated polyglactin 910, polypropylene, or polydioxanone sutures. Twelve rabbits died. Rabbits which survived the intended length of time were evaluated with respect to acute and chronic inflammation and stricture formation. The results suggest that polypropylene is the best suture material, whereas silk is the worst material. Monofilament sutures should be used with caution for bronchial anastomosis, as their bristly knots can perforate adjacent blood vessels.

Simultaneous operation for hydatid cysts of right lung and liver.

Hydatid disease is endemic in certain villages in Galilee, Israel. Most patients seen in our thoracic surgical department have only pulmonary cysts, but some of them have concomitant liver cysts. From 1963 until 1982, 10 patients who were referred for lung operations had echinococci removed from the liver through a right thoracotomy. Every patient with a suspected diagnosis of pulmonary hydatidosis had isotope and ultrasound scans of the liver. Liver cysts found adjacent to the right hemidiaphragm were removed at thoracotomy. Patients having liver cysts remote from the diaphragm were referred for laparotomy. There were no postoperative complications or deaths in this series. We advocate routine search for liver cysts in any surgical candidate with lung hydatids. Accessible liver cysts should be excised at the same thoracotomy. We did not find any mention of this approach in the literature available to us.

Echocardiographic evaluation after blunt trauma of the chest.

We studied by cross-sectional echocardiography 27 consecutive subjects with severe blunt trauma of the chest. Inadequate studies were obtained in 6 subjects (22%). Abnormal, unexpected findings were noted in 6 of the remaining 21 subjects (29%): moderate size pericardial effusion in 3 and focal ventricular dysfunction in 4. No patient with echocardiographic abnormality was suspected clinically of having heart damage. One of the 6 subjects with abnormal echocardiographic findings died from sudden asystole 6 days later. The remaining 5 patients had normal echocardiographic findings when studied 1 week after trauma. This study shows that, following blunt chest trauma, cross-sectional echocardiography can detect unsuspected myocardial and pericardial damage in an appreciable number of patients. Ultrasonic examination of the heart complements other investigations in establishing the diagnosis of heart damage and may help improve the care of patients with heart trauma.

Thoracic wounds in Israeli battle casualties during the 1982 evacuation of wounded from Lebanon.

During the first 3 weeks of the operation "Peace for Galilee" (O.P.G.) 938 wounded soldiers were evacuated from Lebanon to the Rambam Medical Center in Haifa, Israel. Of these, 64 (6.8%) had chest wounds with or without other wounds. The characteristics of these wounds, the treatment given in the field and at the hospital and their results, are examined and a review of the literature of chest war wounds are summarized. A rapid and efficient in-field medical aid was the most important contributing factor to the low mortality and morbidity rates achieved. As far as we know, this is the first time computerized tomography was used in the diagnosis of war wounds of the chest.

A new scapula retractor for posterolateral thoracotomy.

A new retractor is presented for use in performing posterolateral thoracotomy. Its advantages are stabilization of the tip of the scapula and preventing it from protruding over the intercostal space to be incised.

The irreversible ischaemic lesion of human myocardium. Comparison with the experimental animal model.

The autolytic ultrastructural changes of the human myocardium were studied in 25 specimens taken 30 min to 18 h post mortem. Damage to the mitochondrial membranes and the appearance of mitochondrial armorphous densities characterized the irreversible lesions of the autolytic myocardium. The development of these changes was observed in consecutive samples. At 30 min, few small densities were noticed inconsistently, and they progressively increased in size and number over the next 90 min. The development of these changes was unrelated to the cause of death. Comparison of the ischaemic heart lesions of animals with those of humans shows a similarity of the mitochondrial amorphous densities. The best analogy was found to exist between the autolytic changes of the human myocardium and the irreversible ischaemic heart lesions of dogs.

Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences.

Experience with 136 fine-needle aspiration biopsies of mediastinal masses performed in 84 patients is reviewed. Biopsies were performed in all compartments of the mediastinum regardless of age. The biopsy technique included a 22-gauge needle with limitation of needle passes to an arbitrary number of three. The biopsy procedure was guided by either fluoroscopy or computed tomography (CT); guidance by CT is advantageous in the region of the thoracic inlet, hilum, and middle mediastinum, in small mediastinal masses, and in patients with superior vena cava syndrome. In 67 patients (79.7%) a specific cytologic diagnosis was obtained; in seven patients (8.3%), despite the presence of cells in the cytologic specimen, diagnosis could not be assessed. In the other 10 patients (11%), the samples obtained did not contain any cells. Morbidity was low: Light complications occurred in 15 patients (16.6%); drainage of pneumothorax was necessary in only three more. Bronchoscopy provided histology in three patients out of 12, mediastinoscopy established histologic diagnosis in 10 patients out of 16; surgery to remove the mass was performed in 38 patients. It is believed that fine-needle aspiration biopsy should be the first invasive procedure in the workup for diagnosing the nature of a mediastinal mass.