A fatal case of Gradenigo's syndrome in Zimbabwe and the Danish-Zimbabwean ENT collaboration.

As a part of a bilateral educational exchange program two Danish ENT residents were invited to Zimbabwe in 2015. During this exchange a 9-year-old girl was admitted due to complications to acute otitis media (AOM). She developed Gradenigo's syndrome and later on a brain abscess leading to a fatal outcome. Life threatening complications to AOM are rare in developed countries today but are still a challenge in developing countries. We put forward this case from a developing country to bring focus to the fact that a fatal outcome is the consequence if specialist treatment is not accessible.

The introduction of emergency cricothyroidotomy simulation training in Zimbabwe contributed to the saving of two lives.

BACKGROUND: In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS: A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient. CONCLUSION: Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.

Actin microdomains on endothelial cells: association with CD44, ERM proteins, and signaling molecules during quiescence and wound healing.

During studies of the actin cytoskeleton in cultured endothelial cells we have observed that the luminal side of many cells contains F-actin microdomains that are rich in the hyaluronan receptor CD44 and in ezrin-radixin-moesin (ERM) proteins. A small subpopulation of the domains are also enriched in tyrosine phosphorylated proteins and signaling molecules. Confocal microscopy of rat aortic endothelial cells in situ demonstrated that similar microdomains occur in vivo. During healing of endothelial wounds, characteristic alterations of the actin cytoskeleton occurred. Thus, in many cells close to the wound, focal F-actin branching points appeared. The branching points were similar to the microdomains in that they colocalized with CD44 and ERM proteins, but, in addition, they formed centers for actin filament branching and were associated with phosphorylated protein kinase C alpha/betaII. These colocalization data are consonant with the view that activated PKC is responsible for activating ERM-mediated crosslinking between CD44 and the actin cytoskeleton. Importantly, inhibition of PKC activity decreased staining for phosphorylated ERM proteins, decreased the frequency of F-actin branching points, and inhibited monolayer wound healing. Together, our data show that endothelial cells contain a novel actin cytoskeletal structure, the F-actin microdomain, and suggest that during wound healing such structures become associated with activated signaling molecules and thereby enhance actin cytoskeletal remodeling.

Cytokine profiles in adult mink infected with Aleutian mink disease parvovirus.

The aim of this study was to examine the levels of gamma interferon (IFN-gamma)-, interleukin 4 (IL-4)-, and IL-8-producing cells in peripheral blood mononuclear cells from mink infected with the Aleutian mink disease parvovirus (ADV). As expected, ADV-infected mink developed high plasma gamma globulin values (hypergammaglobulinemia) and enhanced quantities of CD8-positive (CD8(+)) cells in the blood during the infection. We quantified the percentages of IFN-gamma- and IL-4-positive lymphocytes and IL-8-positive monocytes up to week 38 after virus challenge. The results clearly indicated marked increases in the percentages of IFN-gamma- and IL-4-producing lymphocytes during ADV infection. The total number of IL-8-producing monocytes in the blood of ADV-infected mink stayed fairly constant during the infection. In order to characterize the phenotype of the cytokine-producing cells, we performed double-labeling fluorescence-activated cell sorter (FACS) experiments with CD8 surface labeling in one channel and cytokine intracellular staining in the other. We found that most IFN-gamma and IL-4 in ADV-infected mink was produced by CD8(+) cells, while in the uninfected mink, these cytokines were primarily produced by a cell type that was not CD8 (possibly CD4-positive cells). We also observed that IL-8 was almost exclusively produced by monocytes. All of the above findings led us to conclude that both Th1- and Th2-driven immune functions are found in mink plasmacytosis.

Regional and functional differentiation in the fat body of pharaoh's ant queens, Monomorium pharaonis (L.).

The insect fat body is generally described as a uniform tissue with multiple functions, but we have found evidence of cell differentiation in the Monomorium fat body. We show that the fat body of a mature egg-laying pharaoh's ant queen is a result of a preceding remodeling of cell material comprising at least 11 different fat cell types, located at specific positions in the head, alitrunk (thorax) and gaster (abdomen). The cell types are classified based on their position, histochemistry, ultrastructure, and immunoreactivity for vitellogenin/vitellin. Some of these cells are primordial cells present at emergence, others invade the histolysing flight muscle tissue, and still others disappear during the maturation process. Only one type, the subepidermal fat cell of the gaster, is active in vitellogenin synthesis and is the only cell type in close association with oenocytes. Although only this type produces vitellogenin, our material indicates that most fat cell types are essential to support egg production. In some queens vitellogenin was found to form crystals in ventral vitellogenin-producing fat cells. This indicates an imbalance between vitellogenin production in the fat cells and uptake in the oocytes, which is probably related to a cyclic regulation of egg production.

Ultrastructural immunocytochemical localization of vitellogenin in the fat body of the blowfly, Calliphora vicina Rob.-Desv. (erythrocephala Meig.) by use of the unlabeled antibody-enzyme method.

The unlabeled antibody-enzyme method was used to demonstrate ultrastructurally the specific localization of vitellogenin in the fat body of Calliphora. In control flies the binding sites to vitellogenin were localized in secretory granules situated in the Golgi complex, and in larger bodies named composite secretory granules. These composite granules appear to be formed when a part of a Golgi complex containing secretory granules and a number of small vesicles become surrounded by a common membrane. Ovariectomized flies, which apparently do not produce secretory granules, exhibited no immunocytochemical staining. Ovariectomized flies in which the administration of ecdysterone induced formation of secretory granules, also revealed specific staining on these granules. This is the first ultrastructural evidence of: (a) the specific localization of vitellogenin in secretory granules of the fat body of an insect; (b) the relationship between the presence of the ovary, and of ecdysterone, and the synthesis of vitellogenin by the fat body.