The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.

The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices.

Gastric and enteral pancreatic polypeptide (PP) immunoreactivity in the dog.

Extrapancreatic pancreatic polypeptide (PP) was quantified by determination of PP-cell density using antibodies to human PP (hPP) and bovine PP (bPP) in stomach, duodenum, jejunum, ileum, and colon of the dog. Further, these organs of 3 beagles were extracted and subjected to radioimmunoassay again using 2 different antisera (one directed against bPP, the other against hPP). Purification of these extracts were performed by Sephadex chromatography. We found bPP immunoreactive cells in stomach, small and large bowel, but hPP immunoreactive cells, besides in the pancreas, only in stomach and duodenum, thus demonstrating heterogeneity of extrapancreatic PP. Extraction and chromatography confirm the presence of PP immunoreactivity in the pancreas, stomach, small and large intestine. The observation of a postprandial rise of serum PP levels in a man with total duodenopancreatectomy suggests that the extrapancreatic PP cell may release PP.

[Endocrine tumors of the gastrointestinal and pancreatic systems. Multiple endocrine adenoma from another viewpoint]. / Endokrine Tumoren des gastro-entero-pankreatischen Systems. Multiple endokrine Adenome aus anderer Sicht.

The 24 endocrine pancreatic tumors and 14 carcinoids were examined immunohistochemically for cholecystokinin, insulin, gastrin, GIP, glucagon, sercretin, VIP, motilin, neurotensin, pancreatic polypeptide (PP), somatostatin, and ACTH. In 12 tumors of the pancreas more than one peptide-containing cell type was observed. The clinical symptoms showed hypersecretion of only one of the hormones, however. The midgut carcinoids (jejunum, appendix) represented the classical view of the carcinoid as an argentaffin cell tumor secreting 5-hydroxytryptamine. Tumors originating in the foregut (bronchus, stomach, duodenum) and hindgut carcinoids (rectum) were nonargentaffine, containing and secreting various polypeptide hormones. We conclude that light microscopic immunohistochemical methods are useful in distinguishing endocrine from nonendocrine tumors and multihormonal syndromes (MEA) in the classification of predominant hormone-secreting tumors.

The effect of intravenous theophylline ethylenediamine on serum gastrin concentration in control subjects and patients with duodenal ulcers and Zollinger-Ellison syndrome.

Serum gastrin concentrations were determined after an intravenous infusion of theophylline ethylenediamine (aminophylline) in 10 patients with duodenal ulcer, 9 patients with Zollinger-Ellison syndrome, 7 control subjects and 3 patients with pernicious anemia. Increases of serum gastrin levels were observed in each group. It is concluded that an aminophylline test would not be useful in the differential diagnosis of the Zollinger-Ellison syndrome.

Immunocytochemical method for the detection of terminal deoxynucleotidyl transferase in acute leukemia.

Terminal deoxynucleotidyl transferase (TdT) has become an important marker for the classification of acute leukemias. Originally detected by a biochemical assay, the presence of this enzyme in leukemia can now be detected by making use of a highly specific antibody and by applying the immunofluorescence method. In this study, an attempt was made to apply the unlabeled peroxidase-antiperoxidase (PAP) technique for the examination of TdT positive cells. We have optimized this method and have compared the different assays - biochemical, immunofluorescence, and immunocytochemical (PAP) - in ten patients with acute leukemia. The results obtained from all three methods are in accordance with one another, but the PAP method is a further simplification for the detection of TdT in the routine diagnostic of acute leukemias.

[Schistosomiasis and signet ring cell carcinoma of the ileocecal valve]. / Schistosomiasis und Siegelringzellkarzinom der Ileozökalklappe.

A 24-year-old male Egyptian complained of cramp-like upper abdominal discomfort and weight loss (3 kg) over 4 weeks. Physical examination merely gave evidence of the weight loss and of a slightly prominent gas-filled abdomen, mild diffuse abdominal tenderness and considerable borborygmus. Radiology of the intestines revealed chronic subileus of the small intestine caused by stenosis of the ileocaecal valve, which was impassable by coloscope. Biopsy suggested schistosomiasis of the ileocaecal valve. Examination of the resected ileocaecum showed a typical signet-ring carcinoma of the ileocaecal valve which had infiltrated all layers but had not metastasised to the regional lymph nodes (pT3, N0, M0). Typical eggs of Schistosoma haematobium were present in the mucosa of the tumour segment and of the neighbouring tissues. It is possible that chronic intestinal schistosomiasis is a potentially precancerous condition, similar to schistosomiasis of the urinary bladder.

Acquired pyruvate kinase deficiency with hemolysis in preleukemia.

Acquired erythrocyte pyruvate kinase deficiency may appear as a symptom secondary to various hematologic disorders, e.g. acute leukemia, sideroblastic anemia, polycythemia vera. The case of a 68-year-old patient with PK deficiency (1.75 U/g Hb) and severe hemolytic anemia is presented, who 1 year later showed acute myeloid leukemia. It is considered that a dialysable inhibiting factor may play a pathogenetic role in this enzyme change since enzyme activity was raised by dialysis. A survey of the literature is presented.

[Changes in the diagnosis and treatment of Zollinger-Ellison syndrome (author's transl)]. / Wandel von Diagnose und Therapie beim Zollinger-Ellison-syndrom.

A gastrinoma was found in 12 of 23 patients with Zollinger-Ellison syndrome. Those with gastrinoma were not different from those without as regarded fasting gastrin level, increased gastrin secretion after secretin and calcium, acid secretion, or survival time. Five of the 23 patients have died, four immediately postoperatively, the fifth of the metastasizing tumour. Treatment with the H2-receptor antagonist cimetidine avoided emergency operation and thus decreased operative mortality, giving time for localization by ultrasound, computed tomography and selective arteriography. The rate of false-negative results was high. Transhepatic selective catheterization of the pancreatic veins with gastrin determination gives localization of the tumour and identification of the secreted hormone. In three patients tumour resection was possible under cover of H2-receptor antagonist administration which normalized gastrin and acid secretion. There is a change in the treatment of the Zollinger-Ellison syndrome, away from total gastrectomy to conservative treatment with H2-receptor antagonists and an attempt of curative treatment by removal of the tumour.