Observation of bose-einstein condensation in a dilute atomic vapor.

A Bose-Einstein condensate was produced in a vapor of rubidium-87 atoms that was confined by magnetic fields and evaporatively cooled. The condensate fraction first appeared near a temperature of 170 nanokelvin and a number density of 2.5 x 10(12) per cubic centimeter and could be preserved for more than 15 seconds. Three primary signatures of Bose-Einstein condensation were seen. (i) On top of a broad thermal velocity distribution, a narrow peak appeared that was centered at zero velocity. (ii) The fraction of the atoms that were in this low-velocity peak increased abruptly as the sample temperature was lowered. (iii) The peak exhibited a nonthermal, anisotropic velocity distribution expected of the minimum-energy quantum state of the magnetic trap in contrast to the isotropic, thermal velocity distribution observed in the broad uncondensed fraction.

Randomized Comparison of Hypochlorous Acid With 5% Sulfamylon Solution as Topical Therapy Following Skin Grafting.

Objective: Infections are a serious complication of thermal injury. Excision and grafting have led to a decrease in incidence, but to ensure successful skin grafting, antimicrobial irrigants are frequently utilized to prevent infection. A safe, efficacious, and cost-effective irrigant capable of preventing infections would be a valuable adjunctive therapy. The objectives of this study were to determine whether the test article was noninferior to current therapy in controlling infection and reducing postoperative pain in patients with skin graft. Methods: Patients with burns requiring skin grafting were randomized to hypochlorous acid or 5% Sulfamylon solution as topical dressings postoperatively. Inclusion criteria included thermal injury 20% or more total body surface area requiring excision and autografting, and age 18 years or more. Exclusion criteria included pregnant females, chlorine sensitivity, and electrical/chemical/cold injuries. The following outcomes were assessed: patient demographics, graft viability, infection, pain score, narcotic usage, adverse events, and cost. Results: Treatment groups were demographically equivalent. There were no differences in adverse or serious adverse events between the 2 groups. Graft viability and infection rate were equivalent between the 2 groups. In addition, pain scores and narcotic usage were similar. Hypochlorous acid was significantly less expensive than 5% Sulfamylon solution. Conclusions: Hypochlorous acid demonstrated equivalent efficacy and safety compared with 5% Sulfamylon when used as the postoperative topical dressing for skin grafts. Hypochlorous acid was more cost-effective. This pilot study was limited by its small sample size. However, hypochlorous acid shows promise as a topical wound dressing and further study with larger groups is warranted.

Stimulant-induced exocytosis from neuronal somata, dendrites, and newly formed synaptic nerve terminals in chronically decentralized sympathetic ganglia of the rat.

Loss of preganglionic neurones underlies the autonomic failure of human multiple system atrophy. In rat sympathetic ganglia decentralization leads to new synapse formation. We explored whether these synapses are functional, and whether chronically decentralized neurones respond normally to activation, in terms of exocytosis. Potassium depolarization and cholinergic agonists were applied to freshly excised rat superior cervical sympathetic ganglia, preganglionically denervated with prevented reinnervation 5 months earlier. Ganglia were incubated and stimulated in the presence of tannic acid, which stabilizes released vesicle cores for subsequent electron microscopy. In denervated ganglia exocytosis was observed from newly formed synaptic nerve terminals, and from nonsynaptic surfaces of neurone somata and dendrites. The results demonstrated that the new intraganglionic synapses, which are mostly catecholaminergic, can function and that chronically decentralized sympathetic neurones remain capable of stimulant-induced exocytosis from somata and dendrites. The maximal release upon potassium depolarization did not differ significantly between denervated and contralateral ganglia. Relative to this, the exocytotic responses of decentralized somata and dendrites to nicotine resembled those of contralateral ganglia. Responses to muscarine were significantly less in denervated than in contralateral ganglia, indicating inhibition in dendrites. Responses to carbachol suggested interactions between nicotinic and excitatory muscarinic effects. Nerve terminals in denervated ganglia showed high basal release. Their responses to muscarine and carbachol resembled those of the decentralized neurones, from which most may originate. Their response to nicotine evidenced inhibition. Their actions, coupled with nonsynaptic effects of soma-dendritic exocytosis, might modulate responses of the decentralized neurone population to other surviving inputs. This modulation could be influential in disease-induced decentralization in man.

Ultrastructure and distribution of substance P-immunoreactive sensory collaterals in the guinea pig prevertebral sympathetic ganglia.

A light and electron microscopic study has been made of the substance P-immunoreactive networks formed by sensory nerve fibres in the prevertebral sympathetic ganglia of the guinea pig to seek confirmation that these networks arise from collateral branches of sensory fibres passing through the ganglia and to explore the synaptic and other specialized relationships established by these networks. Slices from coeliac-superior mesenteric and inferior mesenteric ganglia of young adult males, perfusion-fixed by paraformaldehyde, were immunostained with a monoclonal antibody to substance P, and the immunolabelling was visualized by a peroxidase reaction. Immunolabelled fibres passing through the ganglia were seen by light microscopy to give off varicose collaterals that ramified in the ganglionic neuropil. Electron microscopy showed that the parent fibres were almost exclusively unmyelinated. Many collaterals ran directly beneath the basal lamina bordering the intraganglionic tissue spaces, and the varicosities either remained superficially exposed under the basal lamina or sank deeper into the supporting Schwann cells, becoming apposed to dendrites of the ganglionic neurones, upon which they formed synapses, or to other nerve terminals. The incidence of these specific associations was quantified, singly and in combination. Synapses could be situated at the same level as unlabelled synapses on the same dendrite, and exposed varicosities could lie within 0.5 micron of exposed, postsynaptic dendrites. These observations confirm a collateral, synaptic nature for the networks and suggest additional nonsynaptic modes of release and sites of transmitter action. They are consistent with the hypothesis that the system serves a nocifensor function of axon reflex type.

Exocytotic release from neuronal cell bodies, dendrites and nerve terminals in sympathetic ganglia of the rat, and its differential regulation.

Stimulant-induced exocytosis has been demonstrated in sympathetic ganglia of the rat by in vitro incubation of excised ganglia in the presence of tannic acid, which stabilizes vesicle cores after their exocytotic release. Sites of exocytosis were observed along non-synaptic regions of the surfaces of neuron somata and dendrites, including regions of dendrosomatic and dendrodendritic apposition, as well as along the surfaces of nerve terminals About half the exocytoses associated with nerve terminals were parasynaptic or synaptic, and these appeared mostly to arise from the presynaptic terminal, but occasionally from the postsynaptic element. The results demonstrated that the neurons of sympathetic ganglia release materials intraganglionically in response to stimulation, that release from different parts of the neuron is subject to independent regulation, at least via cholinergic receptors, and that release is partly diffuse, potentially mediating autocrine or paracrine effects, and partly targeted toward other neurons, but that the latter mode is not necessarily, and not evidently, synaptic. Specifically, exocytosis from all locations increased significantly during incubation in modified Krebs' solution containing 56 nm potassium. Observation of the effects of cholinergic agonists (nicotine, carbachol, oxotremorine) and antagonists (atropine, AF-DX 116) showed that nicotinic and muscarinic excitation each, independently, increased the incidence of exocytosis from somata and dendrites. Exocytosis from nerve endings was not altered by nicotine, but was enhanced or, at high initial rates of exocytosis, decreased, by muscarinic stimulation. Evidence was obtained for muscarinic auto-inhibition of exocytosis from nerve terminals, occurring under basal incubation conditions, and for a muscarinic excitatory component of somatic exocytosis, elicitable by endogenous acetylcholine. The M2-selective muscarinic antagonist AF-DX 116 was found to modify the exocytotic response of the dendrites to oxotremorine, widening the range of its variation; this effect is consistent with recent evidence for the presence of M2-like muscarinic binding sites, in addition to M1-like binding, upon these dendrites [Ramcharan E. J. and Matthews M. R. (1996) Neuroscience 71, 797-832]. Over all conditions, disproportionately more sites of somatic and dendritic exocytosis were found to be located in regions of dendrosomatic and dendrodendritic apposition than would be expected from the relative extent of the neuronal surface occupied by these relationships. Such mechanisms of intraganglionic release may be expected to contribute to the regulation and integration of the behaviour of the various functionally distinctive populations of neurons in these ganglia, by autocrine, paracrine, and focal, neuroneuronal, routes of action. Similar phenomena of exocytotic soma-dendritic release might prove to subserve integrative neuroneuronal interactions more widely throughout the nervous system.

A quantitative study of structural features, synapses and nearest-neighbour relationships of small, granule-containing cells in the rat superior cervical sympathetic ganglion at various adult stages.

Groups and sub-groups (clusters) of small granule-containing cells ("small cells") were analysed at 3 and 6 micron intervals and in serial sections, in rats aged 2-13 months. Fully intraganglionic clusters of small cells were all found to receive an incoming ("afferent") innervation, of the order of 3-6 afferent terminals per cell, derived from axons of preganglionic type via multifocal, symmetrical, mainly axosomatic synapses. No evidence was obtained of sharing of preganglionic inputs between small cells and principal neurones. Intraganglionic clusters also regularly gave outgoing ("efferent") synapses of the asymmetrical type, of the order of 2-6 per cell, to intraganglionic nerve elements; 30-50% of these synapses were given from somata, 50-70% from processes of the small cells. Whenever the postsynaptic structure was identifiable these synapses were all found to be given to postganglionic neurones or their dendrites, principally to spine-like processes or slender twigs. In some ganglia a few efferent synapses to other small cells were observed; these were of the symmetrical type. Efferent synapses to nerve profiles resembling chemosensory axon terminals, also of the symmetrical type, were extremely infrequent (fewer than 1% of all efferent synapses) in intraganglionic small cell groups and appeared virtually restricted to glomus-like clusters of small cell, which lay intracapsularly, or in and near the bases of nerves entering or leaving the ganglion. Almost all groups and clusters of small cells were located near to fenestrated capillary vessels, which are not found elsewhere in the ganglion. The implications of possible non-synaptic release of material from small cells via membrane regions not covered by satellite cell cytoplasm, were explored in a nearest-neighbour analysis. These "exposed" regions comprised 1-3% of the small cell surface, a proportion comparable with those engaged in receiving afferent synapses or in giving efferent synapses. The majority of such regions faced toward other nerve profiles (axons and dendrites) ensheathed in satellite cytoplasm (mean 30%), intraganglionic tissue spaces wider than 3 micron (mean, 30%) or other small cells (mean, 14%); 25% faced toward blood vessels, but of these vascularly directed regions, only one fifth (or 5% of the total) on average faced directly toward fenestrated endothelium, the rest being non-fenestrated and/or separated by pericyte processes from the exposed regions of small cell membrane. Thirty-three percent of the small cells in a sample of 242 lay within 2 micron of the nearest blood vessel.(ABSTRACT TRUNCATED AT 400 WORDS)

Autoradiographic localization of functional muscarinic receptors in the rat superior cervical sympathetic ganglion reveals an extensive distribution over non-synaptic surfaces of neuronal somata, dendrites and nerve endings.

Fast synaptic transmission in sympathetic ganglia is mediated by acetylcholine, acting on nicotinic receptors, yet muscarinic receptors are also present and are involved in the production of slow postsynaptic potentials. In order further to elucidate the role of muscarinic receptors in ganglionic transmission their distribution in the rat superior cervical sympathetic ganglion was investigated autoradiographically by use of the tritiated irreversible muscarinic ligand propylbenzilylcholine mustard. It was observed that this agent blocked the carbachol-evoked hydrolysis of inositol phospholipids in the ganglion and that this response to carbachol is itself inhibitable by selective muscarinic antagonists with a potency sequence which indicates involvement primarily of M1 receptors. Light microscope autoradiography showed that labelling inhibitable by atropine and by the M1-selective muscarinic antagonist pirenzepine was essentially confined to the margins of neuronal somata and regions of dendritic arborization, which include synaptic contacts. Quantitative electron microscope autoradiography showed that binding of the radioligand, of which approximately 70% was inhibitable by atropine and 68% by pirenzepine, was associated predominantly with surface membranes of neuronal somata, dendrites, other neurites (including axons and uncharacterized dendrites) and nerve terminal profiles, in the approximate ratios 95:85:52:45. Of the inhibitable binding over neuronal membranes in the ganglion little more than 3% was found to be synaptically located, and this involved para- or peri-synaptic regions of nerve terminal contacts rather than the specialized synaptic zone. About 5% of the inhibitable binding over neuronal membranes involved non-synaptic surfaces of nerve terminals and preterminal axon segments; almost 70% was distributed over non-synaptic surfaces of neuronal somata and dendrites, and about 21% upon other neurites. Binding sites were found not to be more highly concentrated at or adjacent to synapses than over other regions of neuronal surface membranes. About 50%, possibly more, of the binding on non-synaptic surfaces of nerve endings, and about 7% of binding upon dendritic membranes, was of non-M1, possibly M2 type, inhibitable by atropine but not by pirenzepine. Non-synaptic neuro-neuronal appositions, which involve dendrites and somata and often lie adjacent to synapses, showed rather more than twice the binding expected for each membrane individually; and neuronal membrane exposed to basal lamina lining ganglionic tissue spaces showed high levels of binding. Little inhibitable binding was seen over membranes of satellite and Schwann cells, or over cytoplasmic territories or ganglionic interstitial tissue. A model was constructed of the distribution of label, which showed that the observed results for total binding could be approximately matched by assuming the following relative densities of ligand binding sites: interstitial tissue space and supporting cells 1, soma cytoplasm 3, cytoplasm of dendrites, neurites and nerve terminals 4.5, surfaces of mesodermal elements 15, surfaces of neurites and nerve endings including sites of synapse 45, surfaces of dendrites 90, surfaces of neuronal somata 120, non-synaptic neuro-neuronal appositions 180. It is concluded that functional muscarinic receptors in this sympathetic ganglion, predominantly of the M1 type linked with slow depolarizations, but including some non-M1 receptors, are widely distributed over non-synaptic surfaces of the neuronal somata and dendrites and are not concentrated at synapses. Presynaptic autoreceptors are also present, of which half or more are of non-M1, possibly M2, type which might be inhibitory. The presence of M4 receptors is not excluded...

Denervation-induced formation of adrenergic synapses in the superior cervical sympathetic ganglion of the rat and the enhancement of this effect by postganglionic axotomy.

A study has been made at the ultrastructural level of the effects of denervation and axotomy on the synapse population of the rat superior cervical ganglion. Superior cervical ganglia were subjected unilaterally to acute (survival, 48 h) or chronic preganglionic denervation (survival, 41-189 days) by cutting the cervical sympathetic trunk; in chronic denervation experiments regeneration of preganglionic nerve fibres into the ganglion was prevented by suturing the proximal (caudal) stump of the trunk into the sternomastoid muscle. In some chronic experiments the preganglionic denervation was combined with simultaneous crush axotomy of the major postganglionic branches of the ganglion, the internal and external carotid nerves (axotomized-denervated ganglia). Control observations were made in contralateral ganglia and in ganglia from normal rats. After excision and before fixation, ganglia were incubated briefly in the presence of 5-hydroxydopamine to label adrenergic vesicles. Chronic denervation caused a statistically significant 12% decrease from control values in the cytoplasmic minor axes of the principal ganglionic neurones; axotomy combined with chronic denervation led to a 6% increase in this dimension, which was not statistically significant. The minor axes of the neuronal nuclei did not differ significantly from control values in either type of experiment. Axotomy combined with denervation led however to a 36% decrease in the incidence of nucleated neuronal profiles per unit area of ganglion. Counts of synapses were made in the various classes of ganglia and their incidence was expressed per nucleated neuronal profile, to permit comparison within and between experiments. Normal and control ganglia showed a high incidence of synapses of preganglionic cholinergic type. Nerve terminal profiles and synapses containing small dense-cored vesicles, as distinct from the efferent synapses of small granule-containing cells, were not found to be present on the principal neurones or their dendrites in these ganglia, despite strong 5-hydroxydopamine labelling of small dense-cored vesicles within cell bodies and dendrites. After acute denervation extremely few residual synapses were found in the ganglion, in areas remote from small granule-containing cells, and these residual synapses were of the cholinergic type. Acute denervation led to the appearance of vacated or isolated postsynaptic densities; such densities were also found, but were fewer in number, in chronically denervated and axotomized-denervated ganglia.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuroneuronal interconnections in the rat superior cervical ganglion; possible anatomical bases for modulatory interactions revealed by intracellular horseradish peroxidase labelling.

Electrophysiologically identified neurons of rat superior cervical ganglion were intracellularly injected with horseradish peroxidase and processed for light and electron microscopic observation. At light microscope level, neurons could be classified according to their dendritic arborization pattern in the vicinity of the soma into radiate, tufted and intermediate types. Upon electrical stimulation of the internal and external carotid nerves it was observed that radiate and intermediate neurons sent their axons into one or the other of these nerve trunks, whereas a majority of tufted neurons gave no response to stimulation of either of these postganglionic nerves. Electron microscopic exploration of horseradish peroxidase-labelled neurons revealed a surprisingly high prevalence of interconnectivity between ganglionic neurons. These contacts were both dendrosomatic and dendrodendritic, and were a universal feature of the labelled neurons explored. Twenty-two of the 23 labelled cells were found to receive direct dendritic appositions on their somata, and 13 of these 23 cells were seen each to send their dendrites into contact with at least one unlabelled neuronal soma. Dendrodendritic contacts were observed for 87% of the labelled neurons, and most of the cells (80%) were seen to form triadic contacts which included two dendrites and a preganglionic nerve ending. All these figures represent minimum incidences. None of the dendrosomatic or dendrodendritic appositions observed was overtly synaptic although several morphological features indicated the possibility of somatic and or dendritic release and uptake at sites of apposition. It is suggested that the observed appositions provide anatomical substrates for modulatory interactions between the ganglionic neurons, possibly involving slow potentials or the switching of metabolic pathways.

Glioma-associated antigen expression in oligodendroglial neoplasms. Tenascin and epidermal growth factor receptor.

Epidermal growth factor receptor (EGFR), its variant, EGFRvIII, and tenascin are glioma-associated antigens that are hyperexpressed by neoplastic glial cells relative to normal brain, making them attractive antigenic targets for immunotherapy. Preliminary surveys indicate that oligodendroglial tumors also produce these proteins, although the exact patterns and degrees of reactivity are not known. In this study we examined the immunoreactivity of tenascin among 50 oligodendroglial tumors, including 25 well-differentiated oligodendrogliomas (WDOs) and 12 glioblastomas (GBMs) exhibiting high proportions of oligodendroglia-like cells. We used well-characterized immunoreagents with defined specificities against the target antigens on formalin-fixed, paraffin-embedded archival tissue. The tumors were graded according to WHO guidelines. Immunoreactivity was reported on a 1-3 scale according to staining intensity multiplied by a 1-3 distribution scale distribution within tumor as focal (1), multifocal (2), and diffuse (3) for both the parenchymal and the perivascular components. Although there is considerable overlap in antigen production among the grades of tumor, this study establishes the production of tenascin and wild-type EGFR (but not EGFR vIII) in oligodendroglial neoplasms and supports the concept that antigen production increases with tumor grade.

Continuous hemodialysis for the management of acute renal failure in the presence of cerebellar hemorrhage. Case report.

In this report the authors describe the use of continuous venovenous hemodialysis (CVVHD) in a medically unstable patient who suffered from a spontaneous cerebellar hemorrhage. Conventional dialysis techniques carry the risk of developing the dialysis disequilibrium syndrome (DDS) when performed in the presence of a variety of intracranial diseases. The CVVHD technique was used successfully in a morbidly obese, short-statured woman with a spontaneous hypertensive intraparenchymal cerebellar hemorrhage. The woman experienced acute renal failure several days after her hemorrhage and her general medical condition prevented her from undergoing surgical evacuation. The CVVHD did not result in elevations in intracranial pressure (ICP) and the patient made a full recovery from both acute renal failure and life-threatening posterior fossa hemorrhage. This case is noteworthy because of the absence of abnormally high ICP elevations or development of DDS in a patient with a large acute posterior fossa intraparenchymal brain hemorrhage and acute renal failure whose case was managed with CVVHD in the acute period.

Solubility of lead as lead (II) chloride in HEPES-Ringer and artificial seawater (Ca-ASW) solutions.

Total dissolved Pb was measured in a number of commonly used physiological solutions by electrothermal atomization atomic absorption spectrometry (ETA-AAS). In HEPES-buffered solutions (pH 7.30) the concentration of total Pb in solution ("measured" Pb) was only 77% of nominal Pb up to 20 microM added Pb, where experiments were undertaken at room temperature (22 +/- 1 degree C). However, test solutions equilibrated at 37 +/- 1 degree C contained 99% of added Pb up to 2 microM. Above this nominal concentration, percentage recoveries dropped to approximately 72% at a nominal concentration of 20 microM. Tris-buffered artificial seawater (CaASW) solutions (pH 7.60) contained more dissolved Pb compared to HEPES-buffered solutions at 22 degrees C. However, increasing the calcium concentration in ASW appeared to increase precipitation of PbCl2. Concentration-corrected dose-response relationships were plotted from previously published data on the effects of Pb on voltage-activated calcium channels of rat dorsal root ganglion (DRG) cells and Aplysia neurons. The plots suggest that the inhibitory effects of Pb on rat DRG cells may prevail at concentrations of Pb even lower than reported previously when measurements were made at 22 degrees C. However, increasing the temperature to 37 degrees C resulted in closer agreement between measured and nominal dose-response curves. The measured dose-response curves for the Tris-buffered ASW solutions closely followed those of the nominal up to 200 microM Pb. In ASW solutions containing 40 mM calcium, PbCl2 was precipitated at Pb concentrations greater than 200 microM.

Ventral hernia synthetic mesh repair infected by Mycobacterium fortuitum.

We report the occurrence of a refractory infection caused by the "rapidly growing" nontuberculous mycobacterium, Mycobacterium fortuitum, after incisional hernia repair using synthetic mesh. The patient had previously undergone three herniorrhaphies incorporating polypropylene mesh. Multiple surgical debridements were required, along with complete removal of all the mesh, to eradicate the infection. Prolonged antimicrobial therapy with sulfamethoxazole, an agent active against the patient's isolate, was also used. Although this atypical mycobacterium has been reported to cause a variety of infections, including many types of periprosthetic infections, this case represents successful treatment of M. fortuitum infecting abdominal wall mesh.

Pilomatrixoma of the head and neck in children.

OBJECTIVE: Pilomatrixomas are benign skin neoplasms of hair follicle origin. They are one of the most common superficial masses of the head and neck excised in children. Although the entity has been well studied in the literature, few studies have been undertaken to evaluate the clinical characteristics of head and neck pilomatrixomas specifically in children. The purpose of this study was to review the clinical characteristics and management of children presenting with pilomatrixomas of the head and neck at a large tertiary care pediatric hospital. STUDY DESIGN: A retrospective chart review was performed of all patients with histologically confirmed pilomatrixoma of the head and neck excised during a 6-year period (1992-1997) at the Children's Hospital of Philadelphia. RESULTS: Ninety-one cases of pilomatrixoma were confirmed in 86 patients. The age range was 5 months to 17 years. The median age at time of excision was 6.0 years. The most common sites of occurrence were the cheek (36%), neck (20%), periorbital region (14%), and scalp (9%). The male to female ratio was 1:1.5. Multiple lesions were found in 8.2% of patients. Surgical excision was curative in all cases. CONCLUSION: Pilomatrixoma is a cutaneous neoplasm that is one of most common causes of superficial head and neck masses in children. Although the presurgical diagnosis may be difficult in some cases, pilomatrixoma must be kept in the differential of superficial head and neck masses in children. Surgical excision is almost always curative.

Development of a colocutaneous fistula in a patient with a large surface area burn.

A 61 year old female sustained a large surface area burn, complicated by inhalation injury. One month before the incident, she had undergone a left hemicolectomy with colorectal anastomosis for diverticular disease. Due to the severity of her burns, multiple surgical debridement and skin grafting procedures were required, including a large fascial debridement of her flank and back. Her hospital course was complicated by recurrent episodes of pulmonary and systemic infection, as well as pre-existing malnutrition. Prior to her discharge to a rehabilitation center, stool began to drain from her left posterior flank. This complication represented a colonic fistula arising from the recent colon anastomosis. The fistula was managed nonoperatively and gradually closed. To our knowledge, this is the first report of a colocutaneous fistula spontaneously draining from the abdomen via the retroperitoneum in a burn victim, not related to direct thermal injury to the peritoneal cavity.

Fine-needle aspiration cytology of "ancient" schwannoma.

The term "ancient" schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. Prior to the realization that the observed atypia was a regressive phenomenon, many of these lesions were erroneously diagnosed as sarcomas. Fine-needle aspiration (FNA) cytologic material from five patients is included in this study. Tissue examined histologically included four resected tumors and 18 gauge core biopsies of one tumor. Aspirates of ancient schwannoma showed many of the same features as FNA of regular schwannoma: aggregates of spindled cells with indistinct cytoplasm and elongate nuclei with blunt point ends. The feature unique to these lesions was nuclear pleomorphism, which was identified in all aspirates. Nuclear inclusions were identified in all but one case. Cystic degeneration, xanthomatous changes, and perivascular sclerosis were identified in excised lesions. Ancient schwannomas show most of the FNA features of benign schwannomas but can demonstrate marked nuclear atypia. The FNA features of ancient schwannoma are important to note because of the potential to confuse this lesion with a more serious one such as sarcoma on FNA.

Rationale for 'early' percutaneous dilatational tracheostomy in patients with burn injuries.

Several investigators have cited the numerous complications that occur with conventional tracheostomies in patients with burn injuries. However, none of these studies included the technique of percutaneous dilatational tracheostomy, which has been shown to significantly decrease operative time, cost, perioperative, and long-term sequelae as compared to conventional tracheostomy. A retrospective analysis of 36 patients with burn injuries, from 1400 burn admissions, was conducted to compare conventional tracheostomy versus percutaneous dilatational tracheostomy. In this study, percutaneous dilatational tracheostomy resulted in significantly decreased operative times and cost compared to conventional tracheostomy. There were no major operative complications in either group, and alveolar-arterial oxygen gradients were improved in 71% of the patients with a tracheostomy. Percutaneous dilatational tracheostomy is an efficacious technique for airway management in patients with burn injuries. It can be safely performed at the bedside, at one fourth the cost of a conventional tracheostomy. Percutaneous dilatational tracheostomy may also benefit the patient with severe burns by decreasing alveolar-arterial oxygen gradients. Improved ventilatory mechanics might allow for a shorter duration of mechanical ventilation, thereby decreasing patient morbidity, hospital stay, and cost.

Source and origin of nerve fibres immunoreactive for substance P and calcitonin gene-related peptide in the normal and chronically denervated superior cervical sympathetic ganglion of the rat.

Immunohistochemical studies of sympathetic ganglia have indicated that the normal rat superior cervical ganglion contains both SP-IR and CGRP-IR fibres, and CGRP- and SP-immunoreactivity coexist in some fibres. In rat sympathetic ganglia decentralization by preganglionic denervation leads to intraganglionic increase of peptidergic fibres immunoreactive (IR) for substance P (SP) and calcitonin gene-related peptide. We explored the sources of SP- and CGRP-IR fibres in normal and in chronically decentralized rat SCGs. The distribution of immunoreactivities for CGRP and SP was determined in SCGs of normal rats and of rats following preganglionic denervation followed by sensory denervation. Ganglia were studied after short-term (2-5 days) sensory denervation, and long-term (7-16 months) sympathetic denervation followed by short-term (2 days) sensory denervation. To explore for the production of SP and CGRP by intrinsic neurones within the ganglion, normal and chronically decentralized SCGs were examined following pretreatment by local in vivo application of colchicine. Normal and chronically decentralized ganglia were also injected with fluorescent tracer Fluorogold for retrograde tracing of extrinsic fibres back to their neurones of origin. The observations suggest that in normal SCG in the rat the SP-IR and CGRP-IR nerve fibres are derived via direct links from vagus and glossopharyngeal nerves and the cervical plexus, or from nerve fibres running along the cervical sympathetic trunk, and the external carotid and the internal carotid nerves. Sensory nerve inputs to the rat SCG following decentralization may contribute to the low levels of ganglionic activation observable in the autonomic failure of multiple system atrophy in man.