Distribution of pulmonary blood flow and total lung water during partial liquid ventilation in acute lung injury.

BACKGROUND: Gas exchange is improved during partial liquid ventilation (PLV) with perfluorocarbon in animal models of acute lung injury. The mechanisms are not fully defined. We hypothesize that redistribution of pulmonary blood flow (PBF) along with redistribution of, and decrease in, total lung water (TLW) during PLV may improve oxygenation. METHODS: We characterized PBF and TLW in anesthetized adult dogs by using positron emission tomography with H2(15)O. Measurements of gas exchange, PBF, and TLW were made before and after acute lung injury was induced with intravenous oleic acid. The same measurements were made during PLV (with 30 ml/kg perfluorocarbon) and compared with gas ventilated (GV) controls. RESULTS: Oxygenation was significantly improved during PLV. PBF redistributed from the dependent zone of the lung to the nondependent zones, thus potentially improving ventilation/perfusion relationships. However, a similar pattern of PBF redistribution was observed during GV such that there was no significant difference between groups. TLW redistributed in a similar pattern during PLV. By quantitative measurements, PLV ameliorated the continued accumulation of TLW compared with GV animals. CONCLUSIONS: We conclude that PBF and TLW redistribution and attenuation of increases in TLW may contribute to the improvement in gas exchange during PLV in the setting of acute lung injury.

Behavioral effects of spinal cord transection in the developing rat.

Albino rats, 0, 9, 12, 15, 18, 21 or greater than 90 days of age, were given a mid-thoracic spinal cord transection. Evaluation of responses of the hindlimbs to a variety of behavioral tasks was begun on the day of surgery and at intervals throughout the postoperative survival period (up to 300 days). Two investigators, independently and without knowledge of the animals' ages or survival times, rated the response data. Histological study showed all transections to be complete. Large differences in behavior are observed when animals trasected at the neonatal stage (0-4 days of age) are compared with animals transected at the weanling stage (21-26 days of age)37. Results of the present investigation indicate a critical period near 15 days of age; animals lesioned prior to this age (0, 9, 12 days of age) show response development and recovery similar to the neonatally lesioned animal, whereas those animals lesioned at a later age (18, 21, greater than 90 days of age) show little recovery and are behaviorally similar to the weanling transected animal. In animals lesioned prior to the fifteenth postnatal day, postural responses appear depressed for a brief period but recover rapidly while most responses of animals in the older groups are depressed for longer periods and never attain the degree of recovery characteristic of the neonatally transected animal. Finally, like the neonatally transected animal, rats lesioned on the ninth and twelfth postnatal day develop certain responses at appropriate times relative to normal response development. If, however, these responses are mature and supraspinal control is present at the time of lesioning, they appear to be permanently depressed and fail to recover.

Synaptogenesis in the intermediate gray region of the lumbar spinal cord in the postnatal rat.

Mid-thoracic spinal cord transection produces dramatically different behavioral results depending upon a rat's age at the time of surgery. The present study was initiated to determine whether the synaptic development in the gray matter of the normal, developing spinal cord differs before and after the period when maximal behavioral recovery occurs. The L6 segments from 10 groups of animals, 0--30 days of age, taken at 3 day intervals (4 animals/group) were studied by light microscopy. Areal measurements of the gray matter were made using an integrating x-y tablet interfaced to a computer. Cell size, cell density and area of neuropil were evaluated in the lateral portions of the intermediate gray matter, laminae VI and VII. Electron microscopic analyses of synaptogenesis were performed on material from the same region in animals 3, 12, 15, 21 and 30 days old using similar morphometric methods while taking note of vesicle, junctional, and mitochondrial morphology. A 60% increase in area of neuropil paralleled a linear increase, of comparable magnitude, in area of the gray matter until 15 days of age when both curves reached plateau. Neuronal perikaryal size remained constant (congruent to 200 sq. microns in plane of nucleolus) throughout development and so could not have contributed to the increase in area of gray matter. Areal measurements of the size and counts of the number of vesicle containing profiles demonstrated a 50% increase in density of axon terminals between 3 and 12 days of age and a steady decline thereafter. The size of vesicle-containing profiles in laminae VI and VII remained constant at a small value (congruent to 0.35 sq microns) until 12 days of age, showed rapid growth to 0.54 sq. microns between 12 and 15 days of age, followed by a more moderate increase in sectional area after 15 days. These results suggest that during the period when recovery of function follows spinal injury, synaptogenesis in the intermediate gray region of the lumbar spinal cord proceeds rapidly, while at stages when little recovery of function follows spinal transection, synaptogenesis is essentially complete.

A comparison of the effect of mid-thoracic spinal hemisection in the neonatal or weanling rat on the distribution and density of dorsal root axons in the lumbosacral spinal cord of the adult.

Transecting the thoracic spinal cord of the rat has markedly different effects on behavioral responses of the hindlimbs if the lesion is made at the neonatal or weanling stage of development. The present investigation tested the possibility that the behavioral differences were related to a difference in the distribution or density of dorsal root connections in the lumbosacral spinal cord. In order to use each animal as its own control the distribution and density of dorsal root axons was compared on the two sides of the L5-S1 segments of the lumbosacral spinal cord in adult rats given a mid-thoracic spinal hemisection at the neonatal or weanling stage of development. Comparing the experimental (initially hemisected side) and control sides of the cord, we found no evidence for a change in the distribution of dorsal root axons. The distribution of Fink-Heimer stained degeneration 4--6 days after bilateral spinal root section was virtually identical on the two sides of the cord from animals hemisected at either stage. However, in rats spinally hemisected at the neonatal stage (n = 8), a significantly greater density of dorsal root degeneration was found within the intermediate nucleus of Cajal (INC) on the experimental side using coded material and a blind analysis. No difference in the density of dorsal root degeneration was detected in the group of rats spinally hemisected at the weanling stage (n = 6). Controls indicated that the increased density of degeneration was not due to compression resulting from shrinkage of the INC or to degeneration remaining from the initial hemisection. We conclude that the increased amount of argyrophilia within the INC of neonatally hemisected rats is due to an increased density of dorsal root axons in this zone. This result supports the hypothesis that the behavioral differences found when comparing animals transected at the neonatal or weanling stages of development are related to an increased number of dorsal root connections within the lumbosacral spinal cord.

Intradural extension of a sacrococcygeal teratoma.

Intradural extension of a sacrococcygeal teratoma (SCT) is extremely rare and only well-documented in presacral tumors that have been associated with a familial history, anorectal stenosis, and sacral dysraphism. This case documents the extension of a type I SCT into the dural sac with attachment to the filum terminale. A full-term female was transferred to our tertiary newborn intensive care unit with a sacral mass measuring 12 x 13 cm. It protruded from the buttocks and displaced the anus anteriorly. Rectal examination showed no presacral component. Radiographs demonstrated calcification in the soft tissue mass and a normal-appearing sacrum with the last sacral segment not visualized. At operation during dissection of the cephalad component, the SCT extended into the spinal canal. Neurosurgical consultation resulted in a sacral laminectomy which revealed the tumor to be attached to the tip of the filum terminale. The tumor was removed in toto with all sacral roots preserved. The infant required a second operation to revise a wound dehiscence and suspected cerebrospinal fluid leak. The final pathology report was benign SCT. Follow-up at 2 years showed no recurrence, normal sphincter tone, and a normal computed tomography scan. This represents the first well-documented intradural extension of a Type I SCT with attachment to the spinal cord. This extremely rare occurrence requires awareness with the availability of neurosurgical support to expedite operative management.

Stenotic origin of an aberrant left subclavian artery from a right-sided aortic arch. A case report.

A patient with a right-sided aortic arch giving origin to an aberrant left subclavian artery with circumferential ostial stenosis is reported. This asymptomatic anomaly was discovered serendipitously during cerebral arteriography for subarachnoid hemorrhage. The embryologic origin of this anatomic variant is discussed, as are some practical implications relating to the angiographic technique of selective catheterization of branches of the aortic arch.

Enhancing transdural lumbar disk herniation.

Transdural migration of an intervertebral disk fragment is accompanied by more severe clinical manifestations than the more common extradural disk herniation. We report on two patients with transdural lumbar disk herniation who had had no previous surgery. In both, there was intense enhancement of the intradural disk material on magnetic resonance imaging. The pathological specimen showed vascularization of the intradural fibrocartilage in one patient.

Scattered UV irradiation during VISX excimer laser keratorefractive surgery.

PURPOSE: To evaluate the potential occupational health hazards associated with scattered ultraviolet (UV) radiation during photorefractive keratectomy (PRK) using the VISX Star S3 excimer laser. SETTING: The Laser Vision Center, National Naval Medical Center, Bethesda, Maryland, USA. METHODS: Intraoperative radiometric measurements were made with the Ophir Power/Energy Meter (LaserStar Model PD-10 with silicon detector) during PRK treatments as well as during required calibration procedures at a distance of 20.3 cm from the left cornea. These measurements were evaluated using a worst-case scenario for exposure, and then compared with the American Conference of Governmental Industrial Hygeinists (ACGIH) Threshold Value Limits (TVL) to perform a risk/hazard analysis. RESULTS: During the PRK procedures, the highest measured value was 248.4 nJ/pulse. During the calibration procedures, the highest measured UV scattered radiation level was 149.6 nJ/pulse. The maximum treatment time was 52 seconds. Using a worst-case scenario in which all treatments used the maximum power and time, the total energy per eye treated was 0.132 mJ/cm2 and the total UV radiation at close range (80 cm from the treated eye) was 0.0085 mJ/cm2. With a workload of 20 patients, the total occupational exposure at 80 cm to actinic UV radiation in an 8-hour period would be 0.425 mJ/cm2. CONCLUSIONS: The scattered actinic UV laser radiation from the VISX Star S3 excimer laser did not exceed occupational exposure limits during a busy 8-hour workday, provided that operating room personnel were at least 80 cm from the treated eye. While the use of protective eyewear is always prudent, this study demonstrates that the trace amounts of scattered laser emissions produced by this laser do not pose a serious health risk even without the use of protective eyewear.

Gliosarcoma developing from an irradiated ependymoma.

A 17-year-old girl was operated for a cystic mass located deep within the left parieto-occipital white matter. Histologically the tumor was an ependymoma with a vascular stroma. In spite of irradiation the tumor recurred locally twice, 1 and 2 years respectively after the original operation. The ependymoma portion of the tumor remained unchanged, but the stroma showed increased vascular hyperplasia at the time of the second operation and transformation into a fibrosarcoma in the third operative specimen. Proliferating cell markers (MIB-1) were positive only in the ependymoma cell nuclei in the first two specimens, but were also extensively present in the nuclei of the fibrosarcoma in the third specimen. In the latter, the fibrosarcoma portion greatly overwhelmed the residual ependymoma islands, but remained sharply delineated from them. This is the first observed case of a gliosarcoma originating from an ependymoma. The histological pattern of this mixed tumor clearly indicates that the source of the sarcomatous portions was the neoplastically transformed fibrovascular stroma of the original tumor, rather than "desmoplastic" alterations of the neoplastic ependymal cells themselves.

Measuring functional residual capacity in normal and oleic acid-injured lungs.

Functional residual capacity (FRC) is an important oxygen reserve that is often depleted in acute respiratory failure. Recent interest in the mechanisms of liquid ventilation and limited experience in measuring FRC in paralyzed, mechanically ventilated, normal and lung-injured animal models have mandated development of accurate laboratory techniques. Eight sheep, from 17 to 27 kg, were anesthetized and instrumented to provide a tracheostomy, a pulmonary artery catheter, and carotid arterial line. They were randomized to two groups, one of which received 0.07 ml/kg of intravenous oleic acid to induce lung injury. Gas ventilation of both groups was identical except for respiratory rate, which was adjusted to normalize PaCO2. FRC was measured in duplicate by both helium dilution (HD) and body plethysmography (BP). When measurements were completed, the animals were euthanized and their endotracheal tubes clamped at end expiration. The lungs were then removed and their water displacement (WD) FRC values were measured. FRC was the difference between WD and tissue weight assuming 1 ml = 1g. Pearson's correlation coefficient (R(2)) was calculated. During in vitro measurement of test lungs, HD had an R(2) value of 0.99 and BP had an R(2) value of 0.98. When compared to WD, in vivo measurement of FRC by HD had an R(2) value of 0.94 while the value for BP was 0.97. In conclusion, both HD and BP are accurate methods of determining FRC in an uninjured and injured lung model when compared to postmortem WD. Documenting changes in FRC will aid in elucidating the mechanisms of alternative ventilatory techniques.