Effect of solvent pre-treatment on the physicochemical, thermal profiles and morphological behavior of Mangifera pajang seed fat

In this work, the effect of solvent pre-treatment (hexane, petroleum ether and ethanol) on the physicochemical, thermal and morphology behavior of Mangifera pajang seed fat (MPSF) were investigated. Fat extraction was performed using Soxhlet method, and results showed that the yield, physicochemical, and crystalline structures of the MPSF were significantly (p < 0.05) influenced by the extraction solvents. Hexane gave the highest fat yield (7.67 %) with low unsaturation value (52.13 g iodine/g) compared with petroleum ether and ethanol. Hexane MPSF also had low oxidation rate (peroxide value of 1.1 mEq/g). Both non-stabilized and stabilized hexane MPSF showed a single melting endothermic peak at high temperature with onset, maximum peak and offset temperature of 16.23 ˚C-18.21 °C, 28.22 ˚C-31.25 °C and 34.85 ˚C-39.58 °C, respectively. Hexane MPSF crystallized rapidly at high temperature with single maximum peak starting at 16.51 ˚C-16.68 °C and ending at 0.23 ˚C-1.13 °C. In comparison with ethanol extract, hexane MPSF demonstrated a compact crystalline structure with a large densely packed center. Therefore, MPSF obtained from hexane presented better overall quality than those obtained from other extraction solvents. MPSF exhibited similar melting and morphological behavior to mango kernel fat and commercial cocoa butter. These results suggested that hexane was the best solvent for the extraction of MPSF. This fat also has the potential to be applied as a cocoa butter alternative fat or functional fat.

Angiosarcoma - a rare fatal cause of recurrent pericardial effusions

A 40-year-old man presented to the Hospital Sultanah Bahiyah, Alor Setar, Kedah, with constitutional and respiratory symptoms. Physical examination and echocardiogram demonstrated massive pericardial effusion. Patient required multiple attempts of pericardiocentesis due to recurrent pericardial effusion. Initial workup including pericardial fluids examination and computed tomography imaging did not reveal any apparent cause. Magnetic resonance imaging showed a suspicious mass infiltrating into the right atrium. Autoimmune screening was negative. Patient was subsequently treated as having tuberculous pericarditis. However, his disease progressed rapidly and he eventually passed away due to right atrial rupture. Postmortem revealed a ruptured right atrial tumour leading to massive haemothorax. Histopathological examination confirmed the diagnosis of primary pericardial angiosarcoma.

[Analysis of mental state of allergic rhinitis patients in Chengdu city by symptom check list 90 (SCL-90) scale]

Objective: To analyse the mental state of patients with allergic rhinitis (AR) in Chengdu. Methods: One thousand five hundred and thirty-six AR patients from Sichuan Provincial Integrated Traditional Chinese and Western Medicine Hospital, West China Hospital of Sichuan University, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan People's Hospital, Sichuan Second Hospital of Traditional Chinese Medicine were selected from July 2013 to January 2018. Eight hundred and twenty-seven patients were screened into study group by inclusion and exclusion standards. The symptom check list 90 (SCL-90) was used to group and score the mental state of these patients according to nine classification criteria: gender, BMI, age, marital status, monthly salary, disease duration, living environment, education level and working environment. Then, the scores were compared within groups. Inter-group comparison was made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, i.e. nasal itching, sneezing, clear discharge and nasal congestion, were scored on the visual analogue scale (VAS). SPSS 19.0 software was used to carry out statistical analysis. Partial correlation analysis was performed between the positive factors and the symptom scores by multiple regression statistical method. Results: The total score of SCL-90 in the study group was 2.64±0.25, which was accorded with mild to moderate mental health impairment. There were 124 (15.0%) without mental health damage, 176 (21.3%) with mild damage, 474 (57.3%) with mild to moderate damage, 41 (5.0%) with moderate to severe damage and 12 (1.4%) with severe damage. The in-group comparison showed that the top three categories of different items were the living environment, gender and working environment. The scores of somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, psychosis, other (sleep, diet) and total average score of urban residents were higher than that of country residents (3.29±0.61 vs 2.65±0.50, 2.81±0.77 vs 2.05±0.38, 3.10±0.19 vs 2.49±0.67, 3.40±0.84 vs 2.49±0.70, 3.04±0.64 vs 2.33±0.51, 3.02±0.55 vs 2.40±0.77, 3.40±0.41 vs 2.52±0.77, 2.91±0.11 vs 2.29±0.40, Z value was 4.88, 5.25, 4.57, 5.91, 5.09, 4.63, 5.55, -4.55, respectively, all P<0.05). Women scored higher than man for somatization, interpersonal sensitivity, depression and others (2.66±0.51 vs 2.00±0.45, 3.37±0.47 vs 2.63±0.51, 3.44±0.57 vs 2.85±0.52, 3.47±0.36 vs 2.76±0.45, Z value was -5.10, -5.51, -4.86, -5.28, respectively, all P<0.05). The scores of somatization, interpersonal sensitivity, psychosis and other (sleep, diet) were higher in the indoor group than those in the outdoor group (3.49±0.64 vs 2.78±0.46, 3.33±0.30 vs 2.56±0.68, 3.28±0.60 vs 2.67±0.31, 3.50±0.85 vs 2.85±0.37, Z value was 5.31, 5.79, 4.89, 5.00, respectively, all P<0.05). The outdoor group scored higher on obsessive-compulsive symptoms, anxiety and hostility (3.44±0.40 vs 2.83±0.35, 3.40±0.50 vs 2.57±0.93, 3.34±0.88 vs 2.69±0.56, Z value was 4.96, 6.22, 5.08, respectively, all P<0.05). The inter-group comparison found that depression, anxiety, psychosis and other (sleep, diet) could be partially correlated with VAS scores as 4 positive factors. The results of partial correlation analysis showed that depression was positively correlated with sneezing and nasal runny discharge, anxiety was positively correlated with nasal itching and nasal obstruction, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with nasal runny discharge and nasal obstruction. Conclusion: AR patients have mild to moderate mental health impairments, which are correlated with AR symptoms.

Engineering Vaccines to Reprogram Immunity against Head and Neck Cancer

The recent Food and Drug Administration's approval of monoclonal antibodies targeting immune checkpoint receptors (ICRs) for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) offers exciting promise to improve patient outcome and reduce morbidities. A favorable response to ICR blockade relies on an extensive collection of preexisting tumor-specific T cells in the tumor microenvironment (TME). ICR blockade reinvigorates exhausted CD8+ T cells and enhances immune killing. However, resistance to ICR blockade is observed in about 85% of patients with HNSCC, therefore highlighting the importance of characterizing the mechanisms underlying HNSCC immune escape and exploring combinatorial strategies to sensitize hypoimmunogenic cold HNSCC to ICR inhibition. Cancer vaccines are designed to bypass the cold TME and directly deliver cancer antigens to antigen-presenting cells (APCs); these vaccines epitomize a priming strategy to synergize with ICR inhibitors. Cancer cells are ineffective antigen presenters, and poor APC infiltration as well as the M2-like polarization in the TME further dampens antigen uptake and processing, both of which render ineffective innate and adaptive immune detection. Cancer vaccines directly activate APC and expand the tumor-specific T-cell repertoire. In addition, cancer vaccines often contain an adjuvant, which further improves APC function, promotes epitope spreading, and augments host intrinsic antitumor immunity. Thus, the vaccine-induced immune priming generates a pool of effectors whose function can be enhanced by ICR inhibitors. In this review, we summarize the major HNSCC immune evasion strategies, the ongoing effort toward improving HNSCC vaccines, and the current challenges limiting the efficacy of cancer vaccines.

[Desmoplastic fibroblastoma: a clinicopathologic analysis of 7 cases]

Objective: To investigate the clinical features, immunohistochemical and differential diagnosis of desmoplastic fibroblastoma. Methods: The clinical data and pathology features of 7 cases of desmoplastic fibroblastoma were collected and immunohistochemical study were carried out in all cases with a review of the literatures. Results: There were 2 males and 5 females, with age ranging from 31 to 71 years (average and mean age were 59 and 61 years, respectively). The tumors were located in extremities and abdomen (left toe and right toe, right foot back, left leg and right thigh, right forearm and left hepatic lobe). Clinically, the tumors presented as slow growing painless masses of long standing duration. Grossly, the tumors were well-circumscribed with firm, white to gray cut-off surface. Tumor size ranged from 1.2 to 4.0 cm in maximum diameter (average 3.0 cm). Microscopically, 2 cases were located in dermis, 4 cases were located in subcutaneous and 1 case was located in liver parenchyma. It was composed of spindle-shaped or stellate cells with a fibroblastic or myofibroblastic appearance, and sparsely scattered in densely fibrous or fibromyxoid background. There was small vascular component in tumor background. At high magnification, the tumor cells were medium size with abundant cytoplasm, and the nucleus were small and always with small nucleoli. In some cases, the tumor cells were slightly larger with enlarged nuclei, but without cellular atypical and mitosis. Immunohistochemical study showed that the tumor cells were strongly positive for vimentin, desmin, S-100 protein and CD34, but CKpan was negative. α-SMA showed focal positive in one case. Ki-67 index ranged from 1% to 2%. Four cases were followed-up (ranged from 11 to 21 months, average 16.5 months) and the patients had no recurrence after surgery. Conclusions: Desmoplastic firoblastoma is a rare soft benign tumor. The differential diagnosis includes other benign or low-grade fibroblastic/myofibroblastic lesions.

Emergency Lung-Sparing Surgical Repair of a Complete Transection of the Right Mainstem Bronchus due to Blunt Chest Trauma

Traumatic chest injury with complete tracheo- bronchial disruption is uncommon and occurs in approximately 1% of motor vehicle accidents (MVA) (1,2). Such injuries carry a high mortality and patients rarely survive transfer to hospital. A high index of suspicion facilitates early diagnosis. Early operative intervention is vital for survival. We describe a rare case of traumatic complete disruption of the right mainstem bronchus (RMB) due to blunt chest trauma. The transected airway was reanastomosed emergently avoiding a lung resection.

Experiences in caring for the dying: a doctor's narratives

The study of narratives is increasingly noted for its value in the professional and personal development of doctors. We present the narratives of one of the author's experiences in the care of dying patients over a span of three decades. From the narratives, we identified three paradigms with which doctors respond to and care for dying patients and their families: 'No death', where there is a general denial of death and dying; 'Death', where the care provider's focus is directed to the facilitation of a 'good' death; and 'Life', where the doctor responds to the patients' death and dying as integrated and inseparable aspects of the patient's and family's life. The origins and implications of the paradigms are discussed. In addition to good communication, these narratives underscore the importance of personal reflection and insight when providing end-of-life care.

Flow studies in three-dimensional aorto-right coronary bypass graft system

This paper presents the fluid dynamics of blood flow in a coronary bypass model of the aorto-right coronary bypass system. Three-dimensional computational fluid dynamic simulations are developed of the blood flow in coronary artery-bypass systems, using the computational fluid dynamics software (FLUENT 6.0.1). These blood flow simulations are performed within small intervals of the cardiac cycle, using input data consisting of physiological measurements of flow rates in the aorta, obtained from earlier studies. We have calculated the flow-field distributions of the velocity and the wall shear stress at four typical instants of the cardiac cycle, two during systole and two during the diastole phase. Plots of velocity vector and the wall shear stress are displayed in the aorto-graft-coronary arterial flow-field domain, providing an insight into the link between fluid dynamics and arterial diseases. The prime regions of disturbed flow patterns are at the entrance into the graft from the aorta and at the exit from the graft into the right coronary artery. Our objective is to obtain an understanding of how the coronary artery is perfused by the graft, and thereby into the factors affecting graft patency.

Particle image velocimetry measurements of three proximal anastomosis models under a pulsatile flow condition

This study was designed to examine the effects of the anastomotic angle on the flow and haemodynamic parameter distribution patterns of the proximal anastomoses, with emphasis on identifying site-specific haemodynamic features that could reasonably be expected to trigger the initiation and further development of anastomotic intimal hyperplasia. Particle image velocimetry measurements were carried out with three simplified glass proximal models under a physiological flow condition. The results revealed that the disturbed flow and the induced shear stress patterns including low recirculation flow, stagnation point, high wall shear stress, high temporal wall shear stress gradient, low time-averaged wall shear stress (TAWSS), and high oscillating shear index (OSI) occurred around the anastomotic joints and the flow field at proximal anastomosis was strongly affected by the anastomotic angle. Among the three models investigated, the 45° backward anastomosis is found to have a smaller low-recirculation-flow region along the graft inner wall, non-stationary stagnation, and separation points, a higher TAWSS and smaller high-OSI low-TAWSS and low-OSI high-TAWSS regions.

Intraductal papillary neoplasms of bile duct. A distinct entity like its counterpart in pancreas

To recognize the new entity-intraductal papillary neoplasia of bile duct in liver, the authors reviewed the clinical records of sixteen patients, analyzed the microscopic features, and selected immunohistochemical reactivity (cytokeratins and mucins) that might correlate with classification. Ten patients were male and six were female, with a mean age of 58 years (range, 21-73 years). According to their cell phenotypes, these papillary tumors were classified as intestinal type (6 cases), pancratobiliary type (4 cases), gastric type (5 cases) and oncocytic type (1 case). Most were located in the left hepatic duct and accompanied with bile duct dilatation (10 cases). Eight showed minimal expansile invasion into the ductal wall and eight were noninvasive. Five patients were treated with a hepatectomy, three underwent segmental resections, and one underwent a left hepatic lobectomy. One patient died of unrelated causes 6 years after operation, and another died of postoperative complications. The remaining 7 patients are alive and disease free 1-5 years after surgery. Because of its distinct clinical, pathological features and a favorable prognosis can be expected after complete surgical resection, we suggested that intraductal papillary neoplasia should be distinguished from other types of peripheral cholangiocarcinoma, as a distinct entity, like its counterparts in the pancreas. Neoexpressed and overexpressed mucins are of clinical value as a marker for supportive diagnosis, prognosis or monitoring therapy.

Schwannoma of the gastrointestinal tract: a clinicopathological, immunohistochemical and ultrastructural study of 33 cases

AIMS

Thirty-three cases of gastrointestinal schwannomas were analysed to elucidate their peculiar clinicopathological, immunohistochemical and ultrastructural features.

METHODS AND RESULTS

The patients were 16 men and 17 women, whose ages ranged from 27 to 81 years (median 52.6 years). Tumour size ranged from 10 to 120 mm in diameter. Follow-up in 23 cases from 6 months to 13 years showed no recurrences or metastases. Microscopically, all tumours were composed of spindle cells with focal epithelioid cells in four cases. In all cases except one, there were peripheral cuff-like lymphoid aggregates. Immunohistochemically, tumours were strongly positive for S100 protein and vimentin, the tumours were variably positive for nestin (78.8%, 26/33) and glial fibrillary acidic protein (63.6%, 21/33), three tumours had CD34+ cells, but all were negative for CD117, alpha-smooth muscle actin and desmin. Ultrastructurally, the tumours were composed of elongated spindle shaped cells with prominent parallel membranous structures.

CONCLUSIONS

Gastrointestinal schwannomas have characteristic histological features, especially the presence of a lymphoid cuff, that are different from their soft tissue and central nervous system counterparts. Gastrointestinal tract schwannomas behave in a benign fashion.

Numerical Study on the Pulsatile Flow Characteristics of Proximal Anastomotic Models

Haemodynamics was widely believed to correlate with anastomosis restenosis. Utilizing the haemodynamic parameters as indicator functions, distal anastomosis was redesigned by some researchers so as to improve the long-term graft patency rate. However, there were few studies upon the proximal anastomosis. Therefore, in this study, flow characteristics and distributions of the haemodynamic parameters in proximal anastomosis under physiological flow condition have been investigated numerically for three different grafting angles: namely, 45° forward facing, 45° backward facing, and 90° anastomotic joints. The simulation results showed a flow separation region along the graft inner wall immediately after the heel at peak flow phase and it decreased in size with the grafting angle shifting from 45° forward facing to 45° backward facing. At the same time, a pair of vortex was found in the cross-sectional planes of the 45° backward facing and 90° grafts. In addition, stagnation point was found along the graft outer wall with small shifting during the physiological cycle. High spatial and temporal wall shear stresses gradients (WSSG) were observed around the anastomotic joint. Low time-averaged wall shear stress (WSS) with elevated oscillation shear index (OSI) was found near the middle of anastomosis at the aorta wall and along the graft inner wall respectively, while high time-averaged WSS with low OSI was found at the heel, the toe, and the region downstream of the toe. These regions correlated to early lesion growth. Elevated time-averaged WSSG was found at the same region, where the elevated low-density lipoprotein (LDL) permeability was observed as reported in the literature. The existence of nearly fixed stagnating location, flow separation, vortex, high time-averaged WSS with low OSI, low time-averaged WSS with elevated OSI, and high time-averaged WSSG may lead to graft stenosis. Moreover, the simulation results obtained were consistent with those of experimental measurements. Based on the validated simulation results, the 45° backward-facing graft was found to have the lowest variation range of time-averaged WSS and the lowest segmental average of WSSG among the three models investigated. The 45° backward-facing graft is thus recommended for the bypass operation with expected higher patency rate.

Fever attribution in the SARS outbreak

Fever as a somatised symptom is not commonly described. We report a patient who complained of recurrent unexplained "fevers" during the severe acute respiratory syndrome (SARS) outbreak in Singapore. The presentation, while likely to be peculiar to the outbreak, posed challenges and difficulties to the primary care doctors. Investigations did little to allay her anxiety. Instead, appreciating the psychosocial backdrop and how the SARS outbreak affects patient and doctor may be useful.

Control of hypertension in postoperative patients

In this paper, adaptive control systems have been developed for the closed-loop control of mean arterial pressure using vasoactive drugs. An adaptive algorithm based on generalized predictive control law has been presented. A adaptive PI controller has been designed. The recursive least-square identification algorithm is used for on-line parameter estimation. The supervisor is added to provide safety and efficacy of control under the consideration of the physical and physiological constraints. Extensive computer simulation in the presence of unpredictable disturbances shows the system is capable of inducing hypertension.

Cardiopulmonary exercise testing in heart transplant candidates

INTRODUCTION

We evaluated the results of patients with congestive heart failure (CHF) who underwent cardiopulmonary exercise testing (CPET) as part of their assessment for heart transplantation in order to examine the relationship between exercise capacity and resting indices of left ventricular function in these patients.

MATERIALS AND METHODS

Twenty-seven ambulatory heart transplant candidates underwent CPET using a cycle ergometer and an incremental work-rate protocol till symptom-limitation. These patients included 24 men and 3 women with a mean age of 42.3 years. The aetiology of CHF was coronary artery disease in 14 patients, dilated cardiomyopathy in 11 patients, and congenital heart disease in 2 patients. Mean resting left ventricular ejection fraction (LVEF) was 19% (range 7% to 36%).

RESULTS

Thirteen of the 27 tests performed were maximal studies and all except 2 subjects attained a measurable anaerobic threshold during CPET. Of the 13 maximal tests, the causes of exercise limitation were cardiomyopathy in 3 patients, ischaemic heart disease in 2 patients, significant oxygen desaturation in 2 patients, ventilatory limitation due to obstructive lung disease in 1 patient, ventilatory limitation secondary to a restrictive lung disease in 3 patients, and combined obstructive ventilatory and cardiovascular limitation in 2 patients. There was no significant correlation between resting LVEF and peak VO2 percent predicted (r = 0.14, P = 0.49).

CONCLUSIONS

Exercise intolerance in patients with CHF may not be related to limited cardiac reserve and non-cardiac causes of exertional symptoms should also be considered. CPET is useful for the evaluation of functional capacity and mechanisms of exercise intolerance in patients with CHF.

Changing the institutional practice of prolonged mechanical ventilation after coronary artery bypass graft surgery to early extubation

Since 1997 some of our cardiac anaesthetists have, whenever possible, extubated the patients early after cardiac surgery to improve their level of comfort, to allow an early return of the cardiopulmonary physiological function, and to help reduce health care costs. After a few months of implementing this practice, an audit was carried out to evaluate the success of early extubation after coronary artery bypass graft (CABG) surgery. Over a 6-month period starting from May 1997, the perioperative data of 110 consecutive patients with good or moderate left ventricular function scheduled for elective CABG were prospectively collected and analysed. The anaesthetic regime was according to the preference of the anaesthetists. Initially consent was obtained from the surgeons when the extubation criteria were fulfilled, but subsequently as the practice became more accepted by the surgeons, extubation was initiated by the anaesthetists. Within 4 hours of admission into the intensive care unit (ICU), 50 (45.5%) of the 110 patients satisfied the early extubation criteria and were extubated. The extubation criteria are described in the article. For the remaining patients, the median duration of mechanical ventilation was 14.3 hours. The profiles of the two groups of patients and the possible reasons for not extubating early are discussed. Forty-five per cent of the patients with moderate to good ventricular function were extubated safely within 4 hours of admission into the ICU after CABG surgery. With gradual acceptance of the practice and a change in mindset amongst all the care givers, more patients can benefit from this practice. This article highlights the challenges associated with changing institutional practices with respect to the postoperative care of cardiac patients.

Smoking in the Singapore Armed Forces

The Singapore Armed Forces has, since 1986, established a comprehensive smoking control programme which combines health education, counselling and administrative measures aimed at discouraging non-smokers from smoking, and encouraging smokers to quit the habit. The prevalence of regular smoking decreased from 28.6% in 1987 to 20.7% in 1993. The latest, 1993 survey as in past surveys covered 3,545 respondents, made up of regulars (32.0%), NSF (62.2%) and NUSAF (5.6%). The 1993 survey revealed that the majority of smokers (88.9%) in the SAF who consist primarily of 18 to 20-year-olds, had started smoking before enlistment. Most acquired the habit on their own (49.8%) or through influences outside the SAF (40.3%). Very few smokers became smokers through the influence of fellow soldiers (4.9%). The majority (87.7%) of smokers readily agreed that smoking is harmful, but this is not translated into practice. Health education efforts need to focus more on bringing about positive attitudinal and behavioural changes, rather than merely give information and advice. The young age of smoking onset (mean age of 14.3 years) In the SAF population surveyed points to the need to focus preventive efforts further upstream than hitherto emphasised.

The effect of recombinant growth hormone on nitrogen balance in malnourished patients after major abdominal surgery

The effect of recombinant growth hormone (rGH) on nitrogen balance was studied in malnourished patients receiving total parenteral nutrition after major abdominal surgery. Fifteen patients were randomized to receive either subcutaneous rGH (0.2 iu/kg) or placebo (saline) injection daily for seven days after surgery. Positive nitrogen balance was achieved throughout the treatment period with rGH administration and was significant on days 3 and 6. This was associated with increase in mid-arm muscle circumference and significant weight gain. Plasma insulin-like growth factor-1 (IGF-1) concentration was significantly raised in the rGH group at day 7, suggesting its role in the anabolic effect of growth hormone. Plasma pre-albumin and retinol-binding protein concentrations were raised in both the rGH and control groups, indicating improvement in the nutritional status. We conclude that the postoperative catabolic response can be attenuated using recombinant growth hormone.

Autotransfusion: is there a benefit in a current practice of aggressive blood conservation?

Findings from early studies suggested that the autotransfusion of shed mediastinal blood (ATS) after cardiac surgical procedures led to a reduction in the postoperative banked blood requirements. However, changes in baseline patient characteristics and other blood conservation methods may now negate the benefits of ATS. To determine whether the routine use of ATS is effective in the context of current surgical practice, risk factors related to postoperative banked blood requirements were analyzed in a prospective series of 155 consecutive patients undergoing cardiac operations: 71 patients before and 84 patients after the addition of ATS to an already aggressive standardized blood conservation protocol. The overall mean patient age was 66 +/- 11 years; the mean preoperative patient hemoglobin level was 11.8 +/- 1.8 g/dL; 48% of the procedures were elective and 12% were reoperations; coronary artery bypass grafting was performed in 73% of the patients and valve repair or replacement in 34%, with no differences between the non-ATS and ATS groups (all, p = not significant). The mean 24-hour postoperative blood loss was 1,278 +/- 814 mL in the non-ATS group and 1,721 +/- 1,510 mL in the ATS group (p < 0.03). The mean volume autotransfused in the ATS group was 1,122 +/- 97 mL. The overall reoperation rate for bleeding was 0.6% (70% confidence interval, 0 to 1.3%) and the hospital mortality was 1.9% (70% confidence interval, 0.8% to 3.1%), which did not differ between the non-ATS and ATS groups (both, p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

[Torticollis and C1-C2 rotation subluxation. Apropos of a case. The value of a dynamic scanner and of a 3-dimensional scanner]

The authors report the rare and complex case of a girl who had been followed since the age of 3 years for hydrocephalus the cause of which was found only when she was 6-year old. The causative agent was a pilocytic astrocytoma of the cerebellum. On April 10, 1990, she underwent subtotal excision of the tumour, associated with radiotherapy. Four months later she developed an increasingly painful and irreducible torticollis which did not respond to tractions. Dynamic CT scans and 3-dimensional CT scans were performed in the fourth month and provided a diagnosis of right C1-C2 rotatory subluxation. There was no history of injury and no sign of inflammatory process. Rotatory subluxation is a very rare lesion difficult to diagnose, and few cases have been published, although the signs are those of classical torticollis in children. When medical treatment fails, often due to belated diagnosis, the only surgical treatment is uni- or bilateral C1-C2 arthrodesis. If the diagnosis can be made at an early stage, reduction of the rotatory luxation is usually easy and without consequences to the child. It is therefore recommended to perform a dynamic CT scan and a 3D CT scan as soon as possible in all children with lasting painful torticollis.

Digital speckle-displacement measurement using a complex spectrum method

An alternative approach to fully automatic speckle-displacement measurement is described. Two speckle patterns of a specimen, one before and one after deformation, are captured by a CCD camera and registered by a frame grabber. Two series of small subimages are obtained by segmenting the two speckle patterns. The corresponding subimage pairs extracted from both series are analyzed pointwise. The interrogation of each subimage pair involves a two-step fast-Fourier transform. While the first-step fast-Fourier transform achieves a complex spectrum characterized by the local displacement information, the second-step one generates a signal peak in the second spectral domain that resolves the local displacement vector. A rough estimate of the displacement vector is achieved by detecting the maximum pixel of the discrete spectrum. A more accurate determination is attained by a subpixel-maximum determination through a biparabolic fitting near the signal peak. The u- and v-displacement fields are deduced by analyzing all subimage pairs. A large rigid-body displacement can be overcome by introducing an artificial rigid shift of the two speckle patterns toward each other before the numerical process. The technique retains all the advantages of optical speckle photography and provides an extended range of measurement. Dynamic incremental deformations can be inspected by registering more speckle patterns at many consecutive deformation stages by using a high-speed CCD camera. The system was applied successfully to the study of crack-tip deformation fields.

[Residual liver cancer after transcatheter hepatic arterial chemoembolization in patients with large primary hepatic carcinoma]

15 cancer specimens resected after hepatic arterial chemoembolization (TCE) were studied pathologically. It was found that residual tumor tissue was present in three forms: failure of complete tumor necrosis; tumor emboli in small portal veins; and multiple cancer foci in adjacent liver parenchyma. It is believed that presenting residual tumor tissue after TCE may be attributed to one of the following conditions: low drug concentration in residual tumor tissue; the larger tumor size after TCE; more residual cancer tissue in ASCCL than in HCC, collaterals formed soon after hepatic arterial occlusion.

Prevalence of protein calorie malnutrition in general surgical patients

The prevalence of protein calorie malnutrition (PCM) based on ten nutritional parameters was studied in 307 patients undergoing major elective surgical operations. These parameters included anthropometric measurements (weight/height, triceps skin fold thickness, arm muscle circumference) and biochemical (serum total proteins, albumin, transferrin, prealbumin, retinol binding protein) and immunological tests (total lymphocyte count and delayed hypersensitivity test). Using these criteria, the prevalence of PCM was high. Eighty-six percent of patients had at least one abnormal parameter. The prevalence of PCM as judged by weight/height and arm muscle circumference was 49% and 62% respectively. The incidence was higher in cancer than non cancer patients (63% vs 43%). Although serum albumin and total protein levels were normal in 93.5% of patients, acute serum protein markers such as transferrin, prealbumin and retinol binding protein were low in 20-30%. Lymphopenia of 1500 cells/cu mm or less was found in 18% and abnormal delayed hypersensitivity test in 60%. We found that only weight/height, serum protein, transferrin and lymphopenia had predictive values in postoperative morbidity and mortality. By identifying PCM patients early, adequate nutritional support can be given in order to reduce the risk of major surgical complications.

Surgical management of intrathoracic aortic aneurysm

The pathology, clinical features, indications for surgery and the results of intrathoracic aneurysm are analysed in thirty-nine consecutive patients who underwent surgery at Singapore General Hospital from January 1986 through December 1990. There were twenty cases of non-dissecting aneurysm and nineteen cases of dissecting aneurysm or aortic dissection. The 30 day survival for the twenty patients with non-dissecting aneurysm was sixteen patients (80%). The best results were obtained in patients with aortic root aneurysms. The overall 30-day survival for the nineteen patients with aortic dissection was twelve patients (64%). The mortality was especially high in patients with acute aortic dissection (46%). Recent advances in the management of these aneurysms make early recognition and diagnosis mandatory to achieve the best results.

Adenocarcinoma associated with chronic anal fistula

Adenocarcinoma in association with chronic anal fistula is a rare disease entity with a male preponderence in most reported series. The patient typically presents with a long history of perianal disease. Diagnosis is often delayed because of failure to obtain biopsy evidence of the condition. A chronic anal fistula may become malignant. However, despite delay in diagnosis, complete removal which usually entails abdominoperineal resections with wide excision of perianal skin and ischiorectal fossa is necessary to achieve good results. We relate our experience with two such rare cases and a literature review on the current views on the relationship between adenocarcinoma and the occurrence of anal fistula is presented.

[Thymus pathological changes in perinatal babies and children]

The most outstanding pathological changes of perinatal babies and children, based on the review of the autopsy files in the 1st Affiliated Hospital of West China University of Medical Sciences, are lymphocytic depletion, and reticuloepithelial cell swelling and/or fusiform malformation in the cortex, while in the medulla apoptosis is more prominent. We suppose that these alterations are due to immaturity of cortical thymocytes, and in the diseased condition, they are easily affected by extraordinary factors, especially the influence of corticosterone inducing acute severe necrosis, so the number of lymphocytes are obviously diminished. But, in the medulla, as intact mature lymphocytes exist, physiological phenomenon such as apoptosis is rather prominent in it. While in the medulla, Hassall's corpuscles have various characteristic changes, such as cornification, calcification, fusion, cystic change and disintegration. Besides, we observed a new alteration in the thymus defined as vacuolization. All the above pathological changes reached the peak in the 28- day group; there after, they might become either worse or better according to the condition of the disease and growth of the body. However, these are still problems to be further studied separately.