Saccular mucocele and laryngeal cancer

Saccular mucoceles are a definite entity and probably occur more frequently than is supposed. Confusion with internal laryngoceles is possibly due to lack of understanding of basic anatomy and physiology. A 49-year-old man had a saccular mucocele that was possibly associated with laryngeal cancer, although a definitive diagnosis was only made two years later. The laryngectomy specimen was serially sectioned and showed an internal laryngocele on the side that was not operated one. This patient remains alive and well four years after excision of a T4 carcinoma, although a unilateral radical neck dissection was performed two years ago.     

Saccular aneurysms of meningeal artery: case report

OBJECTIVE AND IMPORTANCE: A rare observation of double saccular aneurysms of the meningeal artery is presented. CLINICAL PRESENTATION: This 22-year-old man was referred to the Neurosurgical Institute with a suspicion of an aneurysm of the anterior communicating artery. Bilateral angiography of the carotid arteries was performed 1 week after the subarachnoid hemorrhage, but the aneurysms were not visualized. Routine angiography of both carotid arteries and selective studies of the left vertebral artery were performed again, and angiography of the right carotid artery revealed an aneurysm. The patient's neurological state at the time of admission was normal. Fundoscopic examination revealed papilledema and conjunctival injection of the left eye. INTERVENTION: The patient was treated using a right pterional approach. One aneurysm had caused spontaneous subarachnoid hemorrhage. The aneurysms were removed using a direct approach, with histological examination of dura matter fragment containing both aneurysms. The results of the patient's 2-week follow-up examination were normal. Follow-up angiography of the right carotid artery showed absence of the aneurysm with a clip on the branch of meningeal artery. CONCLUSION: Saccular aneurysms of the meningeal artery can be manifested by subarachnoid hemorrhage, and intradural arterial aneurysms are similar to saccular cerebral vessel lesions structurally.     

Saccular influence on the otolith-spinal reflex and posture during sudden falls of the cat

We made intradendritic recordings in Purkinje cells (n = 164) from parasaggital slices of cerebellar lobule HVI obtained from rabbits given paired presentations of tone and periorbital electrical stimulation (classical conditioning, n = 27) or explicitly unpaired presentations of tone and periorbital stimulation (control, n = 16). Purkinje cell dendritic membrane excitability, assessed by the current required to elicit local dendritic calcium spikes, increased significantly in slices from animals that received classical conditioning. In contrast, membrane potential, input resistance, and amplitude of somatic and dendritic spikes were not different in slices from animals given paired or explicitly unpaired stimulus presentations. The location of cells with low thresholds for local dendritic calcium spikes suggested that there are specific sites for learning-related changes within lobule HVI. These areas may correspond to learning "microzones" and are consistent with locations of learning-related in vivo changes in Purkinje cell activity. Application of 4-aminopyridine, an antagonist of the rapidly inactivating potassium current IA, reduced the threshold for dendritic spikes in slices from naive animals to levels found in slices from trained animals. In cells where thresholds for eliciting parallel fiber-stimulated Purkinje cell excitatory postsynaptic potentials (EPSPs) were measured, levels of parallel fiber stimulation required to elicit a 6-mV EPSP as well as a 4-mV EPSP (n = 30) and a Purkinje cell spike (n = 56) were found to be significantly lower in slices from paired animals than unpaired controls. A classical conditioning procedure was simulated in slices of lobule HVI by pairing a brief, high-frequency train of parallel fiber stimulation (8 pulses, 100 Hz) with a brief, lower frequency train of climbing fiber stimulation (3 pulses, 20 Hz) to the same Purkinje cell. Following paired stimulation of the parallel and climbing fibers, Purkinje cell EPSPs underwent a long-term (> 20 min) reduction in peak amplitude (-24%) in cells (n = 12) from animals given unpaired stimulus presentations but to a far less extent (-9%) in cells (n = 20) from animals given in vivo paired training. Whereas 92% of cells from unpaired animals showed pairing-specific depression, 50% of cells from paired animals showed no depression and in several cases showed potentiation. Our data establish that there are localized learning-specific changes in membrane and synaptic excitability of Purkinje cells in rabbit lobule HVI that can be detected in slices 24 h after classical conditioning. Long-term changes within Purkinje cells that effect this enhanced excitability may occlude pairing-specific long-term depression.     

Tibial torsion?

A longitudinal study evaluating the degree of rotation of the bimalleolar axis of tibia and fibula at birth, 6 month, 12 months and 24 months revealed a gradual statistically significant external rotation from a mean of 4 degrees at birth to a mean of 11 degrees at 24 months. There was no correlation with the sex or race of the child or with the age at which the child began independent walking. It is concluded that this external rotation is a part of normal growth and development of the infants' lower extremities.     

Saccular intracranial aneurysms: endovascular treatment with mechanical detachable spiral coils

PURPOSE: To evaluate endovascular treatment of saccular intracranial aneurysms with mechanical detachable spiral coils. MATERIALS AND METHODS: Fifty-three patients with 56 saccular aneurysms underwent endovascular treatment with spiral coils. All but five had symptomatic subarachnoid hemorrhage staged according to the Hunt and Hess classification as follows: stage IV or V (n = 20), stage III (n = 10), stage I or II (n = 20), and stage 0 (asymptomatic [n = 6]). RESULTS: Forty-seven aneurysms were occluded (100% occlusion) on follow-up angiograms with the following time distribution: 24 months for six aneurysms (six patients), 12 months for 14 aneurysms (11 patients), 6 months for 13 aneurysms (13 patients), 4 months for four aneurysms (four patients), and only immediate postprocedure study for 16 aneurysms (16 patients) (excludes two deaths and one failure). CONCLUSION: In this relatively small group, endovascular treatment with mechanical detachable spiral coils had a success rate of 90%, and it appears to be a rapid, reliable, and relatively safe technique in the treatment of life-threatening subarachnoid hemorrhage.     

Saccular aneurysm associated with fenestration of the distal segment of basilar artery

A 32-year-old man who presented with subarachnoid hemorrhage was found to have a saccular aneurysm arising from the proximal end of the fenestration formed at the distal third of basilar artery. The aneurysm dome was directed anteriorly and measured 3mm in diameter. It was successfully clipped via subtemporal transtentorial approach and the patient returned to his previous job. Basilar artery fenestration is angiographically found in 0.23-0.6%. The fenestration is most frequently located in the proximal basilar trunk close to the vertebro-basilar junction. In this report a rare case with an aneurysm associated with fenestration in the distal part of the basilar artery will be presented.     

Measurement of tibial torsion

AIM OF STUDY: To investigate the Singaporean doctor's and lawyer's definition of child abuse and neglect, their attitudes towards reporting and their manner of handling suspected cases. METHODS: A self-addressed questionnaire survey was carried out in a population of hospital doctors, family physicians and lawyers. A total of 368 respondents participated in the survey. RESULTS: Most respondents had similar parenting attitudes. The majority felt that child abuse occurred sporadically but 25% of family physicians felt it seldom occurred. Thirty-eight per cent of family physicians had a personal definition of child abuse compared to less than a third of hospital doctors. There was a high consensus among all 3 groups concerning 21 behaviours studied. In all 3 groups, more than 80% agreed that having sex, burning child, tying child and not protecting the child from sexual advances were both unacceptable and abusive. More than 80% of respondents felt that some form of compulsory reporting is necessary in Singapore. Doctors preferred to refer cases of physical abuse to the hospital while lawyers preferred the police. All agreed that sexual abuse is a matter for the police. Respondents were more likely to act in cases of physical abuse and sexual abuse than for cases of emotional abuse and neglect. CONCLUSIONS: There is a need to formalise definitions of child abuse in our society. More education and training in the understanding and handling of child abuse by doctors and lawyers may be necessary.     

Kyphoscoliosis and bronchial torsion

STUDY OBJECTIVE: Severe idiopathic scoliosis is associated with respiratory failure. This usually is secondary to restrictive airway disease and reduced vital capacity. Patients may also suffer from an increase in airway resistance when severe kyphoscoliosis is present. SETTING: Three patients (two of whom required assisted ventilation) with varying degrees of kyphoscoliosis presented with moderate to severe breathing difficulties. INTERVENTION: Bronchoscopic examination of these patients showed evidence of torsion with secondary obstruction of the central airways. RESULTS: The airway obstruction was notable for its slit-like appearance, for the normality of the mucosa at the site of the obstruction, for the relative ease through which an instrument could traverse the obstruction, and once the retained secretions had been cleared, for the preservation of normal anatomy of the distal airways. The insertion of metal prostheses to stent the areas of obstruction prompted an impressive improvement in respiratory status, radiologic findings, and spirometric criteria in each case. Improvement has been maintained over a maximum follow-up period of 4 years. CONCLUSION: Severe kyphoscoliosis can lead to bronchial torsion and obstruction of the central airways. Patients should be assessed by bronchoscopy to exclude this deformity or any other cause of obstruction. The use of a metal endobronchial stent has been effective in both the immediate and long-term period.     

Radiographic diagnosis--lung lobe torsion

Neuron-specific enolase (NSE) is a dimeric cytoplasmic enzyme detected in high levels in neurons and acts in the glycolytic pathway. It is known that there is a quantitative relationship between the concentration of serum NSE and the degree of cell damage in the central nervous system. We examined serum levels of NSE by enzyme immunoassay in 89 patients with head injury and aimed to evaluate its relationship with neurological status and prognosis of the patients.     

Effects of suramin on ocular onchocerciasis

A single 10-14 day course of diethylcarbamazine (DEC) was given under betamethazone cover to 18 patients (Group A) with ocular onchocerciasis, and the effects were studied in detail over 1-2 years. A comparison was made with the findings in 21 patients (Group B) who received a similar course to be followed by a weekly suppressive 100-200 mg dose of DEC. A further 18 patients (Group C) served as controls. The initial DEC course provoked severe general reactions, but ocular complications could be controlled by betamethazone. The weekly suppressive dose was not acceptable to the majority of patients, and only one young patient with severe iritis who improved during the initial course took the weekly tablet voluntarily over 2 years. The initial DEC course reduced the numbers of microfilariae in the eye and was of temporary benefit to lesions of the anterior segment, but it did not affect lesions of the posterior segment. A possible adverse effect on the optic disc is discussed. Any beneficial long term effect was almost confined to Group B, and to lesions of the anterior segment. The best to hope for in lesions of the posterior segment was arrest of further development. The findings at the end of the trial were as follows: No. of lesions (see article).     

高压扭转半径对SiC_p/Al基复合材料组织和硬度的影响

SiCp/Al复合材料由于耐磨性好、比强度高、热膨胀系数小等优点而广泛应用于航空航天、汽车工业等众多领域。利用高压扭转法制备SiCp/Al复合材料,通过硬度测试和扫描电子显微镜观察金相组织,分析研究不同高压扭转半径对SiCp/Al复合材料组织和硬度的影响。结果表明,随着扭转半径的增大,剪切作用不断增强,等效应变增大,颗粒团聚现象减少,SiC颗粒分布均匀性增加,试样的显微硬度逐渐提高。