Predictors for routine admission to paediatric intensive care for post-supraglottoplasty laryngomalacia patients.

OBJECTIVES: Supraglottoplasty for the treatment of laryngomalacia has little current evidence regarding post-operative care. Our study aimed to: (1) retrospectively assess what proportion of patients required paediatric intensive care unit level of care; (2) identify pre-operative predictive factors common to these cases; and (3) report patient outcomes at six weeks' follow up. METHODS: A 10-year retrospective case series analysis was conducted of all patients diagnosed with laryngomalacia and subsequently treated with supraglottoplasty. Paediatric intensive care unit level of care was defined as the need for intubation or tracheostomy, positive pressure ventilation, multiple doses of nebulised adrenaline, and oxygen dependency beyond 12 hours. RESULTS: Forty-two patients (19 males, 23 females) were identified; 28.5 per cent of cases met our criteria for paediatric intensive care unit level of care. A low pre-operative oxygen saturation was the only significant risk factor that predicted a future need for paediatric intensive care unit level of care (p = 0.0008). CONCLUSION: This is the first study published in the UK to suggest the importance of pre-operative oxygen saturation as a predictor of a future need for paediatric intensive care unit level of care.

Expression and immunolocalisation of antimicrobial peptides within human palatine tonsils.

BACKGROUND: Recurrent acute tonsillitis is one of the most frequent ENT referrals, yet its pathogenesis remains poorly understood, and tonsillectomy still costs the National Health Service more than pound 60,000000 annually. Antimicrobial cationic peptides are components of the innate immune system. They are generally small, highly positively charged peptides with broad spectrum antimicrobial activity which function as the body's 'natural antibiotics'. The role of antimicrobial cationic peptides in the susceptibility of patients to recurrent acute tonsillitis is unknown. AIMS: To characterise and compare antimicrobial cationic peptide expression and localisation in human palatine tonsils from control subjects and recurrent acute tonsillitis patients, and to assess the potential role of these peptides in the pathogenesis of tonsillitis. METHODS: Palatine tonsils were harvested with informed consent from 19 recurrent acute tonsillitis patients and from five control subjects undergoing tonsillectomy for sleep disorders. Total ribonucleic acid was isolated and antimicrobial cationic peptide expression was characterised using reverse transcription polymerase chain reaction. Fluorescent immunohistochemical techniques were used to localise antimicrobial cationic peptides within fresh frozen tonsil sections. RESULTS: Using molecular analyses, the palatine tonsils from control and recurrent acute tonsillitis subjects were confirmed as a site of expression of the antimicrobial cationic peptides human beta-defensin 1-3, LL-37 (cathelicidin) and Liver expressed antimicrobial peptide-1 (LEAP-1). We also demonstrated for the first time the expression of Liver expressed antimicrobial peptide-2 (LEAP-2). Our analyses indicated that all six antimicrobial cationic peptides were expressed in all 26 tonsil samples. Immunohistochemical staining indicated that the antimicrobial cationic peptides were localised to the tonsil surface and crypt epithelium. However, the surface epithelium of tonsils from recurrent acute tonsillitis patients showed reduced amounts of antimicrobial peptides human beta-defensins 1 and 3, and LL-37, compared with healthy controls. CONCLUSION: The tonsil epithelium synthesizes an array of antimicrobial cationic peptides which function as host defence. Preliminary immunohistochemical data suggest that the surface epithelium of tonsils from recurrent acute tonsillitis patients contains reduced amounts of such peptides, which may increase these patients' susceptibility to infection.

Acquired idiopathic laryngomalacia treated by laser aryepiglottoplasty.

Laryngomalacia is the most common paediatric airway problem presenting as stridor in the neonate. This congenital anomaly is thought to be caused by inward inspiratory collapse of the supraglottic larynx due to a prolapsed, tall and tubular epiglottis with flaccid aryepiglottic folds. The natural history of this condition usually results in spontaneous resolution by the second year of life. Although acquired cases of adult laryngomalacia have been reported, a search of the literature has yet to show any cases of idiopathic laryngomalacia. We present two cases of idiopathic acquired laryngomalacia in adults.

Retropharyngeal abscess as a complication of oropharyngeal trauma in an 18-month-old child.

An 18-month-old boy presented to the accident and emergency department following trauma to the oropharynx by a doll's umbrella. Although no significant injury could be identified at first, it later transpired that he had developed retropharyngeal surgical emphysema with abscess. This case report aims to review the nature of retropharyngeal abscesses and to highlight and re-emphasize the fact that apparently non-serious pharyngeal injuries in children should be treated with suspicion.

[Toxicology of reproduction: predictive value of experimental models. Round Table No 1 at Giens XIII]. / Toxicologie de la reproduction: valeurs prédictives des modèles expérimentaux. Table Ronde No 1 de Giens XIII.

The carrying out of clinical trials with a view to the marketing of drugs for human use is directly related to results of some animal studies. This workshop was devoted to evaluation of the quality and interest of these experimental models in reproductive toxicology. The predictive ability of preclinical trials to make extrapolations from animals to man decreases from foetotoxic to tetratogenic risks respectively and from the effects on fertility in both sexes to postnatal risks. As a result of this workshop, we propose the following improvements: (1) standardization and generalization of fertility test evaluations, especially the spermogram, in order to improve animal and human correlations; (2) development of knowledge and standardization of the follow up of the oestral cycle; (3) improvement of standardization, harmonization and diffusion of postnatal tests that prove relevant in animals; (4) increase in initiatives aimed at better mutual understanding of all drug partners; (5) creation of registers for new drugs, as soon as possible during clinical trials, to study their effects on the whole reproductive process; (6) recommendations for the creation of guidelines for International Conference on Harmonisation (ICH) to enable classification of observed effects in experimental models. This could lead to specific (potentially for each phase of the reproductive cycle) guidelines, precautions for use and/or contraindications which are listed in the summary of product characteristics.

A developmental study of the localization of NADPH-diaphorase in the ganglionated plexus of the guinea-pig gallbladder.

A histochemical investigation of age-related changes that occur with respect to the localization of NADPH-diaphorase in the ganglionated plexus of the guinea-pig gallbladder was carried out. In all age groups examined (embryonic stages day 34 and 52, 2 to 4-day old, 6-month old and 2-year old), the mean percentage of NADPH-diaphorase-positive neurons per ganglion was obtained by taking the number of neurons that were immunoreactive to protein gene product 9.5 (a general neuronal marker) as 100%. In addition, the possible co-existence of NADPH-diaphorase and nitric oxide synthase in the ganglionated plexus of 2 to 4-day old and 6-month old guinea-pig gallbladder was investigated. NADPH-diaphorase was not present in the ganglionated plexus of the gallbladder at embryonic day 34. At embryonic day 52, all the protein gene product 9.5-immunoreactive neurons showed positive staining to NADPH-diaphorase; this dropped to a minimum at 2-4 days (26.7%), rose slightly at 6 months (33.6%), and finally returned close to the 100% value at 2 years. In the gallbladders of 2-year old guinea-pigs, some (3 out of 10) ganglia were devoid of protein gene product 9.5-immunoreactive neurons, but NADPH-diaphorase-stained granules were found within the ganglia. However, all those neurons that were immunopositive to protein gene product 9.5 also expressed NADPH-diaphorase. Moreover, NADPH-diaphorase-positive neurons in the gallbladder of 2 to 4-day-old and 6-month-old guinea-pigs were found to express nitric oxide synthase.

Age-related changes in galanin- and calretinin-immunoreactive nerves of guinea-pig gallbladder.

Age-related changes in the expression of galanin- and calretinin-like immunoreactivity in the ganglionated plexus of 2-4 day, 6 month and 2 year old guinea-pig gallbladder were investigated. The ganglionated plexus was studied using immunohistochemical labelling techniques on whole mount stretch preparations of the gallbladders. Galanin- and calretinin-like immunoreactivity did not differ significantly between age groups of the 2-4 day and 6 month olds except for some reduction of calretinin-immunofluorescent nerves in the 6 month old preparations. However, in the ganglionated plexus of the 2 year old guinea-pig gallbladders, neither galanin- nor calretinin-like immunoreactivity could be detected. The implication of these findings, in relation to the physiological activity of the gallbladder is discussed.

Toxicological aspects of vanadyl sulphate on diabetic rats: effects on vanadium levels and pancreatic B-cell morphology.

This study explored some toxicological aspects of vanadyl sulphate (VOSO4) treatment of rats made diabetic with a single intravenous injection of streptozotocin (60 mg/kg). Administered in drinking water (0.25, 0.5, 0.75 or 1 mg of VOSO4, 5H2O ml) VOSO4 treatment partially or totally corrected some of the alterations associated with the diabetic state (hyperglycaemia, polydipsia, polyphagia, high cholesterol and triglycerides levels) and did not produce any changes in various plasma or blood cell parameters which were not previously altered by diabetes. Measurement of vanadium levels indicated that tissues accumulated vanadium in the following order of concentrations: bone greater than kidney greater than spleen greater than liver greater than lung greater than or equal to muscle greater than blood. Histopathological studies did not reveal any difference in liver, stomach, ileum, spleen, heart and lung from control, non-treated diabetic or VOSO4-treated diabetic animals. Kidney of all non-treated diabetic animals showed an epithelial cellular swelling of distal tubules while only 2 of 6 VOSO4-treated diabetic animals showed this alteration. Cellular degeneration of pancreas B-cells was less marked in VOSO4-treated that in non-treated diabetic animals. The study indicates that VOSO4 may be a potential antidiabetic agent.

[Experimental cadmium poisoning]. / Intoxications expérimentales par le cadmium.

During the past years, many publications and reviews have described kidney and bone lesions observed after human chronic cadmium poisonings of food or occupational origin. In this experiment carried out in rat fed with normal diets or polydeprived of vitamin D3, calcium and proteins, with or without addition of cadmium, the bone lesions observed are as severe in all polydeprived animals, wether treated with cadmium or not.

In vivo and in vitro effect of the Haemophilus influenzae lipopolysaccharide on ciliated respiratory epithelium.

The lipopolysaccharide of Haemophilus influenzae is presumed to have a toxic effect on the tracheal epithelium, and then induce a bronchial obstruction. This activity of LPS was studied in vitro on the ciliary beat using a photo-oscillographic apparatus, and in vivo on the rabbit trachea. Neither modification of ciliary beat frequency, nor epithelial damage in the rabbit trachea was observed after a single administration of LPS. In contrast, histopathologic changes were observed in vivo when the intratracheal administration of H. influenzae LPS was followed 24 h later by an intravenous injection of the same LPS. These experimental models seem thus to implicate a Shwartzman type cellular necrosis in the trachea in vivo in the absence of a direct toxic effect of endotoxin itself on trachea in vivo or in vitro.

Evaluation of the clastogenic action of benzene by oral administration with 2 cytogenetic techniques in mouse and Chinese hamster.

In previous studies, we found, using the micronucleus test, that the adult male mouse is about twice as sensitive as the female to the clastogenic action of orally administered benzene (Siou and Conan, 1978). For new-born mice suckling mothers receiving benzene orally (Siou and Conan, 1979), or for three-week-old mice receiving benzene orally (Siou and Conan, 1980), there was no significant difference in sensitivity between females and castrated males; castrated males treated with testosterone regained their original sensitivity. The objectives of the experiments described here were to confirm these findings by metaphase chromosome analysis of bone-marrow cells from mice and Chinese hamsters. Metaphase chromosome studies and micronucleus counts were performed on each animal to investigate the relationship between the 2 techniques.

[General schema for safety evaluation of residues of embryotoxic drugs (author's transl)]. / Schéma général d'évaluation de la sécurité des résidus de médicaments embryotoxiques.

Concerned with adapting the withdrawal time to real risks attributed to residues, the authors present a general schema of evaluation based on the metabolism-toxicity relationship. This schema takes into account: a) possible distinction between potentially toxic and atoxic metabolites for extractable residues, b) the more or less large biovailability of residues, c) the methodological evaluation difficulties of toxicity of bound residues. Without neglecting public health, this procedure leads to less constrained restrictions in use of veterinary drugs.

[Experimental alpha-chymotrypsin model of glaucoma in the rabbit: histopathological studies (author's transl)]. / Le modèle de glaucome expérimental à l'alpha-chymotrypsine chez le lapin: étude histologique.

The injection of alpha-chymotrypsin into the posterior chamber of the eye is known to produce an experimental ocular hypertension of long duration in animals. The present study reports the pathological changes which occur in the eye during the first nine months after the ocular injection of alpha-chymotrypsin in rabbits. Six weeks after treatment most of the eyes showed a buphthalmia and an intraocular pressure elevation which varied greatly from animal to animal. The anterior chamber angle of the treated eyes showed a progressive enlargement. Several days after the enzyme injection a transient increase in thickness of the cornea and Descemet membrane was noted. Cupping of the optic disc, characterized by a total disappearance of the optic nerve head fibers and an excavation beginning at margins of the retina appeared after four months and in most cases were present seven months after the treatment. More or less prominent retinal degeneration was also evidenced three months after enzyme injection. The results indicate alpha-chymotrypsin-induced occular hypertension in the rabbit leads after several months to pathological change in the eye analogous to that observed in human glaucoma.