Left main bronchus compression as a result of tuberculous lymphnode compression of the right-sided airways with right lung volume loss in children.

RATIONALE: The superior mediastinal space is confined by the sterno-manubrium anteriorly and the vertebral column posterior. An abnormal relationship between the superior mediastinal structures may result in compression of the left main bronchus. In patients with right-sided pneumonectomy an exaggerated compensatory response may lead to stretching and compression of the remainder of the intra-thoracic airway. Lymphobronchial TB mimics pneumonectomy when it causes compression of the bronchus intermedius, between nodal lymphnode groups with resultant volume loss in the right lung and displacement of the mediastinum to the right. The left main bronchus may be at risk of compression due to rotation and displacement of the major vessels. AIM: To report pediatric cases of right-sided lymphobronchial TB with volume loss, demonstrate the use of angle measurements to quantify mediastinal dynamics and support a pathogenetic theory for left main bronchus compression. MATERIALS AND METHODS: CT scans in children with TB and right lung volume loss, were compared retrospectively with controls using angle measurements based on descriptions of the aorta-carinal syndrome and the post-pneumonectomy syndrome. The Mann-Whitney U-test was used to compare groups. RESULTS: The "Pulmonary bifurcation angle" between the main pulmonary arteries reached statistical significance (P = 0.025). The "Pulmonary outflow tract rotation" angle (pulmonary trunk with the mid sagittal plane) approached statistical significance (P = 0.078). The left main bronchus ranged from complete obliteration in two patients to 0.7 cm. In 16 of 30 patients the size was reduced to less than 75% of expected. CONCLUSION: In children with right lung volume loss from TB, the compression of the contralateral bronchus is due to narrowing of the pulmonary artery bifurcation angle as the main trunk rotates towards the midline. This is comparable to the post-pneumonectomy syndrome.

A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons has become a common surgical procedure. Lower leg paresthesia following injury to the infrapatellar nerve during harvesting of the tendons has been well documented. Few authors have described the position of the infrapatellar nerve on a flexed knee, which is the position used during ACL reconstruction. The purpose of this study was to determine a safe area and angle where an incision could be made for harvesting of the semitendinosus and gracilis tendons, with the knee in flexion. Twenty right cadaver knees and 20 left knees were dissected. Landmarks on the knee were identified, from where the distances to the nerves (infrapatellar and saphenous) were measured with a vernier caliper. A safe area on the right knee was determined to be on the tibial tuberosity plane between 3.7 and 5.5 cm with a safe angle of incision of 51.6 degrees. A safe area on the left knee was determined to be on the tibial tuberosity plane between 3.6 and 4.9 cm with a safe angle of incision of 52.5 degrees. The results may assist orthopedic surgeons performing ACL reconstruction with semitendinosus and gracilis tendons to avoid cutaneous nerve damage and, therefore, patient discomfort.

Endoscopic investigation for gastric cancer in a high-risk group.

Early gastric cancer (EGC) was diagnosed in only a small percentage (less than 1%) of gastric cancer cases seen at Tygerberg Hospital over a 10-year period (1976-1985). This study, aimed at increasing the yield of EGC, was conducted in some high-incidence areas for gastric cancer. Coloured men, who are at high risk for gastric cancer, were identified by their medical practitioners and investigated. A total of 272 coloured males with nonspecific foregut symptoms underwent upper gastro-intestinal endoscopy and multiple biopsy specimens were obtained from all localised mucosal lesions. Twelve gastric cancers were histologically verified, of which 11 were diagnosed in males over 40 years of age. Two EGCs were diagnosed in older males, resulting in a markedly higher proportion of EGC in this subgroup (18.2%) than the proportion of EGC in inpatients at our institution (0.9%). Twenty-two per cent of males over 40 years of age had gastric ulcers compared with 9.2% of younger males. Chronic atrophic gastritis was present in 56.2% of older males but in only 24.6% of younger males. Those over 40 years of age emerged as a subgroup with a high prevalence of gastric cancer and EGC, and concomitant conditions.

Atherosclerosis. Chronic effects of fish oil and a therapeutic diet in nonhuman primates.

Prolonged testing of marine fish oil (FO) as a dietary supplement is necessary because of widespread claims that it is antiatherogenic. The basis for such claims is inadequate because atherogenesis is chronic and may not respond to short-term changes induced by dietary treatments. A proven (vervet) model of atherosclerosis promoted by an atherogenic diet (AD) was used to test dietary supplementation with Atlantic pilchard FO for 20 months in 47 omnivorous nonhuman primates. Responses were controlled against known favorable effects of changing from the AD to a therapeutic diet (TD). Compliance was achieved, and tissue responses to the FO dose were confirmed. Compromise of reflex vasoconstriction by atherosclerosis was demonstrated for the first time in the model. Aortic, peripheral, coronary, and cerebral atherosclerosis were assessed by light microscopy and computerized image analysis. No component of atherosclerosis regressed after dietary FO, and several deteriorated. After a change to the TD, stainable lipid was cleared from aortas and there were few lipophages, but advanced atherosclerosis was not reduced. Male vervets developed more severe atherosclerosis than did females, and the association among aortic, peripheral, and coronary atherosclerosis was positive in males. Females were resistant to coronary atherosclerosis. Only mild cerebral atherosclerosis was detected. In conclusion, the FO used was not antiatherogenic in the model, and there is a need for caution. The TD regresses some components of atherosclerosis, but it was not effective against fibrosis, mineralization, and cholesterol crystals within 20 months.

Chronic atrophic gastritis, gastric pH, nitrites and micronutrient levels in a population at risk for gastric carcinoma.

One hundred and seventy-eight patients at risk for gastric carcinoma had upper gastrointestinal endoscopy. Twenty-seven selected patients with the type B of chronic atrophic gastritis, 32 patients with normal mucosa and 47 non-scoped healthy controls were tested for plasma vitamin C, retinol and tocopherol. The total vitamin C level was also assessed in gastric juice of scoped patients. Micronutrient levels were related to gastric pH, nitrites and gastric mucosal pathology. The study showed a higher level of pH (greater than 4) and high nitrites in gastric juice in patients with chronic atrophic gastritis, gastric malignant and dysplastic lesions. Neither the hypochlorhydria nor gastric nitrites affected the prevalence of C. pylori in gastric mucosa. Low gastric and plasma concentrations of vitamin C observed in patients with chronic atrophic gastritis showed an inverted relationship with pH level, and an inter-relationship of other vitamins with antioxidant properties (vitamins A and E).

Oesophageal mucosal pathology in a population at risk for gastric and oesophageal carcinoma.

Statistical studies of oesophageal and gastric carcinoma at Groote Schuur Hospital during a 4 year period and a detailed pathological assessment of oesophageal mucosal biopsies of 526 rural outpatients are reported. A statistically suggested high incidence of oesophageal carcinoma was confirmed by endoscopical studies. Oesophageal carcinoma was detected endoscopically in 1.14% of patients with dyspepsia. Oesophagitis and glycogenic acanthosis were common findings which were related to smoking and alcohol intake, but were not related to cancer risk. Precursor lesions for oesophageal carcinoma are discussed.

The association of Campylobacter pylori with mucosal pathological changes in a population at risk for gastric cancer.

In the study of a group of 178 unselected patients (105 men, 73 women, mean age 44.5 years), from a population at high risk for gastric carcinoma, who presented with chronic dyspepsia, a minimum of 8 gastric and oesophageal biopsy specimens were taken during upper gastro-intestinal endoscopy, and examined histologically and histochemically for the presence of Campylobacter pylori and other pathological lesions. Gastric colonisation by C. pylori was found in 75% of men and 68.4% of women. In 90% of patients with duodenal or gastric ulcer and in 71.6% of patients with non-ulcer and non-cancer dyspepsia there was a moderate or severe degree of bacterial colonisation. Association between C. pylori colonisation and microscopic evidence of type B gastritis, gastric or duodenal ulcer, gastric cancer, oesophagitis and oesophageal glycogenic acanthosis was found.

Promotion and regression of atherosclerosis in vervet monkeys by diets realistic for westernized people.

We have described and measured aortic and arterial atherosclerosis in adult female Vervet monkeys (n = 61) after application of dietary treatments for 47 months. The diets were compounded entirely of normal food items for westernized people, with no extra cholesterol added. A 'Western' diet (WD), known to induce hypercholesterolaemia, was found to be atherogenic in aortas and some arteries. A more 'prudent' diet (PD) induced much less lipid infiltration into aortic intimas and was not associated with serious atherosclerotic changes. However, when this PD was used as a treatment for 27 months, following 20 months of nutrition by the WD, minimal regression of cholesterol crystals and non-lipid components of atherosclerotic plaque was detected. There was no significant coronary artery or myocardial disease in these adult females after 47 months of feeding on the WD whereas males do develop coronary atherosclerosis and myocardial fibrosis. For this model the PD would be more effective in preventing atherosclerosis than treating advanced lesions. We believe this is the first time that the pathology of atherosclerosis promoted by realistic diets has been modelled in adult females of this species.