Habitat use and movement patterns of bull sharks Carcharhinus leucas determined using pop-up satellite archival tags.

Habitat use, movement and residency of bull sharks Carcharhinus leucas were determined using satellite pop-up archival transmitting (PAT) tags throughout coastal areas in the U.S., Gulf of Mexico and waters off the south-east U.S. From 2005 to 2007, 18 fish (mean size = 164 cm fork length, L(F)) were tagged over all seasons. Fish retained tags for up to 85 days (median = 30 days). Based on geolocation data from initial tagging location to pop-off location, C. leucas generally travelled c. 5-6 km day(-1) and travelled an average of 143.6 km. Overall, mean proportions of time at depth revealed C. leucas spent the majority of their time in waters <20 m. They exhibited significant differences among depths but were not found at a particular depth regardless of diurnal period. Most fish occupied temperatures c. 32 degrees C with individuals found mostly between 26 and 33 degrees C. Geolocation data for C. leucas were generally poor and varied considerably but tracks for two individuals revealed long distance movements. One fish travelled from the south-east coast of the U.S. to coastal Texas near Galveston while another moved up the east coast of the U.S. to South Carolina. Data on C. leucas movements indicated that they are found primarily in shallower waters and tend to remain in the same location over long periods. While some individuals made large-scale movements over open ocean areas, the results emphasize the importance of the coastal zone for this species as potential essential habitat, particularly in areas of high freshwater inflow.

Effects of phenobarbital on cerebral blood flow velocity after endotracheal suctioning in premature neonates.

OBJECTIVE: To examine the effect of phenobarbital administration on anterior cerebral artery blood flow velocity before and after endotracheal suctioning in premature neonates. DESIGN: Transcutaneous PO(2) (TcPO(2)), heart rate, mean arterial blood pressure (MABP), and Doppler velocimeter blood flow of the left anterior cerebral artery were measured before and immediately after 3 consecutive endotracheal suctioning procedures in premature neonates. Intravenous phenobarbital (20 mg/kg) was administered immediately after the first procedure. SETTING: Neonatal intensive care unit. PATIENTS: Nine neonates with a mean birth weight of 807 g (range, 620-1060 g) and a mean gestational age of 27 weeks (range, 25-30 weeks) were studied at age 8 to 12 hours. RESULTS: Transcutaneous PO(2) decreased in response to endotracheal suctioning at each of the suctioning procedures before and after phenobarbital was given (P<.001). Changes in heart rate were not observed. There were increases in MABP and area under the velocity curve (AUVC) per minute in response to endotracheal suctioning before but not after phenobarbital administration (P=.046). Use of phenobarbital lowered the overall peak systolic blood flow velocity in response to endotracheal suctioning (P =.02, analysis of variance, interactions for the effect of phenobarbital therapy on the response to suctioning). Changes in end-diastolic blood flow velocity were not observed. There were decreases in the differences before and after endotracheal suctioning for MABP at 2 and 4 hours and for AUVC and peak systolic blood flow velocity 4 hours after phenobarbital was given (P =.04). CONCLUSIONS: In very low-birth-weight neonates, endotracheal suctioning is associated with decreases in TcPO(2) and increases in MABP and AUVC. Treatment with phenobarbital attenuates the increases in MABP and AUVC but not the decreases in TcPO(2) after endotracheal suctioning.

Surgical hazards posed by marine and freshwater animals in Florida.

Marine and freshwater animals can cause injury to humans by biting, stinging, being poisonous to eat, and causing infections. Biting aquatic animals in Florida include sharks, barracudas, alligators, and moray eels. Devitalized tissue should be débrided, and vascular, neurologic, and tendinous injuries should be repaired. Radiographs should be obtained to examine the injury sit for fractures and retained foreign bodies (teeth). The spines of stingrays and marine catfish can cause soft tissue injury and infection. The spine has a recurved, serrated shape that may cause further injury and break if it is pulled out. The venom may cause local tissue necrosis requiring débridement. Soft tissue infections with marine Vibrio bacteria can occur after eating raw oysters or receiving even minor injuries from marine animals. Thirty-one individuals developed soft tissue infections, 49 developed sepsis, and 23 developed both sepsis and soft tissue infection with marine Vibrio species during a 12-year period. Sixteen patients developed necrotizing soft tissue infections. Treatment is with antibiotics and débridement when necrosis occurs.

Blood-brain barrier integrity and brain water and electrolytes during hypoxia/hypercapnia and hypotension in newborn piglets.

This study examines the effects of hypoxia/hypercapnia and hypoxia/hypercapnia with hypotension (hypotensive-hypoxia/hypercapnia) on blood-to-brain transfer constants (K1) for sodium and mannitol and brain water and electrolyte contents in newborn piglets. Hypoxia/hypercapnia was induced for 60 min with the piglets breathing a gas mixture of 15% carbon dioxide, 10-12% oxygen, and 73-75% nitrogen adjusted to achieve an arterial pH less than 7.15, pO2 less than 40, and pCo2 greater than 60 mmHg and hypotension for 20 min by rapid phlebotomy to achieve a mean arterial blood pressure less than 40 mmHg. Piglets were studied during 1 h of, and 24 h after resuscitation from hypoxia/hypercapnia (arterial pH 6.9 +/- 0.18, pO2 36 +/- 6 mmHg, pCO2 68 +/- 8 mmHg, mean +/- S.D.) and 10 min, and 24 h after resuscitation from hypotensive-hypoxia/hypercapnia (mean arterial blood pressure 28 +/- 10 mmHg, mean +/- S.D.). Values for K1 for sodium and mannitol, measured using the integral technique were 15.9 and 5.2 ml.g-1.min-1 x 10(4) respectively, in 2-4-day-old controls, suggesting that the barrier is fully developed in newborn piglets. Values were not different during or after hypoxia/hypercapnia or 24 h after hypotensive-hypoxia/hypercapnia. Ten to forty min after hypotensive-hypoxia/hypercapnia, there was a proportional decrease in the K1 for sodium and mannitol of about 40%. These results suggest that the newborn piglet is similar to the adult with respect to impermeability of the blood-brain barrier to ions and small molecules and resistance of this barrier to systemic hypoxia/hypercapnia and hypotension.(ABSTRACT TRUNCATED AT 250 WORDS)

The cardiovascular abnormalities associated with duplicated segments of chromosome 7.

Congenital heart disease is an integral part of many genetic syndromes such as the major trisomies 13, 18, and 21. Little information, however, is available with reference to the incidence of cardiac anomalies in the trisomy 7 syndromes. Two patients with partial trisomy 7q, one of whom had congenital heart disease, are presented. A review of the literature reveals incomplete description of the cardiovascular abnormalities in the majority of case reports of patients with this syndrome, however, when described it appears that there are no specific defects associated with trisomy 7p and 7q, but only an increased frequency of occurrence. Further clinical and postmortem data regarding details of the congenital heart defects associated with trisomy 7 is required to confirm this preliminary observation.

The effects of brain blood flow on brain bilirubin deposition in newborn piglets.

Since kernicteric lesions are usually found in the subcortical regions of the brain and these areas also receive the highest blood flow during asphyxia and hypercapnia, we hypothesized that increases in brain bilirubin deposition may be related to increases in brain blood flow. Fourteen piglets underwent a 3-h infusion of bilirubin to maintain total serum bilirubin at approximately 8 mg/dl, during which time blood gases, hemodynamic variables, and brain blood flow were determined. After sacrificing the animals, regional brain bilirubin content was determined. Ten piglets underwent the same protocol; in addition, hypercapnia was induced during the last hour of study (PaCO2 approximately 70 mm Hg). The regional brain blood flow and bilirubin deposition were significantly increased over control values (p less than 0.05) following hypercapnia in the subcortical region and significantly so in the midbrain and cerebellum. In separate groups of control (n = 6) and hypercapnia (n = 6) piglets, 125I-labeled albumin was infused and demonstrated that hypercapnia was not associated with increased regional brain albumin content. We conclude that hypercapnia-induced augmentation in regional brain blood flow is associated with increased deposition brain blood flow is associated with increased deposition of unbound bilirubin. Although the causal relationship between these two observations has not been firmly established, the findings deserve future investigation to clarify the role of brain blood flow, brain bilirubin deposition, and the production of kernicterus in high risk infants.

Brain bilirubin deposition and brain blood flow during acute urea-induced hyperosmolality in newborn piglets.

Acute hyperosmolality-induced blood brain barrier breakdown has been demonstrated to increase the permeability of sucrose, which is similar in molecular weight to bilirubin, independently of changes in regional brain blood flow. We studied three groups of piglets given continuous bilirubin infusions to maintain serum bilirubin concentrations at approximately 8 mg/dl. Normal serum osmolality was maintained throughout the study in control animals. Two experimental groups were made hyperosmolar (330 and 375 mosmol/liter) with bolus urea infusions during the last hour of the study. Regional brain bilirubin concentrations were elevated in the 375 mosmol/liter hyperosmolal experimental group, but not in the 330 mosmol/liter group. Regional brain albumin concentrations also were increased over the control group in the 375 mosmol/liter animals. There were no differences in regional brain blood flows to account for the increases in brain bilirubin concentrations. Our results show that brain bilirubin deposition occurs following breakdown of the blood brain barrier by acute, severe hyperosmolality (375 mosmol/liter) and that the deposited bilirubin is derived from both bound and unbound fractions. The bilirubin deposition occurs independently of changes in regional brain blood flow; however, regional differences in the blood brain barrier permeability to albumin also occur.

Squamous cell carcinoma in dominant type epidermolysis bullosa dystrophica.

The unusual genetic disorder epidermolysis bullosa dystrophica has been reported in several patients in whom the chronic cutaneous scars led to the development of cutaneous squamous cell carcinoma. However, only one of these previously reported cases involved the autosomal dominant form of the disease; the remainder occurred in its recessive counterpart. We report the second and third patients with squamous cell carcinoma associated with the dominant form of epidermolysis bullosa dystrophica. In addition, we not only observed the previous electron microscopic findings of decreased numbers of anchoring fibrils beneath the basal lamina but have also noted marked disruption of the basal lamina itself.

Reticulate pigmented anomaly.

Reticulate pigmented anomaly of the flexures is a benign, recently described genodermatosis reported to involve the flexural areas as well as the scrotum. Described herein is a twenty-nine year old man in whom the characteristic speckled macules were limited to the scrotal and penile skin. The authors suggest that the anomaly be designated reticulate pigmented anomaly without reference to specific anatomic sites. It is possible that this pigmented eruption of the genitalia is a cutaneous marker of this patient's underlying testicular carcinoma.

Patch stage Kaposi's sarcoma.

The patch stage of Kaposi's sarcoma (KS) has been recently recognized as histologically distinct from that seen in well-developed violaceous nodules of KS. We report a patient with patch stage KS and its angioendothelioma-like histology. The presence of glomerulus-like vascular structures is a newly described feature.

Treatment of Kaposi's sarcoma with vinblastine.

Fourteen patients with Kaposi's sarcoma (KSY were treated systemically with vinblastine sulfate in a low-dose regimen and compared with 23 patients reported in the medical literature. The therapeutic results in our series were excellent in terms of regression of cutaneous lesions. Vinblastine appears to be a drug that is well suited for the management of KS in an outpatient setting. Intravenous therapy may be supplemented with intralesional or intraarterial vinblastine.

Sclerodermoid changes in a patient with metastatic malignant melanoma.

A 55-year-old man with metastatic malignant melanoma suddenly developed sclerodermoid changes in association with a large metastasis on one side between neck and shoulder. Sclerodermoid changes are not commonly associated with visceral malignancies. We suggest that such cutaneous changes may result from immunologic phenomena related to rejection of malignancies, analogous to graft-versus-host reactions in which sclerodermoid changes are seen.

Mycosis fungoides associated with florid sarcoid reactions.

We report a 59-year-old woman with disease manifestations diagnosed as mycosis fungoides (MF), as well as findings of sarcoidosis. The concurrence of these two disorders, both of which may be associated with basic immunopathogenic factors, has been reported. Histologically, the cutaneous findings of both non-caseating granulomas and an infiltrate compatible with MF in the same site leads to a discussion of granulomatous MF. Whether granulomatous MF simply represents sarcoidosis developing concomitantly with MF lymphoma or is, in fact, a distinct clinical and histologic type of MF is discussed. Reasons why granulomatous MF, like granulomators Hodgkin disease, might have a more favorable prognosis than the usual type of MF are considered.

Verrucous carcinoma of the foot.

A 50-year-old man presented with verrucous carcinoma on the sole of the foot. This unusual tumor, also called an epithelioma cuniculatum plantare, was successfully treated employing wide surgical excision.

Breast carcinoma and basal cell epithelioma after x-ray therapy for hirsutism.

We report a 60-year-old woman with a history of x-ray therapy for generalized hirsutism at 20 years of age who at the age of 37 years developed the first of numerous basal cell epitheliomas on her trunk, including chest, on a background of radiation damaged skin. At the age of 51 years one of the basal cell epitheliomas was biopsied and an incidental histologic finding was a breast carcinoma. The basal cell epithelioma is clearly linked with x-ray exposure; breast cancer is less so although there is impressive epidemiologic evidence supporting an association between human breast cancer and radiation exposure. In view of an association between thyroid cancer and dermatologic x-ray therapy, further investigation of such an association with breast cancer should be considered. It may be wise to evaluate patients who received dermatologic x-ray exposure to their breasts for possible breast cancer and to consider radiation induced skin damage on or near the skin overlying the thyroid or breasts as a cutaneous marker of internal malignancy or potential internal malignancy.