Crescent Shape Research Articles

Synthesis and evaluation of some pyrimidine analogs against toxoplasmosis

Toxoplasmosis is a worldwide infection caused by the obligate intracellular protozoan parasite Toxoplasma gondii. Some pyrimidine analogs were synthesized to be evaluated for their antitoxoplasma effects in animal experiments. Results were assessed by studying parasite density, estimation of serum Toxoplasma antigen, studying the ultrastructural changes of the parasite, and the histopathological changes of the affected organs and inhibitory activity for dihydrofolate reductase (DHFR) isolated from Cryptosporidium parvum. The result showed that 4 out of 12 synthesized compounds have promising antitoxoplasma potentials. The animals that received these four compounds showed statistically significant decrease in the mean number of the parasite count in the liver and the spleen when compared to the corresponding control group. Moreover, Toxoplasma antigen was very low or even absent in the serum of animals receiving these compounds. Light microscopic examination of the peritoneal exudates of animals receiving these compounds showed stoppage of movement and deformity in shape of the tachyzoites, whereas scanning electron microscopy revealed that the organisms had lost their crescent shape, with dimples and deep ridges on their surfaces. Very mild histopathological changes were noticed in liver, spleen, and lungs of the groups of animals receiving these compounds in comparison to the other groups. Thus, these compounds proved their effectiveness in eradication of the experimental Toxoplasma infection and inhibition of DHFR from C. parvum.

Surgical Anatomy of Retaining Ligaments in the Periorbital Area

The aim of this study was to elucidate an anatomic detail of ligamentous attachments in the periorbital areas of Korean cadavers. Sixty-one hemifaces of 35 Korean adult cadavers (age range, 43-101 years; 23 men and 9 women) were used. Fifty-five specimens were dissected, 12 used for tension measurement, and 6 for histologic study. Definite retaining ligaments were found in 42 (76.4%) of 55 dissected hemifaces. We named the retaining ligaments attached to the bony orbit periorbital ligament (PL). Periorbital ligament was in the medial and lateral orbital area. Medial PL (MPL) was curvilinear shaped and between an angle of +23.4 and -23.1 degrees on the horizontal at a midpupillary line. Lateral PL (LPL) was crescent shape and between an angle of +39.1 and -42.1 degrees. The MPL was vertical along the medical orbital rim just outer to the orbital septum. The width of MPL was 0.8 mm, and vertical length was 22.1 mm. The crescent-shaped LPL was located a few millimeters (up to 4 mm) lateral to the lateral orbital rim. The maximum width of LPL was 6.9 mm, and vertical length was 28.2 mm. The breaking strength of the LPL (14.2+/-11.1 N) was significantly higher (P=0.016) than that of the central lower eyelid (5.1+/-2.5 N). The breaking strength of the MPL (8.4+/-3.0 N) was also significantly higher (P=0.013) than that of the central lower eyelid. However, there was no significant difference between LPL and MPL (P=0.055). Knowledge of the retaining ligaments is conducive to performing the midfacial rejuvenating surgery.

Discrete arcs of increased fundus autofluorescence in retinal dystrophies and functional correlate on microperimetry

To describe the occurrence of discrete arcs of increased fundus autofluorescence (FAF) associated with various retinal dystrophies and to assess their functional significance by fundus-controlled microperimetry. Seven patients, three with pigmented paravenous retinochoroidal atrophy (PPRCA), one with sector retinitis pigmentosa (RP), one with typical RP, and two with macular dystrophy were assessed by retinal imaging including FAF imaging. Serial images were obtained within a review period of 6 and 10 years in a patient with PPRCA and macular dystrophy, respectively. Fundus-controlled microperimetry was performed in eight eyes of five patients to determine light increment sensitivity. A discrete arched line of increased FAF was observed without obvious correlate on fundus biomicroscopy. The orientation of this line differed from ring shape in RP and macular dystrophy, a semi-circle structure in sector RP to crescent shape with tiplike extensions towards branching retinal veins in PPRCA. Longitudinal investigation revealed slight migration of the arc in PPRCA and peripheral extension of the ring diameter in macular dystrophy. Microperimetry revealed that the arc of increased FAF sharply delineated areas of severely impaired retinal sensitivity. The findings indicate that arcs of increased FAF in PPRCA and other retinal dystrophies demarcate areas of impaired retinal function and may migrate over time. FAF imaging may therefore reveal the exact extent of neurosensory dysfunction that may exceed the dimensions anticipated by conventional examinations.

Fine structure of the reproductive system of Chrysomya megacephala (Diptera: Calliphoridae): the external sexual organ

The fine structure of the reproductive system of Chrysomya megacephala (Fabricius), a blow fly species of medical importance, was studied using scanning electron microscopy (SEM) to contribute detailed morphological information on the external sexual organs or genitalia of this species. Analysis of the male genitalia or hypopygium revealed that the epandrium is a broad organ resembling a crescent shape, while the ejaculatory apodeme and aedeagal apodeme show similarity in their lengths. The cercus is significantly longer than the surstylus with its apical end being more or less rounded. Dense patches of long bristles, morphologically similar to the sensilla chaetica and sensilla trichodea, were found along the lower half of the cercus. The surstylus has a stout triangular shape, and the proximal half is greatly endowed with sensilla thought to be sensilla chaetica and sensilla trichodea. The aedeagus per se is prominent and has a clavate shape formed by the base theca and elongated phallus. The vesica of the phallus is a smooth bilobed structure, which curves inward. The juxta and juxta process are armed with many rows of strong spines resembling thorns in their appearance. The harpe is slender, recurved anteriorly, and distally pointed like a sickle. Regarding the female genitalia or ovipositor, SEM observation of the supraanal plate revealed it to be sclerotized and more or less triangular-shaped, lying between a pair of short cerci. Several types of sensilla were found on the supraanal plate, subanal plate and cercus, including the sensilla trichodea, sensilla basiconica, sensilla placodea, and probably, sensilla styloconica. The possible functions of sensilla distributed in particular regions of the fly genitalia are discussed.

Scar-Saving Flap during Serial Excision by Borrowing from the Opposite Side.

Congenital melanocytic nevi may have various shapes according to the anatomic location. Therefore, it is desirable to apply proper surgical designs to the diverse forms considering the characteristics of the sites as well as the shape and size. The purpose of this article is to introduce a new scar-saving flap design for semicircular defects after removing congenital melanocytic nevi without excising additional normal skin. In most cases to excise semicircular nevi, normal skin should be excised to prevent dog ear, resulting in the long length of the scar. So we use a new scar-saving flap design by borrowing a partial length from the opposite side. We used this new technique for 4 cases of large semicircular skin defects. In all cases, this method had some advantages from this perspective: (1) it does not require excision of normal adjacent skin to convert a semicircular defect into a crescent shape or to remove dog-ears (2) the final suture line is not much longer than the diameter of the original defect and (3) it makes the removal of a much larger volume possible in one procedure rather than using the classic serial excision technique, which consists of a central elliptical excision within the confines of the nevus. In this way the frequency of procedures and discomfort to the patient can be reduced. We think that a scar-saving flap design by borrowing a partial length from the opposite side can be a good strategy for a semicircular skin defect.

An Anatomic Study on the Overlap Patterns of Structural Components in the Keystone Area in Noses of Koreans

ObjectivesThe keystone area has critical importance in maintaining the stability of the nasal dorsum. However, overlap patterns between structural components in the keystone area have rarely been studied, especially in the noses of Koreans.MethodsDissections were performed on 18 cadaveric noses. The length and width of the structural components in the keystone area were measured. The shape of the caudal margin of the nasal bone and the overlap patterns between the upper lateral cartilage and the nasal bone were classified.ResultsThe shape of the caudal margin of the nasal bone were classified as follows: type A, curvilinear margin; type B, paramedian retractions or "M" shape; type C, elongated midline; and type D, retracted midline. The overlap area between the upper lateral cartilage and the nasal bone was classified as follows: type Ao, crescent shape; type Bo, short midline extension; and type Co, long midline extension. The cephalocaudal length of the overlap area between the upper lateral cartilage and the nasal bone was 4-10 mm (mean, 7 mm) in the midline, and 0-7 mm (mean, 3.1 mm) in the paramedian area. The overlap width of the upper lateral cartilage with the nasal bone was 8-14 mm (mean, 9.7 mm).ConclusionThe overlap pattern of the structural components in the keystone area is variable. Therefore, a thorough understanding and a cautious evaluation of the relationships of these components before and during surgery is important in performing safe and effective nasal procedures.

A study of arthroscopic rotator cuff repair in elder patients

目的 探讨关节镜下手术治疗老年退行性肩袖撕裂的疗效.方法 2002年9月-2005年6月,对16例50岁以上肩袖撕裂的患者,采用关节镜下手术治疗.根据肩袖撕裂的大小和形状分成新月形和U形,新月形撕裂直接采用Mitek(GⅡ)铆钉腱骨缝合的方法,U形撕裂采用对边缝合后加用Mitek(GⅡ)铆钉固定的方法.结果 16例患者均获得随访,随访时间为12～24个月,平均15个月.术前、术后的功能情况采用UCLA肩关节评分系统进行疗效评价:优8例,良7例,可1例,优良率为93.5%.术后无明显的并发症,两种修补方法疗效相同.结论 关节镜下手术创伤小、出血少、术后恢复快,且能最大程度地恢复肩关节的功能,是治疗老年人肩峰撞击肩袖撕裂的首选术式。

Partial airway obstruction caused by dissection of a reinforced endotracheal tube

EDITOR: Ventilatory problems during surgery in the prone position may be a serious complication [1]. We report an incident where there was dissection of a reinforced endotracheal tube that led to its partial obstruction. This case shows an unexpected complication from reusing products intended for single use. A 62-yr-old female (weight 68 kg) who was scheduled for total laminectomy with posterior lumbar fusion for lumbar stenosis was intubated with a 7.0-mm reinforced endotracheal tube (Safety-flex; Mallinckrodt®, Athlon, Ireland). Her lungs were ventilated with a mixture of sevoflurane 1.5 MAC (minimum alveolar concentration) in oxygen (35%) and nitrous oxide (65%). Her peak airway pressure (Ppeak) was 25 cmH2O and end-tidal CO2 (etCO2) was 36 mmHg at the beginning of anaesthesia without wheezing. Ppeak increased to 30 cmH2O and etCO2 to 40 mmHg in the prone position. Approximately 30 min after prone positioning, Ppeak increased to 40 cmH2O and etCO2 increased to 45 mmHg. We could not pass a suction catheter beyond a distance of 24 cm from the entrance of the tracheal tube. Using a fibrescope, we could see the appearance of a meniscus and a crescent shape on the inner wall. Because of the prone position, we could not change the tube but managed to maintain ventilation, saturation and etCO2 within the normal range by a change of ventilatory mode for the remaining 5 h of the procedure. After returning to the supine position at the end of the operation, we extubated the patient and her self-respiration was good. Unfortunately, we found mild left lower lobe atelectasis postoperatively, which responded to physiotherapy. Her lung condition had returned to normal without complication by the second postoperative day. Examination of the reinforced tube showed two internal blisters, one at the entrance and one at 24 cm from the entrance. Examination using a rigid fiberscope and computed tomography (Fig. 1) showed a dissection of the inner layer of the tube. The dissection had caused longitudinal blisters of 2.8 and 4.2 cm length and reduction of the internal diameter to 3.5 and 2.9 mm at the proximal and distal parts, respectively.Figure 1.: Computed tomographic picture and fibrescopic view of the inside of the endotracheal tube. ( a - c ) distal part and ( d - f ) proximal part. Arrows indicate the area of dissection.We assumed that the damage of the tube was caused by faulty manufacture. However, we subsequently discovered that the cause was multiple re-use of the single-use tube. Similar complications have been reported during anaesthesia with use of N2O [2,3] or even without N2O [4], exposure of heat, ethylene oxide [4-6] and gluteraldehyde solution [6] and stretching of a reinforced endotracheal tube [6]. The tube in this case had been cleaned after each use with hypochlorous acid (Medilox solution; Hicro-S®, Soosan GIC Co Ltd, Seoul, Korea) after ultrasonic cleansing for 30 min. We should bear in mind that repeated reuse of reinforced endotracheal tubes that are designed for single use is unwise.

Design of DNA Minor Groove Binding Diamidines That Recognize GC Base Pair Sequences: A Dimeric-Hinge Interaction Motif

The classical model of DNA minor groove binding compounds is that they should have a crescent shape that closely fits the helical twist of the groove. Several compounds with relatively linear shape and large dihedral twist, however, have been found recently to bind strongly to the minor groove. These observations raise the question of how far the curvature requirement could be relaxed. As an initial step in experimental analysis of this question, a linear triphenyl diamidine, DB1111, and a series of nitrogen tricyclic analogues were prepared. The goal with the heterocycles is to design GC binding selectivity into heterocyclic compounds that can get into cells and exert biological effects. The compounds have a zero radius of curvature from amidine carbon to amidine carbon but a significant dihedral twist across the tricyclic and amidine-ring junctions. They would not be expected to bind well to the DNA minor groove by shape-matching criteria. Detailed DNase I footprinting studies of the sequence specificity of this set of diamidines indicated that a pyrimidine heterocyclic derivative, DB1242, binds specifically to a GC-rich sequence, -GCTCG-. It binds to the GC sequence more strongly than to the usual AT recognition sequences for curved minor groove agents. Other similar derivatives did not exhibit the GC specificity. Biosensor-surface plasmon resonance and isothermal titration calorimetry experiments indicate that DB1242 binds to the GC sequence as a highly cooperative stacked dimer. Circular dichroism results indicate that the compound binds in the minor groove. Molecular modeling studies support a minor groove complex and provide an inter-compound and compound-DNA hydrogen-bonding rational for the unusual GC binding specificity and the requirement for a pyrimidine heterocycle. This compound represents a new direction in the development of DNA sequence-specific agents, and it is the first non-polyamide, synthetic compound to specifically recognize a DNA sequence with a majority of GC base pairs.

Chronic Phenobarbital-Induced Mitochondrial Pleomorphism in the Rat Liver

Posttreatment effects of phenobarbital (30 mg/kg I.P. per day for 5 days) on liver mitochondrial TEM ultra-structure in adult rats were studied. Liver mitochondria population samples in treated rats exhibited pleomorphic morphological dumbbell shapes (7%), U-type (crescent) shapes (4%) and O-type (ring-like) shapes (4%). This pathology was not observed in vehicle-treated animals. Phenobarbital is a drug that induces within the rat liver increased protein synthesis in the mitochondria and mitochondrial morphological shape changes.

Quantitative analysis of pore space of moraine clay soils by SEM images

Problems of studying the pore space of moraine clay soils are considered by analyzing SEM images of the surface of samples prepared using a special technique. A new algorithm for estimating the pore shape is described. The study of the microstructure of moraine clay soils showed that they are characterized by five pore types. Of particular interest is the existence of large micropores with specific anisometric crescent shape in such soils. These micropores are formed at the interface between the surface of large sand-dust quartz or feldspar grains and the finely divided unoriented clay matrix. Such pores can be ways of localized groundwater filtration through soils, significantly affecting the soil properties.

Sickle Cell Disease

1. M. Catherine Driscoll, MD* 1. *Director, Hematology Program, Children's Hospital at Montefiore, Bronx, NY After completing this article, readers should be able to: 1. Describe the pathogenesis of sickle cell disease. 2. Delineate the complications of sickle cell disease and their management. 3. Review guidelines for health maintenance and preventive measures. 4. Discuss the current treatments for sickle cell disease. Sickle cell disease (SCD) is a chronic hemolytic anemia that includes the hemoglobin (Hb) variants SS, SC, S-beta thalassemia, SO Arab, SD, and other rare S-Hb genotypes. SCD is one of the most common genetic diseases worldwide. Sickle disorders are seen commonly in sub-Saharan Africa but also occur in the Mediterranean, India, and the Arabian Peninsula. The geographic distribution of sickle hemoglobinopathies corresponds to the distribution of malaria; indeed, the sickle gene in the heterozygote (AS) form protects against death from endemic Plasmodium falciparum malaria infection. In addition, the clinical manifestations of SCD vary among these geographic sites, with individuals from India, the Arabian Peninsula, and Senegal having milder disease than those from parts of Africa. This pattern suggests that genetic modifiers ameliorate the disease in certain populations and contribute to the significant variation in clinical manifestations. The presence of SCD in North, South, and Central America is due to immigration patterns and represents primarily the more severe African types. The genetic defect producing sickle Hb is a single nucleotide substitution (GTG for GAG) at codon 6 of the beta globin gene on chromosome 11 that results in the substitution of valine for glutamic acid. This hydrophobic amino acid substitution allows Hb S to polymerize on deoxygenation, and multiple polymers bundle to form rodlike structures that distort the red cell into the classic crescent shape. Sickled red cells are less deformable in the microcirculation and provoke a cascade of events that results in vascular occlusion, organ ischemia, and eventually, chronic end-organ damage. The ancillary events of polymerization that …

Macrocycles Incorporating an Endocyclic But Non‐Sterically‐Hindering Chelate: Synthesis and Structural Studies

AbstractTwo rings of different size have been prepared both incorporating a 3,3′‐biisoquinoline (biiq) chelate. The biiq ligand bears phenyl groups at its 8‐ and 8′‐positions, which provide it with an approximate crescent shape. The incorporation of the 8,8′‐diaryl‐3,3′‐biisoquinoline motif in a ring leads to an unusual situation. The complexing site of the macroring is unambiguously pointing towards the inner part of the macrocycle, but, at the same time, it is not sterically hindered, due to the relatively large distance between the coordinating site and the various organic groups belonging to the macrocyclic structure. The synthesis of the two compounds is reported, as well as the X‐ray structure of one of them, which confirms the expected geometrical properties of the molecules.

Three-dimensional Echocardiographic Evaluation of Right Ventricular Volume and Function in Pediatric Patients: Validation of the Technique

The right ventricle (RV) is the main ventricular chamber in many congenital heart diseases before and after surgical correction, and it is the most important determinant of outcome in postoperative tetralogy of Fallot and other complex malformations. Unfortunately its irregular crescentic shape does not allow the use of the geometric assumption used for the left ventricle. Many methods have been suggested in the literature to overcome this problem, none fully reliable. The introduction of volume-rendered 3-dimensional (3D) reconstruction of echocardiography images provides a tool for the direct measurement of cardiac chambers, not based on geometric assumptions. The aim of this research study was to determine the accuracy of 3D echocardiography (3DE) to measure RV volumes in pediatric patients with secundum atrial septal defects, compared with direct volume measurements performed during the intervention. We performed 3DE study in the operating department, with the patient anesthetized, intubated, and ventilated before the surgical procedure. Sequential 2-dimensional echocardiographic images for subsequent 3D rendering were acquired using an ultrasound machine with a transthoracic 4-MHz rotational or 5-MHz transesophageal omniplane probe; in the last 5 patients a machine was used that was equipped with a 3600-crystal real-time 3D probe. To validate the 3DE measurements, these were compared with the volume of the RV directly measured in the operating department, at the end of the surgical procedure, injecting saline solution through the tricuspid valve, using a graduate syringe. Among 25 pediatric patients enrolled in the study, with an age range of 1 and 14 years (mean 4 years) and a weight range of 8.5 to 57.4 kg (mean 18.6 kg), in 23 a mean of 3 echocardiographic acquisitions were performed and compared with the direct measurement. A close comparison was found between RV volumes measured by 3DE and direct volume measurements (P < .00001). The regression line, shifted toward the y axis, which describes the 3DE volumes, indicated that the echocardiographic measures overestimate the surgical ones. In our study this overestimation had the mean of 9% with values comprised between 3% and 19%. The coefficient of repeatability was 4.79 mL with all the values within this range (2 SD of the mean). We conclude that 3DE provides an accurate measurement of RV volume in pediatric patients with RV volume overload. It is a reliable, noninvasive, and nongeometric method of evaluation of the volume of this chamber, and can be considered a precious tool in the armamentarium of the pediatric cardiologist.

Lee waves from a sphere in a stratified flow

Two asymptotic analyses of the generation of lee waves by horizontal flow at velocityUof a stratified fluid of buoyancy frequencyNpast a sphere of radiusaare presented, for either weak or strong stratification, corresponding to either large or small internal Froude numberF=U/(Na), respectively. ForF⋙1, the fluid separates into two regions radially: an inner region of scaleawith three-dimensional irrotational flow unaffected by the stratification, and an outer region of scaleU/Nwith small-amplitude lee waves generated by theO(1) vertical motion in the inner region. ForF⋘1, the fluid separates into five layers vertically: from the lower dividing streamsurface situated at a distanceU/Nabove the bottom of the sphere to the upper dividing streamsurface situated at a distanceU/Nbelow the top, there is a middle layer with two-dimensional horizontal irrotational flow; from the upper dividing streamsurface to the top of the sphere, and from the lower dividing streamsurface to the bottom, there are top and bottom transition layers, respectively, with three-dimensional flow; above the top and below the bottom, there are upper and lower layers, respectively, with small-amplitude lee waves generated by theO(F) vertical motion in the transition layers.The waves are calculated where they have small amplitudes. The forcing is represented by a source of mass: forF⋙1, the surface distribution of singularities equivalent to the sphere in three-dimensional irrotational flow; forF⋘1, the horizontal distribution of singularities equivalent, in the upper (resp. lower) layer, to the flat cut-off obstacle made up of the top (resp. bottom) portion of the sphere protruding above (resp. below) the upper (resp. lower) dividing streamsurface. The analysis is validated by comparison of the theoretical wave drag with existing experimental determinations. ForF⋙1, the drag coefficient decreases as (lnF+7/4-γ)/(4F4), with γ the Euler constant; forF⋘1, it increases as$(32\surd2)/(15\upi)F^{3/2}$. The waves have the crescent shape of the three-dimensional lee waves from a dipole, modulated by interferences associated with the finite size of the forcing. For strong stratification, the hydrostatic approximation is seen to produce correct leading-order drag, but incorrect waves.

Minimal size of a barchan dune

Barchans are dunes of high mobility which have a crescent shape and propagate under conditions of unidirectional wind. However, sand dunes only appear above a critical size, which scales with the saturation distance of the sand flux [P. Hersen, S. Douady, and B. Andreotti, Phys. Rev. Lett. 89, 264301 (2002); B. Andreotti, P. Claudin, and S. Douady, Eur. Phys. J. B 28, 321 (2002); G. Sauermann, K. Kroy, and H. J. Herrmann, Phys. Rev. E 64, 31305 (2001)]. It has been suggested by P. Hersen, S. Douady, and B. Andreotti, Phys. Rev. Lett. 89, 264301 (2002)] that this flux fetch distance is itself constant. Indeed, this could not explain the protosize of barchan dunes, which often occur in coastal areas of high litoral drift, and the scale of dunes on Mars. In the present work, we show from three-dimensional calculations of sand transport that the size and the shape of the minimal barchan dune depend on the wind friction speed and the sand flux on the area between dunes in a field. Our results explain the common appearance of barchans a few tens of centimeter high which are observed along coasts. Furthermore, we find that the rate at which grains enter saltation on Mars is one order of magnitude higher than on Earth, and is relevant to correctly obtain the minimal dune size on Mars.

Crescentic Nasojugal Flap for Nasal Tip Reconstruction

Carcinomas of the tip of the nose are very common, and the nasal tip defect is one of the most challenging subunit to reconstruct. There are numerous available procedures for the reconstruction of the tip of the nose. We have developed a flap for the management of a tissue loss from the tip of the nose and report the use of this flap for 11 patients. The purpose of this presentation is to report a refinement of a nasojugal flap for the reconstruction of a nasal tip defect. The flap we describe has the characteristic of excising the dog-ear, created by the movement of the flap, in a crescent shape of skin in the perialar area, allowing the mobilization of the skin of the lateral surface of the nose and cheek. Eleven patients presenting tissue loss from the tip of the nose after excision of carcinoma underwent surgery using the flap. The flap described constitutes a good alternative for reconstruction of nasal tip defect, up to 2 cm of diameter, with excellent aesthetic results. Numerous flap options are available to reconstruct tissue loss from the tip of the nose. The nasojugal flap we describe, due to its great reliability, yields excellent functional and cosmetic results, and we believe that it is a valuable alternative to other techniques of reconstruction for defect of the nasal tip. For the 11 patients who underwent surgery with this flap, no major complication was reported. The aesthetic result was never compromised, and the scars result was very satisfactory.

Ultrasonographic examination of the omasum in 30 healthy cows

A 3·5 MHz linear transducer was used to scan the intercostal spaces of 30 healthy cows from dorsal to ventral on the right side, and the appearance, dorsal and ventral...

Tracheobronchomalacia-Like Lung Collapse During Three Separate Trials of General Anesthesia

To the Editor: We report a case of unexpected tracheobronchomalacia-like lung collapse. A 66-year-old woman (48 kg, 139 cm) was scheduled for right total hip arthroplasty. Preoperative chest radiograph was normal. We induced anesthesia with 4 mg midazolam followed by 7% sevoflurane inhalation in oxygen. Following endotracheal intubation, the patient's breath sounds decreased over the left lung. Bronchoscopy showed expiratory narrowing of the distal trachea and left main bronchus into a crescent shape (Figs. 1a and b). Although Pao2 was 354 mm Hg, surgery was postponed to evaluate the lung collapse.Figure 1.: Severe narrowing in the expiratory phase observed in the trachea and the left main bronchus (a, b). The left upper and lower bronchus almost closed in both expiratory and inspiratory phase (c). Bronchoscopy in the awake patient showed no abnormalities in the trachea and the left bronchus (d, e).Immediately upon recovery from anesthesia, the breath sounds of the left lung returned to normal and the collapse seen on bronchoscopy disappeared. Chronological CT scanning showed modest narrowing of the trachea, but the tracheobronchial tree was otherwise normal. Subsequent bronchoscopy with the patient awake was also unremarkable. For the second attempt, we induced and maintained anesthesia with sevofluorane. We also placed an epidural catheter, and administered 20 mL of 1.5% lidocaine with epinephrine, 1:200,000. As before, the patient's breath sounds decreased over the left lung. Bronchoscopy again showed severe, crescent-type narrowing of the distal trachea and main bronchus. However, we proceeded with the right total hip arthroplasty. On recovery from anesthesia, normal breath sounds returned over the left lung. For the third attempt for left total hip arthroplasty half a year later, we placed an epidural catheter, and then induced and maintained anesthesia with propofol and fentanyl. Although breath sounds were again reduced over the left lung and bronchoscopy showed severe narrowing of the distal trachea and main bronchus, we proceeded with the total hip arthroplasty. The distortion of the trachea and bronchus disappeared after recovery from anesthesia, and breath sounds returned over the left lung. In all three attempts, we observed tracheobronchomalacia-like collapse with induction of anesthesia, whereas bronchoscopy with the patient awake was completely unremarkable. However, we noted her breathing sounds were reduced during normal sleep. Therefore, the underlying pathology may also occur, at least partly, when the patient is asleep. Takeshi Yokoyama, DDS, PhD Koichi Yamashita, MD, PhD Masanobu Manabe, MD, PhD Department of Anesthesiology and Critical Care Medicine Kochi Medical School Nankoku City, Japan [email protected] Kathleen A. Sluka, PT, PhD Graduate Program in Physical Therapy and Rehabilitation Science University of Iowa Iowa City, IA

Free radical scavenging abilities of polypeptide fromChlamys farreri

An upwelled region as seen through satellite imagery off the Somali coast is compared with sea surface temperature during summer Monex-79. The relationship between satellite-derived low-level cloud drift winds and the sea-surface temperature is studied. Cloudiness associated with a prime eddy off the Somali coast is also studied. It is observed that the upwelled region has a unique crescent shape and reflects the sea-surface temperature that is driven by low-level strong winds. The prime eddy, as observed through a satellite imagery, shows that low cloud convection tends to be greater over the warm waters of the prime eddy, and the upwelled cold water tends to encircle the eddy leading to the identification of its outer boundary.