Minor Mouth Research Articles

Interpretation of TEG Studies in Management of a Severe Glanzmann Thrombasthenia Patient

Glanzmann thrombasthenia (GT) is an autosomal recessive bleeding disorder which can result in mild to severe mucocutaneous bleeding. Patients with GT usually have normal platelet count, no clumping noted on peripheral blood smear and distinctly abnormal platelet dysfunction studies. NovoSeven®RT has been approved for treatment of this disease, however some patients have ongoing bleeding in spite of treatment with NovoSeven®RT and platelet transfusions. To add to the complexity of the treatment plan, sometimes the bleeding is retropharyngeal and children swallow blood making a timely assessment even more difficult. This case report summarizes additional tools used to control nasal bleeding and the use of TEG (Haemonetics Corporation) to assess therapeutic interventions.Our patient is a 6 year old female with GT who has behavioral issues and has lived in numerous foster homes. Severe nasal and retropharyngeal bleeds have resulted in repeated emergent transfusions. Part of the difficulty in her management has been her ability to swallow large amounts of blood without notifying her caregiver. She has had multiple blood transfusions and has had an allergic response to platelet plasma requiring washed platelet products with premedication (Benadryl/Solumedrol/Tylenol). Consideration for unrelated HLA donor stem cell transplant had been explored, however our patient's behavioral issues made her less likely to tolerate the transplant process. Her current treatment plan was developed to address local control, systemic control and to attempt to develop a means of assessing therapeutic interventions.Both nares and her retropharyngeal region were her primary bleeding sites. ENT evaluation identified numerous telangiectasias (AFP= 0.09). Repeated surveillance and cauterization followed by estrogen cream applied to the nasal mucousa twice daily greatly diminished the number of telangiectasias. Amicar® nasal spray (compounded as 10% nasal spray, used as 0.1 mL spray in each nostril), Zyrtec® nasal spray, nightly use of humidifier, normal saline nose gel, and cellulose gauze are medications used for local prevention and have been effective in preventing minor mouth and nose bleeds from becoming major bleeds.Systemic prevention regimen consisted of NovoSeven®RT prophylaxis BID 2 mg (90 mcg/kg/dose), Amicar® BID and behavioral support to avoid causing self induced trauma/bleeding. Since starting this regimen, all of her bleeds have been related to trauma or digital manipulation. NovoSeven®RT administered every 2 hours in addition to Amicar® TID and 1 to 2 units of washed pheresis platelets were utilized for treatment of active bleeding.Because of 2 prolonged bleeding episodes following transfusion with a single washed pheresis platelet unit, we attempted to find testing to assist us with evaluation.TEG Studies and InterpretationI. Table 1With a single dose of NovoSeven®RT our patient's RTEG value (time to produce thrombin) improved. However, the rate of clot development/propagation only improved to varying degrees (ANGLE TEG). The overall clot strength (MATEG) remained virtually unchanged.II. Table 2With a single washed pheresis unit of platelets, RTEG normalized and MATEG as well as the rate of propagation of the clot improved, however these values were not normal.With more than one washed pheresis platelet unit and NovoSeven®RT, TEG values almost normalized or returned to normal range, including clot strength represented by MATEG. These findings suggested the greater number of normal platelets transfused increased the likelihood of normal thrombin generation and clot formation. The loss of platelet product from washing likely resulted in decreased platelet numbers, perhaps decreasing the effectiveness of a single washed pheresis unit.We have utilized these findings to assist with the treatment of severe bleeds and to determine if more washed platelets would be beneficial when clinically the extent of bleeding cannot be determined in a short amount of time (i.e retropharyngeal bleeding). TEG is especially suited for rapid assessment and frequently used in Adult Trauma Centers. Treatment of a pediatric patient with significant bleeding and behavioral concerns requires a tool box of supportive measures. With local, systemic measures and use of TEG, we have been able to improve the safety of our GT patient, with decreases in major bleeds over the last year. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Benthic foraminifera as a key to delta evolution: Acase study from the late Holocene succession of the Po River Delta

Benthic foraminifera from stratigraphically expanded, late Quaternary prodelta successions of the Po Delta plain reveal small-scale paleoenvironmental variations within lithologically homogeneous deposits formed under conditions of rapid sedimentation (ca. 6 cm/yr). A detailed paleoenvironmental reconstruction was obtained comparing benthic foraminifera with shallow-water assemblages from the modern Po Delta. The integration with sediment geochemistry and radiocarbon dates was also tested to detect short time-scale delta dynamics controlled by autogenic factors. Core 7 records the development of an inner-shelf environment (interval A), replaced by a prodelta with strong fluvial influence, shown by the sharp increase in Ammonia tepida and Ammonia parkinsoniana (interval B). These taxa are replaced by Aubignyna perlucida (interval C) which indicates a major mouth shift (Ficarolo avulsion). Subsequent abrupt increases in A. tepida and A. parkinsoniana document a step-like progradation of the Po di Goro delta lobe (intervals D and E). In the seaward Core 1, possible minor mouth shifts are recorded by a sharp increase in A. tepida and A. parkinsoniana, paralleled by Cr/Al2O3 depletion. The upper portion of both prodelta successions includes stacked flood layers formed near the river mouth, as indicated by scarce A. tepida and A. parkinsoniana.

Palaeovalleys in foreland ramp settings: what happens as accommodation decreases down dip?

AbstractRecent advances in our understanding of palaeovalleys are largely guided by examples from passive margins, in which accommodation increases down depositional dip. This study tests these models against a dataset from the Pennsylvanian Breathitt Group of the central Appalachian foreland basin, USA. This fluvio‐deltaic succession contains extensive erosionally based fluvio‐estuarine sand bodies that can be tracked over 80 km down depositional dip from a proximal zone of high accommodation close to the orogenic margin to a distal, lower accommodation zone close to the cratonic margin of the basin. The sand bodies are up to 25 m thick, multi‐storey and characterized in their lower parts by strongly amalgamated storeys containing sandy fluvial to estuarine bar accretion elements, and in their middle to upper parts by more fully preserved storeys up to 10 m thick and laterally extensive over 100s of metres. The upper storeys include abandonment channel‐fills of heterolithic marine or marginal marine deposits or muddy to sandy point‐bar elements. Three major regional‐scale architectures include: (i) Tabular sand bodies that everywhere incise open marine prodelta and mouth bar facies and are interpreted as palaeovalleys formed during falling stage and lowstand systems tracts, when eustatic sea‐level fall outpaced tectonic subsidence across the entire study area. (ii) Sand bodies that incise genetically related floodplain lake and/or bay‐fill minor mouth bar deposits up depositional dip and open marine prodelta and mouth bar facies down dip. These stacked distributary channel deposits map down dip into palaeovalleys and formed when up dip subsidence rate resulted in positive, but reduced rate of accommodation creation, while lower tectonic subsidence rate down‐dip resulted in incision. (iii) Sand bodies that incise genetically related floodplain, lake and/or bay‐fill minor mouth bars up dip and pass down‐dip into genetically related unconfined floodplain, prodelta and mouth bar deposits. These sand bodies represent stacked distributary channel fills and channel amalgamation was the product of high rates of lateral migration, typical of the behaviour of channels above their backwater reach. Case (2) sand bodies demonstrate that in rapidly subsiding foreland basins, cross‐shelf palaeovalleys may form down depositional dip from aggradational, distributive fluival strata. Additionally, the genetic relationship between stacked distributary channels and palaeovalleys supports recent models for palaeovalley formation that emphasize diachronous, cut‐and‐fill during falling stage and lowstands of relative sea level.

Stratigraphic Record of River-Dominated Crevasse Subdeltas With Tidal Influence (Lajas Formation, Argentina)

Abstract Crevasse subdeltas develop on modern river-dominated delta plains, and may be affected by the interaction of river currents and marine processes. However, their sedimentology and stratigraphic architecture is poorly constrained, leading to simplistic depositional models of delta-plain systems in the ancient record. Extensive exposures of the Middle Jurassic Lajas Formation permit the architecture, main stratigraphic surfaces, and lateral and vertical facies variations of crevasse subdelta deposits to be constrained. Lower-delta-plain successions studied in the Lajas Formation consist of up to 5-m-thick distributary channels and interdistributary-bay deposits, interpreted as crevasse subdeltas. Crevasse subdelta deposits consist of small-scale lenticular units (∼ 1–2 m thick) interpreted as crevasse channels and upward-coarsening and upward-thickening packages (∼ 2 m thick) with clinothems interpreted as crevasse mouth bars. These deposits preserve interbedding of coarser and finer sediments that are interpreted as river flood and interflood couplets associated with variations in river discharge. River flood beds are commonly structureless and erosionally based, and show little evidence of tidal action and brackish-water conditions. Interflood deposits show rhythmically distributed mudstone drapes, bimodality, and brackish trace fossils. This study highlights an important but largely undocumented component of interdistributary deposits consisting of tide-influenced, but strongly river-dominated, prograding depositional bodies. An implication is that some coarsening-upward, forward-accreting units previously interpreted from the rock record as interchannel “tidal bars” may instead represent minor mouth bars of tide-influenced crevasse subdeltas. Furthermore, present-day crevasse subdeltas are restricted to river-dominated delta systems that flow into semi-enclosed or enclosed seas and lakes with microtidal conditions and limited wave action, which is comparable to paleogeographic reconstructions for the Neuquen Basin during the Middle Jurassic.

Sedimentological study of the Szőreg-1 reservoir (Algyő field, Hungary): a combination of traditional and 3D sedimentological approaches

The paper presents a 3D sedimentological characterization of a delta plain reservoir. The analysis started with detailed core description studies focusing on the genetic interpretations of the sedimentary structures and multivariate statistical analyses, (including Q-mode cluster and R-mode factor analysis), of the sporadic grain-size distributions. These results made the depositional processes of channels, bar-crests and crevasse splays probable. By calibration of the well log responses to the cores with total core recovery, we were able to identify two types of vertical facies transitions: (1) mouth-bars and channels; (2) crevasse splays, crevasse channels and minor mouth bars. In addition, a vertical sequence of a relative thick distributary mouth bar was also recognized. Lateral extension was determined by contouring the sand content on surfaces parallel to the upper time horizon. On these surfaces, the sand content and porosity grid systems facilitated the use of an unconventional 3D geo-cellular modelling approach for both well-log-porosities and sand contents. Since vertical depositional facies were extended into the 3D, rock bodies of the most characteristic channel and mouth bar environments could be cut out from the porosity and sand content models. In this way not only their general geometry and internal characteristics, but also the basic geostatistical features (ratio of anisotropy, the direction of major and minor continuity) of their sand content and porosity were identified.

Management of Aphthous Ulceration with Topical Quercetin: A Randomized Clinical Trial

Recurrent aphthous ulceration is the most commonly known oral mucosal disease. Quercetin is a useful therapeutic agent for the treatment of colitis and gastric ulcer. The objective of this study was to determine the effect of topical application of quercetin in the treatment of minor aphthous ulcers. Forty male patients with no known pathology of the oral mucosa other than minor aphthous ulcers were enrolled in this study. Patients were randomly divided into two groups, each consisting of 20 patients. Group 1 (control group) patients used a benzydamine hydrochloride mouthwash three times daily. Group 2 patients placed two to three dabs of quercetin three times daily directly on their ulcers. Clinical evaluation of patients included assessment of ulcer size, pain measure, and interviews regarding the topical application of quercetin in terms of consistency, taste, local tolerability, and ease of application. The topical application of quercetin cream to minor mouth ulcers relieved pain and produced complete healing in seven of the Group 2 patients (35 percent) in 2-4 days, 18 patients (90 percent) in 4-7 days, and 20 patients (100 percent) in 7-10 days. When comparing the mean ulcer size after 10 days, lesions in the Group 2 patients were smaller than those in Group 1, and the size difference between the two groups was significantly different (p<0.004). Also, 90 percent of patients responded that they appreciated the ease of application when using the topical quercetin, and they did not object to its consistency or taste. Quercetin is a safe, well-tolerated, and highly effective promising new, adjunctive treatment for healing common aphthous ulcers. Although aphthous ulcers typically resolve on their own in one to two weeks, the daily topical application of quercetin may be useful in accelerating the healing process of minor aphthous ulcers.

Isolation and identification of antimicrobial compound from Mentha longifolia L. leaves grown wild in Iraq

BackgroundMentha longifolia L. (Lamiaceae) leaves have been traditionally implemented in the treatment of minor sore throat and minor mouth or throat irritation by the indigenous people of Iraq, although the compounds responsible for the medicinal properties have not been identified. In the present study, an antimicrobial compound was isolated and characterized, and its biological activity was assessed.MethodsThe compound was isolated and characterized from the extracted essential oil using different spectral techniques: TLC, FTIR spectra and HPLC. Antimicrobial activity of the compound was assessed using both disc diffusion and microdilution method in 96 multi-well microtiter plates.ResultsA known compound was isolated from the essential oil of the plant and was identified as (-) menthol. The isolated compound was investigated for its antimicrobial activity against seven selected pathogenic and non-pathogenic microorganisms: Staphylococcus aureus, Streptococcus mutans, Streptococcus faecalis, Streptococcus pyogenis, Lactobacillus acidophilus, Pseudomonas aeruginosa and the yeast Candida albicans. Menthol at different concentrations (1:1, 1:5, 1:10, 1:20) was active against all tested bacteria except for P. aeruginosa, and the highest inhibitory effect was observed against S. mutans (zone of inhibition: 25.3 mm) using the disc diffusion method. Minimal inhibitory concentration MIC values ranged from 15.6–125.0 μg/ml, and the most promising results were observed against S. aureus and S. mutans (MIC 15.6 μg/ml) while, S. faecalis, S. pyogenis and L. acidophilus ranked next (MIC 31.2 μg/ml). Furthermore, menthol achieved considerable antifungal activity against the yeast C. albicans (zone of inhibition range: 7.1–18.5 mm; MIC: 125.0).ConclusionThe isolation of an antimicrobial compound from M. longifolia leaves validates the use of this plant in the treatment of minor sore throat and minor mouth or throat irritation.

Reply: Bevacizumab reverses need for liver transplantation in hereditary hemorrhagic telangiectasia

We would like to thank Buscarini and colleagues1 for their interest in our use of bevacizumab in a patient with severe hereditary hemorrhagic telangiectasia (HHT) with life-threatening hepatic involvement and for allowing us to provide follow-up information. Our patient was on maximal medical therapy for her high-output cardiac failure, portal hypertension, and ascites. Failure of standard medical therapy had led to referral for consideration for liver transplantation. Specifically, prior to the trial of bevacizumab, she was on fluid and sodium restriction, propanolol (40 mg 3 times a day), spironolactone (400 mg daily), and furosemide (40 mg twice daily). Higher doses of diuretics had been limited by renal impairment and electrolyte imbalance. Anemia was corrected with iron infusions and transfusions of packed cells with some difficulty, as it precipitated fluid overload. Her hemoglobin was 100 g/L at the time of her first bevacizumab infusion. At the end of her bevacizumab infusions, all medications were able to be stopped. We agree that HHT patients fit to be considered for liver transplantation should undergo right heart catheterization if noninvasive techniques suggest ventricular failure and/or high pulmonary arterial pressures. Right heart catheterization was not performed in our patient as she was considered too unwell for transplantation. At the time of presentation, her echocardiogram showed moderate to severe biventricular and biatrial dilatation, with an estimated pulmonary arterial systolic pressure of 41 mm Hg. Magnetic resonance cardiography revealed right and left ventricular ejection fractions of 54% and 62%, respectively, and right and left ventricular cardiac outputs of 10.4 and 10.2 L/minute, respectively. She remained in sinus rhythm throughout. After her dramatic response to the first course of bevacizumab, the patient remained stable and asymptomatic for 9 months. At this time, she redeveloped mild ascites associated with weight gain, tachycardia, and increased epistaxis. She began to experience breathless walking on flat ground, whereas previously she had been able to kayak for several kilometers. Her symptoms were associated with an increase in hepatic volume and cardiac output (see Fig. 1). Spironolactone and propranolol were reinstituted without improvement. After discussion with the patient, a second course of 6 infusions of bevacizumab was given. This was again tolerated well apart from minor mouth ulceration. By the end of the second course, her ascites had again disappeared, and the cardiac and hepatic volumes had fallen back to posttreatment values of the first course. Again, she was able to cease her medications. Seven months after the completion of the second course of bevacizumab, the patient remains asymptomatic and off medications. Six months after her second course, her cardiac output and hepatic volumes have increased slightly; however, they remain significantly lower than their baseline values. At this stage, we have continued to monitor her closely and have not treated her further, given that she is asymptomatic. Response of the liver volume and cardiac output to bevacizumab therapy. The role of bevacizumab in the management of patients with HHT cannot be established on the basis of our single case report, nor is it a replacement for liver transplantation. As Buscarini and colleagues1 point out, increased toxicity has been found in phase 3 trials in which bevacizumab was added to standard chemotherapy in patients with nonresectable colorectal or lung malignancy.2, 3 In particular, mucocutaneous hemorrhage, including grade 1 epistaxis, may be a specific concern in HHT patients, although our patient noted a reduction in her epistaxis. In addition, bevacizumab has been associated with poor wound healing, although it has not been reported to be associated with increased surgical complications when given after a perioperative window of 28 days.4 Alternative therapies, including hepatic arterial ligation or embolization and transplantation, have considerable toxicity of their own. Up to 39% of HHT patients undergoing hepatic artery ligation or embolization have complications that lead to death or requirement for liver transplantation,5 which in itself has a perioperative mortality rate of 18%.6 Given the dramatic response to bevacizumab, we strongly feel that bevacizumab should be considered for patients too ill to undergo transplantation. Its role in symptomatic patients suitable for transplantation is unclear, and further experience in a clinical trial setting is required to clarify this. Lastly, it is exciting to ponder that vascular endothelial growth factor antagonists may have a role in reducing symptoms in the substantial number of HHT patients who are symptomatic but do not require liver transplantation. We agree with Buscarini et al.1 that only with time will the full clinical role of bevacizumab in symptomatic HHT be made clear. Leon A. Adams* , Andrew Mitchell*, Gerry MacQuillan* , Jonathon Tibballs , Rohan vanden Driesen , Luc Delriviere , * Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital, Nedlands, Australia, Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Australia, School of Medicine and Pharmacology, University of Western Australia, Nedlands, Australia.

Sediment budget of the Rhône delta shoreface since the middle of the 19th century

This study analyses long-term (1841–1872–1895–1974) changes in the Grand Rhône prodeltaic lobe to (1) quantify the accumulation, (2) determine the evolution of relict prodeltaic lobes and (3) establish long-term relationships between river sediment discharge, the shoreface and the continental shelf. Our results show a reduction of the sedimentation of the prodeltaic lobe at the main river mouth, since 150 yr by a factor of 3.7 (12.63 to 3.41 × 10 6 m 3 yr − 1 ). At the minor mouth of the river, erosion dominates and speeds up during the same period (− 0.53 to − 1.34 × 10 6 m 3 yr − 1 ). These changes are found to directly result from the river sediment input decrease related to the natural decreasing of the frequency of major floods (end of the Little Ice Age), the reforestation in the catchment area, the dam construction and the dredging activities (since the 1950s). Our results indicate that while there is large sediment accumulation in the area around a growing prodeltaic lobe, there is also a reduced contribution of the river sediments to the non-adjacent beaches of the mouth. Following a shift in the river channel and mouth, the relict prodeltaic lobes (Petit Rhône–St Férreol, Bras de Fer and Pégoulier) are reworked by waves and their sediments contribute partially to the growth of the spits (Espiguette, Beauduc and Gracieuse). This suggests that there is a “time-shift” between the input of river sediment to the sea and the build up of a beach. The chronic erosion of the coastline is likely to continue in the future since (1) a river shift is not possible, because the river channels are controlled by dykes and human intervention, (2) the decrease of river sediment input and (3) the relict prodeltaic lobes constitute sedimentary reservoirs that are gradually being used up.

Treatment of Aphthous Stomatitis with Topical Alchemilla vulgaris in Glycerine

Recurrent aphthous ulceration is the most common oral mucosal disease known. It presents as three types: minor (most prevalent), major and herpetiform. However, there are no well established effective and reliable treatments of this condition. Alchemilla vulgaris (Lady's Mantle) has traditionally been used in oral hygiene and was recently shown to accelerate wound healing when used in combination with glycerine. The objective of this study was to determine whether this combination is effective in the treatment of the most prevalent form of aphthous ulcers. An open-label study was conducted in 48 otherwise healthy male and female patients aged 4-44 years to determine the putative healing properties and tolerability of a standard 3% extract of A. vulgaris in glycerine (Aphtarine) on common minor oral ulcers. Patients with major or herpetiform ulcers were excluded from the study. Topical application three times daily of Aphtarine gel to minor mouth ulcers relieved discomfort and produced complete healing in the majority of patients (60.4%) within 2 days and in 75% within 3 days, compared with 10.4% and 33.3%, respectively, without treatment and 15% and 40%, respectively, with commonly available treatments. Most patients appreciated the product's ease of application, taste and texture. Aphtarine was well tolerated locally and most patients rated the product good to excellent overall. Aphtarine is a safe, well tolerated and highly effective promising new treatment for healing common mouth ulcers.

The sedimentology of the Middle and Upper Border groups (Viséan) in the Stonehaugh Borehole, Northumberland

SUMMARY A sedimentological study has been made of the core from the Stonehaugh Borehole, which proved strata from the Viséan Middle and Upper Border groups of central Northumberland. Much of the Middle Border Group was deposited in a fluvially dominated delta, in interdistributary bays, minor mouth bars, crevasse splays and backswamps. However, a significant part of the group was deposited under more arid conditions in temporary lakes and on muddy floodplains. Sediments of the Upper Border Group were more tidally influenced, being deposited on tidal flats and as bay in-fills. All of these associations are locally cut by major fluvial and delta distributary channels. The transition from fluvial to tidally influenced sedimentation close to the Middle/Upper Border Group boundary is broadly coincident with a period of volcanism, footwall uplift and changing palaeogeography associated with the transition from extensional to thermal relaxation subsidence in the Northumberland Trough.

Depositional Analysis of Hill Sand of Rodessa Formation (Lower Cretaceous) in North Shongaloo-Red Rock Field, Webster Parish, Louisiana: ABSTRACT

ABSTRACT The Hill sand is an informal subdivision of the Lower Cretaceous Rodessa Formation and forms significant petroleum reservoirs in many parts of northeast Texas, southern Arkansas, and northern Louisiana. The North Shongaloo-Red Rock Field is located in north-central Webster Parish, Louisiana and southern Columbia County, Arkansas. The Hill sand is lithologically variable within this region and consists of conglomerate, fine-grained sandstone, siltstone, mottled red to green claystone, black shale, and occasionally fossiliferous limestone. Thickness of the Hill sand in the area ranges from 160 to 220 ft (48.8 to 67.1 m) and averages 186 ft (56.7 m). Based on a combination of sedimentary structures, texture, lithologic composition, fossil content, and sand-body geometry, five major lithofacies were delineated within the primary study area of the North Shongaloo-Red Rock Field. These include: Facies A-thick (up to 32 ft, 9.8 m), fining upward, cross-bedded sandstone with numerous large-scale sedimentary structures, typically with an erosive lower contact; Facies B- thin (up to 11 ft, 3.4 m), coarsening upward, cross-bedded sandstone containing both large- and small-scale sedimentary structures; Facies C- thinly interbedded siltstone and black shale; Facie D- massive red to green mottled claystone; and Facies E- fossiliferous wackestone to packstone. Detailed analyses of the lithofacies present in the study area led to the following depositional environment interpretations: Facies A- fluvial point bar; Facies B- crevasse system (minor mouth bar/crevasse channel couplet); Facies C- interdistributary bay and lake; Facies D- swamp; and Facies E- interdistributary bay with carbonate production. Fluvial point bar and crevasse deposits commonly form hydrocarbon reservoirs in the Hill sand with porosities often exceeding 20% and permeabilities exceeding 1000 md. Combination structural-stratigraphic traps occur where these sand bodies pinch out against a westerly plunging anticline within the north Shongaloo-Red Rock Field. On a regional basis, the Hill sand was divided into upper and lower units based on observed changes in sedimentation pattern. The boundary chosen to separate the upper and lower Hill sand is defined as occurring at a stratigraphic level 80 ft (24.4 m) above the top of the Gloyd Limestone. (The Gloyd Limestone lies directly beneath the Hill sand). Depositional environments of the upper and lower Hill sand were similar, but the relative locations of the environments varied. On a regional scale, depositional environments observed in the Hill sand include several fluvial deposystems trending northeast-southwest. Regional dip during Hill sand deposition in this area was to the southwest. The fluvial deposystems terminate downdip into deltaic distributary mouth bars distributed along a roughly northwest-southeast trending coastline. Areas to the west of the coastline were occupied by shallow marine environments. Interchannel areas to the east of the coastline were occupied by a variety of environments including interdistributary bay, lake, swamp, and crevasse system environments in both upper and lower deltaic positions. Lowermost deposits (approximately 35 ft, 10.7 m) of the Hill sand throughout the region are interpreted to consist of shallow marine environments. Interchannel areas to the east of the coastline were occupied by a variety of environments including interdistributary bay, lake, swamp, and crevasse system environments in both upper and lower deltaic positions. Lowermost deposits (approximately 35 ft, 10.7 m) of the Hill sand throughout the region are interpreted to consist of shallow marine environments. These marine environments are overlain by thick, predominantly non-marine fluvial and deltaic sediments. Near the end of Hill sand deposition, the entire region was covered by very shallow marine environments, just prior to deposition of the overlying First Lower Anhydrite stringer. End_of_Record - Last_Page 587-------

Caustic Injuries to the Esophagus in Children

The ingestion of caustic chemical agents, usually accidentally by children, produces a wide range of injuries from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment for the average burn is fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy to prevent more serious complications.

Chemical Burns of the Esophagus

The ingestion of caustic chemical agents, usually accidentally by children, produces a range of injury from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment of the average burn has been fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy.

Lower Cretaceous fluvial-deltaic sediments at Kuk, Nugssuaq, West Greenland

About 140 m of Lower Cretaceous sediments of the Kome Formation overly the gneiss basement in the Kuk, area. Three facies associations have been recognised in these sediments. Facies association A, which dominates the succession, consists essentially of trough cross-bedded coarse subarkosic sandstone alter­nating with dark laminated mudstone rich in coalified plant debris. Sedimentary structures, facies sequ-ences, and channel morphology suggest that this facies association was deposited by distributaries flowing from east-southeast across a delta plain. Facies association B occurs as coarsening-upwards mudstone - rippled fine sandstone - medium-grained sandstone sequences within the fluviatile sediments of facies association A. These sequences are regarded as the deposits of minor mouth bars and crevasse splays that prograded into interdistributary bays. Facies association C, consisting of tabular cross-bedded medium-grained sandstone, is interpreted as having been deposited from transverse bars in the distal part of a sandy braided river that flowed from south-southwest. The sub-Cretaceous sudace was a deeply weathered uneven plain; the present slopes and abrupt steps in this surface are entirely the result of post-Lower Cretaceous faulting and tilting. The sediments are cut off to the east by a major fault.

Sedimentary sequences from the Upper Limestone Group of Northumberland

Synopsis The Namurian Upper Limestone Group on the Northumberland coast is dominated by a variety of clastic sedimentary sequences which accumulated in an interdistributary bay complex. Small-scale, current-dominated coarsening upwards sequences reflect repeated infilling of the bay by minor mouth bars, crevasse splays and levees. Associated with these sequences are minor crevasse channels and major fluvial channels, one of which is an easterly flowing low sinuosity channel characterised by transverse bars. Transgressive marine carbonate facies periodically interrupt bay sedimentation and are overlain by wave-dominated coarsening upwards sequences which resulted from beach-spit progradation at the bay mouth.

THE SEDIMENTARY HISTORY OF A DELTA LOBE FROM A YOREDALE (CARBONIFEROUS) CYCLOTHEM

Summary A delta lobe has been recognised in the Great Limestone (Yoredale) cyclothem over an area of approximately 700 square kilometres in the northern Pennines (Weardale to Stainmore). The lobe occupies the entire clastic interval of the cyclothem and has a complex history of sedimentation involving four distinct phases. The coastal plain phase includes small-scale fluvial channels, and a mudstone-spiculite chert association deposited in a shallow, shoreline bay. This phase preceded lobe development in the Stainmore Trough and was terminated by a localised transgression. In the upstream and intermediate lobe area, the progradational phase consists of small-scale coarsening upwards sequences which represent the repeated infilling of an extensive interdistributary bay by levees, crevasse splays, sand spits and minor mouth bars. Small-scale (crevasse) channels and larger-scale (distributary) channels are associated with these sequences. Farther south the progradational phase comprises a single large-scale coarsening upwards sequence which represents progradation of a river-dominated (mouth bar) shoreline over offshore muds. During the abandonment phase, a thin marker horizon accumulated, comprising coal in the upstream area (widespread marsh development) and fossiliferous sandstone, mudstone and limestone towards the shoreline (reworking and normal sedimentation). This horizon reflects slow deposition rates related to conditions of minimal sediment supply and subsidence. In the post-abandonment phase, sediment supply recommenced and a barrier island—lagoon complex was established on the abandoned lobe. The lagoon facies include small-scale coarsening upwards sequences formed during infilling, in one case by washover fans. The barrier is made up of medium-scale, wave-dominated coarsening upwards sequences which demonstrate contrasted migration trends equivalent in time along the barrier.

Interdistributary bay sequences and their genesis

ABSTRACTInterdistributary bay sedimentation is dominated by flood‐generated incursions from the distributaries. There are three processes by which sediment‐laden flood waters can be transferred to the bay: overbank flooding, crevassing and avulsion. These processes combine to produce a family of sedimentary sequences, the majority of which are small‐scale coarsening upwards sequences representing infilling of the bay. Subordinate related sequences include those of small‐scale (crevasse) channels and larger scale (distributary) channels. Spits or beaches at the mouth of open interdistributary bays produce larger scale, wave‐dominated coarsening upwards sequences.A model of bay sedimentation concerning a recently initiated (hypothetical) distributary is presented. Four phases of sedimentation (overbank flooding, crevasse splay, minor mouth bar—crevasse channel couplets and avulsion) characterize the history of the distributary, and it is postulated that the phases are genetically related to alluvial ridge development.