Neonates presenting with severe complications of frenotomy: a case series

<p>Abstract</p> <p>Introduction</p> <p>Tongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia.</p> <p>Case presentation</p> <p>Case 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later.</p> <p>Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later.</p> <p>Conclusion</p> <p>Treatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated.</p

Opposing effects of D-aspartic acid and nitric oxide on tuning of testosterone production in mallard testis during the reproductive cycle

<p>Abstract</p> <p>Background</p> <p>D-Aspartic acid (D-Asp) and nitric oxide (NO) play an important role in tuning testosterone production in the gonads of male vertebrates. In particular, D-Asp promotes either the synthesis or the release of testosterone, whereas NO inhibits it. In this study, we have investigated for the first time in birds the putative effects of D-Asp and NO on testicular testosterone production in relation to two phases of the reproductive cycle of the adult captive wild-strain mallard (Anas platyrhynchos) drake. It is a typical seasonal breeder and its cycle consists of a short reproductive period (RP) in the spring (April-May) and a non reproductive period (NRP) in the summer (July), a time when the gonads are quiescent. The presence and the localization of D-Asp and NO in the testis and the trends of D-Asp, NO and testosterone levels were assessed during the main phases of the bird's reproductive cycle. Furthermore, in vitro experiments revealed the direct effect of exogenously administered D-Asp and NO on testosterone steroidogenesis.</p> <p>Methods</p> <p>By using immunohistochemical (IHC) techniques, we studied the presence and the distributional pattern of D-Asp and NO in the testes of RP and NRP drakes. D-Asp levels were evaluated by an enzymatic method, whereas NO content, via nitrite, was assessed using biochemical measurements. Finally, immunoenzymatic techniques determined testicular testosterone levels.</p> <p>Results</p> <p>IHC analyses revealed the presence of D-Asp and NO in Leydig cells. The distributional pattern of both molecules was in some way correlated to the steroidogenic pathway, which is involved in autocrine testosterone production. Indeed, whereas NO was present only during the NRP, D-Asp was almost exclusively present during the RP. Consistently, the high testosterone testicular content occurring during RP was coupled to a high D-Asp level and a low NO content in the gonad. By contrast, in sexually inactive drakes (NRP), the low testosterone content in the gonad was coupled to a low D-Asp content and to a relatively high NO level. Consequently, to determine the exogenous effects of the two amino acids on testosterone synthesis, we carried out in vitro experiments using testis sections deriving from both the RP and NRP. When testis slices were incubated for 60 or 120 min with D-Asp, testosterone was enhanced, whereas in the presence of L-Arg, a precursor of NO, it was inhibited.</p> <p>Conclusion</p> <p>Our results provide new insights into the involvement of D-Asp and NO in testicular testosterone production in the adult captive wild-strain mallard drake. The localization of these two molecules in the Leydig cells in different periods of the reproductive cycle demonstrates that they play a potential role in regulating local testosterone production.</p

Non-allergic rhinitis: a case report and review

Rhinitis is characterized by rhinorrhea, sneezing, nasal congestion, nasal itch and/or postnasal drip. Often the first step in arriving at a diagnosis is to exclude or diagnose sensitivity to inhalant allergens. Non-allergic rhinitis (NAR) comprises multiple distinct conditions that may even co-exist with allergic rhinitis (AR). They may differ in their presentation and treatment. As well, the pathogenesis of NAR is not clearly elucidated and likely varied. There are many conditions that can have similar presentations to NAR or AR, including nasal polyps, anatomical/mechanical factors, autoimmune diseases, metabolic conditions, genetic conditions and immunodeficiency. Here we present a case of a rare condition initially diagnosed and treated as typical allergic rhinitis vs. vasomotor rhinitis, but found to be something much more serious. This case illustrates the importance of maintaining an appropriate differential diagnosis for a complaint routinely seen as mundane. The case presentation is followed by a review of the potential causes and pathogenesis of NAR

Tubular structures revealed using tannic acid on the surface of the epithelium of the tympanic cavity of the chicken

We have studied the ultrastructure of the epithelium lining the tympanic cavity of chicken, using two embedding techniques. In certain cases, the epithelium was minced in Karnovsky fixative, post-fixed in osmium, dehydrated and embedded in Epon, following the usual methods. No morphologically detectable structures were seen at the level of the epithelium surface. In other cases, the epithelium was immersed in Karnovsky fixative and subsequently in glutaraldehyde (1%) to which, however, tannic acid (1%) was added; the specimens were then osmicated, dehydrated with Epon and embedded in polar Epon mix. This method was sometimes used to study the alveolar surfactant, since this makes it possible to preserve its phospholipid fraction. The epithelium, in this way, is seen to be covered by an electron-dense material made up of thin, intertwined tubules. The hypothesis formulated is that the tubules are related to the presence of surfactant substances

Fine structure of the middle ear epithelium in the chicken (Gallus gallus).

The epithelium lining the tympanic cavity of the chicken possesses distinct morphological characteristics. Its ultrastructure was studied using 2 preparative techniques. (1) After fixation in Karnovsky's solution, postfixation in osmium tetroxide and embedding in Epon, the epithelium was observed to contain 2 kinds of cell: secretory and basal. The secretory cells (which we refer to as mixed granulated cells) showed numerous secretory vesicles that varied in appearance, some containing paracrystalline formations. The basal cells, located close to the basement membrane, showed no evidence of secretory activity. (2) Other specimens were immersed in Karnovsky fixative and subsequently in a mixture of glutaraldehyde and tannic acid. They were then osmicated and embedded in polar Epon mix. With this method, the epithelium was seen to be covered by electron-dense material made up of thin intertwined tubules. In addition, the secretory cells contained vesicles with concentrically arranged lamellae; such vesicles resembled the multilamellar bodies of mammalian type II pneumocytes. The hypothesis is advanced that tubules and lamellar vesicles are related to the presence of surfactant substances

Effects of chronic ethanol administration on the NOS-related NADPH-diaphorase activity in the mouse Leydig cells

INTRODUCTION - Nitric oxide (NO) is a free radical involved in several physiological and pathological processes (1). NO appears to be involved in crucial aspects of male genital physiology, including relaxation of corpora cavernosa and inhibition of sperm mobility and testosterone secretion (2). The gonadotoxic effects of the alcohol were well documented in humans and in animal models (2, 3). In-deed, ethanol administration has been shown to cause morphological alterations on seminiferous tubules (2) and Leydig cells (3) and to decrease testosterone and LH plasmatic levels (4). We examined by TEM the effects of chronic ethanol treatment on the NADPH-diaphorase (NADPH-d) activity in the mouse Leydig cells. MATERIAL AND METHODS - Ten adult Wistar mice were treated with ethanol 0.5g/Kg/die intragastrically for two weeks. The animals were anaesthetised, perfused by aldehydes and treated for NADPH-d histochemistry (5). Specimens incubated with NADPH-free medium were utilised as controls. In order to test the specificity of NADPH-d staining for NOS activity, some specimens were immersed in the medium containing 0.3 mM iodonium diphenyl (6). The specimens were post-fixed in osmium tetroxide, and embedded in Epon 812. RESULTS AND DISCUSSION - About 20% of Leydig cells of the ethanol-treated mice showed morphological alterations. The cells were characterised by irregular protrusions of the plasmatic membrane, rarefaction of the cytoplasmic matrix and increased number of lipid droplets. Irregular mitochondria were also observed. Some Leydig cells (about 10%) showed signs of degeneration. As regards the enzymatic study, the controls animals exhibited the NADPH-d activity in the nuclear cistern, mitochondria and SER. In the ethanol treated-mice the enzymatic reaction was strongly reduced both in apparently normal and injured Leydig cells. A moderate reactivity was detected only in the SER. These findings suggest that chronic ethanol treatment inhibits the NOS-related NADPH-d activity in the Leydig cells of mouse. This effect could be a consequence of the impaired synthesis of the testosterone, inducing an inhibition of NO production through a negative feedback mechanism. However it can not be excluded a direct action of the alcohol on the NOS/cGMP enzymatic pathway