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PubMed1979

The use of the Vidal-Adrey external fixation system. Part 2: The treatment of infected and previously infected pseudarthrosis.

A total of 23 infected or previously infected non-unions were treated by the Vidal-Adrey modification of the Hoffmann apparatus. The external fixators were applied after decortication and bone grafting either immediately in cases with no evidence of infection or later in cases of draining, infected wounds. The average healing time for these non-unions, that is time when no external support was required, was 12 months after the initial application of the Vidal-Adrey external fixators. The results were considered good or acceptable in 21 of 23 cases. Union occurred in 21, although union did not necessarily mean a good result overall when all other factors (shortening, etc.) were considered. This fixation device, when correctly applied and in conjuction with adequate debridement and bone grafting is an excellent method for the treatment of severe non-unions where infection is or was a problem.

Adult↗
PubMedDate not supplied

Coagulolysis assay in the detection of deep vein thrombosis in the orthopedic patient. A preliminary report.

The recently developed coagulolysis assay was utilized in conjuction with fibrinogen uptake scanning to monitor 91 of 111 consecutive orthopedic patients scheduled for hip surgery or total knee replacement. Sixteen patients had abnormal coagulolysis assays and positive scans. Venography was performed in 15 of these patients, and deep vein thrombosis was documented in 12. Five patients developed pulmonary emboli, including one with negative venogram. Thus, over 80% of the patients in which both the coagulolysis assay and the fibrinogen scan were abnormal had additional documentation of deep vein thrombosis. In 41 patients, the coagulolysis assay was negative. Venograms were not routinely performed in this group. However, 3 patients developed pulmonary emboli indicating that deep vein thrombosis developed in this group. Only one patient had a normal coagulolysis with a positive fibrinogen scan. Venography documented a deep vein thrombosis. Thirty-three patients who had normal coagulolysis assays and negative fibrinogen scans also had no evidence of deep vein thrombosis or pulmonary embolism. The coagulolysis assay appears to be a safe, noninvasive study for the detection of deep vein thrombosis. There was only a one per cent false-negative incidence.

Blood Coagulation Tests↗
PubMed1979

Radiolographic exhibits in gross anatomy.

The discipline radiology is well suited to teach anatomy to first-year medial students. A series of exhibits of radiographic anatomy in the dissection laboratory, in conjuction with small group teaching sessions, serves this purpose well. Such displays are readily constructed from materials available in most radiology departments and are easily reproduced.

Anatomy↗
PubMed1983

Evidence for synaptic plasticity in the cerebellar cortex.

The learning machine model of the cerebellum by Marr and Albus contains a special type of synaptic plasticity. Experimental evidence for this synaptic plasticity has been meager, but very recently positive evidence has become available. Ito, Sakurai and Tongroach (7) demonstrated the occurrence of a long-lasting depression in mossy fiber responsiveness of Purkinje cells subsequent to conjuctive stimulation of mossy fibers and climbing fibers. A similar long-lasting depression was shown to occurred in sensitivity of Purkinje cell dendrites to a putative neurotransmitter of parallel fibers, i.e., glutamate. Furthermore, Ito and Kano (6) produced a long-lasting depression in the molecular layer of the cerebellar cortex by simultaneous direct stimulation of parallel fibers and climbing fibers. These long-lasting depressions appear to represent a synaptic plasticity of the form proposed by Albus.

Animals↗
PubMed1978

The cardiac profile.

The clinical laboratory furnishes information valuable not only in the diagnosis of myocardial infarction (MI), but also in screening for possible causes of ischemic heart disease through definition of the lipid status of individuals. Accordingly, the panels used in the study of hyperlipidemia as a possible cause of ischemic heart disease are reviewed, including the determination of serum cholesterol, triglycerides, and electrophoretic development of the lipoprotein pattern. The results of an on-going study of more than 500 patients admitted to the emergency room of a general hospital with symptoms of "chest pain" are presented--including the electrocardiogram, enzyme tests, and isoenzyme patterns, in conjuction with the clinical picture. The relative diagnostic value of test procedures is considered, convering the pre-enzymatic period, current test panels, and possible future approaches. It is concluded that the laboratory's position in providing data for diagnosis of MI would be enhanced through development of procedures with as great or greater specificity than the isoenzyme patterns of creatine kinase and lactate dehydrogenase, currently the most specific indicators of MI, but which have results available in two to five minutes.

Cholesterol↗
PubMed1980

Surgical placement of a chin cleft concomitant with genioplasty.

This article presents a surgical technique for creation of a chin cleft in conjuction with advancement genioplasty. The technique is simple. However, the cleft should be made deeper than seems aesthetically desirable at the time of surgery because healing and muscle function will decrease the final depth of the depression. The depth that can be anticipated can be determined by the degree of tension of the subcutaneous sutures. Minor recontouring of bone may be necessary when there is a prominent bony apex to the symphysis. The actual chin cleft is a soft tissue phenomenon, rather than a bone cleavage point. It is not suggested that this procedure be offered to every patient, but familiarity with the technique is needed should there be a request to perform such surgery.

Adult↗
PubMed1978

The strength of metal reinforced methylmethacrylate fixation of pathologic fractures.

Fixation of the pathological fracture in terminal patients has in the past added the trauma of an extensive surgical procedure to an already weakened patient. Intramedullary fixation with single and double rods in conjuction with polymethylmethacrylate have been compared to ascertain the effect of different loading conditions using torque and analysis under compression measurements of the strength of repair bone. Extensive intramedullary reaming can be avoided with polymethylmethacrylate. The cement effectively transmits the load from the proximal to the distal fragment. The single large rod method would be more desirable for stiffer bones while the double thin rod technique may be applicable to more flexible bones.

Animals↗
PubMed1995

Streptokinase and rt-PA activate platelets by a different way: implications on the rethrombosis rate after their administration in myocardial infarction.

The natural history of acute myocardial infarction has been dramatically changed by the advent of thrombolytic treatment, with a 30% mortality reduction, a better recovery of ventricular function, and a better quality of life. This treatment notwithstanding, failure or delay in achieving reperfusion, along with reocclusion and bleeding, still worry clinicians and challenge researchers to improve thrombolytic regimens and concomitant antithrombotic treatments. Platelet activation, at least in part because of thrombolytic treatment itself, plays a pivotal role in the pathogenesis of resistance to lysis and rethrombosis. The aim of this study was to compare in vitro the effects on platelets of therapeutic concentrations of streptokinase (SK) and recombinant type plasminogen activator (rt-PA). The effects of plasmin and thrombin were also studied as a reference. Fluorescence flow cytometry was used to evaluate (1) fibrinogen binding and (2) surface expression of GMP-140, a sensitive marker of platelet release reaction. Platelet function was further studied by measuring the release of carbon 14-labeled serotonin, beta-thromboglobulin, plasminogen activator inhibitor-1 (PAI-1) and the generation of thromboxane (TxB2). We found that 10 nmol/L SK and 14 nmol/L rt-PA increased fibrinogen binding to platelets by 12 +/- 2 and 10 +/- 4 times, respectively (p = not significant). At the same concentrations, SK, but not rt-PA, also induced the platelet release reaction: surface expression of GMP-140 was increased by 6 +/- 1.5 times by SK and 1.3 +/- 0.2 times by rt-PA (p < 0.05). TxB2 production was not modified by plasmin and plasminogen activators. Our data showed that plasmin and SK stimulate fibrinogen receptor expression and platelet degranulation. Conversely, rt-PA, at concentrations up to 14 nmol/L, only promotes fibrinogen binding. These results, coupled with the less-pronounced lytic state induced by rt-PA, could explain the higher incidence of reocclusion accompanying rt-PA therapy in comparison with SK that occurs unless effective "adjunctive" antithrombotic treatment is used. Neither of the thrombolytic agents activates the arachidonate pathway. Thus aspirin is probably not an ideal agent to be used in conjuction with thrombolytic agents. We speculate that newer approaches, particularly RGD peptides and antibodies against GP llb/llla, might produce better results.

Adenosine Diphosphate↗
PubMed1993

A dog ecology study in an urban and a semi-rural area of Zambia.

Characteristics of dog populations and their accessibility for rabies vaccination were compared in an urban and a semi-rural area in Zambia. A total of 1,190 households were interviewed. In the urban study area (Mutendere, a low income suburb of Lusaka) only 11% of the households kept dogs with a dog:human ratio of 1:45. In the semi-rural area (Palabana) dogs were kept by 42% of households with a dog:human ratio of 1:6,7. In conjuction with the study of the dog populations in these two areas, immunization of dogs against rabies was provided by door-to-door visits in both study areas and also through central point vaccination in the urban area. The attitude of the public towards free rabies vaccinations was positive, although some misconceptions regarding indications and modalities of treatment following exposure to suspect dogs were found. Approximately 50% of the dog removals were as a result of disease and the demand for dogs was higher than the supply. Although only information on the owned segment of the dog population was obtained during the study, the proportion of ownerless dogs appeared to be very low. Generally, there is a need for better co-ordination between the different services involved in rabies control in Zambia to enhance the sustainability of vaccination programmes and improve the treatment of persons bitten by dogs.

Animals↗
PubMed1994

Allergies and skin testing: a Nairobi experience.

A prospective study of 72 consecutive patients with symptoms of allergy is presented. Patients aged 20-39 years formed the bulk of the study population (55.6%). Most patients had allergic rhinitis (48.6%); bronchial asthma and atopic dermatitis occurred in 29 patients (40.3%) each. Drug allergies were found in 22 patients (30.6%), urticaria in 15 (20.8%), food allergies in 13 (18.1%), contact dermatitis in 10 (13.9%) and allergic conjuctivitis in 6 patients (8.3%). In many cases more than one allergic condition appeared simultaneously. Skin and prick tests and skin patch tests were done on 46 (63.9%) and 65 (90.3%) patients respectively. Soaps were most frequently implicated in positive reactions (75.0%); D. pteronyssinus, drugs, animal dander and foods gave positive reactions in 40.3%, 30.6%, 19.4% and 18.1% respectively. The need to have a high index of suspicion towards allergic conditions, especially extrinsic bronchial asthma, is stressed.

Adolescent↗
PubMed1996

[Effects of traumatic subarachnoid hemorrhage on pathological properties in diffuse brain injury: a comparison with aneurysmal subarachnoid hemorrhage].

As a result of recent advances in continuous monitoring equipment, it has been reported that vasospasm (VS) and delayed ischemic neurological deficit (DIND) occur as frequently in traumatic subarachnoid hemorrhage (TSAH) as in subarachnoid hemorrhage due to ruptured intracranial aneurysm (ASAH), and these VS and DIND have been reported to affect the outcome of TSAH adversely in many cases. When we compared TSAH secondary to diffuse brain injury (DBI) with ASAH, however, these two conditions were evidently different from each other in nature. Then we compared laboratory data, clinical course, and outcomes of TSAH associated with DBI with those of ASAH, to determine whether TSAH results in poor outcomes of DBI. On CT scans, patterns of SAH distribution were different from each other, and SAH was detected in 76% of the patients with ASAH on day 4, whereas only 2.0% of the patients with TSAH had detectable SAH on day 3. The incidence rates of detectable SAH in both groups remained significantly different from each other after day 2. The cerebral blood flow (CBF) decreased to around 75% of the normal flow in the acute stage of ASAH, and it decreased further to around 65% in the subacute stage. In TSAH, in contrast, CBF varied widely among the patients. The average CBF decreased to about 70% in the acute stage, and then it increased to around the lower limit of the normal range in the subacute stage. The urinary output and serum concentration of low molecular protein compositions in TSAH were markedly different from those in ASAH. In addition, the contour of a low density area (LDA) in CT scans in the subacute-chronic stage was the same as that of the area supplied by the artery being constricted due to cerebro-vascular spasm in ASAH. In TSAH, in contrast, hardly any LDA had a form that was suggestive of this conjuction, with cerebro-vascular spasm and the incidence rate of LDAs was significantly different from that for ASAH. About 30% of the patients with ASAH had ventricular enlargement, which was diagnosed as normal pressure hydrocephalus by cisternography, in the chronic stage. Surgical shunting was effective for these patients. In TSAH, ventricular enlargement was observed in more than 50% of the patients, but almost none of these patients underwent surgical shunting, because it resulted from cerebral atrophy. Regardless of causes of SAH, the severer SAH was, the more often patients had a poor outcome. The outcome of TSAH was, however, significantly poorer than that of ASAH. When SAH was traumatic, it disappeared by the time VS developed and, in addition, changes in CBF and the form and incidence rate of LDAs were different from those in ASAH. We concluded that, although TSAH is an adverse prognostic factor for DBI, it does not contribute to poor outcomes of DBI by giving rise to DIND caused by VS.

Acute Disease↗
PubMed1996

Sonographic and clinical findings of granulosa cell tumor.

BACKGROUND: Granulosa cell tumor (GCT) accounts for roughly 1.5% of all ovarian neoplasms and 5-10% of ovarian cancers. GCT, which may have profound end-organ effects, has attracted a significant amount of attention despite its rarity. This tumor is rare, and difficult to diagnose before operation. Until now, no specific sonographic findings have been reported. METHODS: Twelve cases of pathologically proven GCTs were diagnosed from June 1985 to March 1993. Nine of those cases had preoperative sonographic pictures taken. RESULTS: Eight out of the nine cases tested exhibited a complex multicystic sonographic pattern. For a case evaluated by a transvaginal color and pulsed Doppler assessment, the blood vessels located in the central part with diffuse dispersed vascular arrangement were found to have a resistance index of 0.38 and a pulsatility index of 0.50. The most common complaints of our patients were postmenopausal bleeding and lower abdominal pain. CONCLUSIONS: We conclude that complex multicystic sonographic features observed by high-resolution ultrasonography, in conjuction with a high preoperative estradiol level and clinical symptoms, may help to establish a preoperative diagnosis of GCT.

Adult↗
PubMed1977

Dorsal laminectomy techniques in the dog.

The effects of various lengths of complete dorsal laminectomy were compared with the effects of Funkquist method B laminectomy on the spinal cord of dogs. Complete dorsal laminectomies were done on L1 (group 1), L1 and L2 (group 2), and L1, L2, and L3 (group 3). Dogs of group 4 had Funkquist method B laminectomies on L1 and L2. Complete dorsal laminectomy on 1 vertebra and Funkquist method B laminectomy on 2 vertebrae did not result in any clinically untoward signs. In conjuction with these results, there was no dorsoventral flattening of the spinal cords and minimal microscopic damage within the spinal cords. If 2 or 3 vertebrae had a complete laminectomy, tonic spasticity of the pelvic limbs developed after surgery. Dorsoventral flattening of the spinal cord and moderate to severe microscopic damage were seen in the spinal cords of these dogs.

Animals↗
PubMed1997

Effect of the South African asinine-94 strain of equine arteritis virus (EAV) in pregnant donkey mares and duration of maternal immunity in foals.

Clinical, virological and serological responses were investigated in five pregnant donkey mares after experimental exposure to the South African asinine-94 strain of equine arteritis virus (EAV), and the duration of maternal immunity to EAV was studied in their foals. In four intranasally inoculated mares, fever with maximum rectal temperatures of 39.1-40.7 degrees C was recorded 2-11 d after challenge. All the inoculated mares developed mild depression, and a serous ocular and nasal discharge; in three mares mild conjuctivitis was observed. The virus was recovered from the nasopharynx and from buffy-coat samples of all the mares 3-10 d, and 2-18 d post inoculation (p.i.), respectively. Seroconversion to EAV was detected on days 8-10 p.i. Peak serum-virus-neutralizing antibody titres of log10 1.8-2.4, and IgG ELISA OD values of 0.85-2.15 were recorded 2-3 weeks p.i. The in-contact (p.c.) control mare developed fever on days 15-19 post exposure, and showed mild clinical signs of equine viral arteritis similar to those observed in the inoculated mares. Seroconversion to EAV was detected in the p.c. mare on day 20 post exposure, and virus was isolated from nasal swabs and blood samples collected at the time of the febrile response and 1-3 d afterwards. None of the mares aborted. After they had given normal birth 45-128 d p.i. or after p.c. exposure, no virus could be isolated from their placentas. The concentration of EAV-neutralizing antibody in colostrum was two to eight times higher than in serum samples collected at the time of parturition. All the foals born to infected mares were clinically normal at the time of birth and throughout the subsequent 1-2 months of observation. No EAV was recovered from the buffy-coat fraction of blood samples collected at birth nor from those collected on days 1, 2 and 7 after birth. Also, no virus-serum-neutralizing or IgG ELISA antibody to EAV was detected in sera collected immediately after birth before the foals started nursing. The colostrum-derived maternal antibodies against EAV gradually declined and could not be detected by either the VN test or ELISA for 2-3 months after birth. This study demonstrates that the asinine-94 strain of EAV does not cause abortion in pregnant donkey mares. Furthermore, no carrier state could be demonstrated in foals born to mares infected at the time of pregnancy.

Abortion, Veterinary↗
PubMed1998

Twice-a-day versus four-times-a-day ofloxacin treatment of external ocular infection.

PURPOSE: The purpose of this study was to compare the efficacies of 0.3% ofloxacin eyedrops, when given twice-a-day (BID) versus four-times-a-day (QID), for the treatment of external ocular disease. METHOD: Fifty patients with blepharitis, conjuctivitis, or blepharoconjunctivitis were randomly assigned to treatment with 0.3% ofloxacin eyedrops, BID or QID, for 10 days. Signs, symptoms, and cultures were evaluated at the beginning and at the end of the study. RESULTS: The clinical outcome was virtually identical in the two groups. There was a significant decrease in clinical scores in the BID and QID groups by days 3 to 5 (2.6-3.0 points) and a further decrease by day 11 (4.3-5.0 points). There was no significant difference between the two groups at any time interval. Microbiologic studies showed a reduction in colony-forming units in 87% of the BID group and in 80% of the QID group. CONCLUSION: The treatment of external ocular disease with 0.3% ofloxacin eyedrops was equally effective when given BID or QID.

Administration, Topical↗
PubMed1976

Hearing under stress: IV. a speech delivery communication system for utilization in high ambient noise environments.

Many communication systems have been devised to improve the individual's ability to receive speech information in the presence of ambient noise. The purpose of this study was to determine the effectiveness of a speech delivery system which combined a high degree of ambient noise attenuation with the ear's own natural amplification phenomenon--the occlusion effect. It was demonstrated that occlusion of the auditory system at the level of the external auditory meatus, in conjuction with bone-conducted speech stimuli presented at the mastoid, was most effective in providing high speech discrimination ability with significant attenuation of ambient noise.

Adult↗
PubMed1997

[Guidelines for quality assurance in bronchial carcinoma].

Quality management in lung cancer needs interdisciplinary cooperation among thoracic surgeons, pneumologists, oncologists and radiologists. This requires defined standards in the structure, process and outcome quality of the involved departments. The German Society for Thoracic Surgery has established a concept for internal and external quality assurance of operative treatment of lung cancer, according to the requirements for quality management developed by Selbmann. The future calls for the integration of nonoperative treatments in conjuction with relevant specializations.

Carcinoma, Bronchogenic↗
PubMed1998

Prevalence of and risk factors for latex sensitization in patients with spina bifida.

PURPOSE: We determined the prevalence of and risk factors for latex sensitization in patients with spina bifida. MATERIALS AND METHODS: A total of 59 consecutive subjects 2 to 40 years old with spina bifida answered a questionnaire, and underwent a latex skin prick test and determination of serum IgE specific for latex by RAST CAP radioimmunoassay. We also noted the relationships of total serum IgE skin prick tests to common air and food allergens. In addition, skin prick plus prick tests were also done with fresh foods, including kiwi, pear, orange, almond, pineapple, apple, tomato and banana. RESULTS: Latex sensitization was present in 15 patients (25%) according to the presence of IgE specific to latex, as detected by a skin prick test in 9 and/or RAST CAP in 13. Five latex sensitized patients (33.3%) had clinical manifestations, such as urticaria, conjuctivitis, angioedema, rhinitis and bronchial asthma, while using a latex glove and inflating a latex balloon. Atopy was present in 21 patients (35.6%). In 14 patients (23%) 1 or more skin tests were positive for fresh foods using a prick plus prick technique. Tomato, kiwi, and pear were the most common skin test positive foods. Univariate analysis revealed that a history of 5 or more operations, atopy and positive prick plus prick tests results for pear and kiwi were significantly associated with latex sensitization. Multivariate analysis demonstrated that only atopy and a history of 5 or more operations were significantly and independently associated with latex sensitization. CONCLUSIONS: A fourth of the patients with spina bifida were sensitized to latex. Atopy and an elevated number of operations were significant and independent predictors of latex sensitization in these cases.

Adolescent↗