Secondary Sternal Closure: A Method of Preventing Cardiac Compression

A patient with severe congenital pulmonary stenosis who underwent pulmonary valvulectomy is reported. Acute cardiac compression and left ventricular failure developed in the immediate postoperative period. Because of extreme cardiac dilatation, the chest wall could not be closed. A technique of secondary sternal closure is described.     

Neutrophil function in adults after traumatic splenectomy

The syndrome of postsplenectomy sepsis in both children and adults is receiving increased clinical attention. However, the exact immunologic reasons for the increased susceptibility to bacterial sepsis after splenectomy is unclear. The purpose of the current report is to describe the results of studies of peripheral neutrophil function in 24 healthy adult individuals who had previously undergone incidental or traumatic splenectomy. The patient population studied had their splenectomies performed a mean of 6.8 years prior to the current study to avoid any bias resulting from the acute hospitalization or injury. None of the patients had underlying hematologic or malignant diseases. The results of these experiments indicate that peripheral neutrophil chemotaxis, phagocytosis, and intracellular killing of Staphylococcus are normal in this population, and additionally, that the sera of these patients adequately support the opsonization of S. aureus and generates chemotactic factors normally. No neutrophil defect or impairment of serum opsonic or chemotactic activity after incidental or traumatic splenectomy was identified in the population studied.     

β-Adrenoceptor activates endothelium-dependent release of nitric oxide in rat aorta

AIM:To examine the possible role of agents elevating cAMP to release NO from aortic en-dothelial cells. METHODS:NG-nitro-L-arg inine methylester (L-NAME) , an inhibitor of NO synthase, partially inhibited endothelium-dependent relaxation evoked in phenylephrine-precontracted rings by isoproterenol and abolished relaxation mediated by forskolin 0. 2 umol L-1.RESULTS: In rings without en-dothelium, isoproterenol and forskolin were less effective relaxants and L-NAME had no effect on the responses. In methylene blue-treated rings isoproterenol- and forskolin-induced relaxation were prevented in both en-dothelium-intact and -denuded rings, but the inhibitory effects of methylene blue were significantly more in rings with endothelium than in those without. On the other hand, relaxation induced by sodium nitroprusside was not inhibited by L-NAME, but was inhibited by methylene blue in both the endothelium-intact and -denuded rings. The concentration relaxation curves to sodium nitroprusside after methylene bl     

Factor VIII antibody in a patient with mild haemophilia

We present the rare occurrence of an inhibitor of factor VIII procoagulant arising in a patient with mild haemophilia A and rheumatoid arthritis. The inhibitor was transient and behaved like a low titre, type II factor VIII procoagulant inhibitor similar to previously reported cases (Biggs et al, 1972b). In vitro studies confirmed the type II-like interaction of this inhibitor with the factor VIII procoagulant molecule. Factor VIII procoagulant antigen level was equal to the factor VIII procoagulant activity, which excluded dysproteinaemia as the cause. This patient's HLA type has no known association with abnormal immune responsiveness or autoimmune disease, and his clinical course as well as in vitro studies were similar to the eight previously reported cases of factor VIII procoagulant inhibitors arising in mild haemophilia A.     

MEDIA REVIEW

Book reviewed in this article: Review of the Freebies Pancreatic Pathology Günter Klöppel and Phillipp U. Heitz (Eds).     

Preventive Management of Cerebrospinal Fluid Leakage in Translabyrinthine Surgery

A simple technique can be used to prevent cerebrospinal fluid (CSF) leakage through the nose and the wound in translabyrinthine surgery. This method, evolved from Glasscock's technique of packing the eustachian tube, adds only 5 to 10 minutes to the procedure. The procedure was modeled in the temporal bones of 20 human cadavers, and the findings are described. With this technique, no nasal CSF leaks occurred in a consecutive series of 25 patients who underwent acoustic tumor surgery. Factors thought to be necessary for the success of the technique are discussed. Laryngoscope, 106:610-613, 1996