Long-term review of the surgical treatment of radial deficiencies

Sixty-four patients with 101 radial deficiencies form the basis of this review of anatomy, treatment, and long-term follow-up. Average follow-up was 8.6 years, with a range of 1 to 27 years. A radiologic classification of radial deficiencies is presented. The preferred method of treatment is centralization. The goal is to create a centralized, cosmetically and functionally improved hand, yet maintain wrist motion. There were 21 good, 20 satisfactory, and 10 unsatisfactory results. Good and satisfactory results all had adequate preoperative stretching, proper surgical technique, and postoperative brace compliance. Failure to adhere to outlined principles of soft tissue release and adequate centralization resulted in the unsatisfactory results.     

Somatostatin receptor imaging in intracranial tumours

The somatostatin analogue [¹¹¹In-DTPA-d-Phe¹]-octreotide (¹¹¹In-octreotide) allows scintigraphic visualization of somatostatin receptor-expressing tissue. While it is well known that a large variety of tissues express somatostatin receptors and ¹¹¹In-octreotide scintigraphy has a clearly defined role in various neuroendocrine diseases, the clinical value of ¹¹¹In-octreotide scintigraphy in brain tumours is still under clinical investigation. In 124 patients with 141 brain lesions (63 meningiomas, 24 pituitary adenomas, 10 gliomas WHO class I and II, 12 gliomas WHO class III and IV, 11 neurinomas and 2 neurofibromas, 7 metastases and 12 other varieties: three non-Hodgkin B-cell lymphomas, two epidermoids, one abscess, one angioleiomyoma, one chordoma, one haemangiopericytoma, one osteosarcoma, one plasmacytoma and one pseudocyst), ¹¹¹In-octreotide scintigraphy was performed 4–6 and 24 h after i.v. injection of 110–220 MBq ¹¹¹In-octreotide. Planar images of the head in four views with a 128×128 matrix and single-photon emission tomographic images (64×64 matrix) were acquired, and lesions were graded according to qualitative tracer uptake. Fifty-nine of the 63 meningiomas showed moderate to intense tracer uptake. Nine of 24 pituitary adenomas were visible; the remaining 15 did not show any tracer uptake. None of the class I and II gliomas with an intact blood-brain barrier were detected whereas 11/12 class III and IV gliomas showed ¹¹¹In-octreotide uptake. None of the neurinomas or neurofibromas were positive. Five of seven metastases were classified as positive, as were the osteosarcoma, two of three non-Hodgkin B-cell lymphomas, one abscess, one angioleiomyoma, one chordoma and one haemangiopericytoma. The other varieties (one non-Hodgkin B-cell lymphoma, two epidermoids, one plasmacytoma and one pseudocyst) did not show ¹¹¹In-octreotide uptake. The results demonstrate that a large variety of intracranial lesions express somatostatin receptors and therefore can be visualized by [¹¹¹In-DTPA-d-Phe¹]-octreotide scintigraphy. This technique can be valuable in the differentiation between meningiomas and pituitary adenomas, based on qualitative tracer uptake. [¹¹¹In-DTPA-d-Phe¹]-octreotide scintigraphy allows differentiation between meningiomas and neurinomas or neurofibromas and therefore provides complementary information to computed tomography or magnetic resonance imaging. Furthermore, this technique allows differentiation between scar tissue and recurrent meningiomas postoperatively and can help in non-invasive tumour differentiation of multiple intracranial lesions, which can be of value in defining the most adequate therapeutic strategy. Received 1 December 1997 and in revised form 17 March 1998     

The Graz SIDS Risk Questionnaire: prospective study of 6,000 infants]

In a prospective study (1988-1990) the SIDS risk questionnaire SRFB was applied to 6000 infants born in the Department of Obstetrics, University Hospital Graz. In all infants at an increased statistical risk for SIDS a standardized intervention including pediatric and polysomnographic investigations was performed. As a result the SIDS incidence decreased from an average of 1.92 per thousand lifeborns (1984-1988) to 0.83 per thousand lifeborns (1989-1990) in our test group, which means a striking reduction of the SIDS incidence by 57%. In addition to this effect, the intensified information of parents and physicians about possible signs of an increased risk for SIDS lead to a general reduction of SIDS in Styria.     

Effects of recombinant human interleukin 6 (rhIL-6) in marmosets (Callithrix jacchus)

The physiological and toxicological properties of recombinant human interleukin 6 (rhIL-6) were assessed in marmoset monkeys (Callithrix jacchus). Two experimental series were performed with daily subcutaneous administration: (a) 5 or 1000 μg rhIL-6/kg per day for three weeks and (b) 25, 100 or 500 μg rhIL-6/kg per day for 3 months. RhIL-6 was well tolerated and did not induce fever or any other non-specific signs of toxicity. The main findings were: (1) A two- to threefold increase in platelet counts at 2–4 weeks, which decreased following further continuous rhIL-6 administration; (2) increase in total white blood cells between 1 and 4 weeks of administration, including an absolute increase in granulocytes (including band forms) and basophils. A change in the number of monocytes was not detected; (3) an increase in total red blood cells, which peaked at 4 weeks, sustained elevation of red cell distribution width and a slight decrease in hemoglobin between week 1 and 4, concurrent with a distinct decrease in mean corpuscular hemoglobin at 4 weeks. This effect persisted for 9 weeks in the 100 μg/kg and 500 μg/kg groups; (4) decrease in plasma AST activity and increase in plasma protein concentration after 2 weeks of treatment; (5) no clinical or biochemical signs of renal glomerular dysfunction; (6) RhIL-6 after s.c. administration was detectable in the plasma, peak levels (mean values ±SD) of 9.4 ± 6.3 and 72.4 ±7.7 ng/ml were measured after a single dose of 100 or 1000 μg/kg; (7) antibodies against rhIL-6 developed within 2 weeks, increased during administration and neutralized the biological effect of rhIL-6 progressively from 4 to 9 weeks. In conclusion, aside from a mild anemia, rhIL-6 was well tolerated in marmosets and had a profound and sustained effect on thrombopoiesis. Due to the formation of neutralizing antibodies, the chronic biological effect of rhIL-6 is lost in marmosets and studies beyond 4 weeks are rendered less meaningful. The analyses of antibody formation, induction of acute phase proteins, histological changes and alterations on lymphocyte receptors will be reported in two following publications.     

Rechtsseitige Unterbauchschmerzen nach Appendektomie?

A young male patient presented with right lower quadrant abdominal pain 3 years after laparoscopic appendectomy. Clinical and radiological findings were in keeping with acute appendicitis and the diagnosis of stump appendicitis could be confirmed by laparoscopy. This case serves as a reminder of this differential diagnosis and to discuss therapy and prevention of this rare condition.     

Significance and evaluation of gingival and bony pockets]

The reproducibility of measurements of gingival pocket depth was tested on a total of 200 patients and assessed by statistical analysis. Significantly differing values were observed only in the region of the upper molars, whereas consistent values were found in all the other regions. The measurement of pocket depth is an easy-to-determine reproducible parameter in periodontal diagnostics. A gross information about the presence and depth of intrabony pockets cannot be obtained from clinical values for pocket depth.