Verapamil as an adjunct to local anaesthetic for brachial plexus blocks

Background: Calcium channel blockers potentiate the effects of local anaesthetics. We examined the effect of adding verapamil to local anaesthetic solution on anaesthetic duration in patients undergoing surgery under brachial plexus block.     

Short‐ and long‐term vertical diplopia secondary to blunt trauma

This report describes the short‐ and long‐term ocular signs and symptoms of a patient with an orbital blow‐out fracture and discusses the differential diagnosis of vertical diplopia. A blow‐out fracture occurs when blunt trauma is applied either directly to the eyeball itself or the orbital rim and usually results in a fracture of the orbital floor with consequential excavation and entrapment of orbital contents in the fracture. Vertical diplopia is a common presenting symptom for a blow‐out fracture of the orbit but careful considerations should be given to other potential conditions leading to such diplopia. A patient is presented who suffered a blow‐out fracture almost a decade earlier, secondary to blunt trauma to the globe. The clinical findings are provided immediately after the trauma, post‐surgery and during a recent ocular examination.     

绝经后女性类风湿关节炎患者骨密度变化影响因素分析

目的探讨绝经后女性类风湿关节炎(RA)患者发生骨质疏松(OP)的原因。方法收集63例绝经后女性RA患者一般临床资料、疾病活动相关指标、手足X线资料,并同时测量患者7个部位的骨密度。结果23例患者(36.5%)有至少一处检测部位表现为低骨量。前臂和桡尺骨远端的低骨密度发生率(23.8%)与OP总发生率(28.6%)无显著性差异(P>0.05)。OP的发生与疾病活动指标及糖皮质激素的使用均无相关性。多元回归分析显示绝经的年限和关节腔狭窄为低骨量发生的独立危险因素(P<0.05);而雌激素替代疗法(HRT)为低骨量发生的唯一保护因素(P<0.05),小剂量糖皮质激素对本组患者的骨密度无影响。结论OP是绝经后女性RA患者的常见并发症,绝经年限长和关节破坏严重是低骨量发生的独立危险因素,HRT是防治低骨量的保护因素。     

Thrombocytopenia and absent radii syndrome: defective megakaryocytopoiesis-thrombocytopoiesis

Thrombocytopenia and absent radii (TAR) syndrome is a congenital defect with osseous abnormalities and thrombocytopenia. It is inherited as an autosomal recessive trait, but the mechanism of thrombocytopenia in this disorder is not clear. We have had the opportunity to study the mechanism of thrombocytopenia in an infant with TAR syndrome. The infant had normal levels of thrombopoietin and megakaryocyte colony-stimulating activity in spite of marked thrombocytopenia. However, the megakaryocyte progenitor cells in the bone marrow produced abnormal colonies with increased numbers of megakaryocytes per colony and small megakaryocytes similar to the small megakaryocyte seen in vivo. These findings suggest that the TAR syndrome in this infant is due to a failure in the production of thrombopoietin or to an abnormal progenitor cell with a maturational defect.     

Breast-Feeding and Its Promotion

An increase in the rate of breast-feeding is beneficial for the developing countries both with regard to economy and health (1). The nutritional and immunological superiority of breastfeeding compared to artificial feeding is universally recognized. Breast-feeding has advantages not only for the infant but also for the mother and the family unit. It has also been recognized as the most effective method of birth-spacing in developing countries (2, 3) and it has advantages for the family because of its convenience and low cost (4).     

Recurrence incidence of sudden infant death syndrome.

The incidence of sudden infant death syndrome (SIDS) between birth and 2 years of age in South Australia was found to be 2.1/1000 live births. The incidence in previous siblings was 10 times that expected, in second degree relatives five times, and in third degree relatives four times that expected for the community. The minimum incidence in the next subsequent sibling was five times that expected. Except for one family in which both twins died during the same night, the surviving twin has never died (23 infants). The incidence of SIDS in adopted infants was similar to the incidence in natural born infants. Families in which two or more siblings died from SIDS differed from families in which only one infant died from SIDS in several ways. More infants were over 12 months old, and the mothers had an increased incidence of previous miscarriage and threatened miscarriage during the pregnancy with the infant who died. In one family both infants had bronchomalacia, and two families were severely socially deprived. For most families (92%) in which an infant died from SIDS the risk of recurrence is small (less that twice the expected risk). We have identified a small subgroup (8%) with a significantly increased risk of recurrence.     

Lymphocyte oxidative DNA damage and plasma antioxidants in Alzheimer disease

CONTEXT: A large body of experimental evidence suggests that in Alzheimer disease (AD) pathogenesis an important role is played by oxidative stress, but there is still a lack of data on in vivo markers of free radical-induced damage. OBJECTIVES: To evaluate levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of oxidative damage to DNA, in peripheral lymphocytes; to measure plasma concentrations of several nonenzymatic antioxidants; and to assess the relationships between any observed changes in lymphocyte DNA 8-OHdG content and plasma antioxidant levels in patients with AD and healthy aged control subjects. SUBJECTS: Forty elderly outpatients with AD and 39 healthy age- and sex-matched controls were studied. MAIN OUTCOME MEASURES: The level of 8-OHdG was determined in DNA extracted from lymphocytes and plasma levels of vitamin C, vitamin A, vitamin E, and carotenoids (zeaxanthin, beta-cryptoxanthin, lycopene, lutein, and alpha- and beta-carotene) were measured by high-performance liquid chromatography. RESULTS: Lymphocyte DNA 8-OHdG content was significantly higher and plasma levels of antioxidants (with the exception of lutein) were significantly lower in patients with AD compared with controls. In patients with AD, a significant inverse relationship between lymphocyte DNA 8-OHdG content and plasma levels of lycopene, lutein, alpha-carotene, and beta-carotene, respectively, was observed. CONCLUSIONS: Markers of oxidative damage are increased in AD and correlate with decreased levels of plasma antioxidants. These findings suggest that lymphocyte DNA 8-OHdG content in patients with AD reflects a condition of increased oxidative stress related to a poor antioxidant status.     

N-acetyl-L-cysteine improves survival and preserves motor performance in an animal model of familial amyotrophic lateral sclerosis

Increasing evidence implicates oxidative damage as a major mechanism in the pathogenesis of amyotrophic lateral sclerosis (ALS). We examined the effect of preventative treatment with N-acetyl-L-cysteine (NAC), an agent that reduces free radical damage, in transgenic mice with a superoxide dismutase (SODI) mutation (G93A), used as an animal model of familial ALS. NAC was administered at 1% concentration in the drinking water from 4-5 weeks of age. The treatment caused a significantly prolonged survival and delayed onset of motor impairment in G93A mice treated with NAC compared to control mice. These results provide further evidence for the involvement of free radical damage in the G93A mice, and support the possibility that NAC, an over-the-counter antioxidant, could be explored in clinical trials for ALS.