Complications associated with alloplastic implants used in orbital fracture repair.

BACKGROUND: The treatment of orbital wall fractures involves observation and/or surgical reduction with repositioning of herniated orbital tissues. To prevent reherniation of tissue and development of enophthalmos, the orbital floor or wall defect is commonly covered with an alloplastic implant. Complications associated with these implants are infrequent and generally appear as isolated case reports. METHODS: The authors reviewed the files of four consultative oculoplastic surgeons and searched for individuals with complications secondary to their alloplastic implants used during orbital fracture repair. FINDINGS: Seventeen patients were identified with a variety of complications related to their alloplastic implant. CONCLUSION: Although these implants are relatively inert and develop a fibrous capsule walling them off from the surrounding orbit, they remain foreign bodies and are thus subject to possible complications at any time. The authors review the spectrum of complications occurring with various alloplastic implants.     

Hepatic photopenia in gallium imaging

Although Ga-67 has been used extensively in imaging many different conditions, much is yet unknown about the mechanisms by which gallium concentrates preferentially in tissues such as the liver. This paper reports three patients with markedly diminished hepatic uptake of gallium. The cases are examined in light of published data demonstrating such factors as transferrin levels, radiation, and chemotherapeutic agents as altering the hepatic uptake of gallium. Of the many factors believed to influence the biodistribution of gallium, none can definitively account for the lack of hepatic uptake in these patients.     

HLA-DR expression in macaque neuroendothelial cells in vitro and during SIV encephalitis

HLA-DR expression in neuroendothelial cells (NEC) was studied during the course of SIV encephalitis in rhesus monkeys. HLA-DR determinants were detected on NEC in monkeys with SIV encephalitis, but not in control animals. In situ hybridization with an SIV probe indicated that HLA-DR expression was not a consequence of SIV replication within NEC. Cultured rhesus NEC stimulated with gamma interferon expressed HLA-DR to a higher degree than cultured brain fibroblasts or astrocytes. These data support the contention that NEC participate in retrovirus-induced inflammation and autoimmunity within the central nervous system.     

Research highlights from the literature

Genes influencing the autonomic nervous system continue as a focus of research. Recent publications applied different methods to identify genes influencing autonomic cardiovascular regulation in humans. Two reports relied on a candidate gene approach. Common genetic polymorphisms in the promoter region of the tyrosine hydroxylase gene were shown to influence catecholamine synthesis and blood pressure. The same group tested the hypothesis that the GTP cyclohydrolase 1 (GCH1) gene influences catecholamine excretion and cardiovascular regulation. GCH1 affects tyrosine hydroxylase function indirectly. The authors concluded that the GCH1 gene may influence cardiovascular autonomic regulation through changes in nitric oxide production rather than a change in tyrosine hydroxylase activity. The third genetic study used a single nucleotide polymorphism chip to analyze 100,000 genetic polymorphisms scattered throughout the genome in participants of the Framingham study. The authors identified several polymorphisms that may influence QT interval duration, heart rate, and heart rate variability. The respective genes have not been identified with certainty. Another study suggested that catecholamines may be released from phagocytes and regulate pulmonary inflammation through alpha-2 adrenoreceptor activation in an autocrine or paracrine fashion.     

A survey of the viral flora of two commercial Pekin duck flocks

Ducklings on a problem farm which showed persistent and unacceptably high mortality yielded a larger range and greater number of viruses than did ducklings from a second flock, in which mortality was of a power and acceptable level. Reoviruses were the viruses most frequently isolated from young birds from both farms, but for longer at the problem site. ELAs (Embryo Lethal Agents), named since they caused high mortality in chick embryos, but could not otherwise be characterized, were recovered frequently and throughout the growth cycle of the problem flock, but not at all in the other flock. Lentogenic Newcastle disease virus was detected at all ages on the problem farm but less often than ELAs. The faeces of birds on the problem farm yielded rota-like viruses, corona-like viruses and adeno-like viruses, and on the farm with normal mortality, Egg Drop Syndrome-76 virus and adenovirus. Detection techniques included culture on chick embryos and chick embryo liver cells, and electron microscopy (EM). Inoculation of whole eggs was particularly valuable and more successful than cell culture for virus recovery. EM was most useful for direct examination of faecal preparations and confirmation of the viral type.     

Functional restoration in chronic low back pain

Conventional treatments have not slowed down the ever expanding low back pain (LBP) problem. Traditional treatment has most probably contributed to the growth of the problem. Therefore, in a search for new solutions, 'functional restoration' has been devised. In connection with chronic LBP the term has been associated with a full-day program lasting from 3 to 5 weeks. it includes multidisciplinary treatment of patients in groups with intensive physical and ergonomic training, psychological pain management, back school, as well as teaching in social/work related issues. The key concepts are 'acceptance of the pain', 'activity', 'self-responsibility', 'multidisciplinary' and 'quantitative functional evaluation (QFE)'. The latter is aimed so that the participants can feel the physical improvement, encouraging them to be able to go back to work, or at least to lead a more active life style. Several controlled studies suggest a lasting effect in terms of regaining their ability to work and improving pain behavior for a good part of disabled chronic LBP patients. However, it is noteworthy that randomized studies seemingly show poorer results than studies not employing randomized controls.     

Cortical asymmetry--a preliminary study: neurons-glia, female-male

Previous studies on human cortical area 39 suggested that neuron:glial ratios differed between the sexes. These findings were the inspiration for the present investigation which dealt with neuronal and glial counts in area 39 in the male and female rat cerebral cortex. Transverse, celloidin or frozen sections, were cut from male and female brains (respectively) from 90-day-old Long-Evans rats. Neurons and glia were counted on enlarged photographs of stained sections, including area 39, with 35-mm Kodak Panatomic-X film using a Zeiss photomicroscope (X400). Five-by-three-inch prints were taped together in sequence to yield a 640X enlarged "montage" of area 39. Five cell types were differentiated with reference to a standard: neurons, astrocytes, oligodendrocytes, "dark astrocytes," and unidentified glia. The data were analyzed with a two-way analysis of variance (ANOVA: five cell types by two hemispheres). Student's t test and a paired t test were used when appropriate. The neuron:glial ratios in the male rats were consistently higher than those in the females in both hemispheres. The male right side had 12% (P less than 0.05) more neurons than the left; the female had 13% (P less than 0.05) more neurons on the left than the right. Similar, but not identical, asymmetrical patterns were seen with the glial cells.     

Early recognition of postoperative hematoma formation

Summary Postoperative hematoma formation must be treated as a potential infection. One fourth of all postoperative hematomas are already contaminated. Ultrasonographical examination is an effective method for early recognition of such postoperative hematomas. Ultrasonic diagnosis on a routine basis is not necessary, but it should be carried out as soon as clinical symptoms appear. Our postoperative late results with only one early and one late infection after 100 postoperative treatments of the hip joint and femoral shaft emphasize the importance of early diagnosis of hematomas.

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Zusammenfassung Die drohende Infektion im postoperativen Verlauf nach Osteosynthesen bereitet diagnostische Probleme, da keine objektiven Kriterien vorhanden sind. Das postoperative Hämatom ist als eine drohende Infektion zu beurteilen. 1/4 aller postoperativen Hämatome sind bereits kontaminiert. Die Ultraschalluntersuchung ist eine wirksame diagnostische Hilfe zur frühzeitigen Erkennung der drohenden Infektion bei postoperativen Hämatomen. Sie muß sicherlich nicht routinemäßig, bei klinischem Verdacht aber frühzeitig durchgeführt werden. Das postoperative Spätergebnis mit lediglich einem Frühund Spätinfekt bei 100 operativen Eingriffen am Hüftgelenk und Oberschenkelschaft belegen die Bedeutung der frühzeitigen Hämatomdiagnostik.