Tarsal tunnel syndrome: a review of the literature

Tarsal tunnel syndrome is an uncommon clinical entity. This article will review the published reports on tarsal tunnel syndrome with respect to its anatomy, cause, pathophysiology, clinical presentation, diagnosis, treatment, and results of treatment in an attempt to improve understanding of this problem.     

Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study

Acute catatonic syndromes occurring in the context of various medical and neuropsychiatric conditions, including schizophrenia, have been shown to respond well to benzodiazepines (BZD). However, there have been no studies specifically designed to address the BZD treatment response of persistent catatonic states. Eighteen patients with clinically stable chronic schizophrenia, who also displayed enduring catatonic features, underwent a 12-week long, random assignment, double-blind, placebo-controlled cross-over trial with lorazepam (6 mg/day). A comprehensive assessment, including the subjects’ clinical and motor (catatonic as well as drug-induced movement disorders) condition, was performed at baseline and four weekly intervals thereafter. Pre-existing medication was kept constant throughout the study. Lorazepam had no effect on the subjects’catatonic signs and symptoms, suggesting that acute and chronic catatonic syndromes associated with schizophrenic illness might have a different neurobiological basis. Received: 25 May 1998/Final version: 22 September 1998     

Angioplasty, stenting, atherectomy, and laser treatment after coronary artery bypass grafting

Saphenous vein grafts remain an essential part of coronary artery bypass surgery. However, their inferior long-term patency due to graft attrition often means recurrent ischemia or infarction. Repeat surgical revascularization carries a significantly higher morbidity and mortality and is frequently associated with less symptomatic improvement as compared with the initial surgery. Thus, nonsurgical alternatives are preferred in such a situation, particularly when the lesions are technically approachable and amenable to these transcatheter procedures. Traditionally, percutaneous transluminal coronary angioplasty has been the standard approach. However, there are certain shortcomings of this technique, principally its inadequacy in treating certain adverse lesion morphologies. Problems include an appreciable risk of coronary debris embolization and acute complications in old vein grafts, and the prohibitively high restenosis rate for stenoses situated at the ostium or the proximal and middle segments of grafts. Newer, second-generation intravascular techniques such as stents, atherectomy, and laser procedures have been introduced in an effort to overcome these problems. This review presents an update of the results of these new tools together with some suggestions on their clinical utility in a vein graft setting.     

Partial Artificial Heart (ALVAD) Use with Subsequent Cardiac and Renal Allografting in a Patient with Stone Heart Syndrome

The abdominal left ventricular assist device (ALVAD) is an order of magnitude more effective than conventional intra-aortic balloon pumping (IABP) in unloading and providing circulatory support to the failing left ventricle. This is a report of a unique case which demonstrates that in the absence of pulmonary vascular obstruction or constriction, the ALVAD can substitute for both left and right heart function. A 21-year-old patient with a congenital bicuspid aortic valve developed acute valvular endocarditis which rapidly progressed to congestive heart failure. An operation was undertaken, the mitral and aortic valves were excised and replaced by porcine heterografts, and a fistula from the right sinus of Valsalva to the right ventricle was closed. When coronary circulation was restored, irreversible ischemic contracture of the left ventricle, or "stone heart" syndrome, developed and emergency ALVAD or partial artificial heart implantation was effected. This device functioned as a total artificial heart for nearly six days, while a donor heart was sought. The patient then underwent removal of the ALVAD and cardiac and renal allografting. The transplanted heart functioned well, but the patient expired fifteen days later from gram-negative sepsis.     

Linear model for visual-vestibular interaction.

The results of experiments are evaluated in terms of a simple model for the interaction of eye movement responses to simultaneous optokinetic and vestibular stimuli. The model predictions agree with the results of these experiments and explain many clinical observations concerning the effect of vision on nystagmus. The model accounts for the dominance of the visual system's response over the vestibular system's response at low frequencies. It also accounts for the inability of patients with decreased smooth pursuit system response to suppress the vestibulo-ocular reflex during simultaneous optokinetic and vestibular stimulations. The model provides useful information for the design of combined optokinetic and vestibular stimuli for test vestibulo-ocular reflexes.     

Morphological changes of retinal ganglion cells regenerating axons along peripheral nerve grafts: a Lucifer Yellow and silver staining study

The morphology of the retinal ganglion cells (RGCs) with their axons regenerating along a peripheral nerve graft at different post-grafting periods was studied by the intracellular injection of Lucifer yellow (LY) and silver staining methods. Several morphological features which were observed on developing RGCs, but not mature RGCs, have also been observed in the regenerating RGCs studied by the intracellular injection of LY. These morphological features observed on the regenerating RGCs included intraretinal axonal branches and collaterals, spine-like processes on the dendrites and soma, and short processes on the soma. These results suggest that damaged mammalian RGCs may be able to recapitulate certain cellular events which occur during normal development provided the regenerating cells are given the proper stimulus and a favorable environment for regrowth. From the results of both LY injection and silver staining experiments, it was found that the dendrites of the regenerating RGCs were, in general, much simpler than that of control Type I RGCs. However, regenerating RGCs with different degree of dendritic complexity could be observed in all post-grafting periods studied, and the dendritic complexity seems to decrease continuously with the increase in the post-grafting time. These results suggest that the ability to regenerate an axon is not closely related to dendritic responses and the peripheral nerve does not seem to be able to prevent the deterioration and retraction of the dendrites.     

Isoprenaline increases brain concentrations of administered l-dopa and l-tryptophan in the rat

A small dose of isoprenaline or saline was administered intraperitoneally to rats 20 min before the administration of one of the amino acids l-dopa or l-tryptophan. Isoprenaline caused a marked increase in the brain concentration of the administered amino acid. Isoprenaline has previously been shown to cause a decrease in at least some of those plasma amino acids which compete with l-dopa and tryptophan for carrier-mediated transport into the brain. The effect of isoprenaline on the concentrations of dopa and tryptophan in the brain is suggested to be at least partly caused by a change in the relationship between endogeneous and administered amino acids. It is also possible that a direct effect of isoprenaline on the blood-brain barrier transport system contributes to the effect.The reported finding might be of clinical interest in view of the therapeutic importance of aromatic amino acids with a central site of action.