Lower limb blocks for children

Femoral and lateral cutaneous nerve of the thigh blocks have been performed in a group of 50 children; the method has not previously been described in paediatric practice. The technique was judged to have been successful in 48 (96%) of the children. There were no early or late complications. It is concluded that these blocks are easy to perform, even in small children and infants, and that they can produce reliable postoperative analgesia for a variety of orthopaedic and plastic procedures.     

Hirschsprung's disease in young adults

Hirschsprung's disease is rarely seen in the young adult, and presents unique problems in management because of the massive dilatation and hypertrophy that occur proximal to the aganglionic rectum or the rectosigmoid colon. The diagnosis, which may be suspected by barium enema, is confirmed by suction or full-thickness biopsy of the rectum that may be complemented by anal manometry. Based on our experience with eight patients, a two-stage surgical reconstruction is recommended, with a preliminary sigmoid colostomy through the normally innervated colon and an associated defunctionalized stoma constituting the initial operation. The distal colonic stoma permits cleansing of the caudal colon while the normally innervated proximal colon reverts to near normal caliber, usually within 2 to 6 months. This approach is in accord with the recommendation of Fairgrieve. Reconstruction using a Duhamel or Soave procedure has given good results. The Duhamel procedure seems preferable when a considerable discrepancy remains between the ganglionic and aganglionic segments of rectum.     

Factors relating to the sensory acuity of limbs with peripheral vascular insufficiency

We examined several possible causes for the high incidence of poor sensory acuity in the limbs of 176 patients with moderate to severe peripheral vascular insufficiency. We investigated the relationships of diabetes, alcoholism, and smoking, as well as the severity of peripheral vascular disease, to the integrity of basic sensory modalities such as two-point discrimination and perception of light touch. The presence or absence of diabetes exerted the strongest effect on peripheral sensation. In patients who did not have diabetes, sensation in the limbs was most strongly affected by whether the patient was an alcoholic. Smoking did not have a significant effect on limb sensation. Among nondiabetic, nonalcoholic patients, there was a weak residual effect related to the severity of the peripheral vascular insufficiency. Even among these patients, however, systemic factors predominated in determining the loss of sensation. We also examined the extent to which loss of sensation might be related to the development of ulcers. Among patients who were not diabetic, there was a highly significant relationship between loss of sensation and the presence of limb ulceration. Surprisingly, however, there was no discernable relationship between the presence of ulcers in diabetic patients and the degree of loss of peripheral sensation. This result suggests that a large percentage of ulcers seen in diabetic patients are not of neurogenic origin.     

Caloric intake and weight gain according to the shift schedule of shift workers

Survey involved 84 workers matched for age, socio-occupational and families status and divided into 3 groups : A : 27 shift workers on 3 days rotating shift, B : 47 shift workers on 5 days rotating shift, C : 20 days workers. Each subject was submitted to dietary survey by means of 24 hours recall, realised 3 times for shift workers and once for control. All workers were interviewed about caloric intake of the preceding day off caloric intake. Annual weight gain was studied through the use of occupational health service records. There was no significant difference between the 3 groups for working day caloric intake. Day-off intake was lower (p less than 0.05) in group A (day-off any day of the week). Annual weight gain was not different between the 3 groups. Shift workers with faster weight gain had a higher caloric intake on day-off and after evening meal.     

Paranoid and aggressive behavior in two obsessive-compulsive adolescents treated with clomipramine.

Obsessive-compulsive disorder is increasingly recognized in patients of different age groups. Serotonergic agents, such as clomipramine, have been recently found to be useful in the management of this condition. However, unexpected side effects, such as dysphoria, aggressiveness, and paranoid ideation, may occur with therapeutic doses of this compound, as evidenced in the cases of two male adolescents presented here. Possible pathogenetic factors, involving serotonin and serotonin-receptor abnormalities are discussed. Management of these side effects is based on adequate dose reduction and monitorization.     

Effect of antibiotics on oral contraceptive efficacy.

It is estimated that there are currently 10 million women in the United States who are taking oral contraceptives on a daily basis. Although the actual number is not known, it is also estimated that a large number of these same women are on concomitant drug therapy. In recent years, there has been a number of published reports linking a loss of contraceptive efficacy with the concurrent administration of other drugs, including antibiotics. Because of the common practice of prescribing antibiotics in dentistry, oral healthcare providers should be aware of the possibility of oral contraceptive failure with antibiotic treatment. Since it is often the dental hygienist who interviews patients and assists them in completing their health questionnaire, she or he can play an important role in educating and counseling these patients in possible drug interactions. This article reviews the published incidence of oral contraceptive/antibiotic interaction, along with a discussion of the possible mechanisms by which this interaction occurs. Recommendations are also presented for the oral health management of women taking oral contraceptives and other prescribed drugs.     

Primary hyperparathyroidism and monoclonal gammopathy

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal gammopathy, benign or malignant, in patients with primary hyperparathyroidism, and some practical implications of this interesting coexistence are presented.     

Encephalo-myelo-radiculo-ganglionitis presenting as pandysautonomia

A 68-year-old man developed pandysautonomia with severe orthostatic dysfunction, fixed heart rate, low serum levels of norepinephrine and epinephrine, absent sympathetic skin responses, and pupillary abnormalities. CSF protein was 92 mg/dl. In spite of a good recovery following corticosteroid administration, a relapse occurred, with accompanying sensory symptoms confined to both arms. Fatal sudden cardiac arrest occurred after 4 months. Autopsy revealed numerous lymphocytic infiltrates, predominantly in autonomic and sensory ganglia and, to a lesser extent, in the nerve roots, spinal cord, and brainstem without evidence for an underlying tumor. This case provides histopathologic evidence for an inflammatory etiology of panautonomic neuropathy in some patients.