Hepatitis prevalence in trauma patients

The risks of viral transmission from trauma patients is a continuing concern to those involved in their care. However, the prevalence of hepatitis (HPT) in trauma patients is poorly described. The purpose of this study is to evaluate the prevalence of HPT in trauma patients admitted to an urban trauma center. Two hundred sixty-four consecutive admissions to an urban Level I trauma center underwent serologic screening for HPT. Risk factors were assessed by direct patient questioning. Serologic evidence of HPT B was found in 19.7 per cent of patients. Intravenous (IV) drug abusers represented eight per cent of the study population; this group had a 67 per cent rate of seropositivity. Hepatitis A was not found in any patient. Antigenemia was found in 1.9 per cent of patients. It is concluded that HPT B seropositivity is common in trauma patients. IV drug abusers have particularly high prevalence of HPT. This high prevalence rate of HPT B serology poses a significant risk to those involved with the care of trauma patients. The authors suggest that specific protocols to avoid the transmission of viral disease should be mandatory in urban trauma centers.     

Sciatic nerve entrapment in a child. Case report

A child was brought for evaluation of signs of unilateral chronic progressive sciatic nerve dysfunction found to be due to nerve entrapment in the thigh by a fibrovascular band. Sectioning of the band was followed by marked improvement in the nerve function. Compression by a band is a rare but treatable cause of sciatic neuropathy.     

Spatiotemporal modeling of cerebral evoked magnetic fields to median nerve stimulation.

We measured somatosensory evoked magnetic fields during median nerve stimulation in 6 normal subjects. We applied multiple dipole models to study the spatiotemporal structure of early somatosensory evoked magnetic fields (SEFs), as well as the number, 3-dimensional location and time activity of their underlying neuronal sources. Two dipole sources were necessary to model the first 40 msec of SEFs explaining 85% of the data variance. Source 1 was located deeper than source 2, showed primarily a tangential orientation, and accounted for a larger part of the variance; source 2 showed no consistent orientation across subjects. Both sources showed biphasic time activities corresponding to the previously described N20-P30 and P25-N35 components. Spatiotemporal modeling could identify sources which could not be modeled consistently above noise by single moving dipoles (P25 component), revealed small latency differences of the two sources in some subjects suggesting parallel activation of these sources, and allowed separation of sources overlapping considerably both in space and time. We conclude that spatiotemporal modeling of SEFs may be useful to study functional anatomy of human sensorimotor cortex non-invasively.     

COMPARISON OF REFLEX MODIFICATION PROCEDURES AND AUDITORY BRAINSTEM RESPONSE IN HIGH-RISK NEONATES

This study compared the results of reflex modification (RM)--an objective technique for assessing brainstem sensorineural processing--with those of auditory brainstem response (ABR) for a group of high-risk infants at comparable postconceptional ages. For the RM procedure, an eyeblink-eliciting tap to the glabella was presented either alone or accompanied by a brief 90dB SPL tone. 37 high-risk infants were tested with both RM and ABR at a mean postconceptional age of 37.3 weeks. Seven had an increased brainstem conduction time ('failed ABR') and eight did not exhibit significant reflex augmentation ('failed RM'), seven of whom also failed the ABR. These data provide evidence that sensory stimuli which affect the neural mechanisms responsible for the organization of the startle response and auditory processing share essential neural components.     

Reproductive Function in Epilepsy

Summary: : The hypothalamic-pituitary-gonadal axis is a complex system within which both positive and negative feedback occur among its elements and higher brain systems. The occurrence of seizures and changes in the secretion of pituitary hormones can affect the feedback loop. Both seizures and antiepileptic drugs can affect the hypothalamic-pituitary-gonadal axis of males and females and cause changes in hormones and sexuality. Reproductive dysfunction has a social impact because of reduced fertility. Once conception occurs, live birth rates are not diminished. Prospective studies of men and women with epilepsy are needed.     

Congestive gastropathy

15 patients with congestive gastropathy were reported including clinical and pathological characteristics of the disease. Every patient had alcoholic liver cirrhosis and portal hypertension. 6 patient's stomach was resected while in 2 further cases the disease was found at autopsy. In additional 7 cases the characteristic microvascular changes were observed in endoscopic biopsy specimens from the gastric mucosa. The authors presume that this disease has an acute and a chronic stage. In the acute stage dilated capillaries are present under the surface, not related to the inflammation of gastric mucosa. This phenomenon was described in the literature. In the chronic stage there are dilated and tortuous vessels in the submucosal layer surrounded by collagenous connective tissue. The authors suppose that the thick and fibrotic submucosal layer causes microcirculatory disturbances in the gastric mucosa. The impaired microcirculation may cause extensive ulcers with profuse and sometimes lethal bleeding.     

Elective aortocoronary bypass grafting in the elderly

Operative mortality, postoperative morbidity and follow up data were analyzed retrospectively from 122 consecutive patients, over 65 years old undergoing elective aortocoronary bypass grafting for symptomatic relief of angina pectoris at the Plains Health Centre, Regina, Saskatchewan, from January 1980 to December 1985. There were two in-hospital deaths (operative mortality 1.6%). Definite perioperative myocardial infarction occurred in 12 patients (9.8%). The 120 survivors were followed for a mean of 32 months. There were three deaths during follow-up, giving a five-year probability of survival of 93%. Twenty-three clinical events (including deaths) occurred during follow-up, giving a five-year probability of event free survival of 72%. Ninety percent of patients say they are pleased with their operation. Seventy-eight percent are currently angina free. These data illustrate the effectiveness of aortocoronary bypass grafting in low risk elderly patients with symptomatic coronary artery disease.     

Marked hypodiploidy in blast phase chronic myelogenous leukemia: report of a case and review of the literature

The emergence of a near-haploid clone of cells in blast phase chronic myelogenous leukemia is an unusual event. We report such a case and review eight other cases described in the English literature. The significance of the substantial loss of genetic material is discussed as is the phenotypic and genotypic heterogeneity observed in this group of patients.     

Myosin light chains and muscle pathology

We evaluated the isoform composition of heavy and light chains of myosin in single muscle fibers from patients with Duchenne dystrophy, myotonic dystrophy, or polymyositis. In all myopathic muscles, there was an increase in the proportion of intermediate fibers which, by analysis of myosin isoforms, fell into two subpopulations, one that contained both fast and slow myosin and another that contained myosin molecular hybrids. The increased proportion of intermediate (or transitional) fibers suggests changes in the equilibrium between fast and slow motor units. These changes could result from regeneration and subsequent maturation of fibers or from direct transformation of mature fibers of one type into the opposite.