Sensory recovery after median nerve grafting.

Fourteen patients were evaluated prospectively after median nerve grafts. Twelve male and two female patients with a mean age of 41 years were included. Mean time since surgery was 4 years. Detailed sensory evaluations were completed. Statistical evaluation analyzed relationships between object identification, sensory tests, and graft length. According to the S-0 to S-4 grading system, 11 patients were considered to be S-3+ or greater. Recovery of moving two-point discrimination of 2 to 3 mm. was achieved by 50% of the patients. Strong correlations were found between object identification and static two-point discrimination, moving two-point discrimination, and graft length. Cutaneous pressure threshold and vibration threshold correlated weakly with object identification.     

An evaluation of the pedicled thoracoumbilical flap in upper extremity reconstruction

A pedicled thoracoumbilical flap was evaluated in 5 patients for upper limb reconstruction. The flap appears to be a reliable axial flap that can be elevated safely to the midaxillary line. It has the capacity to transfer a large amount of tissue, allowing the damaged limb, during the attached period, to be elevated and to receive physiotherapy. Although the working portion of the flap uses the thin, hairless skin over the lateral ribs, the base of the flap is thick and difficult to tube in all but the thinnest of individuals. The donor scar is much more conspicuous than that of a groin flap.     

Adrenaline concentration and turnover in the arcuate nucleus and median eminence during the critical period in the rat

Previous work has shown a relatively high turnover of adrenaline in the mediobasal hypothalamus during the critical period (15.00-17.00 h) of the proestrous rat. We now report that this high level of adrenergic activity can be detected in the median eminence (turnover rate 1.62 +/- 0.36 pg/micrograms protein/h) rather than the arcuate nucleus (turnover rate 0.18 +/- 0.32 pg/micrograms protein/h). In addition the median eminence was isolated as medial and lateral components and determination of catecholamine concentrations revealed a greater proportion of adrenaline (A) (59%) in the lateral median eminence whereas a larger proportion of dopamine (60%) was found in medial median eminence.     

Effect of Cigarette Smoking on Duodenogastric Reflux of Bile Acids*

Abstract: The possibility that smoking induces duodenogastric reflux was examined in 13 healthy male volunteers. Gastric juice was aspirated for four consecutive 20-minute periods, and reflux quantitated by measuring total bile acids (TBA), chenodeoxycholic acid (CDCA) and glycocholic acid (GCA) in the juice. One cigarette was smoked during either period 2 or period 3. Amounts of bile acids (μmoles; means ±SEM) refluxing into stomach during the pre-smoking, smoking, and post-smoking periods respectively were: TBA—4.5 ± 1.1, 5.4 ± 3.0 and 3.9 ± 1.6; CDCA— 1.7 ± 0.6, 1.5 ± 0.9 and 2.0 ±1.1; GCA—1.8 ± 1.7, 1.1±0.6 and 1.0 ± 0.6. Paired analysis revealed no significant effect of smoking on any of these parameters. These findings, based on quantitative methods, do not confirm those of previous unblinded and semiquanti-tative studies. We conclude that smoking one cigarette does not provoke duodenogastric reflux.     

Human ulnar neuropathy at the elbow: clinical, electrical, and morphometric correlations

This study explored and compared clinical, electrodiagnostic, and morphometric observations on bilateral ulnar nerves obtained at necropsy in a patient with severe bilateral ulnar compression neuropathy at the elbow. There was excellent correlation among all three evaluation techniques. On the patient's more symptomatic side, there was significant slowing of conduction velocity across the elbow, with sensory conduction unobtainable in the little finger. Morphometric results demonstrated loss of myelin, decreased nerve fiber diameter, and reduction in percent of neural tissue present in the compressed elbow segment of the ulnar nerve.     

Archenteronoma (yolk sac tumors).

Ten cases of archenteronoma are reviewed with a follow-up between 2 mo and 7 yr. Their presentation was similar to that of rhabdomyosarcoma except for testicular tumors that may present as a hydrocele. A good prognosis was found with tumors amenable to primary resection and chemotherapy. Other tumors are best treated initially with chemotherapy before relatively conservative surgery, radiotherapy being used either pre- or postoperatively.     

The relationship between serum creatinine and estimated glomerular filtration rate: implications for clinical practice

INTRODUCTION: A new classification of chronic kidney disease (CKD) has been widely adopted that stratifies patients into 5 'stages' according to estimated glomerular filtration rate (eGFR). In adults the most commonly used formulae to calculate eGFR are the Cockcroft and Gault (C and G) and Modification of Diet in Renal Disease (MDRD) formulae. The UK Renal Association has recommended calculation of MDRD eGFR to screen for reduced kidney function in primary and secondary care. AIM: The aim of this study was to explore the implication of using these predictive formulae. METHODS: We searched for patients currently attending a renal clinic who have ever had a serum creatinine (SCr) of exactly 100 micromol/L, 150 micromol/L or 200 micromol/L. The C and G and MDRD eGFRs corresponding to that SCr were calculated. The proportion of patients in each stage of the CKD classification was determined. RESULTS: For a SCr of 100 micromol/L mean eGFR was 86.5 ml/min (range 31.0 - 192.8) by C and G and 63.8 ml/min (range 39.7 - 99.9) by MDRD (p < 0.0001; t-test of mean). For SCr 150 micromol/L mean eGFR was 51.7 ml/min (18.0 - 110.4) by C and G and 38.0 ml/min (20.7 - 54.8) by MDRD (p < 0.0001). For SCr of 200 micromol/L mean eGFR was 34.4 ml/min (12.6 - 89.5) by C and G and 27.3 ml/min (16.7 - 41.3) by MDRD (p < 0.0001). Using MDRD eGFR 46.5% patients with a SCr of 100 micromol/L have stage 3 CKD (GFR 30-60 ml/min) and all patients with a SCr of 150 micromol/L or 200 micromol/L have CKD 3 or worse. 8.6% of males with SCr 100 micromol/L had stage 3 CKD or worse compared with 86.8% females. 70.2% patients > 65 years old with SCr 100 micromol/L had stage 3 CKD. CONCLUSIONS: Targeted screening of patients at-risk for CKD will identify a large number of patients who require management of CKD and potential referral to nephrology services even at levels of SCr regarded as 'normal' or mildly.