Is additional epidural sympathetic block in microvascular surgery contraindicated? A preliminary report

The use of additional epidural sympathetic block during and after microvascular surgery in the lower extremities to prevent vasospasm is generally agreed on. However, a significant fall in the perfusion rate of the transplants was seen after application of bupivacaine (Marcain) via the epidural catheter. This effect has, to our knowledge, not been described before and is probably caused by the sympathectomy effect of this type of analgesia.     

Dietary Tryptophan Reverses Alcohol-induced Impairment of Facial Recognition But Not Verbal Recall

The present study demonstrates that alcohol-induced memory impairment can be attenuated by pretreatment with an oral tryptophan supplementation. These results provide support for the role of a brain serotonin deficit in this impairment and highlight the impact a dietary manipulation can have on a complex behavioral process.     

Memory clinic attenders: A review of 150 consecutive patients

The Dundee Memory Clinic was established in 1991. This paper reviews the diagnosis of the first 150 attenders and compares the findings with those of other memory clinics.     

X-Ray Study of the Cat Hindlimb During Treadmill Locomotion

With pulsed X-ray cinematography we have analysed the angular excursions of the distal hindlimb joints (proximal interphalangeal, PIP; metatarsophalangeal, MTP; ankle) in cats walking on a treadmill. These distal joints transmit the body weight and the dynamic forces onto the ground. We have included the knee and hip joints in the analysis to relate the angular excursions of the proximal and distal joints and to verify the data previously obtained with external markers on the kinematics of the proximal joints. At the beginning of the stance phase the PIP joints flexed rapidly, the MTP joints extended slowly and the ankle and knee yielded under body weight. Whereas the PIP joints maintained a rather constant angular position of −75° throughout the stance phase, extension continued in the MTP joints from −230° at touch-down to −270° at the end of the stance phase. Around 50 ms before lift-off the MTP joints flexed rapidly. Early (−30 ms) after lift-off this flexion changed into a slow extension. The PIP joints extended swiftly at the stance-swing transition and moderately at the end of the swing phase. During the middle part of the swing phase they flexed slowly. Small rotatory movements around the long axis of the foot took place in the last 100 ms of the swing phase. The results of this study on the distal joints are discussed in relation to the placing of the paw, to the translation of forward propulsion into a MTP movement and to the lifting of the paw (conventionally described as toe curling). They show a differentiated mechanical interaction between the different distal limb joints during these different phases, which must be known in detail to interpret the corresponding electromyographic data and to understand how the hip is moved forward over the MTP joints which serve as the final pivot during stance.     

Formation of thrombin-antithrombin III complex using polyamide and hemophan dialyzers.

The recently developed ELISA for the thrombin-antithrombin III complex (TAT) is a sensitive, specific, and simplified means of detecting intravascular coagulation. For further evaluation of the thrombogenicity of a polyamide (P) and a Hemophan (H) hollow-fibre dialyzer a cross-over study was done in ten stable patients on maintenance hemodialysis. At the same doses of heparin (mean bolus of 30 U/kg bw and maintenance doses of 86 U/kg bw), thrombin time and partial thromboplastin time were significantly lower using H. At the end of dialysis TAT was significantly higher in H (mean +/- SEM before HD 3.57 +/- .56, at 240 min 14.9 +/- 6.5 ng/ml, p less than 0.05, Wilcoxon-test) than in P (before HD 4.36 +/- .98, at 240 min 8.95 +/- 3.0 ng/ml, p less than 0.05 H 240 vs. P 240, Wilcoxon-test). Visible clotting was more pronounced in the H filter. Among other favourable features of blood compatibility the polyamide/polyvinylpyrrolidone copolymer with a hydrophilic/hydrophobic microdomain structure has less thrombogenicity. The modified cellulosic membrane H has advantages in complement activation and leukocyte depression, but thrombogenicity seems less favourable since the incorporated diethyl-amino-ethyl groups with their positive charge bind and inactivate negatively charged heparin.     

Malignant fibrous histiocytoma in the area of the head and neck]

Although malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of adult life, it is fairly rare in the head and neck region (3-6%). Between 1983 and 1991 8 patients with MFH in the head and neck region have been observed and treated at the ENT-department of the University of Tübingen. 5 patients have been operated (laryngopharyngeal localization), 2 patients underwent irradiation (unresectable fast growing T4-tumors of the pharynx and thyroid) and one female patient refused further therapy after two resections elsewhere. Operated patients showed no evidence of disease 2-8 years after resection (all margins have been controlled histologically). Both irradiated patients died 4 respectively 2 months after full (70 Gy) and incomplete (17 Gy) radiotherapy without visible positive effects. Both patients developed pulmonary metastasis. Since MFH can grow in thin layers along musculaoponeurotic structures the exact size is not always demonstrable by ultrasound, CT or MR scans. Metastasis occur in up to 40%, preferentially in regionary lymph nodes, in lung, liver and skeletal system. These phenomenon requires a full pretherapeutic staging. Histologically MFH is sometimes hard to distinguish from other tumors as for example various sarcomas and pleomorphic carcinoma. Therefore, immunohistochemical (mesenchymal markers) and electron microscopical investigations are advised. Resection with exact histological controll of all margins is the therapy of choice. We experienced that laryngeal MFH (n = 3) can be resected without laryngectomy under certain circumstances. Although unsuccessfull in our two cases, according to the literature, radiotherapy should be administered in unresectable cases. Depending on localization and size of MFH long survival, in single cases healing, of this disease is possible by surgical treatment.