Tears of the medial meniscus associated with increased radionuclide activity of the proximal tibia

Summary Three patients who presented with long-standing medial knee pain and normal radiographs had an isotope bone scan in an attempt to arrive at a diagnosis. In each case there was a well-defined area of increased uptake over the medial tibial condyle and arthroscopy subsequently revealed meniscal damage. After arthroscopic menisectomy each patient became asymptomatic and the bone scan returned to normal. We suggest that patients with incapacitating knee pain, normal radiographs and a positive bone scan undergo an arthroscopy even in the absence of clinical signs of meniscal damage.

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Résumé Trois malades qui présentaient depuis longtemps des douleurs de la partie interne du genou et dont les radiographies étaient normales ont bénéficié d'une scintigraphie afin d'essayer d'ðablir un diagnostic. Dans tous les cas il y avait une zone bien limitée d'hyperfixation au niveau de la partie interne de l'extrémité supérieure du tibia, et l'arthroscopie ultérieure découvrit une lésion méniscale. Après méniscectomie arthroscopique tous les malades furent soulagés et la scintigraphie redevint normale. Nous proposons que l'on pratique une arthroscopie, même en l'absence de signes cliniques d'atteinte méniscale, chez les sujets présentant des douleurs notables du genou, avec des radiographies normales et une scintigraphie positive.

     

Ocular prosthesis following plastic surgery

The shape of the eye prostheses depends on the plastic surgery type. Standard prostheses with thin but not sharp edges are used to recreate the conjunctival cavity, prostheses with a deep retraction or flat ones are employed for a delayed introduction into the stump, prostheses with a 'swelling' at the upper edge are of use in surgery to correct the upper eyelid falling in, prostheses with a flattened lower edge and a 'shelf' at the upper edge are used to fortify the lower eyelid. Individual prostheses are recommended after plastic surgery. The prostheses should not prevent free closing and blinking of the eyelids, retaining the identical opening of the eyes. An inadequately chosen prosthesis brings to nothing the tremendous work made by the surgeon. Ocular prosthetics may be regarded as the final stage stabilizing the results of plastic surgery.     

Evaluation of the apical seal obtained with two calcium hydroxide based endodontic sealers

Summary. In this study, a comparison of the sealing properties of two calcium hydroxide based endodontic sealers, Sealapex and CRCS with those of the root canal cement Tubli-Seal was performed. The results showed that all materials failed to produce an effective apical seal and that the degree of leakage increased with time. The differences observed among the 1-, 3- and 10-day observation periods were statistically significant for all materials (P<0.001) whereas no significant differences between materials were observed at each observation period (P<0.05).     

Chronic tonsillitis, tonsillectomy and sickle cell crises

A study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p less than 0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.     

The effect of cimetidine on anesthetic metabolism and toxicity

Because the H2-receptor antagonist cimetidine has been shown to inhibit drug metabolism, the effects of cimetidine on anesthetic metabolism and toxicity were investigated in a rat model. Cimetidine decreased inorganic plasma fluoride production after methoxyflurane administration both in 21% oxygen (P less than 0.001) and in 100% oxygen (P less than 0.001). Phenobarbital produces an increased fluoride formation after methoxyflurane anesthesia, and this fluoride formation is also reduced by cimetidine (P less than 0.005). There was no significant difference between the plasma fluoride levels in rats anesthetized with halothane or enflurane. Although cimetidine inhibited the in vivo defluorination of methoxyflurane, fluoride levels were still within the nephrotoxic range, and cimetidine is not likely to play a role as part of a preanesthetic regimen that would permit the increased clinical use of methoxyflurane. Cimetidine also inhibited the oxidative metabolism of halothane; cimetidine decreased (P less than 0.05) trifluoroacetic acid concentrations after halothane anesthesia in 21% oxygen and in 100% oxygen and decreased (P less than 0.05) bromide concentrations after halothane anesthesia in 100% oxygen. Trifluoroacetic acid levels were less (P less than 0.02) after halothane anesthesia in 14% oxygen as compared with 100% oxygen, indicating a reduction in oxidative metabolism under hypoxic conditions. However, bromide concentrations were maximal after halothane anesthesia in 21% oxygen, and significantly (P less than 0.001) less after halothane anesthesia in 14% and 100% oxygen. Bromide production, therefore, seems to be inhibited by both hypoxia and hyperoxia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of transtympanally applied lidocaine on the cochleovestibular function

Twenty-two patients with recurring attacks of tinnitus, hearing loss and dizziness were treated with transtympanally injected lidocaine. The tinnitus improved in 19, and the pure tone and speech audiometric thresholds decreased in 15 cases. The dizziness and latent spontaneous nystagmus disappeared in all subjects where these symptoms were manifest before treatment.     

IS VECURONIUM A LONG-ACTING NEUROMUSCULAR BLOCKING AGENT IN NEONATES AND INFANTS?

Vecuronium was used as the only neuromuscular blocking agentin 81 paediatric patients (neonates to adolescents) during fentanyland nitrous oxide anaesthesia. The thenar electromyogram wasused to monitor neuromuscular blockade. Neonates and infantshad a mean requirement of vecuronium 105 µg kg^–1during the first 1 h of anaesthesia, to establish and maintain90–98% neuromuscular blockade, compared with a mean requirementof 217 µg kg^–1 for children aged 3–10 yr (P< 0.05). Vecuronium 100 and 150 µg kg^–1 maintainedneuromuscular blockade > 90% for 59 and 110 min, respectively,in neonates and infants, but only for 18 and 38 min in childrenand for 37 and 68 min in adolescents (P < 0.05). Vecuroniummay be regarded as a long-acting neuromuscular blocking agentin patients aged less than 1 yr. Present address: Department of Anaesthesia, Royal Children'sHospital, Flemington Road, Parkville, Victoria 3052, Australia.