Malfunctioning peritoneal dialysis catheter and accompanying surgical pathology repaired by laparoscopic surgery.

OBJECTIVES: To review the laparoscopic salvaging of malfunctioning peritoneal dialysis (PD) catheters, and to present our experience with laparoscopic repair of dysfunctional Tenckhoff catheters and the treatment of accompanying surgical pathologies. DESIGN: Malfunctioning peritoneal catheters were repaired using laparoscopic rescue techniques. Accompanying surgical problems were treated in the same operation. The effectiveness of these approaches was validated by comparison with other remedial techniques described previously. PATIENTS: Malfunctioning PD catheters were salvaged by laparoscopic surgery in 8 patients, and accompanying surgical problems were treated in the same operation in 3 of the 8 patients. MAIN OUTCOME MEASURES: Outcome was measured by the successful return to adequate PD and effective treatment of surgical problems. RESULTS: Eight patient studies show laparoscopic correction of malfunctioning catheters and the treatment of accompanying surgical pathologies with the return to successful PD. CONCLUSION: The salvaging of malfunctioning PD catheters by laparoscopic surgery is an ideal method. This procedure permits simultaneous identification and correction of other surgical problems that could otherwise complicate dialysis therapy.     

Mitochondrial complex I and IV activities in leukocytes from patients with parkin mutations.

The parkin protein functions as a RING-type ubiquitin protein ligase. Considering the possibility that impaired ubiquitin-proteosomal system activity may impair antioxidant defenses and enhance oxidative stress, we have investigated the activity of mitochondrial respiratory enzymes in patients with parkin gene mutations. A significant decrease in the leukocyte complex I activity was found both in patients with parkin mutations (62.5%) and idiopathic PD (64.5%) compared with age-matched controls (P < 0.001). Complex IV activity was also decreased significantly in idiopathic PD patients (60%), but no difference was detected between controls and patients with parkin mutations.     

Fever development in neuroleptic malignant syndrome during treatment with olanzapine and clozapine

Neuroleptic malignant syndrome (NMS) is the most dangerous life-threatening complication of antipsychotic medication. It's development is connected with the blockade of dopaminergic transmission (D₂ receptors) in the nigrostriatal system of the brain. Fever is one of the main symptoms of this syndrome and it's elevation is due to the activation of the immune system. Numerous studies report that treatment with clozapine (doses 37.5–600 mg) or olanzapine (doses 10–25 mg) or the use of these drugs in polytherapy cause pyrexia between 37.8–40.6°C. Additionally, levels of proinflammatory interleukins such as IL-6, IL-1,TNF-α were increased. The aim of this article is to describe how olanzapine and clozapine influence fever development in NMS, in relation to the dose of the drug taken by schizophrenic patients including changes in immunological system.     

Central third bone-patellar tendon-bone arthroscopic anterior cruciate ligament reconstruction: a 4-year follow-up

This prospective study reports the 4-year follow-up results of 56 patients (44 males and 12 females) who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) using a central third bone-patellar tendon-bone free autologous graft and assesses the mid-term effectiveness of this technique. Mean patient age was 30.2 years (range: 17-44 years). Sports injuries were the primary cause of ACL deficiency in 93% of patients. All knees had an isolated ACL tear, and 31 had associated meniscal or chondral lesions. Patients in the acute phase did not undergo surgery for 3-4 weeks. In patients with subacute and chronic ACL ruptures, the mean interval between injury and surgery was 62 weeks (range: 8-104 weeks). According to the International Knee Documentation Committee grading system, 53 (95%) knees were considered normal or nearly normal postoperatively. Improvement by at least 1 grade was noted in 12 knees, 30 knees had an improvement of at least 2 grades, 12 knees had a 3-grade improvement, and 1 had a grade that remained unchanged. One knee deteriorated from a grade C to a grade D, which was attributed to graft lysis 1 year postoperatively. For best results, subacute reconstruction between 3 and 5 weeks postinjury is recommended.     

Arthrodesis for tuberculous coxarthritis: good outcome in 32 adolescents

BACKGROUND: There is no consensus on best treatment of advanced tuberculous coxarthritis in young patients. PATIENTS AND METHODS: We report our results concerning hip arthrodesis for advanced tuberculous arthritis of the hip in 32 adolescents. The operation was preceded by standard antituberculous chemotherapy for 4 weeks, which was continued for 12 months after surgery. At the last follow-up, clinical and radiographic examinations of the ipsilateral knee, contralateral hip and lower back were done. We evaluated function, limitations, and presence of pain with our usual questions. RESULTS: Their average age at the time of operation was 16 (12-18) years and the average duration of followup 12 (10-18) years. Solid bony fusion occurred in all patients after mean 5 months and no complications developed in the postoperative period. 28 patients were satisfied with the fused hip. No patients had reactivation of tuberculosis in any part of their body. The results were comparable to those of arthrodesis performed for other causes. INTERPRETATION: Hip arthrodesis is an alternative method of treatment for advanced stages of tuberculous coxarthritis in the adolescent.     

Metastatic breast carcinoma mimicking periodontal disease on radiographs

BACKGROUND: Tumors can metastasize to the jaws, oral soft tissues, or salivary glands. Metastasis from distant organs and tissues to the jaws or oral cavity is considered rare. RESULTS: The mandible is the most common site of metastasis of the oral and maxillofacial region. Radiographically, there is usually an area of radiolucency with hazy outline. Such lesions are manifested as radiopaque or sclerotic areas. CONCLUSIONS: Radiographic view of a tumor in the present case mimicked a periodontal lesion with an osteolytic area around the roots.     

Neurotization as an alternative for restoring finger and wrist extension

OBJECT: In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. METHODS: Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior interosseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. CONCLUSIONS: These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.