Unilateral dysplasia of the superior articular facet of the axis: a case report

A child with unilateral dysplasia of the superior articular facet of the axis is described. This congenital anomaly, due to incomplete ossification, may be a cause of torticollis, although no signs of instability were noted.     

Rapid determination of benzalkonium chloride in pharmaceutical preparations with flow injection liquid-liquid extraction

Benzalkonium chloride was assayed by on-line extraction of the benzalkonium ion with picrate to chloroform. The absorbance of picrate was measured. The extractions were performed with a home-made flow injection extraction unit. Calibration curves (1.5-180 x 10(-4)% w/v) were straight lines (r = 0.9993) and the relative standard deviation of a series of injections was less than or equal to 2%. Pharmaceutical benzalkonium preparations, containing xylometazoline, timolol, phenylephrine or carbachol could also be assayed. The method was compared with a modified HPLC assay.     

Injection of perfluoropropane gas to prevent hypotony in eyes undergoing tube implant surgery

Hypotony after fistulizing surgery is common, and most cases resolve without complications. Occasionally, a flat anterior chamber in phakic or pseudophakic eyes may lead to corneal decompensation or cataract formation. In aphakic eyes that have undergone previous vitreous surgery, flat anterior chambers will not develop, but large choroidal detachments and delayed suprachoroidal hemorrhage may occur while the eye is soft. To maintain intraocular pressure (IOP) in the early postoperative period, the authors used a technique to seal the drainage tube with a Vicryl tie, combined with injection of sodium hyaluronate, sulfur hexafluoride (SF6), or perfluoropropane (C3F8), perioperatively in 28 eyes undergoing glaucoma tube implant surgery. Eight eyes were treated with injection of sodium hyaluronate, 8 with SF6, and 12 eyes with C3F8. Hypotony was significantly less frequent in eyes treated with C3F8 compared with sodium hyaluronate (P less than 0.05). Mean IOP was significantly higher for eyes treated with C3F8 injection compared with sodium hyaluronate for the first 4 days after surgery (P less than 0.05).     

Influence of HLA phenotypes on the inhibition of in vitro alloreactivity by cyclosporine

Interindividual variations in the immunosuppressive effect of Cyclosporine have been observed in clinical organ transplantation. Searching for an in vitro correlate we investigated a possible relation between inhibition of alloresponsiveness by CsA and the HLA phenotypes of the responder or stimulator in mixed lymphocyte reactions. Peripheral blood mononuclear cells from 28 healthy volunteers were used as responder or stimulator cells (gamma-irradiated) and the inhibitory effect of graded amounts of CsA was determined in 130 criss-cross combinations. Sensitivity of alloresponsiveness to the drug was expressed as the dose causing 50% inhibition (ED50) and was read from the inhibition curves generated after four-parameter logistic curve fitting. ED50 ranged from 0.35 ng/ml to 33.4 ng/ml and correlated only weakly with the magnitude of the response (r = 0.12). In MLC with HLA DR4-positive responder cells, ED50 was significantly lower (Pc = 0.0035, Kruskal Wallis) when compared with MLC with responder cells of other DR haplotypes. For HLA DR5-positive responder cells ED50 was significantly higher (Pc = 0.042) when compared with DR5-negative responder cells. No significant correlation between ED50 and any particular haplotype of the stimulator cells could be observed. Sensitivity to CSA did not differ in MLC with 1 or 2 mismatches in the HLA-DR locus. In summary, we found that sensitivity of in vitro alloreactivity was different for particular HLA DR phenotypes, which may have important implications for the immunosuppressive therapy of transplanted patients with cyclosporine.     

Tendon injuries of the knee joint extensor mechanism

Diagnosis, aetiology and therapy of injuries to the extensor mechanism of the knee joint are presented. 22 cases of ruptures and discisions of the lig. patellae or the quadriceps tendon could be reexamined. All cases but one, with operation within the first week after injury, suturing with absorbable or non absorbable material, immobilisation for 6 weeks and following physical therapy, had a good functional result. No rerupture occurred. In one case a limitation of the range of movement had to be seen afer an open discision of the lig. patellae. After transposition of the tuberositas tibiae, discission of the scares and functional therapy a good result could also be achieved.     

CNS-active substances: synthesis of epoxybenzoxocines

The 2-(2-Bromophenyl)-acetaldehyde acetals 8 are treated with n-BuLi and the aldehydes 7 and 11 to form the hydroxyacetales 9 and 12, respectively. 9 is cyclized under acidic conditions to the epoxybenzoxocine 2; analogously 12 yields the epoxydibenzoxocine 14.     

A comparison of the Brooker-Wills and Russell-Taylor nails for treatment of patients who have fractures of the femoral shaft

Seventy-three fractures of the femoral shaft (seventy patients) were randomized to treatment with interlocked nailing with either the Brooker-Wills femoral nail (thirty-nine fractures) or the Russell-Taylor femoral nail (thirty-four fractures). Sixty-one patients (sixty-four fractures) were prospectively followed from admission until healing of the fracture. Specific attention was paid to recording operative details, including technical difficulties associated with insertion of the nails. Technical difficulties were encountered in insertion of the proximal screw, distal screw, and nail, and in deployment of the fins. Insertion of the Russell-Taylor nail was associated with less technical difficulty, operative time, and estimated loss of blood. The two nails differ in their biomechanical properties, methods of fixation, and instrumentation. These differences did not affect the clinical outcome; the fractures in both groups of patients healed with excellent functional results.     

Toxic shock syndrome after inguinal hernia repair. Report of a case with patient survival

A 40-year-old man developed fulminant multisystem failure several days after elective repair of an inguinal hernia. Toxic shock syndrome (TSS) was diagnosed. There was, however, no evidence of wound infection at the time of multisystem failure. Only later in his hospital course did the wound drain. Staphylococcus aureus was cultured from the wound and was the presumed etiologic agent in the patient's life-threatening illness. The patient recovered fully with supportive care, antibiotics, and surgical debridement of the inguinal hernia site. This case is discussed in the context of existing literature on the toxic shock syndrome. The site of infection is typically nonsuppurative, but the systemic manifestations are typically life threatening. The responsible organism is commonly believed to be a strain of S. aureus that expresses a toxin (TSS toxin-1) that effects multisystem failure, but which also diminishes the local inflammatory response and explains the benign appearance of the wound. Although this is a rare clinical entity, elective surgical procedures complicated by fatal TSS have been reported. Surgeons should understand this disease and the management necessary to avert mortality.     

Rate of flow of aqueous humor determined from measurements of aqueous flare

Measurement of light scattered in the anterior chamber can provide important clinical information about the eye. In this study, a scanning ocular spectrofluorophotometer was used to measure scattering in the anterior chamber. Pathologic scattering (flare) was induced by argon laser photocoagulation of the iris in pigmented rabbits. The spectrally corrected intensity of the flare in inflamed eyes decreased as the inverse 2.2 power of the wavelength of the illuminating beam. The strongest signal with this instrument was measured at 470 nm. Diurnal variation of normal and spontaneous scatter from the aqueous humor was measured in nine pigmented rabbits entrained to a 12-hr light/12-hr dark cycle and in eight human subjects. A technique is described for determining the rate of flow of aqueous humor from scattered light when the transfer rate of scattering substance into the anterior chamber is constant. This technique was used to study changes in flow over the diurnal cycle. The rate of flow in human subjects during sleep was 60% of the rate during waking hours. In rabbits, the rate was lowest (44% of maximum) during the 6 hr after the lights were turned on, and were greatest just before the lights were turned on. These findings confirm previous studies of the circadian rhythm of aqueous humor flow in rabbits and humans.     

Cytostatic and immunosuppressive treatment of ocular Beh?et syndrome

Ocular symptoms of Beh?et's syndrome in 16 patients and the results of cytostatic and immunosuppressive therapy with cyclosporin A (6 patients), chlorambucil (6 patients), and a combination of cyclophosphamide and procarbacin (4 patients) are described. The clinical course and therapeutic outcome were compared to the patients' visual acuity and the duration of the disease prior to institution of cytostatic therapy. Average follow-up was 4.6 years, maximum 9 years. The principal ocular symptom in all patients was hemorrhagic, occlusive periphlebitis. Other symptoms, in descending order of frequency, were chorioretinitis, iridocyclitis, complicated cataract, secondary glaucoma and exudative retinal detachment. The patients in whom cytostatic therapy was instituted no later than 6 months after onset of the disease showed an improvement in or stabilization of visual acuity, as well as a clear reduction in signs of intraocular inflammation and frequency of recurrence. No improvement in visual acuity or ocular symptoms was achieved in cases where the disease was very advanced, despite cytostatic-immunosuppressive therapy. The results support early institution of immunosuppressive therapy in cases with Beh?et's syndrome where severe, irreversible damage has not yet occurred and in which vision is threatened in both eyes. However, due consideration must be given to the potential risks of immunosuppressive therapy, in particular the risk of a malignant tumor.