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.     

The value of sonography in the diagnosis and follow-up of patients with blunt renal trauma

Eighty-eight patients with blunt renal trauma were examined sonographically. Rupture of the kidney was diagnosed in 41 patients and contusion of the kidney in 45. The correlation between operative findings, sonography and urography showed positive sonographic findings to be correct in all patients with rupture of the kidney. In 4 patients with normal sonograms, the diagnosis of a contusion was based on the urographic results. Three patients underwent angiography. An intimal lesion was seen in 2 and a tear of the renal artery in 1. The results of our investigation suggest that sonography should be applied in the first place in the evaluation of blunt renal trauma. It is the investigation of choice during follow-up after surgical as well as conservative therapy.     

Significance of lung contusion in mortality following polytrauma. Possibilities for therapeutic influence

Multiple trauma is often associated with blunt thoracic injuries. Especially lung contusion can result in respiratory insufficiency and therefore a higher mortality rate. In our prospective study comparing 8 multiple trauma patients with and without associated lung contusion, we found that respiratory function was already significantly disturbed (decrease of paO2/FiO2 and increase of AaDO2, a rise in extravascular lung water (EVLW) both early after trauma and also with a second peak following the 4th day. This group (LK) developed significantly more cases of respiratory distress (ARDS). The disturbance of respiratory function seen initially was interpreted as a consequence of the direct mechanical impact, leading to the formation of interstitial fluid and hematoma. The frequent development of ARDS in the LK-group probably results from a pronounced activation of cellular and humoral mechanisms and therefore an enforced injury of the pulmonary capillary bed. A significant increase of pulmonary infections or the development of sepsis was not seen in the LK-group and is probably not responsible for the higher ARDS-rate in this group.     

A systematic approach to reconstruction of neglected tears of the patellar tendon. A case report

Neglected tears of the patellar tendon due to loss of active extension remain a difficult therapeutic endeavor. The goals in the approach to this diagnosis include restoration of both structural and functional integrity of the extensor mechanism. A procedure has been developed utilizing Z-shortening of the patellar tendon, Z-lengthening of the quadriceps tendon, and the semitendinosis gracilis as a biologic splint. This technique allows establishment of preoperative goals, including restoration of the muscle-tendon complex in its anatomic position, restoration of quadriceps function, preservation of vascularity of the reconstructed tendon, and splinting of the patellar tendon. This reconstruction allows early mobilization and rehabilitation.     

Metastatic carcinoid of bone. Report of two cases and review of the literature

The skeletal manifestations of malignant carcinoid seem not to have been reported in the orthopedic literature. Bronchial and hindgut carcinoid tumors are less numerous than midgut tumors but metastasize to bone much more frequently. Carcinoid skeletal deposits are usually osteoblastic and most commonly affect the axial skeleton. The radiologic appearance is frequently indistinguishable from prostatic skeletal metastases or chronic sclerosing osteomyelitis. Two cases of skeletal metastases from midgut carcinoid are reported to demonstrate that metastases from carcinoid should be considered in the differential diagnosis of either bone malignancy or chronic sclerosing osteomyelitis.     

Effect of diffusion chamber pore size on differentiation and proliferation of periosteal cells. An experimental study

The influence of the pore size of Nucleopore diffusion-chamber filters on the rate of proliferation and differentiation of periosteal cells in muscle was studied in 44 growing rabbits. Periosteal grafts were placed in chambers (16-19 in each experimental group) sealed with filters with a pore size of 0.4, 0.6, 0.8, 1.0, or 2.0 micron. Each chamber was implanted into the paraspinal muscle of the rabbit, where it remained for 16 weeks. The osteochondrogenic activity of the graft grew linearly when the pore size increased from 0.4 to 1.0 micron. In the chambers with a pore size of 2.0 micron, both bone and cartilage were found in only one chamber. Bone and cartilage were not found outside any of the chambers. The present results showed that the pore size of the filters significantly affected the ability of the periosteal graft to form bone and cartilage.     

Chromogenic ionophore-based methods for spectrophotometric assay of sodium and potassium in serum and plasma

We report spectrophotometric methods for quantifying sodium and potassium in serum and plasma without sample pretreatment or solvent-extraction steps. The methods are based on novel chromogenic ionophores characterized by molecular structures highly preorganized for binding, which result in exceptionally high sensitivity and selectivity (negligible responses to sodium at 80 to 200 mmol/L in the potassium assay and to potassium at 0 to 10 mmol/L in the sodium assay). The within-run imprecisions are comparable with those for ion-selective electrodes (for K, 1.0% at 4.5 mmol/L; for Na, 1.1% at 136 mmol/L); the analytical range is 2-10 mmol/L for potassium, 80-170 mmol/L for sodium. The results for greater than 100 patients' samples correlated well with results obtained with ion-selective electrodes (r = 0.99 for K, 0.97 for Na). The ready-to-use aqueous reagents will be available under the trade name of ChromoLyte for use with Technicon's RA family of clinical analyzers.     

Adrenal and pseudoadrenal masses: CT and US findings

Computed tomography (CT) is currently the imaging modality of choice for assessing the morphology of the adrenal glands in adult patients. Much useful information can be gained using CT in disease processes which primarily involve one or both of the adrenal glands, such as adenomas, as well as in entities which secondarily affect the adrenals, such as pituitary or metastatic disease. The size and configuration of the glands can be readily determined, and masses may be detected. We discuss CT of normal and abnormal adrenal glands with sonographic (US) and pathological correlation, when available. Entities which may mimic adrenal abnormalities are emphasized. Relative advantages of US over CT in the pediatric patient are discussed.