Gastric wall necrosis owing to its incarceration through a rupture of the diaphragm into the left thoracic cavity

A 73 year-old female patient was admitted to the 3rd Medical Department of Semmelweis University with a painful haematoma in the left loin and respiratory disorders. Her general condition was getting progressively worse. Chest X-ray demonstrated a left sided hemopneumothorax caused by a fractured rib. Thoracic drainage was planned, but the tube introduced on the usual place into the left thoracic cavity perforated the stomach which was incarcerated in the chest. After this an urgent operation was carried out. We found an incarcerated, twisted stomach prolapsing through a rupture of the diaphragm. It was partially necrotic. Excision of the stomach wall with suturing the diaphragm, lavage and drainage of the thoracic and abdominal cavity was carried out. Despite the operation multi-organ failure developed as a result of sepsis, and the patient'died. We discuss the literature in connection with the presentation of this rare and interesting case. In the past 15 years we could not find similar case in the Hungarian surgical literature.     

The possible effect of long-term high plasma levels of phenytoin on mortality after acute myocardial infarction

Summary In a group of patients studied for 12 months after myocardial infarction plasma levels of phenytoin were measured whilst the patients received phenytoin 300–400 mg per day or placebo therapy. Two sub-groups of patients treated with phenytoin were identified, based on the steady state level of plasma phentyoin concentration. Patients who had achieved phenytoin plasma concentrations of 10 µg/ml or above, had a significantly lower mortality than patients who had plasma concentration below this level or than patients treated with placebo. Ventricular premature beats occurred significantly less often in the phenytoin treated group than among the comparative group of patients. The significance of these findings is discussed.     

Dynamics of directional selectivity in area 18 and PMLS of the cat

Visual latencies and temporal dynamics of area 18 and PMLS direction-selective complex cells were defined with a reverse correlation method. The method allowed us to analyze the time course of responses to motion steps, without confounding temporal integration effects. Several measures of response latency and direction tuning dynamics were quantified: optimal latency (OL), latency of first and last significant responses (FSR, LSR), the increase and decrease of direction sensitivity in time, and the change of direction tuning in time. FSR, OL and LSR values for PMLS and area 18 largely overlapped. The small differences in mean latencies (3-4 ms for FSR and OL and 11.9 ms for the LSR) were not statistically significant. All cells in area 18 and the vast majority of cells in PMLS showed no systematic changes in preferred direction (monophasic neurons). In PMLS 5 out of 41 cells showed a reversal of preferred direction after approximately 56 ms relative to their OL (biphasic neurons). Monophasic cells showed no systematic changes in direction tuning width during the interval from FSR to LSR. In both areas, development of direction sensitivity was significantly faster than return to the non-direction sensitive state, but no significant difference was found between the two areas. We conclude that, for the monophasic type of direction-selective complex cells, the dynamics of primary motion processing are highly comparable for area 18 and PMLS. This suggests that motion information is predominantly processed in parallel, presumably based on input from the fast conducting thalamocortical Y-pathway.