Operative treatment of femoral head necrosis

Summary The cases of 80 patients with necrosis of the femoral head who underwent operative treatment in the period April 1980 to April 1988 are reported. Altogether, 102 operative procedures were carried out: 48 intertrochanteric osteotomies, 50 arthroplasties, 3 subchrondral bone graftings, and in one case drilling of the necrotic focus. Joint-preserving methods in advanced-stage disease seem to be of doubtful use when judged by clinical and socio-economic criteria over a mean follow-up time of 4.5 years. Since no conservative treatment exists, an improvement in therapeutic results can only be achieved by early diagnosis using magnetic resonance imaging and operating when the disease is still at an early stage.     

Effect of the NK3 receptor antagonist, talnetant, on rectal sensory function and compliance in healthy humans

Visceral hypersensitivity is important in the pathophysiology of irritable bowel syndrome and thus a target for modulation in drug development. Neurokinin (NK) receptors, including NK(3) receptors, are expressed in the motor and sensory systems of the digestive tract. The aim of this study was to compare the effects of two different doses (25 and 100 mg) of the NK(3) receptor antagonist, talnetant (SB223412) with placebo on rectal sensory function and compliance in healthy volunteers studied at two centres. Rectal barostat tests were performed on 102 healthy volunteers, randomized to receive either oral talnetant 25 or 100 mg or placebo over 14-17 days. Studies were performed on three occasions: day 1 immediately prior to 1st dose, day 1 4 h postdose, and after 14- to17-day therapy. Compliance, and pressure thresholds for first sensation, urgency, discomfort and pain were measured using ascending method of limits, and sensory intensity ratings for gas, urgency, discomfort and pain determined during four random phasic distensions (12, 24, 36 and 48 mmHg). Talnetant had no effect on rectal compliance, sensory thresholds or intensity ratings compared with placebo. In general, the results obtained at the two centres differed minimally, with intensity scores at one centre consistently somewhat lower. At the doses tested, talnetant has no effect on rectal compliance or distension-induced rectal sensation in healthy participants.     

Sternal abscess due to Bartonella (Rochalimaea) henselae in a renal transplant patient

 Bartonella henselae, previously called Rochalimaea henselae, is the causative agent of cat scratch disease (CSD) in immunocompetent subjects and bacillary angiomatosis in immunocompromised ones. Bone lesions are common in bacillary angiomatosis, but not in CSD. We present the case of a patient with a renal transplant treated by immunosuppressive therapy who developed a sternal abscess with a histological pattern of CSD. The CT pattern was that of a lytic bone lesion with adjacent fluid collection. The diagnosis was made on the basis of a polymerase chain reaction amplification performed on bone material. Bartonella henselae is a newly described bacteria that causes CSD in a normal host and bacillary angiomatosis in immunocompromised patients. We report a case of an osteolytic lesion of the sternum with adjacent fluid collection related to CSD, which occurred in a patient with a renal transplant.     

Iodine-125 Brachytherapy of Brain Stem Tumors

PURPOSE: To report on iodine-125 ((125)I) interstitial irradiation in the treatment of brain stem tumors. PATIENTS AND METHODS: Two patients with brain stem tumors were treated with CT- and image fusion-guided (125)I stereotactic brachytherapy. RESULTS: By March 2003, the patients had been followed up for 47 and 13 months, respectively. In case 1, the tumor volume was 1.98 cm(3) on the control CT, indicating a 65.5% shrinkage as compared to a target volume of 5.73 cm3 at the time of brachytherapy. In case 2, shrinkage was more distinct. After irradiation, the cyst volume was 0.16 cm(3) on the control MRI, indicating a 97.4% shrinkage as compared to a target volume of 6.05 cm(3) at the time of brachytherapy, i. e., the metastasis had virtually disappeared. CONCLUSION: CT- and image fusion-guided (125)I stereotactic brachytherapy can be performed during the biopsy session. The procedure can be well planned dosimetrically and is surgically precise.     

Mitral valve prolapse: a benign abnormality?

Mitral valve prolapse should be considered a benign condition as there are few complications. The natural history is not significantly different to that of a matched control population. There are potentially severe forms of the condition which are mainly observed in specialised centres and this introduces a bias in patient selection when compared with the general population. These forms are relatively rare in clinical practice and can be easily identified by simple echocardiographic criteria of valvular thickness. In any case, patients with mitral valve prolapse should be reassured in order not to create or unduly increase anxiety which in itself may cause incapacity.     

The use of oral sedatives in dental care

Oral administration of tranquillizing and anxiety-suppressing drugs has long been the commonest method of achieving light sedation. The benzodiazepines are the drugs of first choice. Benzodiazepines given orally may be indicated to avoid 'treatment stress', alleviate mild anxiety before dental treatment, and facilitate sleep on the night before the treatment. Furthermore, they could be used for the dental treatment of medically poor risk patients, particularly those with cardiovascular disease. The drug can be given either in a fractionated dose or a single dose. The recommended doses for diazepam vary from 0.1–0.8 mg/kg body weight, depending on age, with higher doses in children and lower doses in elderly patients. Few side effects are reported.     

测定血液脱氧核糖核酸方法的探讨

本文探讨６种测定ＤＮＡ的方法。以吲哚反应一醋酸异成酯抽提的方法最好，比较稳定而灵敏，一般实验室条件就可进行，测定仅需０．１ｍｌ血液。