Intraspinal synovial cysts. Magnetic resonance evaluation

Five intraspinal synovial cysts in four patients were evaluated with noncontrast magnetic resonance imaging and magnetic resonance imaging with the contrast agent gadolinium diethylenetriaminepentaacetic acid. Useful findings included demonstration of both solid and cystic components, early enhancement of the solid component and cyst periphery, delayed enhancement of the cyst, persistent enhancement of the solid component and cyst capsule, enhancement of the apophyseal joint, and recognition of a possible connection between the cyst and apophyseal joint. Although computed tomographic findings of synovial cysts are quite characteristic for the diagnosis in most cases, contrast magnetic resonance imaging may provide additional information for a more definitive diagnosis.     

Musculoskeletal disorders in hemodialysis patients: different disease clustering according to age and dialysis vintage

Clinical Rheumatology - Musculoskeletal disorders remain a major problem in hemodialysis patients. The aim of the study was to estimate the prevalence of musculoskeletal manifestations in...     

Cast brace treatment of proximal tibia fractures. A ten-year follow-up study

The long-term outcome of tibial plateau fractures treated by cast bracing was observed in 29 patients sustaining 30 tibial plateau fractures more than ten years after injury. Clinical and roentgenographic evaluation was performed and showed 61% good results overall. Range of motion averaged 117 degrees. Iowa knee score averaged 71 of 100 possible points. Thirty-two percent of the patients developed moderate or severe roentgenographic posttraumatic degenerative arthritis. Minimally displaced fractures were observed to do very well clinically without roentgenographic evidence of degenerative joint disease after a ten-year follow-up period. Seventy percent of displaced bicondylar fractures developed degenerative joint disease in clinical and roentgenographic evaluation. Cast bracing of minimally displaced fractures gave satisfactory results, whereas cast bracing of more complex fractures produced variable functional results.     

Prostacyclin levels during orthotopic liver transplantation

Many anesthesia providers involved in orthotopic liver transplantation (OTL) have become increasingly aware of the incidence of hypotension immediately following revascularization of the donor liver. Postreperfusion syndrome (PRS) is usually characterized by a decrease in systemic blood pressure of at least 30 torr with a duration of 5 minutes or more. Several researchers have suggested that the etiology of this hypotension may be related to acute hyperkalemia, acidosis, hypothermia, reflex systemic vasodilation, or some yet unidentified prostaglandin liberated from the gut at reanastomosis. The potential role of prostacyclin as the primary etiologic agent responsible for this syndrome was studied. Serum prostacyclin measurements were obtained in seven patients 1 minute before and 5 minutes after revascularization. Coincident measures were taken of preselected cardiovascular parameters. Five patients demonstrated increased levels of prostacyclin during clamping of the portal vein and four experienced significant hypotension at reperfusion. In the five patients demonstrating hypotension, a decrease in heart rate and systemic vascular resistance and an increase in cardiac output and PCWP was noted. It is concluded that one or more endogenous prostacyclins may play an important role in the etiology of postreperfusion syndrome.     

Radiographic abnormalities of the lumbar spine in college football players. A comparative analysis.

The purpose of this study was to make a direct comparison between lumbar spine radiographs of incoming college football players and of an age-matched control group to determine whether there is a higher prevalence of lumbar spine abnormalities in football players before competing at the Division I level. We reviewed 187 lumbar spine radiographs. Of these, 104 were taken as a standard part of the preparation physical examination for incoming college football players. The remaining 83 radiographs were taken during routine preemployment physicals at a local factory. Each radiograph was read independently by three separate orthopaedic radiologists in a blinded fashion. Data were collected and statistically evaluated for 13 variables. The rate of spondylolysis was only 4.8% in our group of athletes and 6.0% in the control group (not significantly different). Only in the category of degenerative changes was a significant difference found. The control group had a 16.9% incidence of disk space narrowing and spurring and the football players had a 6.7% incidence. The remainder of the variables were not significantly different between the two groups. Our findings differ from previously published reports and indicate that football players entering college at the Division I level may have a similar prevalence of radiographic lumbar spine abnormalities, including spondylolysis and spondylolisthesis, as age-matched controls.     

Liver transplantation in children.

Although liver transplantation is now accepted as the ideal therapy for end-stage liver disease, relatively few centers have gained a large experience in children, and good results have been elusive. Technical difficulty and a high incidence of graft failure are among the obstacles to success. At the University of California at Los Angeles, 39% of our liver transplants are in the patients who are younger than 18 years. We have analyzed our experience with 103 patients to emphasize factors important to a favorable outcome with the procedure. One hundred twenty-three transplants were performed in 103 children (mean age, 5.2 years; 48% younger than 3 years). No reduced-size grafts were used. Scrupulous attention to technical details of the vascular reconstruction, including frequent use of the supraceliac aorta of the recipient and interrupted suture techniques, ensured construction of sound hepatic artery and portal vein anastomoses at the first operation. Preoperative exchange transfusions were used if the prothrombin time was prolonged beyond 7 seconds, resulting in an average blood loss of only 3.3 volumes. Cyclosporine dosage was maintained in the high therapeutic range for the first 4 weeks, and anti-T-cell antibody (OKT3) was used for rejection (38%). Amphotericin prophylaxis was used for biliary atresia patients with multiple previous operations. Eighty-two of one hundred three patients (80%) are alive. There were no intraoperative deaths. Actuarial survival rates at 6 months, 1 year, and 5 years are 80%, 79%, and 77%, respectively. Survival of patients who underwent transplantation at age less than 1 year is 65% versus 85% at age more than 1 year (p = 0.08). Retransplantation was performed in 19 patients (18%), with a survival rate of 58%. Hepatic artery thrombosis, the most frequent technical complication, occurred in only 16 patients (13%). Survival rates of ABO identical-match versus nonidentical-match grafts were 96% and 60%, respectively (p = 0.02). Graft survival was only 47% if more than one steroid cycle was needed, compared to 75% survival with OKT3 treatment. Despite impairment of renal function (glomerular filtration rate [GFR] less than 80 cc/kg/min) in 54% of patients and hypertension requiring therapy in 27%, 90% of the children demonstrated enhancement of growth, development, and functional status. The following conclusions were made. (1) Pediatric liver transplantation is the treatment of choice for all types of end-stage liver disease and should be considered early. (2) Factors that enhance survival include technical precision, aggressive retransplantation, antifungal chemoprophylaxis and therapy, and judicious immunosuppression with use of OKT3 for rejection.(ABSTRACT TRUNCATED AT 400 WORDS)     

Can amino acid requirements for nutritional maintenance in adult humans be approximated from the amino acid composition of body mixed proteins?

The quantitative needs for the dietary indispensable amino acids in adult human protein nutrition are still poorly established. Tracer studies with 13C-labeled amino acids have been undertaken previously in our laboratories to reevaluate and further determine the minimum physiological needs for selected indispensable amino acids in healthy adult volunteers. For those amino acids that have not yet been studied by this approach we have proposed a tentative set of requirement figures based on considerations of the amino acid composition of body mixed proteins and the rate of obligatory amino acid losses (i.e., losses when the diet contains no proteins or amino acids). Here we provide an argument for, and a justification of, this approach as an interim measure until more comprehensive data become available on the quantitative aspects of amino acid metabolism in healthy humans.     

Echocardiographic study of 4 cases of dilatation of the sinus of Valsalva]

Four cases of dilatation of the sinus of Valsalva with or without rupture were studied by echocardiography before surgical correction. In three cases the dilatation affected the right anterior sinus with rupture into the right atrium or ventricle. In the other case dilatation of the right anterior sinus dissecting the interventricular septum was associated with an aneurysm of the left anterior sinus dissecting the free wall of the left ventricle.