Partial versus complete acute anterior cruciate ligament tears. The results of nonoperative treatment

A study was undertaken to determine whether a significantly different clinical outcome could be expected following nonoperative treatment of acute partial anterior cruciate ligament (ACL) tears from that of complete tears. A detailed follow-up of 107 patients with arthroscopically confirmed tears was obtained; 72 were complete tears and 35 partial. The overall results in those with partial tears were 23% excellent, 29% good, 17% fair, and 31% poor; with complete tears the results were 11% excellent, 20% good, 15% fair, and 54% poor. The patients with partial tears had a lower incidence of associated meniscal tears, needed fewer reconstructions and more of them returned to sport than those with complete tears.     

Paraganglioma of the cauda equina: a case report and review of the literature

A rare slowly growing paraganglioma of the cauda equina is described, with characteristic immunocytochemical and electron microscopic appearances. Twenty-one cases of similar tumours have been reported at this site. The literature is reviewed and the main features discussed.     

Hypotensive effect of 13-hydroxylinoleic acid in the rat: mediation via the release of a CGRP-like mediator from capsaicin-sensitive nerves.

1. The effect of 13-hydroxylinoleic acid (13-HODE) on changes in blood pressure in the rat was measured. 2. 13-HODE (0.1 - 100 micrograms kg-1) had no direct effect on blood pressure in the rat and had no effect on histamine (0.1 - 1000 micrograms kg-1)-induced changes in blood pressure. In contrast, it was found that 13-HODE itself induced a decrease in diastolic arterial blood pressure when it was injected intravenously after either a single dose of histamine (10, 100 or 1000 micrograms kg-1) or after a dose-response curve of histamine (0.1 - 1000 micrograms kg-1). 3. This hypotensive effect of 13-HODE was not observed after administration of the endothelium-dependent vasodilator, acetylcholine (0.1 - 10 micrograms kg-1), the endothelium-independent vasodilator, sodium nitroprusside (0.1 - 100 micrograms kg-1) or the inflammatory mediator, leukotriene B4 (0.1 - 300 micrograms kg-1). However, prior injection of bradykinin (0.1 - 100 micrograms kg-1) allowed a dose-dependent hypotensive effect of 13-HODE to be revealed. 4. The hypotensive effect of 13-HODE after histamine and bradykinin could be inhibited by neonatal capsaicin treatment of the rats (50 mg kg-1, s.c. on day 1 and 2 after birth). 5. Ruthenium red (120 micrograms kg-1 min-1), an inhibitor of excitatory effects on sensory nerves, and the CGRP antagonist, CGRP8-37 (1-3 micrograms kg-1 min-1) also inhibited the hypotensive effect of 13-HODE.(ABSTRACT TRUNCATED AT 250 WORDS)     

Endocrine and renal response to water loading and water restriction in normal man

1. Nine normal subjects (eight male, one female) on a fixed daily intake of 150 mmol of sodium and 80 mmol of potassium, were randomized to receive either 3 days of 1.0 litre total water intake/24 h (food + fluid) or 4 days of 6.8 litres total water intake/24 h, and were then crossed over after a 3 day control period (2.7 litres water/24 h). 2. During water restriction, urine volume fell from 1.94 litres/24 h to less than 1 litre/24 h by the first day and was 0.77 litre/24 h on the final day. Plasma atrial natriuretic peptide levels were unchanged from baseline despite a large increase in plasma vasopressin and plasma and urine osmolality. Urinary sodium was unaltered throughout, while urinary potassium was increased on the final 2 days of water restriction. 3. During water loading, urine volume increased from 1.85 litres/24 h to 5.44 litres/24 h on the first day and remained at approximately 6 litres/24 h for the final 3 days. Plasma atrial natriuretic peptide showed no change. Plasma vasopressin and plasma and urine osmolality were reduced. Urinary sodium and potassium output were unchanged from baseline. 4. These results suggest that changes in plasma atrial natriuretic peptide are unlikely to be involved in the normal homoeostatic response to changes in water balance in man.     

Magnetic resonance imaging and discography in the diagnosis of disc degeneration. A comparative study of 50 discs

The lumbar spines of 22 patients were examined for disc degeneration by magnetic resonance imaging (MRI) and by discography. The results from 50 intervertebral discs visualised by both techniques were independently assessed and graded on a five-point scale from normality to gross degeneration and then compared. In 44 discs the results agreed. Of the six discs which gave differing results, four discrepancies were due to observer error and two to incorrect placement of the discographic needle. MRI was shown to be more accurate than discography in the diagnosis of disc degeneration. It has several major advantages, which should make it the investigation of choice.     

Monocular blindness developing 7 days after repair of zygomaticomaxillary complex fracture. A clinical report

Blindness following zygomaticomaxillary complex (ZMC) fracture and surgical repair is an unfortunate and uncommon complication. A review of the literature reveals fewer than 25 cases of monocular blindness resulting from zygomaticomaxillary fracture or repair. The case presented here is that of a man who was assaulted with a baseball bat and suffered a mildly displaced ZMC fracture. On admission, the patient had light perception only in his left eye. During his convalescence, vision in his left eye gradually improved to the point of allowing him to read a newspaper without difficulty. Then, 9 days after the injury (7 days after surgical repair), the patient awoke with complete blindness of the left eye. The possible mechanisms for such loss of vision are discussed.     

Partial seizures triggering infantile spasms in the presence of a basal ganglia glioma.

Infantile spasms associated with brain tumors have been reported. A focal cortical lesion can induce infantile spasms by triggering the brainstem and basal ganglia in this vulnerable age group. We report the case of a female infant with a low-grade glioma in the right basal ganglia, spreading to the cortical area. She presented at the age of five months with left hemiparesis and partial seizures. She developed infantile spasms at the age of 12 months. This is the first video clip report of partial seizures triggering symmetrical spasms in series, secondary to a basal ganglia glioma extending to the cortex. [Published with video sequences].