Complications experienced in the rehabilitation of zone I flexor tendon injuries with dynamic traction splinting

A retrospective review of all flexor tendon repairs done between January 1985 to June 1987 determined the complication rate with our method of rehabilitation. One hundred sixty-three flexor tendon lacerations in 83 patients were reviewed. Follow-up ranged from 6 to 42 months. All patients participated in the same 12-week rehabilitation protocol. All patients had passive motion exercises of the interphalangeal joints in the first 2 weeks. We believe that passive stretching of zone I injuries during the first 2 weeks contributed to the zone I complication rate. Of the 20 patients with zone I tendon-to-tendon repairs, 7 patients had significant complications. The 35% complication rate found with zone I injuries has prompted us to modify our postoperative rehabilitation protocol in zone I injuries.     

靶向给药系统——甲氨蝶呤肝动脉栓塞微球特征及其对大鼠肝癌的实验治疗

本文介绍用乳化—冻凝技术制备甲氨蝶吟—明胶微球的方法。实验结果证实,包裹在微球内的MTX对~(60)钻幅射、温度和光照射是稳定的。微球的体外溶出试验、明胶微球在介质中不同时间的溶胀度试验也在文中介绍。微球肝动脉栓塞实验治疗用大鼠移植性肝癌进行,结果表明MTX微球治疗组的大鼠在肿瘤抑制率、促使肿瘤坏死程度以及延长荷瘤动物存活期方面比肝动脉灌注生理盐水、MTX溶液和明胶微球为佳.由于MTX微球具有阻断肿瘤血供和在其局部缓释化疗药物等双重功用,故治疗肝癌的效果明显优于动脉化疗或单纯栓塞方法。     

Infectious Complications in Irradiated Breasts Following Conservative Breast Therapy

Abstract: Delayed infectious complications are reported to occur following radiation therapy in women who have undergone conservative breast therapy. Herein, we have reviewed the clinical history of women undergoing conservative therapy in our institution. Of 46 patients treated over a span of 2 years, 13% developed a delayed infectious complication in their irradiated breast ranging from cellulitis to abscess. Onset occurred weeks to months following the completion of radiotherapy. Women experiencing these infections typically had undergone excision of a large volume of breast tissue and had received a radiation boost as part of the radiotherapy technique. Treatment entailed aggressive antibiotic therapy plus drainage of any abscess. All cases resolved; one patient experienced multiple episodes. Resulting cosmetic appearance was often less than ideal. Awareness of this potential problem is important when discussing treatment options with women newly diagnosed with breast cancer, especially those with larger lesions.     

Development of phenylethanolamine N-methyltransferase (PNMT) in cultures of dissociated embryonic rat medulla oblongata

The adrenergic phenotypic marker, phenylethanolamine N-methyltransferase (PNMT) is expressed in a subgroup of catecholaminergic neurons in the brain, as well as in the chromaffin cells of the adrenal medulla. Although PNMT in the rat adrenal is regulated by glucocorticoids, PNMT in the rat brainstem appears not to be regulated by glucocorticoids. Furthermore, little is known about factors required for the differentiation of this specific class of central neuron. The identification of such factors has been hampered not only by the heterogeneity of cell types in the brainstem, of which only a smaller number express PNMT, but also by the lack of a well characterized in vitro system in which the development of these neurons can be studied under defined conditions. The present study addresses this issue by establishing and characterizing a culture system for the study of adrenergic neurons.Dissociated cultures were prepared from embryonic rat medulla oblongata and the expression and development of PNMT was studied using immunocytochemistry and radioisotopic assay of PNMT activity. The survival of PNMT-immunoreactive (IR) neurons in vitro was found to be critically dependent on embryonic age. Numerous PNMT-IR neurons were observed in cultures prepared only from embryos of 46–51 somites (embryonic day E13–13.5). In contrast, cultures containing numerous neurons immunoreactive for tyrosine hydroxylase (TH), the rate-limiting enzyme in catecholamine biosynthesis, could be successfully established from medulla oblongata of any age between E13 and E16. In cultures of the E13 rat, PNMT was found to be catalytically active at 4 days in vitro and the levels of PNMT activity per neuron, as estimated from the number of PNMT-IR neurons in sister cultures, increased 2-fold in cultures grown for 8 days in the presence of 10% fetal bovine serum and 1.5-fold in defined, serum-free conditions. Treatment of cultures with either corticosterone or dexamethasone had no effect on PNMT activity, supporting previous studies suggesting that PNMT in central neurons is not regulated by glucocorticoids.These studies provide a convenient and defined in vitro system for studying factors that influence the development of central adrenergic neurons. The differential development of PNMT-IR and TH-IR neurons in these cultures suggests that the factors involved in adrenergic neuron survival and/or differentiation are not common to catecholaminergic neurons in general.     

Hypertrophic subaortic stenosis: Clinical and hemodynamic effects of long-term propranolol therapy

Thirteen patients with hypertrophic subaortic stenosis underwent right and transatrial septal left heart catheterization. Outflow obstruction was measured in the resting state and during a variety of stimulating maneuvers before and after the intravenous administration of 150 μg/kg of propranolol. The patients were then treated with orally administered propranolol and followed up for an average period of 17 months. Nine patients were available for a second catheterization, during which detailed hemodynamic measurements were repeated. Most patients had an initially favorable response to propranolol. However, 3 with an initially good response had a return of symptoms during the period of study. The initial clinical response appeared to correlate with the reduction of outflow obstruction seen after intravenous administration of propranolol. The long-term clinical course correlated with the hemodynamic findings at the second catheterization. The severity or lability of the outflow obstruction during the initial catheterization did not appear to have predictive value for the patient's response to long-term therapy. Propranolol had a favorable effect on the symptomatic state of the patients, but did not appear to change the course of the underlying disease.     

Hemodialysis for methanol intoxication

We describe nine patients with methyl alcohol poisoning who were treated with hemodialysis. The time from ingestion to dialysis varied from 4 to 100 hours. Predialysis blood methanol levels ranged from 3 to 570 mg/dl. All patients were acidotic and had an increased anion gap. Two patients died, seven recovered, but three had permanent visual impairment. There was little correlation between the blood methanol level or anion gap and visual outcome. The interval from ingestion to treatment appears to be more important than the initial biochemical status. We recommend prompt hemodialysis if the blood methanol level is above 50 mg/dl, when an amount of methanol exceeding the minimal lethal dose (30 ml) is known to have been ingested, when there is evidence of acidosis or when an abnormality has developed in vision, funduscopic examination or mental state. Concurrent therapy with alkali and ethanol is vital.     

The syndrome of T8 hyperlymphocytosis: variation in phenotype and cytotoxic activities of granular cells and evaluation of their role in associated neutropenia

We performed a longitudinal study of the phenotype and functions of granular lymphoid cells from seven patients with T8 hyperlymphocytosis and neutropenia. Whereas cells retained a T3+ T8+ (six cases) or T3- T8+ (one case) phenotype at different examinations, the expression of natural killer (NK)-related antigens (HNK1- and Leu11-defined antigens) exhibited striking variations, some of which were also observed after in vitro culture. Similarly, natural or antibody-mediated cytotoxic activities fluctuated in vivo and in vitro. Cells from the patient with T3- T8+ proliferation were able to inhibit directly the growth of early CFU-GM, CFU-E, and BFU-E and to a lesser extent of late CFU-GM, as shown by cultures of autologous blood or marrow progenitors after depletion (and subsequent addition) of granular cells. In the other six patients with T3+ T8+ cells, no such effect was found. However, after a 24-hour incubation of the progenitors with the granular cells, CFU-GM growth was clearly inhibited; this was not observed in all experiments, a finding which may be related to the spontaneous variations of cell killer functions. Finally, no correlation was noted between the clinical course or extent of lymphoid proliferation and cell function or phenotype or with the monoclonal (two cases), polyclonal (three cases) or germ-line (one case) patterns of T cell receptor beta gene configuration.     

Allograft renal-artery stenosis: increased peripheral plasma renin activity as an early indicator of uncontrollable hypertension.

We measured indices of the renin-aldosterone system and body-fluid spaces in 11 adolescents who had received a renal transplant after removal of their own diseased kidneys. None had hypervolemia but 6 had hypertension. Renal angiography revealed greater than 50% luminal occlusion by allograft renal-artery stenosis (RAS) in only the 3 patients who had severe hypertension refractory to conventional medical therapy. Excessive peripheral plasma renin activity (PRA) distinguished these patients from those who had less severe stenosis or normal angiogram, and diuretic stimulation heightened the PRA differences. We conclude that significant allograft RAS does not necessarily act like a typical single-kidney Goldblatt model until after volume depletion. Our findings indicate that peripheral PRA values can be used to assess the degree of graft ischemia clinically. This permits early identification of patients who have severe RAS that probably will be difficult to control medically, and, therefore, should be followed closely with a view of reconstructive vascular surgery before further deterioration of renal function.