Vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia

Free vascularized fibular bone grafts were used in nineteen children, seen consecutively, who had congenital pseudarthrosis of the tibia. The average age was 5.1 years (range, 1.4 to 11.4 years). Sixteen of the patients had been treated with electrical stimulation for at least one year, and the tibia had not united. All but four patients had had at least one previous operative procedure. At an average follow-up of 6.3 years (range, 2.0 to 11.0 years), eighteen (95 per cent) of the nineteen pseudarthroses had healed. The leg-length discrepancy averaged 1.6 centimeters (range, 0 to 4.0 centimeters), but ten tibiae had residual or progressive valgus or anteroposterior malalignment despite bracing. There was minimum morbidity at the donor site.     

The effect of carbamate local anesthetics on artificial lipid membrane

The influence of phenylcarbamic acid basic esters with local anesthetic activity on the phase transition temperature (Tc) of a model dipalmitoylphosphatidylcholine (DPPC) membrane from gel to liquid crystalline state was studied. It was found that (Tc) in the presence of carbamate anesthetics decreases. The decrease of Tc (delta Tc) correlated well with the biological activity of the compounds studied.     

Prolonged inhibition of acid secretion causes hypergastrinaemia without altering pH inhibition of gastrin release in humans

Hypergastrinaemia induced by potent inhibitors of acid secretion is thought to occur as a result of the elimination of the inhibitory effects of intragastric acid on gastrin release. The present study was designed to determine if the mechanisms responsible for feedback inhibition of gastrin release and acid secretion by intragastric acid are preserved during four weeks of varying degrees of drug-induced acid inhibition. Forty-eight healthy male volunteers were randomly assigned to one of four treatments for four weeks: 10 mg omeprazole o.m., 20 mg omeprazole o.m., 40 mg omeprazole o.m. or 150 mg ranitidine b.d. Gastrin release and acid secretion in response to peptone meals maintained at pH 2.5 and pH 5.5 by intragastric titration, and 24-hour gastrin profiles in response to standard meals were determined before treatment, at the fourth week of treatment and two weeks after discontinuing treatment. As expected, omeprazole produced dose-related effects on acid secretion and gastrin concentrations that were largely reversed after treatment was discontinued. Gastrin release in response to pH 5.5 peptone meals remained significantly greater than gastrin release in response to pH 2.5 meals during treatment with all doses of omeprazole. The ratio of pH 5.5/pH 2.5 peptone meal-stimulated gastrin release was approximately 1.5, and remained constant for all treatment groups throughout the study period. These data indicate that four weeks of drug induced hypochlorhydria causes an apparent increase in overall G-cell function, but it does not interfere with normal feedback inhibition of gastrin release and acid secretion mediated by intragastric acidity.     

Effects of fenfluramine on neuropsychological and communicative functioning in treatment-refractory schizophrenic patients

Reported behavioral improvement among autistic patients following feufluramine treatment and a high serotonin level among certain chronic schizophrenic patients suggested that fenfluramine treatment might be beneficial with such schizophrenic patients, especially within the realm of neuropsychological and communicative functioning. A brief neuropsychological battery was administered to eight chronic schizophrenic subjects before, during, and after fenfluramine treatment. Conversations in controlled settings were audiotaped before and during fenfluramine treatment for seven of these subjects and one additional subject. These language samples were analyzed for communicative competence and evidence of thought disorder. Overall, neuropsychological and communicative functioning was worse under the fenfluramine condition, even though blood serotonin levels were about half those at baseline conditions. The results suggest that it is not the higher levels of blood serotonin by themselves that are related to depressed neuropsychological, communicative, and other functioning. In fact, the higher levels of serotonin may well be related to adaptations for maximal level of functioning. These results suggest caution in the use of fenfluramine for other schizophrenic populations.     

Treatment of ununited fractures and pseudarthroses of long tubular bones complicated by suppurative infection

The work is based on the analysis of examination and treatment (external +transosseous osteosynthesis) of 172 patients with ununited fractures and false joints of the long tubular bones complicated by purulent infection and posttraumatic osteomyelitis. All patients were divided into 4 clinical groups according to the activity of the purulent wound infection and choice of the surgical tactics. Some risk factors were taken into consideration in choosing the tactics of treatment and predicting the outcomes. The clinical course of the wound process in the groups of the patients studied and the errors and complications of operative treatment are analysed. The necessity for active postoperative management of patients and endolymphatic and +intra-arterial administration of antibiotics is substantiated. Good and satisfactory results of treatment were produced in 85.6% of patients.     

Use of ultraviolet irradiation of the blood in the complex treatment of peritonitis

According to the data of tetrasolium nitroblue test and titer of the blood serum antibodies to the most frequently cultured microflora in complex treatment of 27 patients with diffuse purulent peritonitis, it was established, that the use of ultraviolet irradiation of the blood stimulated the specific and non-specific organism resistance.     

Lateral shoulder graft for microsurgic plasty of hand and foot

The authors have thoroughly studied the versions of anatomic structure, peculiarities of blood circulation and innervation of lateral arm graft at 20 recent cadavers. The graft can be utilized in different modifications; cutaneofascial, subcutaneofascial, musculocutaneous, osteocutaneous. In the clinic were made 8 free microsurgic transplantations of lateral arm graft for plasty of tissues of different genesis in functionally important zones of hand and foot. In long-term post-operative period all patients demonstrated good functional and cosmetic results.     

Anaesthetic hazards of the 'passion gap'. A case report

Dental abnormalities cause problems for both dentist and anaesthetist. The anaesthetic hazards associated with the 'passion gap'--a term used in the western Cape Province for removal of the top four incisor teeth, a practice widespread among members of the Cape Coloured community--are discussed. Recommendations are made to assist the anaesthetist when dealing with such a patient.