Computerized tomography and Trotter's syndrome in the diagnosis of maxillofacial pain

Trotter's syndrome is a clinical triad of unilateral deafness, neuralgia affecting branches of the trigeminal nerve, and defective mobility of the soft palate, which is caused by malignant tumors involving the lateral pharyngeal recess (Rosenmüller's fossa). It is an ominous presentation, which can masquerade as dental or masticatory pain. Computerized tomography (CT) can be used not only to explain the anatomic basis of Trotter's syndrome but also to determine the extent and distribution of the malignant tumor involved. The advantages of CT over conventional radiography are illustrated by a case of adenoid cystic carcinoma that presented as Trotter's syndrome. Perineural invasion by tumor is shown on the gross level for the first time with CT, and important diagnostic considerations, which may aid in the early diagnosis of future cases, are discussed.     

Adjustment and adaptation

As in many other scientific disciplines, in gerontology adaptation is a central term. Yet it is not being used in a standardized way. This article describes the concepts and theoretical approaches which can be identified in Social Gerontology, together with their functions and the results of research.     

Pancreatic carcinoma. An unusual presentation--inferior vena cava thrombosis

The case reported here demonstrates the importance of considering the possibility of occult malignancy in young patients presenting with extensive or migratory thromboses in atypical locations that appear resistant to standard therapy. Suspicion for malignancy-related thrombosis is heightened by the absence of known precipitating causes and by a negative family history of thrombosis. The search for the responsible underlying neoplasm can be frustrating, but diagnosis and successful treatment of the tumor remain the keys to controlling the abnormal thrombotic state.     

Histology of port wine stains after copper vapour laser treatment

We report histological changes in four patients with port wine stains treated with 578 nm yellow light from a high power copper vapour laser. Histology showed that selective damage occurred to the ectatic blood-vessels in the dermis, without haemorrhage and damage to non-vascular structures, and without scarring. The initial damage to the overlying epidermis was not permanent, and the damaged ectatic vessels returned to normal size or were completely necrosed and replaced by collagen.     

The place of colectomy with ileo-rectal anastomosis in inflammatory bowel disease

The present status of total colectomy with ileorectal anastomosis in the surgical treatment of inflammatory bowel disease is examined. Special reference is made to the different indications for the use of the operation in Crohn's disease and in ulcerative colitis. The late results are illustrated by the outcome in the 59 patients in a personal series, and other published results.     

Synovectomy of the knee in hemophilia

Synovectomy of the knee in patients with hemophilia presenting in countries with demographic characteristics that make central referral difficult is the subject of this article. Ten patients, six surgeons, and two countries contributed to this study, which demonstrated that approximately 40% of these patients had no further hemarthroses into the affected joint and the remainder had reduced frequency and severity of bleeding. Continuous passive motion has an important place in postoperative management, and manipulation with the patient under anesthesia is of doubtful value. The possible relationship between diminished range of movement and a successful outcome in terms of abolition of hemorrhage is explored. One patient underwent synovectomy of the knee without complication; the other nine suffered significant complications.     

Reserpine enhances amphetamine stereotypies without increasing amphetamine-induced changes in striatal dialysate dopamine

Indirect evidence suggests that amphetamine (AMPH) releases dopamine (DA) from an extravesicular, cytoplasmic pool. Disruption of vesicular DA storage by reserpine has been hypothesized to increase the concentration of extravesicular DA available for release by AMPH, which is consistent with the observation that reserpine does not prevent but augments the behavioral response to AMPH. In order to more directly test this hypothesis, the in vivo microdialysis technique was used to concurrently examine the behavioral and striatal dopaminergic response to AMPH (1.25 or 2.5 mg/kg) 24 h following reserpine pretreatment (2.5 mg/kg). Reserpine decreased tissue levels of DA by approximately 90% and reduced baseline dialysate DA concentrations by approximately 80%. Reserpine augmented the behavioural effects of AMPH, particularly increasing the occurrence and intensity of stereotypies. In contrast, reserpine did not alter the amount or duration of AMPH-induced DA release. This observation confirms that DA release by AMPH does not depend on vesicular stores but is inconsistent with the hypothesis that augmentation or behaviour by reserpine results from increased striatal DA release.