Treatment of chronic bursitis by a local cryogenic procedure

Treatment of 92 patients with bursitis of different localizations by routine methods was followed by recidivations in 51.1% of the cases. Seventy patients were treated by cryodestruction. The follow-up observation of the patients during 1-2 years did not reveal any recidivations.     

Dendritic potentials in granular cells of carp olfactory bulbs

Fast prepotentials in the granular interneurons of carp olfactory bulb were recorded by means of intracellular microelectrodes. Data are presented indicating that fast prepotentials are generated in the electrogenic membrane of granular cell dendrites. It is supposed that dendritic spikes play an important role in the inhibitory synaptic influences of granular cells upon secondary olfactory neurons.     

Technical possibilities and limitations of mechanical circulatory support

Ventricular assist devices (VAD) to support the left (LVAD), the right (RVAD) or both ventricles (BVAD) have emerged as one standard of care for advanced heart failure patients. Initially used to bridge patients to transplantation (BTT) they are now more frequently implanted as permanent support (destination therapy, DT). Bridge to recovery (BTR) is a valid option for only a small number of patients. Although there are different devices available, patient selection, preoperative and intraoperative management, and the timing of VAD implantation are the elements critical to successful circulatory support.     

Influence of wire extension and type on splint rigidity – evaluation by a dynamic and a static measuring method

Abstract – Objectives: To evaluate the influence of wire dimension and wire length on the splint rigidity of wire‐composite splints in vitro. Materials and Methods: A custom‐made artificial model was used. The central incisors simulated ‘injured’ teeth with increased mobility, and the lateral incisors and canines served as ‘uninjured’ teeth with physiological mobility. To assess horizontal and vertical tooth mobility before and after splinting, the Periotest and Zwick methods were applied. Teeth 13–23 were splinted using wire‐composite splint 1 (WCS1; Dentaflex 0.45 mm) and wire‐composite splint 2 (WCS2; Strengtheners 0.8 × 1.8 mm). Splint length was varied by successively shortening the wire. The influence of wire dimension was tested using t‐test and Wilcoxon–Mann–Whitney test with the Bonferroni‐Holm procedure (α = 0.05). To test the influence of wire length, anova and Kruskal–Wallis tests as well as Tukey range and Wilcoxon test with Bonferroni‐Holm procedure were applied (α = 0.05). Results: Wire dimension significantly influenced splint rigidity (P < 0.05). The wire length significantly influenced the splint rigidity of WCS1 in the horizontal dimension and WCS2 in the horizontal and vertical dimensions (P < 0.05). Splint rigidity was significantly reduced when splinting only ‘injured’ teeth compared with splints including ‘uninjured’ adjacent teeth (P < 0.05). No differences were found between splints including one or two ‘uninjured’ teeth on each side (P > 0.05). Conclusion: WCS1 is flexible compared with the more rigid WCS2. The wire length influences the rigidity. To ensure adequate fixation and reduce the risk of enamel damage during splint removal, the splint should include only one ‘uninjured’ tooth bilaterally.     

Mechanical circulatory support of systemic ventricle in adults with transposition of great arteries

We report the successful use of the implantable ventricular assist device HeartWare (HeartWare International Inc., Framingham, MA) to support the systemic circulation in two adult patients with transposition of the great arteries (TGA). One had undergone the Senning procedure as a neonate; the other had congenitally corrected TGA and dextrocardia with palliation in adulthood. It is possible to implant the HeartWare pump into the morphological right ventricle with cannulation of either the diaphragmal surface or the free wall without additional changes in implantation technique and employing off-pump insertion.     

Role of β₁-adrenoceptor autoantibodies in the pathogenesis of dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is a common cause of heart failure. After the identification of several immune regulatory abnormalities in DCM increasing attention has been focused on autoimmune mechanisms as potential key elements in the pathogenesis of the disease. DCM has appeared to be often related to elevated levels of autoantibodies against cardiac structural or functional proteins. Among several autoantibodies (AABs) which react against cardiac cellular proteins that have been detected in sera from DCM patients, those against β1-adrenoreceptors (β1-ARs) appeared particularly relevant from a pathophysiological point of view. The available experimental and clinical data suggest that in β1-AAB-positive patients with DCM the cardiomyopathy might be a β1-AR-targeted autoimmune disease. This review summarizes the present knowledge about β1-AABs, their role in DCM etiopathogenesis and the therapeutic benefits of β1-AAB removal. Special attention is focused on the possible origin of β1-AABs, their interaction with the β?-ARs, the prevalence of β1-AABs in patients with DCM and the potential pathophysiologic impact of these AABs in the development and progression of the disease. Attention is also given to the amelioration of β1-AAB cardiotoxicity by β?-AR antagonists and especially to immunoadsorption (IA) therapy. Responsiveness to IA therapy and its long-term efficiency, as well as post-IA reappearance of β?-AABs and its impact on patients' outcome are also discussed in detail. Finally the important question of whether the therapeutic results of IA are indeed related to β?-AAB removal is analyzed on the basis of available data. Overall the review aims to provide an exhaustive overview of the available experimental and clinical data on β?-AABs in DCM and also a theoretical and practical basis for clinicians who are or intend in future to be engaged in this field.     

Spectrin-alpha I/61: a new structural variant of alpha-spectrin in a double-heterozygous form of hereditary pyropoikilocytosis

Recent biochemical studies have led to the identification of abnormal spectrins in the erythrocytes of patients with hereditary pyropoikilocytosis (HPP) and hereditary elliptocytosis (HE). In this report we describe the biochemical characterization of the erythrocytes from a proband with severe HPP who is doubly heterozygous for two mutant spectrins (Sp): Sp alpha I/74 and a new, previously undetected, mutant of alpha-spectrin designated Sp alpha I/61. The proband's erythrocytes are unstable when exposed to 45 degrees C, and her membrane skeletons exhibit instability to shear stress. The content of spectrin in the proband's erythrocyte membranes is decreased to 75% of control values. The amount of spectrin dimers in crude 4 degrees C spectrin extracts is increased (58%) as compared with control values (6% +/- 4%). Limited tryptic digestion reveals a marked decrease in the normal 80,000-dalton alpha I domain, an increase in the 74,000-dalton fragment that is characteristic of Sp alpha I/74, and an increase in a series of new fragments of 61,000, 55,000, 21,000, and 16,000 daltons. Both parents are asymptomatic, but they have increased amounts of spectrin dimers (17% to 25%). Limited tryptic digestion of the father's spectrin demonstrates the presence of a previously identified abnormal spectrin (Sp alpha I/74) that is characterized by a decrease in content of the 80,000-dalton peptide and an increase in concentration of the 74,000-dalton peptide. The mother's spectrin digests show a decrease in the amount of 80,000-dalton peptide and the formation of new peptides of 61,000, 55,000, 21,000, and 16,000 daltons. The data indicate that this severe form of HPP is due to the inheritance of two distinct abnormal spectrins, Sp alpha I/74 and a new spectrin mutant, Sp alpha I/61.     

Prognostic value of ICP, CPP and regional blood flow monitoring in diffuse and focal traumatic cerebral lesions

Forty patients with severe traumatic brain injury (GCS score 8 and less) aged 16-54 years treated in our clinic were analyzed. Correlations between clinical symptoms, CT signs of diffuse and focal traumatic lesions, intracranial hemorrhage, indices of cerebral blood flow (CBF) according to perfusion CT study, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were assessed. Main mechanism of injury in 27 of 40 (67.5%) patients was acceleration-deceleration due to traffic accidents which usually leads to diffuse axonal injury (DAI) of different severity. In the other 13 (32.5%) cases injury was associated with coup-countercoup mechanism which caused focal contusions mostly. Not only GCS score but CT-signs of DAI severity, intracranial hemorrhage and minimal levels of CPP had significant prognostic value. Results of perfusion CT studies demonstrated that in 37 of 40 (92.5%) patients cerebral blood flow decreased (below 28.6 ml/100 g/min) in one or more arterial blood distribution areas. Increase of CBF was registered in 9 cases (over 69 ml/100 g/min), in 6 of them elevation of CBF in one arterial distribution area was associated with reduction in the other. Generally, mean CBF values were higher in the middle cerebral artery circulation than in the other. The lowest CBF levels (16.3 +/- 6 ml/100 g/min) were observed in cortical and subcortical hemorrhagic foci while these values were significantly higher in the same contralateral intact zones (36.0 +/- 10.0 ml/100 g/min; p < 0.01). In 3 patients with DAI the CBF in the midbrain varied from 12.5 to 30.1 ml/100 g/min with the lowest levels in hemorrhagic focus in cerebral peduncle. It corresponded to cystic-atrophic alterations found on subsequent follow-up MRI. Thus, reduction of CBF and episodes of low CPP were the leading pathophysiological phenomena of diffuse and focal brain damages.