Remarks on treatment of unstable fractures of the thoracolumbar spine]

An evaluation of treatment results of unstable spine fractures using the Harrington instruments in 37 patients has been performed. The described method can result in anatomical restoration of the vertebral canal. If vertebral canal lumen is not restored, anterior decompression should be performed making possible removal of posteriorly dislocated bone fragments. The earlier anterior decompression, the greater chance of improvement of neurological conditions. The described procedure is especially useful in fractures with partial palsy. After treatment 70 per cent of the patients with partial palsy resumed their normal lives.     

Closure of the cleft palate in one or two stages: the surgical methods

The details of two consecutive groups of cleft palate patients treated with one- or two-stage palate repair are presented. The total number of patients is 237, with 128 operated in one stage, and 109 operated in two stages. In the two-stage group, the frequency of 'unintended' palatal fistulas decreased by 80%, and the use of blood transfusions was greatly reduced, but total operation time and hospital stay were longer. The results in terms of speech quality, facial growth and dental occlusion, will be reported on separately.     

Validation of impedance cardiography measurements of cardiac output during limited exercise in heart transplant recipients

Abstract. Twenty-one patients were studied at rest and during exercise after heart transplantation to compare cardiac output measured by thermodilution and impedance cardiography. Exercise was performed on a bicycle ergometer over a limited range of work load (25 and 50 watt) whilst metabolic gas exchange was recorded. One patient was studied at rest whilst his circulation was maintained by a Jarvik-7 artificial heart. The values of cardiac output measured by impedance cardiography corresponded closely with the flow rate from the artificial heart. There was also close agreement between the impedance and thermodilution measurements of cardiac output at rest and during exercise. Both measurements followed the changes in heart rate and oxygen consumption. Both thermodilution and impedance cardiography methods elicited good reproducibility of cardiac output measurements at rest and during exercise. These observations suggest that the noninvasive and continuous record of cardiac output obtained by impedance cardiography can be used for the postoperative monitoring of heart transplant recipients.     

Lyme disease presenting as urinary retention

We report a case of Lyme disease that presented with urinary retention. The individual then experienced lower extremity paralysis. Paralysis and urinary retention resolved with intravenous ceftriaxone antibiotic. To our knowledge this is the first report of a urological manifestation as the initial clinical presentation of Lyme disease. Recognition of clinical symptoms and urological complications of Lyme disease also are discussed.     

Nonselective measurement of cyclosporine for therapeutic drug monitoring by fluorescence polarization immunoassay with a rabbit polyclonal antibody: I. Evaluation of the serum methodology and comparison with a sheep polyclonal antibody in an 3H-tracer mediated radioimmunoassay

Among the new techniques available for CyA monitoring, the FPIA offers the advantages of rapidity and simplicity. The present communication assesses the technical performance of this test in comparison with a 3H tracer-based PC-RIA for serum CyA levels using 971 samples obtained during the first 6 posttransplant months from 14 kidney transplant recipients. The FPIA evaluation included verification of CyA concentrations in manufacturer-supplied calibrators and controls by reference methods, determination of intraassay/interassay precision and accuracy, feasibility of specimen dilution and assessed assay sensitivity, and range of linearity. Comparison of FPIA with PC-RIA indicated that trough samples, when assessed by FPIA, averaged 1.3-fold greater than the PC-RIA, whereas non-trough FPIA measurements indicated similarity between the two methods. Although the two assays showed similar trends in most renal transplant recipients, two subjects demonstrated discrepancies, presumably reflecting the differing specificities of the polyclonal antibodies used in each assay. Thus, the FPIA appears to be a useful addition to CyA monitoring technology.     

The fate of the remaining bladder following supravesical diversion

A retrospective study of 30 adults who underwent supravesical diversion for a variety of benign and malignant conditions was done with special attention to the fate of the residual bladder. Diversion was performed for diverse conditions, including radiation cystitis, cyclophosphamide cystitis, interstitial cystitis, incontinence and trauma. All groups experienced significant morbidity from the remaining in situ bladder. Over-all, 80% of the patients experienced at least 1 complication, chief among which were pyocystis (67%), hemorrhage (23%), severe pain (13%), and unremitting feelings of incomplete emptying and spasm (17%). Complications of sufficient severity to require rehospitalization occurred in 43% of the patients. Several patients required multiple rehospitalizations. Reoperation requiring general or regional anesthesia was necessary in 9 patients (30%) and included 4 cystectomies. Serious consideration should be given to performing primary cystectomy at the time of supravesical diversion in any patient in whom subsequent undiversion is not anticipated.     

Progressive necrosis of the conus medullaris: magnetic resonance imaging and surgical findings

A 67-year-old man with non-insulin-dependent diabetes mellitus progressively developed, over a 2-year period, lower extremity sensory and motor defects associated with impaired bladder function and perineal and perianal sensation related to a disease of the conus medullaris extending from T12 to S5. The magnetic resonance imaging scan suggested myelomalacia and the diagnosis of progressive necrotic myelopathy was confirmed by surgical intervention.