0.4% nitroglycerin ointment : in the treatment of chronic anal fissure pain

0.4% Nitroglycerin ointment is an intra-anal formulation of nitroglycerin (glyceryl trinitrate) indicated for the treatment of chronic anal fissure pain.black triangle Nitroglycerin is a nitric oxide (NO) donor, which reduces the increased anal canal pressure caused by a hypertonic internal anal sphincter, improving anodermal blood flow. A twice-daily 375 mg application of 0.4% nitroglycerin ointment, delivering a daily nitroglycerin dose of 3mg, significantly increased the rate of decrease in mean visual-analogue-scale pain scores, recorded daily, versus placebo (actual vehicle) over the first 3 and 8 weeks of treatment in patients with chronic anal fissure pain participating in randomised double-blind trials. Most recipients of 0.4% nitroglycerin ointment experienced headache, which was transient but severe in 20-25% of patients in randomised double-blind trials; however, compliance was generally good with few study withdrawals.Features and properties of 0.4% nitroglycerin (Rectogesic) rectal ointment Indication Pain associated with chronic anal fissures Mechanism of action Donor of nitric oxide Mediates relaxation of internal anal sphincter Dosage and administration Dosage 375 mg of 0.4% nitroglycerin rectal ointment, delivering nitroglycerin 1.5 mg Frequency Twice daily Route of administration Intra-anal Pharmacokinetic profile Mean bioavailability (0.2% nitroglycerin ointment, 0.75 mg nitroglycerin dose)50%Maximum plasma concentration 0.1 to >1 microg/L Volume of distribution approximate, equals 3 L/kg Clearance approximate, equals 1 L/kg/min Elimination half-life approximate, equals 3 min Most common adverse event Headache.     

Congenital Aortic Regurgitation Due to Absent Aortic Cusps and High-Degree Mitral Stenosis

Congenital absence of aortic cusps leads to severe aortic regurgitation. We present a newborn with this rare entity with extreme mitral stenosis. Hemodynamic features were those of hypoplastic left heart syndrome. Surgical management consisted of initial modified Norwood procedure followed by orthotopic heart transplantation.     

A low cost computer aided design (CAD) system for 3D-reconstruction from serial sections

This paper describes an approach to computer-assisted 3D-reconstruction of neuronal specimens based on a low cost yet powerful software package for a personal computer (Atari ST). It provides an easy to handle (mouse driven) object editor to create 3D models of medium complexity (15,000 vertices) from sections or from scratch. The models may be displayed in various modes including stereo viewing and complex animation sequences.     

Osteopenia, hematopoiesis, and bone remodelling in iliac crest and femoral biopsies: a prospective study of 102 cases of femoral neck fractures

Cancellous microanatomy, bone remodelling, and hematopoietic tissue were studied in iliac crest and femoral neck biopsies taken intraoperatively in 102 consecutive patients with displaced intracapsular fractures. About half of the femoral biopsies had osteopenia, and most showed replacement of hematopoietic tissue by fat cells, with absence of osteoblasts and osteoclasts. In contrast, most of the iliac crest biopsies showed relatively less decrease in cancellous bone, while hematopoietic tissue and bone remodelling cells were present in approximately 75%. These results indicate that the iliac crest biopsy does not necessarily reflect cancellous microanatomy, hematopoietic tissue, and bone remodelling at other skeletal sites in any given patient.     

Clinical evaluation of a desktop robotic assistant

A desktop vocational assistant robotic workstation was evaluated by 24 high-level quadriplegics from the Palo Alto Veterans Affairs Spinal Cord Injury Center. The system is capable of performing daily living and vocational activities for individuals with high-level quadriplegia via voice control. Subjects were asked to use the robot to perform a repertoire of daily living activities, including preparing a meal and feeding themselves, washing their face, shaving, and brushing teeth. Pre- and post-test questionnaires, interviews, and observer assessments were conducted to determine the quality of the robot performance and the reaction of the disabled users toward this technology. Results of the evaluations were generally positive and demonstrated the usefulness of this technology in assisting high-level quadriplegics to perform daily activities and to gain a modicum of independence and privacy in their lives.     

Identification of pedicles of putative blue-sensitive cones in the human retina

Cone photoreceptor pedicles from midperipheral regions of the human retina (6 mm from the foveal center) have been studied by light and electron microscopy. Three areas of cone pedicle mosaic were serially thin-sectioned, in the tangential plane, from the inner border of the outer plexiform layer to the emergence of the cone axons from the cone pedicles. Semithin sections were then collected from the cone axon level through the cone cell bodies to the cone inner segment level. Two hundred twenty-one cone pedicles were followed by this means to their respective inner segments. Eight percent of the cone pedicles were from cones with inner segment characteristics of the blue cones. All 221 cone pedicles were reconstructed by tracing images from electron micrographs. The cone pedicle locations, surface areas, telodendrial projections, and synaptic ribbons could then be measured by morphometry and analyzed by statistical methods. Some selected cone pedicles were reconstructed by computer graphics methods. The cone pedicles identified as belonging to the blue cone type could be distinguished from the surrounding longer wavelength types on the following morphological criteria: 1) they were smaller (50% the area of the surrounding pedicles), 2) they contained shorter synaptic ribbons, 3) they exhibited essentially no telodendrial contact to neighboring cone pedicles, 4) they were positioned slightly more vitread in the outer plexiform layer than neighboring pedicles, and 5) their irregular occurrence in the cone mosaic coincided with the distribution criteria established in our previous paper (Ahnelt et al: J. Comp. Neurol. 255:18-34, '87) for putative blue sensitive cones in midperipheral human retina.     

Morphometric evaluation of benign prostatic hyperplasia.

Resected prostate tissue from 9 patients with benign prostatic hyperplasia was subjected to a morphometric analysis. The relative volume density of 4 prostatic tissue components was determined: fibrous (47%), muscular (8%), vascular (3%), and glandular (18%). The resolution of the stromal portion of the hyperplastic prostate into 3 subcomponents represents a finer level of resolution than that previously reported. This enhanced precision in the determination of tissue composition lends new insight into the etiology of benign prostatic hyperplasia, and provides a basis for the evaluation of novel approaches to its treatment.