Life-threatening respiratory failure due to cranial dystonia after dental procedure in a patient with multiple system atrophy.

We report on a woman with a an 8-year history of multiple system atrophy with predominance of parkinsonism who developed jaw-locking oromandibular dystonia within hours after insertion of ill-fitting dentures. Dystonia spread rapidly to involve other facial muscles and the larynx causing stridor with respiratory failure necessitating crush intubation.     

Weichteilschaden im Oberschenkelbereich

Anatomically, the thigh is well covered by soft tissue in the form of the muscles surrounding the shaft. In the assessment of the severity of an injury, not only the obvious skin wound but also the mechnism of the trauma has to be considered. The extent and severity of the soft tissue damage cannot usually be fully established until later in the course of treatment, when necrosis of the skin, the subcutaneous fat and the musculature and also compartment syndrome or a secondary disturbance of perfusion may become obvious. Therefore, when extensive soft tissue injuries are present, following the primary débridement, a repeat wound débridement after 24–48 hours is generally indicated. Only after consolidation of the wounds and the successful treatment of any infection is definitive soft tissue reconstruction performed. The main danger in the treatment of soft tissue injuries of the thigh is underestimation of their total extent.     

Prognostic importance of human papillomavirus type 16 DNA in cervical cancer.

Human papillomavirus (HPV) type 16 DNA is frequent in invasive cervical cancers. Among 43 patients with invasive cervical cancer, HPV-16-positive tumors spread to the parametrial and pelvic lymph nodes significantly more often than did HPV-16-negative tumors (P less than 0.05). Demonstration of HPV-16 DNA in invasive cervical cancers may be an additional prognostic factor for this disease.     

Erfahrungen zur PFFB von isolierten radiusköpfchenfrakturen

Zusammenfassung Den Vorteilen einer osteosynthetischen Versorgung einer Fraktur mit sofortiger Aufnahme seiner Funktion, stehen die aus der Literatur bekannten Komplikationen gegenüber. Diese und unsere eigenen unbefriedigenden Ergebnisse nach der operativen Versorgung von Radiusköpfchenfrakturen ließen uns zu einer prospektiven randomisierten Studie einer primär funktionellen Behandlung unter Verzicht auf eine äußere oder innere Stabilisierung greifen. Seit Dezember 1991 haben wir im UKH-Graz bis einschließlich Dezember 1992 insgesamt 70 Patienten nach einem strikten Behandlungskonzept, unter Zuhilfenahme der Computertomographie zur Verlaufsbeobachtung versorgt. Die in 91% der Fälle als sehr gut and gut einzustufenden Frühergebnisse sowie das fehlende Auftreten einer, wie bei operativer Versorgung möglichen Komplikation, ebenso die zusätzlich deutlich frühere Arbeitsfähigkeit bzw. deutlich kürzere, wenn auch aufwendigere Behandlungszeit, lassen uns diese Verfahren nicht nur in unserem Hans weiterführen, sondern können wir auch weiter empfehlen.

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Experience with internal fixation of fractures of the head of the radius

The advantages of internal fixation of fractures, with the possibility of immediate resumption of the function of the fractured bone, are in contrast to the well-known complications described in the literature. These complications and our own unsatisfactory results after surgical treatment of fractures of the head of the radius induced us to carry out a randomized prospective study of primary functional treatment of such fractures without external or internal stabilization. From December 1991 through December 1992, a total of 70 patients were treated according to a strict treatment protocol at the Graz Hospital for Accident Surgery, and CT was used for observation of the healing process. The positive early results, which in 91% of all cases were classified as very good or good, the lack of complications that sometimes follow surgical treatment, the markedly earlier recovery of the patient's working capacity, and the clearly shorter — albeit somewhat more expensive — treatment period required have led us to continue using this method at our hospital and also to recommend its use elsewhere.

     

Impact of gastrointestinal endoscopy on HIV‐infected children

Objective: To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems. Methods: From 1998 to 2002, we retrospectively reviewed all cases of HIV‐infected children presenting with GI problems in which an upper or lower GI endoscopy was indicated. The initial diagnostic endoscopic examination and any repeat endoscopic session leading to a new diagnosis were used in the data analysis. Tissue biopsies were obtained from all abnormal lesions and representative sites of normal‐appearancing GI mucosa. Results: Fourteen patients (median age: 22.5 months) underwent 23 sessions of GI endoscopy, including 10 esophagogastroduodenoscopy, nine colonoscopy and four flexible sigmoidoscopy. Chronic diarrhea was the most common indication, followed by lower GI bleeding, abdominal/retrosternal pain, dysphagia/odynophagia, and upper GI bleeding. Gross endoscopic abnormalities were observed in 78.3%; whereas histological inflammation and opportunistic pathogens were identified in 87% and 43.5%, respectively. Cytomegalovirus was the most common identified pathogen. Abnormal gross findings were significantly associated with histological inflammation and identification of pathogens (P = 0.006 and 0.046, respectively). Specific changes in medical management were made in 50% of cases as a result of endoscopic investigation. Conclusion: If non‐invasive investigations for HIV‐infected children with GI symptoms fail to establish a diagnosis, gastrointestinal endoscopy should be performed and often yields a positive result leading to changes in medical management.     

Heart Transplantation in a 68-Year-Old Patient with Senile Systemic Amyloidosis

Senile systemic amyloidosis (SSA) results from deposition, predominantly in the heart, of amyloid fibrils derived from wild-type transthyretin (T TR) molecules. Cardiac autopsies indicate that SSA progressively increases in subjects 80 years of age and older. However, only a few cases of patients with SSA and cardiac failure have been recognized by cardiac biopsies during life. Here, we report a case of heart transplantation in a 68-year-old male patient with SSA. After cardiopulmonary resuscitation in October 1998, he underwent complete evaluation. Myocardial biopsies revealed the presence of amyloid deposition. Immunohistochemical staining of the amyloid indicated T TR. Genomic DNA analysis of the T TR exons did not result in any identification of a mutation. In 2001, heart transplantation was performed because progressive heart failure occurred. At the 1-year follow-up, no amyloid deposits were found in the donor heart. At the 2-year follow-up, the patient's physical and mental health was excellent. We conclude that heart transplantation can be an effective treatment in progressive heart failure due to SSA.     

Folic acid in the treatment of acute watery diarrhoea in children: a double-blind, randomized, controlled trial

One-hundred and six male children aged 6-23 months with a history of acute watery diarrhoea of less than 72 h duration were randomized to receive either folic acid in a dose of 5 mg at 8-h intervals or placebo for 5 d. There were 54 children in the folic acid group and 52 in the placebo group. The admission characteristics were comparable between the two groups. No significant differences were observed in the intake of oral rehydration solution or stool output between the groups. The mean ± SD of total stool output (g kg⁻¹) was 532 ± 476 vs 479 ± 354 and the duration (h) of diarrhoea was 108 ± 68 vs 103 ± 53 in the folic acid vs placebo group, respectively. The findings, therefore, should have a positive influence on preventing the inappropriate use of folic acid in acute diarrhoea.