FOERSTER'S OPERATION FOR SPASTIC PARAI,YSIS OF THE LOWER EXTREMITIES* REPORT OF A CASE

Ncurologist and surgeon alike are often confronted with the problem of treatment of spasticity of the extremities due to diseases of the brain or of the spinal cord. Among the various causes which may produre such spasticity are syphilis, acute infectious diseases, mechanical injury to the central nervous system, vascular disturbances, thcir sequelae, and other degenerative diseases. Of all tbc varieties of spasticity none has attracted more attention than Little''s diseasc-the spastic paralysjs of children, because here enough motor power of the extre- mities persists to warrant successful devclopment of control if the spasticity can be eliminatPd or diminished.     

STUDIES OF SERUM LONG-ACTING THYROID STIMULATOR (LATS) IN RELATION TO EXOPHTHALMOS AFTER THERAPY FOR THYROTOXICOSIS

Observations have been made on a series of 30 thyrotoxic patients before and after therapy, with particular attention to exophthalmos (measured by the Hertel exophthalmometer) and serial determinations of serum levels of protein-bound iodine (PBI) and long-acting thyroid stimulator (LATS). In 14 cases in which there was an exacerbation of exophthalmos (mean maximal increase of 2·8 mm. Hg) there was a greater fall in serum PBI levels (7.3 µg. per 100 ml.) than in 16 cases in which there was no such exacerbation (3.5 µg. per 100 ml.), although initial serum levels of PBI were the same in the two groups. The serum LATS level was more likely to be initially elevated in the group showing exacerbation. and a further rise was observed more frequently in this group following therapy, whether with antithyroid drugs, surgery or radio-iodine. Suppression of serum levels of LATS with azathioprine or steroids did not significantly affect the exophthalmos which had already developed in two cases. These observations suggest that a determination of serum level of LATS could be carried out advantageously before therapy. If a high level is seen, then exacerbation of exophthalmos is more likely to occur. Immunosuppressive therapy may be indicated in addition to antithyroid drug therapy. surgery or the use of radio-iodine if exacerbation is to be prevented. Further studies are suggested to try to define more clearly the susceptible group of patients and to assess the value of immunosuppressive therapy in preventing exacerbations of exophthalmos.     

Novel Side Branch Ostial Stent

Bifurcation lesions are technically challenging and plagued by a high incidence of restenosis, especially at the side branch orifice, which results in a more frequent need for revascularization during the follow-up period. This report discusses two clinical experiences with a novel side branch ostial stent, the BIGUARD™ stent, designed for the treatment of bifurcation lesions; procedural success with no in-hospital complications was observed in types IVb and Ia lesions.     

Selective 5-HT2 receptor blockade in exercise-induced asthma

Seven young extrinsic asthmatics participated in an open, pilot study to determine the protective effect of a selective 5-hydroxytryptamine (5-HT) blocking agent, ketanserin, on exercise induced asthma. ketanserin in a dose of 10 mg given intravenously 20 min before exercise altered the basal bronchomotor tone in only 1 of 6 subjects and offered partial protection against exercise-induced bronchoconstriction in 1 of 5 asthmatics with no overall effect in the group. All patients experienced sleepiness after administration of ketanserin and one had bradycardia with hypotension. The ineffectiveness of ketanserin suggests indirectly that serotonin has a limited role in the pathogenesis of exercise-induced asthma.     

Screening test for growth hormone deficiency: Usefulness of L-dopa-propranolol provocative test

This is a retrospective review of 185 short children who were tested for growth hormone (GH) secretion using the L-dopa-propranolol provocative test. One hundred and thirty-three children were deemed to have passed the screening test when a GH concentration of greater than 15 miu/L was elicited after stimulation. Fifty-two failed the screening test, of which 33 were diagnosed as having growth hormone deficiency (GHD) when they had inadequate growth hormone response to insulin-induced hypoglycaemia. The other 19 were low-responders since they showed adequate GH response to insulin tolerance test (ITT). The low-responder rate to L-dopa-propranolol provocative test among short children who are not GH deficient was 12.5%. The low cost of L-dopa and propranolol, the simplicity and safety of the test, and the acceptable rate of low-responders make the test an effective screening test for GHD.     

RECOVERY OF COGNITIVE FUNCTIONS AFTER ANAESTHESIA WITH DESFLURANE OR ISOFLURANE AND NITROUS OXIDE

We studied recovery in 25 adult patients, ASA I, undergoingelective orthopaedic procedures after anaesthesia with 0.65MAC desflurane (n = 16) or isoflurane (n = 9) with 60% nitrousoxide in oxygen. Early emergence from anaesthesia was assessedin the operating room by measuring time to spontaneous movement,cough, response to painful pinch, tracheal extubation, openingof the eyes and stating correct age, name and body parts. Thereturn of cognitive functions in the late recovery phase wasassessed in the post-anaesthesia care unit (PACU) by post-anaesthesiarecovery scores (PARS), the Trieger dot test (TDT). and thedigit substitution test (DST). In the early recovery phase,time to tracheal extubation, opening eyes, telling correct name,age and body parts occurred significantly faster in the desfluranegroup than in the isoflurane group (P < 0.05). The mean "tripleorientation" time (to name, age, body parts) was 10.9 (SEM 0.9)min for desflurane, compared with 18.6 (2.5) min for isoflurane(P < 0.01). In the late recovery phase, desflurane patientshad significantly greater PARS, more correct responses to theDST and fewer error responses to the TDT. Recovery times werenot increased by increased duration of desflurane anaesthesia.The desflurane patients showed no delirium, minimal sedationand less shivering during the entire postoperative course. Weconclude that desflurane anaesthesia was superior to isofluraneanaesthesia, not only in emergence, but also in the recoveryof cognitive functions. ^*Present address: Department of Anesthesiology, Veterans GeneralHospital, and Yang Ming Medical College, Taipei, Taiwan, R.O.C.      

肌浆网钙泵的抑制不参与过氧化氢诱导的大鼠主动脉收缩

目的:研究肌浆网钙泵抑制是否参与H_2O_2诱导的大鼠主动脉收缩反应。方法:离体主动脉环张力实验比较H_2O_2及钙泵特异性抑制剂环匹阿尼酸(CPA)缩血管效应及其信号机制的差异。结果:H_2O_2和CPA均收缩去内皮主动脉环,但H_2O_2触发快速短暂相位相收缩,而CPA诱导缓慢持续的张力相收缩。在无钙液中,仅CPA30μmol/L而非H_2O_230μmol/L预处理取消苯肾上腺素10μmol/L缩血管效应。Thap-sigargin 30μmol/L诱导最大收缩反应时,仅H_2O_2能使血管环进一步收缩。另外,P_2受体拮抗剂suramin、RB-2(各100μmol/L)以及多种酶抑制剂包括PLC、PKC、PLA_2、COX和蛋白质酪氨酸激酶均能抑制H_2O_2而非CPA诱导的缩血管效应,但2-APB50μmol/L对两者都有抑制作用。结论:肌浆网钙泵抑制不是H_2O_2收缩大鼠去内皮主动脉的机制。     

毒性中药生川乌质量标准研究

目的:建立毒性中药生川乌的液质联用等质量检验方法。方法:采用显微、化学、液相色谱、液质联用方法进行定性鉴别、含量测定。结果:采用液相色谱质谱/质谱联用具有灵敏、专属性强等优点,适用于微量乌头生物碱的检测。结论:建立的方法可为其质量标准的提高提供参考。