The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade

Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Long-term follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.     

Thymus size and its relationship to the respiratory distress syndrome.

Thymic size can be affected by both exogenous and endogenous glucocorticoids. The risk of respiratory distress syndrome is reduced after maternal steroid administration. To find whether fetal lung maturity correlates with size of the thymus, the cardiothymic:thoracic ratio was measured in 167 newborn infants with and without RDS. Mean CT/T was significantly greater (0.40 vs 0.35; P less than 0.001) in those babies with RDS. This relation was independent of gestational age, although an increase in CT/T with advancing gestational age was shown. Prepartum maternal steroid administration did not result in significant involution of the cardiothymic shadow when compared with control infants with and without RDS. The CT/T may be of use in predicting which premature babies are more likely to develop RDS.     

Internal ophthalmoplegia following inferior oblique myectomy: a report of three cases

Three patients are reported in whom paralysis of accommodation and mydriasis (internal ophthalmoplegia) developed following inferior oblique myectomy. In all three patients, accommodation eventually returned to normal; in two, mild anisocoria persisted; in one patient, pupillotonia was noted after 2 1/2 years. The mechanism of this previously unreported surgical complication is thought to be excessive stretching of the nerve to the inferior oblique muscle with secondary trauma to the ciliary ganglion.     

A method for direct coronary sinus flow measurement and blood sampling in the dog

Various methods for sampling and measurement of coronary sinus flow in animals have been reported. All have disadvantages because of the need for fluoroscopy or for special tubing or equipment. A technique using readily available materials is described that provides direct measurement of coronary sinus blood flow and allows coronary sampling.     

Bilateral Multifocal Intraocular Cysticercosis

A 47-year-old male from India was treated for the rare condition of bilateral multifocal intraocular infestation with Cysticercus cellulosae, the larval form of Taenia solium. The intravitreous parasite in the left eye was removed via pars plana vitrectomy. A subretinal cysticercus in the right eye, which caused a rhegmatogenous retinal detachment, was removed via sclerotomy during the scleral buckling procedure. An additional peripapillary subretinal cyst could not be removed. A subconjunctival cysticercus was incidently found and removed at the time of surgery. The patient returned to India six weeks after surgery and is doing well.     

Application of Classical and Model-Based Spectral Methods to Describe the State of Alertness in EEG

Electrophysiological recordings are considered a reliable method of assessing a person's alertness. Sleep medicine is asked to offer objective methods to measure daytime alertness, tiredness and sleepiness. In this study, EEG signals recorded from 30 subjects were processed by PC-computer using classical and model-based methods. The classical method (fast Fourier transform) and three model-based methods (Burg autoregresse, moving average, least-squares modified Yule–Walker autoregressive moving average methods) were selected for processing EEG signals to discriminate the alertness level of subject. Power spectra of EEG signals were obtained by using these spectrum analysis techniques. These EEG spectra were then used to compare the applied methods in terms of their frequency resolution and the effects in determination of vigilance state of subject. It is found that, FFT and MA methods have low spectral resolution, these two methods are not appropriate for the analysis of the a wake–sleep correlation. Burg AR and least-squares modified Yule–Walker ARMA methods' performance characteristics have been found extremely valuable for the determination of vigilance state of a healthy subject, because of their clear spectra.     

Cancer in relatives of patients with aplastic anemia

The risk of cancer was examined among family members of 9 patients with Fanconi's anemia. Seven cancers of diverse types were observed, as compared with the 10.4 expected (P > 0.05). In addition, the study of relatives of 60 patients with acquired aplastic anemia showed no unusual distribution of cancers by site and age at diagnosis. In particular, no relative in either series had acute leukemia. Methodologic issues complicate the interpretation of several published reports of excess cancers among heterozygotes of Fanconi's anemia, ataxia-telangiectasia, and xeroderma pigmentosum.     

Diagnosis of affective disorders in the elderly

Depression is the major affective disorder in the elderly, as in the younger population. Complicating factors in its diagnosis include situational changes, depressive symptoms arising from medical illnesses or drug effects, and difficulty in differentiating the pseudodementia of depression from true dementia. The authors assess possible diagnostic applications of the dexamethasone suppression test, and also comment on specific features of bipolar disorders in the elderly.     

A Method of Enlarging the Distal Transverse Arch in Infants with Hypoplasia and Coarctation of the Aorta

Immediate operation in infants suffering from severe congestive heart failure and coarctation of the aorta associated with hypoplasia of the distal transverse aortic arch often poses a difficult technical problem. Frequently the anastomosis between the hypoplastic arch and the descending thoracic aorta fails to relieve the gradient across the hypoplastic segment appreciably. A technique of enlarging the lumen of the distal arch and thereby further lowering the gradient has been found effective and is presented.