Choreoathetosis related to lithium intoxication

A 76-year old woman was admitted because of severe gait ataxia and dysarthric speech that had worsened over the last 24 h. The patient was initially suspected of having repeated transitory ischemic attacks (TIAs) as her daughter reported a similar episode that had happened 3 weeks prior to admission. The onset of spontaneous twisting, choreoathetotic movements of both hands and arms and worsening of symptoms one hour after admission together with a history of lithium therapy lead to the correct diagnosis and appropriate treatment.     

Untersuchung zur Morbidität der indigenen Volksgruppen der Chiquitanos im südlichen Amazonasgebiet

The Chiquitano-tribe lives in the southern Amazonas region in Bolivia, remote from larger towns. A study (n=1514) on morbidity over an one year period (April 1995 till March 1996) and its relation to general and social medicine is given. Most frequently, childreh under 15 years and women in parity age (15–45 years) sought consultation (34,1 %, 42,7 %). Gastrointestinal, respiratoral and gynecological-obstetric diseases were predominant (22,4 %, 16,2 % and 15,7 %). In the dry season, common colds and respiratoral infections represented the major health problem. In the rainy season, infectious diarrhea diseases caused by polluted water as a consequence of extended floods were most frequent. Typical tropical diseases (malaria, Dengue fever, Chagas’ disease, leprosy a.o.) and socially caused diseases (AIDS, dependencies on drugs and alcohol, consequencies of crime) were rarely seen. With respect to severity, 55,8 % of the patients showed mild disorders. More serious diseases were observed in 39, 8 %. 4,6 % of the patients were diagnosed severly ill and needed hospitalization. Epidemiological data on general and social medicine of minorities in developing countries and their actual degree of medical care are important in a shrinking world. The data are useful to estimate medical needs and plan improvements to the health care system especially in rural areas.     

Quartz glass pipette puller operating with a regulated oxy-hydrogen burner

Quartz glass electrodes are superior to conventional glass electrodes for low-noise recording. They have better electrical characteristics and hydrophobic surfaces which resist creeping of salt solutions. We used oxy-hydrogen heating with program-controlled gas pressure to melt quartz glass capillaries. Usually, the relative wall thickness (the quotient of the outer and inner diameters do/di) of capillaries is, at best, maintained up to the electrode tip. If tips with thicker walls can be produced, coating and other surface treatments can be avoided. We found that programmed heating periods without pull allowed an fivefold increase of do/di in the tip region. Since do/di is inversely proportional to input capacity, the recording noise was minimized and became insignificant relative to amplifier and holder noise. A sample patch-clamp recording is shown.     

Activation kinetics of Glutamate receptor channels from wild-type Drosophila muscle

Outside-out patches from wild-type Drosophila larval muscle were exposed briefly to L-Glutamate (Glu) using a piezo-driven application system. Glu in concentrations of 0.1 to 30 mM was applied and the responses to repeated applications of a given concentration were averaged. The peak current, î, and the current rise time, t_r, from 0.1 î to 0.9 î were determined from the averages. Half-maximum activation of the channels was reached with ≈ 2 mM Glu. î increased proportional to the power n = 3.5 to n = 5.8 (average of four experiments, n = 4.4) for Glu concentrations between 0.3 and 0.5 mM. t_r increased from ≈ 0.2 ms at 10 mM Glu to a value of ≈ 3.5 ms at 0.2 mM Glu. A linear reaction scheme with five binding steps preceding the channel-opening conformational change is proposed as the kinetic mechanism of channel activation and investigated in computer simulations. A set of rate constants assuming the same affinity for each binding site is found to describe the data better than one assuming positive cooperativity. The results are very similar to those for Glu-gated channels of crayfish and locust muscle, which is evidence for a common kinetic mechanism of these channels.     

Therapeutic Ultrasound: Its Effects on the lntegrity of a Nonpenetrating Wound*

This study investigated the effect of ultrasound applied to traumatized muscle tissue of an adult male rat. Sixty-six rats were traumatized, treated, and sacrificed. The rats were assigned to one of 11 groups, to which experimental and control (two mock) ultrasound treatments were given at 3- and 7-minute time periods at 0.5 and 1.5 watts per square centimeter intensities (pulsed and continuous ultrasound). The rats were given a total of six treatments, once every other day three times a week. Treatments began on the third day following the receipt of a nonpenetrating wound on the right lateral thigh. The animals were subsequently analyzed histologically to determine the extent of healing cells present. The principal findings were as follows: 1) ultrasound intensities had a significant effect on healing, 2) there was no statistical difference between the overall means of the control and experimental groups, and 3) there was no difference between the pulsed and continuous modes of ultrasound or between treatment times.J Orthop Sports Phys Ther 1984;5(5):278-281.     

The Effect of Functional Pelvic Tilt on the Three-Dimensional Acetabular Cup Orientation in Total Hip Arthroplasty Dislocations

BackgroundAnterior and posterior pelvic tilt appears to play a role in total hip arthroplasty (THA) stability. When changing from the standing to the sitting position, the pelvis typically rotates posteriorly while the hips flex and this affects the femoro-acetabular positions. This case-control study compares changes in 3-D acetabular cup orientation during functional pelvic tilt between posterior THA dislocations vs stable THAs.MethodsStanding and sitting 3-D cup orientation was compared between fifteen posterior dislocations vs 233 prospectively followed stable THAs. 3-D cup orientation was calculated using previously validated trigonometric algorithms on biplanar radiographs. Those algorithms combine the angles in the three anatomical planes (coronal inclination, transverse version, and sagittal ante-inclination) in the standing position with the change in sagittal pelvic tilt from standing to sitting to calculate the 3-D orientation in the sitting position.ResultsThe standing cup orientation of the dislocated THAs was only characterized by a lower coronal inclination (P = .039). Compared with the controls, from standing to sitting, they showed less posterior pelvic tilt (P < .001). This led to a significant lower coronal inclination (P < .001) and sagittal ante-inclination (P < .001) in the sitting position but similar transverse version (P = .366).ConclusionsComparing posterior THA dislocations to stable THAs, there is a lower increase of all three orientation angles from standing to sitting. This leads to a decreased sitting coronal inclination and sagittal ante-inclination which may lead to an increased risk of impingement ensued by THA instability. By contrast, the transverse version was not significantly different in both positions. This confirms the importance of biplanar data on functional cup orientation.Level of EvidenceDiagnostic, Level III.     

Palliative chemo-radiotherapy with ifosfamide and epirubicin as first-line treatment for high-risk metastatic breast cancer Results of a prospective multicenter trial

From June 1986 to December 1988, 107 patients (median age, 49 years; median performance score, 1) with haematogeneous metastases from breast carcinoma were treated with concomitant radiation and chemotherapy. Overall, 97% of the patients had been pretreated with surgery; 65%, with radiation; and 56%, with hormones. In all, 38% had received adjuvant chemotherapy. Patients with prior palliative chemotherapy were excluded from the study. All patients fulfilled at least two high-risk criteria. Chemotherapy was given according to the EI protocol (4-epirubicin and ifosfamide), and all patients simultaneously received radiation to the main tumor sites. Gastro-intestinal toxicity was moderate (11.1%, WHO grade 4), and bone marrow depression was marked in all cases. After three treatment courses, the overall response rate was 67% [21% complete response (CR), 46% partial response (PR)]. In all, 28% had stable disease (NC) and the rate of progressive disease (PD) was 5%. The median duration of tumour response was 8 months, with 12 months for CRs, 9 months for PRs and 6 months for NCs. The median survival was 13.5 months.Presented at the Satellite Symposium Ifosfamide in Gynecological Tumors of the 5th European Conference on Clinical Oncology and Cancer Nursing', London, September 3–7, 1989