Myomectomy as a reproductive procedure

This series of 64 myomectomies describes the indications, technique, and efficacy of the procedure; the majority of operations were performed on large multinodular uteri. Indications included enlarging pelvic mass, menorrhagia, anemia, and pregnancy wastage in women who wished to preserve reproductive capability. Although infertility was not the primary indication in any case, 32 patients were nulligravid. Only 10 patients were parous and 14 had a history of spontaneous abortion or pregnancy wastage. The average age of the patients was 35.8 years (range, 27 to 47 years). There were no major complications and no patients received blood transfusions. Follow-up revealed three patients with recurrent tumors necessitating repeat procedures. Successful pregnancies have occurred in 40% of those attempting pregnancy. It is concluded that successful myomectomy can be performed in most patients regardless of uterine size, thereby preserving reproductive potential.

The influence of time of hydrogen peroxide exposure on the adhesion of composite resin to bleached bovine enamel

Standard sized cylinders of a small particle light-cured resin were bonded to the flattened labial surface of young bovine incisor teeth which had been previously subjected to four different treatments: (a) immersion in 35% hydrogen peroxide and etched with 37% phosphoric acid gel for 60 s, (b) immersion in saline and etched for 60 s, (c) etched for 60 s and immersion in hydrogen peroxide, and (d) etched for 60 s and immersion in saline. Two hydrogen peroxide and saline immersion periods were used, 5 and 30 min. Specimens were stored in water at 37 degrees C for 1 and 7 days before tensile and shear testing. A total of 256 teeth were used, 8 for each treatment group, each immersion period, and each water storage period for each test. Statistical analysis of the results indicated that there was a highly significant reduction in the adhesive bond strength of the resin when the enamel was exposed to hydrogen peroxide and that the reduction was, within the limits of this study, time dependent. The bond strength was unaffected by the etching order and the period of water storage. Scanning electron microscopic examination of randomly selected fractured peroxide-treated specimens indicated that the failure occurred primarily at the bonding resin-enamel interface and that it was associated with areas of resin nonattachment and an alteration in resin quality. It is suspected that these changes were caused by the presence of residual peroxide or peroxide-related substances at or near the enamel surface.

Bleeding marginal ulcers: angiographic evaluation

The authors reviewed angiograms of patients who had previously undergone gastrojejunostomy and who were suffering from gastrointestinal bleeding. In five patients the site of bleeding was a surgically or endoscopically proved marginal ulcer. Only two of these ulcers were supplied by jejunal branches of the superior mesenteric artery; three of the five were supplied by gastric branches of the celiac artery. Thus, in angiography of patients with bleeding from marginal ulcers, the celiac, as well as the superior mesenteric, artery may need to be investigated.

Thrombin generation in nonclottable mixtures of blood and nonionic contrast agents

The four newly introduced contrast agents--iopamidol, iohexol, ioversol, and ioxaglate--are of much lower osmolality than conventional agents, and claims have been made that they are substantially safer. A chromogenic assay for thrombin was applied to 1:1 (50%), 2:1 (67%), and 4:1 (80%) contrast agent-whole blood mixtures, each containing enough contrast agent to render them unclottable. Thrombin generation occurred in the nonionic-whole blood mixtures and increased with time. No thrombin could be detected in any ioxaglate-whole blood mixtures. The authors conclude that this difference presents a novel hazard in that iopamidol, iohexol, and ioversol permit thrombin generation to occur while inhibiting the fibrin polymerization step of blood coagulation, thus posing a significant, albeit theoretical, threat to patient well-being.

Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography

The authors reviewed their experience with 320 transaxillary arteriograms, as well as the English-language literature on neuropathy complicating transaxillary arteriography. Three of their patients had median and ulnar motor and sensory nerve injury, and six others had only sensory involvement. The occurrence or severity of nerve injury did not correlate well with the size or presence of an observable axillary or arm hematoma. Dissection of the axillae and arms of 25 human cadavers revealed a tough medial brachial fascial compartment (MBFC) outside a thin axillary sheath. The median and ulnar nerves were within the MBFC at an arterial puncture site just lateral to the anterior axillary fold. The radial and musculocutaneous nerves exited the MBFC more proximally. The different levels at which the major nerves of the brachial plexus exit the MBFC explain the anatomic distribution of the nerve injuries associated with compression by a hematoma after transaxillary arteriography.

Sedation during spinal anaesthesia: a case for the routine administration of oxygen

We have studied the effect of sedation with midazolam on arterial oxygen saturation during spinal anaesthesia in two groups of patients: one group received supplementary oxygen, the other group breathed room air. A significant reduction in oxygen saturation was observed in patients not receiving supplementary oxygen; six of 15 patients in this group developed hypoxaemia or severe hypoxaemia which was corrected immediately by administration of oxygen. There were no episodes of hypoxaemia in any patient in the group receiving supplementary oxygen. It is concluded that oxygen should be administered routinely to patients receiving sedatives during spinal anaesthesia.

Differing mechanisms of clotting inhibition by ionic and nonionic contrast agents

The anticoagulant potency of ioxaglate has been shown to be approximately twice that of iopamidol and iohexol. Those findings were obtained with use of the thrombin time as a test and platelet-poor plasma as a thrombin substrate. The authors confirmed these findings with use of a whole-blood version of the same test. However, the thrombin time measures only the final stages of the clotting process. A measure of the entire intrinsic pathway would more nearly simulate the situation in the angiographic suite. When measured with such an assay, the anticoagulant potency of ioxaglate was equivalent to that of diatrizoate and was approximately four times that of iopamidol and iohexol. Because of this difference in potency, it seemed likely that the ionic agents were inhibiting the clotting cascade at a late stage as well as at an earlier stage. To investigate this possibility, whole blood-contrast agent mixtures were activated, incubated for several minutes, and then diluted with either citrated or heparinized whole blood. There was rapid clot formation when the unclotted iopamidol and iohexol mixtures were diluted with citrated whole blood but not when they were diluted with heparinized whole blood. The ionic mixtures did not clot in the presence of either anticoagulant. Thus, in unclottable mixtures nonionic agents still permitted the generation of procoagulants. These procoagulants are theoretically capable of causing clotting on reinjection.

Antimalarials. 16. Synthesis of 2-substituted analogues of 8-[(4-amino-1-methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline as candidate antimalarials

A series of 2-substituted analogues of the exceptional drug 8-[(4-amino-1-methylbutyl)amino]-6-methoxy-4-methyl-5-[3- (trifluoromethyl)phenoxy]quinoline (I) were prepared and evaluated for both suppressive and prophylactic antimalarial activity. The preparation of analogues of compound I was of interest due to the high level of both blood and tissue schizonticidal activity demonstrated by this compound. One analogue, 8a, was found to be both more active and less toxic than the parent compound I. In addition, three analogues of example 8a were prepared. Although two of the three analogues showed significant antimalarial activity, both were inferior to compound 8a.

The characterisation of non-sperm cells in the ejaculates of fertile men using transmission electron microscopy

The non-spermatozoal cells (NSC) in the semen samples of 20 fertile human males have been studied by transmission electron microscopy (TEM), in order to accurately distinguish between the different types of cell present and to give a quantitative profile of their relative proportions. The main seminal constituents of the average fertile man were found to be the germinal elements, accounting for 84.0% of the total NSC population. Of this percentage the anucleate bodies, designated "CM" in this study, were the greatest component (43.0%, SEM +/- 4.7). Spermatids were the next commonly occurring cell (22.2%, SEM +/- 2.9), the anucleate cellular masses with organelles, CM(O)'s and the spermatocytes making up the remaining 18.8%. Leucocytes accounted for 13% of the total NSC, respectively: neutrophils - 12% (SEM +/- 4.5); macrophages - 0.9% (SEM +/- 0.3) lymphocytes - 0.1% (SEM +/- 0.1). The remaining 3% consisted of 2.3% (SEM +/- 0.7) epithelial cells and 0.7% (SEM +/- 0.4) Sertoli cells. The principal conclusions reached were: that some normal ejaculates host active phagocytosis and possibly macrophage activation; that anucleate bodies which form a major component of the ejaculate merit further quantitative study and that the shedding of spermatids is an interesting and important aspect of ejaculation.

A novel cervical dilatation force measurement instrument

A simple and robust instrument for cervical dilatation force measurement is described which measures axial insertion force but is not affected by lateral loads. The instrument is battery-powered, self-contained and displays actual axial force and peak axial force on digital liquid crystal displays.

Angiographic demonstration of bleeding in a unusually located Meckel's diverticulum simulating colonic bleeding

A case is reported in which bleeding from a Meckel's diverticulum was mistakenly localized to the hepatic flexure of the colon on superior mesenteric angiography. An unusually long and mobile mesentery, allowing the bleeding Meckel's diverticulum to be positioned high in the right upper quadrant, led to this misdiagnosis. The case illustrates several fundamental principles about the technique and interpretation of mesenteric angiograms.

Adhesion of a glass ionomer cement to bleached and unbleached bovine dentin

Cylinders of Fuji Type II glass ionomer restorative cement were bonded to the superficial dentin layer of young bovine incisor teeth that had previously been subjected to 4 different treatments: 1) teeth immersed in 35% hydrogen peroxide for 60 min and etched with 37% phosphoric acid gel for 60 s; 2) teeth immersed in saline for 60 min and etched with 37% phosphoric acid for 60 s; 3) teeth etched with 37% phosphoric acid for 60 s and immersed in 35% hydrogen peroxide for 60 min; or 4) teeth etched with 37% phosphoric acid for 60 s and immersed in saline for 60 min. Specimens were stored in water at 37 degrees for 1 and 7 days, prior to tension and shear testing. A total of 128 teeth were tested: 8 teeth in each group for each day and for each test. Statistical analysis of the results indicated that there was a highly significant reduction in bond strength of the cement when dentin was exposed to hydrogen peroxide as compared with saline. SEM examination of randomly selected fractured test specimens indicated that bond failure was cohesive in nature, suggesting that the hydrogen peroxide treatment adversely affected the setting process of the glass ionomer cement.

The Pocket Speech Aid

A rapid-access but limited vocabulary communication aid for the non-vocal and speech impaired is useful in some well defined situations. The design and construction of such a device is described. Three distinct situations have been identified where an aid is essential and an initial evaluation has shown the Pocket Speech Aid to be very successful.

Physical properties of calcium hydroxide and glass-ionomer base and lining materials

Compressive, diametral tensile and flexural strengths, moduli of elasticity, pH, and acid solubility values were compared for six calcium hydroxide cements, seven glass-ionomer cements, and one calcium aluminate cement. Results indicated that the glass-ionomer materials were generally stronger than the calcium hydroxide liners. Prisma VLC Dycal showed the lowest value for modulus of elasticity and the least acid solubility. The glass-ionomer materials were initially acidic, reaching a final pH between 5.4 and 7.3, whereas the calcium hydroxide and calcium aluminate cements were strongly alkaline at all time intervals.

Pulse oximetry in the recovery room

Haemoglobin oxygen saturation (SO2) was measured percutaneously with a pulse oximeter, in a group of 150 healthy ambulant volunteers to determine the range of normal values. The measuring site was not arterialised in advance. SO2 was below 94% in 13.3% of cases, while in no case was it below 90%. SO2 was then measured in 350 patients in the recovery room after a variety of surgical and anaesthetic procedures. Only 1.1% of patients who received additional oxygen following general anaesthesia exhibited an SO2 below 90%, compared to 16.7% of similar cases who did not receive additional oxygen. Administration of additional oxygen raised the SO2 above 90% in all the latter cases. In only 55.3% of those who did not receive additional oxygen was the SO2 above 94%, compared to 86.7% of normal volunteers and 73.9% of patients who received additional oxygen. This study reiterates the need to administer supplemental oxygen to all patients in the recovery room, unless facilities are available to measure SO2. A lower alarm limit of 90% is appropriate for the peri-operative period when using the Criticare Systems 501 oximeter.

Retention of three post and core systems with and without etching

The retentive strength of post and cores fabricated entirely of composite material was compared to the retentive strength of Para Posts with composite cores in etched and unetched post preparations. Under tensile forces exerted upon the cores, only one post was removed. In all other samples the posts remained firmly embedded within the roots. The core material fractured at the occlusal surface of the roots. The Para Post with Composite core cemented into etched preparations was significantly more resistant to fracture than all other samples.

Enhanced acetylcholine release from denervated atria: intrinsic neural supersensitivity

Atrial tissue from denervated dog hearts was incubated with [3H]choline. When compared with controls, nicotine released more acetylcholine (ACh) from denervated atria at 10(-5) and 2 x 10(-5) M, but not at 5 x 10(-5) M. In parallel contractility studies using tissue from these same atria, the negative inotropic response to nicotine was enhanced at 5 x 10(-6) and 10(-5) M, but not at 2 x 10(-5) or 5 x 10(-5) M nicotine. These results indicate that denervation (i.e. decentralization) supersensitivity of the intrinsic cardiac nerves of canine hearts is characterized by enhanced release of ACh.

Traumatic avulsion of arch vessels in a child: primary repair using hypothermic circulatory arrest (case report)

We present here the case of a 7-year-old girl who was ejected from a speeding motor vehicle and suffered avulsion of the left carotid and left subclavian arteries. Repair was affected primarily without the need of graft material, using cerebral protection of cardiopulmonary bypass, profound hypothermia, and circulatory arrest.

Oxygen desaturation following sedation for regional analgesia

Moderate to severe arterial oxygen desaturation (SaO2 75-88%) occurred in three of four patients who were given sedation during regional conduction block without the administration of oxygen. No desaturation occurred in six patients given oxygen 2 litre min-1 via a nasal catheter during similar procedures. It is concluded that patients undergoing regional conduction block with concurrent sedation should receive additional oxygen routinely unless a pulse oximeter is available for monitoring.

Transcatheter embolization facilitating surgical management of a giant inferior gluteal artery pseudoaneurysm

This article is a report on a case of a giant pseudoaneurysm of the inferior gluteal artery where important features of the diagnosis, with special mention of magnetic resonance imaging and arteriography, are discussed. Surgical therapy is the treatment of choice for these lesions. Historically, proximal arterial control has been the main dilemma in the management of gluteal artery pseudoaneurysm. We found transcatheter embolization to provide optimal control and eliminate the need for preperitoneal or intraabdominal dissection. Surgical repair can then be carried out without risk of intraoperative hemorrhage.

Systemic-to-pulmonary collateral vessels and shunts: treatment with embolization

Abnormal collateral vessels develop frequently in patients with right ventricular outflow or pulmonary artery obstruction. Surgery is usually used to obliterate these vessels but may be difficult, involve prolonged operative time, or require a different thoracotomy than that used for correction or palliation of the cardiac anomaly. Sixteen trans-catheter embolization procedures were performed in 15 patients with systemic-to-pulmonary collateral vessels and shunts. In eight embolization procedures performed because of congestive heart failure or low oxygenation, clinical improvement was obtained in seven. In all six patients who underwent embolization preoperatively, the outcome of surgical correction or palliation was satisfactory. Hemorrhage ceased in the two patients with hemoptysis. There were two complications, one transient loss of femoral pulse and one segmental pulmonary infarction. Embolization is a useful adjunct to surgery and medical management of patients with systemic-to-pulmonary collateral vessels and shunts.