An unusual case of condylar dislocation

A 28-year-old woman involved in a motor vehicle accident sustained bilateral mandibular condyle dislocation into the infratemporal fossae. Conventional manipulations were unsuccessful in relocating the condyles. By simulating the dislocations on a dried skull, it was evident that the coronoid processes were trapped anteriorly and superiorly to zygomatic arches. An open surgical approach was required to relocate the condyles.

A prospective randomized trial of fluorouracil versus fluorouracil plus cisplatin in the treatment of metastatic colorectal cancer: a Hoosier Oncology Group trial

From May 1984 through December 1986, 141 patients with metastatic adenocarcinoma of the colon or rectum were entered on this Hoosier Oncology Group (HOG) trial evaluating the role of cisplatin in systemic therapy. Patients were stratified by the presence or absence of hepatic metastases and by performance status, and were subsequently randomized to receive fluorouracil (5-FU) (15 mg/kg/wk) alone or the same dose of 5-FU plus cisplatin (60 mg/m2 every 3 weeks). The total duration of treatment was six cycles (18 weeks). In 132 fully evaluable patients the objective response rates were 19% for 5-FU and 22% for 5-FU plus cisplatin. Statistically, the median survival times of 40 and 39 weeks were not significantly different (P = .62). However, the median duration of remission (MDR) was superior (P = .05) for 5-FU alone. This study fails to confirm clinically significant synergy of 5-FU plus cisplatin in the treatment of metastatic colorectal cancer.

Platelet pathology in minimal curve idiopathic scoliosis: an attempt to predict curve progression

Platelets from adolescents with minimal curve scoliosis (mcs) (7-18 degrees) and healthy control subjects were examined for morphometry under the electron microscope and tested for calcium content and surface negative charge. These parameters have previously been found to be abnormal in severe idiopathic scoliosis (is) patients. Significantly more patients than control subjects showed deviations from normal in all tests. Two tests in particular, the average number of dense bodies per cell and an increased surface negative charge, were the most frequent abnormalities. In an attempt to assess the possibility of using platelet tests for prediction of curve progression, statistical comparisons were made and discriminant scores were generated for each patient. The results were compared with the clinical findings after a 2- to 3.5-year follow-up. The predictions proved to be incorrect although each of the five patients who had curve progression had some platelet abnormality. It is concluded that although platelet pathology does occur in early idiopathic scoliosis, it cannot be used as a prognostic indicator of curve progression.

Low serum 24,25 dihydroxyvitamin D in Duchenne muscular dystrophy

Levels of serum 24,25(OH)2D3 (0.69 +/- 0.17 ng/ml) were lower in DMD patients than in age-matched controls (2.13 +/- 0.15 ng/ml). Circulating levels of 1,25(OH)2D3 and 25(OH)D3 were within the accepted normal range. Bearing in mind the proposed pathophysiologic role of calcium in DMD and the influence of vitamin D metabolites on muscle ATP and protein synthesis, as well as on sarcoplasmic reticulum calcium transport and muscle mitochondrial calcium content, the above findings of low or deficient 24,25(OH)2D3 levels in DMD could be meaningful from the etiologic and therapeutic points of view.

[Experiences with transparenchymal coral calculi removal under local hypothermia]

Under certain conditions genuine coral calculi are an absolute offication for nephrotomy. In order to achieve complete hygienization of the cavity ischaemia times of more than 25-30 min are often necessary. Controlled surface cooling proved to be very good for improving ischaemia tolerance and reducing post-ischaemic loss of function in 21 necessary nephrotomies out of a total of 651 operations for concrements in the calyx system of the renal pelvis (= 3.2%; = 32.8% of all nephrotomies). A kidney thermometer with a temperature feeler developed by us allows fine control of the hypothermia induced by means of plastic bags filled with ice crystals. The technique of operation together with its advantages and disadvantages are described.

Enhancement of muscle regeneration by bone marrow cells in the monkey

Transplantation of muscle minces with and without autogenous bone marrow cells was performed in the monkey. The addition of bone marrow cells markedly enhanced muscle regeneration. The findings suggest a possible clinical application of the technique.

A method for assaying aryl hydrocarbon hydroxylase in man using fibroblasts cultured in vitro from oral mucosa

Animal studies have linked aryl hydrocarbon hydroxylase (AHH) with cancer induction by polycyclic aromatic hydrocarbons (PAH), but the relationship between the activation of PAH by AHH and cancer induction in man is unclear. Studies using human lymphocytes to investigate this relationship have produced conflicting results. This report describes a technique for assaying AHH in fibroblasts isolated and cultured from normal human oral mucosa. Fibroblasts were cultured from normal portions of routine oral mucosal biopsy specimens obtained from 6 patients, and AHH activity was found in fibroblasts cultured from all the specimens. AHH activity was induced by 1,2-benzanthracene and reached a peak after 48 h. The assay had a pH optimum of 8.6 and an absolute requirement for reduced nicotinamide-adenine dinucleotide phosphate. The fibroblasts maintained their inducibility of AHH through 11 cell passages. Fibroblasts cultured from oral mucosal biopsy specimens offer several advantages over other systems for comparison of individual differences in AHH activity in man, including the consistent presence of inducible AHH activity, stability of enzyme activity in culture, provision of ample number of cells for study, and availability of oral mucosal specimens from patients having routine diagnostic biopsies.

Precocious puberty in myelomeningocele patients

Of a group of 79 patients (45 males, 34 females) with myelomeningocele (MMC), 52 had associated hydrocephalus. Three of the hydrocephalic patients (two arrested and one shunted) were found to have precocious sexual development. Endocrine investigations confirmed true isosexual precocity. Hydrocephalus is known to be associated with precocious puberty, but the occurrence of sexual precocity in patients with hydrocephalus in conjunction with MMC has not been described to date. As the clinical diagnosis of hydrocephalus in a young child is often unreliable, routine computerized tomographic scans of all MMC patients is advised, and even patients with arrested hydrocephalus should be followed carefully for signs of precocious puberty. In addition, a high incidence (15%) of cryptorchidism was found in the group of MMC patients reviewed.

Rehabilitation aspects of Apert's syndrome

Two children with the unusual condition known as Apert's syndrome are presented. Both have the typical manifestations of the syndrome: craniosynostosis, exorbitism, hypertelorism, maxillary hypoplasia, dental malocclusion, cleft palate, compound syndactyly of the hands and simple syndactyly of the feet. A review of the latest surgical procedures for correction of these defects is presented and the importance of early physical and social rehabilitation is stressed.

Inferior vena cava anomalies associated with giant omphalocele--a proposed classification

Thirteen patients with hepatomphaloceles were investigated pre-operatively by an inferior venocavogram as to the shape of the eviscerated liver and the course of the inferior vena cava. Roentgenographic findings correlated with operative findings and three distinct patterns of anomaly were seen. Type 2 and particularly Type 3 are likely to be associated with severe post-operative complications if the peculiar anatomy is not recognized beforehand. We feel that a pre-operative inferior venocavogram and determination of type of anomaly is mandatory in planning the treatment of these patients.

Platelet abnormalities in muscular dystrophy

Platelets which have complex membranes and calcium shifts similar to those in muscles were investigated in 14 patients with muscular dystrophy and 20 suitable controls. In 4 Duchenne and one limb-girdle dystrophy aggregations were done and found to be depressed with adrenaline and ADP. Electron microscopic and chemical examinations revealed an increased number of dense bodies, changed permeability and/or binding of cations and elevated intracellular calcium in all the 9 cases of Duchenne dystrophy while the 2 limb-girdle and 3 myotonic dystrophies varied. A two phase polymer separation system applied to fixed platelets of all patients and controls showed no abnormality of surface negative charge.

Muscle regeneration and transplantation enhanced by bone marrow cells

This work was undertaken in an attempt to improve the usually poor results of muscle regeneration and grafting in cases of muscle injury. Since bone marrow cells markedly increase myogenic growth in vitro (in Millipore diffusion chambers), we added autogenous and isologous bone marrow cells to minced muscle grafts or to sites of excised muscle in rats. In each case the opposite side was left without added marrow cells, to serve as a control. The results showed that addition of bone marrow produces more extensive muscle regeneration with little fibrosis. The myogenesis-stimulating and antibacterial properties of bone marrow cells warrant further study, aiming towards clinical application of the method.

Platelet Abnormalities in Muscular Dystrophy

Platelets which have complex membranes and calcium shifts similar to those in muscles were investigated in 14 patients with muscular dystrophy and 20 suitable controls. In 4 Duchenne and one limb-girdle dystrophy aggregations were done and found to be depressed with adrenaline and ADP. Electron microscopic and chemical examinations revealed an increased number of dense bodies, changed permeability and/or binding of cations and elevated intracellular calcium in all the 9 cases of Duchenne dystrophy while the 2 limb-girdle and 3 myotonic dystrophies varied.

A two phase polymer separation system applied to fixed platelets of all patients and controls showed no abnormality of surface negative charge.

Enhancement of human muscle growth in diffusion chambers by bone marrow cells

Samples of minced human muscle were cultured in millipore diffusion chambers incubated in the peritoneal cavities of mice. In about half the chambers the minced muscle samples were mixed with autogenous bone marrow cells which lead to improved myogenic growth. A similar but less marked effect was produced by mononuclear cells from the patients' blood. No growth enhancement occurred when the muscle and marrow cells were separated by a filter in double chambers. In addition to accelerated myogenesis, the chambers with added bone marrow cells had a much lower incidence of infection. This work may have practical clinical implications for the treatment of muscle injuries. Local implantation of autogenous marrow cells (+/- minced muscle) may prove useful in improving myogenic regeneration.

Persistent neonatal hypoglycemia due to hyperinsulinism: medical aspects

Eight neonates with persistent hypoglycemia were seen over a four-year period and a ninth infant with neonatal onset was treated from 9 months of age. Seven infants had high absolute insulin levels (range 12 to 50 microunits/ml) during hypoglycemia whereas two patients had normal levels which were, however, inappropriate for the low blood glucose levels. Six patients with severe intractable hypoglycemia resistant to intensive medical therapy (including high dose diazoxide) had partial or total pancreatectomy, whereas three with relatively controllable hypoglycemia eventually had spontaneous remissions. In one of the medically treated patients, remission occurred at the unusually early age of 4 months. In the six surgically treated patients and in a seventh patient who had a biopsy only, the pancreas showed characteristic pathologic changes compatible with those described as nesidioblastosis or "endocrine-cell dysplasia." Of the six patients followed up for greater than or equal to 24 months, four have normal psychomotor development, despite periods of arrested head growth in early infancy in three of them.

Metal impregnation abnormalities in platelets of patients with idiopathic scoliosis

A heavy metal impregnation technique revealed that platelets from patients with idiopathic scoliosis (IS) are more frequently ‘metallophilic’ and have a higher surface to volume ratio of the dense tubular system (DTS) than age-matched controls. These findings suggest that the fundamental defects in IS platelets involve membrane abnormalities related to cation binding and transport.

Studies of platelets with heavy metal impregnation techniques

Various methods of heavy metal impregnations were performed on human platelets. The optimal technique consisted of glutaraldehyde fixation, incubation in warm uranyl acetate at a pH of 3.5, followed by a double solution of lead and copper, and finally overnight immersion in cold osmium tetroxide. Semi-thin sections, viewed at 90 kV, revealed three types of platelets: (1) 'reticular' cells, with a prominent tubular network and very dark granules in a pale cytoplasm; (2) 'dark' cells, with an electron-dense cytoplasm; and (3) 'pale' cells, with microvesicles and non-staining granules. Pre-treatments with EGTA, aspirin and various platelet activators altered the appearances and proportions of the three cell types. A cell-partitioning two-phase polymer system showed that the sub-grouping is related to surface membrane properties, the cells retained in the top phase being exclusively type 2 'dark' cells. The changes in cell type distribution produced by activation show that metal impregnation may be a useful method for studying structure-function correlations in platelets.

Negative surface charge on platelets of patients with idiopathic scoliosis

In order to assess the negative surface charge on platelets from patients with idiopathic scoliosis (IS) and suitable controls, formalin-fixed cells were examined by the two-phase aqueous polymer separation system and by binding of cationised ferritin. The results show that IS platelets have a higher negative surface charge. This could be responsible for several functional and structural abnormalities observed previously in IS platelets.

Prosthetic replacement in hip fractures: a comparison between the Moore and Christiansen endoprostheses

Two endoprostheses, the Moore and the Christiansen, for the treatment of fresh intracapsular fractures of the neck of the femur in the aged were compared at intervals of an average follow-up of over two years. There was better hip function, less pain, fewer instances of acetabular intrusion, and a lower incidence of total failure of the prosthesis in the Christiansen group. Using Harris' rating system, the Moore prosthesis group averaged a low score of 55 points, while the Christiansen group averaged 77 points. The latter indicates a fair to good result. The Christiansen prosthesis was most effective in the treatment of intracapsular fracture of the neck of the femur in the aged.

[Enzyme-immuno-assay in listeriosis: detection of antibody and antigen (author's transl)]

An enzyme-immuno-assay (EIA) was developed for the determination of antibodies to Listeria monocytogenes O- and H-antigens of serotypes 1 and 4b, which are predominant in the Federal Republic of Germany. The results correlated well with the tube agglutination but the titers in EIA were considerably higher. Thus one advantage of EIA was its sensitivity. In addition, the EIA offers the possibility to detect antibodies belonging to different immunoglobulin classes. The EIA is easy to perform and required smaller amounts of reagents than the tube agglutination. Since optical densitys is determined in the EIA, the data obtained in this system are less variable than the tube agglutination which is read by eye. The method proved also to be useful for the detection of Listeria-Antigen. Approximately 0.3 microgram/ml of H-antigen could still be detected in the EIA. Since the serological diagnosis of Listeria-infections is hampered by the cross-reactions to various other bacterial antigens the detection of Listeria-antigen by a sensitive immunological procedure could be of considerable value. This is especially the case when culture procedures are not promising, e.g. during or after antimicrobial chemotherapy.

Case report. The pathogenesis of neurovascular complications following penicillin injection

A 12-year-old patient presented following inadvertent intraarterial injection of benzathine penicillin. Complications manifested as an incomplete cauda equina lesion with ischaemia and necrosis over the buttock in the distribution of the injected artery. Angiography confirmed damage to the superior gluteal artery while histology revealed severe ischaemic damage without evidence of an allergic process. Spasm of the injected vessel with retrograde flow and occlusion by particulate matter can explain the clinical manifestations. The prognosis for these complications is poor and the best approach lies in prevention.

A critical efficacy test of cambendazole in equids: the use of the geometric means to assess efficacy

The anthelmintic efficacy of a 44.5% paste formulation of cambendazole was evaluated in a critical trial performed on 5 horses and a donkey. A dosage of 20 mg/kg showed reduction of mean parasite burdens as follows: Strongylinae greater than 99%; Cyathostominae 94%; immature and adult Oxyuris equi 89 and greater than 99%; Probstmayria vivipara greater than 99% and Habronema muscae 97%. Parascaris equorum and Anoplocephala perfoliata were present in small numbers in individual animals only, and while all were removed by treatment, the small numbers did not justify calculation of a percentage efficacy for these 2 parasites.

Neonatal hyperinsulinism--surgical and pathologic considerations

Hyperinsulinism in infancy is most often associated with a diffuse pancreatic lesion designated islet-cell dysmaturation syndrome. This disease is commonly associated with persistent hypoglycemia which usually results from inappropriate secretion of insulin. Urgent medical therapy consisting of hypertonic glucose infusion, frequent feeding, and diazoxide is mandatory in order to prevent central nervous system damage. Where medical means of therapy are not effective, an early 85% subtotal pancreatectomy with preservation of the spleen, is indicated. Nine infants who suffered from hyperinsulinism are reported. In two, medical measures were sufficient to control the disease. One of these patients in whom treatment was started late, remained slightly mentally retarded. Seven patients underwent 85% pancreatectomy. In one of these, an additional 7.5% of the pancreas had to be removed and in a second patient total pancreatectomy was performed in order to control the disease. One patient died on the eighth postoperative day after acute gastric perforation. There was no evidence of residual brain damage in the patients who underwent subtotal pancreatectomy.

Erythrocyte glyoxalase I and esterase D polymorphisms in four French populations

The genetic polymorphism of two new erythrocyte markers GLO I (EC 4.4.1.5) and esterase D (EC 3.1.1.1) has been investigated in four French populations: Basques and Toulouse groups (southwest area), Lille and Strasbourg (northern and eastern part of the territory). The distribution of GLO I and EsD alleles within these communities has shown some significant differences. Basques samples are characterized by the highest frequency of EsD1 gene (0.911) and the lower rate of GLO1 (0.364). The observed data are compared with other results previously reported in France and in Western European populations.