Atlantoaxial subluxation. An unusual complication after local anesthesia for tonsillectomy

After tonsillectomy, atlantoaxial subluxation occurred in two patients. Operations had been performed with the use of local anesthesia, and it was assumed that, during the injection of anesthetics, bacteria infected the prevertebral space. The initial symptoms of the prevertebral space infection were neck pain and stiffness; the movements of the neck were minimal, and opening of the mouth caused pain due to spasm of the deep cervical muscles. Both patients had persistent fever. The roentgenographically observed subluxation developed in one to two months after tonsillectomy. One of the patients was treated only with antibiotics; the other patient required atlantoaxial spondylodesis. Healing of the subluxation lasted about six months in both cases.

The effect of gemfibrozil on serum lipids in diabetic patients

The effect of gemfibrozil, a new hypolipidaemic compound, on serum lipids, lipoproteins and ophthalmic signs was studied in 20 diabetics during a 28 week trial. Ten of the patients were taking oral hypoglycaemic agents and another ten insulin. Genfibrozil elevated the proportion of alpha-lipoproteins (HDL) (P less than 0.005) in patients on oral agents to the same level as in those using insulin, who experienced no change in HDL. The pre-beta-lipoprotein proportion (VLDL) decreased (P less than 0.001) along with the serum triglyceride level in patients on oral agents only. The proportion of beta-lipoproteins (LDL) remained unchanged in both groups. The serum cholesterol and total lipid levels decreased significantly whether the patients were on oral treatment or insulin. The gemfibrozil was well tolerated. A minor increase in diabetic therapy was made in 9 patients in order to control the blood sugar levels. The ophthalmic signs were generally unchanged.

Bacteriology of the chronically discharging middle ear

Suitable bacteriological techniques revealed anaerobic bacteria in 38 (33%) of 114 chronically discharging middle ears. The genus Bacteroides was cultured from 25 ears. Aerobic bacteriology showed the predominance of staphylococci, facultative enteric gramnegative rods, diphtheroid bacilli and Pseudomonas species. Anaerobic bacterial cultures were always mixed with aerobic bacteria. 12 ears were culture-negative, and 9 of the 108 Gram-stained smers revealed no bacteria. No significant difference in bacteriology was noted between ears with or without local antimicrobial treatment, or between profusely draining or only moist ears. The ears with postoperative recurrent infection or with clinical suspicion of cholesteatoma grew anaerobes significantly more often, and were seldom sterile. Because anaerobic bacteria are frequently associated with chronic otitis media, their characteristics with regard to susceptibility to antimicrobials and to air must be remembered in the choice of therapy.

A new cause of increased serum aspartate aminotransferase activity

Two healthy young women had an unexplained persistent elevation of aspartate aminotransferase (ASAT) activity. In both cases electrophoresis of serum ASAT isoenzymes displayed an abnormally moving fraction that comprised the whole serum activity, while liver and muscle revealed the normal cytoplasmic and mitochondrial isoenzymes. In the first case serum ASAT was found to be bound by serum IgG, in the second case the binding protein remained unidentified.

Anaerobic bacteria in chronic otitis media

The bacteriology of 70 consecutive cases of active chronic otitis media was studied. Using appropriate technology, anaerobic bacteria were recovered in 33%, Bacteroides species accounting for one half of them. They were always found in mixed infections involving the average of 3.8 bacteria, 1.9 anaerobic, and 1.9 facultative species. The bacteriology was relatively stable from one ear to the other in the ten bilateral cases studied. The results were alike in the groups differing with respect to local antimicrobial therapy or appearance of the middle ear discharge. The cases with chronic otitis in spite of previous radical surgery presented more often with anaerobic infection than the unoperated ones, and none of them yielded sterile cultures. The recognition of anerobic middle ear infections may be clinically significant because the susceptibilities of the organisms to antimicrobial agents and to air are characteristically different from those of aerobic or facultative bacteria.

Human serum and myocardium digoxin

Linear correlation was demonstrated between serum digoxin and papillary muscle digoxin concentrations in patients undergoing mitral valve surgery. The mean ratio of myocardial tissue to serum digoxin concentrations was 6711. This result supports the use of serum digoxin as a guide for assessing the degree of digitalization under steady-state conditions.

Therapeutic and toxic lanatoside C serum concentrations in hospital patients

Serum lanatoside C concentrations were measured by radioimmunoassay in 56 patients on oral maintenance therapy. Seven patients were judged to have digitalis toxicity and the lanatoside C concentration in this group was 6.99+/-2.00 ng/ml (mean +/-1 SD). 49 patients were non-toxic and the mean serum lanatoside C concentration in this group corresponded to 2.32+/-1.08 ng/ml.

Determination of amylase activity and amylase isoenzymes in serum and urine using a solid phase blue starch substrate

The alpha-amylase of serum and urine was determined in 40 healthy people using the modified "Phadebas Amylase Test". The original method was modified by decreasing the incubation volume to one millilitre and by adding to all urine speciemens a small amount of albumin in saline. The normal values obtained are slightly higher than those obtained by the original method. The amylase isoenzymes were likewise determined from the serum and urine of the same 40 healthy people. For separation were used electrophoresis on cellulose acetate and Phadebas tablets as substrate. These urine and serum isoamylases were investigated and compared. The distributions obtained deviate somewhat from ones reported earlier. The clinical usefulness of isoamylase is briefly discussed.