Management of the acute burn wound: an overview

Goals for managing an acute burn wound are similar to those of other wounds such that infection and scar formation are minimized, a moist wound environment is provided, and the surrounding tissue is protected from trauma. A variety of cleansing techniques are used with burn wounds, including local wound care and nonsubmersion and immersion hydrotherapy. Topical agents have significantly decreased the development of burn wound sepsis since the 1960s, and now various experimental agents are being investigated to improve wound healing. The choice of dressings depends on many patient and wound-related factors, and synthetic, biologic, and biosynthetic dressings are used to treat the different depths of burn wounds. However, skin grafts and the newer cultured skin substitutes remain the mainstay for healing a full-thickness burn wound.

Mathematic model to estimate change in burn scar length required for joint range of motion

Burn scar contracture results from an insufficient amount of extensible tissue to permit complete range of motion. The purpose of this study was to develop a mathematic model to estimate additional tissue length required for full range of motion in the presence of a scar contracture. Seven areas with a known predilection for burn scar contracture were assessed. Twenty-five volunteers with normal range of motion had the length of their limbs measured at predetermined angles. Changes in limb length through range of motion were documented. On the basis of these changes, a mathematic model was developed to estimate the additional amount of tissue length required to complete range of motion for each area. This information may be useful to determine burn patient rehabilitation potential or need for reconstructive surgery.

To splint or not to splint--past philosophy and present practice: Part I

The purposes of this study were to document (1) the historical use of splints, (2) record the current practice of splint application, and (3) compare splint philosophy of the past with present practice. One hundred burn references were reviewed for information on the past use of splints. Present practice was determined on the basis of a survey of 99 burn centers. Information is presented as to when splints are applied to burn patients in their course of recovery for 12 body areas prone to scar contracture. The influence of burn depth is noted. A change in the practice of applying splints to burn patients appears to have occurred. Part I of this series describes the global results and details whether splints are necessary.

Functional outcomes for the patient with burn injuries

In health care, outcome measures have become important tools to assist with monitoring the efficacy of therapeutic interventions. This article defines functional outcomes and describes why therapists should begin monitoring the care of patients with burn injuries in terms of function. Suggestions are provided on the identification and documentation of functional outcomes for patients with burn injuries.

[Intrathoracic textiloma after cardiac surgery. Apropos of a case]

The authors report an exceptionally rare case of intrathoracic textiloma presenting with a recurrence of chest pain after myocardial revascularisation by double internal mammary artery bypass grafting. The diagnosis was suspected before reoperation from the results of echocardiography. CT scanning and magnetic resonance imaging. The authors discuss the clinical and paraclinical features and the treatment. The medico-legal aspects of this surgical complication are not negligeable.

Dynamic versus static splints: a prospective case for sustained stress

Application of constant tension to elongate tissue has been shown to be beneficial. A dynamic splint was used to achieve tissue creep and full elbow extension. Use of a static splint on the contralateral elbow did not allow elbow extension. This case report demonstrates for this patient the superiority of a dynamic elbow extension splint over a static splint when used to correct progressive loss of elbow range of motion.

Anticipated affective reactions and prevention of AIDS

Controlling the AIDs epidemic may depend largely upon health education aimed at adolescents. A number of approaches have been applied to human immunodeficiency virus (HIV) preventive behaviour in adolescents, including the health belief model (Becker, 1974), protection motivation theory (Rogers, 1983), and the theory of planned behaviour (Ajzen, 1985, 1991). Since sexual behaviour is heavily influenced by emotions, a possible shortcoming of these models is that little attention is given to affective processes. In this study we investigated the role of anticipated, post-behavioural, affective reactions to (un)safe sexual behaviours in the context of the theory of planned behaviour (TPB). The results showed that anticipated affective reactions such as worry and regret predicted behavioural expectations over and above the components of the TPB. The implications for our understanding of adolescent sexual behaviour and for campaigns aimed at the reduction of risky sexual practices will be discussed.

Spatiotemporal gait parameters measured using the Bessou gait analyzer in 79 healthy subjects. Influence of age, stature, and gender. Study Group on Disabilities due to Musculoskeletal Disorders (Groupe de Recherche sur le Handicap de l'Appareil Locomoteur, GRHAL)

The Bessou gait analyzer provides quantitative measurements of spatiotemporal gait parameters. The purpose of this study was to determine whether and how these parameters are influenced by age, stature, and gender. Seventy-nine normal individuals (38 males aged 20 to 80 years and 41 females aged 20 to 80 years) were divided into ten-year age groups. Males and females were studied separately. In each subject, the Bessou gait analyzer was used to measure spatiotemporal gait parameters (spatial parameters: stride and step lengths; temporal parameters: cycle, stance and swing durations). Mean walking speed was calculated in each subgroup. In both males and females, all study parameter values were identical for the left and right sides. Females younger than 60 years had shorter stride and step lengths (M: 1.5 +/- 0.2 m; F: 1.3 +/- 0.1; p < 0.001) but faster pace values (M: 104.8 +/- 9.0 cycles/min; F: 115.6 +/- 7.6 cycles/min; p < 0.001) than males, and consequently mean walking speed was similar in females and males (M: 4.8 km/h +/- 0.8 km/h; F: 4.4 km/h +/- 0.6 km/h). In contrast, females older than 60 years walked at the same pace as males and consequently had slower walking speeds. Stride length was correlated with age, stature, and gender. However, age was correlated with stature, and only age and gender had independent effects on gait parameters in the multiple regression analysis. In subjects of similar age and gender, effects of stature may need to be taken into account.

[Course of the left ventricular mass in a population of 893 hypertensive patients. Effects of treatment with perindopril]

Left ventricular hypertrophy is now recognized to be a major and independent risk factor of mortality and morbidity. Although all classes of antihypertensives are able to reduce left ventricular mass, two recent metaanalyses have shown that ACE inhibitors are the most effective. The antihypertensive efficacy of perindopril in man is accompanied with a significant improvement in the functional properties of large arteries and with a reduction of LVH. This study was designed to assess the course of left ventricular mass by echocardiography in a population of 893 hypertensive patients with moderate left ventricular hypertrophy, treated with perindopril for 3 months. A significant fall in blood pressure was observed by the 6th week. The morphological and functional echocardiographic parameters on a large population provided more valid statistical results than in a small series. The left ventricular cavity was found to undergo symmetrical remodelling, adapted to the new haemodynamic status. The reduction of the thickness of the wall was in line with the reduction of the size of the ventricular chamber, and left ventricular mass was reduced by 8% (p < 0.001). Systolic function was preserved and diastolic function was improved. In particular, the E/A ratio was increased by 8% (p < 0.001) and the duration of isometric relaxation was decreased by 11 ms (p < 0.02). This improvement of filling was confirmed by the reduction of the diameter of the left atrium by 0.2 mm (p < 0.001). This open study in 893 patients therefore confirmed that perindopril corrects LVH in hypertensive patients.

Aspergillus spondylodiscitis: successful conservative treatment in 9 cases

OBJECTIVE

To assess the effectiveness of medical treatment by clinical, radiological, and biological analysis of outcome in 9 patients with aspergillus spondylodiscitis.

METHODS

Retrospective study including 9 patients with aspergillus discitis, in which 7 were immunosuppressed; 3 were heart transplant patients, 2 had acute lymphoblastic leukemia, 1 hairy cell leukemia and one was receiving prednisone for bronchial asthma. Four patients had isolated spinal aspergillosis infection. In 4 cases, disc space infection occurred after pulmonary aspergillosis. In the last case the spondylodiscitis occurred after aspergillus endocarditis and mycotic limb embolism. In all cases a percutaneous needle biopsy of the intervertebral disc was performed; the subsequent culture produced Aspergillus fumigatus in 8 cases and Aspergillus flavus in 1. Itraconazole was given to all patients (mean dose: 350 mg/day); it was given alone in 2 cases, in addition to 5 flucytosine and amphotericin B in 6 cases, and in addition to amphotericin B in the last case.

RESULTS

Improvement was obtained in the 9 cases, with full recovery in the absence of any surgical debridement after a mean treatment duration of 5.5 months and a mean followup delay of 16 months.

CONCLUSION

Early recognition of aspergillus spondylodiscitis in immunocompromised hosts is important. Itraconazole alone or in combination is an effective therapy. There may be an increased incidence of aspergillus discitis due to the increasing frequency of immunosuppression associated conditions including organ transplantation, chemotherapy, or acquired immune deficiency syndrome.

Changing adolescents' sexual behaviour: perceived risk, self-efficacy and anticipated regret

This article focuses on determinants of adolescent AIDS-related behaviour. First, we will focus on the perception of risk for AIDS and possible optimistic biases in perceived risk. The behavioural consequences of optimism or perceived invulnerability will be briefly discussed. Next, we will focus on other determinants of sexual risk behaviour, i.e. self-efficacy and anticipated regret. Gender differences in the predictive power of these factors will be discussed. Finally, we will summarize the results of a series of studies investigating the role of anticipated regret as a determinant of adolescent sexual risk behaviour. The possible contribution of stressing anticipated regret in prevention programs aiming adolescents to adopt safer sex practices will be discussed.

The effect of extremity range of motion on vital signs of critically ill patients and patients with burns: a pilot study

The purpose of this study was to evaluate the effects of range-of-motion exercise on vital signs of critically ill patients. The vital signs of 10 consecutive critically ill patients were evaluated during passive and active-assistive range-of-motion exercise. Vital signs monitored were heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. The average length of an exercise session was 22.6 minutes. No clinically significant difference was found between pretreatment and treatment heart rate, systolic blood pressure, diastolic blood pressure, or mean arterial pressure. It appears from this study that passive and active-assistive range-of-motion exercise can be performed safely, without unnecessary physiologic stress, on critically ill patients.

The wide variety of designs for dorsal hand burn splints

A search of the burn literature to find standard dimensions for fabrication of a typical splint to use with patients with a dorsal hand and finger burn is an elusive endeavor. The original impetus for such a search stemmed from a discussion with a student therapist on how to properly splint a burned hand. An ongoing interest was sustained when no one set of universal dimensions for a hand splint design was found to exist. In fact, the literature is replete with numerous individual recommendations on the dimensions to make such a hand splint. In general, dorsal hand burn splints can be classified either as position of function or antideformity splints. However, there is little agreement among authors about how to make these splints. The purpose of this investigation was to document the wide range and variable designs among splints for dorsal hand burns and present the findings for use as a resource guide when making decisions about their fabrication.

Hypothermia and bleeding during abdominal aortic aneurysm repair

Patients undergoing abdominal aortic aneurysm repair routinely have a depressed core body temperature during surgery, and hypothermia is known to cause abnormalities in coagulation. This study was designed to determine whether platelet function is altered as a result of hypothermia or heparin during abdominal aortic aneurysm repair. Ten patients scheduled for abdominal aortic aneurysm surgery were prospectively studied. Bleeding times and temperature were measured every hour beginning preoperatively. Each patient was heparinized intraoperatively, and the effects reversed with protamine sulfate prior to closure. Despite efforts to keep the patients warm, all of them developed hypothermia (mean lowest core temperature 34.8 +/- 0.7 degrees C). A significant linear relationship between the change in core temperature and the change in bleeding time was demonstrated. In 7 of 10 cases the greatest change in bleeding time occurred when patients experienced the lowest mean core temperature and not when they were heparinized. These data suggest that hypothermia has a marked effect on platelet function during abdominal aortic aneurysm repair. Although heparin can cause abnormalities in platelet function, hypothermia may be a more important role in inhibiting normal platelet function. By preventing severe hypothermia (< 35 degree C), excessive bleeding associated with abdominal aortic aneurysm repair may be minimized without the concomitant risk of blood product transfusion.

The effect of mechanical compression on chronic hand edema after burn injury: a preliminary report

Chronic hand edema after wound healing is a troublesome condition to treat in patients with burns. Stagnant edema can cause fibrosis, which impedes rehabilitation and may lead to deformity. Although favorable results have been reported with mechanical compression used in acute injuries, no literature was found on the effects of compression for the treatment of chronic hand-burn edema. Five male patients with nine chronically edematous burned hands were subject to mechanical compression at 55 mm Hg pressure. A single-cell unit was used for a 30-minute treatment at 4:1 treatment ratio. Goniometric and volumetric hand measurements were recorded both before and after treatment. Although patients expressed a subjective feeling of improvement, no statistical difference was found in finger joint range of motion nor in hand volume when comparing pretreatment and posttreatment measurements. Many different treatment protocols exist in the literature and are discussed.

Photographic measurement of volar forearm skin movement with wrist extension: the influence of elbow position

An important function of skin is to allow joint range of motion to occur. An assumed clinical relationship exists between joint movement and skin pliability. The purpose of this research was to document skin movement of the forearm and wrist with photography, to quantify the amount of skin movement during wrist extension, and to investigate the influence of elbow positions on forearm skin movement. Twenty volunteers had markings placed on the skin of the volar forearm. Each subject performed the motion of wrist extension in two elbow test positions of flexion and extension. Photographs were taken of the skin markings at the beginning and end of wrist extension. A significant difference was found in the amount of forearm skin movement that occurred when the elbow was extended and flexed (p < 0.001). These results substantiate the use of multijoint range of motion during burn rehabilitation.

A comparison of the Tanner and Bioplasty skin mesher systems for maximal skin graft expansion

Maximizing wound coverage of patients with burns who have meshed autografts is a primary intervention for wound closure. This study compared the Tanner and Bioplasty skin graft meshing systems for optimal skin graft expansion. Twenty patients for skin grafting were randomly assigned to either a Tanner or Bioplasty skin mesher group. Skin expansion ratios used with the Tanner group were 1.5:1 and 3:1, while Bioplasty ratios included 2:1 and 4:1. The patients' thighs were used exclusively as donor sites, and all grafts were harvested by the same surgeon. Expanded skin ratios were compared as to the difference in percent of predicted expansion outcome compared with the actual areas of the measured skin grafts. Comparing the differences of actual skin expansion with expected expansion, statistically significant results were found. When meshed skin grafts are used for wound closure, a 12.9% to 58.6% greater than anticipated area of donor skin should be harvested based on the expansion ratio selected.

The elderly patient with burns: treatment considerations

When therapists treat elderly patients with burns, they should ask themselves several questions: Am I treating elderly patients with burns "just like other patients with burns?" Am I assessing the patient's joint mobility and strength as critically as I should? Am I ensuring that further tissue trauma is avoided by instructing the nursing staff in turning/transfer techniques? Am I routinely monitoring heart rate and blood pressure? Am I requiring repetition and practice of exercises before the patient's discharge? Is my patient safe to function in the environment to which he or she is being discharged? Most physical changes in the elderly population are attributed to the aging process but often are due to diminished movement disorders arising from poor physical fitness and disuse. The "slowdown" in the older adult may result from a lack of appropriate movement practice and failure to receive reinforcement for activity. Regardless of age, physiological challenges result in enhanced functional status. Training for a specific skill increases performance in that skill just as strength training increases strength. Practice or repetition of a task improves movement and response time for that task. Appropriate physical training programs for the elderly can (1) counterbalance age-associated declines in work capacity and physical performance; (2) maintain and improve range of motion, strength, flexibility, balance, and endurance; and (3) reduce the disability of the cardiovascular, respiratory, and musculoskeletal systems that may result in decreased risk of falls and accidents. Practice of a task and maintenance of physical fitness helps ensure a high level of motor performance and speed as a person grows older. One is never too old to exercise!

A silver anniversary tribute to therapists of the American Burn Association

The year 1993 marks the Twenty-fifth Anniversary of the American Burn Association (ABA). Since Dr. Curtis P. Artz extended an invitation for membership in 1968, therapist membership has increased to 387 current members. During the quarter century the ABA has met, therapists have presented 211 abstracts, and 17 therapists have presented instructional courses and educational symposia. Thirty-three therapists have moderated correlative sessions, and 95 therapists have fulfilled this capacity for Breakfast Symposia. The OT/PT Special Interest Group has been lead by 12 therapists, whereas 30 therapists have participated in two rehabilitation workshops. On the organizational level, three therapists have served as At-Large Members to the Board of Trustees, whereas 11 others have served on the At-Large Advisory Board. Sixty-three therapists have worked on 11 ABA committees. As senior authors, therapists have had 118 articles published in the Journal of Burn Care & Rehabilitation. In addition, four therapists have served the Journal in an editorial capacity. Therapists have been recognized for their efforts as recipients of Distinguished Service Awards, Educational Exchange Grants, and President's Continuing Education Awards.

[Aspergillus spondylodiscitis. Apropos of 3 cases]

Three cases of Aspergillus discitis are reported in immunodepressed patients. Vertebrae osteomyelitis was preceded in 2 cases by pulmonary infection. The diagnosis was established in every case by disc aspiration or closed-needle-biopsy and mycological examination of the material. Aspergillus fumigatus was identified in two cases; in one case itroconazole led to recovery within three months.

Clinical trials of an intravenous oxygenator in patients with adult respiratory distress syndrome

In patients with severe adult respiratory distress syndrome, mechanical ventilation may not be able to ensure gas exchange sufficient to sustain life. We report the use of an intravenous oxygenator (IVOX) in five patients who were suffering from severe adult respiratory distress syndrome as a result of aspiration, fat embolism, or pneumonia. IVOX was used in an attempt to provide supplemental transfer of CO2 and O2 and thereby reduce O2 toxicity and barotrauma. All patients were tracheally intubated, sedated, and chemically paralyzed and had a PaO2 < 60 mmHg when the lungs were ventilated with an FIO2 = 1.0 and a positive end expiratory pressure of > or = 5 cmH2O. The right common femoral vein was located surgically, and the patient was systemically anticoagulated with heparin. A hollow introducer tube was inserted into the right common femoral vein, and the furled IVOX was passed into the inferior vena cava and advanced until the tip was in the lower portion of the superior vena cava. IVOX use ranged from 2 h to 4 days. In this group of patients, IVOX gas exchange ranged from 21 to 87 ml x min-1 of CO2 and from 28 to 85 ml x min-1 of O2. One of the five patients survived and was discharged from the hospital. The IVOX transferred up to 28% of metabolic gas-exchange requirements. One patient with a small vena cava showed signs of caval obstruction. Three other patients demonstrated signs of a septic syndrome after the device was inserted.(ABSTRACT TRUNCATED AT 250 WORDS)

Canine GM1-gangliosidosis. A clinical, morphologic, histochemical, and biochemical comparison of two different models

The clinical, morphologic, histochemical, and biochemical features of GM1-gangliosidosis in two canine models, English Springer Spaniel (ESS) and Portuguese Water Dog (PWD), have been compared. The disease onset, its clinical course, and survival period of the affected dogs were similar in both models. Skeletal dysplasia was noted radiographically at 2 months of age, whereas at 4 1/2 months of age there was progressive neurologic impairment. However, dwarfism and coarse facial features were seen only in ESS. Both models had similar deficiency in activity of lysosomal beta-galactosidase, but possessed a normal protein activator for GM1-beta-galactosidase. Both models stored GM1-ganglioside, asialo-GM1, and oligosaccharides in brain. Furthermore, only the PWD stored glycoproteins containing polylactosaminoglycans in visceral organs, and neither model stored them in the brain. Morphologically, both models demonstrated similar storage material in multiple tissues and cell types. The ultrastructure of the storage material was cell-type specific and identical in both models. However, some differences in the lectin staining pattern were noted. Our clinical, biochemical, and histochemical findings indicate that PWD and ESS may represent two different mutations of the beta-galactosidase gene. Moreover, the authors conclude that it is difficult, and inappropriate, to apply the human classification of GM1-gangliosidosis (i.e. infantile, juvenile, and adult forms) to these canine models.

Clinical, neurophysiological, biochemical and morphological features of eyes in Persian cats with mannosidosis

The clinical, neurophysiological, morphological and biochemical manifestation of eyes from Persian kittens affected with alpha-mannosidosis were studied. Clinically the disease is characterized by progressive corneal and lenticular opacification. In addition there is asymmetry in shape and latency of signal conductions which were demonstrated by visual evoked potential studies. Morphological and histochemical studies revealed vacuolization of various ocular cell types which stained positively with Concanavalia ensiformis agglutinin (Con A) and wheat germ agglutinin (WGA). Biochemical studies illustrated low activity of acid alpha-mannosidase in cultured keratocytes and abnormal storage of partially degraded oligosaccharides in these cells, in vitreous humor and lens. This comprehensive study of ocular alpha-mannosidosis demonstrates enzyme deficiency which leads to abnormal storage of oligosaccharides in affected cells and is manifested by morphological alterations and functional impairment.

Glycoprotein storage in Gaucher disease: lectin histochemistry and biochemical studies

Lectin histochemical studies were performed on formalin-fixed, frozen, and paraffin-embedded tissue sections from 19 patients with glucosylceramide lipidosis (i.e., Gaucher disease). Eleven different lectins were used to identify the specific carbohydrate residues in the undegraded stored compounds in the cytoplasm of Gaucher cells. In all cases studied, Gaucher cells stained with Concanavalia ensiformis agglutinin, Datura stramonium agglutinin, Lens culinaris, Ricinus communis agglutinin-I, and wheat germ agglutinin. These results demonstrated common carbohydrate residues in the undegraded material stored within Gaucher cells and indicated the presence of fucosylated N-linked complex oligosaccharides, and glycans containing N-acetyllactosamine repeating sequences, as well as nonreducing terminal beta-galactosyl and sialyl residues. In order to confirm these findings using biochemical methods, livers and spleens from Gaucher patients and controls, and from a patient with Niemann-Pick disease type C (included for comparison) were digested with Pronase and the resulting glycopeptides separated by gel filtration into fractions with high and low molecular weight. In the high-molecular-weight fractions from livers of Gaucher patients, the levels of sugars corresponding to N-linked glycans, as measured by gas-liquid chromatography, were elevated over those in controls. In the high-molecular-weight fractions from spleens, the levels of the same sugars were elevated in both Gaucher and Niemann-Pick type C patients. Digestion of the glycopeptides with endo-beta-galactosidase, which specifically cleaves polylactosaminoglycans, showed the presence of material containing N-acetyllactosamine repeating units in Gaucher liver glycopeptide fractions, but not in control and Niemann-Pick type C derived glycopeptide fractions. Our histochemical and biochemical studies demonstrated that in addition to glucosylceramide, affected tissues of patients with Gaucher disease accumulate glycoproteins. This accumulation could not have been predicted on the basis of the primary enzymatic defect.

Steady-state levels of pro-dynorphin-related end-products from the brain of the amphibian, Xenopus laevis

Steady-state analyses of prodynorphin-derived opioid peptides were conducted on acid extracts of the brain of the frog. Xenopus laevis. Radioimmunoassays specific for dynorphin A(1-17), dynorphin A(1-8), alpha-neoendorphin and dynorphin B coupled with gel filtration chromatography and reverse phase high performance liquid chromatography were used. The major prodynorphin-related end-product detected was alpha-neoendorphin. Interestingly, Leu-enkephalin was also detected. Since the Xenopus proenkephalin precursor does not contain the Leu-enkephalin sequence, these data suggest that some of the prodynorphin-related end-products had been cleaved to yield Leu-enkephalin.

Effects of breathing a normoxic He-O2 gas mixture on exercise tolerance and VO2 max

The purpose of these experiments was to compare the effects of breathing air (79% N2-21% O2) and a normoxic helium oxygen gas mixture (He-O2) (79% He-21% O2) on maximal oxygen uptake (VO2 max) and work tolerance during both incremental and high-intensity constant load exercise. First, eight subjects underwent two separate short incremental cycle ergometer exercise tests until the subject could not maintain the desired power output. Second, four subjects exercised to exhaustion on two separate occasions at a constant exercise intensity (100% VO2 max). Each exercise protocol required the subject to breathe air on one test and a normoxic He-O2 mixture on an additional occasion. Data analysis revealed higher (P less than 0.05) minute ventilations, an increased time to exhaustion, and a greater VO2 max during He-O2 breathing in both exercise conditions. Small but significant (P less than 0.05) differences existed in the percent hemoglobin saturated with O2 (% SO2) at exercise demands greater than 120 W during the incremental experiment and during each minute of the constant load test with He-O2 giving the higher value. These data support the hypothesis that breathing a normoxic He-O2 gas mixture during exercise elevates VO2 max and increases exercise tolerance. Further, although it appears that breathing a He-O2 mixture results in higher %SO2 during intense exercise, the increase in arterial O2 content is small and probably does not fully account for the higher VO2 max observed under these conditions.

Unilateral Meniere's disease: is the contralateral ear normal?

Certain investigations in patients with unilateral Meniere's disease may on occasion show abnormalities in the completely symptomless contralateral ear. These tests include transtympanic electrocochleography, the acetazolamide cochlear hydration test, vestibular aqueduct tomography, and caloric testing. Eventually these ears may well become symptomatic. Previous studies have shown that otoadmittance changes are a sensitive indicator of glycerol-induced intracochlear pressure alterations in hydropic ears, but do not occur in patients without Meniere's disease. Otoadmittance parameters were evaluated in the asymptomatic ears of 73 consecutive patients with unilateral Meniere's disease. Satisfactory traces and adequate dehydration were achieved in fifty-nine. A significant change in the maximum conductance, similar to that often seen in symptomatic hydropic ears, was found in twenty-four cases (40.7%). The presence of functional abnormalities in well over one-third of asymptomatic ears means that they cannot be used as controls in clinical research studies. Furthermore, recognition of contralateral latent hydrops at the initial otologic assessment may modify the subsequent treatment strategy.

Otoadmittance changes following glycerol dehydration in Meniere's disease

Otoadmittance studies were undertaken in 76 patients with Meniere's disease and 8 control subjects undergoing glycerol dehydration. Baseline otoadmittance values were significantly higher in ears with fluctuant hydrops compared to the non-fluctuant ears (p less than 0.01), suggesting that there is a pathophysiological difference between these clinical Meniere's groups. Significant maximum conductance changes were seen in 53.4% of hydroptic ears, and were associated with subjective audiometric threshold shifts in 23.2%. Similar changes were not seen in the control ears. These findings provide further clinical evidence to support an underlying physical basis for the auditory symptoms of endolymphatic hydrops and the effects of glycerol dehydration on the inner ear. Objective otoadmittance changes appear to be a more sensitive indicator of reversible hydrops than conventional audiometry. Possible mechanisms to explain the somewhat paradoxical increase in the resistance to the flow of sound energy through the cochlea following reduction of the endolymphatic hydrops by glycerol dehydration are discussed.

Uptake of tritium-labelled biogenic amines by the prostomium of the polychaete Nereis virens (Sars) (Annelida)

The uptake of tritium-labelled 5-HT, noradrenaline, 5-hydroxytrytophan, DOPA and dopamine by the cerebral ganglion and prostomial nervous system of the polychaete Nereis virens has been examined using radioautography at the level of the light microscope. Pronounced uptake of (3)H-5HT occurred in the antennal, palpal, tegumentary and nuchal nerves as well as in ganglionic nuclei 13, 14, 15, 16, 17, 20, 24 and 25, the mid-brain neuropile, the neurosecretory neuropil and the infracerebral organ; (3)H-NA uptake was observed in small cells in the prostomial epidermis, and the infracerebral organ; (3)H-dopamine only in one of two common types of epidermal mucus cells. Prostomial muscles labelled generally with (3)H-NA and at specific sites with (3)H-5HT. These observations support the concept of an efferent serotonergic system originating in several cerebral ganglionic nuclei and serving prostomial muscle and epidermis. Evidence for an afferent adrenergic system is less substantial. The role of dopamine remains obscure.

[Sclerosing injections of oesophageal varices. Analysis of 247 cases treated between 1964 and 1977 (author's transl)]

The authors analyse 247 cases of haemorrhagic oesophageal varices treated using sclerosing injections of Quinine-Urea between 1964 and 1977. Portal hypertension as a result of intrahepatic block accounted for 83% of the patients (alcoholic cirrhosis 65%, meta-icteric 12%) and cavernomas 11%. Sclerosing injections were used in patients refused by surgeons (85%) or after the failure of surgery (15%). Only 11 cases were treated during the period of active haemorrhage, and the others during the following weeks. Tolerance of treatment so long as all safety factors were employed routinely in order to deal with any possible haemorrhagic complications. Deaths due to the method totalled 2.8%, including those due to worsening of the underlying disease. Overall results were of 69% survival of more than one year, 40% at more than 3 years and 24% at more than five years. For alcoholic cirrhosis, these figures were respectively 62, 30 and 18%. The prognosis in cases of cavernoma was much better; 80% survival at more than 5 years.

[Sclerosis of esophageal varices. Results of 10 years experience]

Before they give their results, the authors, whose experience of sclerosis of oesophageal varices under the oesophagoscope has so far involved 157 patients, deal specifically with the problems facing the anaesthetist and resuscitator when this technique is used, tolerance of the product injected and possible accidents. Firstly, they point out the unsuitability of the patients referred to them by their medical or surgical colleagues. By implication therefore, treatment should only be undertaken with the assistance of a team of experienced resuscitators and every precaution taken to mitigate the effects of possible accidents to these patients who are particularly at risk. These cases are mainly characterized by serious haemorrhages (seven cases described, one resulting in death). Oesophageal injury is, on the other hand, the exception where trained personnel are involved (2 minor mucosal tears out of more than 800 oesophagoscopies). Finally, secondary parietal oesophageal necrosis occurs. Quininaemia assessment after injection of quinine-urea confirms that the product is being efficiently eliminated. Overall results reveal a survival rate of 61 p. 100 after more than a year and 20 p. 100 after more than than three years. These figures underline the limitations of therapeutic possibilities and the serious prognosis for this result of portal hypertension. This leads the authors to express a wish that the procedure should be used as a measure to prevent haemorrhage as soon as the presence of varices is realized. On the other hand, they reject on practical grounds emergency sclerosis of oesophageal varices, as a direct heamostatic method, since, according to their statistics, this almost invariably results in failure.