Treatment of phonic tics in patients with Tourette's syndrome using botulinum toxin type A

We assessed the effect of botulinum toxin type A (BTX-A) on phonic tics in patients with Tourette's syndrome. A total of 30 patients received 2.5 IU BTX-A (BOTOX; Allergan) in both vocal cords. All patients were assessed after 15 days and then 4 times over a 12-month period. At each visit the following data were collected: phenomenology of tics, global impression of changes by physician and patient, number of BTX-A injections given, interval between injections, time to response, duration of response, presence of post-injection hypophonia and side effects, presence of premonitory sensory tic component, and interference with social life and work or school activities. Vocal tics improved after treatment in 93% patients, with 50% being tic-free. Mean response time was 5.8 days, and mean duration of response was 102 days. Quality of life improved, and premonitory experiences dropped from 53% to 20%. Hypophonia was the only side effect of note (80% of patients). BTX-A is an effective and safe treatment for phonic tics associated with Tourette's syndrome.

Fosmidomycin-clindamycin for Plasmodium falciparum Infections in African children

BACKGROUND

Fosmidomycin is a new antimalarial drug with a novel mechanism of action. Studies in Africa that have evaluated fosmidomycin as monotherapeutic agent demonstrated its excellent tolerance, but 3-times-daily treatment regimens of >or=4 days were required to achieve radical cure, prompting further research to identify and validate a suitable combination partner to enhance its efficacy.

METHODS

We conducted a randomized, controlled, open-label study to evaluate the efficacy and safety of fosmidomycin combined with clindamycin (n=12; 30 and 5 mg/kg body weight every 12 h for 5 days, respectively), compared with fosmidomycin alone (n=12; 30 mg/kg body weight every 12 h for 5 days) and clindamycin alone (n=12; 5 mg/kg body weight every 12 h for 5 days) for the clearance of asymptomatic Plasmodium falciparum infections in schoolchildren in Gabon aged 7-14 years.

RESULTS

Asexual parasites were rapidly cleared in children treated with fosmidomycin-clindamycin (median time, 18 h) and fosmidomycin alone (25 h) but slowly in children treated with clindamycin alone (71 h; P=.004). However, only treatment with fosmidomycin-clindamycin or clindamycin alone led to the radical elimination of asexual parasites as measured by day 14 and 28 cure rates of 100%. Asexual parasites reappeared by day 28 in 7 children who received fosmidomycin (day 14 cure rate, 92% [11/12; day 28 cure rate, 42% [5/12]). All regimens were well tolerated, and no serious adverse events occurred.

CONCLUSION

The combination of fosmidomycin and clindamycin is well tolerated and superior to either agent on its own with respect to the rapid and radical clearance of P. falciparum infections in African children.

Swallowing disorders: management data

Aim of the investigation was to assess the workload and verify the results of oropharyngeal dysphagia management in a large state hospital by means of a descriptive, observational prospective study and descriptive statistical analysis. 81 patients [37 females, 44 males, mean age 61.3 (+/- 13) years] suffering from oropharyngeal dysphagia were evaluated and treated in the in- and outpatient Divisions of the "Azienda Ospedaliera S. Giovanni Battista" in Turin. Treatment of oropharyngeal dysphagia included changes in consistency and texture of food, compensatory postures of head, strengthening exercises for oropharyngeal muscles, and stimulation of pharyngeal sensitivity. In data collection and analysis, the following were used as outcome measures: mode of nutrition delivery (oral, enteral, parenteral), dietary adjustments, presence of aspiration or penetration, and use of compensatory head positioning. Results showed that the number of patients fed by parenteral or enteral tube (50/81 prior to treatment) dropped to 36/81 upon discharge from hospital. Those unable to take anything by mouth, from 55 dropped to 9. The number of patients with aspiration or penetration dropped, respectively, from 47 and 8 to 20 and 4. Postural changes were used in 15 cases. Data obtained indicate that oropharyngeal dysphagia rehabilitation outcomes are promising. Better understanding of the rheological characteristics of food and a stricter, more rigorous evaluation of the outcomes on activities and social participation are warranted.

Comparison between two perception tests in patients with severe and profoundly severe prelingual sensori-neural deafness

Patients with severe and profoundly severe bilateral sensorineural prelingual deafness constitute a group of particular interest in the organization of the National Health Service; every patient must, in fact, follow a prosthetic-rehabilitative-educational programme lasting many years and organized under different areas to compensate for his/her communicative difficulties, especially with regard to the speech canal. No reliable data providing details of the efficacy and efficiency of any of these points is available. A critical point in the rehabilitation process is that of auditory perception training. Of the few auditory perception tests presently available in Italian, the following were examined: namely, EARS (Evaluation of Auditory Responses to Speech) battery, on the one hand, and the Italian version of the ESP (Early Speech Perception), GASP (Glendonald Auditory Screening Procedure). NU-CHIPS (Northwestern University Children's Perception of Speech) and WIPI (Word Intelligibility by Picture Identification) tests on the other. A group of 10 patients presenting severe and profoundly severe bilateral sensori-neural prelingual deafness received the two tests at the beginning and after six months of auditory perception rehabilitation. The findings emerging from the two different test sessions were analysed and compared. The EARS battery was seen to have enabled even very early and highly developed stages of auditory perception to be detected in comparison with the other battery, which, however, was more accurate in evaluating the ability to discriminate and identify words on the basis of their spectral characteristics. The Authors propose the combined use of the two test batteries to evaluate the efficacy and efficiency of auditory perception training in patients with severe and profoundly severe bilateral sensori-neural prelingual deafness.

Short-course artesunate treatment of uncomplicated Plasmodium falciparum malaria in Gabon

Artesunate is one of the most important antimalarial agents available, since it is effective against parasites that have developed resistance to conventional antimalarials in sub-Saharan Africa. Antimalarial combination chemotherapies with artesunate (4 mg/kg of body weight once daily for 3 days) as one partner have been proposed. However, the efficacy of a 3-day course of artesunate alone has never been evaluated in individuals in Africa (which has 90% of the worldwide malaria burden) living in regions of hyperendemicity, where a considerable degree of immunity might substantially enhance the efficacy of short courses of artesunate compared to those in regions where the levels of endemicity are low. This lack of information does not permit a systematic assessment of the value of artesunate-based combination chemotherapies in Africa. Therefore, we studied the efficacy and safety of a 3-day course of artesunate (4 mg/kg of body weight, orally, once daily) for the treatment of uncomplicated Plasmodium falciparum malaria in Gabonese patients aged 4 to 15 years (n = 50). Artesunate was well tolerated, and no severe adverse event was reported. Parasite elimination was rapid and was achieved in all patients within < or =72 h (geometric mean time to elimination, 34 h). The PCR-corrected cure rate by day 14 was 92% (46 of 50 patients), but it dropped to 72% (36 of 50 patients) by day 28. We conclude that a 3-day course of artesunate fails to achieve sufficiently high cure rates for uncomplicated falciparum malaria in Gabonese children.

Fosmidomycin, a novel chemotherapeutic agent for malaria

In previous studies, fosmidomycin has been shown to possess activity against Plasmodium falciparum in vitro and in the mouse model. It has a novel mode of action through inhibition of 1-deoxy-D-xylulose 5-phosphate reductoisomerase, an enzyme of the nonmevalonate pathway of isoprenoid biosynthesis, which is absent in humans. In this open-label, uncontrolled trial, the efficacy and safety of fosmidomycin, in an oral dose of 1,200 mg every 8 h for 7 days, were evaluated in the treatment of acute uncomplicated Plasmodium falciparum malaria in 20 adult subjects in Gabon and Thailand. Clinical assessments were performed and thick blood smears were evaluated every 8 h until parasite clearance and resolution of symptoms were achieved; assessments continued at weekly intervals thereafter for the duration of the 28-day followup period. All subjects were clinically and parasitologically cured on day 7 (primary end point). Parasite and fever clearance were rapid, with means of 44 and 41 h, respectively. On day 28, seven out of nine subjects (78%) were cured in Gabon and two out of nine subjects (22%) were cured in Thailand. The drug was well tolerated, although mild gastrointestinal side effects were recorded for five subjects. Analysis of hematological and biochemical parameters showed no clinically significant changes throughout the study. Fosmidomycin is an effective and safe antimalarial drug, although its use as a single agent is restricted by the occurrence of recrudescent infections. However, its role in combination therapy should be explored.

Fosmidomycin for malaria

Safe and effective antimalarial drugs with new methods of action are urgently needed. Fosmidomycin inhibits the synthesis of isoprenoid by Plasmodium falciparum, and suppresses the growth of multidrug-resistant strains in vitro. Our aim was to assess the efficacy and tolerability of fosmidomycin in adults with malaria in Gabon. We administered the drug for 5, 4, or 3 days (1.2 g every 8 h), in nine, eight, and ten evaluable patients, respectively. All treatment regimens were well tolerated. Cure rates by day 14 were 89% (eight of nine), 88% (seven of eight), and 60% (six of ten), for treatment durations of 5, 4, and 3 days, respectively. These data suggest that fosmidomycin is a safe and effective treatment for uncomplicated malaria if given for 4 days or more.

Cloning, genomic organization and expression pattern of a novel Drosophila gene, the disco-interacting protein 2 (dip2), and its murine homolog

We report the cloning and initial characterization of a novel gene encoding the Disco interacting protein 2 (Dip2). dip2 DNA complementary to RNA (cDNA) showed a high degree of sequence similarity to cDNAs of unknown function previously identified in humans and Caenorhabditis elegans. We have cloned the mouse homolog of the dip2 cDNA and characterized the expression of this gene by Northern blotting analysis and in situ hybridization to whole mount embryos. Our observations demonstrate that there is a remarkable degree of sequence conservation at the dip2 locus that is reflected in the nervous system-specific expression of both the Drosophila and mouse homologs.

[Hearing disability in relation to audiometric threshold values: hypothesis on the determination of the onset of hearing loss]

BACKGROUND

The term auditory disability (AD) means the presence of auditory symptoms due to hearing loss. Until now the audiometric threshold cut-off between the presence or absence of AD was not clear.

OBJECTIVES

In this study we attempted to define the value of audiometric threshold that could be considered as the limit between the presence or absence of weakness of auditory function, considered as the threshold as the 95th percentile of subjects that did not report AD.

METHODS

The study group consisted of 1641 males, 891 normally hearing and 750 affected by noise-induced hearing loss (NIHL) Each subject was submitted to a questionnaire specifically created in order to determine the presence of AD.

RESULTS

Statistical analysis confirmed the reliability of answers to items. AD was present in 577 subjects, not all affected by NIHL. Audiometric threshold and age correlated significatively with the degree of AD.

CONCLUSIONS

The results obtained allowed the audiometric threshold values to be determined at the 95th percentile of subjects who did not report AD, in relation to the average of frequencies normally used in hearing loss evaluation.

The effect of single-dose oxytocin application on time to ejaculation and seminal parameters in men

PURPOSE

To report the effect of a single dose of oxytocin on ejaculation time and seminal parameters.

METHODS

The prospective randomized clinical study was performed at a private assisted reproduction technology center and included 103 consecutive healthy men (semen donors or husbands of IVF patients). Oxytocin (16 IU) were administered intranasally to 49 subjects, randomly assigned to the study group just before masturbation to ejaculation. The time needed for ejaculation as well as the semen parameters was recorded according to the WHO standards, and compared to the control group of 54 subjects with no prior oxytocin treatment.

RESULTS

No significant difference was noted between the two groups concerning ejaculation time and semen parameters.

CONCLUSIONS

Although the administration of oxytocin stimulates sexual behavior and performance in mammalian species, our data indicate that oxytocin has no detectable effect on ejaculation time and seminal parameters after intranasal application in normal, healthy men.

[Management of oropharyngeal dysphagia: outcomes in a group of 81 adult patients]

BACKGROUND

Aim of the study is to assess outcomes in the management of 81 patients with diagnosis of oropharyngeal dysphagia.

METHODS

DESIGN

retrospective study on the outcome of logopedic treatment.

SETTING

patients have been assessed and treated as in- and out-patients of the Azienda Ospedaliera "S. Giovanni Battista" of Turin.

PATIENTS

81 patients, 37 female and 44 male, mean age of 61,3 years, with diagnosis of oropharyngeal dysphagia.

INTERVENTION

phoniatric and logopedic assessment and management including: food consistency change, compensatory head posture, oropharyngeal muscle strengthen and pharyngeal sensibility stimulation.

SURVEY

tube feeding, dietary adjustments, presence of aspiration or penetration and postural techniques utilization were used as outcome measures.

RESULTS

The number of patients on tube feeding changed from 50 out of 81 before treatment to 36 out of 81 at discharge time. Subjects who couldn't take anything by mouth decreased from 55 to 9. The number of patients with aspiration or penetration changed respectively from 47 and 8 to 20 and 4. Postural techniques were used in 15 cases.

CONCLUSIONS

The data suggest that outcomes of oropharyngeal dysphagia rehabilitation are promising. The role of tube feeding and of food consistencies is of key importance in the management of deglutition disorders. All clinicians dealing with dysphagic patients should know the importance of food rheologic characteristics, the consequences of alimentation by nasogastric tube and percutaneous endoscopic gastrostomy.

[Validity of operationalized psychodynamic diagnostics]

The paper describes results of "operationalized psychodynamic diagnostics" (OPD) with 54 adolescent and young adult drug addicts prior to outpatient family therapy. Focus of investigation is the prognostic and factorial validity of the OPD-system. Furthermore, relationships between conflicts and psychic structure are investigated. The use of the OPD-system allows a clinical description of the patient sample. Thus, adolescent drug addicts are characterized by autonomy versus dependence and self-esteem conflicts. A neurotic or sometimes borderline level is found on the structure axis. Low scores on the structure axis are significantly correlated with self-esteem conflicts. There is some evidence for the prognostic validity of the OPD I axis. However, prognostic validity of the structure and conflict axes require further research.

Human telomerase reverse transcriptase antisense treatment downregulates the viability of prostate cancer cells in vitro

Telomerase, a ribonucleoprotein complex is activated in the vast majority of human malignancies, including prostate cancer. Its inhibition is a putative way to affect cancer proliferation and might be used in the therapy of tumors. We analysed the influence of antisense phosphorothioate oligonucleotides (PTO) against the reverse transcriptase subunit of telomerase on prostate cancer cell viability, telomerase activity and telomere length. DU145 prostate cancer cells were cultivated in PTO containing medium. The PTO-incorporation was confirmed by confocal laser scanning microscopy. Cell viability was measured by a WST-1 tetrazolium assay. After 15 days of antisense PTO treatment, a significant inhibition of cell viability occurred. Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay and telomere length by Southern blot analysis. Since the long-term telomerase antisense treatment reduces the viability of prostate cancer cells significantly, this antisense approach could be a new therapeutic strategy to treat patients with advanced prostate cancer.

[Hiatal hernia and risk of aspiration in anesthesia induction]

Papers recently published in the literature have questioned whether residual gastric fluid volume at the time of induction is the most important risk factor for pulmonary aspiration. To estimate the risk, more factors than the gastric fluid volume have to be considered. Concomitant diseases such as the hiatal hernia must be considered. Pulmonary aspiration during induction of anaesthesia seems to be caused by a multifactorial process, which consists of gastric fluid volume, anaesthetic technique and concomitant disease. A fifty-year-old man was scheduled for elective cholecystectom. During induction, the patient surprisingly regurgitated and aspirated gastric fluid. Postoperatively, an additional barium-swallowing x-ray examination showed a hiatal hernia. This case report shows that patients who report heartburn in their case history should be prophylactically treated as endangered by aspiration, even when they are considered to have an empty stomach.

Hemichondrodiastasis for the treatment of genu varum deformity associated with bone dysplasias

Hemichondrodiastasis has been reported for treatment of angular deformities in children close to skeletal maturity. The use of distraction through the physis in younger children was not recommended. The authors report three children 3 to 7 years of age who underwent bilateral proximal tibial hemichondrodiastasis for correction of genu varum due to bone dysplasia. Ilizarov external fixators were applied in all cases. The patients underwent gradual angular correction at a rate of 0.5 mm/d. Distraction was continued until a normal mechanical axis was achieved. Normal alignment was achieved in two patients and slight overcorrection in the third. The patients were followed for 3 to 11 years, and no adverse affects on the physis were identified. This is the first report of physeal distraction in patients this young. Our results are good, and we believe that hemichondrodiastasis can be safely used for correction of angular deformities in young children.

Roughness evolution of ion sputtered rotating InP surfaces: pattern formation and scaling laws

The topography evolution of simultaneously rotated and Ar (+) ion sputtered InP surfaces was studied using scanning force microscopy. For certain sputter conditions, the formation of a highly regular hexagonal pattern of close-packed mounds was observed with a characteristic spatial wavelength which increases with sputter time t according to lambda approximately t(gamma) with gamma approximately 0.26. Based on the analysis of the dynamic scaling behavior of the surface roughness, the evolution of the surface topography will be discussed within the limits of existing models for surface erosion by ion sputtering.

Water vapour in a closed anaesthesia circuit reduces degradation/adsorption of halothane by dried soda lime

Dry lime causes a loss of volatile anaesthetics by degrading and adsorbing them. Degradation produces toxic substances and heat. Rehydration of lime stops degradation. If humidified breathing gases rehydrate lime, closed anaesthesia-circuits may reduce the loss of anaesthetics. To test this hypothesis we ventilated a reservoir bag with PhysioFlex-devices using fresh (F) and dried (D) soda lime both in the presence (+H) and absence (-H) of halothane. We measured halothane delivery, humidity, temperature, and lime weight. Halothane was lost for 13 min in D + H. Humidity increased steeper with fresh lime, whereas absorbent weight increased more with dried lime; halothane increased both variables (F + H: 99%, 8 g; F - H: 93%, 6 g; D + H: 58%, 17 g; D - H: 24%, 15 g). Surprisingly, temperature remained constant, probably because of the high gas flow (70 litres min-1) generated inside the Physioflex. These findings indicate rehydration of dried lime by humid gases and a rapid cessation of the loss of halothane in the PhysioFlex.

Accuracy and reproducibility of long-term implanted transit-time ultrasound flow probes in dogs

OBJECTIVE

To assess the accuracy and reproducibility of long-term implanted ultrasound transit-time flow probes for measuring cardiac output.

DESIGN

Prospective animal study.

SETTINGS

Animal research laboratory in a university department.

ANIMALS

Eleven anaesthetised dogs, 24-34 kg.

MEASUREMENTS AND RESULTS

Flow probes (16-24 mm S-series, Transonic) were implanted around the pulmonary artery for a mean duration of 22 months (range 6-47 months). Comparisons (n = 147) were made between cardiac output thus obtained and that measured by the direct Fick principle using oxygen uptake (Deltatrac II Metabolic Monitor) and the arterial to mixed venous oxygen content difference measured by a galvanic cell (Lex-O2-Con-TL). Measurements were made either during baseline conditions or during pharmacologically altered cardiac output (range 22-180 ml x kg(-1) x min(-1)). Regardless of the intervention, the two methods yielded the same results in half of the dogs. In the others, however, cardiac output was underestimated by the flow probes by up to 38% (probably because of non-perpendicular position of the probe towards the vessel). This difference was constant for the whole range of cardiac output studied and remained constant over the entire observation period for each individual dog, so that a correction factor was used. Thereafter, the mean difference between the two methods was -1.1 ml x kg(-1) x min(-1) with a precision (SD) of 14.2 ml x kg(-1) x min(-1) for all experiments.

CONCLUSIONS

After in vivo calibration, ultrasound transit-time flow probes measure cardiac output precisely for several years, regardless of the intervention.

[Iodine therapy for iodine deficiency goiter and autoimmune thyroiditis. A prospective study]

PROBLEM

There is epidemiological and clinical evidence that iodine may induce or promote the manifestation of autoimmune thyroiditis. For this reason it is important to know if substitution of alimentary iodine deficiency or iodine treatment of endemic goitre can cause formation of thyroid antibodies. On the other hand the practical importance of this phenomenon should be evaluated.

PATIENTS AND METHODS

During a prospective study we examined 209 patients with endemic non-toxic goitre and 53 healthy people. For treatment were used 200 micrograms iodine/d (n = 119), 500 micrograms iodine/d (n = 27), 1.5 mg iodine/week (n = 41), 150 micrograms iodine/d plus 75 to 100 micrograms T4/d (n = 26), 100 micrograms iodine plus 100 micrograms T4/d (n = 24). The observation took 1 year with a 3-month interval for check ups including clinical examination, ultrasound, TSH, T3, fT4, TPO- and thyreoglobuline antibodies and urinary iodine.

RESULTS

After 12 months 7.5% of iodine treated persons had produced antibodies, most of them at low levels. In healthy people we found increased antibody-levels in 3.8%, in patients with goitre in 9.0%, in patients with nodular goitres in 11.1%. 500 micrograms iodine caused the most antibody reaction in 14.8%. People treated with 200 micrograms iodine/d showed positive antibody levels in 5%. T4 seems to reduce antibody-reactions. Pathological antibody-levels were not found in patients with combined iodine/T4- and single-T4 therapy. Among the 22 primary pathological antibody levels only 4 increased further (18.2%). Three of them belonged to the group of 5 persons treated with 500 micrograms iodine/d. Primary high antibody values were normalized in 5 patients (22.7%). Hypothyroid disturbances were not found. Ultrasound did not show any alterations, and the reduction of thyroid volumes in antibody-positive patients was not affected. Median urinary iodine excretion during the observation-interval was 5.2 to 7.2 micrograms/dl.

CONCLUSIONS

Possible antibody reactions have no clinical importance at all. Individual cases must be observed. Low iodine doses should be preferred. Combined iodine/T4 treatment seems to have an advantage regarding immunological thyroidal reactions.

[Heparin-induced coagulation disturbance from mechanical autotransfusion]

Disorders in blood coagulation during the use of autotransfusion have been reported in recent literature. We wondered whether or not heparine, remaining in the prepared sample of retransfusion blood might be responsible for these disturbances.

METHODS

Therefore we created a setting in which heparine was added to animal blood in order to imitate clinical situations during the use of the CELL SAVER.

RESULTS

According to our results the blood shows no irregular heparine load as long as the machine is used following the operating instructions. But if the volume of rinsing liquid is decreased or the pumpflow is increased, the heparine load is increased enormously (Table 1).

CONCLUSIONS

If the CELL SAVER is used with reduced volume of rinsing liquid or higher velocity of the pump, the coagulation status of the patient has to be monitored meticously.

Estimation of the lumbar curve magnitude with correction of the right thoracic curve in idiopathic scoliosis

A simple formula was proposed to estimate the magnitude of the postoperative uninstrumented lumbar curve with correction of the right thoracic curve in idiopathic scoliosis. This formula is as follows: PLC < or = LC - 0.5(TC - BTC) (PLC, predicted postoperative standing lumbar Cobb angle; LC, preoperative standing lumbar Cobb angle; TC, preoperative standing thoracic Cobb angle; BTC, preoperative supine lateral bending thoracic Cobb angle). Sixty-five patients' preoperative and postoperative radiographic measurements were taken, and of these 45 had measurements taken after > or = 12 months of follow-up. Multiple regression (R) value for the proposed formula postoperatively was 0.8048 and at > or = 1 year follow-up was 0.6869.

[Renal iodine excretion by students in East Germany. A prospective study 1989 to 1996]

AIM

A prospective longitudinal study was performed from 1989 to 1996 in order to check the effectiveness of prophylactic measures in Germany.

TEST PERSONS AND METHODS

In 3 periods the urinary iodine excretion was examined in 1849 adolescents from 2 regions (north, south) of former Eastern Germany.

RESULTS

The consumption of iodized salt has increased substantially since 1994. This coincides with an increase in urinary iodine excretion. The median iodine excretion found in 1989/92 (n = 744) was 39.0 micrograms/g creatinine (4.7 micrograms/dl), in 1994 (n = 123) 60.1 micrograms/g creatinine (6.0 micrograms/dl), and in 1995/96 (n = 982) 101.1 micrograms/g creatinine (9.8 micrograms/dl). However, the concentration was < 5.0 micrograms in 27.8% and < 10.0 micrograms iodine/dl in 58.0%. Regional differences were not found.

CONCLUSION

The iodine supply has been improved. However, the declared targets have not yet been met. The findings show that effective goitre prophylaxis can still be achieved while maintaining the voluntary principle.

[Nutritional iodine supply in Germany. Results of preventive measures]

Germany is an iodine deficiency area with endemic goitre. The prophylactic procedures which have been initiated gradually since 1983, were different between the eastern and western part of Germany. In East Germany iodine supply could be improved by "mandatory prophylaxis" until 1989. However, after the reunification of Germany and the adaption of the "voluntary principle", the iodine intake decreased again. In December 1993, new regulations concerning iodized salt became effective (so called "2nd decree") combined with a relaxation of the declaration of duty. This relaxation considerably contributed to the significant increase in iodized salt utilisation in food production. The rise of iodine content of food and breast milk, the higher iodine intake with food, the decrease of fetal thyroid volume and the increase in renal iodine excretion are clear indicators of a better iodine supply. However, the desired target figures have not been obtained yet.

Residual bone cysts after correction of severe foot deformities with the Ilizarov technique

Fourteen patients with severe foot deformity treated by application of the Ilizarov device were evaluated for residual bone changes in the foot. Cyst formation was noted in all patients, most commonly in the base of the fifth metatarsal. These cysts did not develop in the area of bone penetrated by the wires. In an average follow-up of 3.4 years after device removal, the cysts did not resolve. Histologic examination of one resected cyst demonstrated an empty lacuna with no cell lining, as seen in the "cysts" associated with osteoarthrosis.

Occult fracture of the calcaneus in toddlers

Five children 14-33 months of age were treated for calcaneal fractures. All had a history of trauma with limping or refusal to walk. Physical examination could not localize the fracture. Initial radiographs were negative. There were no signs of systemic illness. They were treated with long-leg casts. Radiographs after 2 weeks revealed an arc of sclerosis across the tuberosity of the calcaneus. In no case was a bone scan instrumental in making the diagnosis. Awareness of calcaneal fractures in the child younger than 36 months can prevent the routine use of bone scans to make the diagnosis.

Distal transfer of the greater trochanter revisited: long-term follow-up of nine hips

Seven female patients (nine hip joints) with avascular necrosis and functional coxa vara secondary to developmental dysplasia of the hip joint (DDH) were treated by distal transfer of the greater trochanter (DTT). A 5-year follow-up showed good results in 89% of the hip joints. We reviewed the patients again 12 years later using the Mayo Clinic hip score. Improvement of gait was maintained in the majority of the patients (71%), but the hip score was low in 67% of the patients because of the development of osteoarthritis. Two patients underwent a total hip arthroplasty, and a third is awaiting this operation. Distal transfer of the trochanter is beneficial in improvement of gait but may enhance the development of osteoarthritis.

Diagnostic and therapeutic arthroscopy of the hip in children and adolescents: evaluation of results

Twenty-four arthroscopies of the hip performed at the Alfred I. duPont Institute, Wilmington, Delaware, in 21 patients between 1981 and 1991 were retrospectively studied. The average age of patients at the time of arthroscopy was 16 years (range, 11-21 years). The arthroscopies were diagnostic if the procedure was performed to visualize the hip or to perform a synovial biopsy and therapeutic if the procedure was performed to treat a suspected intra-articular abnormality. There were eight diagnostic arthroscopies and 16 therapeutic arthroscopies. The arthroscopy correlated with the presumptive causes of symptoms in 13 hips (54%) and failed to correlate in 11 hips (46%). Two patients had complications of transient pudendal nerve dysesthesia with full recovery. There were no infections or residual hip stiffness. A diagnostic arthroscopy is not helpful as a confirming diagnostic procedure. Arthroscopy of the hip is helpful in obtaining synovial biopsies and allows loose body removal, thus obviating the need for open surgery and intraoperative dislocation of the hip.

[Reconstruction of the diaphragm with various materials. An animal experiment study]

The relative merits of three methods of diaphragmatic hernia repair were evaluated in animals. Eighty Sprague-Dawley rats underwent laparotomy. The control group had an incision in the diaphragm with primary repair. The other three groups underwent partial resection of the left hemidiaphragm. The defects were repaired in 20 rats with lyophilized Dura, in 20 with polytetrafluoroethylene (PTFE) and in another 20 with absorbable serosa from a cow. Seventy-two animals survived the operation; they were followed up by electromyography (EMG) and post-mortem physical and histological examinations after 3 and 6 months. The EMG showed normal function for the absorbable material. Only scanty physiological waves were registered in the PTFE group. The examination for stretching and stress showed good results for all materials tested. The histological examinations amount to strong foreign body reactions with Dura and PTFE groups. The absorbable bovine serosa had vanished after 3 months postoperatively. It is concluded that bovine serosa can be recommended for diaphragmatic hernia.

Expanding mass in the gluteal area of a 7-year-old child

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first two pages. The final clinical and differential diagnoses are presented on the following page.

Unilateral persistence of the dorsal ophthalmic artery in man

The left ophthalmic artery (OA) of a Caucasian male originated from the transverse portion of the cavernous part of the internal carotid artery (ICA), indicating the persistence of a dorsal OA. It entered the orbit through the most medial part of the superior orbital fissure, close to the medial aspect of the ophthalmic nerve. In the orbital cavity, the OA crossed above the optic nerve to reach the medial wall of the orbit. At the medial end of the upper eyelid it anastomosed with the angular artery and thereafter divided into the dorsal nasal and supratrochlear arteries. Whereas the right OA did not present any irregularities, some additional anatomical variations, above all a bilateral pterygospinosus muscle, were found in this individual. Since except the existence neither the course and branching pattern of a persistent dorsal OA nor its occurrence together with other varieties have been previously reported in man, phylogenetic and ontogenetic aspects of this aberrant vessel are discussed.

A complication of internal fixation rods in sport

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The snapping biceps femoris syndrome

Snapping of tendons is a well-described entity in the literature, occurring mostly in athletes around the hip, ankle, shoulder, and elbow, but rarely the knee. A case of snapping of the biceps femoris tendon (BFT) in a patient with a painful knee and no history of trauma is described. An abnormal anterior insertion of the BFT was found to be the cause of the pain and snapping. Surgical treatment, reinsertion of the tendon in its anatomic position, completely corrected the abnormality, whereas conservative treatment failed.

Evaluation of a 1-year levonorgestrel-releasing contraceptive implant: side effects, release rates, and biodegradability

OBJECTIVE

To determine the release rates, effects on ovulation, and side effects of two lengths of a biodegradable, subdermal contraceptive implant containing levonorgestrel in a caprolactone capsule.

DESIGN

Phase II randomized clinical trial.

SETTING

Public family planning clinic at an urban general hospital.

PARTICIPANTS

Forty-eight healthy, parous, ovulating volunteers.

INTERVENTION

Subjects were randomly assigned either a 2.5- or a 4.0-cm contraceptive capsule that was worn under the skin of the upper arm for 1 year if not removed earlier for other reasons.

MAIN OUTCOME MEASURES

Serum concentrations of levonorgestrel, progesterone, estradiol, and lipoproteins were measured as were metabolic parameters. Vaginal bleeding and other side effects were recorded. After implant removal, remaining levonorgestrel, capsule viscosity, and molecular weight were measured.

RESULTS

The 4-cm implant provided serum concentrations of levonorgestrel ranging from 0.65 ng/mL shortly after insertion to 0.20 ng/mL at 12 months, but the 2.5-cm implant resulted in levels too low for contraception. The 4-cm implant suppressed ovulation in approximately 80% of cycles over 1 year of use, but the 2.5-cm implant failed to suppress ovulation. The implants were rapidly and easily inserted and removed. They retained structural integrity through 1 year of use. Of 48 subjects, 32 had abnormal bleeding patterns; the mean number of days of bleeding per month was 7 with 23 days between episodes. Women using capronor maintained normal metabolic parameters except that low-density lipoprotein decreased slightly.

CONCLUSIONS

The 4.0-cm implant is a promising contraceptive. There were no important metabolic effects, but there were bothersome minor side effects typical of progestin-only contraception.

Factors influencing elbow arthrolysis

Over the period 1982 to 1988, 31 consecutive patients at the Hand Surgery Unit of the Sheba Medical Centre were subjected to elbow joint arthrolysis to treat restriction of range of motion solely due to trauma. This retrospective study aims to evaluate the relative influence of the followings factors on functional outcome: sex, age, type of original injury and initial management, presence of para-articular ossification, delay between injury and arthrolysis, and the use of manipulation and a continuous passive motion device (CPM) following surgery. The range of motion was recorded prior to arthrolysis and after operation (excluding one patient who subsequently underwent arthrodesis for intractable pain). Follow-up averaged 15.3 months (+/- 5.4). In the 24 patients with extension deficit (greater than 20 degrees), the mean improvement was of 26.9 degrees (greater than 23.1 degrees); in the 21 patients with flexion deficit the mean improvement was of 21.2 degrees (greater than 18 degrees). The mean improvement for total range of motion in the series overall was of 35.2 degrees (+/- 23.8 degrees). 90% showed an improvement of at least 10 degrees and 30% attained normal ROM. All of these improvements in range were statistically highly significant (p less than 0.0001). None of the variables had predictive value with regard to improvement of flexion. With regard to improvement in extension, the only variable of value was the use of a continuous passive motion device following surgery; those patients subjected to CPM showed a mean improvement of 32.6 degrees (+/- 19.0 degrees), while those without averaged 12.8 degrees (+/- 27.5 degrees) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Differentiation of Trypanosoma brucei bloodstream trypomastigotes from long slender to short stumpy-like forms in axenic culture

An axenic cultivation system was used to study the differentiation of Trypanosoma brucei bloodstream forms from long slender to short stumpy-like forms. Trypanosomes in the logarithmic phase are similar to long slender bloodstream forms freshly isolated from infected mice, differing only in the rate of oxygen uptake. In contrast, trypanosomes in the stationary phase show a decreased level of glucose oxidation, express pyrroline-5-carboxylate reductase (proline oxidase), are inhibited in oxygen uptake to about 44% by KCN, undergo considerable morphological changes on the cellular and subcellular level, and have a significantly smaller cell volume. These results are comparable to those observed during the differentiation of long slender to short stumpy forms in infected animals, suggesting that the differentiation process towards insect procyclic forms can be initiated in culture at 37 degrees C. As judged from immunofluorescence and electron microscopy analysis, the surface coat remains intact.

Self-other differences in children's perceptions about the causes of important events

Three studies examined differences between children's (ages 8-15) beliefs about the effectiveness of multiple internal and external causes for producing outcomes in their own lives versus in those of their peers. Differences specific to the school domain were found: Starting at age 11 or 12, children perceived internal causes as more important for others than for themselves; and only beliefs about the self related to perceived control. More strikingly, a sample of gifted children, who presumably receive social feedback that they are different from their peers, reported that (a) they exerted more control and possessed more ability than their peers and (b) other children knew less about the causes of school performance and had to rely more on effort and powerful others; only beliefs about the self correlated to cognitive performance. These results suggest that self-other differences are produced by both developmental change and environmental opportunities.

Self-other differences in children's perceptions about the causes of important events

Three studies examined differences between children's (ages 8-15) beliefs about the effectiveness of multiple internal and external causes for producing outcomes in their own lives versus in those of their peers. Differences specific to the school domain were found: Starting at age 11 or 12, children perceived internal causes as more important for others than for themselves; and only beliefs about the self related to perceived control. More strikingly, a sample of gifted children, who presumably receive social feedback that they are different from their peers, reported that (a) they exerted more control and possessed more ability than their peers and (b) other children knew less about the causes of school performance and had to rely more on effort and powerful others; only beliefs about the self correlated to cognitive performance. These results suggest that self-other differences are produced by both developmental change and environmental opportunities.

An oral zinc loading test in psoriasis

Changes of zinc in body fluids were evaluated in 12 patients with extensive psoriasis and compared with those of 11 healthy volunteers, using an oral zinc loading test. Plasma zinc levels and urinary zinc excretion were measured by atomic absorption spectrophotometry. No significant difference was found between plasma zinc levels and urinary zinc excretion following an overnight fast. Both groups showed extensive increases in urinary zinc excretion following the loading test. The peak levels of plasma zinc were significantly lower in the psoriatic patients two and four hours after zinc ingestion (P less than .01 and P less than .02, respectively).

The intracellular degradation of poly(epsilon-caprolactone)

Poly(epsilon-caprolactone) [PEC], a biodegradable aliphatic polyester, undergoes a two-stage degradation process: The first lengthy phase involves nonenzymatic hydrolytic cleavage of ester groups, the second phase beginning when the polymer is more highly crystalline, and of low molecular weight. The cellular events of the second phase were examined by implanting gelatin capsules containing 25 mg of low molecular weight (Mn 3000) PEC powders, 106 to 500 micron, in rats. PEC fragments ultimately were degraded in phagosomes of macrophages and giant cells, the process requiring less than 13 days for completion at some sites. PEC was also identified within fibroblasts. These studies support the intracellular degradation of PEC as the principal pathway of degradation once the molecular weight of the aged polymer is reduced to 3000 or less.