The relationship between pes cavus and idiopathic scoliosis

STUDY DESIGN

The incidence of pes cavus and scoliosis was studied in three groups of patients. Group A contained 130 patients with idiopathic scoliosis, Group C contained 210 patients with idiopathic pes cavus, and Group B (control) contained 200 patients of similar age.

OBJECTIVES

To investigate the joint presentation of pes cavus and idiopathic scoliosis, because both deformities may share a common etiology linked to muscle imbalance.

SUMMARY OF BACKGROUND DATA

Sixty five percent of Group A patients (85 of 130) had an abnormally high plantar arch, compared to only 9.5% (19 of 200) of Group B control subjects. Nine percent (20 of 210) of the patients in Group C had scoliosis curves, compared to only four patients in Group B.

METHODS

Radiographs were taken to determine the type of scoliosis curve, its location, and its magnitude, and to identify the incidence of spina bifida occulta in the three groups. The incidence and degree of pes cavus were established by means of foot prints. Statistical analyses were performed on all results.

RESULTS

A statistically significant relationship (P < 0.01) was found for the incidence of pes cavus between Group A (scoliosis) and Group B (control), and for the incidence of scoliosis between Group C (pes cavus) and Group B (control). No statistical significance was observed for the other relationships investigated (sex, curve location, magnitude, spina bifida).

CONCLUSIONS

There was a significant correlation between scoliosis and pes cavus--spina bifida was not an etiologic factor. Therefore, in certain patients where scoliosis and pes cavus present jointly, deformity may be secondary to altered balance or to disorders of the central nervous system.

Study of the retinal fiber layer in patients with acquired immunodeficiency syndrome

A study using the monochromatic photography technique to examine the retina of a group of patients with human immunodeficiency virus (HIV) infections in different degrees of evolution and with no history of opportunistic retinal infection revealed the existence of lesions on the level of the retinal nerve fiber layer. The lesions detected included wide, slit-like defects; sector defects; and generalized diffuse atrophies. Both the sector defects and the diffuse atrophies appeared at times to be related to retinal cotton-wool exudates, but at other times they occurred in eyes with no observable retinal pathology. The results of this study can be interpreted as "in vivo" confirmations of the findings obtained by other authors in the postmortem study of optic nerves of patients with acquired immunodeficiency syndrome (AIDS), presenting a generalized degenerative process of the optic nerve with a loss of up to 40% of the axons of the retinal ganglion cells. In some cases, the results obtained in our study directly related the presence of cotton-wool exudates to the production of lesions in the retinal nerve fiber layer, whereas in other cases, the fiber lesions did not appear to be secondary to the cotton-wool exudates. Therefore, a primary lesion of the retinal ganglion cells or of the optic nerve fibers could be considered, as studies by other authors have suggested.

In vitro replication of plasmids containing human ribosomal gene sequences: origin localization and dependence on an aprotinin-binding cytosolic protein

We previously investigated the role of an aprotinin-binding protein (ADR) in the initiation of DNA replication in isolated quiescent nuclei. In the present study, we have used a cell-free DNA replication system to test the ability of plasmid vectors which contain sequences from the human ribosomal RNA gene to serve as replicative templates in vitro when exposed to ADR-containing preparations. Significant dTTP incorporation was seen using DNA from either a 7-kb sequence in the 5' spacer region (CHE) or a 7-kb sequence which begins near the end of the 28S coding region and extends into the 3' spacer region (ADBB), while sequences from other regions of the rRNA gene mediated little or no dTTP incorporation. The characteristics of plasmid-directed dTTP incorporation indicate that most incorporation is due to DNA replication and not repair or damage-initiated processes. To conclusively demonstrate origin-dependent replication in the plasmid system and to further map replication origins, an approach was developed using ddGTP to restrict the length of daughter strands followed by hybridization of these replication products to restriction fragments spanning the putative origin region. This approach allowed us to identify replication origin activity apart from parent strand repair or synthesis initiated at random damaged sites. One of the origins was localized to a 1375-bp fragment within the 5' spacer region, and this fragment contains sequences homologous to those found in other replication origins.

Neurologic complications in liver transplantation

A retrospective review is presented of neurologic complications in our first 143 consecutive adult patients (208 liver transplants in 143 adults and 18 children) undergoing liver transplantation. Nineteen (13.2%) of the 143 patients developed neurologic complications in the postoperative period. Immunosuppression was initiated intraoperatively with steroids with the addition of azathioprine on Day 1 and cyclosporine, adjusted by RIA to a level of 400-600 ng/ml, on Day 2 post-transplantation. Azathioprine is discontinued in the third month. Fourteen of the 19 patients (73.6%) presented with CNS complications characterized by: diffuse multifactorial encephalopathy (5 patients); leukoencephalopathy (2 patients) which required temporary (1 case) or permanent (1 case) discontinuation of cyclosporine A; hemorrhage (in 2 cases due to arterial hypertension and coagulopathy and another due to unknown causes); ischemic/anoxic injury secondary to cardiorespiratory arrest (2 patients) or arteriothrombosis (1 patient); and myelopathy (1 patient) due to vertebral compression (T10-T11) secondary to osteoporosis. The diagnostic studies most often employed were computed tomographic (CT) (85.7%) and electroencephalography (EEG) (42.8%). Five of 19 patients (26.3%) suffered peripheral nervous system (PNS) complications: 1 patient with reversible Claude-Bernard-Horner Syndrome caused by central venous catheterization during anesthesia; 2 patients with peroneal nerve palsy due to compression below the knees by operating room table supports; 1 patient with an irreversible lesion of the right recurrent laryngeal nerve secondary to prolonged intubation and central venous catheterization; and 1 patient with a reversible lesion of the left brachial plexus secondary to inadvertant hyperextension of the upper extremity on the O.R. table due to the need for dialysis and catheterization of the axillary vein for veno-venous bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Major bacterial infections following liver transplantation: a prospective study

The incidence and characteristics of major bacterial infections were studied prospectively in 50 consecutive adult patients who underwent liver transplantation (LT). All patients received the same protocol of immunosuppression, bowel decontamination, antibiotics prophylaxis, and follow-up. Thirty-two patients (64%) had at least one episode of major bacterial infection. One death was directly related to a bacterial infection, accounting for 13% of postoperative mortality. The most critical period for infection was the first 2 months after surgery, when 69% of the infections occurred. The most frequent clinical presentations were bacteremia, pneumonia and abdominal abscesses. Eighty percent of the bacteremias had an identifiable source, the most frequent being intravascular catheters. Gram-positive microorganisms (69%) predominated over gram-negative rods (26%) and anaerobes (5%). The use of selective bowel decontamination (SBD) with norfloxacin may explain this predominance. Major bacterial infections are an important source of morbidity and mortality after LT. Efforts to prevent these infections and to determine their source and specific treatment, will improve the management and the outcome of these patients in the future.

Behavioural effects in adulthood of neonatal manipulation of brain serotonin levels in normal and androgenized females

5HT concentrations in the hypothalamus are higher in females than males over the second week of life and this differentiation is testosterone-dependent. We have investigated the possible influence of 5HT over this period on the development of systems that control adult behaviour, in particular those influenced by neonatal testosterone. Neonatal androgenization (250 micrograms/pup testosterone propionate; TP; on day 1 postpartum) induced a masculine pattern of behaviour in females ovariectomised in adulthood and bearing a TP implant. The neonatal treatment reduced exploration, motor activity and female sexual behaviour and increased anxiety, orientation toward the incentive female and male sexual behaviour. Depletion of 5HT by pCPA (100 mg/kg days 8-16 postpartum) enhanced the TP-induced increment in locomotion and female sexual behaviour and increased sexual orientation toward the incentive female, while 5HTP (20 mg/kg days 8-16 postpartum) antagonised the reduction in exploration by TP. Thus 5HT may normally exert an inhibitory control on the action of neonatal testosterone on exploration, motor activity and sexual behaviour. Neonatal PCPA treatment also had a marked anxiolytic effect which was independent of the presence of T as it was noted in normal and androgenized females and previously has been observed in intact males. This might indicate a primary control by a serotonergic system on the development of the systems controlling anxiety.

Human ribosomal RNA gene repeats are localized in the dense fibrillar component of nucleoli: light and electron microscopic in situ hybridization in human Sertoli cells

The distribution of the human ribosomal gene repeat within human Sertoli cell nucleoli was investigated with the help of DNA-DNA in situ hybridization at the light and electron microscopic level. Probes from both the transcribed part of the gene repeat and the "non-transcribed" spacer were found to hybridize predominantly to the dense fibrillar component of nucleoli. It therefore can be concluded that the dense fibrillar component of nucleoli is the major site of the intranucleolar location of the ribosomal DNA. This holds true not only for the dense fibrillar component adjacent to fibrillar centers, but also for the dense fibrillar component remote from the fibrillar centers.

[Heart involvement in diabetic patients]

Diabetic cardiomyopathy appears to be due to "premature ageing" of the myocardium which loses some of its compliance and becomes less sensitive to catecholamines. The condition seems to be severe mainly in those frequent cases where it is associated with hypertensive and/or ischaemic cardiomyopathy. Neuropathic denervation of the heart, usually partial and predominantly affecting the parasympathetic system, might play a part in the myocardial dysfunction. It has been held responsible for sudden death, but its real consequences in diabetic patients remain to be assessed. Coronary artery disease is the most common cardiac complication of diabetes mellitus: it accounts for 50 per cent of deaths among noninsulin-dependent, and 25 per cent among insulin-dependent diabetic subjects. Its incidence does not seem to decline and its severity, notably in women, is demonstrated by a mortality rate that is twice as high as that observed in the non-diabetic population; hence the importance of primary prevention and treatment of risk factors. However, the specificity to abnormal lipid metabolism, notably hypertriglyceridaemia, the potentiation by chronic hyperglycaemia of the harmful effects of arterial hypertension, and the possible responsibility of coagulation disorders and hyperinsulinism are points that have not yet been elucidated. We still do not know whether the objectives to be attained in terms of plasma cholesterol, triglycerides and fibrinogen levels, as well as of blood pressure values, should be different in diabetic and non-diabetic subjects. In any case, the treatment of risk factors should be accompanied by a systematic search for silent ischaemia which is 2 to 3 times more frequent among diabetic patients. Detection of silent ischaemia by electrocardiography during exercise and/or Holter recordings, and by echocardiography and/or thallium scintigraphy should be performed not only in diabetic patients with coronary artery disease but also to those with other risk factors or albuminuria.

Inhibition of HIV replication by naphthalenemonosulfonic acid derivatives and a bis naphthalenedisulfonic acid compound

Several naphthalenemonosulfonic acid analogs and a bis naphthalenedisulfonic acid have been evaluated for anti-HIV activity in assays using H9 and MOLT-3 cells. Among the naphthalenemonosulfonic acids, a 4-amino-5-hydroxy compound and a 4,5-diamino compound showed low anti-HIV activity (upto 50% inhibition) at non-toxic doses. The bis naphthalenedisulfonic acid compound demonstrated significant suppression of HIV-1 antigen expression as measured by monoclonal antibodies to p17 (95%), p24 (94%) and syncytia inhibition (82%) at a dose of 20 micrograms/ml that was non-toxic to the host cells. The bis naphthalenedisulfonic acid analog represents a new class of compounds which may be effective in the treatment of HIV infected patients. The structure activity relationship and a probable mode of action of these compounds is discussed.

Angiocardiographic demonstration of a partial defect of the pericardium with herniation of the left atrium and ventricle

A case of a patient of 44 years of age with nonspecific thoracic symptomatology and anomalous protrusion of the second arch of the left border of the cardiac silhouette is reported. Cineangiocardiography showed a herniation of the left atrium and ventricle through a partial defect in the left pericardium demonstrating a mechanism that can give rise to sudden death by cardiac incarceration. Prophylactic longitudinal pericardiectomy was performed and the patient made an uneventful recovery.

Open heart surgery for thrombosis of a prosthetic mitral valve during pregnancy. Fetal hydrocephalus

Pregnant women with cardiac valvular prostheses present an important risk factor and the major complications are endocarditis and thromboembolism. Thromboembolism is determined by a hypercoagulation state. Compulsory anticoagulation treatment is an associated risk factor producing maternal and fetal complications. Different open heart surgical cases during pregnancy have been reported and a review of the literature shows favourable maternal prognosis. A 30-year-old woman with a Björk-Shiley mitral prosthesis, during the 6th week of pregnancy presented with thrombosis and embolism due to a change in anticoagulation treatment from acenocumarol to heparin. Open heart surgery was carried out and the patient's course was favourable. A fetal hydrocephaly of unknown etiology was discovered during the 18th week of pregnancy. Open heart surgery during pregnancy and the necessity of thromboembolic prophylaxis, have been analysed and revised.

Muscular structural changes following fadenoperation

The authors describe the macroscopic, histological, and ultrastructural findings observed in an experimental animal model of the fadenoperation . Grossly, muscular fibrosis and musculo-scleral adhesions were well established after the second postoperative month. Histologic findings demonstrated the development of a granulomatous, foreign body reaction around the musculo-scleral fixation suture, collagenization of the muscle tissue from the first postoperative month and degenerative phenomena in the muscle fibers. Electron transmission microscopic study showed atrophy and angulation with distortion of the myofibrillar matrix, along with alteration of the Z bands of muscle fibers, mitochondrial alteration, and dilatation of the sarcotubular system. All these experimental findings suggest the relative irreversible effects of the fadenoperation after the early postoperative period and for the first time, demonstrated that this surgical technique alters the muscle structure.

Erosive lichen planus and fibroxanthosarcoma (malignant fibrohistiocytoma): coincidence or association?

Severe erosive lichen planus of the skin and oral and anal mucosae coincided with retroperitoneal fibroxanthosarcoma (malignant fibrohistiocytoma) in an asthmatic patient. Clinical evolution after surgical removal of the tumor, radiotherapy, and chemotherapy was favorable, with great improvement of the lichen planus and the asthma. The exact nature of the relationship between erosive lichen planus and tumors is not known, but there is circumstantial evidence that their coexistence is not just a fortuitous coincidence.

The surgical management of left atrial thrombosis

A series of 122 consecutive patients with left atrial thrombosis is reviewed. Positive diagnosis was achieved in only 40 cases (36%) based on the angiographic findings and the presence of coronary fistula. The main cause of mortality and morbidity was cerebrovascular embolism. A change in our surgical technique, including the occlusion of the mitral orifice, has so far eliminated this problem.