Correction of foot deformity by the Ilizarov method in a patient with Segawa disease

Hereditary progressive dystonia, or Segawa disease, is rare. Diagnosis depends on typical clinical features with normal laboratory findings. It responds well to levodopa treatment. This article contains a case report of a patient with Segawa disease with a fixed equinovarus foot. A 21-year-old woman was diagnosed with Segawa disease since she was 8 years old; she became wheelchair dependent at the age of 15. The dystonia responded well to levodopa, except for the fixed-foot deformity. The deformity was corrected successfully by the Ilizarov method. The patient returned to independent ambulation after surgery. Because similar types of foot deformities appeared in several progressive degenerative neurologic diseases, the treatable Segawa disease should be added to the list of differential diagnoses of progressive degenerative neurological diseases with talipes equinovarus.

The influence of pyruvic acid on the pharmacokinetics of sulphadiazine in rabbits

During the past few years, acetylation polymorphism has been shown to be a proven, established fact, and N-acetyltransferase, an enzyme that transfers an acetyl group to the substrate, has been recognized as the main factor in acetylation polymorphism. In a recent study, a significant difference between the acetylation phenotype and plasma pyruvic acid (PA) concentration in rabbits was found. In this report, the influence of PA on the pharmacokinetics of sulphadiazine (SDZ), a drug that has been used in pharmacogenetic studies of acetylation, was studied. By using a loading dose of 300 mg kg-1, and an infusion rate of 7.5 mg min-1 kg-1 of PA, the concentration of PA reached a steady state (Css approximately equal to 100 micrograms mL-1) in 30 min. During PA infusion in rapid-acetylation rabbits, no significant changes were found in any of the pharmacokinetic parameters for SDZ. However, differences were found in the beta half-life, AUC, clearance, and k10 of SDZ in slow acetylators: the beta half-life decreased from 115.74 +/- 12.47 min to 62.96 +/- 4.36 min (p < 0.001); AUC decreased from 10,617.38 +/- 1179.81 micrograms min mL-1 to 6217.14 +/- 391.32 micrograms min mL-1 (p < 0.001); clearance increased from 0.0044 +/- 0.0008 L min-1 kg-1 to 0.0068 +/- 0.0007 L min-1 kg-1 (p < 0.001); and k10 increased from 0.0090 +/- 0.0009 min-1 to 0.0193 +/- 0.0028 min-1 (p < 0.005). The reason for this may be that PA influences the elimination of SDZ in slow-acetylation rabbits.

Determination of (+)-catechin in plasma by high-performance liquid chromatography using fluorescence detection

A high-performance liquid chromatographic method, using fluorescence detection, was developed for the determination of (+)-catechin in rabbit plasma. The procedure involved the precipitation of plasma protein using acetonitrile, followed by solid-phase adsorption onto alumina. After washing with water and methanol, the residue was vortex-mixed with perchloric acid solution to release the adsorbed (+)-catechin. Separation was performed on a reversed-phase column using an eluent consisting of phosphoric acid solution with 12% acetonitrile. The excitation and emission wavelengths were set at 280 and 310 nm, respectively. The retention times for (+)-catechin and the internal standard (deoxyhigenamine) were 6.87 and 8.47 min respectively, without any interference. Validations of accuracy and precision were satisfactory in both within- and between-run assays. All coefficients of variance were less than 6% and mean relative errors were within +/- 3.75%. The average recovery was 73.77%. The limit of detection and quantitation were 1 ng and 0.02 micrograms/ml, respectively. Application of this method was successfully assessed by intravenous administration of a 15 mg/kg dose of (+)-catechin in rabbits. This new method provides a simple, specific and sensitive determination for (+)-catechin in rabbit plasma and is suitable for pharmacokinetic studies.

Surgical treatment of second primary lung cancer: report of eight cases

Of 312 patients undergoing resection for lung cancer at National Taiwan University Hospital during 1980 to 1990, eight presented with second primary lung cancer. One patient had synchronous and seven patients had metachronous primaries. There were five males and three females with ages ranging from 41 to 77 years. In the metachronous group, two patients had a different histology between the first and the second tumor, and the intervals between the two tumors varied from 12 to 60 months. The initial resections included pneumonectomy in one and lobectomy in six patients. At the second operation, the surgical procedures included lobectomy in three, completed pneumonectomy in one, segmentectomy in another, and wedge resection in two patients. There was no operative mortality and all patients were regularly followed up from 6 months to 6 years after the second operation. Two patients died, one from repeated respiratory tract infection and the other from brain metastasis. Kaplan-Meier analysis showed 2-year and 3-year survivals of 80% and 60%, respectively. It can be concluded that surgical resection for second primary lung cancer is justified, as it can prolong the patient's survival. Lobectomy can be performed for patients with a second primary lung cancer and sufficient lung reserve, but limited resection should be chosen for patients with poor lung reserve.

Optical restoration of photorefractive holograms through self-enhanced diffraction

For the first time to our knowledge, we demonstrate the use of self-enhanced diffraction to optically restore weak dynamic volume holograms. This restoration process is achieved through the use of a novel beam-toggling scheme that significantly enhances the steady-state diffraction efficiency of volume index gratings stored in photorefractive media. Experiments demonstrating and confirming theory are presented and discussed.

Lumbar intraspinal synovial and ganglion cysts (facet cysts). Ten-year experience in evaluation and treatment

STUDY DESIGN

This study analyzed the clinical history, physical examination, diagnostic studies, and operative and histologic findings in 19 patients with lumbar intraspinal synovial and ganglion facet cysts evaluated and treated over a 10-year period.

OBJECTIVES

The results were correlated to provide a greater understanding of lumbar facet cysts and rationale for conservative or surgical treatments.

SUMMARY OF BACKGROUND DATA

The 19 patients included 13 women and 6 men ranging in age from 38 to 79 years. 84.4% of the patients presented with radicular pain. 26.3% had significant motor deficit. 68.4% of the facet cysts were found at L4-L5, 21.1% at L5-S1, 5.2% at L1-L2, and 5.2% at L2-L3.

METHODS

The clinical history and findings on physical examination, standard radiography, myelography, computed tomography-myelography, facet arthrography, post-facet arthrograph computed tomography, magnetic resonance imaging with and without contrast, and computed tomography scans were reviewed.

RESULTS

Bilobed cysts were found on both dorsal and ventral aspects of the involved facet joints within and outside of the spinal canal on facet arthrography, computed tomography, magnetic resonance imaging, and at the time of surgery in more than 60% of the patients. Significant facet degeneration was found in 75% of standard radiographs, and on all of the magnetic resonance imaging and computed tomography scans. In six patients, symptoms improved with rest, medication, and bracing. Epidural corticosteroid injections provided short-term relief in three out of four patients. Facet corticosteroid injections provided good relief in one, partial relief in one, and no relief in one patient. Surgical decompression in eight patients resulted in three excellent, four good, and one fair outcome.

CONCLUSIONS

Most of the lumbar intraspinal facet cysts were associated with significantly degenerated facet joints. Patients with intraspinal facet cysts may respond to conservative treatments if there is no significant neurologic deficit. Surgical decompression and removal of large facet cysts usually are successful in relieving symptoms.

Successful treatment of hereditary progressive dystonia--a case report

Hereditary progressive dystonia or Segawa disease is a very rare disease. Diagnosis depends on typical clinical features with remarkably good response to levodopa and normal laboratory findings. Here, we report on a unique case of Segawa disease with a fixed equinovarus foot. The patient was a twenty one year old female with the typical clinical manifestations since eight years of age who became wheel-chair dependent at the age of fifteen. The dystonia responded well to levodopa except for the foot deformities. The foot deformities were successfully corrected by use of the Ilizarov apparatus and she ambulated freely at follow up. Since several similar foot deformities appeared in the early stage of a progressive neurological degenerative disease, the treatable Segawa disease should be added to the differential diagnosis when facing a patient with pes equinovarus.

Irreducible volar rotatory dislocation of the proximal interphalangeal joint

Volar rotatory dislocation of the proximal interphalangeal (PIP) joint often cannot be reduced by closed manipulation because of interposition of soft tissues. In this case, the condyle of the proximal phalanx was trapped between the central slip and the lateral band. This case is reported to reemphasize the importance of recognizing serious injuries involving the soft tissues around the PIP joint. Deprival of its normal dorsal stabilizing forces can cause a loss of both static and dynamic joint support. Secondary scarring and contractures affect all damaged structures of the joint.

Matrix-matrix multiplication by using anisotropic self-diffraction in BaTiO(3)

We propose a matrix-matrix multiplication by using anisotropic self-diffraction in BaTiO(3). The input matrices are carried by the two incident beams with special Bragg-matched incident angles. The output matrices are produced by anisotropic self-diffraction with the polarization orthogonal to those of the incident matrices. By thresholding the output this architecture is particularly suitable for the applications of optical interconnects and an optical switch.

Intercondylar fractures of the distal humerus: routine anterior subcutaneous transposition of the ulnar nerve in a posterior operative approach

Intercondylar fractures of the distal humerus in adults are rare and notoriously difficult to treat. The goals of open reduction are to preserve the articular surface and restore elbow function. We treated 20 patients by open reduction with dual-plate internal fixation and routine anterior subcutaneous transposition of the ulnar nerve. The follow-up period ranged from 15 to 35 months. The fractures were classified according to Muller's system. The results were evaluated using the Cassebaum rating system and subjective functional status. Excellent or good results were achieved in 15 elbows (75%), two had a fair result, and three, poor. A clearer understanding of fracture patterns, rigid dual-plate internal fixation, and early rehabilitation are needed to improve the results from this vexing injury. We recommended routine ulnar nerve anterior subcutaneous transposition using a posterior approach. Compared with published reports, our preliminary results demonstrated no postoperative ulnar nerve compression syndrome at follow-up. Routine anterior subcutaneous transposition of the ulnar nerve to avoid the postoperative ulnar nerve compression syndrome is required.

Traumatic patellar tendon ruptures: a follow-up study of primary repair and a neutralization wire

Thirty-five patients with traumatic patellar tendon ruptures treated with primary repair and with a neutralization wire were retrospectively reviewed. All the ruptures occurred in acute trauma; 12 of the patients (34%) had multiple injuries, and 19 had open wounds around the knee joints. The diagnostic clues included a high-riding patella by palpation or seen on roentgenograms, hemarthrosis, a palpable gap over the tendon, and inability of patients to extend the knee actively. Using the criteria of Siwek and Rao, at follow-up 57% of outcomes were rated as excellent; 28.6% as good; and 14.2% as unsatisfactory. None of the 35 patients had a rerupture of the tendon. We conclude that primary repair with a neutralization wire can be a treatment of choice for traumatic patellar tendon ruptures.

Coracoid process fracture combined with acromioclavicular dislocation and coracoclavicular ligament rupture. A case report and review of the literature

A coracoid process fracture associated with acromioclavicular joint dislocation and with rupturing of the coracoclavicular ligaments of an adult has been reported only once in the literature. This report adds another unusual case to the literature to reemphasize the importance of recognizing this unusual lesion. Two separate mechanisms--direct trauma to the shoulder girdle and sudden pull on the coracoid process by the conjoined tendons of short head biceps and coracobrachialis muscles--appear to be responsible for this unusual triple lesion. Open reduction with coracoid screw and acromioclavicular fixation, combined with an All-dredge repair to replace the ruptured coracoclavicular ligaments, resulted in an excellent outcome.

Traumatic patellar tendon ruptures--a follow-up study of primary repair and neutralization wire

Thirty-five patients with traumatic patellar tendon ruptures treated with primary repair and neutralization wire were retrospectively reviewed. The length of follow up ranged from 1.5 years to 5 years with an average follow up period of 20 months. All the ruptures occurred due to acute trauma, twelve of them (34%) involved in a multiple injuries, and nineteen had an open wounds around the knee joints. The diagnostic clues included a high riding patella by palpation or by X-ray, hemoarthrosis, a palpable gap over the tendon; and being unable to extend the knee actively. Using the criteria of Siwek and Rao, at follow up 57% were rated as excellent, 28.6% good; and 14.2% unsatisfactory. None of the 35 patients had a rerupture of tendon. It is recommended that primary repair with a neutralization wire can be a treatment of choice for traumatic patellar tendon ruptures.

Simultaneous dislocation of the five carpometacarpal joints with concomitant fractures of the tuberosity of the trapezium and the hook of the hamate: case report

Multiple carpometacarpal dislocations, with fractures of the trapezium and hook of the hamate carpals are rare. We report an exceedingly rare constellation of these injuries. The routine use of a carpal tunnel view is advised to identify the associated avulsion fractures with multiple carpometacarpal dislocations. We found little on this subject in existing papers. It is important because painful nonunion of avulsion fractures and compressive ulnar or median neuropathy may be ignored and thus not receive suitable treatment.

Brachial plexus injury with erect dislocation of the shoulder

Luxatio erecta, or inferior dislocation of the glenohumeral joint, is an extremely uncommon variety of shoulder dislocation. Several types of neurovascular injuries may be associated with luxatio erecta. Concomitant fracture of the coracoid, clavicle, acromion, greater tuberosity, and humeral head may also be noted. A case of luxatio erecta associated with a fracture of the greater tuberosity and transient mixed brachial plexus injuries is presented.

Optimal incident conditions for a Cat-type self-pumped phase-conjugate mirror

We present a simplified method, based on experimental observations, for predicting the best incident conditions for obtaining the highest reflectivity of a Cat-type self-pumped phase conjugator with given crystal dimensions.

Generation of neutrophil-chemoattractant by degradation of tumor cell membrane protein

Polymorphonuclear leukocytes (PMN) infiltrating into tumors are assumed to be the result of a migration in response to a tumor-derived chemotactic factor. It is hypothesized that tumor-derived chemotactic factors, which are supposed to be in aggregates, can be exposed by proteolytic degradation of the tumor cell membrane protein (TCM). The TCM suspension made from either Sarcoma 180 or Ehrlich ascites tumor after incubation with Varidase at 37 degrees C for six to eight weeks is referred to as a degraded TCM protein (DTCM). The purpose of this study was to detect whether or not the DTCM was chemotactic for PMNs. Chemotactic activity was assayed by a sponge-matrix model and expressed in the number of PMNs infiltrating into the sponge per mouse after intrasponge injection of the DTCM, dose range, 0.4-0.005 mL. Maximal response to DTCM was restricted to the limited dose between 0.01 and 0.02 mL. Quantities of DTCM > 0.02 mL caused a response in roughly reciprocal proportion to the dose of DTCM. Changes in the circulating leukocyte count in response to an intravenous (i.v.) injection of DTCM was biphasic. The initial relative leukopenia was followed by leukocytosis within 24 hours in rats surviving the effect of DTCM doses < 0.5 mL. However, in rats with i.v. injections of higher doses, profound leukopenia was present at death. The mice, after an intraperitoneal (i.p.) injection of DTCM, dose range, 0.5-1.0 mL, died between 16 and 24 hours after the injection. The bone marrow of these mice showed complete depletion of PMNs.(ABSTRACT TRUNCATED AT 250 WORDS)

Lower extremity compartmental syndrome following snake-bite envenomation--one case report

Acute compartmental syndrome develops when the intracompartmental pressure rises rapidly, even if only for a short duration. Loss of function and/or viability of the intracompartmental muscles may occur within a short period. Consequently early recognition and management are essential. We report a case where a young child with severe snake bite envenomation who and acute compartmental syndrome who had complete functional recovery following emergent fasciotomy and delayed primary closure.

Determination of isoniazid methanesulphonate and its metabolites in rabbit blood by high-performance liquid chromatography

A rapid and sensitive high-performance liquid chromatographic method is described for simultaneous determination of isoniazid methanesulphonate (IHMS) and its metabolites, such as isoniazid (INH) and acetylisoniazid (AcINH) in rabbit blood. According to stability studies, IHMS was most stable at pH 3-5. After acidifying the blood to pH 5.0, a suitable amount of acetonitrile was added to the supernatant for extraction and niacinamide served as an internal standard. After evaporation, the residue was reconstituted with phosphate buffer and aliquots of this solution were separated on a reversed-phase phenyl column by a mobile phase consisting of 0.25 mM tetrabutylammonium phosphate as a paired-ion reagent. UV detection was performed at 280 nm. Under these conditions, the between-run coefficients of variation of IHMS, INH and AcINH from 1 to 25 microns/ml were 4.7 +/- 2.5, 5.4 +/- 1.0 and 5.1 +/- 3.1%, respectively. Hence this sensitive, reproducible and accurate method was suitable for pharmacokinetic studies of IHMS.

Effects of rifampicin and phenobarbital on the fate of isoniazid and hydrazine in vivo in rats

After the intraperitoneal (i.p.) administration of isoniazid (INH) to male Wistar rats, the liver and plasma levels of hydrazine (Hz) and acetylhydrazine (AcHz), which are hazardous metabolites of INH and well known as mutagens, carcinogens and hepatotoxins, were determined by gas chromatography-mass spectrometry (GC-MS). The levels of Hz in rifampicin (RMP)- or phenobarbital (PB)-pretreated groups were lower than those in the control group, while the amount of AcHz was scarcely altered. In each of the pretreated groups a pronounced increase in the oxidative elimination rate of Hz was observed. These results are of important toxicological significance in INH therapy with RMP, since an active intermediate of Hz seems to be a hepatotoxin.