Fistula in ano

An eight year retrospective review of 133 patients with fistula in ano found the majority to be of cryptoglandular causation. Many patients had symptoms for longer than one year. Operation was performed safely under spinal anesthesia, locating the internal opening in 117 patients, performing a fistulectomy in 80 patients and a fistulotomy in the remainder. Associated procedures, such as a hemorrhoidectomy, could be performed safely. Early recurrence of a fistula, spinal headache, bleeding and temporary incontinence were the complications present in 14 patients. All patients with an early recurrence had undergone a fistulotomy.

Uptake and subcellular compartmentation of gibberellin a(1) applied to leaves of barley and cowpea

The uptake and subcellular accumulation of gibberellin A(1) (GA(1)) by leaves and protoplasts of barley (cv. Numar) and cowpea (cv. Blackeye pea No. 5) were investigated.Uptake of GA(1) by cowpea leaves is optimal at pH 5.8 and occurs by a saturable, probably carrier-mediated process having a half-maximal velocity at 10 to 20 micromolar. Uptake by both barley and cowpea leaves is inhibited by low temperature (+4 C) and the metabolic inhibitors 2,4-dinitrophenol and azide and is stimulated by ATP. Mesophyll protoplasts isolated from leaves fed radioactive GA(1) retain 20 to 80% of the radioactivity incorporated by excised leaves.The subcellular localization of the [(3)H]GA was determined by lysing protoplasts and separating subcellular organelles by density gradient centrifugation. Less than 5% of the incorporated [(3)H]GA was found associated with chloroplasts, mitochondria, nuclei, or other organelles or membranes with densities in sucrose gradients greater than 1.15 grams per cubic centimeter. Fifty to 100% of the [(3)H]GA was found in vacuoles. Isolated vacuoles were judged to be free of contamination by cytoplasm using phosphoenolpyruvate carboxylase as a marker enzyme. Osmotic breakage of vacuoles or protoplasts released > 95% of the [(3)H]GA, suggesting that GA is associated with the vacuolar sap rather than with the tonoplast membrane.

Viral antibody titres in HBs antigen-positive and -negative chronic active hepatitis

A comparative study of antibody titres to nine common viruses has been carried out in hepatitis B surface (HBs) antigen-positive and -negative chronic active liver disease. The results show that increased titres of antibody to morbilli virus by complement fixation and to rubella by haemagglutination inhibition are found in HBs antigen-negative but not in HBs antigen-positive chronic active liver disease. There was a significant association of increased morbilli but not of rubella virus antibody titres with the presence of high-titre nuclear antibodies (ANA) but no association with smooth-muscle antibody or the presence of HLA-B8.

The impact of psychiatric intervention on patients with uncontrolled seizures

There is much evidence that emotional stess can trigger both neurogenic and hysterical seizures in susceptible patients. We reviewed out experience with 37 patients whose seizures appeared to be precipitated at times by emotional stress and had not been controlled by anticonvulsant medication alone. Approximately 70 per cent of patients demonstrated substantial improvement in seizure control after psychiatric treatment and maintained this improvement during follow-up. The findings of this study suggest that patient characteristics associated with better prognosis include normal intelligence, partial (as opposed to generalized) neurogenic seizures, a diagnosis of hysterical seizures, a less severely abnormal EEG, and being hypnotizable. After psychiatric treatment, 32 per cent of patients had their anticonvulsant medication reduced and another 16 per cent had it discontinued.

HLA antigens in chronic relapsing idiopathic inflammatory polyneuropathy

Observations are reported on 14 patients with a clinical diagnosis of recurrent or chronic relapsing idiopathic inflammatory polyneuropathy of Guillain-Barré type. The results suggest the possibility of a disease susceptibility gene for this disorder associated with the HLA-A1, -B8, -DRw3, and -Dw3 haplotype.

[Experimental reproduction of a secondary pacemaker center for alimentary motivation]

In chronic experiments on rabbits the possibility of artificial modeling of motivational feeding pacemaker's function by different limbic-reticular structures was investigated. It was shown that simultaneous stimulation of the lateral hypothalamic "feeding" centre with various structures of the limbic-reticular complex makes secondary pacemaker of feeding motivation in the midbrain reticular formation only.

A histochemical method for the detection of metals in tissues, with reference to the use of surgical implants

This report describes a method for the detection of metals in tissues that is suitable for a routine pathology laboratory. The method has been developed specifically for the examination of soft tissues taken at biopsy from the site of surgical implants. It involves the mineralization of organic matter in sections by sodium metasilicate and the conversion of the metals to sulphates by sulphuric acid, which are then stained by appropriate solutions. The method is described with particular reference to titanium and cobalt.

Nitrous oxide pollution levels in oral surgery offices

Nitrous oxide pollutant levels, surveyed in oral surgery offices in Southern California, were lower than previously reported. These evaluations were related to rebreathed gas samples obtained from the operator and assistants, and appear to correlate well with exposure to nitrous oxide contamination. The lower levels in the hallway were tenfold less than those previously reported. Better air-conditioning in these offices and better airway control could be responsible, in part, for the difference.

Carbon fiber-reinforced carbon as a potential implant material

A carbon fiber-reinforced carbon is being evaluated as a promising implant material. In a unidirectional composite, high strengths (1200 MN/m2 longitudinal flexural strength) and high modulus (140 GN/m2 flexural modulus) may be obtained with an interlaminar shear strength of 18 MN/m2. Alternatively, layers of fibers may be laid in two directions to give more isotopic properties. The compatibility of the material with bone has been studied by implanting specimens in holes drilled in rat femora. For a period of up to 8 weeks, a thin layer of fibrous tissue bridged the gap between bone and implant; but this tissue mineralizes and by 10 weeks, bone can be observed adjacent to the implant, giving firm fixation. Potential applications include endosseous dental implants where a greater strength in the neck than that provided by unreinforced carbon would be advantageous.

Accessory nerve palsy

After apparently uncomplicated excision of benign lesions in the posterior cervical triangle, two patients had shoulder pain. In one, neck pain and trapezius weakness were not prominent until one month after surgery. Inability to elevate the arm above the horizontal without externally rotating it, and prominent scapular displacement on arm abduction, but not on forward pushing movements, highlighted the trapezius dysfunction and differentiated it from serratus anterior weakness. Spinal accessory nerve lesions should be considered when minor surgical procedures, lymphadenitis, minor trauma, or tumours involved the posterior triangle of the neck.

HLA antigens in Guillain-Barré syndrome

Sixty patients with suspected lumbar herniated disk and/or canal stenosis were studied prospectively with surface coil MRI, CT, and/or myelography, and the results were compared with the surgically confirmed abnormality. Forty-eight patients had lumbar surgery at 62 levels. There were no negative explorations. Thirty-nine patients had a myelogram and CT. Thirty of the CTs were performed following the injection of metrizamide for myelography. Nine patients had a CT without intrathecal contrast material 1 to several days before the myelogram. Six patients had myelography only, and three patients had CT only. All studies were evaluated for the location and type of disease in a forced choice fashion. Independent of the surgically correlated levels, there was 86.8% agreement between the MR and CT studies in all patients at 151 levels and 87.2% agreement between MR and myelography at 218 levels. At the operative levels, there was 82.6% agreement between MR and surgical findings for both type and location of disease; 83% agreement between CT and surgical findings; and 71.8% agreement between myelography and surgical findings. There was 92.5% agreement when MR and CT were used jointly, and 89.4% agreement when CT and myelography were used jointly. The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease. CT and MR can be complementary studies, and surface coil MR can be viewed as an alternative to myelography.

The cost and advantages of establishing an age-sex register

The advantages and disadvantages of different methods of creating an age-sex register are described. The cost of setting up such a register in a NHS practice with 10,000 patients is shown, and it is suggested that financial advantages may cover the costs involved.

The effects of left ventricular load and contractility on mitral regurgitant orifice size and flow in the dog

Acute mitral regurgitation (MR) was produced in 12 dogs by closed chest partial valvulectomy and the relative contributions of MR pressure gradient (MRG), the time for regurgitant flow (VSI), and the MR orifice area (MRA) to mitral regurgitant volume (MRV) assessed. Aortic and left atrial pressures, biplane left ventricular (LV) angiography, forward flow and mitral regurgitant flow (MRF) were measured following MR induction and following augmentation of left ventricular end-diastolic volume (EDV), increased aortic resistance (angiotensin), and in the presence of increased ventricular contractility (calcium or epinephrine). Mitral regurgitation orifice area was determined by calculation and the diameters of the mitral anulus and subvalvular areas measured angiographically. Angiotensin and volume infusion induced a substantial increase in MRF which was largely dependent on an increase in MRA but not MRG, while augmentation of contractility decreased MRF accompanied by a decrease in MRA, relatively independent of MRG. Left ventricular size and shape are major determinants of MRA and resultant MRF in acute mitral regurgitation. These findings may help to explain the effects of such factors as ventricular loading and volume on the clinical course of mitral regurgitation in man.

Aseptic osteomyelitis and necrosis of the mandibular condylar head after intracapsular fracture

Aseptic osteomyelitis and necrosis of the mandibular condylar head is a rare complication which may occur several months after an untreated intracapsular fracture. Clinical symptoms are pain in the temporomandibular joint on the affected side and limitation of opening of the mouth. Radiographically, the condylar head is characteristically eroded and irregular. Treatment consists of surgical removal of the necrotic condylar head and débridement of the area, which are performed via a preauricular approach.

Keratinization of the oral epithelium

The morphology of the keratinizing epithelia in the mouth is reviwed in the light of recent knowledge. There appears to be a spectrum of degrees of keratinization rather than distinct types, and a degree of keratinization is reflected in the degree of packing and orientation of tonofilaments. The role of keratohyaline and other granules in the process is discussed and it is suggested that modification of the cell membrane is an important part of keratinization. Although the potential of the various areas in the mucosa is genetically determined and appears early in fetal life, the connective tissue exerts an influence on the extent of keratinization of the surface in a manner which is not understood.

A histochemical method for the determination of titanium in tissues surrounding implants

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Human alpha-crystallin. I. The isolation and characterization of newly synthesized alpha-crystallin

Studies of the incorporation of 14C amino acids into human lens proteins demonstrate that an alpha-crystallin fraction takes up more than six times as much radioactivity as any other lens protein. Based on analyses with a calibrated Bio-Gel A-1.5 m column, a molecular weight of 4.9 x 10(5) +/- 5 per cent was obtained for this protein while sedimentation equilibrium analyses indicated a weight average molecular weight, Mw, of 7.5 x 10(5) +/- 4 per cent at 10,000 r.p.m. Gel electrophoresis in sodium dodecyl sulfate revealed two components with molecular weights of 22,000 and 20,000, values similar to those found with calf alpha-crystallin. Alkaline urea gel electrophoresis indicated one major polypeptide with a mobility similar to the B2 chain of calf alpha-crystallin and two major bands with mobilities between those of the calf alpha-crystallin A2 and A1 chains. Amino acid analyses of this newly synthesized alpha-crystallin gave a composition which with a few exceptions is very similar to that of calf alpha-crystallin. All three major polypeptides contained 14C amino acids. However, from the present data, it cannot be determined whether the three polypeptides were independently synthesized or a rapid transformation produced one of the labeled polypeptides in the A region. There appears to be between three and four times as many presumptive A as B polypeptides.

Electron spin resonance analysis of irreversible changes induced by calcium perturbation of erythrocyte membranes

Introduction of calcium during hemolysis of erythrocytes causes irreversible membrane changes, including protein aggregation. These changes have been investigated by incorporation of one protein and three fatty acid spin label probes into washed membranes from erythrocytes hemolyzed with a range of Ca2+ concentrations. Electron spin resonance spectra of the lipid probes were analyzed for changes in the order parameters, isotropic coupling constants and mean angular deviations of the lipid hydrocarbon chains. The results generally indicated an increased freedom of mobility of the probes with increased Ca2+ concentration during hemolysis, but the response of each probe showed a different concentration dependence. The maximal response was obtained with the I(5, 10) probe. Variations in the responses were interpreted to reflect different modes of protein-lipid or protein-probe interactions arising from Ca2+ -induced membrane protein alterations. Spectra from membranes treated with the protein spin label showed an increased ratio of immobilized to mobile label with increased Ca2+ concentrations at hemolysis. This is consistent with the membrane protein aggregation phenomena previously observed. It is suggested that the increased protein-protein interactions formed as a result of calcium treatment permit an increased lipid mobility in the membrane regions monitored by the fatty acid probes.

Modifying nitrous oxide analgesia circuits to reduce pollution in the dental operatory

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Surface coatings of cells in the oral epithelium of the human fetus

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