Incidence of phrenic nerve block and hypercapnia in patients undergoing carotid endarterectomy under cervical plexus block

Past approaches for inducing protective stepping to preserve standing balance in humans have either lacked the flexibility of control over the initial conditions of falling, or involved considerable mass which limits mobility of the system. This report describes the design and function of a stepper motor closed-loop waist-pull system for evoking protective stepping responses. Bench testing with applied load-motion profile combinations indicated performance degradation for force levels greater than 204 N which was well within the levels encountered in human experiments. An optical encoder feedback design allowed a positional accuracy of 0.00225 mm per step. A regression analysis of specified versus recorded velocities resulted in an acceptable fit (r2 = 0.99). The mean rise time was 63.0+/-18.0 (SD) ms and was consistent up to the load limits of the device. In human experiments repeated perturbations were consistently realized. Applied motion profiles were generally comparable at the pelvic level for subjects of different geometry, weight, and inertia despite a tendency for slight positional lag. The method allows flexible and accurate control of the initial conditions of a perturbation-induced fall to elicit steps. The system dimensions and moveability allow it to be implemented into clinical environments.     

Injuries to the phrenic nerve resulting in diaphragmatic paralysis with special reference to stretch trauma

The effectiveness of purines and purine analogues as inducers of erythroid differentiation in cultured murine erythroleukemia cells has been investigated. These cell lines have previously been shown to differentiate in vitro in response to dimethylsulfoxide (DMSO) and a number of other polar solvents. Two purine analogues, 6-thioguanine and 6-mercaptopurine, as well as the naturally occuring purine, purine, hypoxanthine, are shown to be extremely potent inducers. 6-Thioguanine is effective at a concentration of 0.06 mM, 750 fold lower than the DMSO concentration required for equivalent induction. 6-Mercaptopurine and hypoxanthine are effective inducers at a concentration of approximately 2 mM. Accumulation of globin mRNA was monitored during induction with purine inducers and shown to be similar in amount to globin mRNA levels reached in DMSO-induced cultures. Induction of differentiation by all three compounds follows a similar time course to induction with DMSO. All three compounds are potent inducers of HGPRT (hypoxanthine-guanine phosphoribosyltransferase)-negative cell lines; hence incorporation of purines into DNA is not required for induction of differentiation. Comparison of these compounds with other purines and purine analogues suggests a high degree of specificity in their interaction with a cellular target.     

Jaw lesions resulting from renal hyperparathyroidism in a young dog--a case report

A five-month-old male Labrador retriever presented with massive bilateral jaw and facial swelling. Ulcers were found on the buccal mucosa and palate, and the jaws were flexible on firm palpation. The dog could eat only soft food and was underweight. Renal hyperparathyroidism was diagnosed based on serum chemistry screen, parathormone concentration, radiological findings and histopathology. The dog was euthanatized because of an extremely poor prognosis.     

Delayed cerebrospinal fluid leakage after head and facial trauma resulting in meningitis: a case report

BACKGROUND: Several years ago, a successful surgical technique for treating depigmentation resulting from burn injuries was developed. OBJECTIVE: The purpose of this study was to investigate results of dermabrasion with melanocyte transplantation using new modifications of the technique in patients with vitiligo. METHODS: We performed 17 procedures on 12 patients with stable vitiligo. The epithelium of the vitiliginous areas was removed by dermabrasion. The dermabraded area was then reepithelialized with ultra-thin sheet grafts, which more recently were meshed and partially expanded. RESULTS: Good to excellent repigmentation was observed in 88% of the procedures. Scarring did not develop in the repigmented or donor site regions. The final color match has been good to excellent. CONCLUSIONS: This technique has proven beneficial in 88% of the procedures on our patients. Both our patients and we feel that this provides a valuable treatment option in patients who have failed medical management.     

Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases

Thirty-two patients with absent elbow flexion secondary to brachial plexus injury underwent nerve transfer using 1 or 2 fascicles of the ulnar nerve to the motor branch of the biceps muscle. Twenty-six patients had root avulsion injury of C5 and C6; 4 had root avulsion injury of C5, C6, and C7; and 2 had lateral and posterior cord injury with distal injury of the musculocutaneous nerve. The follow-up period ranged from 11 to 40 months (average, 18 months). Thirty patients had biceps strength of M4 (flexion power ranged from 0.5 to 7 kg) and 1 had biceps strength of M3. All but 1 patient demonstrated signs of recovery of the biceps muscle. No notable impairment of hand function was observed.     

Tibial nerve and fibular nerve paresis in pigs after intramuscular injection in the caudal thigh muscle (case report)

Paresis of the hindlimb in piglets after intramuscular injection of various therapeutics in the caudal thigh muscles were observed. The injection was followed by inflammatory changes of the muscle tissue at the injection site. The tibial and fibular nerve were enclosed in the alterations and showed a distinct to complete loss of nerve fibers resulting in clinical signs of paresis. The affected hindlimb was dragged on the dorsal digital surface. The piglet showed an extended consecutive swelling and ulceration below the hock and loss of the claws. These findings strongly demonstrate the necessity of a correct intramuscular injection in piglets, which should be done in the lateral neck muscles.     

Immediate TRAM flap breast reconstruction in an obese patient with relapsing benign phyllodes tumor: report of a case

The authors present a case of relapsing benign phyllodes cystosarcoma of the breast in an obese female treated with a simple mastectomy and an immediate reconstruction using a bipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. After a brief review of treatment options for phyllodes tumors, they discuss the advantages of TRAM flap breast reconstruction, suggesting that it may also be applied in obese patients.     

Recurrent ameloblastoma in an autogenous bone graft after 28 years: a case report

The growth characteristics of ameloblastoma is such that recurrence can occur regardless of treatment method, although recurrence rates following a block resection are considerably less than that following enucleation and curettage. A small number of recurrences in autogenous bone grafts have been reported in the literature. This report describes a recurrent ameloblastoma in an autogenous bone graft occurring 28 years following resection and reconstruction.     

Myocardial infarction in an adult resulting from coronary aneurysms previously documented in childhood after an acute episode of Kawasaki's disease

Coronary aneurysms resulting from a previous episode of Kawasaki's disease are considered an important cause of myocardial infarction in children. A case of a 19-year-old man presenting with an acute myocardial infarction associated with coronary aneurysms is described. These coronary lesions were previously evaluated angiographically and echocardiographically at the age of 13 years, 5 months after the acute episode of a Kawasaki's disease.     

Comparative recovery from three nondepolarizing neuromuscular blockers in a patient before and after chronic anticonvulsant therapy: a case report

We describe a 51-year-old patient undergoing a second neurosurgical procedure after being prescribed anticonvulsant therapy. The patient had significant changes in the duration of action of identical doses of nondepolarizing muscle relaxants and we were able to compare the duration of action of neuromuscular blockers before and after the chronic administration of anticonvulsant therapy. A brief review of the possible mechanisms of action of the acceleration of the patient's recovery profile is also presented.     

Complications with infection and foreign body reaction after silicon implant arthroplasty in the second metatarsophalangeal joint in an adolescent: a case report

A 21-year-old otherwise healthy male was referred to our clinic due to severe pain, deformation, development of fistules, and swelling of the second metatarsophalangeal joint of the right foot. He presented a history of two previous operations. At the age of 13, a 2-cm. resection of the distal part of the proximal phalanx was performed due to severe hammertoe deformity. At the age of 19, a partial phalanx resection and implantation of a silicon elastomer ball-shaped joint spacer was performed due to second metatarsophalangeal joint instability. After this operation, the patient suffered from fistules that appeared in the second metatarsophalangeal region. Following referral to our clinic, the patient was operated on. The proximal phalanx was removed along with the prosthesis which had slipped from the metatarsophalangeal joint into the proximal phalanx with the ends of the prosthesis perforating the skin. Debridement of infected tissue and implantation of gentamicin containing beads were performed. Bacterial specimens revealed growth of coagulase-negative staphylococci. Microscopic examination of the debrided tissue showed signs of acute and chronic inflammation. Postoperatively, the patient was treated with antibiotics and healing was uneventful. This case advocates the need for proper selection criteria and strict indications in patients with joint disease needing an arthroplasty.