Bell's palsy (prevention and treatment)

The effectiveness of a variety of the most popular methods used for treatment Bell's paralysis is analyzed on a great number (1168 patients) of cases. It has been found that the results of the treatment are predetermined primarily by the gravity of the facial nerve affection. No convincing dependence of the treatment effect on the disease etiology was noted, except cases of Bell's paralysis of vascular etiology, the outcome of which was worse. A less favourable outcome was also observed in patients over 60 years of age and in cases of paralysis relapses. Of the methods of treating Bell's paralysis tested by the authors it was early use of perineural injections of hydrocortisone and novocaine in combination with the traditional methods (etiotropic, resorptive, and restorative means, electrotherapy, exercises) that proved to be the most efficacious. On the basis of the follow-up study of 676 patients recommendations on the treatment of residual phenomena of Bell's paralysis and on preventing the latter's relapses are given.     

Hemodynamic function of the Hancock standard orifice aortic valve bioprosthesis

Reports that the hemodynamic performance of the standard orifice aortic bioprosthesis in less than optimal have prompted recommendations that mechanical prosthesis or anulus-enlarging procedures be used in adult patients with a small aortic root. The hemodynamic function of the Hancock bioprosthesis was evaluated in 77 patients who underwent cardiac catheterization of rest and with isoproterenol infusion (15 patients) an average of 6 months after operation. The average peak systolic gradient (basal conditions) was 7 mm Hg (range 0 to 37 mm Hg); 35 patients had no resting gradient. Fifteen patients received 21 mm diameter valves and had an average systolic valve gradient of 10 mm Hg (range 0 to 30 mm Hg); the average effective valve orifice area was 1.27 +/- 0.17 cm2 for 21 mm, 1.46 +/- 0.11 cm2 for 23 mm, 1.72 +/- k0.20 cm2 for 25 mm, and 1.97 +/- 0.06 for 27 mm bioprostheses. Isoproterenol infusion, elevating cardiac output 66%, increased the peak systolic gradient from an average of 11 mm Hg (range 0 to 37 mm Hg) to 44 mm Hg (range 10 to 85 mm Hg). It is concluded that small-diameter (21 and 23 mm) Hancock bioprostheses can be used with acceptable clinical and hemodynamic function in patients with a small body surface area.     

Complexes in serum between alkaline phosphatase and immunoglobulin G: immunological and clinical aspects

A retrospective study was performed on 31 patients in whose sera an immune complex between alkaline phosphatase and immunoglobulin G had been detected. The average age of these patients was 64 years and the sexes were equally represented. Twenty-three patients (74%) had a disease with either an autoimmune aetiology or associated with circulating immune complexes or autoantibodies. Sera from 16 patients were tested for the presence of circulating immune complexes in addition to the alkaline phosphatase immune complex, and these complexes were detected in 14 cases (88%). Sera from 17 patients were tested for the presence of specific autoantibodies and these were detected in 9 cases (53%). Twelve patients were followed up for a mean period of 11.6 months (range 0.5 to 39 month). At the end of the follow-up period, 10 patients (83%) showed persistence of the immunoglobulin-G-alkaline phosphatase complex.     

Role of the adenylate deaminase reaction in regulation of adenine nucleotide metabolism in Ehrlich ascites tumor cells

The regulatory properties of adenylate deaminase (EC 3.5.4.6) from Ehrlich ascites tumor cells suggest that the reaction catalyzed by this enzyme serves to protect the cell against sharp decreases in the adenylate energy charge by removing adenosine 5'-monophosphate generated when the rate of utilization of adenosine triphosphate is suddenly increased. The enzyme is effectively inhibited under normal physiological conditions of high energy charge (0.9) and 4 to 5 mM adenine nucleotide pool size. The reaction is sharply activated by a decrease in the energy charge in the physiological range (0.9 to 0.6). At low energy charge (0.6), decrease in the size of the pool causes a marked and nonlinear decrease in the rate of the deaminase reaction. This effect presumably serves to prevent excessive depletion of the adenine nucleotide pool. Calculations based on the kinetic data obtained in this study show that the AMP deaminase reaction can account for the well-established alteration of adenine nucleotide metabolism that is observed following addition of glucose or 2-deoxyglucose to intact ascites cells.     

Hodgkin's disease in children: clinico-roentgenologic features of the lesion in the chest

The roentgenologic features of Hodgkin's disease were studied in 105 patients under 14 years of age. The mediastinal and hilar nodes were involved in 64.7% of patients. Some consistency of extent and pattern of disease was observed in that mediastinal lymphatic lesions could be associated with cervico-supra-clavicular and retroperitoneal lesions. There was lung infiltration in 14.3% of patients and the frequency of this lesion dependent on the histological type. It was commoner in nodular sclerosis, mixed cellularity and lymphocytic depletion. Lung infiltration usually developed in continuity with the lymphatic gland lesion and only rarely in a metastasis-like form.     

Ventriculo-atrial conduction time during reciprocating tachycardia with intermittent bundle-branch block in Wolff-Parkinson-White syndrome

Records from patients with the Wolff-Parkinson-White syndrome were reviewed with particular emphasis on the occurrence of bundle-branch block aberration during reciprocating tachycardia and the significance of this observation with respect to accessory pathway location. Increase by greater than 25 ms in the ventriculoatrial interval during reciprocating tachycardia with bundle-branch block, when compared to reciprocating tachycardia with normal intraventricular conduction, occurred only with right or left free wall accessory pathways. No patient with a septal accessory pathway proven by epicardial mapping showed a ventriculoatrial interval prolongation greater than 20 ms during bundle-branch block aberration. Measurement of ventriculo-atrial interval during bundle-branch block abe-ration also helped to diagnose accessory pathways AH and HV intervals as well as ventriculo-atrial times, may give midleading information. In one patient increase in cycle length during left bundle-branch block was the result of prolonged HV interval rather than prolonged ventriculo-atrial interval. In another patient cycle length remained the same during bundle-branch block while the ventriculo-atrial interval increased by an increment identical to the decrease in AH interval.