Hemispherectomy: a hemidecortication approach and review of 52 cases

Between 1975 and 1994, 52 hemispherectomies, of which two were anatomical and 50 hemidecortications, were performed at Johns Hopkins Medical Institutions. Eighteen patients were 2 years old or less. There were three perioperative mortalities and one patient died 9 months later from causes not related to surgery. One patient developed hydrocephalus 6 years postsurgery and has been treated effectively. Seizure control and the functional status of each patient were measured as outcome variables. Forty-six (96%) of the surviving patients were seizure free or had reduced seizures as of their last follow-up examination. Twenty-one individuals (44%) were participating in age-appropriate classes or working independently, 18 were classified as semiindependent, and nine children will likely depend on a lifetime of assisted living. The relationships between the outcome variables and the patient's age at surgery, the interval to surgery, and the etiology of the disease were compared. The authors' clinical experiences strongly suggest the importance of a multidisciplinary approach to patient selection and follow-up care. Moreover, anesthetic management of infant surgery is a major component of success.     

Effects of pregnancy on hemoglobin AIc in normal, gestational diabetic, and diabetic women

Hemoglobin AIc, a normal minor hemoglobin, has glucose linked by a Schiff base to the N-terminal end of the beta chain. The glucose interferes with the binding of 2,3 diphosphoglycerate, probably resulting in an increased affinity of that hemoglobin for oxygen. Hb AIc is increased to twice normal levels in juvenile-onset (insulin-dependent) diabetes. In the present studies, the Hb AIc, when expressed as per cent of total hemoglobin, was found to be elevated slightly in pregnany normal (m = 6.97 per cent), pregnant nondiabetic obese (m = 6.89 per cent), and gestationally diabetic subjects (m = 8.77 per cent) above that of normal females (m = 5.68 per cent). A remarkable difference was observed between the nonpregnant diabetics (m = 12.77 per cent) and the pregnant diabetics (m = 8.46 per cent). This decrease in the level of Hb AIc in diabetics who are pregnant more than 30 weeks may reflect either a better state of diabetic control and/or a compensatory mechanism to protect the fetus by facilitating oxygen exchange from mother to fetus.     

Oesophageal function in patiensts with angina (author's transl)

Oesophageal functions were measured in 18 patients with angina, 13 healthy volunteers and 29 age-matched patients with reflux disease. Acid clearance was as abnormal in angina patients (88 +/- 46 swallows) as in those with reflux disease (97 +/- 45). The pressure in the lower oesophageal sphincter was low in patients with angina (13 +/- 8 mm Hg). The incidence of hiatal hernia, subjective symptoms during acidification of the oesophagus and results of the reflux provocation test were similar in patients with angina pectoris and healthy controls.     

Influence of inhibitors of prostaglandin synthesis on venoconstrictor responses to bradykinin

The interrelationship between prostaglandins (PGs) and bradykinin (BK) was studied in isolated canine saphenous veins. The hypothesis that PGs mediate the venoconstrictor effect of bradykinin was evaluated by determining the influence of low concentrations of indomethacin (Indo) (1 muM) or eicosa-5,8,11,14-tetraynoic acid (ETA) (3 muM), two inhibitors of PG synthesis, on cumulative concentration-response curves for BK or norepinephrine (NE). In the tissue bath, responses to BK improved with time while responses to NE did not vary. When strips were least responsive to BK, Indo and ETA enhanced these responses. When strips were most responsive to BK, neither inhibitor enhanced the responses. Neither Indo nor ETA altered responses to NE. Phentolamine (10(-8) M) did not alter responses to BK. These data suggest that endogenous PGs act to attenuate, rather than mediate, the venoconstrictor response to BK. Progressive enhancement of responses to BK of untreated saphenous vein strips is associated with a decreased ability of inhibitors of PG synthesis to enhance those responses also. Thus, there may be a time-related decrease in the ability of this preparation to synthesize PGs. From the present results, it cannot be determined whether saphenous veins in vivo are highly responsive or relatively unresponsive to the peptide. However, these data do suggest that PGs are a determinant of venous responsiveness to BK.     

Resuscitation equipment board for nurseries and delivery rooms

A resuscitation equipment board for mounting in delivery rooms and nurseries facilitates orderly and effective resuscitation of asphyxiated neonates.     

Noninvasive myocardial imaging with potassium-43 and rubidium-81 in patients with left bundle branch block

Noninvasive myocardial imaging with potassium-43 and rubidium-81 has been used successfully to identify areas of infarction and exercise-induced ischemia as regions of decreased radioactivity. The image defects observed are believed to be due to a decreased radionuclide uptake in regions of myocardial scar or to heterogeneous myocardial accumulation of tracer as a result of regional ischemia. Of 27 patients with left bundle branch block studied with noninvasive imaging at rest and during exercise, 25 manifested at rest reduced radioactivity in the region of the interventricular septum. This pattern is similar to that seen in patients with anteroseptal myocardial infarction. Sixteen of the 27 patients underwent diagnostic coronary arteriography and left ventriculography. Only five of these patients had evidence of either previous infarction or significant obstructive coronary artery disease as assessed with clinical or angiographic criteria, or both. Although the image defect was routinely demonstrated at rest in patients with left bundle branch block, this defect was generally normalized or less distinct with exercise in patients with no anatomic heart disease. In contrast, a larger, more distinct or new image defect with exercise correctly identified the presence of significant obstructive coronary artery disease in patients with left bundle branch block. In the clinical application of noninvasive myocardial imaging, these image defects observed at rest can lead to the false pasitive radionuclide interpretation of anteroseptal myocardial infarction.     

Inguinal herniography. Its value in the diagnosis of silent patent vaginal process]

The spontaneous contractions of isolated guinea pig atria were arrested by a temperature change in the medium for 30 to 20 degrees C within 20 min. 2. When thiamine tetrahydrofurfuryl sulfide (TTFD) at concentration of 10-5 g/ml was added in the medium, the arrest was not seen for more than 30 min. 3. Arrhythmic contractions induced by the electrical square wave stimulation of threshold intensity were prevented by TTFD at 10-4 g/ml which was added to the medium. 4. These effects of TTFD at respective concentrations were seen even 30 min after the drug was removed from the medium, when the atria had been pre-incubated with the drug for one hour before the removal. 5. From these results, it was assumed that TTFD might show these effects against the extrinsic physical invasions through the stabilization of the tissue membrane.     

Ovarian regulation of postcoital gonadotropin release in the rabbit: reexamination of a functional role for 20 alphadihydroprogesterone

In the rabbit, it has proposed that an ovarian progestin, 20 alpha-dihydroprogesterone (20alphaP), released at mating, is essential for a normal postcoital LH surge. However, we measured plasma levels of LH and 20alphaP after mating in rabbits and observed that the frequency, magnitude and time-course of changes in circulating levels of 20alphaP seemed inappropiate to account for the rapid and major surge of LH secretion. This prompted us to re-evalute the role of the ovary in regulating postcoital LH secretion. In chronically ovariectomized (greater than 30 days) does pretreated with estrogen, mating induced a normal LH surge in only 1 of 10 animals, indicating that an ovarian product in addition to estrogen is required for a normal postcoital LH surge. However, when 20alphaP was injected soon after mating in chronically ovariectomized does pretreated with estrogen, only 2 of 9 displayed normal LH surges; this proportion is not different from that (1/10) observed with estrogen treatment alone. To demonstrate that the estrogen treatment, which produced supraphysiologic plasma estradiol levels, did not itself block LH release, 6 intact anestrus females were treated with the same estrogen regimen. Estrus was induced in 5 and each displayed a large post-coital LH surge and ovulated. As a final test of the 20alphaP hypothesis, 5 spontaneously estrous does were ovariectomized within 15 min post coitum to abolish acute increases in circulating ovarian hormones. Three animals released LH in amounts and temporal pattern indistinguishable from intact estrous does. A fourth released smaller amounts of LH. Two of 4 sham-operated does also had normal LH surges. These findings indicate that ovarian hormones are required before mating to support the capacity of the LH secretory mechanism to respond to coitus. Chronic alteration in the hormonal milieu by ovariectomy appears to produce a change in the hypothalamo-hypophysial complex that is not reversed by estrogen, alone. More importantly, these results demonstrate clearly that neither 20alphaP nor any other ovarian hormone is required post coitum, at least after 15 min, for normal LH release.     

Hepatitis B virus infection in dental surgical practice

Sixty-one dental surgeons at King's College Hospital were interviewed to establish the incidence of attacks of viral hepatitis and to relate this to environmental risk factors. Six (10%) had a history of hepatitis, in one case due to infection with the hepatitis B virus. Screening blood for HBsAg by radioimmunoassay showed no carriers of the antigen, but transient antigenaemia was observed in one dentist. Antibody to HBsAg, tested by radioimmunoassay, was detected in four dentists (7%), only one of whom had had clinical hepatitis. Dental surgeons may be more at risk from infection with the hepatitis B virus than the general population, although this should be minimised in hospital practice, where the most infected patients will already have been identified and appropriate precautions can be taken. The risk of transmission from an antigen-positive dentist to his patients is probably much smaller, and there is no evidence to restrict his clinical activities.