Neuropsychological and motor functioning after unilateral anatomically guided posterior ventral pallidotomy. Preoperative performance and three-month follow-up

This study presents baseline and 3-month follow-up motor and neuropsychological data for 22 patients with Parkinson's disease (PD) who underwent anatomically guided unilateral posterior ventral pallidotomy (PVP). Postsurgical improvements were seen in psychomotor speed, fine motor accuracy, and dyskinesia, whereas grip strength decreased on the side contralateral to the surgery. No change was detected in overall level of cognitive functioning, nor were changes demonstrated in memory, language, or working memory when the entire sample of patients was evaluated. When the group was divided on the basis of side of surgery, patients with left-sided pallidotomies showed a decline in verbal fluency. Patients and caregivers reported improvement in psychosocial functioning. These initial findings of improved motor performance and largely unaffected cognitive functions are consistent with results obtained with functional PVP and provide support for the use of anatomically guided posterior ventral pallidotomy in the treatment of motor symptoms of PD.     

The significance of fetal myocardial and skeletal muscle function as a factor affecting its viability

Histologic study of the heart and functionally active zones of skeletal muscles of the lower limbs of fetuses and newborns (71 cases) is undertakes to distinguish the factors affecting the viability of the fetus (new-born) and detect the total-system muscle tissue involvement after the general morphogenetic mechanism. The basic criteria of a pathological process caused by capillarotrophic myocardial insufficiency are dystrophy, necrosis, and sclerosis. Various forms of nonspecific prenatal myopathy were detected in the skeletal muscles; they were combined with symptoms of chronic myocardial hypoxia. A relationship between cardiovascular abnormalities and intrauterine and neonatal death is revealed.     

The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea

To determine the effect of anterior cruciate ligament (ACL) reconstruction on symptoms of pain and instability in patients with chronic ACL insufficiency who had previously undergone meniscectomy, we reviewed a series of 21 symptomatic, previously meniscectomized patients with chronic ACL deficiency (average age, 31 years). Arthroscopically assisted intra-articular ACL reconstruction using a middle, one-third patella-tendon autograft was performed in all cases. All patients had radiographic evidence of degenerative changes before ACL reconstruction. The average time from meniscectomy to ACL reconstruction was 6.6 years. Preoperative and postoperative range of motion, stability, and subjective evaluations were compared. Follow-up averaged 37.4 months (range, 24 to 67 months). Physical examination and postoperative KT-1000 side-to-side measurements revealed three patients (14%) with pathological ligament laxity. One patient had a 2+ Lachman, a 2+ pivot shift, and > 5 mm difference on KT-1000 maximum manual test, and two patients had a 1+ Lachman and a 1+ pivot shift. Range of motion measurements taken at follow-up were not significantly different from preoperative measurements (extension, P = .14; flexion, P = .46). Subjectively, all items on a panel of 15 visual analog scales were improved, but intensity of pain and instability were significantly improved after statistical analysis (P < .05). This review suggests that symptoms of pain and instability in patients with chronic ACL deficiency who have previously undergone meniscectomy can be improved by ACL reconstruction if objective stability is obtained.     

Nutritional strategies for promoting fat utilization and delaying the onset of fatigue during prolonged exercise

With increasing human age (20-80 years), the electroencephalogram (EEG) dose requirement for the intravenous anesthetic thiopental decreases approximately 10% per decade of life. The goal of this study was to compare the dose required to attain isoelectric EEG in young (4-5 month) vs. aged (24-25-month) Fischer 344 rats. One second isoelectricity was found to be an endpoint where minimal cardiorespiratory depression occurred. The effects of age, infusion rate, and repeated administration were examined in nine young and nine old rodents. Thiopental dose requirement increased with increasing infusion rates. Repeated administration at two-day intervals did not demonstrate tolerance to thiopental. No difference in thiopental dose requirement was detected in the young vs. elderly rats. In a separate group of five young and five old rats, thiopental plasma, brain, heart, and CSF concentrations were measured when five seconds of EEG isoelectricity was achieved: no consistent differences were noted. The rat may not be an appropriate model to investigate acute age-related anesthetic effects in humans, because cardiovascular changes with age are dissimilar between species.     

Role of drugs and environmental agents in lupus syndromes

It is increasingly accepted that a broad range of drugs and environmental factors can give rise to lupus syndromes and other types of connective tissue disease syndromes. This chapter reviews the drugs and environmental agents reported during this past year. Considerable research efforts are now focused on understanding the possible mechanisms, particular specificities of the antibody responses, new patterns of antibody responses, and biochemical pathways. These potentially important contributors to the expression of disease are reviewed.