A masked, randomized, dose-response study between cyclosporine A and G in the treatment of sight-threatening uveitis of noninfectious origin

Thirty-two patients with sight-threatening uveitis and a decrease in visual acuity requiring systemic therapy were randomly assigned to either cyclosporine A or G in a dose-escalation study. Groups received from 2.5 mg/kg of body weight/day to 10 mg/kg of body weight/day of either drug along with low-dose prednisone. More patients taking cyclosporine G had improved visual acuity and a decrease in macular edema, which occurred more rapidly than in the other group, even at the lower doses tested. No difference in renal function was noted between groups at any doses tested. Four patients receiving cyclosporine G had hepatic alterations, but only one required cessation of the drug. The study indicates the potential usefulness of cyclosporine G, particularly at lower doses (4 mg/kg of body weight/day), which could lower the potential for serious renal complications.     

Non specific resistance against malaria pre-erythrocytic stages: involvement of acute phase proteins

Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome characterized by the involvement of several endocrine glands, including the parathyroid glands, the pancreatic islet cells, the anterior pituitary gland and other neuroendocrine tissues. In order to build up a French MEN1 register, a collaborative network was developed through the 'Groupe d'Etude des Néoplasies Endocriniennes Multiples de type 1' or GENEM 1. A 2-year follow-up in 40 medical and surgical units allowed the identification of more than 150 individual patients and 45 MEN1 families, and defined the major clinical features of the disease in our series. Multiple endocrine neoplasia type 1 is inherited as an autosomal dominant trait. The gene causing this syndrome has been localized to chromosome 11, band 11q13, and molecular genetic markers flanking the MEN1 locus are of use in identifying disease gene carriers in predisposed families. Selected data were presented in order to discuss the management of patients by combined clinical, biochemical and genetic screening. The set-up of a national register by a multi-disciplinary and collaborative medical and surgical network will facilitate further research on the clinical management of MEN1 patients and the basic physio-pathology of the disease.     

Use of a modified Roux-en-Y procedure for treatment of pyloroduodenal obstruction in a horse

A modification of the Roux-en-Y anastomosis procedure was used to bypass a pyloroduodenal mass in a 12-year-old Arabian stallion. Clinical signs had consisted of a 4-week progression of ventral and hind limb edema, hypoproteinemia, fecal occult blood, intermittent abdominal pain, weight loss, and gastric reflux. On exploratory celiotomy, an obstructive mass was found in the pylorus and proximal portion of the duodenum. Gastrojejunostomy and duodenojejunostomy were performed by use of stapled side-to-side anastomosis techniques. Inaccessibility of the obstructed pyloric region prevented resection of the affected area.     

External iliac artery occlusion due to pelvic fracture: management with a cross-femoral bypass graft

Vascular injury is not uncommon in cases of major pelvic trauma. Venous injury is by far the most common associated problem and may lead to exsanguinating hemorrhage. Arterial injury is less common, but certainly not without associated morbidity and mortality. It can lead to persistent bleeding after fixation and stabilization of the pelvic girdle, and occlusion of major pelvic arteries can cause limb ischemia and limb loss. The potential problems with revascularizing the ischemic extremity are (1) other life-threatening injuries that may be present and (2) a retroperitoneal hematoma that can interfere with an anatomic approach. Our solution to the latter problem, as presented here, is placement of a cross-femoral bypass graft, which rapidly and safely restores blood flow in the presence of pelvic fracture and an occluded external iliac artery. The pelvic hematoma is avoided, thereby restoring circulation more quickly, with less blood loss and greater ease.     

Vertebral artery injury associated with a Jefferson fracture

BACKGROUND: The evaluation and treatment of Jefferson fractures, a burst fracture of the ring of Cl, has been well documented in the medical literature. Vertebral artery injury associated with a Jefferson fracture is very rare. METHODS: The case study technique was used to summarize the case. Review of the literature was performed to discuss the case. Retrospective chart review of the 174 patients with cervical fractures admitted to St. Michael's Hospital from 1989-1994 was also performed. RESULTS: The case of a patient with a Jefferson fracture, with bilateral lateral displacement of the lateral masses causing bilateral vertebral artery occlusions resulting in a lateral medullary and cerebellar infarction is reported. A review of the literature is provided. CONCLUSION: A high index of suspicion for this injury is paramount, especially in patients with multiple trauma, where the diagnosis of Jefferson fractures can be delayed.     

The tragus as a donor area of cartilage grafts: anatomic study

The American Dental Association (ADA) has developed many resources to address growing concerns regarding HIV (human immunodeficiency virus) issues in dental practice, including continuing education courses, workshops, journal articles, and monographs. In addition, the ADA Council on Dental Practice has established a network for dentists with HIV/AIDS (acquired immune deficiency syndrome). The network has been named PEERS, which stands for Prevention, Education, Ethics, Resources, and Support. This paper provides guidelines for developing programs in each state to address the needs of dentists with HIV/AIDS.     

The relation of passage of gas an abdominal bloating to colonic gas production

OBJECTIVE: To determine the relation of gas passage and abdominal bloating to the production of gas in the colon. DESIGN: Randomized, double-blind, crossover study of gaseous symptoms during a 1-week period. SETTING: A Veterans Affairs medical center. PARTICIPANTS: 25 healthy medical center employees. INTERVENTION: Participants' diets were supplemented with either a placebo (10 g of lactulose, a nonabsorbable sugar), psyllium (a fermentable fiber), or methylcellulose (a nonfermentable fiber). MEASUREMENTS: All participants were polled for gaseous symptoms (including number of gas passages, impression of increased rectal gas, and abdominal bloating), and five were examined for breath hydrogen excretion. RESULTS: Participants passed gas 10 +/- 5.0 times per day (mean +/- SD) during the placebo period. A significant increase in gas passages (to 19 +/- 12 times per day) and a subjective impression of increased rectal gas were reported with lactulose but not with either of the two fiber preparations. Breath hydrogen excretion, an indicator of hydrogen production in the colon, did not increase after ingestion of either of the fibers. However, a statistically significant (P < 0.05) increase in feelings of abdominal bloating (which the participants perceived as excessive gas in the bowel) was reported with both fiber preparations and with lactulose. CONCLUSIONS: The physician should distinguish between excessive gas (which indicates excessive gas production) and feelings of bloating (which are usually unrelated to excessive gas production). Treatment of the former consists of limiting the supply of fermentable material to the colonic bacteria. Symptoms of bloating usually indicate the irritable bowel syndrome, and therapy should be directed accordingly.