Spontaneous fistula formation as a complication of relaxing incisions with suture placement for postkeratoplasty high astigmatism

A 39-year-old man had a corneal relaxing incision with corneal compression suture placement to correct more than 10 diopters of corneal astigmatism. A permanent fistula formed from the compression suture, resulting in a localized corneal pocket of aqueous that broke through the surface. The aqueous drained into the tear film, requiring major surgical repair.     

A randomized comparative study of the metabolic effects of two regimens of gestrinone in the treatment of endometriosis

OBJECTIVE: To study some of the metabolic effects of oral gestrinone on plasma lipoprotein risk markers for cardiovascular disease and on bone density, a risk marker for osteoporosis. DESIGN: Randomized double-blind study. SETTING: All patients were referred to Gynaecology Clinic of Royal Free Hospital Medical School. PATIENTS: Twenty premenopausal women with laparoscopically confirmed endometriosis. INTERVENTIONS: Subjects were randomized in a double-blind fashion to receive either 1.25 mg or 2.5 mg gestrinone two times per week for 6 months. MAIN OUTCOME MEASURE: Laparoscopy was performed before treatment, and clinical responses were determined by second laparoscopy after 6 months. Plasma lipid and bone density measurements during and after therapy were compared with baseline. RESULT: Median total endometriosis scores decreased from 7.5 to 1.0 in the 1.25-mg group and from 7.0 to 0 in the 2.5-mg group. There were no significant between-group differences in endometriosis scores. At both doses, bone density in the spine and the proximal femur was conserved, but plasma concentrations of low-density lipoproteins rose by 13% and those of high-density lipoproteins fell by 40%. CONCLUSIONS: Reducing the dose of gestrinone to 1.25 mg appeared to maintain the therapeutic effectiveness of this treatment but was still associated with potentially unfavorable effects on lipids and lipoproteins.     

Results of renal transplantation in boys treated for posterior urethral valves

The results of renal transplantation in boys treated for posterior urethral valves were evaluated and compared with a matched control group. Patient and graft survival was equal in both groups, although serum creatinine levels were slightly higher in the posterior urethral valves group. Postoperative complications, such as urinary tract infections, occurred more frequently in the posterior urethral valves group. Urodynamic evaluation was performed before transplantation in 11 of 20 patients. Adequate treatment of bladder dysfunction, such as poor compliance and/or hyperreflexia, is essential in diminishing the risks of secondary graft damage due to severe bladder dysfunction.     

Virulence and viability of Yersinia pestis 25 years after lyophilization

When equal volumes of 6% lactose and a broth culture of Yersinia pestis were mixed before freezing, approximately 50% of the cells survived lyophilization and reconstitution on the following day. Concomitantly, the number of viable cells per 50% lethal dose increased from about 16 to 125 organisms. On subsequent storage of the lyophilized cells under vacuum in glass ampoules at 4 degrees C for 25 years, more than 25% of the cells remained viable. When stored cultures were assayed immediately after reconstitution, virulence for mice was significantly reduced (as many as 4,000 cells/50% lethal dose), but the virulence was fully restored when reconstituted cultures were held for 24 h at room temperature, or when a subculture was prepared in fresh medium.     

Detachment of the continent ileostomy poucn from the anterior abdominal wall: report of two unusual cases

The cases of two patients with continent ileostomies are presented. These illustrate the problems encountered with detachment of the pouch from the abdominal wall resulting in angulation of the efferent loop of the pouch in relation to the nipple valve and difficulty intubating the pouch. Both patients required operative correction of the separation. Several suggestions are made in order to prevent or decrease the incidence of the complications. Removal of a peritoneal strip around the efferent loop of the pouch appears to facilitate adequate fixation of the pouch to the anterior abdominal wall.     

Monoamine oxidase in schizophrenia: an overview

A brief history and summary of studies designed to elucidate the role of monoamine oxidase (MAO) in schizophrenia are presented. The majority of these studies have reported a decrease in the platelet enzyme activity of chronic schizophrenic patients when compared to controls. Difficulties encountered when comparing MAO activity measured in different patient populations are also considered. Finally, the significance of decreased platelet MAO activity is discussed with respect to its possible etiological role in some forms of schizophrenia.