Tickborne oculoglandular tularemia: case report and review of seasonal and vectorial associations in 106 cases

A patient acquired tickborne oculoglandular tularemia in early summer in rural Virginia. Tick exposure may be a clue to the diagnosis of tularemia in the eastern as well as the western United States, especially in summer months. A review of the experience with tularemia in Virginia for the last 13 years shows a bimodal seasonal incidence of tularemia with an associated vector exposure in 77.4% of 106 cases. The majority of cases occurring during winter months have been associated with rabbit exposure, while those in summer months are often associated with tick exposure.     

Determination of the facility of aqueous humor outflow in the dog, comparing in vivo and in vitro tonographic and constant pressure perfusion techniques

The gross facility of aqueous humor outflow (C) was estimated in the normal in vivo and in vitro dog eye, using tonography and constant pressure perfusion. Tonographic C value for 36 normal eyes, with the dog anesthetized with ketamine hydrochloride and acetylpromazine maleate, was 0.21 (+/- 0.14, SD); the mean tonographic value in 35 eyes with the patient anesthetized with sodium pentobarbital was 0.15 (+/- 0.09). Constant pressure perfusion of the in vivo normal dog eyes at 20 mm of Hg intraocular pressure yielded a mean C value of 0.13 (+/- 0.07) and at 30 mm of Hg 0.18 (+/- 0.13). As intraocular pressure increased from 10 to 50 mm of Hg, the rate of outflow, as determined by constant pressure perfusion, increased. The C values from in vitro constant pressure perfusion were greater than those in the in vivo eyes and deceased in most eyes as intraocular pressure was increased as compared with the in vivo preparation.     

The single ectopic ureter

A significant number of ureters with ectopic insertion occur in the single (nonduplex) collecting system. We have investigated 16 patients with this anomaly whose ureters were abnormal enough to cause problems. Characteristic symptoms at presentation included a pelvic mass, ureterovesical obstruction, a ureterocele, urinary dribbling, epididymitis, and infection of the urinary tract with or without reflux. Radiographic evaluation is usually possible using only intravenous urogarphy and voiding cystourethrography. Nonvisualization of one kidney in association with one of the above findings should suggest a single ectopic ureter. Particular attention should be paid to the site of ureteral insertion whenever reflux is seen.     

Zinc sulfate: an adjuvant to wound healing in patients undergoing radical vulvectomy

In an experimental study we tried to find out whether halothane, in addition to its effects on vegetative efferents, has also an influence on catecholamine metabolism of the corresponding brain sections. We studied the effects of halothane in the brain stem of rats on dopamine and norepinephrine contents and on the transformation of L-dopa into dopamine and L-norepinephrine. Anaesthesia with 2 vol% halothane reduced dopamine content by 41.4%, norepinephrine content by 17.8%. These findings could be observed even 3 h after narcosis. Electrophysiological studies show that the central nervous sympathetic activity at rest and after central excitation is clearly reduced during anaesthesia with 2 vol% halothane; 70 min after narcosis it returned to normal. Administration of L-dopa led to an increase of dopamine by 43.5% within 45 min. This transformation of L-dopa into dopamine is not affected by concurrent halothane anaesthesia. There is no increase in norepinephrine after administration of L-dopa. Thus, the effect of halothane on catecholamine metabolism in the brain stem affects the precursors of L-dopa. Halothane is said to inhibit transport of the L-dopa precursor L-tyrosine from plasma to brain tissue. Along with such an inhibition goes the depression of the sympathetic activity. In this respect and obviously on the basis of its position within the catecholamine metabolism, dopamine is more important than norepinephrine.     

Forearm fractures in children: avoiding redisplacement

We reviewed eighty-six children with closed extra-articular distal forearm fractures to determine the factors responsible for early redisplacement. The most important favourable prognostic factor was a perfect anatomical reduction on the immediate post-reduction radiograph. This was far more likely when the manipulation was performed by an experienced surgeon.     

Inhibition of proliferation and induction of apoptosis in juvenile myelomonocytic leukemic cells by the granulocyte-macrophage colony-stimulating factor analogue E21R

Juvenile myelomonocytic leukemia (JMML) is a malignancy that almost inevitably leads to death before adulthood. Chemotherapy has given disappointing results and a substantial number of patients relapse after bone marrow transplantation. A salient feature of this disease is that the JMML cells produce granulocyte-macrophage colony-stimulating factor (GM-CSF) spontaneously and survive and proliferate without exogeneous GM-CSF. Furthermore, JMML cells are hypersensitive to GM-CSF with addition of this cytokine leading to enhanced proliferation. We have recently generated a human GM-CSF analogue, E21R, that acts as a complete and selective GM-CSF receptor antagonist. We have now tested this molecule as a potential new agent to control the leukemic cell load in JMML with particular emphasis on its role in JMML cell survival. We found that E21R inhibited the spontaneous growth of JMML cells in vitro and caused their apoptosis in a dose- and time-dependent manner in seven of seven cases. In contrast, neither a neutralizing anti-GM-CSF monoclonal antibody (MoAb) nor a selective interleukin-1 (IL-1) receptor antagonist affected JMML cell survival. Furthermore, the apoptotic effect of E21R was seen even in the presence of interleukin-1 beta and tumor necrosis factor-alpha, which have also been implicated in the pathogenesis of JMML. The inhibitory effects of E21R on JMML cell growth and viability offer a novel approach to therapy in this lethal childhood leukemia.     

A manipulative technique of Andrew Taylor Still as reported by Charles Hazzard, DO, in 1905

This article presents rediscovered osteopathic manipulative techniques described by Charles Hazzard in 1905 and ascribed by him to Andrew Taylor Still, the founder of osteopathic medicine. Still refrained from writing about his manipulative techniques in any significant detail, apparently intentionally. The techniques published by Hazzard have both internal consistency and similarity to those less well described by Still, suggesting that the attribution is accurate. The techniques are analyzed and presented as a variant of a direct articulatory technique with axial compression. In honour of their originator, they are being termed the Still techniques.