Arthroscopic reduction and fixation of bony avulsion of the posterior cruciate ligament of the tibia

Bony avulsion fractures of the posterior cruciate ligament of the tibia have commonly been treated by open reduction and internal fixation using the posterior approach. However, this approach, using the prone position, makes it difficult to investigate and treat other combined injuries of the knee joint. We report a case of posterior cruciate ligament avulsion of the tibia that was arthroscopically reduced and firmly fixed with two cannulated screws. The posterior sag was absent after the operation and the result was excellent. By arthroscopy, we got rigid fixation of the avulsed fragment for early rehabilitation, and detection of a concomitant injury was also possible.     

Thoracic electric impedance and fluid balance during aortic surgery

Indices of fluid balance were evaluated during and after aortic surgery in 16 consecutive patients. Thoracic electrical impedance (TI), heart rate (HR), central venous (CVP), pulmonary artery mean (PAMP), pulmonary wedge (PWP) and mean arterial (MAP) pressures as well as fourteen arterial and venous blood gas variables were followed. Consistent with a reduction of TI during the operation, fluid balance was in excess, and it remained elevated on the first postoperative morning. The HR, MAP and PWP remained stable, while CVP and PAMP decreased. Of the determined variables only TI revealed a meaningful correlation to fluid balance (rho = -0.41; p < 0.01). The results indicate that while central venous and pulmonary artery mean pressures gave the impression of a volume deficit, the positive fluid balance was mirrored by thoracic electrical impedance.     

Rare earth oxides as carbon oxidation catalysts

The behavior of a number of rare earth oxides as catalysts for the oxidation of graphite in air has been investigated by the methods of thermal analysis. Of the oxides studied, only CeO₂ showed significant activity in accelerating the gasification of graphite by oxygen between 500 and 1000°C. Cerium salts, which decompose to a finely dispersed oxide phase at low temperatures, e.g. Ce (III) nitrate and ammonium Ce (IV) nitrate, were found to be very active catalysts. The catalytic effect may be due to a redox process involving the cyclic conversion of the oxide from the Ce (IV) to the Ce (III) oxidation state, or the oxide particles may provide sites for the dissociative chemisorption of oxygen.     

Fibrinolytic variables and cardiovascular prognosis in patients with stable angina pectoris treated with verapamil or metoprolol. Results from the Angina Prognosis study in Stockholm

BACKGROUND: Disturbed fibrinolytic function may influence the progression of coronary atherosclerosis and contribute to thrombotic cardiovascular (CV) events. METHODS AND RESULTS: In the Angina Prognosis Study in Stockholm (APSIS), patients with stable angina pectoris were studied prospectively during double-blind treatment with metoprolol or verapamil. Various measures of fibrinolytic function were studied in 631 (of 809) patients. During a median follow-up time of 3.2 years (2132 patient-years), 32 patients suffered a CV death, 21 had a nonfatal myocardial infarction (MI), and 77 underwent revascularization. Plasma levels of tissue plasminogen activator (TPA) activity and antigen (ag), plasminogen activator inhibitor (PAI-1) activity at test, and TPA responses to exercise were determined at baseline and after 1 month's treatment and were related to subsequent fatal and nonfatal CV events. Univariate Cox regression analysis revealed that elevated levels of TPA-ag at rest (P < .05), high PAI-1 activity (P < .05), and low TPA-ag responses to exercise (P < .05) were associated with increased risk of subsequent CV death. After adjustment for baseline risk factors, TPA-ag independently predicted CV death or MI. In addition, PAI-1 activity independently predicted CV death or MI in male patients. Verapamil treatment was associated with a 10% decrease of TPA-ag levels and metoprolol treatment with a 2% increase (P < .001 for treatment difference). CONCLUSIONS: Plasma TPA-ag levels at rest, and among male patients PAI-1 activity as well, independently predict subsequent CV death or MI in patients with stable angina pectoris.     

Measuring hospital performance: are we asking the right questions?

The aim of this randomized cross-over trial was to evaluate the dose effect and systemic absorption of epinephrine nebulized at 2 and 5 mg in comparison with salbutamol (5 mg). Thirteen asthmatic patients (29 +/- 15 years, 4 men and 9 women) were randomly assigned to receive one nebulization of each of the three treatment regimens at 24 h interval. The evaluation concerned forced expiratory volume in 1 second (FEV1), heart rate, respiratory rate and arterial pressure. All measurements were done at baseline, every 15 minutes during the first hour, and hourly thereafter until return to baseline FEV1. Serum potassium was measured at baseline (T0) and sixty minutes after (T60). Plasma levels of epinephrine were measured at T0, T20, T60. Fifteen minutes after the beginning of nebulization FEV1 improved significantly over baseline in the three groups. These changes were similar in the three groups until T45, while FEV1 improvement was significantly greater in A5 and S groups than A2 group (+640 +/- 470 ml, +721 +/- 349 ml, +406 +/- 306 ml in A5, S and A2 groups respectively, p < 0.01). Bronchodilation lasted significantly longer with salbutamol than with epinephrine (p < 0.05). No side effects were recorded in spite of substantial and dose-dependent systemic absorption of epinephrine. CONCLUSION: Increasing epinephrine doses produces greater bronchodilation without additional side effects. However this bronchodilation lasts shorter than with salbutamol.     

Insanity and adultery: forensic implications of a divorce case

Legal responsibility for acts presumes that a person's behavior is rationally intentional and under voluntary control. Automatism, a type of insanity defense, contends that the person's conscious, voluntary control of behavior has been impaired by a mental disorder. In a recent case in South Carolina, automatism was offered as a defense to adultery, an at-fault grounds to divorce. On appeal, the State Supreme Court recognized the novel application of mental impairment defenses in domestic litigation and remanded the case for rehearing. Implications of the ruling for clinical and forensic practice in family court are discussed.     

31P NMR identification of metabolites and pH determination in the cyanobacterium Synechocystis sp. PCC 6308

The identity of a number of phosphorus-containing metabolites present in Synechocystis sp. PCC 6308 has been confirmed by 31P NMR spectroscopy. The presence of D-ribulose 1,5-bisphosphate (RuBP); DL-glyceraldehyde 3-phosphate (GlyP); D(-)3-phosphoglyceric acid (3PGA); D-ribulose 5-phosphate (Ru5P);6-phosphogluconic acid (6PGA); phosphoenolpyruvate (PEP); inorganic phosphate (Pi); uridine diphosphoglucose (UDPG); ADP and ATP were demonstrated by the pH dependence of their 31P NMR chemical shifts in spectra of perchloric acid cell extracts. Intracellular pH of cells was determined to be 7.5-7.7.     

Regulation of tyrosine hydroxylase and aromatic L-amino acid decarboxylase by dopaminergic drugs

We provide evidence that dopamine receptors differentially modulate tyrosine hydroxylase and aromatic L-amino acid decarboxylase in the mouse striatum. The dopamine D1 receptor family (D1-like) antagonist, R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1 H-3-benazepine (SCH 23390), elevated aromatic L-amino acid decarboxylase activity and protein content in striatum, as well as the mRNA for the enzyme in midbrain. The dopamine D1-like receptor agonist, (+/-)-1-phenyl-2,3,4,5-tetrahydro-(1 H)-3-benzazepine-7,8-diol (SKF 38393), had no effect on aromatic L-amino acid decarboxylase. The dopamine D1-like drugs had no effect on tyrosine hydroxylase. In contrast, the dopamine D2 receptor family (D2-like) antagonists haloperidol and spiperone elevated both tyrosine hydroxylase and aromatic L-amino acid decarboxylase activities. The increase in aromatic L-amino acid decarboxylase activity was accompanied by elevated enzyme protein content but not mRNA. The dopamine D2-like receptor agonists, bromocriptine, quinpirole and (+/-)-7-hydroxydipropylaminotetralin (7-OH-DPAT), all decreased striatal tyrosine hydroxylase. Under the conditions used, bromocriptine and 7-OH-DPAT, but not quinpirole, decreased aromatic L-amino acid decarboxylase activity of striatum. Both the dopamine D1- and D2-like receptor antagonists enhanced the turnover of striatal dopamine to differing degrees, as judged by the ratio of acid metabolites of dopamine to dopamine. Taken together our results indicate that aromatic L-amino acid decarboxylase can be modulated independently of tyrosine hydroxylase.