[Arthroscopic management of recurrent anterior shoulder dislocation by combining a labrum suture with antero-inferior holmium:YAG laser capsular shrinkage]

Current arthroscopic treatments do not address satisfactorily the capsular redundancy frequently associated with the Bankart lesion in recurrent anterior dislocation. Although the Bankart lesion heals, many of the recurrences after arthroscopic procedures are due to capsular redundancy and the laxity of glenohumeral ligaments. We propose that laser-assisted capsular shrinkage (LACS) be combined with arthroscopic labrum reattachment. As shown by Market et al., significant capsular shrinkage can be achieved by the application of non-ablative Ho:YAG laser energy without detrimental effects to the relaxation properties of the tissue. For 1 year we have used LACS together with labrum suture in 18 shoulders in 18 patients (mean age 24.6 years). All patients suffered from chronic anterioinferior recurrent dislocation. The labrum suture was realized by an anterior reattachment (REVO screws, Linvatec, USA) or by transglenoid suture. Two or three sutures were passed through the torn labrum with 2/0 non-absorbable suture material. The LACS procedure was performed with a holmium:YAG laser (VersaPulse, Coherent, USA) at an energy of 10 W (1 J, 10 Hz) with a 30 degrees curved handpiece. All patients were immobilized in a sling for 4 weeks postoperatively. Physical therapy was begun at 1 month with passive and active exercise. To date, none of the patients have had a recurrence. Seven of 18 patients returned to their previous sports activity, and at the same level. None of the patients had an iatrogenic lesion due to the laser application or labrum suture. Compared to the other shoulder, the loss of external rotation with the arm 90 degrees abducted was 30 degrees at 4 weeks and 10 degrees at 4 months. We think that the LACS procedure is a good treatment for the capsular redundancy that is frequently associated with Bankart's lesion in recurrent anterior dislocation and is probably responsible for the high failure rate in current arthroscopic procedures. Our results are short-term results, but we expect the capsular shrinkage associated with the labrum reattachment will provide a long-term success rate that is comparable to open procedures.

The effect of in vivo retinal cooling on the electroretinogram of the rabbit

PURPOSE

Studies reporting the effect of retinal cooling on the electroretinogram of mammals have, in most cases, made use of an in vitro approach where the temperature of the retina was lowered by reducing the temperature of the bathing media. The purpose of our study was to investigate, in rabbits, the effect of in vivo retinal cooling using an experimental approach never before reported in order to determine if some of the temperature-related ERG effects previously shown could have been, in part, amplified by alterations in the physiological status of the retina due to preparation for in vitro study.

METHODS

In order to reduce the temperature of the retina, a 20 gauge plastic tubing was coiled around the eye from the limbus to the optic nerve head and glued to the sclera. Cold (15 degrees C) tap water entered the tubing at the limbal extremity and exited (18 degrees C) at the optic nerve extremity. Intraretinal temperature was measured to be within 1 degrees C of that of the circulating water.

RESULTS

Our results indicate that with progressive retinal cooling the a- and b-waves are gradually reduced to 66.9 +/- 17.3 and 90.9 +/- 10.4% of control respectively. The most dramatic temperature induced ERG modifications were observed in the oscillatory potential recordings where the mean summed OP amplitude (OP2 + OP3 + OP4) was reduced to less than 23.9 +/- 13.5% of control with OP2 being the least affected. The peak times of all the ERG components were significantly delayed with cooling.

CONCLUSIONS

Of all the ERG components examined, the OPs were those most severely affected by our manipulation. We believe that our results constitute further evidence in support of the concept that the OPs are more sensitive to retinal disturbance than the b-wave.

[Does laparoscopic treatment of abdominal infections generate bacteremias? Prospective study: 75 cases]

Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteraemia. In a prospective study 90 patients were treated by laparoscopic appendicectomy. 30 of them had no histological abnormality; 30 had an acute appendicitis and 30 an acute peritonitis. 75 patients were eligible for the study. The treatment protocol (surgery-antibiotherapy) was the same for the 3 groups. All patients had blood cultures before, during and after insufflation of CO2 in the peritoneum, and bacterial examination of the operative site. Septic morbidity was evaluated for each patients. Positive bacterial culture from abdominal site are correlated with the pathologic findings. There were no positive blood cultures in the groups studied and no incidence in term of septic morbidity. This study suggests that laparoscopic treatment of septic abdominal diseases does not facilitate bacteriemias and does no affect septic morbidity.

Light adaptation of the human photopic oscillatory potentials: influence of the length of the dark adaptation period

Photopic electroretinograms recorded immediately after a period of dark adaptation show a regular increase in amplitude with time spent in light. The retinal mechanisms at the origin of this light adaptation effect remain obscure. The purpose of this study was to investigate the duration of the dark adaptation period needed to produce an optimal light adaptation effect as demonstrated by photopic oscillatory potential recordings. Our results indicate that the light adaptation effect can be separated into two distinct processes. The first one, activated early in the dark adaptation process, reduces the amplitude of the fourth oscillatory potential to 32% of control after less than 5 min of dark adaptation, while the second process, activated after more than 10 min of dark adaptation, appears to impact solely the amplitude of the earlier oscillatory potentials 2 and 3. Our results suggest that the light adaptation effect is mediated by two distinct retinal pathways or mechanisms.

Destructive arthropathy of the hands in chronic hemodialysis patients. A report of seven cases with pathological documentation

Destructive arthropathy of the hands is common in chronic hemodialysis patients. The clinical and histological features in seven cases are reported. There were five females and two males aged 45 to 78 years. Hemodialysis duration at the time of surgery was 48 to 228 months (mean 92 months). Four patients had arthrodesis, two had insertion of silastic implants and one had a diagnostic surgical biopsy. The site of the surgical procedure was a distal interphalangeal joint in three patients, a proximal interphalangeal joint in one, a trapeziometacarpal joint in two, and both a proximal and a distal interphalangeal joints in one. All seven patients had severe destructive arthropathy responsible for pain and instability. Roentgenograms showed joint space obliteration and subchondral erosions or lysis, without osteophytosis. Several finger joints were involved in six of the seven patients. Histologic studies of the synovial membrane (n = 7) and subchondral bone (n = 4) found no amyloid even in the three patients with clinical or roentgenographic evidence of amyloidosis at other sites. Electron microscopy studies were done in two patients and failed to disclose crystals or amyloid. Our findings demonstrate that destructive arthropathy of the hands in hemodialysis patients is not a manifestation of dialysis-related amyloidosis. The pathophysiology of the condition remains poorly understood.

Maturation of binocular pattern visual evoked potentials in normal full-term and preterm infants from 1 to 6 months of age

The purpose of this study was to evaluate the visual development of preterm infants from 1 to 6 mo of age, using the pattern visual evoked potentials (VEP) in response to three check sizes: 60, 30, and 15 min of arc. Pattern VEP were recorded in 24 full-term and 24 preterm infants (26-36 wk of gestation). The results showed a rapid visual maturation between 1 and 3 mo, followed by a slower progression over the next 3 mo, in both groups. The implicit time of the P100 wave of the pattern VEP was also found to shorten with increasing check sizes. The maturation of pattern VEP in preterm infants was shown to be related to their gestational (or corrected) age rather than their postnatal age. The pattern VEP obtained in response to a 60-min check size in preterm infants aged between 1.5 and 2.5 mo (corrected age) showed a tendency for a faster maturation than those of full-term infants. Our results suggest that within the first 6 mo of age, pattern VEP response is useful to monitor visual development in full-term infants as well as in preterm infants using corrected age.

Idiopathic osteonecrosis of the hip in twins

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The influence of social networks and social support on violence by persons with serious mental illness

OBJECTIVE

The authors examined the relationship between violent acts and threats by persons with serious mental illness, the size and composition of their social networks, and characteristics of the social support they received.

METHODS

A group of 169 respondents with serious mental illness and 59 of their significant others were interviewed using structured and semi-structured protocols to elicit data on demographic characteristics, clinical characteristics, characteristics of respondents' social networks and of the social support they received, and perceptions of threat within the social network. Data on acts and threats of violence by respondents over an 18-month period were collected from self-reports by respondents and significant others and from hospital and court records.

RESULTS

Fifty-six respondents either threatened violence or committed a violent act during the study period. Respondents with a diagnosis of schizophrenia were more likely to commit violent acts but were not more likely to threaten violence than were respondents with other diagnoses. Respondents in larger networks, those with networks composed primarily of relatives, and those who lived with unrelated persons were more likely to threaten violence. Financial dependence on family was associated with more violent threats and acts. Respondents who perceived hostility from others were more likely to engage in violent threats and acts, and those with confused thinking were less likely to act or threaten violence. More than half of the targets of violence were respondents' relatives, particularly mothers living with a respondent. Respondents who were violent perceived their significant others as threatening but did not perceive themselves as being threatening in return.

CONCLUSIONS

The interpersonal and social contexts of respondents and their perceptions of these contexts are important considerations in assessing risk for violence by persons with mental illness. Mothers who live with an adult offspring with schizophrenia may be at increased risk for being a target of violence. Violence by persons with psychiatric disorders may be linked to their perceptions and experience of being threatened by others.

[A rare complication of cholelithiasis. Ulceration of the cystic artery associated with cholecystoduodenal fistula]

We observed a rare complication of gall stones revealed by a paroxysmal digestive haemorrhage. Ulceration of the cystic artery occurred due to a stone trapped in the neck associated with a cholecystoduodenal fistula. This is an exceptional cause of major digestive tract haemorrhage. Treatment is undertaken with that of the gall stone. Most often haemorrhages originating in the bile tract are occult.

Interpretation of the filtered 100- to 1000-Hz electroretinogram

We examined the possibility that the 100- to 1000-Hz oscillatory potentials could represent the derivative version of the 1-1000-Hz electroretinogram. Corneal electroretinograms were recorded from rabbits by means of bandwidths of 1-1000 Hz, 10-1000 Hz, 30-1000 Hz and 100-1000 Hz (6 dB of attenuation). Derivatives of the 1- to 1000-Hz electroretinogram had a waveform similar to the 100- to 1000-Hz signals, but of larger amplitude (21.9% +/- 16.7% larger, n = 16). Similarly, integration of the 100- to 1000-Hz signal resulted in a waveform whose amplitude was 60% of the original 1- to 1000-Hz electroretinogram. Our results suggest that some aspect of the morphologic changes seen when the low-frequency cutoff of the recording bandwidth of the ERG is increased from 1 Hz to 100 Hz could be explained with a simple derivative model. The oscillatory potentials may be significant contributors to the morphogenesis of the 1- to 1000-Hz electroretinogram.

Recording the oscillatory potentials of the electroretinogram with the DTL electrode

Suprathreshold photopic oscillatory potentials recorded with a DTL electrode were compared to those obtained with a Lovac corneal electrode. The overall oscillatory potential response (sum of oscillatory potentials) recorded with the DTL electrode was half of that obtained with the Lovac electrode. However, there was no evidence of a selective attenuation (or amplification) of any given oscillatory potential with the DTL electrode. Similarly, the oscillatory potential relative amplitude ratios and the peak times of the oscillatory potentials were identical for both electrodes. Our findings clearly indicate that the DTL electrode is adequate to record the high-frequency oscillatory potentials. Given the low cost and ease of use, as well as the disposable nature of the DTL electrode, we believe that electroretinographic specialists should seriously consider a wider utilization.

[Elective cholecystectomy by celioscopy versus subcostal approach cholecystectomy. Comparative study of postoperative pain and discomfort]

The aim of this prospective study was to evaluate postoperative pain and discomfort in 70 patients undergoing cholecystectomy. The choice of surgical approach was left to the surgeon. Accordingly, these patients were then divided in two groups: laparoscopic cholecystectomy (group I; n = 37); classic cholecystectomy (subcostal incision) (group II; n = 33). There was no significant difference between these groups concerning weight/height ratio, size and number of stones. Patients in group II were older (55 +/- 16 years) than those in group I (46 +/- 11 years) (P < 0.01). The mean duration of surgery was shorter in group II (96 +/- 31 min) than in group I (119 +/- 49 min) (P < 0.01). Postoperative discomfort was evaluated by (group I versus group II respectively): a) the mean length of hospital stay after surgery (3.7 +/- 1.5 versus 6.7 +/- 1.1 days, P < 0.02); b) the mean delay to return of intestinal motility (1.5 +/- 0.6 versus 2.0 +/- 0.6 days, P < 0.001); c) the mean perfusion time (1.4 +/- 0.6 versus 2.6 +/- 0.8 days, P < 0.001); d) intensity of postoperative pain which was evaluated daily. There was no significant difference between these two groups concerning the use of analgesics; however, a statistically significant difference was found in the visual and verbal scales, starting on the second postoperative day and in autonomy as early as the first postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infected fractures of the leg treated by splints.]

The authors present their method of treatment of suppurative pseudoarthroses which involves three stages: 1. excision, 2. fixation (stabilization), 3. reconstruction. Their method was inspired by the two-stage technique elaborated by Papineau. The first two stages of treatment are made during one surgical session and involve the removal of all alien and necrotic tissue and tissue altered by inflammation. For fixation of bone segments the authors use an external frame of their own design. Reconstruction is performed by means of spongiose autografts on the 15th day after the first surgical session using the method "support of the revitalized adjacent fibula" with partial, cca 80%, closure of surrounding soft tissues and skin. The method is demonstrated in a group of 18 infected fractures of the leg treated primarily by surgery, using splints. Key words: osteosynthesis of the leg by splints, infected pseudoarthrosis of the leg, autospongioplasty.

[Lesions of the ligaments associated with distal fractures of the radius. 58 intraoperative arthrographies]

Intracarpal ligamentous tears and fractures of the radius often have a similar mechanism. For instance, no prospective studies have defined the real incidence of such associations, which are not antagonistic. The authors performed a systematic operative wrist arthrogram during distal radius fractures in a group of 58 patients with a mean age less than 50 years. Such a population was at low risk of degenerative ligamentous tears. Triangular fibrocartilage complex was torn in two-thirds of all types fractures. Extra-articular radius fractures were associated with an intracarpal ligamentous tear in 25% and always a luno-triquetral lesion type. In contrast, intra-articular and radius styloid fractures were frequently associated with a scapho-lunate lesion.

Comparative effects of luminance and scatter on the pattern visual evoked potential and eye-hand reaction time

We investigated the effect of reduced luminance and increased scatter on the pattern visual evoked potential and eye-hand reaction time evoked to a check size of 0.5 degrees in 10 normal subjects. Data analysis indicated that a reduction in luminance as well as an increase in scatter caused a statistically significant increase in the peak time of the pattern visual evoked potential P100 wave. The reaction time, however, was not significantly affected by the initial 0.9-log unit attenuation of the stimulus luminance or the 0.3 scatter filter. Further attenuation of luminance or increase of scatter also yielded statistically significant increases. Our results suggest that the reaction time is less affected by a reduction in luminance or an increase in scatter of a 0.5 degrees stimulus than the pattern visual evoked potential is and therefore represents a more reliable test to assess visual function, especially in the presence of medial opacities, which are known to reduce luminance and produce scatter.

[Local surgical treatment of anal-perineal lesions in Crohn's disease. Retrospective study of 68 cases]

Sixty eight cases of ano-perineal lesions (APL) were studied. Lesions were classified into primary (19) and secondary (49) after Hughes. The course of primary APL was favourable (15 cases, 78 p. cent) when proximal CD was controlled, with 4 proctectomies being required when the latter was not the case. Suppurative secondary APL (48) were treated surgically either for an acute abscess (22) or for a chronic fistula (low: 14; high: 12). The treatment of fistulas involved: opening in 10 cases (4 recurrences, 5 failures) or slow fistulotomy with elastic in 17 cases (9 recurrences, 4 failures). Genital fistulas (9 cases) were studied separately: 3 recto-vaginal fistulas resulted in a permanent bypass and 6 ano-vulval fistulas healed or were tolerated. When proximal CD was controlled medically, proctological treatment alone resulted in the healing or quiescence of APL in 17/24 cases. In the group of patients undergoing intestinal resection with restoration of continuity, 10/25 recurred, with the appearance of worsening of an APL in 9 of them. Fifteen had no recurrence, with the appearance or worsening of an APL in 3 of them. In total, 13 patients (19 p. cent) underwent proctectomy, including 6 from the outset. Five had a stroma which was left open and 46 (72 p. cent) a functional anus. Local surgical treatment improved the comfort of patients without any increased risk regarding sphincter function, but the long term benefits of the active treatment of chronic fistulas remain to be proven.

Impact of a second insemination on the results of an in vitro fertilization-embryo transfer (IVF-ET) program

In an attempt to increase the fertilization and pregnancy rates in our program, a second insemination was carried out when the first insemination yielded fewer than two fertilized oocytes. One hundred eighty consecutive patients were studied retrospectively and thirty-four required second insemination, 35% of them by donor semen. Fifty-five and nine-tenths percent of the patients had at least one fertilized oocyte for embryo transfer, but only 21.9% of the oocytes exposed to a second insemination were fertilized. No pregnancy resulted from the transfer of oocytes fertilized by the second insemination. There were no significant correlations between the success of fertilization after a second insemination and the number of oocytes retrieved, the protocol for the induction of superovulation, or the age of the female patient. Considering that the first insemination was done at a variable time after oocyte retrieval to allow oocyte maturation, we expected all oocytes to be mature at the time of first insemination and we considered the possibility of delayed fertilization as negligible since second insemination was done at least 24-30 hr after oocyte retrieval. Even though a second insemination provides further hope for the patient, by yielding additional fertilized oocytes for embryo transfer, its main value is that it may provide additional information about male fertility.

Gulf deployment highlights need for stronger medical reserve, military says. Interview by Patrick Sullivan

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Temporal relationship between the ERG and geniculate unit activity in rabbit: influence of background luminance

The comparative analysis of the retinal and lateral geniculate nucleus (LGN) intensity-response function revealed that the timing of the LGN unit response was highly correlated to that of one oscillatory potential (OP2). To examine if this OP2-LGN intensity-response function was retained irrespective of the state of retinal adaptation, we performed simultaneous recordings to the ERG and single-cell unit activity at the geniculate level evoked to a flash of constant energy while the level of background luminence was varied. For a stimulus of 6.7 cd m-2 sec, the shifts in latency induced by increasing the background luminance from 0 to 125 cd m-2 are of 1.17 +/- 0.61 msec for OP2, a value almost identical (P greater than 0.10; n = 36) to the one obtained at the geniculate level (1.11 +/- 0.88 msec). However, when a dimmer flash is used, the latency shifts are not so well correlated. The latter could be partly explained by the threshold nature of the resulting stimulus (i.e. high photopic background combined with a dim flash).

Psychosocial distress and infertility: men and women respond differently

The purpose of this study was to evaluate gender differences in psychosocial responses of 449 consecutive first-admission couples in a fertility clinic. Consistent with previous research, infertile women showed higher distress than their partners on a global measure of psychiatric symptoms and subscales of anxiety, depression, hostility, and cognitive disturbances, as well as on measures of stress and self-esteem. When compared with same-sexed population norms on the measure of psychiatric symptoms, both male and female infertile patients were significantly more distressed than average. No evidence was found for unusually high levels of marital or sexual distress at intake. Implications of results for clinical management are explored.

[Dynamic stabilization of a total hip arthroplasty. Apropos of 100 total prostheses of which 52 dislocations]

This paper outlines the principal factors which stabilise a normal hip, and describes the modifications which occur following total joint replacement. Deficiencies in muscle function and mechanical restraints due to the prosthesis may be present. A biomechanical mathematical model has been devised which examines the variations in length of the middle gluteal muscle during movement, particularly in hip flexion, when there is the greatest risk of dislocation. This enables a critical evaluation of the muscle forces surrounding the hip, and allows identification of patients with a high risk of dislocation. These observations have been applied to a group of 100 patients, 52 of whom had experienced a dislocation and 48 with stable prostheses. Patients at high risk according to the statistical model tended to dislocate from one month after operation onwards, and are to be distinguished from those who dislocate early due to malposition of the prosthesis.

The effect of iodoacetic acid on the electroretinogram and oscillatory potentials in rabbits

It has been shown that a single injection of iodoacetic acid selectively (but temporarily) abolishes the b-wave of the electroretinogram. We examined whether such use of this chemical further substantiate our claim that the b-wave of the electroretinogram is a composite potential resulting from the summation (or integration) of faster retinal potentials, usually referred to as the oscillatory potentials. Full-field electroretinograms were recorded from adult New Zealand rabbits before and after a single, bolus injection of 15 mg/kg of buffered iodoacetic acid. Both the 1-1000 Hz electroretinogram and the 100-1000 Hz oscillatory potentials were recorded simultaneously. The oscillatory potentials considered in this study were those normally seen on the rising phase of the b-wave. Following the intravenous injection of iodoacetic acid, there was a progressive decrease in the amplitude and peak time of the b-wave. This observation also was reflected in the oscillatory potential recordings, in which the long-latency oscillatory potentials (3 and 4) progressively disappeared while oscillatory potential 2 remained. We believe that these findings further support our contention that the oscillatory potentials are major components of the b-wave.

Vidarabine-loaded nanoparticles: a physicochemical study

The chemical reaction of vidarabine (VIDA) with isohexyl cyanoacrylate nanoparticles in a pH-dependent fashion occurs only in the presence of dioctylsulfosuccinate (DOSS). The formation of an ion pair with DOSS allows a better contact of VIDA with the monomer during the polymerization process taking place in micelles. On the basis of molecular weight profiles of the polymer, determined by gel permeation chromatography (GPC), it is proposed that VIDA induces the polymerization of cyanoacrylic monomers through a zwitterionic pathway. This mechanism allows the covalent linkage of the drug with the polymer, which is consistent with NMR experiments. The present study illustrates the need for physicochemical studies in the design of new colloidal drug delivery formulations.

The oscillatory potentials in response to stimuli of photopic intensities delivered in dark-adaptation: an explanation for the conditioning flash effect

Previous studies reported that the oscillatory potentials (OPs) evoked to the first flash of a series were always smaller than those produced by the later flashes. This conditioning flash effect (CFE) was suggested to arise from rod inhibition of cone-mediated OPs. We investigated this CFE with the use of two stimulus intensities: 10 cd sec m-2 and 1 cd sec m-2. While the highest intensity did yield the previously reported CFE, the dimmest intensity did not. Our results further indicated that with the brightest stimulus, there is a significant increase in the interpeak interval of the OPs, while dimmest stimuli failed to reveal a similar marked increase. We also noted a significant correlation between the frequency domain of the OPs (as estimated with the interpeak interval) and the amplitude of the OPs (individual or collective: SOPs). Our results would also suggest that the observed CFE could result from a cone inhibition of rod-mediated OPs.

Temporal relationship between ERG components and geniculate unit activity in rabbit

The purpose of this study was to examine if there is an ERG component (alpha-wave, b-wave, oscillatory potentials) which can be used to account for the intraretinal processing time. To address this issue, ERGs and LGN unit responses were recorded simultaneously from anesthetized and paralyzed rabbits. A gradual decrease in the intensity of the light stimulus yields a progressive increase in the latency of the LGN unit response. A similar, highly correlated (r = 0.91 +/- 013), latency shift was also noted for one oscillatory potential (OP2). In comparison, correlation coefficients of r = 0.63 +/- 0.27 and r = 0.70 +/- 0.29 were obtained for the alpha- and b-wave respectively. Furthermore, in 77.6% of the cells examined, OP2 preceded LGN unit activity while the b-wave preceded LGN activity in only 17.8% of the cases. Our results suggest that, of all the retinal potentials considered, the peak time of OP2 better reflects the primary visual processes and the intraretinal time taken for visual processing.

The diagnostic use of the second oscillatory potential in clinical electroretinography

Of all the electroretinogram (ERG) components (a-wave, b-wave, and oscillatory potentials) only one oscillatory potential, OP2, was found to be significantly correlated with the absolute intensity of the flash stimulus (i.e., the intensity of the stimulus irrespective of the state of retinal adaptation). Our finding was further confirmed in single cell recordings of lateral geniculate unit activity in rabbits in which peak time of OP2 was found to correlate better with the geniculate activity. For these reasons we have identified OP2 as the "intensity coding" oscillatory potential of the ERG. In order to investigate if this new feature could have some clinical significance, we examined photopic ERGs recorded from patients affected with various retinopathies. In most instances the peak time of OP2 paralleled that of the b-wave, that is, in the ERG with delayed b-wave the peak time of OP2 was also delayed, while in ERGs with normal b-wave peak time the peak time of OP2 was also normal. However, in some conditions (especially in cone-rod diseases) a delayed OP2 was found in ERGs with normal b-wave peak times.

Methotrexate diffusion from acrylic cement. Local chemotherapy for bone tumours

We investigated the possible use of acrylic cement containing chemotherapeutic drugs in the treatment of malignant lesions in bone. The diffusion of methotrexate (MTX) from methylpolymethacrylate implants was studied in vitro: polymerisation of the cement did not destroy the drug; liberation began immediately and about 10% was released by 18 hours. Some release continued for as long as six months. In vivo experiments on rats with induced osteosarcoma showed that MTX in cement had both local and general effects which were dependent on the dosage. A series of 17 large dogs with spontaneous osteosarcoma were then treated by local resection and cement containing MTX. General chemotherapeutic effects were detectable from 2 hours to 5 days, survival was increased and local recurrence was reduced, but there were four cases of delayed wound healing. Preliminary studies in human patients confirm the possibility that this method of local chemotherapy could be a useful addition to the treatment of malignant tumours of bone.

[Joint complications in patients with chronic renal failure hemodialyzed for over 10 years. 40 cases]

A retrospective study of 40 patients with chronic renal failure who underwent haemodialysis for more than 10 years (mean: 153 months) showed that 18 patients (45 p. 100) had arthralgia in the shoulders, hands, wrists and knees, 13 (32 p. 100) had carpal tunnel syndrome requiring surgery, and 20 (50 p. 100) were found to have bone cavities in the humeral head, external supra-acetabular region, carpus and patella. Aluminium overload was present in 47 p. 100 of the patients, and amyloid deposits were found in 10 of the 12 patient operated upon for carpal tunnel syndrome. This study confirms the frequency in patients under long-term haemodialysis of an articular pathological entity consisting of arthralgia, carpal tunnel syndrome, juxta-articular bone cavities and amyloid deposits which are now known to be made of beta 2-microglobulin. The initial lesion seems to affect the synovial membrane; it appears to be facilitated by age and is often associated with aluminium overload. The mechanism(s) responsible for amyloid deposits remain (s) to be elucidated.

Comparative effects of four surfactants on growth, contraction and adhesion of cultured human fibroblasts

A range of surfactants, including the anionic sodium dodecyl sulfate, the cationic cetyltrimethylammonium bromide and the non-ionics octylphenoxy polyethoxyethanol (Triton X100) and polyoxyethylene 20 sorbitan monoleate (Tween 80) was studied for effects on proliferation, contractibility and attachment of cultured human fibroblasts. Only ionic surfactants exhibited a stimulatory effect on fibroblast proliferation, whereas all the surfactants tested increased the contraction of collagen gels containing fibroblasts, with the greatest effect from the non-ionic surfactants. This activity was not correlated with an increase of cell population or cell attachment within the collagenous matrix. The activity of the surfactants was seen only at levels close to their LD50 values and in a narrow range of concentrations. Thus, we consider that they are the result of the so-called hormesis phenomenon.

Effects of cyclic adenosine monophosphate on human chorionic gonadotropin and estradiol output by cultured human placental cells

We have previously shown that adenosine-3',5'-cyclic monophosphate (cAMP) inhibits basal estradiol output in human trophoblast cells. The objective of this study was to investigate further the effect of 8-bromo-cAMP on the conversion of C19 androgens to estradiol by placental cells. Trophoblast cells were prepared from human term placenta and maintained in monolayer culture. On days 3 and 4 of culture, these cells were treated with dehydroepiandrosterone sulfate, androstenedione, or testosterone with or without the concomitant presence of 8-Br-cAMP. 8-Br-cAMP markedly enhanced human chorionic gonadotropin secretion into the culture medium. On the other hand, the concomitant addition of 8-Br-cAMP with the androgen precursors led to an inhibition of estradiol output. The concentrations of androstenedione and dehydroepiandrosterone in the culture medium after treatment with dehydroepiandrosterone sulfate were elevated by the concomitant presence of 8-Br-cAMP. From these results we conclude that 8-Br-cAMP enhances human chorionic gonadotropin output in human term placental cells, whereas the presence of 8-Br-cAMP in cells given androgen precursors inhibits estradiol output, probably at the level of aromatization.

Differential effects of 8-bromo-cyclic AMP on human chorionic gonadotropin (hCG), progesterone and estrogen production by term placental cells

The present study examined the effects of a cAMP analog on the output of hCG and progesterone (P) in human term trophoblast cells in culture, as well as the conversion of androstenedione and testosterone to estradiol--17 beta and estrone by these cells. The levels of hCG and P in the culture medium increased throughout the four-day culture period. Addition of 8-bromo-adenosine-3',5'-monophosphate (8-Br-cAMP), forskolin or cholera toxin (but not 8-Br-cGMP) stimulated hCG and P production by the cultivated placental cells. In contrast, the presence of 8-Br-cAMP for 2 days significantly decreased basal estradiol-17 beta output, as well as conversion of androstenedione to estradiol-17 beta; the conversion of androstenedione to estrone was not affected. 8-Br-cAMP attenuated the conversion of testosterone to both estradiol-17 beta and estrone. These results further support the view that cAMP could have both stimulatory and inhibitory actions on placental hormonogenesis.

Amniostat-FLM: an initial clinical trial with both vaginal pool and amniocentesis samples

Amniostat-FLM, a new rapid slide agglutination test, was compared with thin-layer chromatography as a method for detecting phosphatidylglycerol in amniotic fluid. This is the first reported use of Amniostat-FLM to evaluate vaginal pool and contaminated vaginal pool amniotic fluid. One hundred one of 161 amniotic fluid samples were collected from the vaginal pool. Thirty-nine of these were contaminated. Vaginal pool amniotic fluid, whether contaminated or not, did not adversely effect the ease of performance, reliability, or interpretation of Amniostat-FLM. This test seems ideally suited to institutions where 24-hour availability of thin-layer chromatography is not available. In institutions where it is available, Amniostat-FLM could be used as a screening test. Amniostat-FLM was found to be significantly less sensitive when compared with thin-layer chromatography in detecting the presence of phosphatidylglycerol. At our institution the screening of amniotic fluid samples with Amniostat-FLM before use of thin-layer chromatography was only cost effective at greater than or equal to 34 weeks of gestation.

Aluminum in the joint tissues of chronic renal failure patients treated with regular hemodialysis and aluminum compounds

We studied the concentrations of aluminum in the articular tissues of 5 hemodialysed patients treated with aluminum compounds. Aluminum crosses the synovial barrier, is found in synovial fluid (SF) and accumulates in the joint structures (synovial membrane and joint cartilage). The concentrations found in synovial tissue were 2.7 to 10 times control values, in SF 2.5 to 8 times the control concentrations and in cartilage 2.6 times the control concentrations. Transmission electron microscopy showed localization of aluminum in the lysosomal structures and wavelength dispersive microprobe analysis showed aluminum in cellular components associated with phosphate. The possible toxicity of aluminum to joints merits further investigations.

[Bilateral symmetrical macrodactyly of the toes (author's transl)]

The authors report a case of bilateral symmetrical macrodactyly affecting the toes in a 17 year old patient. The deformity was treated by bilateral transmetatarsal amputation. After a review of the literature, the authors recall that macrodactyly is more frequently seen in the hand than in the foot. No etiological factor such as neurofibromatosis or a genetic or teratogenic agent was found.