bluuebunny/crossref_metadata_2025 huggingface dataset:
An Approach to the Patient with Skin Disease
Authors: Olumide Yetunde Mercy
Published: July 2017

We practise an integrated approach to the management of skin diseases, leprosy and sexually transmitted diseases because the latter diseases are still stigmatized and patients are unwilling to attend clinics so labelled.

When approached by a patient with skin disease it is advisable to see the patient promptly, because any further delay encourages the use of assorted remedies which may lead to undesirable complications, physically, emotionally and financially. Since there is no health insurance scheme, it is also prudent to manage the patient as much as possible without admission to hospital and with minimal laboratory investigations, to save cost, so that the patient still has sufficient money to buy the required drugs.

Family health workers treat patients at the primary health care (PHC) level. At this level, patients are managed by the use of specially prepared standing orders (SO), where checklists and flow charts are grouped by problems or complaints, to facilitate usage by an individual with minimal training in morphology. The SO presents, so far as is possible, the best treatment available for each condition, but which cannot be misused by the primary health care personnel.

Before discussing the management of individual diseases, it is important for the reader to appreciate the milieu in which we practise which determines our approach to the patient with skin disease. Some of its features will be highlighted before the management of individual disorders is discussed.
Cutaneous Findings Associated with HIV Disease Including AIDS: Experience from Sub Saharan Africa
Authors: Pallangyo K J
Published: July 2017

Cutaneous manifestations are common in patients with HIV infection and tend to be more frequent as immunodeficiency progresses. In the initial stage of HIV infection a transient maculopapular-rash may appear. During the otherwise asymptomatic phase that follows, patients may develop seborrhoeic dermatitis, persistent genital ulcer disease, pruritic papular eruption and/or a variety of scaling dermatoses. The most frequent skin tumour associated with HIV disease is Kaposi's sarcoma. Skin manifestations of adverse reactions to a variety of drugs occur more frequently in patients with HIV disease than in immunocompetent patients.

In general most skin diseases that occur in association with HIV disease respond well to standard treatment regimens. However relapses, and/or recurrences are frequent in this group of patients.
Risk Management of Sex Offenders: A Model for Community Intervention
Authors: Conroy Mary Alice
Published: July 2017

The great majority of convicted sexual offenders will eventually be managed in the community. To date, many jurisdictions have attempted to apply a one-size-fits-all model using a specific treatment program, medication, or a containment approach. These programs have a number of drawbacks and are not well supported by research literature. An alternate way of approaching risk management of sexual offenders that has greater empirical support is proposed. This model relies upon a concentration of attention on the highest risk offenders, individualizing intervention strategies based on identified risk factors, and assessing for psychopathy as part of the planning process.
The Imitation of Dissociative Identity Disorder: Patients at Risk, Therapists at Risk
Authors: Draijer Nel , Boon Suzette
Published: July 2017

Since the late 1980s the authors have been confronted with cases of imitated dissociative identity disorder (DID) in Holland. Because DSM-IV defines “factitious disorder” as intentional, the term “imitation of DID” is used here for patients who, partly unconsciously motivated, simulate a DID profile. DID can be imitated due to contagion, to iatrogenesis, or to both. The core dynamics are: (1) the avoidance of responsibility for negative behavior, found mostly in patients with a borderline or antisocial personality disorder; and (2) the compensation for an overwhelming feeling of not being seen. The last, “hysterical,” dynamic is characterized by identity disturbances varying in severity according to the underlying borderline personality structure. Four cases are described. Differentiating between genuine and imitated DID requires systematic assessment by an experienced clinician. Even then this is difficult, in particular differentiating between flamboyant genuine DID, with coexisting histrionic personality disorder (a minority of patients with genuine DID), and simulated cases. Diagnostic and treatment implications are discussed.
Deception through Factitious Identity
Authors: High James R.
Published: July 2017

Occasionally plaintiffs falsify information beyond the realm of illness to include apparently senseless misrepresentations of personal identity. This more extensive lying can be conceptualized as the creation of factitious identities. Failure to appreciate this phenomenon negatively impacts attorneys, health professionals, plaintiffs, and the legal system. Detailed investigation of one such plaintiff revealed a history of abuse and neglect. In addition to malingering during litigation and creating a factitious illness, he also produced false and conflicting information concerning his developmental, educational, occupational, and social history. His self-concept was unstable and his attachments were chaotic. His habitual use of lying as a relational and coping strategy was largely unrecognized by doctors and attorneys, to the detriment of all. This case is discussed in terms of recent attachment research that suggests an association between early abuse, attachment pathology, and disturbed self-formation and functioning.
Extension of Information-Processing Research for Diagnosis of Learning Problems
Authors: Janzen Henry L.
Published: July 2017

I say moreover that you make a great, a very great mistake if you think that psychology, being a science of the mind's laws, is something from which you can deduce definite programs and schemes and methods of instruction for immediate schoolroom use. Psychology is a science and teaching is an art; and sciences never generate arts directly out of themselves. An intermediary inventive mind must make the application, by using its originality (William James, 1899, Psychology and the Art of Teaching, p. 23).
Quantitative Analysis of Alveolar Type II Cell Tumors in Mice by Whole Lung Serial and Step Sections
Authors: Rehm Sabine , Ward Jerrold M.
Published: July 2017

Alveolar type II cell tumors were induced transplacentally by intraperitoneal injection of pregnant C3H/HeNCr MTV– or Swiss Webster mice with N-nitrosoethylurea at a dose of 0.5 mmol/kg and 0.74 mmol/kg. At different time points after birth (1–32 weeks), the entire lungs from 40 of the male offspring were inflated with Bouin's fixative, separated into lobes, and sectioned at 5 μm serially to detect every microscopic lesion. Results were compared with those obtained from examining only every 10th, 20th, or a single mid-level section from the same material. On average, 150 serial sections were prepared per mouse lung. Initially, only purely solid/alveolar or purely tubulopapillary types were observed but with tumor progression, papillary structures developed within solid tumors resulting in mixed neoplasms. Analyzing mouse lungs in step sections of every 10th section (50–60 μm), 5/238 (2%) of the tumors were missed, in step sections of every 20th section (100–120 μm), 16/238 (7%) of the tumors were not detected and usually less than half of the tumors were seen in the single mid-level section. The approximate size of the neoplasms is indicated by the total number of sections per tumor. The dimensions of tumors evaluated with step sections of 10 or 20 were comparable to the size observed with serial sections. It is concluded that the evaluation of mouse lung tumors in steps of approximately 50 μm is basically equivalent to the study of serial sections and appears to be a feasible method to assess the complete incidence, histological type, and size of all proliferative processes throughout the entire lung.
Effects of Nitrofurantoin on the Primary and Secondary Reproductive Organs of Female B6C3F Mice
Authors: Stitzel Katherine A. , McConnell R. Frank , Dierckman T. A.
Published: July 2017

The National Toxicology Program (NTP) has reported female mice fed high doses of Nitrofurantoin (NFT) were found to have ovarian atrophy as diagnosed histologically and increased benign ovarian tumors after 24 months of exposure (30). This result contrasts with 4 other recent carcinogenicity assays in rodents with NFT, all with no evidence of an ovarian effect. An extensive database documents benign tubular adenomas develop secondary to ovarian atrophy in many mouse strains, including B6C3F1 (see ref 11). The present study was initiated to confirm this mechanism could be responsible for the ovarian tumors in the NTP study and to investigate the time course of ovarian changes seen in female B6C3F1 mice. Mice were provided diet containing NFT at doses of 350 and 500 mg/kg body weight/day and examined after 4, 8, 13, 17, 43 and 64 weeks. A dose-related decrease in feed consumption, feed efficiency and body weight gain was seen and persisted throughout the study. Sexual maturity was delayed in a dose-related fashion, compatible with previously reported effects of reduced food consumption in rodents (12, 16). All groups of mice eventually did have normal estrous cycles, but cycle lengths were increased in a dose-related fashion. Both doses of NFT resulted in histological evidence of senile ovarian atrophy by week 43. Based on the reported association between sterility and ovarian tumors, we conclude the benign tubular adenomas seen at 2 yr in the NTP carcinogenicity study with NFT were secondary to the ovarian atrophy induced in this strain of mouse and not an indication NFT, itself, is a carcinogen.
Pancreatic Hepatocytes Associated with Chronic 2,6-Dichloro-p-Phenylenediamine Administration in Fischer 344 Rats
Authors: McDonald Margarita M. , Boorman Gary A.
Published: July 2017

Pancreatic tissue (original and recut sections) from Fischer 344 rats fed 2,6-dichloro-p-phenylenediamine in a chronic (2-year) carcinogenesis bioassay was evaluated for presence of pancreatic hepatocytes (PH) by light microscopy. PH were found in dose groups as follows: males–0 ppm (controls)–0/50 (0%), 1,000 ppm–4/50 (8%), 2,000 ppm–9/50 (18%); females-0 ppm (controls)–1/50 (2%), 2,000 ppm–15/50 (30%), 6,000 ppm–15/49 (31%). This represented a significant dose-related increased incidence of PH in 2,000-ppm males, and 2,000- and 6,000-ppm females. A statistically significant increase ( p < 0.01) in pancreatic acinar atrophy and fibrosis was also seen in treated female rats, but the relationship of these lesions to the PH is unclear.
Management of Blindness in the Practice of Cosmetic Surgery
Authors: Castillo Guillermo D.
Published: July 2017

Blindness (amaurosis) as a complication of cosmetic surgery Is not common, but has been reported in cases of blepharoplasty, as well as in connection with facial Injection of various substances, Including collagen. The anatomic and pathophysiologic basis for embolization of the retinal artery Is presented, and the literature regarding thromboembolic, spasmodic, and vaso‐obliterative etiologic factors in amaurosis is reviewed. It Is recommended that ocular examination be carried out prior to both Injection of materials Into the face and blepharoplasty. The treatment of this most serious complication Is reviewed in detail. Finally, It is suggested that the surgeons who practice cosmetic surgery be aware of this complication and the current treatment modalities.
A Paraneoplastic Syndrome Associated with Glomus Tumors of the Skull Base? Early Observations
Authors: Jackson C. Gary , Gulya A. Julianna , Knox Glenn W. , Glasscock Michael E. , Pensak Myles L. , Poe Dennis S. , Johnson Glenn D.
Published: July 2017

Independent secretion of vasoactive substances by glomus tumors of the skull base Is widely recognized. Surgical removal of these tumors often results in an unexplained prolonged postoperative Ileus, even in cases in which the vagus nerve Is preserved. There Is evidence that these tumors may secrete neuropeptides, such as cholecystokinin, in addition to catecholamines. A retrospective analysis of cases of glomus tumors of the skull base operated on at the Otology Group was carried out to correlate preoperative neuropeptide levels, vagus nerve status at surgery, and duration of postoperative Ileus. High circulating levels of cholecystokinin associated with these tumors may be responsible for the unexplained phenomenon of prolonged postoperative ileus. The relevance of neuropeptides to the postoperative management of these patients is discussed. Preventative measures that may avert the potentially lethal complications of aspiration and negative nitrogen balance are described.
Rhinomanometry for Preoperative and Postoperative Assessment of Nasal Obstruction
Authors: Gordon Andrew S.D. , McCaffrey Thomas V. , Kern Eugene B. , Pallanch John F.
Published: July 2017

In this retrospective study we used active, anterior mask rhinomanometric methods to measure nasal resistance before and after surgery for nasal obstruction. The study group comprised 60 patients with nasal obstruction who had 63 preoperative and postoperative rhinomanograms and the control group contained 14 asymptomatic patients who underwent rhinomanometric studies before transnasal, transsphenoidal pituitary surgery. Before surgery the study group had significantly higher total and combined unilateral nasal resistances than either the control group before surgery (p < 0.05 and p < 0.01, respectively) or the study group after surgery (p < 0.0001 for both comparisons). Surgery normalized the nasal resistances of the study group in relation to the control group. A total nasal resistance greater than 1 cm H2O/L/sec or a unilateral resistance greater than 3.5 cm H2O/L/sec suggests clinically significant nasal obstruction. Airway narrowing and obstructive symptoms correlated with airway resistance in the preoperative patient, but symptoms did not correlate well with postoperative resistance.
Surgical Management of Sialorrhea
Authors: Shott Sally R. , Myer Charles M. , Coton Robin T.
Published: July 2017

Sialorrhea is a distressing problem in children with cerebral palsy, in children with other neurologic disorders, and in normal children. The constant need for clothing or bib changes in handicapped patients frequently results in further social isolation and causes normal children to be viewed as “impaired.” The surgical treatment of sialorrhea at Children's Hospital Medical Center, Cincinnati, Ohio, has evolved over the past 5 years. Since 1981, 70 surgical procedures have been performed for drooling at this institution; follow‐up information is available on 52 patients. The surgical procedures performed included submandibular rerouting alone, submandibular duct rerouting with bilateral tympanic neurectomy with bilateral submandibular gland excision, and bilateral submandibular gland excision with bilateral parotid duct ligation. Our review indicates that bilateral submandibular gland excision with parotid duct ligation is the only procedure in which consistent control of sialorrhea can be expected. Postoperative complications after this procedure were minimal and only one parent complained that the child had a dry mouth after the procedure. Postoperative hospitalization after bilateral submandibular gland excision and bilateral parotid duct ligation was not significantly different from that required after any of the other procedures. In conclusion, this surgical procedure appears to be the most effective surgical treatment for sialorrhea and precludes the need for multiple operative procedures for this problem.
Magnetic Resonance Imaging of the Facial Nerve
Authors: Wortham Donald G. , Teresi Louis M. , Lufkin Robert B. , Hanafee William N. , Ward Paul H.
Published: July 2017

Magnetic resonance imaging (MRI) of the facial nerve was evaluated by studying normal volunteers and patients with diseases of the facial nerve with a 0.3 Tesla permanent‐magnet MRI system with special surface colls. The normal MR images were correlated with the anatomy of thin cryosection specimens of fresh cadavers. The seventh nerve was followed from its nucleus in the brainstem through the temporal bone to the parotid gland bed. The entire labyrinth and tympanic portions, as well as the geniculate ganglion, could be shown with appropriate scan planes. Examples of brainstem diseases affecting the facial nerve and nucleus, facial neuromas, parotid tumors involving the facial nerve, and other diseases were studied. MRI is a technique that allows unique evaluation of the entire course of the facial nerve. It produces superior Images of the facial nerve with high‐contrast resolution. Unlike computed tomography, there is no beam‐hardening artifact from the temporal bone or exposure to ionizing radiation and contrast agents. MRI also allows visualization of the main trunks of the facial nerve in the parotid bed not possible with any other imaging technique.
Dynamic Rehabilitation of the Paralyzed Face—II. Electronic Control of the Reinnervated Facial Musculature from the Contralateral Side in the Rabbit
Authors: Broniatowski Michael , Ilyes Laszlo A. , Jacobs Gordon , Nosé Yukihiko , Tucker Harvey M.
Published: July 2017

This work is the continuation of a previous pilot study in the rabbit in which motion originating on the face was picked up by miniature strain gages and channeled synchronously to strap muscles reinnervated via crossover nerve‐muscle pedicles. In the current series of experiments, we modified the distal limb of the system to reinnervate the previously paralyzed opposite side of the face via an ansa hypoglossi nerve–thyrohyoid muscle pedicle in five animals. Muscular contraction was induced on the intact side by stimulating different branches of the facial nerve, and corresponding information was channeled to the reinnervated side through an upgraded electronic stimulator via monopolar electrodes placed around the nerve pedicle in the neck. In addition to demonstrating perfect synchrony between intact and reinnervated sides, this facial stimulator allowed the reinnervated side of the face to follow the intact side in a graded and sustained fashion, thus demonstrating that fine tuning of reinnervated facial musculature was possible.
Computed Tomography and Magnetic Resonance Imaging of Cervical Metastasis
Authors: Lydiatt Daniel D. , Markin Rodney S. , Williams Susan M. , Davis Leon F. , Yonkers Anthony J.
Published: July 2017

Thirteen patients with head and neck cancer underwent staging by clinical examination, computed tomography (CT), and magnetic resonance imaging (MRI) in a standardized blinded fashion. All patients subsequently underwent radical neck dissection with subsequent pathologic staging. CT and MRI each predicted 93% of staging results correctly, with clinical examination correct 67% of the time. Staging of primary tumors had an accuracy of 90% by clinical examination, 40% by CT, and 50% by MRI when compared to staging of the pathologic specimen. Understaging was seen in 50% of CT scans and 30% of MRI scans. We believe either CT or MRI should be considered for routine staging of the neck in all head and neck malignancies.
Rhinomanometric Evaluation of Two Nasal Steroid Sprays in Rhinitis
Authors: Kohan Darius , Jacobs Joseph B. , Nass Richard L. , Gonzalez Sandra
Published: July 2017

A prospective, randomized study comparing the effectiveness of two nasal steroid sprays, flunisolide and beclomethasone dipropionate, in the treatment of nasal obstruction associated with allergic or vasomotor rhinitis has been conducted at New York University Medical Center–Bellevue Hospital. All patients underwent routine history and physical examinations and a modified radioallergosorbent test. Paranasal sinus films were used to exclude patients with sinusitis. The Rhinotest microprocessor rhinomanometer was used to quantify pretreatment and posttreatment total nasal air flow and resistance during a period of 2 months. These findings were assessed in conjunction with the patients' subjective complaints. Results demonstrated that anterior rhinomanometric assessment of the nasal airway during inhalant therapy correlated well with the patients' own subjective impressions of nasal air flow. Both steroid inhalants were effective; however, flunisolide provided for earlier and more substantial symptomatic relief. Beclomethasone dipropionate had milder side effects.
The Use of Magnetic Resonance Imaging with High‐Resolution CT in the Evaluation of Facial Paralysis
Authors: Schwaber Mitchell K. , Zealear David , Netterville James L. , Seshul Michael , Ossoff Robert H.
Published: July 2017

Magnetic resonance imaging (MRI) has been widely used in the evaluation of suspected acoustic neuroma, but has not received the same attention with respect to facial paralysis. High‐resolution computed tomography (HRCT) has been the radiologic test of choice to evaluate the facial nerve. The necessary HRCT projections, slices, and enhancement techniques to visualize each segment have been outlined. We have developed a radiologic protocol that uses MRI in conjunction with HRCT, applying the strengths of each to evaluate the facial nerve. We have evaluated 15 patients and have found that MRI is the better study to evaluate the brain stem/cerebellopontine angle segment of the facial nerve and better evaluates bone‐soft tissue Interfaces. HRCT is better in the evaluation of the intratemporal segment of the facial nerve and the assessment of the anatomic perspectives of a lesion within the temporal bone. The results are discussed and case reports Illustrate the efficacy of this approach.
Usefulness of 1000 Hz Tone‐Burst‐Evoked Responses in the Diagnosis of Acoustic Neuroma
Authors: Telian Steven A. , Kileny Paul R.
Published: July 2017

The auditory brain stem response (ABR) has become widely recognized as a sensitive and cost‐effective screening modality in neuro‐otologic diagnosis. However, the audiometric characteristics of the test ear may obscure the interpretation of the click‐evoked ABR, particularly in the face of high‐frequency hearing loss. It is often unclear whether latency delays or absent responses are attributable to retrocochlear disease or simply to the magnitude of the patient's hearing loss. The acoustic click stimulus commonly used in ABR testing activates predominantly the basilar membrane in the 2000 to 4000 Hz range. Because many cochlear and retrocochlear processes are associated mainly with hearing loss in this range, we have found it helpful in selected cases to use 1000 Hz tone‐burst stimuli to circumvent the effects of elevated hearing thresholds on the ABR. In this article, our experience with the use of 1000 Hz nonlinearly gated tonebursts in 17 patients with acoustic neuroma is presented.
Electroneurography and Intraoperative Facial Monitoring in Contemporary Neurotology
Authors: Kartush Jack M.
Published: July 2017

Electrodiagnostic testing of the facial nerve has evolved beyond prognostic and topognostic testing to include preoperative assessment and intraoperative monitoring. The state of the art in facial nerve testing is herein reviewed. Electroneurography is described as a means of preoperative assessment to detect subclinical neural degeneration for temporal bone tumors, malignant external otitis, and recurring facial paralysis. Techniques of intraoperative facial nerve monitoring are presented with clinical correlation of the facial evoked responses. Finally, recent advances in electrodiagnostic testing. Including antidromic recording and transtemporal magnetic stimulation of the facial nerve, are discussed.
Percutaneous Endoscopic Gastrostomy and Jejunostomy for Long‐Term Feeding in Patients with Cancer of the Head and Neck
Authors: Shike Moshe , Berner Yitshal N. , Gerdes Hans , Gerold Frank P. , Bloch Abby , Sessions Roy , Strong Elliot
Published: July 2017

Enteral feeding is often required in patients with cancer of the head and neck. Percutaneous endoscopic gastrostomies (PEGs) and Jejunostomies (PEJs) can facilitate enteral feeding in patients who require this treatment. The endoscopic technique allows for the placement of feeding gastrostomies and Jejunostomies without a surgical procedure and eliminates the need for nasal tubes for long‐term enteral feeding. Forty‐two patients with head and neck tumors were referred for placement of PEGs because of severe dysphagia induced by tumors, surgery, radiation, or chemotherapy. The procedure was performed in the gastroenterology suite. Patients were sedated with intravenous meperidine and diazepam, and local anesthetic with lidocaine was applied to the area of incision. Average procedure time was approximately 20 minutes. The procedure was successful in 39 patients in whom tubes were placed ranging in diameter from 15F to 22F. PEGs were placed in 36 patients with intact stomachs and PEJs in three patients with previous gastrectomies. The remaining three procedures were unsuccessful because of technical reasons. There were three localized skin infections, and all responded to antibiotic therapy. Neither peritonitis nor any other immediate complication occurred. In 16 nonhospitalized patients, the procedure was performed on an outpatient basis. After a mean followup of 4.5 ± 6 months of enteral feeding in the home, there was only one case of aspiration and subsequent pneumonia, and this case responded to antibiotics. No other long‐term complications were noted. Thus feeding gastrostomies and Jejunostomies can be placed safely and easily in patients with cancers of the head and neck by endoscopic methods without abdominal surgery. These tubes can be used for enteral feeding and eliminate the need for nasogastric tubes. They are better tolerated, are of a wider diameter, and have a reduced risk for migration, clogging, and aspiration‐related complications.
MRI Findings in Two Cases of Acute Facial Paralysis
Authors: Labagnara James , Jahn Anthony F. , Habif David V. , Solomon Edward M.
Published: July 2017

This article describes the use of magnetic resonance imaging (MRI) in the evaluation of the facial nerve paralysis of Bell's palsy and herpes zoster oticus. Identification of the nature of inflammatory facial nerve paralysis often presents a diagnostic dilemma. The site of involvement along the course of the nerve may have importance when treatment options are being considered. We have found MRI to be a unique method for localizing the site of nerve injury in both Bell's palsy and Ramsay Hunt syndrome.
On the Search for Markers of Poor Vestibular Compensation
Authors: Blakley Brian W. , Barber Hugh O. , Tomlinson R. David , Stoyanoff Susan , Mai Mabel
Published: July 2017

The effectiveness of pursuit gain, cancellation of the vestibulo‐ocular reflex, and a clinical oscillopsia test were assessed as vestibular function tests and tests that may allow prediction of which patients would compensate poorly after vestibular surgery. Cancellation of the vestibulo‐ocular reflex in 17 patients and 17 control subjects was compared. Pursuit gain for 17 patients was determined for three frequencies at peak velocities of 25 and 50 degrees/sec. The oscillopsia test was administered to seven patients during at least the first 6 postoperative months. We are unable to state that any of these parameters were effective “markers” of impaired compensation, but the oscillopsia test appears to be a useful clinical tool for vestibular examination.
A Granulomatous Colitis of Dogs with Histologic Resemblance to Whipple's Disease
Authors: Van Kruiningen H. J. , Montali R. J. , Strandberg J. D. , Kirk R. W.
Published: July 2017

A disease is described in Boxer dogs clinically characterized by an intractable, sometimes hemorrhagic chronic diarrhea. Nine cases were studied from one kennel. Pathologically the disease is defined as a granulomatous colitis. The histologic lesion is a distension of the lamina propria and submucosa of the colon and cecum with large pink staining macrophages, the majority of which are PAS positive, and some of which contain bacteria-like structures. Lymph nodes draining the cecum and colon contain similar macrophages.

The macrophages, and their contents, are compared to those occurring in lesions of Whipple's disease of man. Whipple's disease is compared with Johne's disease of ruminants.

Based on the histological and histochemical similarities between the granulomatous colitis of dogs and Whipple's disease of man a similar pathogenesis is postulated and similar therapy is suggested.
Staphylococci of Different Virulences Infused Successively into Bovine Udders
Authors: Spencer G. R. , Fluharty D. M. , Newman Barbara
Published: July 2017

Infusion of coagulase-negative cocci into normal udders of cows produced a moderate inflammatory reaction and persistent infection. Such quarters were as susceptible as normal controls to the subsequent infusion of coagulase-positive staphylococci. Cows already infected with coagulase-positive staphylococci were probably more susceptible to infusion of such organisms into their noninfected quarters than were normal cows. The lesions found following infusion of coagulase-negative cocci were similar but not as severe as those produced by coagulase-positive organisms. Ductal fibrosis and rosettes occurred with the latter organisms but not with the former coagulase-negative organisms. Atrophy which followed staphylococcal infection was an all or none effect with focal and lobular distribution.
Clinical and Neuropathological Changes in Cattle Eating the Leaves of Macrozamia lucida or Bowenia serrulata (Family Zamiaceae)
Authors: Hall W. T. K. , McGavin M. D.
Published: July 2017

Two steers were fed leaves of plants of the family Zamiaceae, one Bowenia serrulata and the other, Macrozamia lucida.

Degenerative lesions were demonstrated in the nerve fibres of the fasciculus gracilis and the dorsal spinocerebellar pathways.

Two naturally affected animals from an area where m. lucida was grazed were also examined, and in these, degenerative lesions of the fasciculus gracilis were found.
Cerebrospinal Lipodystrophy in Swine
Authors: Read W. Kay , Bridges Charles H.
Published: July 2017

Spontaneous lipidosis of the central nervous system of two Yorkshire swine is reported. The presence of membranous cytoplasmic neuronal inclusions similar to those reported in Tay-Sach's disease in man was confirmed by electron microscopy.
Pathogenetic Studies of Infection of the Bovine Fetus with Bovine Viral Diarrhea Virus: II. Ocular Lesions
Authors: Brown T. T. , Bistner S. I. , deLahunta A. , Scott F. W. , McEntee K.
Published: July 2017

Twenty-three susceptible pregnant heifers were inoculated with bovine viral diarrhea virus at 150±1 days of gestation. Seven additional heifers were inoculated between 65 and 115 days of gestation. Acute ocular lesions were seen in fetuses taken 17–21 days after inoculation of their dams at 150 days. By the fourth week, the acute lesions were beginning to resolve, and in newborn animals focal to total retinal atrophy was seen. The acute lesions were characterized by a mild to moderate retinitis that resulted in various degrees of destruction of the different layers, mononuclear cuffing of inner retinal vessels, proliferation of pigment epithelium, and choroiditis. Residually there was an absence of cellular elements in the atrophied areas of the retina, frequently a loss of layering and various numbers of pigment-containing cells. Moderately severe acute inflammation was seen in the retina of the fetus taken at 22 days after inoculation of its dam at 95 days. Ocular lesions did not occur in the other fetuses taken from heifers inoculated at earlier stages of gestation.
Platelet Function in Childhood Migraine
Authors: Carrieri Pietro , Sorge Fulvio , Orefice Giuseppe , De Feo Salvatore
Published: July 2017

Platelet function in vitro and in vivo (ADP-induced platelet aggregation, circulating platelet aggregates, β-thromboglobulin plasma levels) has been studied in children with common migraine, in headache-free intervals. Migraine patients demonstrated increased circulating platelet aggregates when compared with controls. Moreover, two of ten patients had pathological β-thromboglobulin levels. These data indicate that in some children with migraine there is an abnormality of platelet function during headache-free periods.
Pupillary and Vascular Effects of Calcium Antagonists in Migraine
Authors: Fanciullacci Marcello , Boccuni Maria , Pietrini Umberto , Cangi Francesca , Gatto Gaetano , Marabini Simone , Fusco Bruno Marcello
Published: July 2017

In migraine patients the effects of calcium antagonists (flunarizine, verapamil and nifedipine) on both venous and pupillary neuromuscular functions, as well as on blood pressure have been evaluated. A single oral dose of flunarizine (10 mg) and verapamil infusion (50 μg/ml/min) increased venous compliance. Verapamil also counteracted dose-dependent dopamine induced venoconstriction. Nifedipine (10 mg orally) reduced mean arterial pressure in upright position in migraineurs but not in controls. In addition, chronic treatment with flunarizine (10 mg for 2 weeks) induced a transient miotic effect and a reduction of tyramine induced mydriasis. These findings demonstrated that calcium antagonists affect vascular and extra-vascular structures. It is postulated that, in migraine, calcium entry blockers may prevent exaggerated responses to catecholaminergic stimulation.
Endorphin Patterns within the Headache Spectrum Disorders
Authors: Nappi Giuseppe , Facchinetti Fabio , Martignoni Emilia , Petraglia Felice , Manzoni Gian Camillo , Sances Grazia , Sandrini Giorgio , Genazzani Andrea R
Published: July 2017

The role of opioid peptides in modulating the nervous system adaptability has been demonstrated recently; proopiomelanocortin (POMC)-related peptides, in particular, serve in pain perception, in adaptation to stress, and in modulating higher brain functions. Primary headaches, besides pain, involve neuroendocrine/autonomic/adaptive processes as well as mood and personality factors. The view that primary headaches can be taken as a possible model of POMC-related peptides dysfunction led us to evaluate the resting plasma and CSF peptide levels and their plasma changes in response to various stimuli affecting their release. The data obtained from basal and dynamic studies agree with the concept that primary headaches are sustained by opioid system disturbance. In particular the reduced release of endogenous opioids by anterior pituitary in response to physical, endocrine or pharmacological stimuli agrees with a weak adaptive ability of headache sufferers. This impairment of endorphin responsiveness could play a key role in headache susceptibility to environmental stimuli. Primary headaches constitute a wide, intriguing field, including several subgroups bordering on “ischemic” and behavioral/affective disorders. The development of neuroendocrine techniques could be a useful means for supporting the clinical criteria identifying subpopulations of headache sufferers.
Estrogen Changes as a Critical Factor in Modulation of Central Opioid Tonus: Possible Correlations with Post-Menopausal Migraine
Authors: Genazzani Andrea R , Petraglia Felice , Volpe Annibale , Facchinetti Fabio
Published: July 2017

The effects exerted by ovarian steroids on the modulation of opioid activity were investigated in post-menopausal migraine sufferers and in healthy controls. In order to evaluate central opioid tonus, plasma LH rise after naloxone injection was measured, bearing in mind the tonic inhibition of endogenous opioid on hypothalamic LH-RH. There was no response of plasma LH to naloxone in post-menopausal women or in patients submitted to ovariectomy in fertile life. When the subjects underwent a sequencial estrogens + progestagens therapy, such a response was noted from the first month of treatment; progestagens alone were ineffective. The same phenomena were also evident in post-menopausal migraine sufferers. These data indicate that ovarian steroids modulate the activity of opiate receptors in both healthy women and migraine sufferers. Interestingly, replacement therapies through ovarian steroids restored the activity of central opioid tonus in patients affected by migraine.
Common Migraine versus Daily Chronic Headache: A Study of the Relationship Between Depression and Anxiety Scores, and Dexamethasone Suppression Test
Authors: Falaschi Paolo , Cerbo Rosanna , Di Cesare Gianluigi , Cusimano Giuliana , Iellamo Renata , Formisano Rita , Agnoli Alessandro
Published: July 2017

To achieve a better understanding of CH and DCH, we used a multidisciplinary approach evaluating both the depression and anxiety scores and the ability of DEX to decrease plasma cortisol levels in patients with these two forms of headache. The Hamilton rating scale for depression, the Zung test for depression and Stai ×2 for anxiety showed scores within the control range in both groups of patients without any statistically significant difference between the groups. The DEX test showed significant cortisol suppression in both groups of patients either at 8 a.m. or at 4 p.m. (after DEX administration, 1 mg orally at 11 p.m. The night before). The results obtained indicate that in CM and in DCH, normal depression and anxiety scores exist in the present of the apparent integrity of the hypothalamic-pituitary-adrenal axis.
11: Naproxen Sodium in the Treatment of Migraine
Authors: Welch KMA
Published: July 2017

Naproxen sodium, a potent inhibitor of prostaglandin biosynthesis and platelet aggregation, was studied for efficacy in migraine prophylaxis in a randomized, double-blind, placebo-controlled, cross-over trial. On naproxen treatment, 52% of the patients had no severe headaches whereas 19% had no severe headaches during placebo. Naproxen sodium was much better than placebo when patients' diaries were reviewed for severity of attacks, nausea, vomiting, activity reduction, duration of headache, and decreased use of therapeutic medication. Naproxen sodium can be recommended as a drug of first choice for migraine prevention.
Resection of Clinically Localized Segments of Painful Retinaculum in the Treatment of Selected Patients with Anterior Knee Pain
Authors: Kasim Nader , Fulkerson John P.
Published: July 2017

We reviewed the long-term results of 25 patients who had localized soft tissue resections for refractory anterior retinacular knee pain. Patients completed visual analog scales to determine their activity and pain level changes, subjective assessment of their results, and whether they would have the surgery again under the same circumstances. Five of the 25 patients (20%) had had no knee surgery before the soft tissue excision, with the rest having had an average of two prior operations (range, 1 to 6). Subjectively, 22 patients (88%) noted moderate-to-substantial improvement after surgery; 3 patients (12%) declared no long-term benefit. All 25 patients stated that they would repeat the surgery under the same circumstances. Five patients (20%) noted a decrease in their results over time, but only two patients (8%) decreased their job level after surgery because of their knee pain. The average activity level dropped 60% after knee symptoms developed and increased 40% after surgery. Pain levels decreased 50% after surgery. The patients with the best overall results had lesions that were in the medial, inferomedial, or inferolateral retinaculum. The histologic results of the specimens included fibrosis, vascular proliferation, and small nerves with decreased myelin (neuromata). Our results show that specific soft tissue excision of painful tissue can often lead to successful clinical outcomes.
The Anatomic Relationship of the Brachial Plexus and Axillary Artery to the Glenoid
Authors: McFarland Edward G. , Caicedo Juan Carlos , Guitterez Marie Isabel , Sherbondy Paul S. , Kim Tae Kyun
Published: July 2017

Iatrogenic brachial plexus injury is an uncommon but potentially severe complication of shoulder reconstruction for instability that involves dissection near the subscapularis muscle and potentially near the brachial plexus. We examined the relationship of the brachial plexus to the glenoid and the subscapularis muscle and evaluated the proximity of retractors used in anterior shoulder surgical procedures to the brachial plexus. Eight fresh-frozen cadaveric shoulders were exposed by a deltopectoral approach. The subscapularis muscle was split in the middle and dissected to reveal the capsule beneath it. The capsule was split at midline, and a Steinmann pin was placed in the equator of the glenoid rim under direct visualization. The distance from the glenoid rim to the brachial plexus was measured with calipers with the arm in 0°, 60°, and 90° of abduction. The brachial plexus and axillary artery were within 2 cm of the glenoid rim, with the brachial plexus as close as 5 mm in some cases. There was no statistically significant change in the distance from the glenoid rim to the musculocutaneous nerve, axillary artery, medial cord, or posterior cord with the arm in various degrees of abduction. Retractors placed superficial to the subscapularis muscle or used along the scapular neck make contact with the brachial plexus in all positions tested.
Biomechanical Comparison of Patellar Tendon Repairs in a Cadaver Model: An Evaluation of Gap Formation at the Repair Site with Cyclic Loading
Authors: Ravalin Richard V. , Mazzocca Augustus D. , Grady-Benson John C. , Nissen Carl W. , Adams Doug J.
Published: July 2017

Background

Ruptures of the patellar tendon are rare injuries. Surgical treatment for this injury is mandatory.

Hypothesis

Gap formation does not differ between the three patellar tendon repair techniques.

Study Design

Controlled laboratory study.

Methods

Twelve fresh-frozen cadaveric knees were used to compare three techniques of patellar tendon repairs. The standard suture repair used two Krackow sutures placed in the avulsed patellar tendon, passed through transpatellar drill holes, and secured with the knee in 30° of flexion. In the second group, suture repair was augmented with a No. 5 Ethibond suture. In the third group, suture repair was augmented with a 2.0 Dall-Miles cable. Testing was performed with the specimens mounted to a custom knee jig with the tibia free, simulating the knee moment of a 70-kg person. Each knee was then cycled 250 times at 0.25 Hz.

Results

Gap formation across the standard suture repair averaged 7.3 mm; across the suture augmentation and cable augmentation groups it averaged 4.9 mm and 3.5 mm, respectively.

Conclusions

Augmentation of patellar tendon avulsions can decrease gap formation at the repair site, allowing early mobilization.

Clinical Relevance

Gap formation seen in repair without augmentation could lead to clinical failure with resultant patella alta and extensor mechanism lag.
Prevention of Axillary Nerve Injury in Anterior Shoulder Reconstructions
Authors: McFarland Edward G. , Caicedo Juan Carlos , Kim Tae Kyun , Banchasuek Prachan
Published: July 2017

Background

Previous authors have suggested that the axillary nerve should be explored or palpated during all anterior shoulder stabilization procedures.

Objective

The goal of this study was to document the axillary nerve injury rate in a cohort of patients who had undergone anterior shoulder stabilization without axillary nerve dissection.

Hypothesis

Use of a subscapularis muscle-splitting approach by using a retractor along the scapular neck does not result in significant risk of injury to the axillary nerve, and exploration of the axillary nerve is not necessary using this approach.

Study Design

Prospective cohort study.

Methods

One hundred and twenty-eight anterior stabilizations were performed with a subscapularis muscle-splitting approach that has been previously described. In all cases a retractor was placed along the inferior scapular neck to protect the axillary nerve. The axillary nerve was not exposed or palpated in any case. All patients were evaluated on the 1st postoperative day and again within 10 days for symptoms of axillary nerve palsy, including sensory loss and return of muscle function. One patient (0.8%) had paresthesia in an axillary nerve distribution; recovery occurred without the need for electromyography or other interventions. There were no clinically detected cases of axillary nerve motor dysfunction.

Conclusions

Routine exposure of the axillary nerve is not necessary during anterior stabilization procedures using a subscapularis muscle-splitting approach if proper precautions are taken to protect the nerve. Other techniques of anterior stabilization may require exposure of the axillary nerve.
Improved Healing of Transected Rabbit Achilles Tendon after a Single Injection of Cartilage-Derived Morphogenetic Protein-2
Authors: Forslund Carina , Aspenberg Per
Published: July 2017

Background

Achilles tendon ruptures in humans might be treated more efficiently with the help of a growth factor. Cartilage-derived morphogenetic protein-2 has been shown to induce formation of tendon-like tissue.

Hypothesis

Cartilage-derived morphogenetic protein-2 has a positive effect on mechanical parameters for tendon healing in a rabbit model with Achilles tendon transection.

Study Design

Controlled laboratory study.

Methods

The right Achilles tendon of 40 rabbits was transected without tendon suture. Cartilage-derived morphogenetic protein-2 (10 μg) or vehicle control (acetate buffer) was injected locally 2 hours postoperatively. All tendons were tested biomechanically at 8 and 14 days, and treated tendons were histologically and radiographically evaluated at 56 days.

Results

At 14 days, both failure load and stiffness of treated tendons were increased by 35%. The treated tendons had significantly larger callus size at 8 and 14 days. Histologic and radiographic examination showed no signs of ossification in the treated tendons after 56 days.

Conclusions

A single injection of cartilage-derived morphogenetic protein-2 led to a stronger and stiffer tendon callus than that in the controls without inducing bone formation.

Clinical Relevance

Similar results from a larger animal model would suggest a possible future use of cartilage-derived morphogenetic protein-2 in the treatment of human Achilles tendon ruptures.
Efficacy of Cold Gel for Soft Tissue Injuries
Authors: Airaksinen Olavi V. , Kyrklund Nils , Latvala Kyösti , Kouri Jukka P. , Grönblad Mats , Kolari Pertti
Published: July 2017

Background

The use of cold treatment to limit edema, decrease pain, and induce effective muscle relaxation in soft tissue injuries is widespread.

Purpose

To compare the efficacy of a novel cold gel with that of a placebo gel in patients with a soft tissue injury.

Study Design

Prospective randomized double-blinded controlled study.

Methods

Seventy-four patients with sports-related soft tissue injury were randomly assigned to active cold gel (Ice Power) or placebo gel groups. The gel was applied four times daily on the skin for 14 days. Clinical assessment was made after 7, 14, and 28 days with use of visual analog scale ratings.

Results

Pain scores decreased from 59 to 30 during the first week, to 14 by the second, and to 7 by the end of study in the cold gel group. In the placebo group, pain scores decreased from 58 to 45, 26, and 13, respectively (significant difference). Patient satisfaction with treatment was 71 in the cold gel group and 44 in the placebo group (significant difference). Disability decreased significantly more rapidly in the cold gel group.

Conclusions

Cold gel therapy provided an effective and safe treatment for sports-related soft tissue injuries.