Atlas hypoplasia as a cause of high cervical myelopathy. Case report.

A high cervical myelopathy due to atlas hypoplasia is described in a 56-year-old man; the condition caused marked segmental compression of the spinal cord. A remarkable neurological recovery followed decompressive laminectomy of the atlas and adjacent regions. The authors discuss the embryology and etiology of this anomaly.

[Continuous epidural administration of droperidol for the prevention of postoperative nausea].

Continuous antiemetic effect of epidural droperidol was evaluated by prospective, double-blinded study using 145 ASA physical status I-II patients undergoing major gynecological surgery. All patients received bolus epidural infusion of buprenorphine at the end of the operation and continuous epidural infusion of buprenorphine for 48 hours. Patients were divided into 3 groups, 49 patients of Group I received placebo, 50 patients of Group II received only bolus doses of droperidol 2.5 mg and the remaining 46 patients of Group III received continuous epidural infusion of droperidol 10 mg in 48 hours. Visual analogue scales for nausea, the incidence of emetic episodes and side effects were evaluated at 3 hr, 24 hr and 48 hr postoperatively. The scores for nausea were significantly lower in Group III (P < 0.05) compared with Group I 24 hr after the operation. The incidence of emesis was significantly lower in Group III (P < 0.05) as compared with Group I and II 48 hr after the operation. Extrapyramidal side effects and sedative effects were not observed in any patients. The continuous epidural administration of droperidol is effective in prevention of postoperative nausea and vomiting and the effect lasts during its infusion with no side effects.

Significance of monitoring plasma levels of amitriptyline, and its hydroxylated and desmethylated metabolites in prediction of the clinical outcome of depressive state.

The clinical significance of monitoring the plasma levels of amitriptyline and its metabolites in prediction of the clinical outcome of depressive episode was investigated in 49 inpatients. Discriminant analysis of drug concentrations (at two weeks after initiation of drug treatment) and clinical outcome revealed that increasing the plasma levels of amitriptyline, cis-isomers of hydroxylated metabolites (Z-10-hydroxyamitriptyline and Z-10-hydroxynortriptyline) predicted a better clinical outcome, while increasing of plasma levels of nortriptyline and trans-isomers of hydroxylated metabolites (E-10-hydroxyamitriptyline and E-10-hydroxynortriptyline) were shown to predict a poor clinical outcome in the depressive episode of the subjects, and that clinical outcome of approximately 73% of the subjects could be correctly predicted.

Clinico-radiological study of total knee arthroplasty after high tibial osteotomy.

The results of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) and problems encountered during the operation were investigated in 23 patients (28 knees). HTO was performed by Coventry's method in 18 knees and by Maquet's method in 10 knees. The mean interval from HTO to TKA was 86 months (range, 3 to 288 months) and the mean follow-up period after TKA was 25 months (range, 6 to 116 months). Radiological evaluation showed that the proximal part of the tibia was shifted and tilted lateroinferiorly after HTO. Thus, a tendency to patella infera was observed. Lateral shift of the proximal part of the tibia was more marked with Maquet's method than with Coventry's method (P < 0.01). Posterior inclination of the tibial articular surface before TKA was smaller in the patients who gained a range of motion of 90 degrees or more after TKA than in those with less than 90 degrees (P < 0.05). In patients with 70 points or more on the three-university score after TKA, there was no change in the joint line level between before and after TKA, while the joint line was significantly lower after TKA in those with less than 70 points (P < 0.01). When TKA is done after HTO, various technical problems may influence the outcome, such as correction of the soft tissue imbalance, in addition to difficulties with patellar eversion and exposure of the proximal part of the tibia. The clinical results of TKA after HTO tend to be slightly inferior to those of primary TKA, probably because of such technical problems.