Treatment satisfaction and oral health-related quality of life in patients with cleft lip and palate after secondary alveolar bone grafting.

Secondary alveolar bone grafting (SABG) using autologous iliac crest cancellous bone is a standard procedure for patients with cleft lip and palate (CLP). The aim of this study was to evaluate patient satisfaction after bone grafting of the alveolar cleft. Patients who underwent SABG between 2000 and 2010 in one surgical centre were included in this cross-sectional study. Three questionnaires were used, one addressing functional and aesthetic outcomes (nine items), the second being the 14-item Oral Health Impact Profile (OHIP-G14), and the third addressing donor site morbidity. A total of 103 patients fulfilled the inclusion criteria, of whom 71 could be contacted, and 52 completed the questionnaires. The majority of the patients (98%) were satisfied with the aesthetic and functional results and reported low donor site morbidity. A significant correlation was found between scores from the patient satisfaction questionnaire and the OHIP-G14. Regarding overall patient satisfaction, the manifestation of the cleft had no significant influence. The questionnaires used allowed the assessment of subjective outcome parameters, but might not be absolutely specific and exclusive for the SABG procedure in the framework of comprehensive CLP therapy. Nevertheless, SABG using autologous iliac crest cancellous bone can be considered a highly satisfactory procedure.

Mechanical resistance of the periorbita and the orbital floor complex--are isolated orbital floor fractures only a soft tissue problem?

The primary aims of orbital floor reconstruction are to prevent enophthalmos and herniation of the orbital contents in order to achieve correct globe position. Theoretically, the mechanical load of the orbital floor is approximately 0.0005N/mm(2) (30g orbital content onto 600mm(2) of orbital floor area). Therefore, low mechanical stress from orbital floor reconstruction materials is expected. The periorbita and orbital floor complex (bony orbital floor with periorbita) of 12 human cadavers were investigated for their mechanical resistance to distortion and compared to different absorbable pliable reconstruction materials after modification with pores (Bio-Gide, Creos, and PDS). The human periorbita resistance (approximately 1.4N/mm(2)) was comparable to that of the absorbable membranes (Creos, Bio-Gide), and the resistance of PDS (approximately 2.3N/mm(2)) was comparable to that of the orbital floor complex. The periorbita has a higher stability than the bony orbital floor. Therefore, in isolated orbital floor fractures with a traumatized bony orbital floor and periorbita, reconstruction of the soft tissue as a periorbita equivalent with a resorbable membrane appears to be adequate to prevent enophthalmos and herniation of the orbital contents.

Mechanical properties of collagen membranes modified with pores--are they still sufficient for orbital floor reconstruction?

Adequate mechanical strength is essential for materials used to reconstruct the orbital floor, and collagen membranes have recently been suggested for the repair of isolated fractures of the orbital floor. However, their mechanical properties after modification with pores for increased drainage of blood into the sinus have not been sufficiently investigated. We have tested the mechanical resistance of polydioxanone foils (PDS) to distortion and compared it with that of 3 resorbable collagen membranes (Smartbrane(®), Bio-Gide(®), and Creos(®)) in mint condition and when artificially aged (3 weeks, 6 weeks, and 8 weeks) after modification with pores (diameter 2mm) in a standard configuration (n=12 in each group). PDS and Creos(®) had comparable initial values for mechanical resistance of about 2.3N/mm(2), and Bio-Gide(®) and Smartbrane(®) had about 20% and 80% lower initial mechanical resistance, respectively. All materials tested had lower values after artificial ageing. After eight weeks of ageing, PDS lost about 99% of its initial mechanical resistance, Creos(®) about 66%, Bio-Gide(®) about 30%, and Smartbrane(®) about 95%. After 3 weeks the mechanical resistance in all groups was significantly less than the initial values (p=0.05), but there was no difference between samples aged artificially for 6 compared with 8 weeks. The mechanical resistance of the tested materials was not influenced by the presence of pores in a standard configuration and was in the appropriate range for moderate fractures of the orbital floor. We recommend further clinical investigations of collagen membranes modified with pores.

A comparison of biocompatibility and osseointegration of ceramic and titanium implants: an in vivo and in vitro study.

This study compared the biocompatibility in vitro and the osseointegration in vivo of zirconium and titanium implants regarding implant surfaces and the bone-implant contacts. The different implant surfaces and the biocompatibility of zirconium versus titanium implants were determined by vitality and cytotoxic tests in vitro. The contact of the osteoblasts to the implant surface was determined by scanning electron microscopy (SEM). The in vivo study for osseointegration was performed in domestic pigs over 4 and 12 weeks. In each animal, 4 zirconium and 4 titanium implants (WhiteSky, BlueSky, Bredent, Germany) were inserted in the os frontale and analysed by histomorphometry. Cytotoxicity and SEM showed good biocompatibility in relation to the investigated implant materials. Histological results showed direct bone-implant contact of the implant surfaces. The zirconium implants showed a slight delay in osseointegration in terms of bone-implant contact as measured by histomorphometry (after 4 weeks, zirconium (59.3 ± 4.6%) versus titanium (64.1 ± 3.9%); after 12 weeks, zirconium (67.1 ± 2.3%) versus titanium (73.6 ± 3.2%). A statistically significant difference between the two groups was not observed. The results indicated similar biocompatibility and osseointegration for zirconium compared to titanium implants.

Growth and transplantation of a custom vascularised bone graft in a man.

BACKGROUND: A major goal of research in bone transplantation is the ability to avoid creation of secondary bone defects. We aimed to repair an extended mandibular discontinuity defect by growth of a custom bone transplant inside the latissimus dorsi muscle of an adult male patient. METHODS: Three-dimensional computed tomography (CT) scanning and computer-aided design techniques were used to produce an ideal virtual replacement for the mandibular defect. These data were used to create a titanium mesh cage that was filled with bone mineral blocks and infiltrated with 7 mg recombinant human bone morphogenetic protein 7 and 20 mL of the patient's bone marrow. Thus prepared, the transplant was implanted into the latissimus dorsi muscle and 7 weeks later transplanted as a free bone-muscle flap to repair the mandibular defect. FINDINGS: In-vivo skeletal scintigraphy showed bone remodelling and mineralisation inside the mandibular transplant both before and after transplantation. CT provided radiological evidence of new bone formation. Postoperatively, the patient had an improved degree of mastication and was satisfied with the aesthetic outcome of the procedure. INTERPRETATION: Heterotopic bone induction to form a mandibular replacement inside the latissimus dorsi muscle in a human being is possible. This technique allows for a lower operative burden compared with conventional techniques by avoiding creation of a secondary bone defect. It also provides a good three-dimensional outcome.

Passive transfer of alloantibodies restores acute cardiac rejection in IgKO mice.

BACKGROUND: Alloantibody is an intrinsic component of the immune response to organ transplants. Although alloantibodies have been correlated with decreased graft survival, the mechanisms of alloantibody-mediated injury remain largely undefined in vivo. In the present study, we have established a model of alloantibody-mediated graft injury using B10.A (H-2a) hearts transplanted to wild type (WT) or immunoglobulin knock out (IgKO) C57BL-Igh-6 (H-2b) mice. METHODS: Alloantibodies were measured in the circulation and graft by flow cytometry and in immunofluorescence staining, respectively. Intragraft cytokine mRNA expression was evaluated using a competitive template reverse transcriptase polymerase chain reaction (RT-PCR) technique. P-selectin and von Willebrand factor expression were localized by immunoperoxidase staining. The capacity of alloantibodies to restore acute cardiac allograft rejection was tested by passive transfer of monoclonal antibodies (mAbs) against donor major histocompatibility complex (MHC) class I antigens to IgKO recipients. RESULTS: B10.A cardiac allografts are rejected acutely by WT C57BL/6 recipients, but over 50% of the cardiac allografts survived more than 50 days after transplantation in IgKO mice. Competitive template RT-PCR on the cardiac transplants demonstrated similar levels of IL-1-alpha, IL-12 (p40), TNF-alpha, IL-2, IFN-gamma, IL-4, and IL-10 mRNA in WT and IgKO recipients 8-10 days after transplantation, indicating that macrophage- and T-cell-dependent immune responses were intact in IgKO recipients. The rejection of B10.A hearts in WT recipients was characterized by interstitial and perivascular cellular infiltration; IgG, IgM, and complement (C3) deposition; vascular cell injury and intravascular platelet aggregation; and release of von Willebrand factor and P-selectin. In IgKO recipients the lower degree of vascular injury in the absence of alloantibody responses was reflected by the lack of release of von Willebrand factor and P-selectin, which remained confined to cytoplasmic storage granules of endothelial cells and platelets. Acute rejection of cardiac allografts was restored to IgKO recipients by passive transfer of proinflammatory IgG2b mAbs against donor MHC; recipients injected with isotype-matched control mAbs did not reject. In contrast, passive transfer of IgG1 mAbs against donor MHC failed to restore acute rejection of cardiac allografts to IgKO recipients. Passive transfer of IgG2b, but not IgG1 mAbs was associated with endothelial cell activation and plate. let aggregation together with the release of preformed von Willebrand factor and P-selectin from storage granules. CONCLUSIONS: Acute rejection of cardiac allografts can be reconstituted in IgKO recipients by passive transfer of IgG2b, but not IgG1 antibody. This model allows the mechanism of alloantibody-mediate graft injury to be dissected in vivo.

Nebulized saline solution of dry powder formoterol is useful for acute bronchospasm

Dos nuevos beta agonistas de efecto prolongado son actualmente usados clínicamente: salmeterol y formoterol. El primero no ha demostado efectividad en los casos de asma aguda mientras que el segundo, formoterol, comparable en su período de latencia al albuterol, no ha sido empleado en el manejo de las crisis de asma. En este estudio utilizamos mediciones de flujo espiratorio pico antes y después de la administración de 12 microgramos de fumarato de formoterol (ForadilR) en polvo seco vía nebulización, inmediatamente después de su dilución en solución salina estéril, a treinta pacientes con crisis de asma y grados variables de obstrucción bronquial. Los resultados muestran mejoría significativa a los 5 y 30 minutos después de su administración, sugiriendo estabilidad de este producto así como un novedoso enfoque costo efectivo por su menor dosificación y posible impacto sobre la frecuencia de readmisiones debido a una broncodilatación prolongada

C6 produced by macrophages contributes to cardiac allograft rejection.

The terminal components of complement C5b-C9 can cause significant injury to cardiac allografts. Using C6-deficient rats, we have found that the rejection of major histocompatibility (MHC) class I-incompatible PVG.R8 (RT1.A(a)B(u)) cardiac allografts by PVG.1U (RT1.A(u)B(u)) recipients is particularly dependent on C6. This model was selected to determine whether tissue injury results from C6 produced by macrophages, which are a conspicuous component of infiltrates in rejecting transplants. We demonstrated that high levels of C6 mRNA are expressed in isolated populations of macrophages. The relevance of macrophage-produced C6 to cardiac allograft injury was investigated by transplanting hearts from PVG. R8 (C6-) donors to PVG.1U (C6-) rats which had been reconstituted with bone marrow from PVG.1U (C6+) rats as the sole source of C6. Hearts grafted to hosts after C6 reconstitution by bone marrow transplantation underwent rejection characterized by deposition of IgG and complement on the vascular endothelium together with extensive intravascular aggregates of P-selectin-positive platelets. At the time of acute rejection, the cardiac allografts contained extensive perivascular and interstitial macrophage infiltrates. RT-PCR and in situ hybridization demonstrated high levels of C6 mRNA in the macrophage-laden transplants. C6 protein levels were also increased in the circulation during rejection. To determine the relative contribution to cardiac allograft rejection of the low levels of circulating C6 produced systemically by macrophages, C6 containing serum was passively transferred to PVG.1U (C6-) recipients of PVG.R8 (C6-) hearts. This reconstituted the C6 levels to about 3 to 6% of normal values, but failed to induce allograft rejection. In control PVG.1U (C6-) recipients that were reconstituted with bone marrow from PVG.1U (C6-) donors, C6 levels remained undetectable and PVG.R8 cardiac allografts were not rejected. These results indicate that C6 produced by macrophages can cause significant tissue damage.

[Solid craniopharyngioma in the 3rd ventricle--differential diagnostic aspects]. / Solides Kraniopharyngeom im III. Ventrikel--Differentialdiagnostische Aspekte.

We report on a 54-year-old man with a solid craniopharyngioma in the third ventricle. Differentiation from a meningeoma was possible by visualization of a small cystic component in the suprasellar cistern and a central hypodensity/ hypointensity on CT and MRI, respectively. The latter seems to be a rather typical finding. Considering the differential diagnosis of tumors within the third ventricle, it must be emphasized that tumors arising within the ventricle are rare and invasion from primary extraventricular tumors is more common. A craniopharyngioma of the papillary type often has the typical imaging appearance described above.

Surgical treatment of neoplasms associated with medically intractable epilepsy.

OBJECTIVE: Surgical treatment in patients with brain tumors and medically intractable epilepsy is aimed at the removal of the neoplasm and complete seizure control. However, an adequate surgical approach is still controversial. This study was designed to analyze the factors for the optimum surgical treatment of these patients. METHODS: The clinical, electrophysiological, operative, and histopathological data of 146 consecutive patients who underwent surgery between November 1987 and May 1995 for intrinsic brain tumors and pharmacoresistant epilepsy were evaluated. RESULTS: The majority of the tumors were located in the temporal lobe (n = 116) and involved the cortical gray matter. The most frequent tumors were gangliogliomas (n = 65), pilocytic astrocytomas (n = 21), and dysembryoplastic neuroepithelial tumors (n = 19). All but three tumors (98%) were of low histopathological grade (World Health Organization Grades I or II). The biological behavior of the tumors was strikingly indolent, as indicated by a long preoperative history of chronic seizures (mean, 14 yr). In all cases, complete resection of the tumor, including the epileptogenic area (as determined by noninvasive and/or invasive recordings of the zone of seizure onset and persistent interictal activity), was intended. Complications were encountered in 11 cases (8%). However, no patient died and there was no permanent morbidity. Of the 124 patients who had postoperative follow-up examinations more than 6 months after resection, 71% were seizure-free, 11% had no more than two seizures per year, 13% showed a reduction of seizure frequency of at least 75%, and 5% had no appreciable reduction in seizure frequency. CONCLUSION: The data indicate that neoplasms associated with medically intractable epilepsy constitute a distinct clinicopathological group of tumors that arise in young hosts, involve the cortex, and exhibit indolent biological behavior for many years. Complete surgical removal of these tumors, including the epileptogenic area, can achieve excellent seizure control.

Surgical and neurological complications in a series of 708 epilepsy surgery procedures.

OBJECTIVE: There are few modern data on the complications of surgery for epilepsy from the neurosurgeon's point of view. A survey of complications observed in a large current epilepsy surgery series is presented to facilitate the assessment of a risk:benefit ratio, which must be known when planning for epilepsy surgery and counseling patients. METHODS: A series of 429 consecutive patients operated on during 6.5 years in the newly established University of Bonn epilepsy surgery program was, in part, retrospectively, and, in larger part, prospectively analyzed for complications originating from 279 invasive diagnostic procedures and 429 therapeutic procedures. Neuropsychological and psychiatric complications as well as the rate of failure to control seizures are not addressed in this article. RESULTS: Two hundred and seventy-nine temporal operations, 59 frontal operations, 22 other extratemporal operations, 33 callosotomies, 3 multilobectomies, and 33 hemispherectomies were performed. Complications were grouped into general surgical and neurological complications. No mortality resulted from 708 invasive procedures. Two hundred and seventy-nine invasive diagnostic procedures (various combinations of strip, grid, and depth electrode insertions) resulted in 3.6% transient morbidity (2.9% surgical complications, 0.7% neurological complications) and 0.7% permanent morbidity (dysphasia). During 429 therapeutic procedures, 33 surgical complications were encountered. None of these resulted in permanent morbidity, except for the necessity for permanent shunt insertion in three patients. Wound infection was the most frequent surgical complication, but we were able to demonstrate a steady decrease during the 6.5-year observation period. The total rate of neurological complications in 429 therapeutic procedures was 5.4%, with 3.03% causing transient morbidity and 2.33% causing permanent morbidity. CONCLUSION: Our data indicate that epilepsy surgery can be performed with an acceptable rate of resultant morbidity. The indications for epilepsy surgery, the learning curve determined, and the results from other series are discussed in the light of these figures.

Surgical treatment of extratemporal epilepsy: clinical, radiologic, and histopathologic findings in 60 patients.

PURPOSE AND METHODS: The aim of this study was to analyze clinical, radiologic, and histopathologic findings in 60 consecutive patients with medically intractable extratemporal epilepsy who were operated on between November 1987 and May 1993. RESULTS: Histologically, there were distinct structural abnormalities in 50 (83%) of the surgical specimens. Signal abnormalities on magnetic resonance imaging (MRI) were present in all patients with neoplastic lesions (n = 17) and in 94% of patients with nonneoplastic focal lesions (n = 32). Overall, structural abnormalities were detected by MRI in 47 (96%) of 49 patients with focal lesions. During a mean follow-up of 4 years, 30 (54%) patients remained completely seizure free, 11 (20%) had < or = 2 seizures per year, seven (12%) showed a seizure reduction of > or = 75%, and eight (14%) had < 75% reduction in seizure frequency. The fraction of seizure-free patients was 12 (80%) of 15 in patients with neoplastic lesions, 16 (52%) of 31 in patients with nonneoplastic focal lesions, and two (20%) of 10 for those without histopathologic abnormalities. The differences in seizure outcome between patients with and without focal lesions were statistically significant (p < 0.05), if seizure-free outcome was compared with persistent seizures. CONCLUSIONS: Focal lesions and particularly neoplasms are associated with improved postoperative seizure control compared with patients without histopathologic abnormalities. We advise caution in considering surgery to treat extratemporal epilepsy in patients who have normal MRI scans, because the outcome with the approach described in this study is poor in such cases.

Surgical treatment of temporal lobe epilepsy: clinical, radiological, and histopathological findings in 178 patients.

The surgical treatment of pharmacoresistant temporal lobe epilepsy is increasing rapidly. The correlation of preoperative MRI, histopathological findings, and postoperative seizure control is reported for 178 patients with chronic medically intractable temporal lobe epilepsy who were operated on between November 1987 and January 1993. Histopathologically there were distinct structural abnormalities in 97.2% of the surgical specimens. Signal abnormalities on MRI were present in 98.7% of patients with neoplastic lesions (n = 79), 76.6% of patients with non-neoplastic focal lesions (n = 55), and 69.2% of patients with Ammon's horn sclerosis (n = 39). Overall, structural abnormalities were detected by MRI in 82.7% of all patients. The mean postoperative follow up period was three years. Some 92% of the patients benefited from surgery: 103 patients (61.7%) were seizure free, 26 (15.5%) had no more than two seizures a year, and 24 (14.4%) showed a reduction of seizure frequency of at least 75%. Fourteen patients (8.4%) had a < 75% reduction of seizure frequency. The percentage of patients who were completely free of seizures after operation was 68.5% for patients with neoplastic lesions, 66.7% for Ammon's horn sclerosis, and 54.0% for patients with non-neoplastic focal lesions. By contrast, none of the patients in whom histopathological findings were normal became seizure free postoperatively. The data show that the presence of focal lesions or Ammon's horn sclerosis as determined by histopathological examination is associated with improved postoperative seizure control compared with patients without specific pathological findings. Brain MRI was very sensitive in detecting neoplasms; however, its sensitivity and specificity were limited with respect to non-neoplastic focal lesions and Ammon's horn sclerosis. Improvement of imaging techniques may provide a more precise definition of structural lesions in these cases and facilitate limited surgical resections of the epileptogenic area rather than standardised anatomical resections.

Subdural and depth electrodes in the presurgical evaluation of epilepsy.

From 1987 to 1992, invasive EEG studies using subdural strips, grids or depth electrodes were performed in a total of 160 patients with medically intractable epilepsy, in whom scalp EEG was insufficient to localize the epileptogenic focus. Dependent on the individual requirements, these different electrode types were used alone or in combination. Multiple strip electrodes with 4 to 16 contacts were implanted in 157 cases through burrholes, grids with up to 64 contacts in 15 cases via boneflaps, and intrahippocampal depth electrodes in 36 cases using stereotactic procedures. In every case, localization of the electrodes with respect to brain structures was controlled by CT scan and MRI. Visual and computerized analysis of extra-operative recordings allowed the localization of a resectable epileptogenic focus in 143 patients (89%), who subsequently were referred for surgery, whereas surgery had to be denied to 17 patients (11%). We did not encounter any permanent morbidity or mortality in our series. In our experience, EEG-monitoring with chronically implanted electrodes is a feasible technique which contributes essentially to the exact localization of the epileptogenic focus, since it allows nearly artefact-free recording of the ictal and interictal activity. Moreover, grid electrodes can be used for extra-operative functional topographic mapping of eloquent brain areas.

Comparación entre dos métodos de profilaxia antimicrobiana en colecistectomía electiva / Comparison between two antimicrobial methods of prophylaxis in elective biliary surgery

Dos métodos de profilaxia antimicrobiana en cirugía biliar abierta fueron evaluados y comparados en un estudio prospectivo aleatorio, utilizando dosis única de Cefuroxima sodical (1.5 gr.IV). A 20 pacientes que fueronsometidos a colecistectomía electiva se les administró cefuroxima sodica estéril inmediatamente después de la inducción de la anestesia (Grupo 1), mientras que al otro grupo de 20 pacientes solamente se les administró el antibiótico si la tinción de gram de bilis tomada al comienzo de la cirugía revelaba bacterias (Grupo 2). Las variables introducidas en el estudio fueron controlables, lo que hizoque los dos grupos de pacientes fueran semejantes. Un 20/100 de los pacientes del Grupo 2 desarrollaron infección de la herida operatoria, en comparación a los pacientes del grupo 1 donde no hubo infecciones (p=0.03). El gram de bilis transoperatorio es poco sensible pues sólo detectó a un 33.33/100 de las pacientes con bactebilia, sin embargo su especificidad es del 100/100. Pensamos que la profilaxia antimicrobiana rutinaria en colecistectomía abierta electiva está indicada

[Primary intracerebral non-Hodgkin's lymphoma--a clinicopathologic study]. / Primäre intracerebrale Non-Hodgkin-Lymphome--eine klinikopathologische Studie.

Primary cerebral lymphomas (PCL) were diagnosed with increasing frequency also in our retrospective study of 44 patients. Clinically these tumors presented with signs of a rapidly growing brain neoplasm. The analysis of CCT data showed that the tumors were of varying density before and showed mostly (60%) homogeneous enhancement after contrast medium application. MR imaging was more sensitive, but could not aid in distinguishing PCL from other brain tumors. The lesions lay mainly (82%) in the supratentorial space and involved the frontal lobe in 42% of cases. Only 16% were located in the periventricular region including corpus callosum and basal ganglia. 20% of cases showed multiple lesions. Suspected diagnoses were therefore mainly meningeoma, glioma and metastases. Morphological diagnosis was easily possible with the aid of immunohistological methods: there were 41 B-cell lymphomas (93%), two T-cell lymphomas and one large cell anaplastic lymphoma of the non-B non-T phenotype. An unequivocal correlation between morphology and radiological picture existed in the way that tumors with a dense cellular infiltrate appeared mainly as hyperdense lesions with homogeneous contrast enhancement. The clinical course was characterized by CNS-relapses frequently with multiple cerebral lesions and a spinal recurrence in one case. 7% of cases showed evidence of extracerebral disease in a bone marrow biopsy specimen or at autopsy. The average survival of the patients was 15 months, one year survival was 36%, two year survival 12% and 5% of patients lived for more than 5 years.

[Characteristics of human immunodeficiency virus infection in the San Juan de Dios General Hospital]. / Caracterizacion de la infeccion por el virus de inmunodeficiencia humana, en el Hospital General San Juan de Dios.

PIP: A prospective clinical study was conducted between January 1991 and June 1992 of 92 HIV seropositive patients attending the Adult Outpatient Clinic of the San Juan de Dios General Hospital in Guatemala City. 52 of the patients met the US Centers for Disease Control clinical criteria for AIDS. Limitations in the diagnostic and laboratory facilities of the hospital hampered identification of some opportunistic infections. 74 of the 92 patients were male. 3 of the 18 infected women gave birth during the study period; the status of their children is not yet known. 87% of the cases were in adults aged 18-40. 25 of the patients died during the 18-month study period and 9 were lost to follow-up. 57 of the 92 had lived in the US or Mexico. 43 of the 74 men reported homosexual relations. 6 reported use of intravenous drugs. 3 had received blood transfusions as the only known risk factor. 56 had histories of sexually transmitted diseases. 3 patients reported always using condoms, 57 never did so, and the rest did so occasionally. 52 of the patients had opportunistic infections. 18 had proven and 5 had presumptive extrapulmonary mycobacteria, probably tuberculosis. 2 had salmonella in the blood. 4 had presumptive cytomegalovirus, 6 had chronic mucocutaneous herpes, and 3 had presumptive HIV encephalopathy. 12 had esophageal candidiasis, 6 had extrapulmonary cryptococcosis, and 14 had pneumocystis carinii pneumonia. 13 had proven intestinal cryptosporidiosis, and 1 each had presumptive cerebral toxoplasmosis and extraintestinal strongyloidiasis. 3 had proven Kaposi's sarcoma and 1 had proven immunoblastic lymphoma. 10 had HIV-related weight loss.^ieng

Use of an ecraseur for ovariohysterectomy in mares.

Ovariohysterectomy was performed in 20 mares at three stages of estrus. An ecraseur was used to severe the ovarian branch of the ovarian artery and vein and the ovarian suspensory ligament en masse. All other vessels supplying the ovaries and uterus were doubly ligated and transected. All mares survived. Complications were intraoperative hemorrhage in three mares, postoperative vaginal bleeding in two mares, and a hematoma in the remnant of the broad ligament in one mare. No adhesions between the uterine stump or remnants of the broad ligament and abdominal structures were detected by palpation per rectum.

Urokinase therapy for Silastic catheter-induced intravascular thrombi in infants and children.

Among the serious complications encountered with long-term, indwelling Silastic central venous catheters are catheter-induced intravascular thrombi. These thrombi are usually treated by removal of the catheter to prevent thrombus propagation, embolization, or infection. We treated ten patients with urokinase infusion who had experienced 12 incidents of induced intravascular thrombi. Catheter phlebography and two-dimensional echocardiography were used for diagnosis and follow-up. Eleven of the 12 episodes were treated successfully, with complete dissolution of the thrombus. One patient with a calcific thrombus had only partial clot lysis and required catheter removal. By utilizing urokinase infusion to treat Silastic catheter-induced intravascular thrombi, nine of ten central venous catheters were preserved and the possible need for thrombectomy was averted. No serious complications were encountered. In our experience, urokinase therapy has been an effective and safe method for treating Silastic catheter-induced intravascular thrombi.