[A minimally invasive technique to repair pectus carinatum. Preliminary report]. / Método miniinvasivo para la corrección del pectus carinatum. Comunicación preliminar.

The present report deals with a new technique for the correction of pectus carinatum. Although less frequent than pectus excavatum, this deformity leads to numerous consultations, as it is difficult to conceal and affects the personality and behavior of many young patients. We report the case of a 13-year-old boy with asymmetrical pectus carinatum. The chest wall was compressible, so the protrusion was corrected by means of intrathoracic compression. In this technique, the sternochondral region is compressed by implanting a metal bar in the presternal region and securing it bilaterally to the posterolateral portion of the costal arches. The strut remains implanted until remolding of the chest contour is achieved. In this case, the strut was removed after 1 year and the new chest contour has been maintained unchanged more than 8 months following surgery. In conclusion, this minimally invasive technique for the treatment of pectus carinatum by means of intrathoracic compression appears to be a valid alternative to more invasive techniques and should be considered in appropriate cases.

Método miniinvasivo para la corrección del pectus carinatum. Comunicación preliminar / A minimally invasive technique to repair pectus carinatum. Preliminary report

El presente trabajo trata sobre un nuevo sistema de corrección del pectus carinatum. Aunque menos frecuente que el pectus excavatum, esta anomalía es causa de numerosas consultas, pues es difícil de disimular y produce afectación de la personalidad y de la conducta en numerosos pacientes jóvenes. Se presenta el caso de un paciente de 13 años con pectus carinatum asimétrico. La pared torácica era compresible. Se utilizó el denominado sistema de compresión endotorácica, por el cual se corrige la prominencia mediante la compresión de la región esternocondral implantando una placa metálica preesternal fijada bilateralmente a los arcos costales en su porción posterolateral, la cual permanece implantada hasta lograr la osificación de acuerdo con el contorno torácico obtenido y posteriormente se extrae. Se logró un resultado satisfactorio. El dolor postoperatorio fue aceptable. El implante se retiró al año y el nuevo contorno torácico se mantenía sin alteraciones a más de 8 meses de seguimiento. En conclusión, el método miniinvasivo para el tratamiento del pectus carinatum mediante el sistema de compresión endotorácica parece una alternativa válida a los métodos más invasivos y debe tenerse en cuenta para aplicarlo en los casos adecuados

The present report deals with a new technique for the correction of pectus carinatum. Although less frequent than pectus excavatum, this deformity leads to numerous consultations, as it is difficult to conceal and affects the personality and behavior of many young patients. We report the case of a 13-year-old boy with asymmetrical pectus carinatum. The chest wall was compressible, so the protrusion was corrected by means of intrathoracic compression. In this technique, the sternochondral region is compressed by implanting a metal bar in the presternal region and securing it bilaterally to the posterolateral portion of the costal arches. The strut remains implanted until remolding of the chest contour is achieved. In this case, the strut was removed after 1 year and the new chest contour has been maintained unchanged more than 8 months following surgery. In conclusion, this minimally invasive technique for the treatment of pectus carinatum by means of intrathoracic compression appears to be a valid alternative to more invasive techniques and should be considered in appropriate cases

Automated perimetry in patients with choroidal metastases.

AIMS/BACKGROUND: Recent work using computerised perimetry has documented predictable visual field defects in patients with choroidal melanoma. Despite the higher frequency of occurrence of choroidal metastases, relatively little is known about their exact effects on visual performance, specifically with respect to visual field. This study is a pilot retrospective analysis of the results of automated perimetry testing in patients with choroidal metastatic disease. METHODS: The Humphrey field analyser was used to perform visual field tests on 15 eyes in 11 patients diagnosed with choroidal metastases. All 11 primary tumours were carcinomas originating in the breast (seven), lung (one), kidney (one), stomach (one), and prostate (one). All patients had either central 30 and/or peripheral 30-60 threshold strategies. RESULTS: Each of the 15 eyes tested had a demonstrable visual field defect. Eight eyes (53%) had absolute scotomas and seven (43%) had relative scotomas; the defects did not consistently correspond in size or location to the tumour as depicted by ophthalmoscopy or ultrasonography. This is in contradistinction to automated perimetry results in patients with choroidal melanoma. Three of the four eyes (75%) which were retested after treatment of the metastases showed improvement of the visual field. Seven of nine eyes (77%) that initially had reduced visual acuity had improvement after treatment. This clinical improvement corresponded well to tumour shrinkage and resolution of subretinal fluid. CONCLUSION: These findings may be useful in the decision to initiate treatment for symptomatic choroidal metastatic disease and in explaining to patients and their referring physicians what improvement could be expected from such treatment. A prospective evaluation of patients with choroidal metastases seems appropriate based on this pilot experience and may elucidate if the differences noted between visual field performance of these patients and those with choroidal melanoma may be useful in some diagnostically difficult cases.

Postictal psychosis: a case control series of 20 patients and 150 controls.

We compared clinical data, EEG, and video-EEG studies in a consecutive series of 20 patients with postictal psychosis (PP) to 150 consecutive epilepsy patients with complex partial (CPS) or generalized tonic-clonic (GTCS) seizures but without PP. There was a lucid interval between last seizure and onset of psychosis ranging from 2.3 to 72 h (mean, 25 h). Duration of PP ranged from 16 to 432 h (mean, 83 h). Age, sex, epilepsy type (partial vs. generalized), and history of febrile seizures were similar in the PP and control groups. Patients with PP had more frequent GTCS during monitoring than controls (2.8 vs. 1.3; P < 0.001). Patients with PP were more likely to have a history of encephalitis (P < 0.0001) and psychiatric hospitalization (P < 0.002). More patients with PP had bilateral interictal epileptiform discharges during monitoring than controls (P < 0.0002). Postictal psychosis most often develops in patients with bilateral dysfunction following a cluster of GTCS.

Epilepsy and sleep apnea syndrome.

We identified seven patients with refractory partial epilepsy and sleep apnea. Treatment of the sleep apnea with nasal continuous positive airway pressure (CPAP), protriptyline, trazodone, acetazolamide, or tracheostomy reduced seizure frequency and severity in six patients. Success with CPAP depended largely on compliance. Four of five patients had a clear reduction in seizure frequency with the use of CPAP. Sleep apnea may exacerbate epilepsy by causing sleep disruption and deprivation, hypoxemia, and decreased cerebral blood flow. In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and a polysomnogram obtained when indicated. Treatment of the sleep disorder can improve seizure control.

Effectiveness of psychological and pharmacological treatments for nocturnal enuresis.

This review provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis. With the use of experiments that compared treatments with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychological and pharmacological treatments, (b) the relative effectiveness of specific types of treatments, and (c) moderators of treatment effectiveness including investigator allegiance. Findings from the review confirm that enuretic children benefit substantially from treatment. However, more children improve from psychological than from pharmacological interventions. Moreover, psychological treatments involving a urine alarm are most likely to yield benefits that are maintained once treatment has ended.

Relative cardiotoxicity and cytotoxicity of anthraquinonyl glucosaminosides.

The cardiotoxicity and cytotoxicity for tumor cells of four new synthetic anthraquinonyl glucosaminosides were compared in vitro. The nonhydroxylated anthraquinone was not cardiotoxic, and its cytotoxic activity was the weakest of the compounds in the series. Increasing the number of hydroxyl groups on the anthraquinone moiety increased the inhibition of growth of L-1210 leukemia cells and pancreatic or colonic adenocarcinomas in a soft agar colony formation assay. However, cardiotoxicity was also increased in proportion to the number of hydroxyl groups present. The adenocarcinomas were slightly more sensitive than the leukemias to the inhibitory action of the dihydroxylated anthraquinonyl glucosaminosides on cell growth.

Synthesis of anthraquinonyl glucosaminosides and studies on the influence of aglycone hydroxyl substitution on superoxide generation, DNA binding, and antimicrobial properties.

A series of anthraquinonyl glucosaminosides (10a-e) were synthesized by Koenigs-Knorr glycosidation of the corresponding aglycones (11a-e) with bromo sugar 12 followed by saponification. These glycosides were intended to serve as models to study the role played by the hydroxyl substituents on the aglycone portion of the antitumor anthracycline antibiotics. Superoxide generation as measured in rat heart sarcosomes was found to increase with the addition of successive hydroxyl groups to the anthraquinone nucleus. The 1,8-dihydroxy pattern was determined to generate significantly less superoxide than the 1,4-dihydroxy pattern. Hydroxyl substitution was also observed to stabilize the complex formed between the anthraquinones and DNA and was required for antibacterial activity against a number of Gram-positive organisms.

DNA binding, cardiac superoxide production and cytotoxicity of daunomycin analogs.

Pyridoanthraquinones are potent antibacterial agents especially against gram-positive organisms. We tested two major biologic actions of these compounds: DNA intercalation and superoxide (O2-) production in sarcosomes. Using the bathochromic and hypochromic shifts induced by intercalation, followed by Scatchard analysis, we calculated dissociation constants and the number of binding sites per base pair for several analogues. We compared O2- production using cytochrome c reduction. Unsubstituted compounds do not bind to DNA or change its melting temperature (Tm). Placing a morpholino or piperidyl group at C-5 enhances the binding to DNA. The tetracyclic compounds were equipotent at producing O2- and were 20-fold more active than daunomycin. These compounds were unusual in their solid tumor cytotoxicity.

Biotin analogs activate guanylate cyclase.

The sulfur atom in the vitamin biotin has previously been suggested to be essential in biotin's mechanism of action. In a series of investigations on structure-function relationships with biotin analogs not containing the sulfur atom, the biotin analogs, azabiotin, bisnorazabiotin, carbobiotin and isoazabiotin enhanced guanylate cyclase, an enzyme that has recently been demonstrated to be activated by biotin. These analogs increased guanylate cyclase activity two-fold in liver, cerebellum, heart, kidney and colon at 1 microM concentrations. The ED50 for stimulation of guanulate cyclase activity occurred at 0.1 microM for each of the biotin analogs. These data indicate that the sulfur atom is not essential in biotin's activation of guanylate cyclase since these analogs do not contain the sulfur atom. Studies on the ring structure of biotin revealed that even compounds with a single 5-membered ring (2-imidazolidone) could augment guanylate cyclase activity. The guanylate cyclase co-factor manganese was not essential for the enhancement of guanylate cyclase by these agents but a maximal activation of this enzyme by these analogs could not be obtained without manganese present.

The historical and cultural spectra of homosexuality and their relationship to the fear of being a lesbian.

The cultural spectra of homosexuality are briefly traced in Western and Eastern cultures. Special emphasis is placed on homosexuality in the male, which was a capital offense in the British Navy from 1700 to the early part of the nineteenth century when psychological and medical factors came to be considered of importance. In the American colonies the attitude toward male homosexuality and lesbianism is stated in a clear record of the views of Thomas Jefferson, who proposed in 1779 that "whoever shall be guilty of rape, polygamy or sodomy shall be punished if a man by castration, if a women by cutting through the cartilage of her nose a hole one-half inch in diameter at the least." The growing importance of Freudian theory led to research into child development and the stresses of entering the Oedipal period. Thanks to the insight of female psychoanalysts, Freud's original views were modified to patterns of boys and girls, and the relationship of these differences to the complex systems which may have produced homosexuality in may instances in both sexes. A thesis by Diane M. Greene entitled "Women Loving Women" is reviewed with special reference to the way women adapt to being in the world as lesbians. Prompted by what Bieber and Bieber wrote concerning the use of homosexual themes in males in solving problems related to achievement, e.g., creative success, salary increases, parenting, and drawing on psychoanalytic data, it is considered likely that women exercise similar mechanisms in solving analogous problems. It follows then that a few days delivery, a women could begin to doubt that she could handle this success-the need to mother. This could lead her to doubt her femininity, utilizing the same (hidden) homosexual mechanisms of problem solving in the male. An awareness of this process may assist the physician in management and therapy. Woods' paradigm for the male: I am a failure leads to I am castrated leads to I am not a man leads to I am like a women leads to I am homosexual. For the female, Mayberger and Abramson propose: I am a mother leads to I am successful leads to I cannot handle success because I lack the need to mother my infant lead to I am not a real women, I am like a man leads to I am homosexual.

The intracranial injection of drugs in goldfish. II. Preliminary report of behavior of serotonin as a potential hallucinogen when injected intracranially and intraabdominally.

Serotonin, when injected intracranially and intraabdominally into goldfish produces the surfacing reaction typical of hallucinogenic compounds active in man. It is suggested that serotonin disorders in the brain in man might be connected with the schizophrenias.