[Sudden visual loss in a 7-year old patient]. / Plötzlicher Visusverlust eines 7-jährigen Patienten. Diagnose: Intrakranielles Riesenaneurysma.

A 7-year-old boy presented to us with a sudden bilateral decrease in visual acuity. At the age of 4 months bilateral congenital glaucoma had been diagnosed and trabeculotomy performed. Eye pressure and fundus were monitored regularly. Both magnetic resonance imaging and computed tomography revealed a giant supraclinoid aneurysm originating in the right internal carotid artery. After comprehensive examinations endovascular balloon occlusion of the internal carotid artery was performed in conjunction with extracranial-intracranial bypass to augment the insufficient circulation.

Experimental treatment of neuromas in the rat by retrograde axoplasmic transport of ricin with selective destruction of ganglion cells.

In this experiment the toxic lectin, ricin, was injected into the terminal proximal segment of transected rat sciatic nerves to evaluate its effect on neuroma formation. The dosage of ricin injected ranged from 0.5 microgram to 1.5 micrograms. All animals survived and all treated nerves showed no evidence of neuroma formation and no evidence of viable nerve elements 1 month after treatment. The contralateral untreated nerves in the experimental groups, as well as those of the control group, all showed neuroma formation. This study demonstrates the effectiveness of small doses of ricin in preventing neuroma formation in rats. The mechanism of action of ricin, destruction of the parent ganglion cells of the treated peripheral nerves after its retrograde axoplasmic transport, is also demonstrated.

Shotgun blast injuries to the groin: reconstruction using the rectus abdominis flap.

We discuss our successful management of complex groin wounds caused by shotgun blasts at relatively short range. A straightforward approach to the problem of reconstructing the large soft-tissue defect and providing protection for the femoral artery reconstituted by Gore-Tex graft is described. We emphasize the fundamental principles of management of civilian trauma and illustrate that a Gore-Tex graft need not be covered immediately if there is any possibility that debridement is incomplete. The inferiorly based rectus abdominis flap is recommended as an excellent choice for coverage of the typical shotgun blast groin wound, making it possible to salvage the involved lower extremity in these severe injuries.

Pilomatrixoma presenting as a parotid mass.

A rare case of calcifying epithelioma of Malherbe presenting as a large parotid mass is reported in this paper. Preoperative evaluation and considerations are discussed. An exact diagnosis and definitive treatment in this patient consisted of superficial parotidectomy and histologic study.

Volvulus of the colon. Incidence and mortality.

Between 1960 and 1980, 137 patients with colonic volvulus (52% cecal, 3% transverse colon, 2% splenic flexure, and 43% sigmoid) were seen at the Mayo Clinic. Among the 59 patients with sigmoid volvulus, four (7%) had colonic infarction. Total mortality with sigmoid volvulus was seven per cent. There were 71 patients with cecal volvulus. Colonoscopic decompression was accomplished in two of these patients; in 15 (21%), gangrenous colon developed and mortality was 33%. Total mortality for cecal volvulus patients was 17%. Mortality for all forms of volvulus in patients with viable colons was 11%. Mortality for all patients with volvulus was 14%.

Meat grinder injuries to the upper extremity.

Three cases of hand injury caused by meat grinders are presented. All 3 injuries involved the dominant hand and resulted in varying degrees of deformity. Two of the 3 patients arrived in the emergency room with the injured hand still firmly wedged in the meat grinder. Although these injuries continue to prove very mutilating, maximum restoration of the injured hand can be accomplished by careful extrication, followed by preservation and reconstruction of all viable tissues. Perioperative antibiotics and wound irrigation with antibiotic solution are recommended. Microsurgical technique can be of value in treating selected patients.

Oto-spondylo-megaepiphyseal dysplasia (OSMED).

Four personal longitudinal observations and two cases from the literature are used to introduce the concept of oto-spondylo-megaepiphyseal dysplasia (OSMED). The condition may be recognized at birth. The main clinical findings are sensoneurinal deafness, enlarged 1st interphalangeal joints of the hands, relative short extremities with abnormally large knees and elbows but still normal total body length. In the second decade of life, backpain and decreased mobility of the joints may follow. 4/6 patients had a cleft palate. The diagnostic radiological findings are the big epiphyses combined with a moderate platyspondyly, most marked in the lower thoracic region. The occurrence of OSMED in two sisters suggests an autosomal-recessive transmission. No biochemical anomaly could be detected.

[Multiple bilateral pyelogenic renal cysts (author's transl)]. / Bilaterale multiple pyelogene Nierencysten.

In general, pyelogenic cysts are solitary and unilateral. Multicystic renal dysplasia is as a rule unilateral, and the cysts do not communicate. Here the rare case of multiple bilateral renal cysts communication with the pyelon is presented.