Marfan syndrome with back pain secondary to pedicular attenuation. A case report.

STUDY DESIGN: This is a report of a 31-year-old woman with Marfan syndrome with severe back pain secondary to pedicle fractures of the lumbar spine resulting from attenuation of the pedicles. OBJECTIVES: To report and discuss a case of Marfan syndrome. SUMMARY OF BACKGROUND DATA: The authors report the clinical course of a patient with Marfan syndrome and pedicle fractures secondary to thinning of the pedicles. METHODS: After initial diagnosis of Marfan syndrome was confirmed, radiologic techniques, including magnetic resonance imaging and bone scan, were used to evaluate any abnormalities of the lumbar spine. RESULTS: The patient was treated with pain medications and activity modification, which allowed for no marked improvement. CONCLUSIONS: Thinning and possible fracturing of the pedicles should be considered as an etiology of back pain in the patient with Marfan syndrome.

Pneumatic gouge versus standard method for iliac crest harvesting.

Fifty consecutive patients undergoing posterior lumbar fusion by a single surgeon were prospectively randomized in a study designed to evaluate the efficacy of using a pneumatic oscillating gouge to obtain posterior outer table iliac crest bone graft versus the standard method of using osteotomes and gouges. Variables analyzed included graft harvesting time, blood loss, weight of graft obtained, and graft site morbidity. Mean graft harvesting time with the pneumatic gouge was 1 minute 44 seconds (range, 1 min 5 sec to 3 min 15 sec) compared with the standard method time of 4 minutes 4 seconds (range, 2 min 15 sec to 8 min 56 sec) (P = 0.0001). Blood loss was also less, with a mean of 25.4 cc for the pneumatic gouge compared with 65.2 cc using the standard method (P = 0.0001). There were no complications with the graft site in either group. We conclude that the pneumatic gouge is a viable alternative to standard bone graft harvesting techniques. Benefits include shorter operative time and decreased blood loss without an increased morbidity.

Open hand fractures: an analysis of the recovery of active motion and of complications.

Seventy-five of 104 patients who underwent operative fixation of open hand fractures were reviewed between 6 months and 7 years after injury (average, 17 months). There were 140 fractures involving 125 fingers. Results, evaluated on the basis of total active range of digital motion achieved at final follow-up, correlated highly with severity of soft tissue injury. When open fractures of comparable severity were contrasted between groups that did and did not require additional extension by incision to achieve acceptable reduction and stabilization, there was some additional loss of active range of motion in the surgically treated group. Metacarpal fractures had significantly better outcomes than phalangeal fractures. Fractures involving the proximal phalanx or the proximal interphalangeal joint had the poorest prognosis, especially when they were associated with tendon injury. There were significant complications in 13 fingers. Infection and late amputation were related to wound severity.

Neuronal and adrenal enkephalins and catecholamines in response to acute CNS ischemia and reserpine in pig.

Co-storage of enkephalins and catecholamines in coronary artery, mesenteric artery and vein, middle cerebral artery, vas deferens and adrenal medulla was studied in domestic pig (Sus scrofa). Responses to acute CNS ischemia were correlated with time to peak plasma levels of central venous and adrenal vein outflow samples in controls, during reserpine treatment and after drug withdrawal. Endogenous enkephalins are co-stored in chromaffin granules of adrenal epinephrine-type cells and large dense cored vesicles of noradrenergic terminals. After a lag period, reserpine at near 'therapeutic' doses caused an apparent induction of opioid peptide precursor synthesis accompanied by processing to enkephalins in adrenal medulla up to 8-fold by 30 days and in mesenteric vein up to 4.5-fold by 14 days. Upon 14 days recovery from reserpine, elevated adrenal enkephalins were maintained and depleted catecholamines were largely replenished. Acute CNS ischemia produced rises in MAP (approx. 80 mmHg), marked net depletions of noradrenergic enkephalin stores, and net increases in adrenal vein outflow and central venous levels of enkephalins and catecholamines. Noradrenergic terminals contributed significantly to circulating enkephalins as well as norepinephrine. Reserpine for 7 days nearly abolished all tested responses to acute CNS ischemia, but immediate net 200-400% elevations of endogenous enkephalin stores occurred in coronary artery and mesenteric artery and vein (apparent processing of reserpine-induced neuronal precursor stores). Thus, induction of new synthesis of precursor opioid peptides by reserpine, with or without parallel processing to enkephalins, occurs in noradrenergic terminals in many tissues. All effects of reserpine on endogenous enkephalins implicate a central mechanism to inhibit sympathoadrenal outflow to the periphery. At 14 days recovery from reserpine, when near normal cardiovascular responses to acute CNS ischemia were regained, there was increased net release of the elevated adrenal enkephalins, exaggerated peak plasma enkephalin concentrations, but only minimal depletions of enkephalins from noradrenergic terminals.

Legionella in cooling towers.

Legionellosis (Legionnaires' disease and Pontiac fever) outbreaks have been associated with aerosols ejected from contaminated cooling towers--wet-type heat rejection units (WTHRUs) used to dissipate unwanted heat into the atmosphere. The Vermont Department of Health undertook a program to inventory, inspect, and sample all WTHRUs in Vermont from April 1981 to April 1982. All WTHRUs were sampled for Legionella pneumophila and data were obtained for location, design, construction, and operating characteristics. Of the 184 WTHRUs operating, statistical analyses were performed on those 130 which were sampled for L. pneumophila only once during the study period. Of these, 11 (8.5%) were positive for L. pneumophila. Sources of makeup water and period of operation had significant association with the recovery of L. pneumophila. Five out of 92 towers (5.4%) utilizing surface water sources for cooling were positive for L. pneumophila, in contrast to 6 positive towers of the 38 units (15.8%) which obtained makeup water from ground water sources (p = .054 by chi-square test). Nearly 15% of the 54 units which operated throughout the year were positive, compared to less than 4% of the 76 towers operating seasonally (p = .03 by chi-square test). The mean pH of the cooling water in units where L. pneumophila was recovered (8.3) was significantly higher than the mean pH of 7.9 in units testing negative (p less than .05 by t-test). In addition, the mean log-transformed turbidity of positive towers, 0.03 nephelometric units (ntu), was significantly lower than the mean of log turbidity of negative towers, 0.69 ntu (p less than .02 by t-test).