Therapeutic results of the modified cadenat procedure for acromioclavicular joint separations compared with the modified dewar procedure / Resultados terapéuticos del procedimiento de cadenat modificado para las separaciones de la articulación acromioclavicular en comparación con el procedimiento de dewar modificado

AIM AND BACKGROUND: The surgical treatment for acromioclavicular joint dislocations is recommended for Rockwood's classification types 4, 5 and 6. In this study, we evaluate the therapeutic results of the modified Cadenat procedure on type 5 acromioclavicular joint dislocation, and report on a comparative study of the modified Dewar procedure also on type 5 acromioclavicular joint dislocation. SUBJECTS AND METHODS: The modified Cadenat procedure was performed on 73 patients (66 males and 7 females, group C). The mean age at the time of the surgery was 35.4 years. On the other hand, the modified Dewar procedure was performed on 55 patients (51 males and 4 females, group D). The mean age at the time of the surgery was 34.5 years. RESULTS: The mean therapeutic results were 28.2 points in group C and 27.3 in group D according to the UCLA scoring system. In group C, the subluxation that represented less than 5 mm superior translation of the clavicle, occurred only in 18 of 73 patients. Meanwhile, in group D, the subluxation that represented less than 5 mm, occurred only in 14; that which represented 5 to 10 mm was in seven patients, and the complete dislocation occurred in three patients. Also, the occurrence ofosteoarthritic changes in the acromioclavicular joint was nine patients in group C and 20 in group D, respectively. CONCLUSION: The modified Cadenat procedure could provide satisfactory therapeutic results and avoid postoperative failure of reduction compared to the modified Dewar procedure. However, the modified Cadenat procedure does not aim to restore the anatomical coracoclavicular ligaments. It is believed that anatomic restoration ofboth coracoclavicular ligaments could best restore the function ofthe acromioclavicular joint.

OBJETIVO Y ANTECEDENTES: El tratamiento quirúrgico para las dislocaciones de la articulación acromioclavicular se recomienda para los tipos 4, 5, y 6 de la clasificación de Rookwood. En este estudio, se evalúan los resultados terapéuticos del procedimiento de Cadenat modificado en dislocación de la articulación acromioclavicular de tipo 5, y también se informa sobre el estudio comparativo con el procedimiento de Dewar modificado practicado sobre el tipo 5 de dislocación de la articulación acromioclavicular. SUJETOS Y MÉTODOS: El procedimiento de Cadenat modificado se realizó en 73 pacientes (66 varones y 7 hembras, grupo C). La edad promedio en el momento de la cirugía era 35.4 años. Por otro lado, el procedimiento de Dewar modificado se realizó en 55 pacientes (51 varones y 4 hembras, grupo D). La edad promedio en el momento de la cirugía era 34.5 años. RESULTADOS: Los resultados terapéuticos promedio fueron 28.2 puntos en el grupo C y 27.3 en el grupo D de acuerdo con el sistema de puntuación UCLA. En el grupo C, la subluxación que representó menos de 5 mm de traslación superior de la clavícula, sólo ocurrió en 18 de 73 pacientes. Entretanto, en el grupo D, la subluxación que representó menos de 5 mm, sólo ocurrió en 14; la subluxación que representó de 5 a 10 mm ocurrió en siete pacientes; yla dislocación completa ocurrió en tres pacientes. También, la ocurrencia de cambios osteoartríticos en la articulación acromioclavicular fue de nueve pacientes en el grupo C y 20 en el grupo D, respectivamente. CONCLUSIÓN: El procedimiento de Cadenat modificado podría proporcionar resultados terapéuticos satisfactorios, y podría evitar el fracaso postoperatorio de la reducción en comparación con el procedimiento de Dewar modificado. Sin embargo, el procedimiento de Cadenat modificado no esta dirigido a restaurar los ligamentos coracoclaviculares anatómicas. Se entiende que la restauración anatómica de ambos ligamentos coracoclaviculares pudiera restaurar mejor la función de la articulación acromioclavicular.

Therapeutic results of the modified Cadenat procedure for acromioclavicular joint separations compared with the modified Dewar procedure.

AIM AND BACKGROUND: The surgical treatment for acromioclavicular joint dislocations is recommended for Rockwood's classification types 4, 5 and 6. In this study we evaluate the therapeutic results of the modified Cadenat procedure on type 5 acromioclavicular joint dislocation, and report on a comparative study of the modified Dewar procedure also on type 5 acromioclavicular joint dislocation. SUBJECTS AND METHODS: The modified Cadenat procedure was performed on 73 patients (66 males and 7 females, group C). The mean age at the time of the surgery was 35.4 years. On the other hand, the modified Dewar procedure was performed on 55 patients (51 males and 4 females, group D). The mean age at the time of the surgery was 34.5 years. RESULTS: The mean therapeutic results were 28.2 points in group C and 27.3 in group D according to the UCLA scoring system. In group C, the subluxation that represented less than 5 mm superior translation of the clavicle, occurred only in 18 of 73 patients. Meanwhile, in group D, the subluxation that represented less than 5 mm, occurred only in 14; that which represented 5 to 10 mm was in seven patients, and the complete dislocation occurred in three patients. Also, the occurrence of osteoarthritic changes in the acromioclavicular joint was nine patients in group C and 20 in group D, respectively. CONCLUSION: The modified Cadenat procedure could provide satisfactory therapeutic results and avoid postoperative failure of reduction compared to the modified Dewar procedure. However the modified Cadenat procedure does not aim to restore the anatomical coracoclavicular ligaments. It is believed that anatomic restoration of both coracoclavicular ligaments could best restore the function of the acromioclavicular joint.

[Schizophrenia and ocular misalignment: phenotypic and genetic association analysis].

The increased incidence of minor physical anomalies (MPAs) in schizophrenia is the fundamental basis for the neurodevelopmental hypothesis of schizophrenia etiology. Ocular misalignment falls into the category of MPAs, but this phenotype has not been assessed in schizophrenia. This study reveals that constant exotropia displays marked association with schizophrenia. To assess the genetic mechanisms, we examined the transcription factor genes ARIX and its paralogue, PMX2B. We identified frequent deletion/insertion polymorphisms in the 20-alanine homopolymer stretch of PMX2B, with a modest association between these functional polymorphisms and constant exotropia in schizophrenia. The polymorphisms were also associated with overall schizophrenia and more specifically with schizophrenia manifesting strabismus. These results suggest a possible interaction between PMX2B and other schizophrenia-precipitating factors, increasing the risk of the combined phenotypes. This study also highlights the unique nature of the polyalanine length variations found in PMX2B.

[A case of Klinefelter's syndrome with schizophrenia-like symptoms].

A case of Klinefelter's syndrome with schizophrenia-like symptoms is reported. He was given a diagnosis of schizophrenia at the age of 39. After being treated with medication for many years, he stopped taking them at the age of seventy-two and involuntary movements appeared in his limbs and the trunk. Upon admission to our hospital, he was experiencing delusion and psychosocial excitement. A physical examination showed him to be a thin man of 175.5 cm height, suffering from a mild degree of gynecomastia, testicular atrophy. Serum LH and FSH were both high 10.9 and 47.8 mU/ml respectively. Serum testosterone concentration was 0.2 ng/ml, much lower than the normal range (2.7-10.7 ng/ml). On the Wechsler adult intelligence scale (Revision), his total IQ was 103 (performance IQ 100, verbal IQ105). Karyotype analysis revealed an XXY pattern. Although slight auditory hallucinations remained, the delusional symptoms as well as the involuntary movements diminished after the administration of psychotrophics. Personality changes such as apathy and abulia was subsided. The psychological symptoms were very similar to these of cases in other reports of Klinefelter's syndrome associated with schizophrenia-like symptoms. Some reports about the relationships between sex hormones and schizophrenia including other psychotic disorders suggest that the X-chromosome plays an important part in the mechanism of psychosocial symptoms and in the prognosis in Klinefelter's syndrome.

Vesnarinone inhibits nucleoside and nucleobase transport.

Vesnarinone is a novel synthetic oral inotropic agent that has been successfully used for treatment of patients with congestive heart failure. In addition to its cardiotonic activity, the drug has been proposed to have mild cytostatic and anti-HIV-1 effects. We have observed that vesnarinone profoundly inhibits radiolabeled thymidine and uridine incorporation into cells despite its modest inhibitory effect on DNA synthesis, RNA synthesis or cell proliferation. Here we demonstrate that vesnarinone inhibits both nucleoside and nucleobase transport in mammalian cells. This pharmacological action may be involved in some of its multiple biological effects.

[A case of successful antisyphilitic treatment for a patient with general paresis].

A 59-year-old male patient with general paresis was hospitalized because of personality changes and memory disturbances without any neurological deficits. His Mini Mental State score was 11, and his total IQ on the WAIS-R was 56. TPHA titers in serum and the CSF were over 40960x and 640x respectively. Both the white blood cell count as well as total protein were found to be increased in the CSF and FTA-ABS in the CSF was positive. The patient was treated with penicillin, one million units per day intramuscularly for 14 days, and four million units per day intravenously for 10 days. The abnormal findings in the CSF, his unstable mood and agitation improved, as well as his scores on the Mini Mental State (17) and total IQ (74), and the patient was able to once again function socially. This case emphasizes the importance of early diagnosis and treatment of general paresis.

Pharmacokinetics of benzydamine.

Benzydamine is a non-steroidal anti-inflammatory drug especially used topically for the treatment of primary or normoreactive types of inflammation. The pharmacokinetics of benzydamine are reported after both topical and systemic administration, and the available data are reviewed with particular reference to its topical use.

Extensor digitorum brevis manus associated with attrition rupture of a common extensor tendon.

A 65-year-old Japanese housewife ruptured the common extensor tendon of her left ring finger. This is thought to be caused by the associated digitorum brevis manus.

Antibody to the receptor for polymerized human serum albumin in acute and persistent infection with hepatitis B virus.

The antibody against the receptor for polymerized human serum albumin was determined by radioimmunoassay. The method involved the inhibition by the test serum, absorbed with HBsAg particles without the receptor, on the binding of polymerized human serum albumin to HBsAg particles with the receptor fixed on a solid support. The amount of polymerized human serum albumin captured by the receptor on HBsAg was then determined by the radiolabeled monoclonal antibody directed to an epitope specific for polymerized human serum albumin. In acute infection, the antibody to the receptor for polymerized human serum albumin appeared in the early recovery phase while HBs antigenemia and elevated transaminase levels were still present, preceding the antibody to HBsAg (anti-HBs). The antibody was detected in 4 (1%) of 358 sera from asymptomatic carriers of HBsAg containing antibody to HBeAg, and in none of 67 sera containing HBeAg. Although the antibody was found in as many as 111 (74%) of 150 sera from blood donors who had presumably acquired anti-HBs after natural infection, it was not detected in any sera from 77 recipients of hepatitis B vaccine who had seroconverted for anti-HBs. On the basis of these observations, the determination of antibody to the receptor for polymerized human serum albumin helps in further understanding the immunity to hepatitis B virus.

Three-site sandwich radioimmunoassay with monoclonal antibodies for a sensitive determination of human alpha-fetoprotein.

Utilizing monoclonal antibodies against human alpha-fetoprotein, 3 distinct antigenic determinants were identified. These antigenic determinants, provisionally designated a, b and c, were arranged in such a manner that the binding of one determinant with the corresponding antibody did not inhibit, or only barely inhibited the binding of antibodies directed to the other 2 determinants. Monoclonal antibodies with 3 different specificities were, therefore, applied to develop a sandwich-type solid-phase radioimmunoassay of the antigen in which wells were coated with anti-a, and radiolabeled anti-b together with radiolabeled anti-c was employed to detect the bound antigen. The 3-site sandwich radioimmunoassay involving 3 different determinants gave a higher sensitivity than 2-site assays in which only anti-b or anti-c was employed as a radiolabeled reagent, because the radioactivity of the 2 labeled antibodies was added on the antigen bound to immobilized anti-a.

A case of epilepsia cursiva whose running fits were precipitated by psychogenic factors.

We presented a case of epilepsia cursiva starting with generalized convulsion, then developing as the patient grew older, into frequent attacks of psychomotor seizures including running fits, in which psychogenic causes may have played a vital role in precipitating the seizures.