Spontaneous bilateral internal carotid artery dissection.

Spontaneous internal carotid artery dissection is not an uncommon cause of ischaemic stroke in younger patients, but multiple cervical arterial dissections at presentation are uncommon. Recurrence of dissection in a previously normal artery is common. In this case report we review the history, clinical findings and management of a 42-year-old woman who presented with stroke and Horner syndrome and was found to have spontaneous bilateral internal carotid artery dissection.

The cellular response to transglutaminase-cross-linked collagen.

Collagen, type I, is a highly abundant natural protein material which has been cross-linked by a variety of methods including chemical agents, physical heating and UV irradiation with the aim of enhancing its physical characteristics such as mechanical strength, thermal stability, resistance to proteolytic breakdown, thus increasing its overall biocompatibility. However, in view of the toxicity of residual cross-linking agents, or impracticability at large scales, it would be more useful if the collagen could be cross-linked by a milder, efficient and more practical means by using enzymes as biological catalysts. We demonstrate that on treating native collagen type I (from bovine skin) with both tissue transglutaminase (TG2; tTG) and microbial transglutaminase (mTG; Streptoverticillium mobaraense) leads to an enhancement in cell attachment, spreading and proliferation of human osteoblasts (HOB) and human foreskin dermal fibroblasts (HFDF) when compared to culture on native collagen.

Posterior spinal ligament rupture associated with laryngeal mask insertion in a patient with undisclosed unstable cervical spine.

A case of posterior spinal ligament rupture associated with a general anaesthetic for a laparoscopic cholecystectomy is reported. The role of the general anaesthetic in this case is discussed and a review of the literature is presented.

Epidural and spinal anaesthesia and the use of anticoagulants.

Neurological injuries after epidural/spinal analgesia are a serious but uncommon problem. Spinal haematoma cause a proportion of these complications, and can be minimized by avoiding central nervous blockade in high-risk patients, especially those receiving anticoagulant therapy. Early recognition of spinal haematoma by basic neurological monitoring allows early intervention and improves outcome.

Risk factors in phenytoin-induced gingival hyperplasia.

A survey was carried out into the degree of gingival hyperplasia in 68 patients receiving phenytoin in a hospital for the mentally handicapped. Comparisons of degree of gingival hyperplasia exhibited by the patients were made with a range of parameters by analysis of variance and Chi square tests. The severity of the hyperplasia increased with increasing dose, increasing dose per unit body weight and serum levels of phenytoin and also with decreasing age and weight of the patients.