Dantrolene sodium and dystrophia myotonica.

A patient with dystrophia myotonica was given dantrolene sodium to try to provide muscle relaxation during a cholecystectomy. Dantrolene was used as it is accepted that the drug has a place in the control of spasticity and also causes muscle relaxation, whereas conventional muscle relaxants are unable to control myotonia of muscle origin. Dantrolene alone did not provide good enough intubating and operating conditions in this subject.

Filtering surgery in childhood glaucoma.

A review of 38 eyes of 24 patients receiving filtration surgery for childhood glaucoma is presented. A total of 54 procedures were performed, including both thermal sclerostomies and trabeculectomies. Successful control of intraocular pressure was obtained in 20 eyes (52%).

Botulinum toxin injection into rabbit vitreous.

Botulinum A toxin in a dose of 5.0 X 10(-4) micrograms was injected into the vitreous of eight rabbit eyes. An equal volume of normal saline was injected into the fellow eye as a control.

Suxamethonium spasm. A differential diagnostic conundrum.

Spasm of muscle in association with suxamethonium is not uncommon. As an accepted early sign of malignant hyperpyrexia (MH), patients have been referred for MH screening who have shown only this abnormality. Case histories of 277 probands have been analysed and grouped according to final diagnosis, depending on results of muscle biopsy and in vitro screening.

Cancer of the esophagus and cardia. Role of surgery in palliation.

Palliation will remain the goal of therapy for cancer of the esophagus and cardia until early diagnosis permits improvement in long-term survival rates. Of the various surgical and nonsurgical techniques available for palliation, I prefer resection with esophagogastrostomy. This procedure can now be applied to most patients, with relatively low mortality and morbidity rates.

Ocular lesions caused by caterpillar hairs (ophthalmia nodosa).

The ocular reactions to caterpillar hairs are diverse in nature and location, ranging from a toxic reaction to the external foreign bodies, keratoconjunctivitis or the formation of conjunctival nodules, to intense iritis, vitritis or papillitis. Four cases are presented in this paper to illustrate the various degrees of ocular involvement. Included are clinical photographs of intravitreal and subretinal hairs.

Intraaortic balloon pump morbidity: a comparative analysis of risk factors between percutaneous and surgical techniques.

We reviewed our concurrent experience with percutaneous insertion versus surgical placement of the intraaortic balloon pump over a two-year period both to compare morbidity and to provide guidelines for the choice of method in particular patient groups and clinical settings. The effects on morbidity of sex, age, emergency placement, coexisting peripheral vascular disease, and duration of counterpulsation were determined. Sex was a highly significant factor, with low complication rates (3/29 or 10.

Complications of the Nissen fundoplication.

A more astute selection of patients and greater attention to technical details will preclude most complications. The first step is standardizing the technique, with avoidance of unnecessary ancillary maneuvers. Equally important is a thorough preoperative evaluation.

Incidence of retinopathy of prematurity in a tertiary newborn intensive care unit.

This study determined the incidence of retinopathy of prematurity (ROP) in 2,958 admissions to the Newborn Intensive Care Unit of the James Whitcomb Riley Hospital for Children, Indianapolis, between January 1976 and December 1979. Among 2,484 survivors, acute ROP developed in 72 (2.9%); 60 (83%) of these newborns had birth weights of less than 1,500 g.

Studies of body temperatures, blood lactate, cortisol and free fatty acid levels during exercise in human subjects susceptible to malignant hyperpyrexia.

Body temperature at a variety of sites (external auditory meatus, rectum, thigh, chest wall, pad of thumb), blood cortisol, lactate and free fatty acid levels and urinary adrenaline, noradrenaline and dopamine excretion were measured in five human subjects susceptible to malignant hyperpyrexia (MHS) and five normal subjects during a period of progressively severe exercise, starting at rest and going up to an exercise intensity producing heart rates in excess of 180 beats/min. In addition, results are reported of a further study of rectal temperature measurements made during a period of mild exercise in a different group of nine MH susceptible and nine nonsusceptible subjects. The results of the progressive exercise study indicated that as the exercise increased in severity, central (external auditory meatal) temperature rose more in the MHS subjects than it did in the controls.

Esophagogastrectomy. A safe, widely applicable, and expeditious form of palliation for patients with carcinoma of the esophagus and cardia.

Of 262 patients with carcinoma of the esophagus or cardia seen at the Lahey Clinic between January 1970 and January 1983, 209 (79.8%) underwent surgical exploration. This report is confined to the 167 operations performed in the division of the senior author.

Surgical treatment of congenital esotropia.

We conducted a retrospective study of 133 children (69 boys and 64 girls) who underwent bilateral medial rectus muscle recession (most by the augmented or en-bloc technique) for congenital esotropia. Esotropia was diagnosed before the age of 6 months in 84 patients and after the age of 6 months in the other 49. A total of 27 children underwent surgery before the age of 12 months; of these, three required second procedures.

Superior oblique tuck for superior oblique palsy.

Fifty-nine patients with a superior oblique palsy had a superior oblique tuck as part of their surgical treatment. The average size of the tuck was 12.0 mm.

The control of muscle contracture by the action of dantrolene on the sarcolemma.

Although dantrolene reverses the muscle contracture seen during a malignant hyperpyrexia (MH) crisis, its site of action is not known. It has been inferred from previous work that the major abnormality in MH is in the sarcoplasmic reticulum, and that dantrolene must act on this organelle. In the present study the ability of dantrolene to control drug-induced muscle contraction was tested.

Depth of strabismic amblyopia determined with neutral density filters.

We used a neutral density filter to assess motor responses in the fixation patterns of 25 patients, ranging in age from 5 to 54 years, with strabismic amblyopia. Shifts of fixation back to the preferred eye occurred when the visual acuity of the preferred eye through the filter was marginally better than that of the amblyopic eye. Thus, we were able to correlate the level of the filter at which this shift occurred with the level of amblyopia.

Anthropometric studies of human subjects susceptible to malignant hyperpyrexia.

Height, weight, and skinfold thickness were measured on 82 patients prior to muscle biopsy which was performed to determine their susceptibility to malignant hyperpyrexia. Percentage body fat was calculated from the skinfold measurements. Using AP photographs six coronal diameters of the left thigh, equally spaced between the lower border of the patella and the perineum, were measured on another group of 90 patients referred for biopsy.

Evaluation of a new blood grouping instrument.

A fully automated blood grouping machine, that has recently been introduced was evaluated. The instrument incorporates bar-coded sample identification and a laser scanning device to eliminate potential sample/result errors. A microprocessor interprets results, thus eliminating subjective interpretation.