Extended hemipelvectomy in a Jehovah's Witness with erythropoietin support.

The care of patients refusing blood transfusion who require major ablative surgery for malignancy is a continuing challenge. The use of recombinant human erythropoietin is clearly efficacious in patients with renal disease and may be useful in anemic patients who refuse transfusion. Herein, we report a successful extended hemipelvectomy in a Jehovah's Witness using recombinant human erythropoietin support.

Acute clozapine overdose: plasma concentration and outcome.

Clozapine is a tricyclic dibenzodiazepine derivative that is classified as an "atypical neuroleptic" drug for treatment of psychotic diseases. A 19-year-old schizophrenic female, treated with 400 mg clozapine per day, was admitted to the emergency department after ingestion of 5000 mg (50 x 100 mg tablets) of clozapine. Clozapine plasma level 2.

Hyperosmotic induction of the mitogen-activated protein kinase phosphatase MKP-1 in H4IIE rat hepatoma cells.

The action of hyperosmotic stress on the MAP kinase phosphatase MKP-1 mRNA expression was studied in H4IIE rat hepatoma cells. Hyperosmotic (405 mosmol/L) challenge of the cells led to a transient expression of MKP-1 mRNA, which was maximal after 6-8 h and disappeared completely after 24 h. Hyperosmotic MKP-1 mRNA induction was preceded by a transient activation of the MAP kinases Erk-1, Erk-2, and JNK-2, which were not prerequisite for MKP-1 mRNA accumulation.

Development of a low flow resistance intravenous oxygenator.

A potentially attractive support device for patients with acute respiratory failure is an intravenous membrane oxygenator. One problem, however, is that the membrane surface area required for sufficient gas exchange can unduly increase vena caval pressure drop and impede venous return. The purpose of this study was to design and develop an intravenous oxygenator that would offer minimal venous flow resistance in situ.

Role of MRI in diagnosis of childhood sarcoidosis with fever of unknown origin.

Childhood sarcoidosis is a disease with multisystem organ involvement, and initial presentation as fever of unknown origin (FUO) is relatively common. We describe herein three children (aged 9, 7, and 11 years) with sarcoidosis who were seen initially with FUO. Common clinical and laboratory features include fever of > 2 weeks' duration, weight loss, fatigue, leg pain, anemia, increased erythrocyte sedimentation rate, elevated immunoglobulin G level, negative antinuclear antibodies and rheumatoid factor, and negative purified protein derivative and Candida skin tests.

Florid reactive periostitis.

An 11-year-old boy developed florid reactive periostitis several years after minor trauma. The symptoms responded initially to antibiotics, but after cessation, rapidly recurred and progressed, requiring a ray amputation to relieve the pain and to achieve a functional hand. The reactive periostitis affected the volar aspect of two adjacent phalanges with sparing of the intervening joint, confirming that this is a reactive process rather than a benign neoplasm.

Molecular mechanism of membrane protein integration into the endoplasmic reticulum.

As proteins are integrated into the membrane of the endoplasmic reticulum, some hydrophilic polypeptide segments are transported through the translocation channel, others remain in the cytosol, and hydrophobic transmembrane sequences are released into the lipid phase. We have addressed the molecular mechanism by which these events occur. We demonstrate that both the lumenal and the cytosolic domains of a membrane protein are synthesized while the ribosome is membrane bound, so that even cytosolic domains come in contact with the translocation channel.

Self-starting short-pulse XeCl laser with a stimulated Brillouin scattering mirror.

A commercial XeCl laser system is operated with a phase-conjugating mirror based on stimulated Brillouin scattering (SBS). No conventional start resonator is required. The near-field profile is converted from rectangular to near-Gaussian and the far-field spatial beam quality is increased by up to 60% relative to a conventional plane-plane resonator.

Orthopedic manifestations of acute pediatric leukemia.

The variety and distribution of skeletal lesions in children with acute lymphoblastic leukemia is rarely seen in other diseases. Skeletal radiographic changes that can occur in a child with acute leukemia include diffuse osteopenia, metaphyseal bands, periosteal new bone formation, geographic osteolysis, osteosclerosis, mixed osteolysis and sclerosis, and permeative destruction. It is important for orthopedic surgeons to recognize the skeletal manifestations of acute leukemia of childhood because the physician who initially evaluates the child will often be an orthopedic surgeon, and a delay in diagnosis has an adverse affect on survival.

Evaluation of the child with a bone or soft-tissue neoplasm.

The prebiopsy evaluation of a child with a musculoskeletal neoplasm is the cornerstone for all subsequent treatment. A better understanding of the natural history of pediatric musculoskeletal tumors and an explosion in the development of sensitive new imaging modalities have significantly advanced the care of the child with a musculoskeletal pathologic condition. This article details the prebiopsy clinical and radiographic evaluation of the child or adolescent with a musculoskeletal neoplasm.

Regulation of taurocholate excretion by a hypo-osmolarity-activated signal transduction pathway in rat liver.

Background & Aims: Hypo-osmotic cell swelling increases the capacity of taurocholate excretion into bile in the perfused rat liver. The aim of this study was to clarify the mechanisms linking cell swelling to bile acid secretion.

Methods: The influence of hypo-osmotic cell swelling on intracellular signal transduction and bile acid secretion was studied in isolated rat hepatocytes and the perfused rat liver.

Acute annular ligament interposition into the radiocapitellar joint in children (nursemaid's elbow).

Acute annular ligament interposition into the radiocapitellar joint ("nursemaid's elbow") is a common injury in children younger than 5 years. The injury occurs when axial traction is applied to an extended, pronated arm. There are no abnormal radiographic findings associated with this condition.

Trisomy 8 in alveolar soft part sarcoma.

Cytogenetic studies were performed on an alveolar soft part sarcoma of a 6-year-old boy. An extra chromosome 8 was present in 26 of 28 metaphases analyzed.

Bone invasion by a recurrent digital fibroma of infancy in a child with Beckwith-Wiedemann syndrome.

We describe a child with features of the Beckwith-Wiedemann syndrome with congenital recurrent digital fibroma of infancy that extended into and replaced the marrow of the terminal phalynx of the little finger. Digital fibromas of infancy have not previously been associated with either Beckwith-Wiedemann syndrome or invasion into underlying bone.

Fracture of the superior pelvic quadrant in a child.

We present a case report (with review of the literature) of a 3-year-old child who was struck by an automobile, sustaining a superior quadrant pelvic fracture that involved the sacroiliac joint, the adjacent ilium, and the acetabulum. This was successfully treated by open reduction and fixation with cannulated screws.

Operative stabilization of pediatric femur fractures.

Femur fractures represent approximately 1.7% of all pediatric bony injuries. Most femur fractures were treated nonoperatively prior to the early 1980s.

The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis.

Seventy-eight diaphyseal femur fractures in 77 children were stabilized with flexible intramedullary nails. The patients ranged in age from 2 + 9 to 18 years. All patients had open femoral growth plates at the time of fixation.

Undiagnosed fractures in severely injured children and young adults. Identification with technetium imaging.

A whole-body bone scan was performed to search for undetected fractures in forty-eight patients who had multiple injuries or a head injury, or both, and who were less than twenty-two years old. The study took place from January 1991 to July 1992. Radiographs had been made of all areas of suspected skeletal trauma at the time of admission.

The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood.

The variety and distribution of skeletal pathology in children with acute lymphoblastic leukemia is rarely seen in other disease states. Skeletal radiographic changes associated with and/or suggestive of acute leukemia include diffuse osteopenia, metaphyseal bands, periosteal new bone formation, geographic lytic lesions, sclerosis, mixed sclerosis/lysis, and permeative destruction. This retrospective analysis of 83 children with acute lymphoblastic leukemia suggests that children without radiographic skeletal abnormalities have an "aggressive" form of leukemia.

The conservative management of congenital dislocation of the hip after walking age.

Congenital dislocation of the hip (CDH) is a developmental disorder with a wide spectrum of clinical manifestations. Recent advances in imaging techniques have improved clinicians' understanding and early detection of CDH. Despite recent advances, some children remain undiagnosed until after they reach walking age.

Stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails (a technique paper).

The indications for surgical stabilization of a pediatric diaphyseal femur fracture are expanding. Children with multiple system injuries, a head injury, and/or multiple fractures have fewer local and distant complications if the femur fracture is treated operatively. Other indications include a pathological fracture in osteoporotic bone, a fracture in a child with a preexisting condition that prevents the application of a spica cast, a child older than 10 years of age, or a child less than 10 years of age who cannot be kept adequately aligned using conventional (traction/casting) methods of fracture management.