CURRENT LITERATURE 147

This technique restored the ability to smile but was not Reprint requests to Dr. Kortilla: Department of Anesthesia, Hel- successful for restoring eyelid ClOSUre.-TIMOTHY E. sinki University Central Hospital. Haartmaninkatu 4. SF-00290

KABOT Helsinki 29, Finland.

Reprint requests to Dr. May: Facial Paralysis Clinic of Pitts- burgh. 3600 Forbes Ave.. Pittsburgh, PA 15213.

Acute Monoarticular Herpetic Arthritis. Brna JA, Hall RF. Bone Joint Surg 66:623. 1984

infectious acute monoarticular arthritis can be caused by a number of bacterial agents. Hepatitis, cytomegalo- virus infection, and rubella have been previously reported as the initiating events of viral arthritis. Such viral infec- tions associated with acute arthralgia have usually been monoarticular and associated with a large joint of an ex- tremity. A single case of herpes simplex virus infection has been previously reported in the etiology of acute ar- thritis. A six-year-old Hispanic girl three days into a course of primary herpetic stomatitis developed a painful. swollen, and warm knee. Physical examination revealed no additional positive data. The erythrocyte sedimenta- tion rate was elevated to 41 mm per hour. Histologic ex- amination of a knee aspirate revealed mononuclear leu- kocytes. Microbiologic culturing of the aspirate produced a negative Gram stain, a sterile bacterial culture, and a viral culture positive for herpes simplex virus. The pa- tient’s herpes virus viral titers rose from 1:4 to 1:256 four weeks later. The patient improved following aspiration and was discharged 48 hours later. This case illustrates that Herpes simplex virus may be involved in the etiology of acute arthritis. The key was a negative Gram stain. negative bacterial culture, and current history of herpetic infection. The clinical course of spontaneous and rapid resolution without surgical drainage is consistent with the previously reported case.-FREDRK BONINE

Reprint requests to Dr. Brna: 1835 West Harrison Street, Chi- cago, III 60612.

Clinical Effectiveness and Untoward Effects of New Agents and Techniques Used in Intravenous Sedation. Kortilla K. J Dent Res 63:848, 1984

An ideal intravenous sedative agent for dentistry should provide antianxiety and analgesic activity, am- nesic action, and patient cooperation, without depression of the cardiorespiratory system and with rapid recovery. The author studied the clinical effectiveness and side- effects of some commonly used intravenous agents and techniques used in dentistry and oral and maxillofacial surgery. Criteria for the measuring of clinical effective- ness should include antianxiety activity, analgesic ac- tivity, amnesic effect, and patient cooperation. In con- trast, the evaluation of untoward effects of an old or newly developed drug for intravenous sedation should be considered in light of its side-effects, and the risk-to-ben- efit ratio should be assessed in clinical situations.

Methohexital, diazepam, lorezepam, and midazolam were all reviewed with regard to their effectiveness and potential untoward effects when used in intravenous se- dation. Midazolam. the new water-soluble benzodiaze- pine drug. showed some distinct advantages. The author concludes by stating that, in the near future, the recently synthesized, selective benzodiazepine receptor antago- nists may be found clinically acceptable for the control of oversedation with benzodiazepines.-GREGORY K. IN- GALLS

Lacrimal and Salivary Secretion in Sjogren’s Syndrome: The Effect of Systemic Treatment with Bromhexine. Prause JU. Frost-Larsen K. H@j H. et al. Acta Opthalmol 62:489, 1984

The purpose of this paper was to confirm earlier find- ings of the stimulating effect of bromhexine on tear se- cretion in patients who have Sjogren’s syndrome and to evaluate the effect of bromhexine on tear fluid and saliva protein concentrations. In a randomized clinical study, 32 patients who had either primary or secondary Sjogren’s syndrome were given a placebo or bromhexine (Bi- solvona), 48 mg daily, for 3 weeks. The criterion for in- cluding a Sjogren’s syndrome patient in the study was a Schirmer-l-test value of less than IOmm/5mm for both eyes. Tear and saliva samples were obtained before and after the placebo or bromhexine dose. The results of the study were: 1) the Schirmer-l-test and break-up time were significantly higher after bromhexine than after pla- cebo: 2) cornea1 sensitivity improved significantly during bromhexine treatment: 3) there was no effect of brom- hexine on the concentration of lysozyme and other pro- teins in tears: 4) in saliva, the 1gM concentration, in con- trast with other proteins, decreased in patients who had high pretreatment levels. In conclusion. bromhevine stimulates tear secretion significantly. presumably without changing the composition of the patient’s tear fluid.-STEVE BUCKLEY

Reprint requests to Dr. Prause: @jenpatologisk Institut. Frederik V’s Vej I I. 5. DK-2100 Copenhagen, Denmark.

Magnesium Enhances Local Anesthetic Nerve Block of Frog Sciatic Nerve. Akutagawa T, Kitahata LM. Saito H. et al. Anesthesia Analgesia 63: 1 I I - 116. 1984

In an attempt to determine if changes in magnesium concentration affect local anesthetic nerve block. nonfre- quency- and frequency-dependent conduction blocks were measured in the presence of local anesthetics and various magnesium concentrations. Desheathed northern Ram pipien frog sciatic nerves were placed in a sucrose gap recording chamber. For control studies, the chamber was perfused with Ringer’s lactate solution and for drug studies magnesium concentrations of 3 mM. 10 mM and 20 mM were employed with and without 0.5 mM lido- Caine. 0.5 mM benzocaine. and 0.75 mM QX.572 (a qua- ternary derivative of lidocaine). Magnesium, in the ab- sence of local anesthetics. increased the nonfrequency- dependent block in increasing concentrations but did not change the frequency-dependent block. Benzocaine caused a significant increase in both blocks. but only the nonfrequency-dependent block was increased with in- creasing magnesium concentrations in the presence of benzocaine. Lidocaine enhanced both blocks, and both blocks were increased with increasing magnesium con- centrations in the presence of lidocaine. The results ob- tained for QX572 were the same as those for lidocaine. The authors conclude that a local increase in magnesium concentration may enhance the block produced by some local anesthetics.-BRADLEY C. WRIGHT

Reprint requests to Dr. Kitahata: Department of Anesthesiology. Yale University School of Medicine. 333 Cedar Street, New Haven. CT 06510.