Irreducible Salter-Harris type II fracture of the distal tibial epiphysis

An 11-year-old boy was admitted to the hospital after he fell to the ground from the roof, complaining of pain in his left ankle. Radiographs showed a Salter-Harris type II fracture-separation of the distal tibial epiphysis together with a transverse bending fracture of the distal fibula. An attempt at closed reduction was unsuccessful. At open reduction, torn periosteum and the posterior tibial tendon were interposed between the tibial metaphysis and epiphysis. After the tendon was deflected to its normal position, fracture-separation of the distal tibial epiphysis was easily reduced. At the latest follow-up 4 years after surgery, radiographs showed no evidence of growth arrest or residual deformity.

[Immunoregulatory role of gamma delta T cell receptor in atopic asthma--association with the IgE response to molds antigen]

To evaluate the role of gamma delta T cells in atopic asthma, we examined the relationship among atopy bronchial asthma, and genetic polymorphism of the gamma chain of T cell receptors (TCR) in families through atopic asthmatic probands. We recruited 5 families (69 subjects). Total serum IgE levels were estimated by a radioimmunosorbent test (IgE RIST). Skin prick tests were done with inhaled allergens consisting of house dust, grass and tree pollens, common molds, and animal danders. Antigen-specific IgE levels in response to these allergens were also measured by multiple antigen simultaneous test (IgE MAST). The atopic phenotype was determined by the presence of a positive skin test, an elevated antigen specific IgE value, an elevated total IgE level, or some combination of these. Although linkage of atopy or bronchial asthma to the gene encoding the gamma chain of TCR was excluded, the lod score between this gene and molds-specific IgE responses was 0.42 at the recombination fraction of 0.1. In an association study, a 19 kb allele of the gamma chain of the TCR gene was found more frequently in asthmatic subjects than in non-asthmatic subjects (p = 0.068). Also, molds-specific IgE responses were significantly associated with this allele (p = 0.018). These findings suggest that molds-specific IgE responses underlying atopic asthma are partly regulated by the gene encoding the gamma chain of the TCR.

Hemangiopericytoma of the mediastinum causing spontaneous hemothorax

Mediastinal tumors rarely cause spontaneous hemothorax. We report a case of right-sided hemothorax that occurred in a 37-year-old woman with a hemangiopericytoma in the posterior portion of the superior mediastinum.

Giant sacral cysts with neurogenic bladder

Most sacral cysts are accidentally found on lumbar myelograms and are usually asymptomatic. We operated on two patients with giant sacral cysts from S3 nerve roots who complained of neurogenic bladder and perianal sensory disturbance as well as buttock pain. Morphology of these cysts and intraoperative electrophysiological findings of nerve conduction block showed two kinds of pathogenesis causing these neurological symptoms. One was attributed to conduction block of more caudal sacral nerves squeezed between these giant sacral cysts and the other was due to degeneration of nerve root fibers involved in the sacral cyst walls. Postoperatively, buttock pain and perianal hypesthesia were resolved, but the neurogenic bladder showed only partial recovery.

[Usefulness of continuous intra-arterial blood gas monitoring in a patient undergoing tracheal transection and reconstruction]

Usefulness of a new continuous intra-arterial blood gas monitoring system (PB3300, Puritan-Bennett, Carlsbad, California) was evaluated in a patient with tracheal cancer who was undergoing tracheal transection and reconstruction. The PB3300 detected continuous changes in pH, PaCO2, and PaO2 during the surgical intervention and provided reliable information to take appropriate therapeutic measures. PB3300 was superior to pulse oximetry because the latter can not detect changes in PaO2 more than 100 mmHg accompanying pulmonary dysfunction caused by surgical procedures. We conclude that the PB3300 is a useful monitor when used during anesthetic management of the patient who needs frequent arterial blood gas analyses.

Intracellular calcium responses and shape conversions induced by endothelin in cultured subepithelial fibroblasts of rat duodenal villi

Subepithelial fibroblasts of rat duodenal villi were cultured and the physiological characteristics were studied using fura-2 fluorescence. The intracellular calcium concentration (Ca2+i) responded to various substances, i.e., endothelins (ET1 and ET3), substance P, serotonin, angiotensin II, ATP, and bradykinin. The Ca2+i responses to ET1 (> 0.1 nM) and ET3 (> 1 nM) were transient and sometimes followed oscillations that consisted of an initial Ca2+ release from the intracellular store and a sustained Ca2+ influx. Simultaneously with Ca2+i measurement, changes in the cell shape were monitored using fluorescence intensity upon 360-nm excitation. Stellate cells (with thick cell body and slender processes), formed as a result of 1 mM dibutyryl(Bt2)-cAMP treatment, began to change immediately after the short-term application of the endothelin and became flat about 20 min later. This process was not affected by the depletion of extracellular Ca2+ or by the treatment with BAPTA acetoxymethyl ester that completely suppressed the Ca2+i response. Substance P (> 100 nM) increased Ca2+i, but did not induce any morphological changes. The conversion of the shape from flat to stellate, induced by Bt2cAMP treatment, was not accompanied by any Ca2+i change. BQ-123, a specific blocker of the ETA-type receptor, did not block either Ca2+i change or shape conversion at low (100 nM) concentration. The results indicated that shape conversion in subepithelial fibroblasts did not require any Ca2+i response. Our findings regarding the characteristics of subepithelial fibroblasts in intestinal villi imply a functional similarity to astrocytes in the brain.

Posteromedial release of congenital club foot in children over five years of age

We reviewed 19 children with 24 congenital club feet at a mean of 11 years after one-stage posteromedial release at the age of five years or older (mean 6.8 years). Thirteen feet had undergone previous surgery. Nineteen feet were functionally excellent or good, three were fair and two had required subtalar arthrodesis. Radiographs showed good alignment of the tarsal bones, although mild adduction or varus deformity remained in several feet. Deformities of the bones were more common in feet which had had previous surgery.

The increase in the intracellular Ca2+ concentration induced by mechanical stimulation is propagated via release of pyrophosphorylated nucleotides in mammary epithelial cells

Mechanical stimulation of one mammary tumor cell in culture induced an increase in its intracellular calcium concentration which spread to surrounding cells. The increase in calcium can also be induced by addition of a solution in which cultured mammary tumor cells were stimulated by repeated pipetting (solution after pipetting cells, SAPC). The activity of the SAPC was completely abolished by treatment with snake venom phosphodiesterase or pyrophosphatase. Uridine triphosphate (UTP), uridine diphosphate (UDP) and ATP (1 microM each) were detected in the SAPC, whereas 5'-UMP and 5'-AMP were produced by phosphodiesterase digestion. A mixture of UTP, UDP and ATP (1 microM each) elicited a calcium response which was comparable to that induced by SAPC, while UTP, UDP or ATP alone at 1 microM elicited a small increase in calcium concentration in mammary tumor cells. Suramin, a competitive antagonist of P2 purinoceptors, diminished the spreading of the calcium wave induced by mechanical stimulation. It also blocked the responses to SAPC, UTP, UDP and ATP. These findings suggest that the mechanical stimulation results in the release of UTP, UDP and ATP into the extracellular space which mediates induction of the spreading calcium response via P2U-type purinoceptors.

Posteromedial release of congenital club foot in children over five years of age

We reviewed 19 children with 24 congenital club feet at a mean of 11 years after one-stage posteromedial release at the age of five years or older (mean 6.8 years). Thirteen feet had undergone previous surgery. Nineteen feet were functionally excellent or good, three were fair and two had required subtalar arthrodesis. Radiographs showed good alignment of the tarsal bones, although mild adduction or varus deformity remained in several feet. Deformities of the bones were more common in feet which had had previous surgery.

[Angiotensin-converting enzyme (ACE) polymorphism and serum ACE activities in sarcoidosis]

Recently, a genetic control of serum ACE (SACE) levels has been suggested by the identification of an insertion/deletion (I/D) polymorphism of the ACE gene by Rigat et al. We have also confirmed significant association between ACE gene polymorphism and SACE activities both in controls and sarcoidosis and established the new reference intervals of SACE activities for each genotype. The new reference intervals improved discrimination between normal and abnormal SACE activities. The frequencies of two alleles (I/D) in Japanese were quite different from those in whites and the insertion allele was dominant in Japanese. This genetic variation may affect the pathogenesis and prognosis of various diseases such as sarcoidosis and ischemic heart diseases.

[Practical CT classification for thalamic hemorrhage: relationship between localization of hematoma and prognosis]

It is not easy to predict functional outcome in patients with acute-stage thalamic hemorrhage. We analysed 100 cases of hypertensive thalamic hemorrhage less than 4 cm in diameter, and devised a practical CT classification for predicting the patients' prognoses. On an axial CT scan at the level of the pineal body, four lines were drawn as follows: line (a) between the lateral edge of the anterior horn and the midpoint of the third ventricle; line (b) vertical line to the sagittal line from the midpoint of the third ventricle; line (c) between the lateral edge of the trigone and the midpoint of the third ventricle; line (d) between the lateral edge of the anterior horn and the lateral edge of the trigone. The location of hematoma was divided into three types according to lateral extension as follows: type A (anterior type), center of hematoma located between line (a) and line (b); type P (posterior type), center of hematoma located between line (b) and line (c), and external margin of hematoma localized medial to line (d); type PL (postero-lateral type), center of hematoma located between line (b) and line (c), and showing lateral extension beyond line (d). Then, the correlation between hematoma location and severity of motor paresis at onset and its prognosis was investigated. Severe hemiparesis (MMT: 0-2) was observed in 15.3% of patients with type A, 21.8% with type P, and 59.3% with type PL hematoma in the acute stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior transfer of the toe flexors for equinovarus deformity due to hemiplegia

We report the results of transfer of the long toe flexors and lengthening of the calcaneal tendon in 33 patients with equinovarus deformity requiring orthoses after a stroke. Review of 29 patients more than two years after surgery showed that 21 were able to walk without an orthosis. Equinovarus deformity had recurred in six patients and hammer toe in 11, but walking ability without bracing was still better in seven of these. Results are improved by the release of the short toe flexors.

Anterior transfer of the toe flexors for equinovarus deformity due to hemiplegia

We report the results of transfer of the long toe flexors and lengthening of the calcaneal tendon in 33 patients with equinovarus deformity requiring orthoses after a stroke. Review of 29 patients more than two years after surgery showed that 21 were able to walk without an orthosis. Equinovarus deformity had recurred in six patients and hammer toe in 11, but walking ability without bracing was still better in seven of these. Results are improved by the release of the short toe flexors.

Cause of toe-in gait after posteromedial release for congenital clubfoot

Eighteen children with 24 congenital clubfeet were examined for their foot-progression angle and radiographic angles before and after Turco's posteromedial release. The foot-progression angle was -12.9 degrees before surgery and 1.6 degrees after surgery. The ratio of correction of the foot-progression angle was 58%. Using multiple regression analysis, this ratio was mostly related to the ratio of correction of the anteroposterior talo-first metatarsal and lateral talocalcaneal angles. These results suggest that it is important in correction of toe-in gait of congenital clubfoot to correct adduction deformity of the forefoot and equinus deformity of the hindfoot.

A case of 17 alpha-hydroxylase deficiency with retained menstruation

A patient with 17 alpha-hydroxylase deficiency (17OHD) who continued to menstruate is reported. A 24-year-old woman who presented with hypertension, hypokalemia and irregular menses had increased plasma ACTH and mineralocorticoids without any increase in glucocorticoids or sex steroids, and a bilateral adrenal enlargement on abdominal X-ray CT. ACTH stimulation test revealed hyperresponse of the metabolites of the mineralocorticoid pathway and blunted or absent response of those of the glucocorticoid and androgen pathway. Almost all of the abnormalities disappeared after dexamethasone administration. While 17OHD is usually known to accompany hypergonadotropic hypogonadism, the patient continued to menstruate, though irregularly. Although human chorionic gonadotropin administration failed to induce response, basal plasma levels of ovarian steroid (estradiol) and gonadotropins as well as response to LHRH stimulation test were all normal. Thus, the clinical and biochemical features of this case is compatible with the partial deficiency of both adrenals and ovaries, being less severe in the latter. A further analysis especially at molecular level is needed to elucidate the basis for the heterogeneity of this disorder.

Isolation and characterization of a diagnostic polysaccharide antigen from larval Echinococcus multilocularis

A diagnostic antigen, C-antigen, was evaluated in serodiagnosis of alveolar hydatid disease by Western blotting. The C-antigen migrated diffusely to the region of 30-35 kDa in 8% polyacrylamide-SDS gel electrophoresis. We isolated this antigen from a crude metacestode extract by a simple method of phenol/chloroform extraction. The isolated antigen was resistant to boiling, proteolysis and acid hydrolysis, but destroyed with sodium periodate. Such lectins as peanut agglutinin (PNA), Ricinus communis lectin (RCA120) and wheatgerm agglutinin (WGA) were capable of binding with the isolated antigen; no binding to concanavalin A (Con A), Lens culinaris agglutinin (LCA) or Phaseolus vulgaris (PHA-E4) was demonstrated. C-antigen is associated with a polysaccharide containing galactose and N-acetyl glucosamine residues.

A novel biological aspect of ovarian oxytocin: oxytocin gene expression in cumulus/luteal cells and the effect of oxytocin on embryogenesis in fertilized oocytes

Recently, several reports have demonstrated the presence of oxytocin (OT) in the corpus luteum of mammalian species. However, the biological role of ovarian OT remains obscure. This study was performed to examine OT gene expression in cumulus cells of mice and humans, and in human corpus luteum, and the role of OT in early embryogenesis. OT gene and OT mRNA were analyzed by reverse transcription-polymerase chain reaction, with single-strand-conformation polymorphism and heteroduplex procedures. OT-treated in-vitro-fertilized mouse oocytes were cultured and the rate of blastocyst development estimated. An immunohistochemical study was also carried out to detect OT on the surface of the mouse oocytes.

Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint

We used computerized tomography to evaluate the position of the tibial tubercle and to determine if the tibial tubercle is positioned more laterally in female patients with patellofemoral pain. We also wanted to determine the relationship of the tibial tubercle to tibial external rotation and patellar tilt. Sixty female patients and 19 healthy female controls were evaluated. To evaluate the position of the tibial tubercle, the tibial tubercle rotation angle (the angle formed by the line between the posteriormost edges of the medial and lateral femoral condyle and the line between the central point of the intercondylar space and the central point of the patellar tendon at the level of the tibial tubercle) was measured by superimposing the images from the level of the distal femoral condyle and the tibial tubercle. The relationship between the tibial tubercle rotation angle and patellar tilt was then assessed by dividing the patients into 3 subgroups according to the patellar tilt. The tibial tubercle rotation angle was significantly different between the patellofemoral pain patients and the controls. There were also significant differences between the patients with moderate patellar tilt (10 degrees to 20 degrees) and the controls, and between the patients with high patellar tilt (> 20 degrees) and the controls.

Cord blood levels of calcium-regulating hormones and osteocalcin in premature infants

We measured cord blood levels of calcium-regulating hormones and osteocalcin in 34 premature infants of various gestational ages. 1,25(OH)2D levels were low in mid-gestation and increased with advancing gestation. Parathyroid hormone levels were low, and calcitonin levels were high in mid-gestation. Both of them declined with advancing gestation. Osteocalcin levels were high in mid-gestation. They increased from 22 weeks through 27 weeks of gestational age, and decreased thereafter. Circulating osteocalcin is considered as a clinical marker of bone turnover. However, cord blood osteocalcin decreased between 27 and 36 weeks of gestation during which period calcium accumulation by the fetus increases. Therefore, cord blood osteocalcin does not appear to reflect fetal bone formation.

Neuroradiologic and electrophysiologic assessment of cervical spondylotic amyotrophy

Dissociated motor loss due to cervical spondylosis and disc herniation was evaluated in 10 patients who presented with left deltoid paresis in the absence of sensory deficits or myelopathy. All of these cases underwent cervical anterior decompression. Based on magnetic resonance imaging, computed tomography myelography, and computed tomography discography, patients were divided into two pathologic types: The first showed focal bony spur and disc herniation with axial cord rotation and nerve root compression, and the second demonstrated ventral cord flattening. Electrophysiologic studies included evoked spinal potentials, motor evoked potentials, and evoked muscle action potentials. Motor evoked potentials, recorded epidurally from the ventral aspect of the thecal sac and the nerve root within the anterior discectomy or vertebrectomy sites, proved clinically most useful. Combining the latest available neuroradiologic and electrophysiologic information, 4 types of neural injury associated with deltoid pareses were identified in the 10 patients. The first included isolated C5 nerve root lesions; the second, C6 nerve root lesions; the third, both C5 and C6 nerve root lesions, and finally, intrinsic cord pathology.

Isolation and identification of a cardioactive peptide from Tenebrio molitor and Spodoptera eridania

We isolated several cardioactive peptides from extracts of whole heads of the mealworm, Tenebrio molitor, and the southern armyworm, Spodoptera eridania, using a semi-isolated heart of Manduca sexta for bioassay. We have now isolated from each species the peptide with the strongest effect on rate of contraction of the heart. The peptides were identified using micro Edman sequencing and mass spectrometric methods. This cardioactive peptide has the same primary structure from both species: Pro-Phe-Cys-Asn-Ala-Phe-Thr-Gly-Cys-NH2, a cyclic nonapeptide which is identical to crustacean cardioactive peptide (CCAP) originally isolated from the shore crab, Carcinus maenas, and subsequently isolated from Locusta migratoria and Manduca sexta. This is additional evidence that CCAP has widespread occurrence in arthropoda.

Correlation of GM-CSF mRNA in bronchoalveolar fluid with indices of clinical activity in sarcoidosis

BACKGROUND

Granulocyte-macrophage colony stimulating factor (GM-CSF) has several proinflammatory effects, some of which potentially favour granuloma formation. Its mRNA expression by the inflammatory cells recovered from lungs of patients with pulmonary sarcoidosis has been previously reported. In this study an association between GM-CSF expression and manifestations of the disease was explored.

METHODS

GM-CSF mRNA was detected by reverse transcription polymerase chain reaction in the cells of bronchoalveolar lavage (BAL) fluid of 20 patients with pulmonary sarcoidosis.

RESULTS

GM-CSF mRNA expression was positive in 15 of 20 patients with sarcoidosis. Fourteen of the 15 patients with positive mRNA expression had worsening or unchanged disease during the year preceding this study, on the basis of radiographic or physical findings, or both, whereas all five "negative" patients were judged to be improving. Similarly, serum levels of angiotensin converting enzyme, the proportion of lymphocytes in BAL fluid, and the CD4+/CD8+ ratio of lymphocytes in BAL fluid were significantly higher in the positive patients.

CONCLUSIONS

There was an association between the presence of GM-CSF mRNA in the cells in BAL fluid and other indices of disease activity in sarcoidosis.

Aquastatin A, an inhibitor of mammalian adenosine triphosphatases from Fusarium aquaeductuum. Taxonomy, fermentation, isolation, structure determination and biological properties

A new inhibitor of mammalian adenosine triphosphatases, designated aquastatin A, has been isolated from a fungus identified as Fusarium aquaeductuum. The structure of this compound has been determined by MS and NMR analyses. It inhibits Na+/K(+)-ATPase with an IC50 value of 7.1 microM, and H+/K(+)-ATPase with an apparent IC50 value of 6.2 microM.