Pedicle morphology of the lower thoracic and lumbar spine in a Chinese population

Knowledge of pedicle diameter and surface landmarks is crucial for safe placement of screws. Little attention has been paid to variations of entrance points for pedicle screws, differentiation of male and female pedicle sizes and pedicle size differences in nonwhite populations. Forty thoracolumbar spinal columns from T9 to L5 were measured using vernier calipers. Cephalad-caudad and medial-lateral diameter of the pedicle, length of the pedicle from posterior cortex to anterior cortex at the midline and parallel to midline was measured. Relation of the centre of the pedicle to the transverse process (TP) and to the superior facet joint was noted. Twenty-five male and 15 female specimens were measured. Average pedicle width in the female was 5.2 mm at T9 (SD 0.9) to 13 mm at L5 (SD 2.7) and in the male 6.0 mm at T9 (SD 1.1) to 12.8 mm at L5 (SD 2.7). Cephalad caudad diameter was 12.5 mm (SD 1.2) at T9 to 20.5 mm (SD 3.6) at L5 in the male and in the female 12.2 mm (SD 1.3) at T9 to 18.7 mm (SD 3.9) at L5. All specimens had starting points cephalad to the midpoint of the TP at T9. At L5, 37 of 40 specimens had starting points at the midpoint of the TP. Starting points were parallel to the middle or lateral third of the superior facet joint at T9. At L5 starting points were at least one third of the facet joint lateral to the lateral border of the facet. Female pedicle width was smaller than male at T9 (P = 0.03) and T12 (P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for multiple binding sites for several components of human lymphoblastoid interferon-alpha

The antiproliferative and competitive binding activities of 20 purified components of human lymphoblastoid interferon (IFN)-alpha were compared with that of recombinant human IFN-alpha 2b on Daudi and AU937 cells. We observed broad ranges of antiproliferative activities of the IFN-alpha components on these cell lines. Daudi cells were more sensitive to the IFN-alpha components than AU937 cells; the concentrations of the components that resulted in 50% inhibition of cell growth ranged from 0.003 ng/ml to > 10 ng/ml on Daudi cells and 0.05 ng/ml to > 200 ng/ml on AU937 cells. Component o was the most active human IFN-alpha on both cell lines. Scatchard analysis demonstrated that the number of IFN-alpha 2b binding sites is greater on Daudi cells (12,700 binding sites/cell) than AU937 cells (3,300 binding sites/cell); however, their receptor affinities were similar. Component o, which exhibited high antiproliferative activity on both cell lines, had low affinity for the IFN-alpha 2b binding site on AU937 and Daudi cells. Several human IFN-alpha s (components b', b", and e) appeared to have high affinity binding sites but low antiproliferative activity on both Daudi and AU937 cells. These data suggest that there may be more than one binding site or receptor for human IFN-alpha, and/or there may be a multicomponent receptor involved in the biological actions of these molecules.

Anterior cervical corpectomy for the treatment of complex cervical lesions

Instability and stenosis of the cervical spine have been treated by posterior decompression and anterior decompression with fusion. In this study the authors evaluate the results obtained in 31 patients who underwent anterior cervical corpectomy for compressive or unstable lesions of the cervical spine. Operative level, preoperative and postoperative symptoms and physical findings were assessed. Twenty-seven patients had preoperative neurologic symptoms and signs, including alterations in sensation, motor findings and reflexes. The average follow-up was 12 months, average number of disc spaces excised was 2.5 and average number of vertebral bodies excised was 1.6. With respect to relief of pain, results were good or excellent in 27 patients. All patients but one had union of the bone graft. No neurologic deterioration occurred. The authors believe that patients with compressive lesions of the cervical spine can benefit from anterior cervical corpectomy with fusion and that complications are minimal.

Occurrence and distribution in Rhode Island of Hunterellus hookeri (Hymenoptera: Encyrtidae), a wasp parasitoid of Ixodes dammini

The wasp Hunterellus hookeri Howard parasitizes several species of ixodid ticks including Ixodes dammini Spielman, Clifford, Piesman & Corwin, the vector of Lyme disease spirochetes, Borrelia burgdorferi, in the northeastern United States. We detected the occurrence and evaluated the distribution of this wasp parasitoid in populations of I. dammini in Rhode Island. There has been no intentional introduction of a tick parasitoid recorded anywhere in Rhode Island; yet, we found this wasp at one of the six study sites (Prudence Island), where it parasitized 21 (n = 243) and 17% (n = 284) of nymphal I. dammini collected during 1988 and 1989, respectively. The proportion of nymphs parasitized was greatest during May (46%) and was less in June (18%), July (18%), and August (11%). In Rhode Island, the wasp was only found parasitizing ticks at the site with the highest (by a factor of 2) tick population, confirming similar observations in Massachusetts and New York. It is suggested that establishment as well as the distribution of H. hookeri depends upon a super abundant deer tick population. The usefulness of this parasitoid as a biological control agent is yet unknown.

Drill sleeve for pedicle screw fixation

Pedicle screw fixation is a popular method of fixation of the spine. Placement of screw and prevention of injury are surgeon dependent. We describe an easily made drill sleeve and depth gauge to assist in the preparation of the vertebral pedicle for pedicle screw application. Use of this device will help prevent soft tissue injury and overpenetration of the drill in the vertebral body.

HLA class II genes in Graves' disease

Inheritance of Graves' disease has been linked to the HA-DR3 gene product which may function in some specific way in antigen presentation. To determine whether the first extracellular domain of this protein, which is specifically involved in antigen presentation, has the same sequence in patients with Graves' disease and in normal individuals, we have amplified the second exon using the polymerase chain reaction, and then cloned and sequenced the DNA segment. In eight subjects with Graves' disease, sequences identical to prototypic reported sequence for DRB1*0301 were recovered, and in two individuals sequences varied by a few nucleotides, leading to 1-3 amino acid substitutions which did not occur in a pattern. Sequences identical to the prototypic sequence known as DRB3*0101, also previously known as DRw52, were also recovered. Thus the HLA-DRB1 and B3 genes present in patients with autoimmune disease appear to be the same as those present in the general population. These observations indicate that a unique allele is not present in patients with autoimmune disease, but rather that the normal DR3 allele itself, in a manner yet to be described, increases the probability of developing autoimmune thyroid disease.

Detection apparatus for multiple heterogeneous chemiluminescence immunoassay configurations

We describe an apparatus for measuring signals emanated from two heterogeneous chemiluminescence immunoassay (CLIA) configurations: antibody-coated polystyrene beads, in reaction tray wells, and microparticles captured by a porous matrix. An optics and fluidics design which allows the use of a common detection head for these two different assay configurations is described. The detection head moves along three Cartesian coordinates to create a localized light-tight compartment around each individual disposable reaction vessel. Reproducibility of the light seal, trigger solution delivery, and mixing is achieved for acridinium-labeled CLIA. The coated polystyrene beads configuration is tested using beta HCG, CEA, and TSH assays. The microparticle-capture configuration is tested using beta HCG and HBsAg assays. The microparticle capture CLIA has shorter incubation times and the potential for ease of automation.

Improvement in the specificity of assays for detection of antibody to hepatitis B core antigen

Reducing agents dramatically alter the specificity of competitive assays for antibody to hepatitis B core antigen (anti-HBc). A specificity improvement was demonstrated with a new assay which utilizes microparticle membrane capture and chemiluminescence detection as well as a current radioimmunoassay procedure (Corab: Abbott Laboratories, Abbott Park, Ill.). The effect was most noticeable with elevated negative and weakly reactive samples. In both systems, reductants increased separation of a negative population (n = 160) from assay cutoffs. With a selected population (n = 307), inclusion of reductant eliminated apparent anti-HBc activity in 54 of 81 samples in the 30 to 70% inhibition range. Reductant-stable anti-HBc samples were strongly associated with the presence of antibody to hepatitis B surface antigen (21 of 27). The association persisted below the detection limits of current assays to 0.3 to 0.4 Paul Ehrlich Institute units per ml. Only 1 of 54 reduction-sensitive borderline samples was confirmed to be positive for antibody to hepatitis B surface antigen. The modified procedures had unchanged or slightly improved sensitivity for immunoglobulin G (IgG)-associated anti-HBc activity. Although IgM anti-HBc detection was reduced from four- to eightfold in the presence of reductants, sensitivities remained at least twofold greater than tha of an enzyme immunoassay (Corzyme M; Abbott) designed to detect acute-phase levels of IgM anti-HBc. The use of reducing agents should significantly improve the reliability of anti-HBc testing, especially near assay cutoffs.

[Changes in serum thyroid hormones in acute cerebrovascular apoplexy and their clinical significance]

Serum thyroid hormones were measured in 62 cases of acute cerebrovascular apoplexy. Compared with the control group, T3, FT3 were markedly lowered and rT3, T4 and TSH were significantly increased with lowered T3/rT3 ratio. The patients were divided into two groups, according to whether there was hemorrhage in their CSF. Changes of serum thyroid hormones in cerebral haemorrhage were more remarkable than those observed in cerebral thrombosis. 16 cases with increased T4, FT4 were diagnosed as euthyroid hyperthyroxinemia. It was found that the amount of thyroid hormone changes appeared to be in proportion to the severity of acute cerebrovascular apoplexy. The determination of serum thyroid hormones would be useful in evaluating the severity of the strokes and in studying the thyroid function in acute cerebrovascular apoplexy.

Bone banking in Canada: a review

Transplantation of human tissues has become increasingly popular, and associated with this increase are reports of the transmission of diseases including acquired immune deficiency syndrome. To reduce the risk of transmitting disease through transplantation, careful scrutiny of current tissue transplantation procedures is necessary. Bone banking in Canada was evaluated by questionnaire, sent to the head operating room nurse of every Canadian hospital listed in the 1986 Canadian Medical Directory as having 100 or more beds. From this questionnaire, the authors identified 60 bone banks in Canada, many of which failed to meet recommended guidelines. The authors review the literature relating to bone banking procedures and present in detail the results of their survey.

Prophylaxis of deep-vein thrombosis in total hip surgery

Thromboembolism is a common and serious complication of total hip replacement. Methods of prophylaxis include combinations of physical compression of the legs and anticoagulation. Results of treatment are difficult to document and quantitate. The authors reviewed 122 patients who underwent hip arthroplasty with intermittent pneumatic calf compression, intravenous administration of dextran and platelet inhibitors. In 20% of them, clinically suspected pulmonary embolism was confirmed by ventilation perfusion lung scanning. The true incidence of pulmonary embolism is probably greater than this and it appears that the prophylactic regimen used in this study does not confer any benefit.

The nonoperative treatment of burst fractures of the thoracolumbar junction

Treatment of thoracolumbar spine burst fracture with a neurologically intact patient is controversial, with advocates of operative and nonoperative approaches. Of 404 patients in a prospective spinal trauma study, 21 had burst fractures, were neurologically intact, and had greater than 1-year followup. This group was analyzed to evaluate treatment with early mobilization using a thoracolumbar total contact orthosis. The average time in a brace was 6 months. Two patients had pulmonary embolus treated successfully with anticoagulants. No patient required subsequent surgery for increasing kyphosis or neurologic deficit. Change in K angle at followup was 4.6 degrees (+/- 5.7) and change in anterior vertebral height was 6.1 degrees (+/- 10). All patients had a satisfactory pain score and most individuals returned to full employment. It is concluded that it is not necessary to routinely treat patients operatively with burst fractures if they fulfill the following criteria: 1) neurologically intact; 2) kyphosis angle less than 35 degrees; 3) other injuries do not preclude the use of a total contact orthosis; and 4) the patient is capable of understanding and cooperating with the treatment regime. These criteria are irrespective of the CT findings of posterior vertebral retropulsion and spinal canal narrowing.

Characterization of two monoclonal antibodies in an immunohistochemical study of keratin 8 and 18 expression

Two monoclonal antibodies, UCD/AB 6.11 and UCD/PR 10.11, were evaluated for their patterns of immunohistochemical reactivity in a survey of paraffin-embedded human tissues by the avidin-biotin-immunoperoxidase technique. By two-dimensional immunoblotting, UCD/AB 6.11 reacts with keratin number 18 and UCD/PR 10.11 identifies both keratin numbers 8 and 18, the major keratins found in human simple epithelial cells. Both antibodies have excellent signal-to-noise ratios, and specifically react with simple epithelia, transitional epithelia, mesothelia and tumors derived from such tissues, making them superior immunological reagents. They do not react with neural, muscle, hematopoietic, connective or most epidermal tissues. However, within a given tissue or cell type, differences in the distributions of the antigens recognized by these two antibodies can be observed, raising the possibility of differential expression, modification, or masking of the keratin epitopes revealed by UCD/AB 6.11 and UCD/PR 10.11.