Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis

A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An unusual feature of this case was the relapsing and remitting nature of the condition, but there is sufficient evidence to explain the clinical picture on the basis of a recurrent intraspinal inflammatory process. The clinical and radiological features are similar to those of a further 28 reported in the literature. An electromyogram (EMG) proved important in defining the extent of neurological involvement. Computerised tomography (CT) showed marked laminar erosion and no bony exit foramen encroachment. We believe that the clinical diagnosis of this condition can be adequately confirmed with plain radiology, EMG, and CT scan.

Increased incidence of faecal Klebsiella pneumoniae in patients with HLA B7 CREG antigen and men with rheumatoid arthritis

In a study of the carriage of faecal Klebsiella pneumoniae in 106 patients with rheumatoid arthritis the incidence of carriage was higher in men (28%) than women (14%) (p < 0.001) and klebsiellae were isolated on two or more occasions from a higher proportion of men than women (p < 0.002). The incidence of carriage was increased among patients with rheumatoid arthritis who had B7 cross-reacting (B7 CREG) antigens (32% v 13%--p < 0.001). Carriage of klebsiellae was not associated with clinical disease activity, raised erythrocyte sedimentation rate, drug treatment, or the presence of HLA Dw4 or DRw4 or both. Thus the carriage and prevalence of faecal Klebsiella pneumoniae appear to be partly determined by the sex and HLA state of the host.

BK virus DNA sequence coding for the t and T antigens and evaluation of methods for determining sequence homology

The DNA sequence of the early region of the human papovavirus BK (MM strain) was determined. A potential initiation signal for translation is located at nucleotides 3,047 to 3,045 or map position 0.614. Extending counterclockwise from this AUG signal there is only one open reading frame, which can code for a putative t antigen of 100 amino acids in length. If the early mRNA of BKV is spliced, then the regions between nucleotides 3,047 to 2,808 and 2,725 to 884 can code for a T antigen 694 amino acids in length. The sequences of the deduced T antigens in BK virus share 71% amino acid homology with those in simian virus 40, whereas the coding sequences of the two viruses share 70% DNA homology. Comparison of DNA sequences and evaluation of homology measurements between these two viruses are discussed.

The clinical assessment of joint inflammatory activity in rheumatoid arthritis related to radiological progression

A simple clinical method for the assessment of joint disease activity is described, and analysed with respect to radiological progression of erosive disease. Ninety-four patients with rheumatoid arthritis attending a special research clinic as part of a prospective study were studied over a three-year period. A significant correlation was found between clinical activity, assessed at intervals of four months, and progressive erosive disease but not with juxta-articular osteoporosis. This clinical method compares favourably with a modification of the articular index described by the Cooperating Clinics of North America.

Muscle relaxation rate, fibre-type composition and energy turnover in hyper- and hypo-thyroid patients

1. Quadriceps strength, relaxation rate, fibre-type composition and energy-turnover rate during a submaximal contraction have been measured in hypo- and hyper-thyroid patients and compared with findings in normal subjects. 2. Six out of eight hypothyroid patients had normal strength whereas four out of five hyperthyroid patients were weak. 3. Relaxation rate was decreased in all the hypothyroid patients but increased in only three out of five hyperthyroid patients. 4. In hypothyroidism there was a marked reduction in the percentage contributed by type II fibres to muscle cross-section, partly due to type II atrophy but also due to a decrease in the relative frequency of type II fibres. In hyperthyroidism both fibre types tended to atrophy. 5. The rate of ATP turnover during submaximal contraction held to fatigue was reduced in hypothyroidism. This was probably due to decreased ATP utilization rather than an impaired supply of energy-supplying substrates. In hyperthyroidism the rate of ATP turnover was increased. 6. Altered relaxation rate and ATP-turnover rate may be explained on the basis of changes in myosin ATPase activity with thyroid status. Changes in muscle-fibre-type composition, as determined histochemically, could not per se account for the functional abnormalities.

Muscle breakdown and repair in polymyositis: a case study

Muscle breakdown and repair were measured by metabolic balance techniques in a patient with polymyositis who was being treated with prednisolone and azathioprine. Changes in body muscle mass that had been estimated from nitrogen and phosphorus balances correlated with antropometric assessments of thigh muscle mass and quadriceps strength. Decline in muscle strength was associated with a net rate of muscle breakdown of 148 g/day. Recovery was associated with a net rate of muscle repair of up to 100 g/day. Early reduction in corticosteroid treatment appeared to enhance the rate of repair. Changes in the isometric contraction force of the quadriceps muscle (but not in clinical symptoms, plasma creatine kinase [CK] or erythrocyte sedimentation rate [ESR] were found to reliably indicate whether the muscle was in a state of breakdown or repair. Treatment of the individual patient may be quantitatively monitored by metabolic balance studies or, more simply, by measurement of muscle strength.

Relaxation rate of constituent muscle-fibre types in human quadriceps

1. Muscle fibres may be subdivided into type I (with slow-twitch contractile properties) and type II (fast-twitch) depending on their myosin adenosine triphosphatase activity. In voluntary isometric contractions type I fibres are utilized at low forces (less than 20% of maximum) whereas type II fibres are recruited in addition at high forces. This physiological recruitment order has enabled us to measure the relaxtion rate of type I and II fibres in vivo in normal human subjects. 2. Relaxation rate was measured in 16 subjects from low (10% of maximum) and maximum isometric quadriceps contractions and the muscle-fibre type composition determined from needle-biopsy specimens in 10 subjects. The relaxation rate of type II fibres was calculated to be twice as fast as that of type I. 3. It was not possible to estimate, from studies in 33 quadriceps muscles (25 normal subjects), the contribution of type II fibres to overall fibre area from the relaxation rate as determined from electrically stimulated isometric contractions.

Tests of skeletal muscle function in children

The contractile properties of a large proximal muscle (quadriceps femoris) and a small distal muscle (adductor pollicis) have been measured in normal children and children with neuromuscular disorders. The method of stimulating the quadriceps femoris to contract, previously evaluated in adults, was found to be acceptable to children. In normal children a number of indices of muscle function were found to be similar to those in adults. A small study of the function of the adductor pollicis using supramaximal stimulation of the ulnar nerve was carried out in boys with Duchenne dystrophy. Decreased contractile force and prolonged relaxation times from a tetanic stimulation were noted in both the proximal and distal muscles of the boys with Duchenne dystrophy.

Clinical investigations of muscle contractility

The use of tests of muscle contractility based on electrically stimulated contractions means that information obtained from the more traditional tests of voluntary muscular performance and strength may be complemented by indices which are independent of volition and independent of muscle mass. Such tests are no longer limited to peripheral muscles but may now be applied to a large proximal muscle--the quadriceps femoris. This report describes the in vivo testing of a drug's pharmacological activity on the quadriceps muscle by a study of the relative forces produced by different frequencies of stimulation. It also illustrates that hypothyroidism is not the only endocrine disorder whose treatment may be monitored by measuring the speed of muscle relaxation. Finally, it describes a patient whose quadriceps weakness was explained by the demonstration of the failure of the muscle to maintain tension during prolonged stimulation.

Functional and structural changes after disuse of human muscle

1. Seven patients who had suffered unilateral leg fracture were studied after removal of immobilizing plaster casts. 2. Leg volume measured anthropometrically was reduced by 12% in the injured leg (5-68 +/- 1-05 litres) compared with the uninjured (6-43 +/- 0-87 litres). Associated with this loss was a similar reduction in the net maximum oxygen uptake achieved in one-leg cycling, from 1-89 +/- 0-21 1/min in the uninjured leg to 1-57 +/- 0-18 1/min in the injured. 3. Measured by a percutaneous needle biopsy technique, a reduction of 42% was found in the cross-sectional area of the muscle fibres sampled from the vastus lateralis of the injured compared with the uninjured leg. 4. Staining for myosin adenosine triphosphatase activity showed that both type I and II fibres were affected, being reduced respectively from 3410 to 1840 micronm2 and from 3810 to 2390 micronm2 cross-sectional area. 5. Possible reasons and implications are discussed for the discrepancy between the magnitude of the difference observed in the gross measurement of leg function (maximum oxygen uptake) and structure (leg volume) as compared with the cellular level (cross-sectional fibre area).

Human skeletal muscle function: description of tests and normal values

1. The force produced by isometric contractions of the quadriceps muscle have been studied during maximal voluntary contractions and when a substantial part of the muscle was electrically stimulated via surface electrodes. 2. In normal children and adults, the force of a maximal voluntary contraction of the quadriceps was proportional to body weight. 3. The function of the quadriceps has been described in terms of the force/frequency curve, speed of relaxation and the rate of loss of force during 18 s stimulation at 30 Hz and 100 Hz. 4. The functional characteristics of adductor pollicis when stimulated via the ulnar nerve were essentially similar to those of the quadriceps. 5. Studies of the function of these two muscles are complementary since quadriceps femoris is amenable to needle biopsy investigations of its structure and chemistry whereas adductor pollicis is more suitable for electrophysiological studies.

A study of the contractility, biochemistry and morphology of an isolated preparation of human skeletal muscle

1. A new method of studying isolated human skeletal muscle has been evaluated. This involves the incubation and electrical stimulation of strips of muscle, obtained at surgical biopsy, that are tied at the cut ends of the fibre bundles. 2. Morphological examination showed that the fibres were sealed off at the cut ends. Damage appeared to be restricted to the areas immediately adjacent to the ties. 3. Contractile properties were well maintained for several hours and measurements of tissue metabolites showed that muscle contents of the high-energy phosphate compounds were well preserved. 4. The isolated preparations were found to have the same contractile properties as human quadriceps femoris studied in vivo by the methods described in the preceeding paper. 5. Correlation was found between the relaxation speed of the isolated preparations and their fibre-type composition histochemically determined. 6. It is concluded that this technique is a valid addition to the present methods of studying the physiology and pharmacology of human skeletal muscle.

Order, analogy, and efficacy in Ethiopian medical divination

An important source of the efficacy of techniques for managing sickness is their capacity for symbolically ordering the disordered states associated with disease. (The ability to give empirical proofs is another source.) This article describes the symbolic ordering wirked by a method of divination that is practiced by the Amhara of Ethiopia. Emphasis is given to indicating how order is accomplished through linking disease with phenomenological domains that are remote from the biophysical locus of sickness. The point is made that ordering and linking depend on processes of analogy.

Glycine-specific synapses in rat spinal cord. Identification by electron microscope autoradiography

Glycine, an inhibitory transmitter in spinal cord, is taken up into specific nerve terminals by means of a unique high-affinity uptake system. In this study, [3H]glycine was directly microinjected into rat ventral horn in vivo and electron microscope autoradiography used to localize the label in various anatomic compartments. Quantiative analysis showed that [3H]glycine labeled a high proportion of axosomatic and axodendritic synapses which presumably act to inhibit spinal motor neurons.

Tetanus toxin: direct evidence for retrograde intraaxonal transport

The neurotoxin tetanospasmin causes tetanus when it reaches the central nervous system. In this autoradiographic study, 125-I-labeled tetanospasmin was injected into the leg muscles of rodents, and the nerves supplying these muscles were crushed. The labeled toxin accumulated within axons on the distal side of the crush. This study provides direct evidence for retrograde axonal transport of a macromolecular toxin that acts at synapses in the central nervous system.

Peripheral plasma progesterone concentrations in sheep during the oestrous cycle

Progesterone concentrations in peripheral plasma were measured once daily during one oestrous cycle in each of eight sheep. In addition, on days 4–5, 8–9, 12–13 and 15–16 of the oestrous cycle, blood samples were collected at 30-min intervals throughout each 24-h period. A total of three ewes was sampled in each 24-h period and the same three animals were not bled again for at least 1 week. Plasma progesterone concentrations in all the ewes fluctuated considerably throughout each 24-h period. The within-sheep within-day variations observed in peripheral progesterone concentrations were compared with the between-sheep within-day variations and the within-sheep between-day variations previously reported. It is concluded that these previously reported variations in peripheral plasma progesterone concentration could be attributed to within-day variations in each animal.

On days 8–9 and 12–13 of the oestrous cycle there were significantly higher concentrations of progesterone in plasma during the hours of daylight than during the hours of darkness. In contrast, progesterone concentrations on days 4–5 and 15–16 were not found to be significantly different between the hours of daylight and darkness. These results suggest that diurnal changes in peripheral plasma progesterone concentration occur during the luteal phase of the ovine oestrous cycle.

An accurate and rapid radiographic method of determining total lung capacity

The accuracy and reliability of Barnhard's radiographic method of determining total lung capacity have been confirmed by several groups of investigators. Despite its simplicity and general reliability, it has several shortcomings, especially when used in large-scale epidemiological surveys. Of these, the most serious is related to film technique; thus, when the cardiac and diaphragmatic shadows are poorly defined, the appropriate measurements cannot be made accurately. A further drawback involves the time needed to measure the segments and to perform the necessary calculations.

We therefore set out to develop an abbreviated and simpler radiographic method for determining total lung capacity. This uses a step-wise multiple regression model which allows total lung capacity to be derived as follows: posteroanterior and lateral films are divided into the standard sections as described in the text, the width, depth, and height of sections 1 and 4 are measured in centimetres, finally the necessary derivations and substitutions are made and applied to the formula Ŷ = −1·41148 + (0·00479 X₁) + (0·00097 X₄), where Ŷ is the total lung capacity. In our hands this method has provided a simple, rapid, and acceptable method of determining total lung capacity.