[Fibrolipohamartoma of the upper extremity: treatment results in six patients over nine years]

BACKGROUND

Fibrolipohamartoma (FLH) is a rare, benign congenital malformation of peripheral nerves, mainly the median nerve, less frequently of the ulnar or other nerves. Early symptom is an initially painless, slowly growing and circumscript swelling. Affections at the wrist level or the foot are occasionally accompanied by macrodactyly. Although FLH is a congenital disorder, because of absent or discreet symptoms, the diagnosis is often made in early adulthood only due to a compression neuropathy. Magnetic resonance image findings are pathognomonic, biopsies are not necessary. In the medical literature, FLH has been described for the past forty years only by means of case reports or small case series. Meanwhile, surgical decompression is considered as therapeutic gold standard, in case of an accompanying macrodactyly in combination with corrective procedures for length, breadth and axis.

AIM OF THE STUDY

To study long term results after surgical compression of FLH und thus an assessment of this therapeutical concept generally accepted as gold standard in this rare entity.

PATIENTS AND METHODS

Between 1994 and 2004 we treated 9 patients (8 women, 1 man) with 11 tumors, average age was 38 years (3-62). 2 of the 9 patients had macrodactyly. In 7 patients, the median nerve was affected, in one patient bilaterally, in 5 patients the ulnar nerve, and in one patient both ipsilateral median and ulnar nerves. Of those 9 patients, we were able to follow up 6 clinically and electroneurographically. In addition, the DASH-score was collected. Average follow-up after initial decompression was 9 years (2-23). We performed surgical decompression in 5 patients, one patient was treated conservatively.

RESULTS

Patients with affections of the median nerve showed tendentially better results after surgical decompression compared to those with FLH of the ulnar nerve, irrespective of the affected anatomical level. Surgical decompression led to a relief of the symptoms in all patients; an improvement of motor function, hypaesthesia and cold sensitivity, however, could not be demonstrated.

CONCLUSION

FLH must be considered in the differential diagnosis of macrodactyly. We recommend surgical decompression, as it leads to relief of the symptoms. It does, however, not have a beneficial effect on already present motor impairments, sensory deficits and cold sensitivity. We strictly advise against tumor resection.

Enhanced radiative strength in the quasicontinuum of 117Sn

The radiative strength function of 117Sn has been measured up to the neutron separation energy using the (3He, 3He' gamma) reaction. An increase in the slope of the strength function around E gamma=4.5 MeV indicates the onset of a resonancelike structure, giving a significant enhancement of the radiative strength function compared to standard models in the energy region 4.5<or=E gamma<or=8.0 MeV. For the first time, the functional form of this resonancelike structure has been measured in an odd tin nucleus below neutron threshold in the quasicontinuum region.

Quantum criticality perspective on the charging of narrow quantum-dot levels

Understanding the charging of exceptionally narrow levels in quantum dots in the presence of interactions remains a challenge within mesoscopic physics. We address this fundamental question in the generic model of a narrow level capacitively coupled to a broad one. Using bosonization we show that for arbitrary capacitive coupling charging can be described by an analogy to the magnetization in the anisotropic Kondo model, featuring a low-energy crossover scale that depends in a power-law fashion on the tunneling amplitude to the level. Explicit analytical expressions for the exponent are derived and confirmed by detailed numerical and functional renormalization-group calculations.

[Stage 3-5 chronic kidney disease--what is the real prevalence in Romania?]

A high prevalence of reduced GFR has been reported in Western populations. However, little is known about the real prevalence of chronic kidney disease (CKD) in Eastern Europe. Our aims were 1) to identify the true burden of CKD in a large adult population sample; 2) to compare the GFR estimates by the "classic" MDRD4 formula with the GFR derived from the formula proposed recently by Levey.

METHODS

Data from 19.509 consecutive Caucasian adult ambulatory patients, referred to two laboratories affiliated to two regional referral centers in Romania, were recorded. Collected data were on age, gender, and serum creatinine (Scr). For one center, total cholesterol, LDL- and HDL-cholesterol, and Hb values were also available. GFR was determined by the classic four-variable MDRD formula (MDRD4) GFR1 = 186 x Scr(-1.154) X age(-0.203) (x 0.742 if female) and by the new MDRD formula (modMDRD4): GFR2 = 175 x corrected Scr(-1.154 x age(-0.203) (x 0.742 if female).

RESULTS

19394 patients (mean age 47.7 years, 39.1% males, mean Scr 0.9 mg/dL) were analyzed. The prevalence of CKD (defined as GFR < 60 ml/min/1.73 m2) was 8.8% (according to MDRD4), and 11.7% (modMDRD4). Therefore, 506 patients (5%) classified by the "classical" MDRD4 formula with a GFR1 of 60-89 mL/min/1.73 m2 have in fact CKD. Stage III CKD was present in 10.74% of patients (males 9.04%, females 11.82%), stage IV CKD in 0.57% (0.72%-0.47%), and stage V in 0.39% (0.29-0.45%). As expected, in the elderly population, the burden of CKD is much higher: 39.74%, with 9.30% of elderly having GFR severely reduced (< 45 ml/min). The prevalence of end-stage renal disease was at least double in the elderly compared to non-elderly. There was a linear relationship between anemia occurrence, lipid abnormalities, and GFR reduction.

CONCLUSION

The prevalence of chronic kidney disease in this large Eastern European unselected population is high (8.8-11.7%), similar to the NHANES III population. Almost 40% of elderly subjects have reduced GFR, with one in 10 patients having a severe reduction of renal function.

Determination of the N=16 shell closure at the oxygen drip line

The neutron unbound ground state of (25)O (Z=8, N=17) was observed for the first time in a proton knockout reaction from a (26)F beam. A single resonance was found in the invariant mass spectrum corresponding to a neutron decay energy of 770_+20(-10) keV with a total width of 172(30) keV. The N=16 shell gap was established to be 4.86(13) MeV by the energy difference between the nu1s(1/2) and nu0d(3/2) orbitals. The neutron separation energies for (25)O agree with the calculations of the universal sd shell model interaction. This interaction incorrectly predicts an (26)O ground state that is bound to two-neutron decay by 1 MeV, leading to a discrepancy between the theoretical calculations and experiment as to the particle stability of (26)O. The observed decay width was found to be on the order of a factor of 2 larger than the calculated single-particle width using a Woods-Saxon potential.

The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features

BACKGROUND

Varicella zoster virus (VZV) vasculopathy produces stroke secondary to viral infection of cerebral arteries. Not all patients have rash before cerebral ischemia or stroke. Furthermore, other vasculitides produce similar clinical features and comparable imaging, angiographic, and CSF abnormalities.

METHODS

We review our 23 published cases and 7 unpublished cases of VZV vasculopathy. All CSFs were tested for VZV DNA by PCR and anti-VZV IgG antibody and were positive for either or both.

RESULTS

Among 30 patients, rash occurred in 19 (63%), CSF pleocytosis in 20 (67%), and imaging abnormalities in 29 (97%). Angiography in 23 patients revealed abnormalities in 16 (70%). Large and small arteries were involved in 15 (50%), small arteries in 11 (37%), and large arteries in only 4 (13%) of 30 patients. Average time from rash to neurologic symptoms and signs was 4.1 months, and from neurologic symptoms and signs to CSF virologic analysis was 4.2 months. CSF of 9 (30%) patients contained VZV DNA while 28 (93%) had anti-VZV IgG antibody in CSF; in each of these patients, reduced serum/CSF ratio of VZV IgG confirmed intrathecal synthesis.

CONCLUSIONS

Rash or CSF pleocytosis is not required to diagnose varicella zoster virus (VZV) vasculopathy, whereas MRI/CT abnormalities are seen in almost all patients. Most patients had mixed large and small artery involvement. Detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA (p < 0.001). Determination of optimal antiviral treatment and benefit of concurrent steroid therapy awaits studies with larger case numbers.

Z = 50 shell gap near 100Sn from intermediate-energy Coulomb excitations in even-mass 106-112Sn isotopes

Rare isotope beams of neutron-deficient 106,108,110Sn from the fragmentation of 124Xe were employed in an intermediate-energy Coulomb excitation experiment. The measured B(E2,0(1)(+)-->2(1)(+)) values for 108Sn and 110Sn and the results obtained for the 106Sn show that the transition strengths for these nuclei are larger than predicted by current state-of-the-art shell-model calculations. This discrepancy might be explained by contributions of the protons from within the Z = 50 shell to the structure of low-energy excited states in this region.

Selective population and neutron decay of an excited state of 23O

We have observed a resonance in neutron-fragment coincidence measurements that is presumably the first excited state of 23O at 2.8(1) MeV excitation energy which decays into the ground state of 22O. This interpretation is consistent with theory. The reaction mechanism supports the assignment of the observed state as the 5/2+ hole state. This assignment and the recently observed 3/2+ particle state advance the understanding of 23O.

Long-term course of L-dopa-responsive dystonia caused by tyrosine hydroxylase deficiency

The authors report the long-term course of two siblings with L-dopa responsive dystonia (DRD) associated with a compound heterozygous mutation in the tyrosine hydroxylase (TH) gene. Both siblings manifested with lower-limb onset generalized DRD and had a sustained response to low-dose L-dopa therapy for over 35 years. Although the l-dopa therapy was delayed up to 20 years after disease onset, there were no cognitive or neurologic sequelae of the long-term catecholamine deficit.

Large enhancement of radiative strength for soft transitions in the quasicontinuum

Radiative strength functions (RSFs) for the (56,57)Fe nuclei below the separation energy are obtained from the 57Fe(3He,alphagamma)56Fe and 57Fe(3He,3He'gamma)57Fe reactions, respectively. An enhancement of more than a factor of 10 over common theoretical models of the soft (E(gamma) less than or approximately equal 2 MeV) RSF for transitions in the quasicontinuum (several MeV above the yrast line) is observed. Two-step cascade intensities with soft primary transitions from the 56Fe(n,2gamma)57Fe reaction confirm the enhancement.

Totally extraperitoneal repair of recurrent inguinal hernia

BACKGROUND

A variety of procedures with substantial differences in results are employed to treat recurrent inguinal hernia. The advantages of totally extraperitoneal patch repair (TEP) are even more evident when it is applied to recurrent compared to primary hernias. To investigate the superiority of this method more closely, we reviewed our results obtained for recurrent inguinal hernias over a period of 2 years.

METHODS

We performed a prospective single-center study using data obtained in consecutive patients with recurrent inguinal hernia who were operated on in 1997 and 1998.

RESULTS

A total of 179 patients with recurrent inguinal hernia were recruited. Overall, 1329 patients with inguinal hernia were treated in the 2-year period, of whom 1270 underwent TEP. The percentage of recurrent hernias was 14%. The average age of the patients was 56 years. The follow-up rate was 87.5%, and the mean follow-up period was 2.3 years. The 154 patients who were followed up underwent a total of 225 hernia repairs, of which 181 were for recurrent hernias. The average operating time was 57 min. In 68% (104/154) of the patients, adhesions, adherent epigastric vessels, or cicatricial changes were found, which resulted in the inadvertant opening of the peritoneum in 26.3% of the patients. All the openings in the peritoneum were closed by endoscopic suturing. Intraoperative complications developed in 4 patients (2.3%), including one injury to the bladder and three cases of bleeding from side branches of the epigastric vessels. The conversion rate was 0%. The sole postoperative complication was treatment requiring hematomas in 7 patients, in 2 of whom reoperation became necessary. In both cases, a diffuse hemorrhage due to a preoperatively undiagnosed coagulation disorder was found. No cases of wound or patch infection were observed. In a patient undergoing both primary and recurrent hernia repair, displacement of a mesh led to a recurrence on the primary hernia side (recurrence rate, 0.4%; re-recurrence rate, 0%).

CONCLUSIONS

Although for its definitive management, recurrent hernia requires a reliable operative technique, current data do not support the recommendation of any of the currently available procedures as the gold standard. In a representative patient population with recurrent hernia, we were able to demonstrate that TEP achieves very good results in terms of re-recurrence rate, intraoperative and postoperative complications, and rehabilitation. Prerequisites for the reliable and low-complication application of the method are a high level of standardization of the procedure and an advanced learning curve.

Photon propagator, monopoles, and the thermal phase transition in three dimensional compact QED

We investigate the gauge boson propagator in the three dimensional compact Abelian gauge model in the Landau gauge at finite temperature. The presence of the monopole plasma in the confinement phase leads to the appearance of an anomalous dimension in the momentum dependence of the propagator. The anomalous dimension as well as an appropriate ratio of photon wave function renormalization constants with and without monopoles is observed to be an order parameter for the deconfinement phase transition. We discuss the relation between our results and the confining properties of the gluon propagator in non-Abelian gauge theories.

Broken unitarity and phase measurements in Aharonov-Bohm interferometers

Aharonov-Bohm mesoscopic solid-state interferometers yield a conductance which contains a term cos(phi+beta), where phi relates to the magnetic flux. Experiments with a quantum dot on one of the interfering paths aim to relate beta to the dot's intrinsic Friedel transmission phase alpha(1). For closed systems, which conserve the electron current (unitarity), the Onsager relation requires that beta = 0 or pi. For open systems, we show that in general beta depends on the details of the broken unitarity. Although it gives information on the resonances of the dot, beta is generally not equal to alpha(1). A direct relation between beta and alpha(1) requires specific ways of opening the system, which are discussed.