Efficacy of a Multimodal Analgesia Protocol in Total Knee Arthroplasty: A Randomized, Controlled Trial

A total of 100 osteoarthritis patients undergoing unilateral total knee arthroplasty were randomly assigned to receive either a multimodal analgesia protocol, comprising oral celecoxib and tramadol before and after surgery and intra-articular injection of large doses of morphine, ropivacaine, adrenaline and betamethasone during surgery (trial group), or oral and intra-articular placebo (control group). All patients received patient-controlled analgesia for 48 h after surgery. Morphine consumption up to 48 h after surgery was significantly lower in the trial than in the control group. Compared with the control group, the trial group had significantly lower visual analogue scale (VAS) scores for pain at rest from 6 h to 7 days after surgery and significantly lower VAS scores during activity from 24 h to 7 days after surgery. Active straight leg raise and active 90° knee flexion were achieved sooner and range of knee movement at postoperative days 1–15 were significantly greater in the trial group. Postoperative wound healing, infection, blood pressure, heart rate, rash, respiratory depression, urinary retention and deep vein thrombosis were similar in the two groups, but nausea and vomiting were significantly less frequent in the trial group.

Hyper-induction of cytokines by avian influenza A (H5N1): The role of signaling pathways and Toll-like receptors (B131)

Avian influenza virus A/HK/483/97 (H5N1) is associated with unusually severe human disease. H5N1 viruses hyper-induce pro-inflammatory cytokines (tumor necrosis factor alpha [TNF-α] and interferon beta [IFN-β]) and macrophage-tropic chemokines from primary human macrophages in vitro and this is paralleled by elevated levels of these cytokines in patients sera. It is therefore important to understand the mechanisms underlying this H5N1 induced differential hyper-induction of cytokines. Unlike H1N1, H5N1 virus strongly activated interferon regulatory factor 3 (IRF3). siRNA mediated gene silencing of IRF3 led to a dramatic reduction of the gene expression of IFN-β in H5N1-infected cells but only a partial decrease in TNF-α gene expression. Thus the differential activation of IRF3 may explain the hyper-induction of IFN-β, but does not fully explain the hyper-induction of TNF-α. Similarly, gene silencing of toll-like receptor 3 (TLR3) did not completely abrogate the TNF-α response. The significance of these findings in the pathogenesis of human H5N1 disease will be discussed.

Induction of systemic lupus erythematosus-like syndrome in syngeneic mice by immunization with activated lymphocyte-derived DNA

OBJECTIVES

Systemic lupus erythematosus (SLE) is the prototype of autoimmune disease and the mechanisms underlying the disease have not yet been elucidated. Thus, animal models of SLE would facilitate investigation of pathogenetic mechanisms involved in the development of the disease. This study characterizes a murine model of SLE-like syndrome induced by syngeneic activated lymphocyte-derived DNA (referred to as ALD DNA).

METHODS

Normal BALB/c mice were immunized subcutaneously with highly purified ALD DNA. Anti-double-stranded DNA (anti-dsDNA) antibodies were determined by enzyme-linked immunosorbent assay. Other SLE-associated autoantibodies were examined by indirect immunofluorescence and anti-ENA (extractable nuclear antigen) profile assay. Pathological changes were analysed by light microscopy and electron microscopy. Kidney cryostat sections were viewed by immunofluorescence for the presence of glomerular IgG and C3 deposits. Proteinuria was measured by Coomassie brilliant blue assay.

RESULTS

High levels of anti-dsDNA antibodies and other autoantibodies frequently appearing in SLE were detectable in the sera of ALD DNA-immunized mice. Glomerulonephritis and glomerular deposition of IgG plus C3 were observed in the kidney sections. Moreover, proteinuria was seen in the immunized mice.

CONCLUSIONS

SLE-like syndrome can be induced by ALD DNA in normal mice. This induced model may be useful for elucidating the mechanisms involved in autoimmunity to DNA and the development of SLE.

Measurement of fatigue in people with cancer

PURPOSE/OBJECTIVES

To evaluate the quality of existing instruments measuring cancer-related fatigue (CRF).

DATA SOURCES

Nursing and medical literature.

DATA SYNTHESIS

Although fatigue is highly prevalent among patients with cancer and adversely affects their quality of life, CRF often is unrecognized and untreated. The instruments available to measure CRF have numerous limitations. Many have been generated from investigators' observations, not actual experiences described by patients. Others operationalize different definitions of fatigue or differ in dimensionality, which leads to limited reliability and validity testing.

CONCLUSIONS

All of the instruments in this review need further study of their psychometric properties. Qualitative studies of CRF from the patients' perspective are needed to develop better instruments.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to increase their knowledge of assessing CRF to intervene and improve the quality of life for patients with cancer.

The entire trajectories of single olivocerebellar axons in the cerebellar cortex and their contribution to Cerebellar compartmentalization

The functional partitioning of the cerebellar cortex depends on the projection patterns of its afferent and efferent neurons. However, the entire morphology of individual projection neurons has been demonstrated in only a few classes of neurons in the vertebrate CNS. To investigate the contribution of the projection pattern of individual olivocerebellar axons to the cerebellar functional compartmentalization, we labeled individual olivocerebellar axons, which terminate in the cerebellar cortex as climbing fibers, with biotinylated dextran amine injected into the inferior olive in the rat, and completely reconstructed the entire trajectories of 34 olivocerebellar axons from serial sections of the cerebellum and medulla. Single axons had seven climbing fibers on average, which terminated at similar distances from the midline in a single or in multiple lobules. Cortical projection areas of adjacent olivary neurons were clustered as narrow but separate longitudinal segments and often innervated by collaterals of single neurons. Comparison of the cerebellar distribution of olivocerebellar axons arising from different sites within a single olivary subnucleus indicated that slightly distant neurons projected to complementary sets of such segments in a single longitudinal band. Several of these longitudinal bands formed a so-called parasagittal zone innervated by a subnucleus of the inferior olive. Single olivocerebellar axons projected rostrocaudally to segments within a single band but did not project mediolaterally to multiple bands. These results suggest fine substructural organization in the cerebellar compartmentalization that may represent functional units.

Effect of menopause on cognitive performance in women with Down syndrome

We compared cognitive function in nondemented pre- and postmenopausal women with Down syndrome, aged 21-57 years, with their age-matched male peers. The Woodcock-Johnson Tests of Cognitive Ability-Revised were used to assess cognitive function at baseline and 2 years later. Premenopausal women performed better than their age-matched male peers, while postmenopausal women performed more poorly than age-matched male peers (p = 0.007). Premenopausal women and young men showed no significant declines in cognition over time. Postmenopausal women, but not their age-matched male peers, showed significant declines in cognitive function. Our results support the hypothesis that cognitive declines in postmenopausal women are associated with estrogen deficiency rather than with age.

Elevated plasma homocysteine concentrations six months after gastroplasty in morbidly obese subjects

OBJECTIVE

To investigate whether the increased homocysteine levels occur in the first 6 months postoperatively, when nutritional intake is the most inadequate and weight reduction is the most drastic.

PATIENTS AND METHODS

Fasting glucose, insulin, lipoprotein, homocysteine, folic acid and vitamin B12 levels and oral glucose, tolerance test (OGTT) were determined in 12 morbidly obese subjects (3 men and 9 women with a mean age of 31+/-3 years, mean+/-SEM) before, 6 and 12 months after banded gastroplasty.

RESULTS

Gastroplasty resulted in significant weight loss, from 120+/-6 to 92+/-6 and 88+/-7 kgs, 6 and 12 months postoperatively (all p<0.001). Fasting plasma insulin and triglyceride concentrations, the ratio of total cholesterol to HDL cholesterol, glucose and insulin responses to OGTT, and the degree of insulin resistance as expressed by the Homeostasis model index decreased significantly (p<0.05-0.001) following gastroplasty. Fasting plasma homocysteine concentrations increased from 10.2+/-0.8 to 12.1+/-0.6 at 6 months (p=0.036) and 12.0+/-1.2 micromol/l at 12 months (p=0.040), respectively. Pooled plasma homocysteine levels were negatively correlated with serum folate concentrations (r=-0.42, p=0.013). However, serum folate and vitamin B12 levels did not change after gastroplasty, nor did the relation between the loss of body weight and increase in homocysteine levels.

CONCLUSION

We observed that elevated circulating homocysteine levels occurred as early as 6 months after gastroplasty despite improvement in carbohydrate and lipoprotein metabolism in morbidly obese Chinese subjects.

Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival

BACKGROUND

The prognosis of anaplastic thyroid carcinoma (ATC) has been dismal. The objective of this study was to identify prognostic factors in patients who had prolonged survival.

METHODS

Patients with ATC were identified from a computer database at a tertiary referral center. Univariate and multivariate analyses for survival differences were performed using the Kaplan-Meier log-rank statistic and the Cox proportional hazards model, respectively.

RESULTS

Of the 33 evaluable patients, median survival was 3.8 months. Median age was 69 years. Prior goiter was present in 6 patients (18%), and 6 (18%) had prior thyroid carcinoma. Median tumor size was 6 cm, and 12 (36%) had adjacent well-differentiated carcinoma. Of the 26 patients who underwent neck exploration, 8 patients were potentially cured and received postoperative chemotherapy and irradiation; 4 (50%) were surgically macroscopically free of disease, and 4 (50%) patients had minimal residual disease after total thyroidectomy and resection of tumor adherent to adjacent structures. Four of these 8 patients survived longer than 2 years; their 5-year survival estimate was 50%. Eighteen patients underwent palliative resection of neck disease, leaving macroscopic residual disease or distant metastases; postoperative adjuvant chemotherapy and irradiation were administered in 16 of these 18 patients. Seven patients were treated with only chemotherapy and irradiation. In patients treated with potentially curative resection, median survival was 43 months compared with 3 months with palliative resection (P =0.002); the median survival of 3.3 months with only chemotherapy and irradiation was no different than palliative resection (P =0.63). No association was found between survival and age, prior goiter, prior thyroid carcinoma, adjacent differentiated carcinoma, or tumor size.

CONCLUSIONS

Although the prognosis of most patients with ATC continues to be poor, complete resection of ATC combined with postoperative adjuvant chemotherapy and irradiation resulted in long-term survival, even with persistent minimal disease that remained on vital structures. An aggressive attempt at maximal tumor debulking followed by adjuvant therapy was found to be warranted in patients with localized ATC.

A prospective study of menopause in women with Down's syndrome

The present study prospectively examined the age at menopause of 92 women with Down's syndrome (DS) and the influence of hypothyroidism on the age of menopause. Three methods were used to determine the distribution and median age at onset of menopause: (1) Kaplan-Meier life tables; (2) Cox proportional hazards modelling; and (3) maximum likelihood logistic regression. All three methods provided distributions and similar estimates of the median age at menopause, which was approximately 46 years. The presence of hypothyroidism did not influence age at menopause. The earlier-than-expected age at onset of menopause suggests that women with DS are at an increased risk for post-menopausal health disorders.

Death from thyroid cancer of follicular cell origin

BACKGROUND

Although patients with differentiated thyroid cancer (DTC) of follicular cell origin usually have an excellent prognosis, some patients die from progressive tumor. Numerous postoperative criteria have been used to predict prognosis in patients with DTC. The purpose of this investigation was to determine whether the TNM and metastases, age, completeness of resection, invasion, size (MACIS) classifications predicted survival time and why patients died from DTC. The extent of initial treatment and causes of death were also evaluated in these patients who died from thyroid cancer.

STUDY DESIGN

Between 1965 and 1995, 102 of 1,224 patients with DTC treated at the University of California at San Francisco (UCSF) and UCSF/Mount Zion Medical Centers died from DTC. Risk factors including age at diagnosis, gender, histologic characteristics, TNM and MACIS classifications, the intervals among initial treatment, recurrence, and death, and the initial and subsequent treatments were documented in these 102 patients.

RESULTS

Among the 102 patients who died of DTC 50% were men and 50% were women. The mean age of patients with DTC at diagnosis was 58 years at recurrence, 62 and 65 years at death. Thirty percent of these patients initially had unilateral thyroid operations and 70% had a bilateral operation. Tumors at presentation ranged from 0.6 to 13.0 cm (mean 4.4 cm); 46% of patients presented with late-stage tumors (TNM stage III, IV; MACIS score > 8). At presentation 46% of the patients had locally recurrent disease or regional metastases and 18% had distant metastases. Patients with persistent disease had a significantly shorter survival time than those with recurrent disease (p < 0.001). Both TNM and MACIS classifications were good predictors of survival time. Reoperations were performed in 51% of papillary, 26% of follicular, and 67% of Hürthle cell thyroid cancer patients. Fifty percent of patients with papillary thyroid cancer, 50% of patients with Hürthle cell thyroid cancer, and 11% of patients with follicular cell thyroid cancer died of locally advanced disease.

CONCLUSIONS

As expected, patients with local or regional recurrence and those with TNM stage I or MACIS score < 6 survived longer than patients with distant metastasis and TNM stage III or IV, MACIS score > 6, but some patients thought to be at low risk (TNM stage I; MACIS < 6) also died from thyroid cancer.

The entire trajectory of single climbing and mossy fibers in the cerebellar nuclei and cortex

The present study has revealed that OC axons gave rise to a number of thin collaterals. Due to the abundance of these non-CF thin collaterals, it seems better to make a distinction between the terms CFs and OC axons, as was done in the present paper. The present findings on the innervation of PC dendrites by CFs are basically similar to those in previous reports (Ramón y Cajal, 1911; Palay and Chan-Palay, 1974). The number of swellings on a single CF in the present study (n = 250) is comparable to a previously measured value in the rat (n = 288; Rossi et al., 1993) and larger than a value in the frog (n = about 100 beads; Llinás et al., 1969). The average number of CFs per OC axon in this study was close to the number (n = about 7) inferred in the rat by counting the total number of IO neurons and PCs (Schild, 1970). Contact of interneurons by some swellings of CFs in the molecular layer was emphasized by Scheibel and Scheibel (1954) in their study with Golgi staining. Despite the contact of CF terminals on interneurons, the formation of a synaptic structure between them has been excluded in an electron-microscopic study (Hámori and Szentàothai, 1980). On the other hand, electrophysiological studies have demonstrated a weak excitatory effect of CFs on some interneurons (Eccles et al., 1966). Terminals in the granular layer were originated either from thin collaterals of OC axons or from retrograde collaterals of CF terminal arborizations. The former was the main source of swellings in the granular layer. The morphology of the thin collaterals in the present study was consistent with "globose varicosities connected by a fine thread" as described in Golgi preparations and electron micrograms (Chan-Palay and Palay, 1971). Swellings of thin collaterals (about 1.7% of the total number of swellings per OC axon) were most abundant in the upper portion of the granular layer just underneath the PC layer, in which Golgi cells are usually located. Furthermore, some of these swellings were observed to touch presumed Golgi cells in the present study, which is consistent with electron-microscopic findings on the innervation of somata of Golgi cells by thin collaterals (Hámori and Szentàothai, 1980; Chan-Palay and Palay, 1971). Inferior olive stimulation has been shown electrophysiologically to have a weak direct excitatory effect on Golgi cells (Eccles et al., 1966). Ninety-one percent of the OC axons examined had nuclear collaterals; since the possibility of insufficient staining could not be excluded, this percentage may be an underestimation. The ratio of swellings in the cerebellar nuclei versus those of CF terminal arborizations was about 0.036 in individual OC axons in the present study. However, since the volume of the cerebellar nuclei is much smaller than that of the cerebellar cortex, and significant convergence of input from OC axons to cerebellar nucleus neurons is present (Sugihara et al., 1996), cerebellar nucleus projection of OC fibers can still be functionally important. Some swellings seemed to make contact with the soma and the proximal portions of dendrites of large neurons in the present study, which is consistent with the steep rising phase of postsynaptic excitatory potentials in cerebellar nucleus neurons following IO stimulation (Kitai et al., 1977; Shinoda et al., 1987). Although intracellular potentials were presumably recorded only from large output neurons in the cerebellar nuclei, the present study suggested that small neurons were also innervated by OC axons. The present study revealed that virtually all reconstructed LRN axons projected not only to the Cx as mossy fibers, but also to the DCN including the VN by their axon collaterals. None of the LRN neurons specifically projected to the DCN without projecting to the Cx, namely all axon terminals of LRN neurons in the DCN and VN belonged to axon collaterals of mossy fibers projecting to the Cx. (ABSTRACT TRUNCATED)

Recurrent hyperfunctioning parathyroid gland demonstrated on radionuclide imaging and an intraoperative gamma probe

Radionuclide imaging with Tc-99m MIBI is the preferred mode of parathyroid localization in current practice. It also successfully identifies hyperfunctioning autotransplanted parathyroid tissue. The authors report a case with recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in the forearm. Double-phase Tc-99m MIBI imaging successfully localized the hyperfunctioning parathyroid tissue, which was missed by magnetic resonance imaging and ultrasonography. In addition, the parathyroid tissue was localized using an intraoperative probe at subsequent surgery.

Atrial tachyarrhythmias induced by acetylcholine in tilapia (Oreochromis sp.) isolated atria

1. Effects of the parasympathetic neuromediator acetylcholine (ACh) on atrial tissues vary greatly depending on the species, the type of atrial cells and experimental conditions. The aim of the present study was to investigate, with microelectrode techniques, the arrhythmogenic effects of ACh in tilapia (Oreochromis sp.) isolated atria at room (22-25 degrees C) and high temperature (37 degrees C). 2. Acetylcholine (1-10 micromol/L) shortened action potential duration (APD), depressed action potential plateau and decreased twitch force in tilapia atria, as it did in human atrial fibres. In addition, ACh induced premature responses and re-entrant tachyarrhythmias (TA; frequency range from 7 to 25 Hz) in five of 19 and 14 of 22 tilapia atria tested at room and high temperature, respectively. The higher incidence of ACh-induced TA at 37 degrees C compared with room temperature was statistically significant. 3. The ACh-induced TA consisted of high-frequency and uniform action potentials accompanied by tension oscillation and elevation of diastolic force (flutter). Acetylcholine-induced TA could be readily abolished by atropine (1 micromol/L) and prevented by treatment with agents with local anaesthetic properties, such as 0.1 micromol/L tetrodotoxin or 3 micromol/L quinidine. The antagonistic action of quinidine occurred without significant prolongation of APD. 4. The present findings suggest that pharmacological concentrations of the cholinergic muscarinic agonist ACh readily induce TA (mainly atrial flutter) in tilapia atria, presumably via sodium channel-dependent re-entrant excitation. The poikilothermic tilapia appears to be an appropriate animal model for the study of atrial TA.

Invasion of the brain and chronic central nervous system infection after systemic Mycobacterium avium complex infection in mice

Central nervous system (CNS) infections caused by nontuberculous mycobacteria have been described previously, especially in patients with AIDS. To investigate specific aspects of the pathogenesis of this entity, C57BL bg(+)/bg(-) mice were infected intravenously with Mycobacterium avium, and cultures of blood and brain as well as histopathology examination of brain tissue were carried out at several time points up to 6 months after infection. Low-grade inflammatory changes with small aggregates of lymphocytes and macrophages as well as perivascular cuffing were seen early in the infection. A small number of bacteria could be observed in the parenchyma of the choroid plexus. Six months after infection, numerous bacteria were present within the foamy macrophage of the granulomatous lesions along the ventricle and meninges. None of the mice developed clinical signs of meningitis or encephalitis or even died spontaneously during the period of observation. Use of CD18(-/-) knockout mice indicated that transport of the bacterium within neutrophils or monocytes into the brain is unlikely. Mild chronic CNS infection developed in the mice during sustained systemic M. avium infection, similar to what has been reported in most human cases.

Transtentorial cerebellar c-jun expression after focal cerebral cortical injury in mice

Delayed and remote effect of focal cerebral cortical lesion on cerebellum remains unclear. The c-Jun, an inducible transcription factor of cellular immediate early gene, is the predominant transcription factor and consistent marker for neurons that respond to stress or injury. We use a mouse cryogenic injury model to study the spatial and temporal changes of c-jun in the cerebellum after focal neocortical lesion. A transient and moderate expression of c-jun mRNA was found in the cerebellum with central dominance since 3 day postinjury and gradually subsided within 2 weeks. A distinct increment of c-Jun protein expression in Purkinje cells of the bilateral cerebellar hemispheres with focal connotation in the vermis was detected since 1 week postinjury. These findings suggest that the delayed and remote c-jun expression of the cerebellum, functionally connected with the cerebral cortex, indicate transneuronal gene activation.

Iterative thresholding for segmentation of cells from noisy images

We introduce an iterative thresholding algorithm for the segmentation of cells from noisy cell images. The thresholding image, which is initially a constant, changes iteratively with both the previous segmentation and image local activity. Experimental results for both synthesized and real cell images are provided to demonstrate the performance of the algorithm.

Physiologic-pathologic correlation in Guillain-Barré syndrome in children

OBJECTIVE

To correlate electrophysiologic patterns with sural nerve pathology in children with Guillain-Barré syndrome (GBS).

BACKGROUND

Based on electrophysiologic and pathologic observations, GBS has been divided into demyelinating and axonal subtypes. The acute motor axonal neuropathy (AMAN) involves predominantly motor nerve fibers with a physiologic pattern suggesting axonal damage, whereas the acute inflammatory demyelinating polyneuropathy (AIDP) involves both motor and sensory nerve fibers with a physiologic pattern suggesting demyelination. In this study, we sought to confirm these observations by correlating sural nerve pathology with electrophysiologic findings in GBS patients.

METHODS

Biopsies of sural nerve from 29 of 50 prospectively studied GBS patients were obtained. Nerves were examined by light and electron microscopy, and with immunocytochemistry for macrophages, lymphocytes, and complement activation products.

RESULTS

Sural nerves from AMAN patients were normal or had only a few (0.1% to 0.7%) degenerating fibers without lymphocytic infiltration or complement activation. One patient with reduced sural sensory nerve action potential classified as acute motor sensory axonal neuropathy (AMSAN) had many degenerating fibers (2.3%) in the sural nerve. All three AIDP patients displayed active demyelination, and in two patients, lymphocytic infiltration and complement activation products were observed on the abaxonal Schwann cell surface.

CONCLUSION

Classification of Guillain-Barré syndrome subtypes based on motor conduction studies correlates closely with pathologic changes seen in sural nerve. In acute motor axonal neuropathy cases, the sural nerve is almost completely spared pathologically. In acute inflammatory demyelinating polyneuropathy cases, macrophage-mediated demyelination and lymphocytic infiltration are common in the biopsies of sural nerves.

Neuroprotective effects of an antioxidant in cortical cerebral ischemia: prevention of early reduction of the apurinic/apyrimidinic endonuclease DNA repair enzyme

We examined the effects of the free radical scavenger, 21-aminosteroid, on apurinic/apyrimidinic endonuclease (APE/Ref-1) protein expression and subsequent infarction volume after photothrombotic cortical cerebral ischemia in mice. Immunohistochemistry and Western blot analysis showed a significant reduction in APE/Ref-1 expression 6 and 24 h after ischemia in untreated animals, whereas in drug-treated animals the reduction was much less at the same time points. The administration of 21-aminosteroid significantly decreased subsequent infarction volume 3 days after ischemia. These data suggest that 21-aminosteroid prevents the early decrease of APE/Ref-1 expression, thereby reducing cortical infarction after photothrombotic cerebral ischemia.

The study on the expression of membrane HSP70 protein in H22 cell and its immunoprotective mechanism against carcinoma

The mRNA and protein expression of HSP70 were studied using RT-PCR and FCM techniques. It's immune protective effects in vivo and the cytotoxicity in vitro were also observed. Results showed that cell viability didn't change under 42-43 degrees C, but declined in 44-45 degrees C; the level of HSP70 mRNA decreased initially (0.5-4.0 hour) but gradually resumed and increased from 8 to 12 hours at 42 degrees C. The positive cells expressed membrane HSP70 were significantly higher in heat shocked group than in a control group (P<0.001); the highest positive rate was 96.8% at 43 degrees C. The C3H mice immunized with heat shocked H22 cells could resist a secondary subcutaneous inoculation of parental H22 cells and their tumorigenic rate was significantly lower than that in mice immunized with parental H22 cells and RPMI 1640 control mice, which were 1/9.7/8 and 8/8, respectively. Their median survival time was also longer than that of parental cell group and RPMI 1640 control group, which were >90 days, 73.5 days, and 39.5 days, respectively. Through heat-treated tumor cell and lymphocyte mixed culture (TLMC), the induced lymphocytes had higher cytotoxic activities than that of splenic cells. The cytotoxicity against H22 cells reached 65.38% (2 hrs, 42 degrees C) and 67.84% (12 hrs, 43 degrees C) and could be blocked by anti-HSP70 McAb. Phenotype analysis revealed that the rate of TCR gammadelta+ cells rose with increasing cytotoxic activity, but no similar changes could be found in the CD4+ CD8+ TCR alphabeta+ subset. These results suggest that proper heat shock conditions can improve the immunogenicity of tumor cells and CD4- CD8- TCR gammadelta+ T carried on cytotoxic function via the HSP70 molecule.

Ovarian dysplasia in prophylactic oophorectomy specimens: cytogenetic and morphometric correlations

BACKGROUND

Ovarian dysplasia, a potential precursor to ovarian carcinoma, has been described in ovarian tissue obtained by prophylactic oophorectomy and also adjacent to ovarian carcinoma. Women with a family history of ovarian carcinoma, especially those of Jewish Ashkenazi descent, often test positive for BRCA mutant genes. Prophylactically removed ovaries, generally described as normal on macroscopic examination, can exhibit a "preneoplastic phenotype" and unsuspected neoplasm.

METHODS

Histologic slides of ovarian tissue from 54 Ashkenazi Jewish women were reviewed. All had a family history of ovarian carcinoma and all were tested for BRCA mutations. Forty-four women tested positive. Thirty-one women underwent prophylactic oophorectomy and 23 underwent oophorectomy for ovarian carcinoma. Normal, dysplastic, and ovarian carcinoma epithelial cells were analyzed morphometrically combining nuclear area measurements with chromatin texture assessment using a novel method based on the computation of autocorrelation coefficients and a derived parameter (Beta). Discriminant analysis between classificatory algorithms was used to obtain results.

RESULTS

Ovarian dysplasia was identified in 77.6% of the prophylactic oophorectomy specimens. An unsuspected ovarian carcinoma was diagnosed in one prophylactic oophorectomy specimen. Of 10 women who underwent prophylactic oophorectomy and were negative for BRCA mutations, three had ovarian dysplasia. The average nuclear measurements of the dysplastic cells were similar to those published previously. The new autocorrelation-based method evaluating nuclear texture, as revealed by tridimensional surface plots, demonstrated high discriminatory potential. Discriminant analysis based on nuclear area and nuclear texture information resulted in the correct classification of nearly all the cases in the three diagnostic categories.

CONCLUSIONS

Ovaries removed by prophylactic oophorectomy examined in their entirety often reveal ovarian dysplasia and occasionally ovarian carcinoma. The new morphometric method used was highly discriminatory in the evaluation of nuclear texture. Ovarian dysplasia in women with risk factors for ovarian carcinoma is significant in early ovarian carcinogenesis.

Projection patterns of single mossy fibers originating from the lateral reticular nucleus in the rat cerebellar cortex and nuclei

Projection of neurons in the lateral reticular nucleus (LRN) to the cerebellar cortex (Cx) and the deep cerebellar nuclei (DCN) was studied in the rat by using the anterograde tracer biotinylated dextran amine (BDA). After injection of BDA into the LRN, labeled terminals were seen bilaterally in most cases in the vermis, intermediate zone, and hemisphere of the anterior lobe, and in various areas in the posterior lobe, except the flocculus, paraflocculus, and nodulus. Areas of dense terminal projection were often organized in multiple longitudinal zones. The entire axonal trajectory of single axons of labeled LRN neurons was reconstructed from serial sections. Stem axons entered the cerebellum through the inferior cerebellar peduncle (mostly ipsilateral), and ran transversely in the deep cerebellar white matter. They often entered the contralateral side across the midline. Along the way, primary collaterals were successively given off from the transversely running stem axons at almost right angles to the Cx and DCN, and individual primary collaterals had longitudinal arborizations that terminated as mossy fibers in multiple lobules of the Cx. These collaterals arising from single LRN axons terminated bilaterally or unilaterally in the vermis, intermediate area, and sometimes hemisphere, and in different cerebellar and vestibular nuclei simultaneously. The cortical terminals of single axons appeared to be distributed in multiple longitudinal zones that were arranged in a mediolateral direction. All of the LRN axons examined (n = 29) had axon collaterals to the DCN. All of the terminals observed in the DCN and vestibular nuclei belonged to axon collaterals of mossy fibers terminating in the Cx.

Neuroimages of disseminated neurotuberculosis: report of one case

We report a 38-year-old male patient with rare concurrent intracranial and intramedullary tuberculoma demonstrated by serial magnetic resonance image (MRI) and confirmed by a pathological study. The involvement of the middle cerebral artery is also shown by magnetic resonance angiography. These findings have a good correlation with the clinical features including cranial nerve involvement, stroke-like symptoms, and paraplegia.

Pseudomonas aeruginosa central nervous system infections: analysis of clinical features of 16 adult patients

BACKGROUND

The purpose of this study was to analyze the clinical features and therapeutic outcome of 16 adult patients with Pseudomonas aeruginosa central nervous system (CNS) infection. We also attempted to identify the factors that significantly influence the prognosis of this potentially fatal CNS infection.

METHODS

Sixteen adult patients with P aeruginosa CNS infection, nine men and seven women, aged from 18 to 86 years, were included in this retrospective study. The clinical features and the laboratory data of these patients were analyzed. Potential prognostic factors were compared by means of Fisher's exact test and the relative risks were estimated by odds ratio.

RESULTS

Of the 16 patients, 13 had meningitis and three had focal suppuration (two with brain abscess and one with spinal epidural abscess). The 13 meningitis patients with nosocomial or community-acquired infections were classified into two forms: the spontaneous form and the neurosurgical form. The overall mortality rate was 37.5% (6/16). In the meningitis group, the patients with the neurosurgical form had a lower mortality rate (11.1%; 1/9) than the patients with the spontaneous form (100%; 4/4), and those with community-acquired meningitis had a higher mortality rate (80%; 4/5) than those with nosocomial infections (12.5%; 1/8). All the meningitis patients who did not receive appropriate antibiotic treatment expired. The statistically significant prognostic factors included the acquisition of infection, form of infection, bacteremia, initial level of consciousness and the use of appropriate antibiotics.

CONCLUSIONS

Vigilance for P aeruginosa is particularly important in patients with predisposing factors such as head injury, neurosurgical procedures and long-term debilitating diseases. Early appropriate antibiotic therapy and neurosurgical intervention for patients with suppurative infections can bring about improved therapeutic results.