Comparison between posterolateral fusion with pedicle screw fixation and anterior interbody fusion with pedicle screw fixation in adult spondylolytic spondylolisthesis

There have been many reports regarding various operative methods for spondylolytic spondylolisthesis. However, there have been no reports regarding the comparison between posterolateral fusion (PLF) with pedicle screw fixation (PSF) and anterior lumbar interbody fusion (ALIF) with PSF. The purpose of the current study was to compare the clinical outcomes of PLF with PSF and ALIF with PSF, and to help in the selection of treatment options. Fifty-six patients with spondylolytic spondylolisthesis who underwent PLF with PSF (group 1, 35 patients) or who underwent ALIF with PSF (group 2, 21 patients) were studied. Minimum follow-up was 2 years. Demographic variables and disease state were similar for the two groups. We studied operating time, amount of blood loss, duration of hospital stay, clinical outcomes, complications, time at which fusion was complete, fusion rate, and radiological measurements. There were no significant differences between the two groups in terms of the amount of blood loss, duration of hospital stay, back pain, radiating pain, fusion rate, or complication rate. However, in group 2, the operation time and the time at which fusion became complete was longer, and in group 1 there was significant radiological reduction loss. In conclusion, PLF with PSF was just as effective as ALIF with PSF in terms of clinical outcomes, but ALIF with PSF was superior to PLF with PSF in terms of the prevention of reduction loss. Anterior support would be helpful for preventing reduction loss in cases of spondylolytic spondylolisthesis of the lumbar spine.

Pathological findings in cumulative irritation induced by SLS and croton oil in hairless mice

It is known that the pathological features of acute irritant contact dermatitis are specific according to the irritant. However, in chronic irritant contact dermatitis, it is not clear whether specific patterns exist. To investigate whether the specific pathology of acute irritant contact dermatitis is sustained in chronic irritant contact dermatitis, sodium lauryl sulfate (SLS) and croton oil were applied 3x a week for 2 weeks on the dorsal skin of hairless mice using Finn Chambers. The pathologic changes induced by irritants at various concentrations were evaluated using H&E and Luna's staining, as well as immunohistochemistry for 5-bromo-2-deoxyuridine (BrdU), keratin 6 and loricrin. Our results showed that epidermal hyperplasia and inflammatory infiltration were relatively marked in the groups treated with higher concentrations of irritants. These features were more prominent in the 1% croton oil treated group than in the 0.25% SLS treated group. However, lower concentrations of irritants resulted in very similar histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical. Our results suggest that the histological responses to irritants vary with concentration in cumulative irritation, as in acute irritation, but repetitive mild irritation may evoke common histological changes, characterized by epidermal hyperplasia with minimal inflammatory infiltration, irrespective of the chemical used.

Recurrent lumbar disc herniation: results of operative management

STUDY DESIGN

A retrospective evaluation of 28 patients with recurrent lumbar disc herniation.

OBJECTIVES

To analyze the outcome of the revisions (repeat discectomy), the risk factors of recurrent disc herniation, and the factors that influenced the outcomes of repeat discectomy.

SUMMARY OF BACKGROUND DATA

Recurrent herniation following disc excision has been reported in 5-11% of patients. There have been many studies on recurrent disc herniation, but these studies have analyzed mixed patient populations.

METHODS

Recurrent lumbar disc herniation was defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval greater than 6 months. Eight women and 20 men were studied. The levels of disc herniation were L4-L5 (19 cases) and L5-S1 (9 cases). Gadolinium-enhanced magnetic resonance imaging was performed in all patients. Revision surgery was performed in all patients by using conventional open discectomy. The pain-free interval, side and degree of herniation, operation time, duration of hospital stay, and clinical improvement rate were recorded.

RESULTS

The mean pain-free interval was 60.8 months. There were 21 cases of ipsilateral herniation and 7 cases of contralateral herniation. The degrees of herniation in revision were protrusion (14 cases), subligamentous extrusion (3 cases), transligamentous extrusion (8 cases), and sequestration (3 cases). The degrees of herniation in the previous discectomy were protrusion (17 cases), subligamentous extrusion (10 cases), and transligamentous extrusion (1 case). The length of surgery was significantly different (P = 0.003) between the revision surgery and the previous discectomy. There were no significant differences between revision and previous surgery in terms of hospital stay or clinical improvement rates. Age, gender, smoking, professions, traumatic events, level and degree of herniation, and pain-free interval did not affect the clinical outcomes.

CONCLUSION

Conventional open discectomy as a revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of primary discectomy. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation.

Lumbosacral scoliotic list by lumbar disc herniation

STUDY DESIGN

A prospective study of 45 patients with lumbar disc herniation and scoliotic list who had undergone conventional open discectomy.

OBJECTIVES

To determine the association between the location of the disc herniation and the direction of sciatic scoliotic list and to clarify the mechanism of sciatic scoliosis.

SUMMARY OF BACKGROUND DATA

The association between the scoliotic list and lumbar disc herniation is well known. However, there have been few studies regarding the direction of scoliotic list and the location of the disc herniation observed during surgery.

METHODS

The direction of scoliotic list, the preoperative and postoperative Cobb's angle, and the displacement of the first lumbar vertebra from the center sacral line were measured. The location, side, and degree of disc herniation were observed during surgery.

RESULTS

There was no statistically significant association observed between the location or degree of nerve root compression and the direction or degree of sciatic scoliosis. Moreover, there was no statistically significant association observed between the location or degree of nerve root compression and the displacement of the first lumbar spine from the center sacral line. However, there was a significant association between the side of the disc herniation and the direction of sciatic scoliosis. Most of the sciatic scoliotic list disappeared after surgical decompression.

CONCLUSION

The direction of sciatic scoliosis was not observed to be associated with the location of nerve root compression, although it was related to the side of disc herniation.

Naturally acquired antibody responses to the C-terminal region of merozoite surface protein 1 of Plasmodium vivax in Korea

We expressed a protein in Saccharomyces cerevisiae in order to evaluate the humoral immune responses to the C-terminal region of the merozoite surface protein 1 of Plasmodium vivax. This protein (Pv200(18)) had a molecular mass of 18 kDa and was reactive with the sera of individuals with patent vivax malaria on immunoblotting analysis. The levels of immunoglobulin M (IgM) and IgG antibodies against Pv200(18) were measured in 421 patients with vivax malaria (patient group), 528 healthy individuals from areas of nonendemicity (control group 1), and 470 healthy individuals from areas of endemicity (control group 2), using the indirect enzyme-linked immunosorbent assay (ELISA) method. To study the longevity of the antibodies, 20 subjects from the patient group were also tested for the antibody levels once a month for 1 year. When the cutoff values for seropositivity were determined as the mean + 3 x standard deviation of the antibody levels in control group 1, both IgG and IgM antibody levels were negative in 98.5% (465 of 472) of control group 2. The IgG and IgM antibodies were positive in 88.1% (371 of 421) and 94.5% (398 of 421) of the patient group, respectively. The IgM antibody became negative 2 to 4 months after the onset of symptoms, whereas the IgG antibody usually remained positive for more than 5 months. In conclusion, indirect ELISA using Pv200(18) expressed in S. cerevisiae may be a useful diagnostic method for vivax malaria.

Human intervertebral disc cells are genetically modifiable by adenovirus-mediated gene transfer: implications for the clinical management of intervertebral disc disorders

STUDY DESIGN

Human intervertebral disc cells were cultured in monolayer and treated with adenovirus-containing marker genes to determine the susceptibility of the cells to adenovirus-mediated gene transfer.

OBJECTIVES

To test the efficacy of the adenovirus-mediated gene transfer technique for transferring exogenous genes to human intervertebral disc cells in vitro.

SUMMARY OF BACKGROUND DATA

Upregulated proteoglycan synthesis after direct in vivo adenovirus-mediated transfer of growth factor genes to the rabbit intervertebral disc has previously been reported. Before contemplating extending this approach to the treatment of human disc disease, it is necessary to demonstrate that human intervertebral disc cells are indeed susceptible to adenovirus-mediated gene transduction.

METHODS

Human intervertebral disc cells were isolated from disc tissue obtained from 15 patients during surgical disc procedures. The cells were cultured in monolayer and treated with saline containing five different doses of adenovirus carrying the lacZ gene (Ad/CMV-lacZ), saline containing adenovirus carrying the luciferase gene (Ad/CMV-luciferase), or saline alone. Transgene expression was analyzed by 5-bromo-4-chloro-3-indolyl-beta-galactosidase (X-Gal) staining and luciferase assay.

RESULTS

Adenovirus efficiently transferred lacZ and luciferase marker genes to cells from degenerated discs as well as to cells from nondegenerated discs. A minimum dose of 150 MOI Ad/CMV-lacZ was found to be sufficient to achieve transduction of approximately 100% of disc cells-regardless of patient age, sex, surgical indication, disc level, and degeneration grade. No statistically significant difference in the luciferase activities could be detected in disc cell cultures from degenerated and nondegenerated discs treated with Ad/CMV-luciferase.

CONCLUSIONS

In vitro transducibility of human intervertebral disc cells by adenovirus is relatively insensitive to disc degeneration grade. Because the rate-limiting step for successful gene therapy is the ability to transfer genes efficiently to the target tissue, the achievement of efficient gene transfer to human intervertebral disc cells(using a direct, adenovirus-mediated approach) is an important and necessary step in the development of gene therapy strategies for the management of human intervertebral disc disorders.

Effect of cataract extraction and posterior chamber lens implantation on outflow facility and its response to pilocarpine in Korean subjects

AIM

To investigate the effect of the lens on outflow facility in Korean patients with cataracts.

METHODS

Intraocular pressure was measured by Goldmann applanation tonometry in 42 patients with cataracts and outflow facility was determined by tonography preoperatively, before and after instillation of pilocarpine. All patients received clear corneal phacoemulsification and silicone foldable intraocular lens implantation within the capsular bag by one surgeon. Two months after surgery, slit lamp examination and gonioscopy were performed and intraocular pressure and outflow facility were again determined. Statistical analysis was carried out using the Student's paired t test.

RESULTS

There were no anterior chamber reactions and no visible trabecular meshwork damage 2 months after surgery. Intraocular pressure 2 months after lens extraction decreased by a mean of 2.4 (SE 0.4) mm Hg (p<0.001) compared with the preoperative value; postoperative outflow facility with and without pilocarpine increased by 0.080 (0.019) microl/min/mm Hg (p<0.001) and 0.045 (0.014) microl/min/mm Hg (p<0.001), respectively, at 2 months compared with preoperative values. The facility response to pilocarpine after lens extraction, relative to the baseline value and preoperative response, increased by 10.7 (7.1)% which was not statistically significant (p>0.1).

CONCLUSION

Lens extraction causes a reduction in intraocular pressure and an increase in outflow facility in Korean subjects. Pilocarpine causes an increase in outflow facility which persists after cataract extraction and posterior chamber lens implantation.

MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls

OBJECTIVE

Using MR arthrography, we examined normal anatomy, anatomic variations, and pitfalls of imaging the labral capsular ligamentous complex in the asymptomatic shoulder.

SUBJECTS AND METHODS

We obtained 108 MR arthrograms of the glenohumeral joint in 95 asymptomatic volunteers with axial (108 shoulders) and oblique coronal (56 shoulders) images. We examined labral shape, patterns of capsular insertion, presence or absence of glenohumeral ligaments, and pitfalls of imaging. Our patients were men (auxiliary policemen) between 19 and 24 years old (mean age, 21 years).

RESULTS

The shapes of labra were triangular (anterior part, 64%; posterior part, 47%), round (17%; 33%), flat (2%; 17%), cleaved (11%; 1%), notched (3%; 0%), or absent (2%; 2%). Using the system of Mosely and Overgaard, the anterior capsular insertion was type 1 in 63% of shoulders, type 2 in 20%, and type 3 in 17%; the posterior capsular insertion was type 1 in 60% of shoulders, type 2 in 31%, and type 3 in 9%. The superior and inferior glenohumeral ligaments were present in 99% of shoulders, but the middle glenohumeral ligament was present in only 79%. We also detected many pitfalls of MR imaging in identifying findings such as the undercutting of the labrum by cartilage (32% of shoulders), prominent axillary folds (46%), sublabral holes (7%) or recesses (33%), Buford complexes (2%), and sulci between the biceps tendon and superior labrum (30%).

CONCLUSION

Knowledge of normal anatomy and anatomic variations of the labral complex is important for the examination of the shoulder with MR arthrography.

Deep vein thrombosis after major spinal surgery: incidence in an East Asian population

STUDY DESIGN

A prospective study of 313 patients who underwent major spinal surgery.

OBJECTIVES

To determine the incidence of deep vein thrombosis after major spinal surgery in an east Asian population without antithrombotic prophylaxis.

SUMMARY OF BACKGROUND DATA

Spinal surgery has been associated with few thrombotic complications (2-14%) compared with other reconstructive surgeries (20-70%). It has also been well documented that the incidence of deep vein thrombosis in east Asians (10%) is lower than in westerners (20-70%) in total joint replacements. There has been no previous report on the incidence of deep vein thrombosis after reconstructive spinal surgery in east Asians.

METHODS

Three hundred thirteen patients who underwent major spinal surgery were evaluated prospectively. All patients were examined with duplex ultrasonography assessments of both lower extremities. No specific antithrombotic prophylaxis were used in any patients before or after surgery.

RESULTS

There were four patients with positive findings of deep vein thrombosis on duplex ultrasonography, and there was only one with clinically symptomatic deep vein thrombosis. The overall incidence of thrombotic complications was 1.3%, and the incidence of symptomatic deep vein thrombosis was 0.3%.

CONCLUSION

Considering the low rate of deep vein thrombosis, routine screening and prophylaxis for deep vein thrombosis appears unwarranted in east Asians before or after major spinal surgery.

Radiographic knee dimensions in discoid lateral meniscus: comparison with normal control

We reviewed the knee radiographs of 68 cases of arthroscopically proven discoid lateral meniscus, including 42 cases of complete type and 26 cases of incomplete type discoid lateral meniscus. Knee radiographs of 70 cases that had no arthroscopic evidence of pathology of the meniscus were used as controls. We excluded patients who had significant trauma history and who were under 16 years of age or over 60 years to avoid measuring radiographs of skeletally immature or degenerative knees. The absolute values and relative normalized values of specific knee dimensions, such as a squared-off appearance of the lateral femoral condyle, widened femorotibial joint space, cupping of the lateral tibial plateau, obliquity of the lateral tibial plateau articular surface, high fibular head, and hypoplasia of the lateral intercondylar spine, were compared between the patients with discoid lateral meniscus and the normal controls. Among those dimensions, high fibular head and widened lateral tibiofemoral joint space showed statistically significant differences between the discoid lateral meniscus group and normal control group. We suggest that these findings would be useful in screening lateral discoid meniscus on plain radiography.

Tumor volume change as a predictor of chemotherapeutic response in osteosarcoma

The change in osteosarcoma tumor volume after preoperative adjuvant chemotherapy and its relationship to the histopathologic response was investigated using various reproducible volumetric methods. Tumor volume was measured before and after chemotherapy in 41 patients with osteosarcoma using an ellipsoid formula in plain radiography and magnetic resonance imaging and three-dimensional magnetic resonance imaging measurement. Based on intraobserver and interobserver variability for the volumetric measurements of each method, three-dimensional magnetic resonance imaging measurement was the most reproducible. In three-dimensional magnetic resonance measurements, the correlation of the histopathologic response with absolute and relative total tumor volume changes and extraosseous volume change were significant. The good responder group showed a greater reduction in tumor volume after chemotherapy, although there was no significant difference in pretreatment tumor volume between the good and poor responder groups. The group with a decreased or stable tumor volume represented a good histopathologic response with a sensitivity of 85%, specificity of 76%, and positive predictive value of 88%. The change in tumor volume of osteosarcoma measured by three-dimensional magnetic resonance imaging could predict histopathologic response after three cycles of neoadjuvant chemotherapy.

A kinetic study on oxidation of pentachlorophenol by ozone

The kinetics of pentachlorophenol (PCP) ozonation in terms of the gaseous O3 and dissolved PCP concentrations has been investigated. When the O3 concentration in the gas phase was in the range of 10 to 40 g O3/m3, the O3 dissolved for a short time period was proportional to the gaseous O3 concentration. In this range, the ozonation reaction was first order for each reactant and the overall reaction was second order. At 25 degrees C, in an aqueous solution, the reaction rate constant was estimated to be 10.048 L/mol.sec. The reaction rate was much greater than the mass-transfer rate, indicating that the reaction of O3 and PCP was an interface reaction on the surface of gaseous O3 bubbles. The final product of the PCP ozonation was oxalic acid, with the carbon yield of the reaction being 59.4%. The ozonation of PCP in the aqueous solution was not a radical reaction but a direct reaction between O3 and PCP molecules under the conditions investigated in this study, since O3 has a high selectivity toward PCP. The reaction rate increased with the reaction temperature up to 35 degrees C but decreased at temperatures greater than 35 degrees C due to the decreased solubility of O3. The addition of H2O2 did not increase the reaction rate significantly.

Detection of radiation effects using recombinant bioluminescent Escherichia coli strains

Effects of ionizing radiation (0.1-500 Gy) on recombinant Escherichia coli cells containing the stress promoters recA, grpE, or katG, fused to luxCDABE, were characterized by monitoring transcriptional responses reflected by the bioluminescent output. The minimum dose of gamma-irradiation detected by E. coli DPD2794 (recA::luxCDABE) was about 1.5 Gy, while the maximum response was obtained at 200 Gy. The amount of emitted bioluminescence increased proportionally with the gamma-ray doses which were found to elicit a DNA damage response in a range of 1-50 Gy. In addition, the cell growth rate was severely, but transiently, retarded by about 50 Gy. Quantification of the gamma-ray dose may be possible using the recA promoter fusion, since linear enhancement of the bioluminescence emission with increasing gamma-ray dose was observed. Other irradiated strains (50 Gy) responsive to either oxidative stress (DPD2511, katG::luxCDABE) or protein-damaging stress (TV1061, grpE::luxCDABE) did not display an increased bioluminescent output, while DPD2794 irradiated by the same dose of gamma-rays gave a significant bioluminescent output. This indicates that the recA promoter is the one most suitable for developing a biosensor for ionizing radiation.

Endoscopic bone graft for delayed union and nonunion

We performed endoscopic bone grafting for eight patients of delayed union and nonunion which developed after femoral and humeral shaft fractures. The mean interval from initial intervention to endoscopic bone grafting was 7.3 months. Six patients of delayed union and nonunion healed at 4.1 months on average. Two patients had unsatisfactory healing and eventually underwent non-endoscopic revisional surgery. There was no intraoperative on postoperative complication. Endoscopic bone grafting can be a less invasive alternative, obtaining rapid bone union in cases of compromised healing of the diaphyseal fracture.

Modulation of the biologic activity of the rabbit intervertebral disc by gene therapy: an in vivo study of adenovirus-mediated transfer of the human transforming growth factor beta 1 encoding gene

STUDY DESIGN

In vivo studies using a rabbit model to determine the biologic effects of direct, adenovirus-mediated transfer of a therapeutic gene to the intervertebral disc.

OBJECTIVES

1) To deliver an exogenous therapeutic gene to rabbit lumbar intervertebral discs in vivo, 2) to quantify the resulting amount of gene expression, and 3) to determine the effect on the biologic activity of the discs.

SUMMARY OF BACKGROUND DATA

Although growth factors such as transforming growth factor beta 1 appear to have promising therapeutic properties, there currently is no practical method for sustained delivery of exogenous growth factors to the disc for the management of certain chronic types of disease (e.g., disc degeneration). A possible solution is to modify the disc cells genetically through gene transfer such that the cells manufacture the desired growth factors endogenously on a continuous basis.

METHODS

Saline, with or without virus, was injected directly into lumbar discs of 22 skeletally mature female New Zealand white rabbits. Group 1 (n = 11) received the adenovirus construct Ad/CMV-hTGF beta 1 containing the therapeutic human transforming growth factor beta 1-encoding gene. Group 2 (n = 6) received adenovirus containing the luciferase marker gene. Group 3 (n = 5) received saline only. The rabbits were killed 1 week after injection. Immunohistochemical staining for human transforming growth factor beta 1 was performed on the disc tissues of one rabbit from Group 1. Nucleus pulposus tissues from the remaining rabbits were cultured in serumless medium. Bioassays were performed to determine human transforming growth factor beta 1 production and proteoglycan synthesis.

RESULTS

Discs injected with Ad/CMV-hTGF beta 1 exhibited extensive and intense positive immunostaining for transforming growth factor beta 1. The nucleus pulposus tissues from the discs injected with Ad/CMV-hTGF beta 1 exhibited a 30-fold increase in active transforming growth factor beta 1 production, and a 5-fold increase in total (active + latent) transforming growth factor beta 1 production over that from intact control discs (P < 0.05). Furthermore, these tissues exhibited a 100% increase in proteoglycan synthesis compared with intact control tissue, which was statistically significant (P < 0.05).

CONCLUSIONS

The results of this study suggest that the intervertebral disc is an appropriate site for adenovirus-mediated transfer of exogenous genes and subsequent production of therapeutic growth factors. Gene therapy therefore may have useful applications for study of the basic science of the intervertebral disc and for clinical management of degenerative disc disease.

Endoscopic bone graft for delayed union and nonunion

Nonunion and delayed union are serious consequences in the treatment of fractures. Bone graft has been a mainstay of treatment for nonunion and delayed union. But with rapid development of the endoscopic procedure, bone grafting can be performed after curettage of fibrous tissue around the fracture gap and sclerotic fracture end under direct visual control of the endoscope. This technical note provides procedures for this technique.

Clear cell acanthoma presenting as polypoid papule combined with melanocytic nevus

We report on a case of clear cell acanthoma that developed above a preexisting melanocytic nevus. Although melanocytic nevi can be complicated by the presence of several different types of epithelial or appendageal tumors, there have been no reported case of clear cell acanthoma combined with a nevus. Interestingly, in this case the clear cell acanthoma had a polypoid configuration, an unusual finding.

Multiple neurilemomas. A case report

Multiple neurilemomas in diverse locations of the body developed in a 53-year-old woman. The patient had multiple neurilemomas which occurred in the thoracic spine, lumbar spine, retroperitoneal sympathetic chain, sacral nerve root, femoral nerve, both sciatic nerves, radial nerve, and ulnar nerve without evidence of Von Recklinghausen's disease. This is the first well documented report on multiple neurilemomas with whole body distribution.

Increased ciliary neurotrophic factor expression in reactive astrocytes following spinal cord injury in the rat

Expression of ciliary neurotrophic factor (CNTF) was observed in reactive astrocytes in injured spinal cord of the adult rat. After unilateral incision of the dorsal funiculus at a midthoracic level, the rats were sacrificed on the day of postoperation (DPO) 3, 7, 14 or 28. Western blot analysis of spinal cord extracts showed that the intensity of the CNTF-immunoreactive band of 24 kDa was increased on DPO 3 and 7 and decreased on DPO 14. CNTF- or glial fibrillary acidic protein (GFAP)-like immunoreactivity was also increased progressively in the injured dorsal funiculus and adjacent gray matter. Double immunofluorescence histochemistry revealed that all CNTF-like immunoreactive cells showed GFAP-like immunoreactivity. The CNTF upregulation in the reactive astrocytes may play important roles in repair process after spinal cord injury.

Granulocyte macrophage colony-stimulating factor is the main cytokine enhancing survival of eosinophils in asthmatic airways

Interleukin (IL)-3, IL-5 and granulocyte macrophage colony-stimulating factor (GM-CSF) prolong the survival of eosinophils, which are conspicuous in asthmatic airways, but it is still controversial which one plays a major role in enhancing the survival of eosinophils in asthmatic airways. The role of these cytokines in airway eosinophilia was investigated using bronchoalveolar lavage (BAL) fluids from 11 symptomatic and nine asymptomatic patients with asthma and eight normal subjects. Eosinophil survival-enhancing activity (ESEA) was measured by a numerical change in viable eosinophils isolated from the peripheral blood of atopic patients and cultured with BAL fluids. ESEA was characterized by neutralization with antibodies to IL-3, IL-5 and/or GM-CSF. The differential count of BAL cells was achieved using Diff-Quik stain. T-cell subsets and activated T-cells were analysed by flow cytometry with dual stain using monoclonal antibodies to CD3, CD4, CD8 and CD25. ESEA was detected in eight of 11 BAL fluids of symptomatic asthma, but not in those of normal controls or asymptomatic asthmatics. In six symptomatic asthmatics, the mean percentage of inhibition in ESEA by anti-GM-CSF was higher than that of anti-IL-5 as well as anti-IL-3 (p<0.05). A mixture of antibodies to IL-3, IL-5 and GM-CSF totally inhibited the ESEA in four cases. The ESEA correlated with the percentage of eosinophils (p<0.05) and that of CD25(+)CD4 lymphocytes (p<0.05) of BAL cells. In conclusion, granulocyte macrophage colony-stimulating factor, rather than interleukin-3 or -5, is associated with eosinophil survival-enhancing activity inside the airways of symptomatic asthmatics. The activation of CD4 lymphocytes is related to the elevation of such activity.

Transcanalicular laser-assisted revision of failed dacryocystorhinostomy

BACKGROUND AND OBJECTIVE

Despite the high success rate of external dacryocystorhinostomy (DCR), recurrent tearing after DCR can be troublesome. The authors performed transcanalicular revision in 6 patients with failed DCR.

PATIENTS AND METHODS

With the use of a continuous wave Nd:YAG laser with a sclerostomy probe, the internal ostium was reopened by a transcanalicular approach. The authors applied 0.4 mg/ml of mitomycin-C around the opening for 5 minutes intranasally and inserted a silicone tube as a stent.

RESULTS

A total of 7 operations were performed in 6 patients. The operation was successful after the first revision in 5 of the 6 patients, but 1 of the patients required a second procedure.

CONCLUSIONS

The transcanalicular laser-assisted revision has several advantages. It is simple and fast, skin incision is avoided, there is good hemostasis, it is less traumatic, and there is less postoperative morbidity.

The T cell receptor subsets of lymphocytes in bronchoalveolar lavage in patients with active pulmonary tuberculosis

STUDY OBJECTIVE

To determine whether or not the levels of gamma/delta lymphocytes increase in bronchoalveolar lavage (BAL) fluid from patients with pulmonary tuberculosis.

DESIGN

Prospective data collection relating to cells in BAL fluid and peripheral blood mononuclear cells (PBMC) from patients with pulmonary tuberculosis and control subjects.

SETTING

A university hospital, from March 1990 to December 1993.

PATIENTS

Thirteen patients with pulmonary tuberculosis who were diagnosed by culture of Mycobacterium tuberculosis from their sputum of BAL fluid and/or clinical response were enrolled in the study. Fifteen healthy volunteers participated as control subjects.

MEASUREMENTS AND RESULTS

The differential cell counts in BAL fluid were made by Diff-Quik stain. The percentages of T-cell receptor (TCR) (gamma/delta and alpha/beta)-positive lymphocytes and interleukin 2 (IL-2) receptor-positive CD3 lymphocytes in BAL fluid and peripheral blood were measured by dual scan with flow-cytometry. The percentage and absolute number of lymphocytes and the percentages of CD3+, IL2R+ lymphocytes in BAL fluid significantly increased in patients with tuberculosis when compared with those of control subjects. The percentages and numbers of gamma/delta and alpha/beta TCR-positive lymphocytes in BAL fluid and PBMC from patients with tuberculosis and indistinguishable from those of control subjects.

CONCLUSIONS

gamma/delta Lymphocytes do not appear to have as much meaning in patients as they do in animal studies.