Anterior tarsal tunnel syndrome: case report

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy involving the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle and foot. This syndrome may be a clinically under-recognized entity, thus making a missed diagnosis and delayed treatment likely. We present the case of a 53-year-old woman who for many years had experienced the clinical symptoms of anterior tarsal tunnel syndrome, including pain in the dorsum of the right foot with numbness radiating to the first web space. Roentgenograms of the foot revealed osteophytes on the dorsum of the talus as it articulated with the navicular bone. During surgery, the osteophytes were found to be irritating the deep peroneal nerve. After surgical decompression of the anterior tarsal tunnel, the patient had a significant reduction of symptoms. One year later, she was noted to be asymptomatic with normal physical findings. We believe that this case points to the necessity of more thoughtful attention to this syndrome and its diagnosis. That is to say, a thorough knowledge of the pathogenesis and a comprehensive physical examination are the prerequisites for correct diagnosis and appropriate treatment.

Characterization of a new ribotoxin gene (c-sar) from Aspergillus clavatus

A new ribotoxin, c-sarcin, was isolated from a culture of Aspergillus clavatus. A full-length genomic DNA (c-sar) coding for c-sarcin was cloned and sequenced. The deduced amino acid sequence showed a high homology to restrictocin and alpha-sarcin. The native toxin as well as the recombinant protein hydrolysed ribosomes and naked RNA. The genomic structure of the c-sar gene had an intron located between the coding sequences for secretory signal peptide and the mature protein. The intron contained a stretch of 38 adenines. The intron sequence of c-sar was different from that of restrictocin but resembled that of alpha-sarcin. There was 34% identity between the intron of c-sarcin and alpha-sarcin, and this similarity was further increased to 83% if the stretch of polyadenine was omitted.

Percutaneous absorption of 2,4-dichlorophenoxyacetic acid from soil with respect to soil load and skin contact time: in vivo absorption in rhesus monkey and in vitro absorption in human skin

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D), used for control of weeds in agriculture, forestry, and rights of way, can accumulate as a residual chemical in soil. The objective was to determine percutaneous absorption of 2,4-D from soil, with emphasis on soil load and skin contact time. With control acetone vehicle, in vivo absorption of 2,4-D in the rhesus monkey was 8.6 +/- 2.1% of the dose, which compared closely to published human absorption of 6.0 +/- 2.4%. Percutaneous absorption from soil loads of 1 and 40 mg/cm2 were 9.8 +/- 4.0 and 15.9 +/- 4.7%, respectively, values similar to acetone vehicle. In vitro absorption in human skin calculated from skin contact accumulation over 24 h was 1.8 +/- 1.7, 1.7 +/- 1.3, and 1.4 +/- 1.2% for soil loads of 5, 10, and 40 mg/cm2, respectively. Thus, soil load did not affect 24-h percutaneous absorption. Current Environmental Protection Agency (EPA) recommended calculated reductions due to soil load are not supported by these results with 2,4-D. Percutaneous absorption of 2,4-D from acetone vehicle for 8 h dosing period was 3.2 +/- 1.0%, one-third the value of 8.6 +/- 2.1% over 24 h. With soil vehicle, absorption for 8 h was only 0.03 +/- 0.02% for 40 mg/cm2 soil load and 0.05 +/- 0/.004% for 1 mg/cm2 soil load. Absorption for 16 h was 2.2 +/- 1.2%. Absorption over time was linear for acetone vehicle, where total dose is deposited on skin, but not linear for soil vehicle, which had an 8-h delay (lag time). This equates with a normal 8-h work day where most of the contaminated soil can be washed off the skin. The apparent partition coefficient of 2,4-D between soil and water changed over time. This suggests there is a "mobility" phase for 2,4-D in soil that will change with time. For soil vehicle, percutaneous absorption of 2,4-D was not linear in respect to soil load or to skin contact time. Calculation based on assumed linearity can falsely estimate potential human health hazard. Clearly, the dermatokinetics with soil and skin represent complex interactive forces that require detailed evaluation before overgeneralizing rules for interpretation in terms of risk assessment.

Cytogenetic mapping of lambda gt10 lacZ sequences in the transgenic mouse strain 40.6 (Muta Mouse)

The transgenic mouse strain 40.6 (Muta Mouse) was developed for the detection of gene mutations induced in vivo. Strain 40.6 was constructed by microinjecting the shuttle vector lambda gt10 lacZ into the male pronucleus of a single cell embryo resulting from a CD2 (i.e. BALB/c x DBA/2)F1 x CD2F1 cross. Approximately 40 concatenated copies of the shuttle vector were integrated per haploid genome. The resulting mice were bred to disomy for the insert for use in mutagenicity studies. Ultimately, it is hoped that transgenic rodent model systems such as this one will play an important regulatory role in hazard identification. Despite the increasing use of this strain in toxicological studies, relatively little is known about the site of integration of the target gene into the mouse genome. In this study, fluorescence in situ hybridization and DAPI chromosome banding were combined to determine the location of the transgenic element in the mouse genome. The results indicate that the lambda sequences containing the lacZ gene are located in the B region of mouse chromosome 3. No other major chromosomal rearrangements were evident in the genome of this mouse strain.

Production of type II ribotoxins by Aspergillus species and related fungi in Taiwan

A molecular investigation was conducted on the production of type II ribotoxin of the species Aspergillus and related fungi in Taiwan. Species that carried ribotoxin were confirmed by (1) cross-reactivity to anti-alpha-sarcin serum; (2) Southern dot hybridization; (3) PCR amplification of genomic DNA with specific primers; and (4) analysis of ribotoxic activity. Five new strains, A. clavatus, A. oryzae var. effusus, A. ostianus, A. tamarii, and Neosartorya fischeri var. spinosa, were identified to contain an alpha-sarcin-like ribotoxin. These positive strains exhibit ribotoxic activity by cleaving ribosomes and generating an alpha-fragment.

Suitability of human chromosome-specific DNA libraries for mutagenicity studies in Macaca fascicularis

The development and use of chromosome-specific DNA probes to label entire human chromosomes has been an important advance in molecular cytogenetics. Fluorescence in situ hybridization using whole chromosome-specific DNA probes has been used to study both numerical and structural chromosomal aberrations in many human cell types. It would be useful if this technology could be applied to other animal species. However, whole chromosome-specific DNA probes have been reported for only human chromosomes. In this study, experiments were conducted to determine whether human probes could be used to label chromosomes of the cynomolgus monkey, Macaca fascicularis. The results demonstrate that some human DNA probes are suitable for the study of chromosomal aberrations in the monkey. Monkey chromosomes 1 and 4 labelled with human DNA probes had a strong, chromosome-specific labelling pattern. The probe for human chromosome 21 labelled the short arm on the monkey chromosome 2 and the probe for human chromosome 2 could not be detected on any of the monkey chromosomes.

[Second hip fracture]

During the period from 1982-1990, a total of 1644 patients were admitted to our hospital with proximal femoral fractures. Trochanteric fractures were encountered in 54 per cent of the cases (887/1644) with a mean age of 68 years. Cervical fractures were encountered in 46 per cent of the cases (757/1644) with a mean age of 62 years. We found 28 patients who had been readmitted with a second hip fracture in this retrospective study, including twenty three males and five females. Two of these second hip fractures occurred on the same side as the initial fracture and twenty six occurred on the opposite side. The time interval between the first and the second hip fracture was shorter in males than that in females (1.7 years V.S. 2.7 years) and the interval also was shorter in those with a previous trochanteric fracture as compared to those with a previous cervical fracture (1.5 years V.S. 2.6 years). It appeared that a hip fracture reduced the risk of a subsequent hip fracture on the same side, and almost all second hip fractures were located on the opposite side of the patient (93 per cent). A possible reason for this "protective mechanism" is increased strength of the bone due to callus formation. A significant symmetry (trochanteric-trochanteric or cervical-cervical) was found between the first and the second hip fractures (69 per cent). We believe the symmetrical fracture pattern is due to senile osteoporosis, a kind of ongoing systemic weakening of the skeletal system among the elderly.

Side effects during continuous epidural infusion of morphine and fentanyl

Respiratory effects, nausea, somnolence, and pruritus were compared during a 48-hr period of continuous epidural morphine (n = 34) and fentanyl (n = 32) infusion in 66 patients following elective total replacement of the hip or knee joint. Respiratory effects were assessed by PaCO2. Side effects were assessed by visual analogue scale and considered to be present when the score was above 30. Assessment was made at preoperative visits then 3, 6, 12, 24, 36, and 48 hr after the epidural injection. The bolus dose and subsequent infusion rate were 3,900 +/- 1,300 micrograms and 427 +/- 213 micrograms.hr-1 for morphine, and 85 +/- 46 micrograms and 56 +/- 27 micrograms.hr-1 for fentanyl. Pain relief was similar in both groups. In the morphine group, PaCO2 elevation and nausea occurred over a period of more than 12 hr (P less than 0.05). In the fentanyl group, there was no PaCO2 change, and nausea was confined to the first few hours. Nausea was more severe (P less than 0.01 at six hours and more frequent (24 hr cumulative incidence, 53 vs 28%, P less than 0.05) in the morphine group. Somnolence was prominent within several hours in two-thirds of patients in both groups. Somnolence continued to decline thereafter in the morphine group, but it was demonstrable in approximately half of the patients throughout the second day in the fentanyl group. The incidence was higher in the fentanyl group at the 48th hr (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acetabular roof reconstruction with femoral head bone-graft for severe acetabular deficiency in total hip replacement]

From July 1984 to September 1989 at Taichung Veterans General Hospital, 14 patients (15 hips) received femoral head bone-grafting by modified Harris method as a part of their total hip replacement for acetabular bony deficiencies. They were followed up for an average of 31.7 months (range from 7 to 66 months). The clinical results were classified as excellent (58.3%) and good (41.7%) by Harris hip scoring system. All the grafts presented as "solid incorporation" with the pelvic wall and only one of the grafts was assessed to be "definite resorption" (volume reduction greater than 50%) by radiologic study. The "biologic viability" of these grafts were proved to be positive by scintigraphy in three-dimensional technique (SPECT). According to our limited experience and primary follow-up studies, we found that good clinical results depend on ideal positioning of the acetabular component in the true acetabulum and femoral head bone-grafting is an ideal procedure for the reconstruction of severe acetabular dysplasia in total hip arthroplasty.

Stroke volume measurements by electrical bioimpedance and echocardiography in healthy volunteers

To evaluate the validity of three equations for estimation of thoracic electrical field size in a new bioimpedance algorithm, stroke volume (SV) as calculated by these equations was compared with that calculated by Doppler echocardiography in 48 healthy volunteers, both lean and obese. When the volume of electrically participating tissue was estimated from body height (modified Sramek) or body height corrected for body habitus (Sramek-Bernstein), there was considerable variation between bioimpedance and Doppler stroke volumes. When the volume of electrically participating tissue was estimated from the actual measurement of the height of the thorax and the circumference at the base of the thorax, the variation in SV differences decreased substantially (Sramek equation), although still considerable for clinical use, and there was no relationship between SV thus obtained and body habitus. Analysis of calculated stroke indices derived by our Doppler echocardiographic standard, as compared with values in the literature, revealed a systematic underestimation. We conclude that the original Sramek equation systematically underestimates SV by 15% to 20%, and the modified Sramek and Sramek-Bernstein equations systematically underestimates SV by 15% to 20%, and the modified Sramek and Sramek-Bernstein equations systematically overestimate SV in females by about 15%, but provide SV values in males in the predicted range. Further studies on the current assumption that the electrical field size is a truncated cone may improve precision of the bioimpedance method.

Peripheral somatic sensory neuropathy and skin galvanic response in the feet of patients with diabetes

The relationship between abnormality in the peripheral sympathetic nervous system (skin galvanic response) and in the peripheral somatic sensory nerve fibers was studied in the lower extremities of 51 patients with diabetes. Deficits in temperature and pain sensations (the small sensory nerve fibers) were related to abnormal sympathetic nervous function (temperature sensation, p less than 0.001; pain sensation, p less than 0.05). The deficits in temperature sensation, in particular, predicted abnormal sympathetic nervous function reliably and vice versa. There was no relationship between deficits in touch and vibration sensations (the large sensory nerve fibers) and abnormal sympathetic nervous function. There was a relationship between skin galvanic response and RR-variation (p less than 0.01). However, abnormality in RR-variation was not related to the deficits in any of the four sensory modalities.

Dose-dependent elimination of 5-fluoro-2'-deoxyuridine in the monkey

The kinetics of 5-fluoro-2'-deoxyuridine (FdUrd) and 5-fluorouracil (FUra) disposition after bolus intravenous injection were determined in anesthetized rhesus and cynomolgus monkeys. FdUrd disappearance from plasma was an apparent triexponential process with average half-lives of 0.5, 2, and 8 min; FUra disappearance was biphasic with average half-lives of 2 and 13 min. After FdUrd injection, FUra reached peak plasma concentrations of 15-30% of the initial FdUrd concentrations within 3 min, and then disappeared more slowly than FdUrd. Total FdUrd clearance fell from 105 to 73 to 56 ml/kg/min as the dose increased from 10 to 20 to 40 mg/kg. Metabolic clearance was about 85% of total clearance and fell similarly with increasing dosage. Total and metabolic FUra clearances were about 30% of FdUrd values at an equimolar dose. Renal FdUrd clearance exceeded glomerular filtration rate and was decreased by probenecid, indicating tubular secretion; renal FUra clearance was close to glomerular filtration rate. There was no apparent correlation between dose and renal clearance or volume of distribution. It was concluded that FdUrd, like FUra, is eliminated primarily by a dose-dependent process. The metabolic basis of the dose-dependent kinetics remains to be determined.

Peripheral plasma levels of prostaglandin metabolites, cortisol and prolactin in women undergoing falope ring application and tubal cautery

The levels of 11-deoxy-13,14-dihydro-15-keto-11 beta, 16 xi-cyclo PGE2 (bicyclo PGEM), 13,14-dihydro-15-keto PGF 2 alpha (PGFM), cortisol and prolactin were measured by radioimmunoassays in five serial plasma samples collected from fourteen patients undergoing falope ring application and three patients undergoing tubal electrocautery. Bicyclo PGEM, PGFM and cortisol levels were unchanged regardless of the type of tubal occlusion procedure or the type of anesthesia administered (7 received general and 10 local anesthesia). Prolactin levels, on the other hand, markedly increased. The increase was greatest in women that received general anesthesia. The lack of change in bicyclo PGEM and PGFM in peripheral plasma would suggest a local transfer of PGs produced by injured tubal tissue to other parts of the tube and the uterus resulting in increased contractions and pelvic pain.

Mezlocillin prophylaxis against infection after cesarean section: a comparison of techniques

We studied 212 patients undergoing emergency cesarean section at an urban hospital. Four techniques of antibiotic prophylaxis were used, including single-dose and triple-dose parenteral therapy, parenteral and lavage therapy, and lavage therapy alone. One agent, mezlocillin, was used for all patients. There was no significant difference in surgically related infectious morbidity among the groups. This antibiotic proved efficacious when related to historical controls, and was the most economical of the modalities of administration studied.

Effects of meclofenamate and acetaminophen on abdominal pain following tubal occlusion

To test the hypothesis that the postoperative abdominal pain of tubal occlusion is mediated by prostaglandins, the effects of meclofenamate, a potent inhibitor of cyclooxygenase, on postoperative analgesia and incidence of abdominal pain were compared with those of acetaminophen, a weak inhibitor of prostaglandin activity. One hundred patients undergoing tubal occlusion under local anesthesia were studied. The patients were randomly divided into four equal groups: control; acetaminophen, 1300 mg; meclofenamate, 100 mg; meclofenamate, 200 mg. The fallopian tubes were occluded by electrocautery in 47 patients and by application of Falope rings in 53 patients. Both acetaminophen and meclofenamate provided substantial analgesia for 4 hours after the operation (p less than 0.05). Meclofenamate reduced the incidence of abdominal pain by one half (p less than 0.02), but acetaminophen did not. These results suggest that a portion of pain relief achieved by meclofenamate may be due to suppression of myosalpingian and/or myometrial contractions, a process mediated by prostaglandins.

A new technique for measuring water transport across the seawater eel intestine

A new technique was developed for measuring net water flux across the eel intestine in vitro. The new perfusion method was suitable for long duration experiments because of continuous oxygen supply to both the external and the perfusion medium. Net water flux was calculated directly from the difference between the rates of effluent and perfusate flow without measuring the concentration of marker substances. The calculated value of net flux appears to be reliable because: its direction is always from mucosa to serosa in both everted and non-everted intestine; ouabain diminishes it to zero; it is identical with the standard water flux obtained under zero perfusion; and it is identical with the value obtained by means of [14C]PEG following the previous perfusion method. The net water fluxes obtained by the new method were steadier than those obtained with the previous complicated perfusion method. In this new experimental system, the net water flux and the transepithelial potential difference (PD) decreased gradually with time, and were not restored by application of adrenergic agonists or cortisol. These parameters were stimulated by 5 mmol l-1 L-alanine, but not by D-glucose, L-valine or L-glycine, indicating a specific action of L-alanine.

Screening test for urinary glycosaminoglycans and differentiation of various mucopolysaccharidoses

The Ames MPS paper spot test and the cetylpyridinium chloride (CPC)-citrate turbidity test were used to detect urinary glycosaminoglycans (GAGs) as screening tests for the diagnosis of mucopolysaccharidoses (MPSs). The simplicity and reliability of these two methods were evaluated. The MPS paper spot test correlated more closely with the carbazole test than did the CPC-citrate turbidity test. The monodimensional electrophoresis of Cappelletti et al was also used to screen the subtypes of MPSs using differences in electrophoretic patterns. MPS VII cannot be distinguished from normal by its electrophoretic pattern, but can be detected by the MPS paper spot test. Therefore, the MPS paper spot test combined with monodimensional electrophoresis can detect these subtypes of MPSs (MPS I-II, III, IV, VI, VII). Since only 20 ml of random urine is needed and the result can be obtained with complete reliability in only 7 hours, this screening test appears to be useful for the early diagnosis of MPSs.

Glycosaminoglycan excretion in random samples of urine

The measurement of glycosaminoglycans (GAGs) on a single random urine specimen in 405 healthy individuals and in 79 patients with mucopolysaccharidoses (MPSs) is described. The uronic acid (UA) content of the precipitated GAGs was estimated by the method of Bitter and Muir. The results were expressed as uronic acid to creatinine (UA/C) ratio. We found that the UA/C ratio decreased with age but had a rather constant low value between the ages of 20 and 33 in healthy individuals. Except for most patients with Morquio syndrome, the UA/C ratio in random urine samples was higher in patients with MPSs than in healthy individuals.

Effect of penicillin on the renal tubular secretion of methotrexate in the monkey

The effect of penicillin on the renal tubular secretion of methotrexate (MTX) in rhesus and cynomolgus monkeys was studied in vivo and in vitro. In stop-flow experiments in ketamine-anesthetized monkeys, the ratios of urine/plasma MTX concentration to urine/plasma inulin concentration of proximal tubular samples were about 2-fold greater than the base-line free-flow values of 3.3 to 4.8, indicating net proximal tubular secretion. MTX secretion was inhibited by penicillin, which lowered the base-line U/PMTX/U/Pinulin ratios to 0.8 to 1.3; the effect persisted over a 30-min period after discontinuation of penicillin administration. Penicillin also slowed the disappearance of MTX from plasma over a 2-hr period after i.v. bolus administration of MTX. In experiments with renal cortical slices, MTX uptake at 25 degrees was linear over the initial 30 min. The uptake Km and Vmax were 0.09 mM and 0.11 mumol/g of tissue/30 min, respectively. Penicillin competitively inhibited MTX uptake; the Ki was 0.83 mM. MTX efflux from preloaded slices (incubated with 0.5 mM MTX for 45 min) was a first-order process with an initial t1/2 of 7.1 min, which decreased to 2.0 min in the presence of 1.36 mM penicillin. It was concluded that MTX and penicillin share a common secretory system in the kidney and that penicillin blocks MTX secretion by inhibiting cellular uptake and stimulating efflux.