Torticollis of a specific C1 dislocation with split atlas

STUDY DESIGN

A case report.

OBJECTIVE

We report a novel case of torticollis disorder because of a congenital split atlas after minor trauma.

SUMMARY OF BACKGROUND DATA

Torticollis experienced after minor trauma in childhood is usually because of atlantoaxial rotatory fixation, which is a common disorder in pediatric patients and is usually diagnosed with computed tomography (CT). CT scanning with 3-dimensional reconstruction, however, showed a unique rotation of split atlas, a congenital anomaly that presented with torticollis.

METHODS

A female child aged 3 years and 11 months presented to the orthopedic clinic with torticollis after a fall. CT imaging showed no rotatory dislocation of C1-C2. On the 3-dimensional CT reconstruction images, however, anterior and posterior defects in the atlas, the so-called split atlas, and an atypical rotation with malalignment of the posterior arch and asymmetry of the atlantoaxial facet joint were noted. The child was treated with closed reduction using skull traction under general anesthesia.

RESULT

Repositioning of the atlas rotation was confirmed using intraoperative 3-dimensional scanning, and open reduction therapy was avoided. The patient was treated with halo vest for 8 weeks and had full recovery of neck motion with resolution of the torticollis.

CONCLUSION

We present a novel torticollis disorder caused by C1 rotation of a split atlas with closed reduction treatment.

Efficacy of HGF gene transfer for various nervous injuries and disorders

Hepatocyte growth factor (HGF) was originally identified as a molecule that could stimulate DNA synthesis in rat and human hepatocytes by autophosphorylation of the proto-oncogene c-met, which is a high-affinity receptor for HGF. Although it was at first considered that HGF could exert biological effects only on specific target cells, it has since been demonstrated that HGF mediates inflammatory responses to tissue injury and also regulates cell growth, cell motility, and morphogenesis in a wide variety of cell types, including cells within the nervous system. In the nervous system, HGF plays a role as a potent neurotrophic and angiogenetic factor. This factor promotes both the survival of neurons and the regeneration of injured nerves, and may also function as target-derived axonal chemoattractants, guiding axons to their target. These observations raised hopes that HGF protein might be useful for the clinical treatment of nervous system disorders. However, administration of HGF as a recombinant protein is still beset by a number of problems, such as a short serum half-life and poor access to the central nervous system by the systemic route because of the presence of the blood-brain barrier. These problems can be major obstacles to the clinical use of this factor in a recombinant protein form, and has highlighted the need to develop innovative therapeutic strategies for more efficient delivery into the nervous system. Gene transfer into the nervous system has enormous therapeutic potential for a wide variety of disorders. It appears to have advantages over the administration of single or multiple bolus doses of a recombinant protein because gene transfer can achieve an optimally high, local concentration within the nervous system. In this article, we demonstrate the efficacy of HGF gene transfer and provide an overview of ideal treatment regimes for various nervous injuries and disorders.

Impact of superselective transarterial infusion therapy of high-dose cisplatin on maxillary cancer with orbital invasion

BACKGROUND AND PURPOSE

We have been performing the superselective transarterial infusion of high-dose cisplatin for advanced maxillary cancer since 1998 and the local control rate, disease free survival rate, and organ preservation have improved markedly compared with our former therapy. This study evaluates the effectiveness of superselective transarterial infusion therapy by using high-dose cisplatin on maxillary cancer with orbital invasion.

MATERIALS AND METHODS

We treated 23 patients with maxillary cancer by using superselective transarterial infusion therapy with high-dose cisplatin and concomitant radiation therapy for 10 years. Of all patients, 15 showed orbital invasion, with 11 of these tumors fed by both internal maxillary and ophthalmic arteries. In all patients, we performed superselective transarterial infusion therapy via the internal maxillary artery and/or the other feeding branches from the external carotid artery. After the operation, we determined whether a pCR had occurred by checking for the presence of viable cells. In addition, we calculated the overall survival rate, preservation rate of the eyeball, and disease-free survival rate.

RESULTS

For all 23 patients, pCR and overall survival rates were 95.7% and 78.4%, respectively. To date, 2 of these patients died of lung metastasis without local recurrence. For the 15 patients with orbital invasion, the respective pCR and disease-free survival rates were 93.3% and 87.5%. Eyeballs were preserved in all patients, and local recurrence occurred in only 1 patient, at the inferior wall of the maxillary sinus (not in the orbit).

CONCLUSIONS

Superselective transarterial infusion therapy with high-dose cisplatin remarkably improved the local control rate and disease-free survival rate of maxillary cancer. Even in patients with orbital invasion, a high local control rate was achieved, with preservation of the eyeball, through infusion only into branches of the external carotid artery.

An fMRI study of musicians with focal dystonia during tapping tasks

Musician's dystonia is a type of task specific dystonia for which the pathophysiology is not clear. In this study, we performed functional magnetic resonance imaging to investigate the motor-related brain activity associated with musician's dystonia. We compared brain activities measured from subjects with focal hand dystonia and normal (control) musicians during right-hand, left-hand, and both-hands tapping tasks. We found activations in the thalamus and the basal ganglia during the tapping tasks in the control group but not in the dystonia group. For both groups, we detected significant activations in the contralateral sensorimotor areas, including the premotor area and cerebellum, during each tapping task. Moreover, direct comparison between the dystonia and control groups showed that the dystonia group had greater activity in the ipsilateral premotor area during the right-hand tapping task and less activity in the left cerebellum during the both-hands tapping task. Thus, the dystonic musicians showed irregular activation patterns in the motor-association system. We suggest that irregular neural activity patterns in dystonic subjects reflect dystonic neural malfunction and consequent compensatory activity to maintain appropriate voluntary movements.

Acute pyogenic discitis in a degenerative intervertebral disc in an adult

A 35-year-old male who had been receiving conservative treatment for L4 isthmic spondylolisthesis suffered from pyogenic spondylodiscitis in the degenerative L4/L5 intervertebral disc space, which could be identified by comparison with previous images. Symptoms improved with conservative antibiotic treatment. Neovascularization may occur in the annulus fibrosus of a degenerative intervertebral disc, which may increase the risk of hematogenous infection, leading to "discitis" even in adults.

Influence of intra-articular neutrophils on the effects of photodynamic therapy for murine MRSA arthritis

Although there have been some reports about the cytotoxic effects of photodynamic therapy (PDT) on multidrug-resistant bacteria, there have been few reports in which favorable results of PDT on a local infection site are described. This study aimed to verify the hypothesis that the low efficacy of PDT on a local infection site is due to the cytotoxic effect of PDT on leukocytes. PDT using Photofrin exerted significant cytotoxicity for cultured methicillin-resistant Staphylococcus aureus (MRSA). Nevertheless, this therapeutic modality was not effective for a murine MRSA arthritis model. Approximately 30% of intra-articular leukocytes, mainly neutrophils, died immediately after PDT, and a further decrease in the number of intra-articular leukocytes and atrophy of the synovial tissue were seen 24 h after PDT. Isolated peripheral neutrophils showed significant affinity for Photofrin and showed significant morphological damage, resulting in cell death, when they were subject to PDT using Photofrin. These results indicate that intra-articular neutrophils have an influence on the effects of PDT for MRSA arthritis.

Characteristics of light reflected from a dense ionization wave with a tunable velocity

An optically dense ionization wave (IW) produced by two femtosecond (approximately 10/30 fs) laser pulses focused cylindrically and crossing each other may become an efficient coherent x-ray converter in accordance with the Semenova-Lampe theory. The resulting velocity of a quasiplane IW in the vicinity of pulse intersection changes with the angle between the pulses from the group velocity of ionizing pulses to infinity allowing a tuning of the wavelength of x rays and their bunching. The x-ray spectra after scattering of a lower frequency and long coherent light pulse change from the monochromatic to high order harmoniclike with the duration of the ionizing pulses.

Bone mass assessment in naval crew members by quantitative ultrasound technique

OBJECTIVE

Of necessity, naval crews live in confined spaces when on board warships, which may lead to decreased bone mass and to subsequent bone fractures. Therefore, we investigated the bone mass of crew members and the relationship between bone mass and lifestyle factors.

METHODS

We selected 1510 crew members of the Japan Maritime Self-Defense Force. All were men between 18 and 58 years of age. We measured their bone mass by applying quantitative ultrasound (QUS) to the calcaneus. In addition, we reviewed daily milk consumption, levels of physical exercise, type of on-board job, fracture history, nutritional supplementation habits, and body mass index (BMI).

RESULTS

Bone mass values were lower than the published mean values for Japanese men across the twenties to forties age groups.

CONCLUSIONS

The factors found to be related to bone mass in this study were age, type of on-board job, exercise level, and milk consumption. Lifestyle factors are usually within our control. Our data suggest that moderate levels of regular exercise and milk consumption may maintain bone mass.

Laser-filament-induced corona discharges and remote measurements of electric fields

Femtosecond laser pulses were used to make plasma filaments near an isolated positively or negatively highly biased electrode. The electrode was well positioned to sustain a high voltage up to U(max)=+/-400 kV to avoid the induced breakdown or a glow discharge; the shape of the electrode was chosen to reduce the corona effects at the maximal voltage. The filament's UV emission is shown to be very sensitive to the voltage applied: it increases nonlinearly with the electrode potential. Along with nanosecond filament-induced flashes at both polarities, long, about a half microsecond, corona flashes were observed at the negative polarity.

Photocrosslinkable chitosan hydrogel can prevent bone formation in both rat skull and fibula bone defects

UV light irradiation to a photocrosslinkable chitosan (Az-CH-LA) resulted in an insoluble and flexible hydrogel within 30 s. The purpose of this study was to evaluate the ability of the photocrosslinkable chitosan to inhibit bone formation in the bone defects. A 5-mm-diameter defect was made in the rat calvarium, and then photocrosslinkable chitosan was implanted and irradiated with UV for 30 s. Furthermore, a 2-mm defect was made in the fibula of a rat hind leg, and then photocrosslinkable chitosan was implanted and irradiated with UV. Bone formations in the rat skull and fibula defects with photocrosslinkable chitosan hydrogel were significantly prevented for 8 weeks. Thus, the chitosan hydrogel has an inhibitory effect on bone formation.

Ion spectrometer composed of time-of-flight and Thomson parabola spectrometers for simultaneous characterization of laser-driven ions

An ion spectrometer, composed of a time-of-flight spectrometer (TOFS) and a Thomson parabola spectrometer (TPS), has been developed to measure energy spectra and to analyze species of laser-driven ions. Two spectrometers can be operated simultaneously, thereby facilitate to compare the independently measured data and to combine advantages of each spectrometer. Real-time and shot-to-shot characterizations have been possible with the TOFS, and species of ions can be analyzed with the TPS. The two spectrometers show very good agreement of maximum proton energy even for a single laser shot. The composite ion spectrometer can provide two complementary spectra measured by TOFS with a large solid angle and TPS with a small one for the same ion source, which are useful to estimate precise total ion number and to investigate fine structure of energy spectrum at high energy depending on the detection position and solid angle. Advantage and comparison to other online measurement system, such as the TPS equipped with microchannel plate, are discussed in terms of overlay of ion species, high-repetition rate operation, detection solid angle, and detector characteristics of imaging plate.

Skeletal unloading induces a full-thickness patellar cartilage defect with increase of urinary collagen II CTx degradation marker in growing rats

Mechanical stress plays an important role in tissue morphogenesis and extracellular matrix metabolism. However, little is known about the effects of reduced loading without restriction of joint motion on the patella. We investigated the effects of long-term skeletal unloading on patellar cartilage and subchondral bone and systemic collagen II metabolism. Nine-week-old male F344/N rats (n=128) were randomly divided into two groups: caged control (C) and tail suspended (TS). Hindlimbs of the TS rats were subjected to unloading for up to 12 weeks. Sequential changes in the patellar cartilage and subchondral bone were analyzed macroscopically, by pathological findings and histomorphologically. All animals received double tidemark fluorochrome labeling prior to sacrifice. Glycosaminoglycan (GAG) content in patellar cartilage, cross-linked C-telopeptide of type II collagen (CTx-II) in 24-h urine and type II procollagen-C-peptide (pCol-II-C) in sera were also measured by DMB assay, ELISA and EIA, respectively. In the TS group, GAG content was significantly reduced only during the first 3 weeks. No further significant decrease was found. Alkaline phosphatase (ALP) activity was increased, especially at the deep zone. Tidemark mineral apposition rate (MAR) was temporally increased, which resulted in an increase in the ratio of calcified cartilage to the entire cartilage. In the medial part, in addition, thickness of the entire cartilage was decreased by temporal acceleration of subchondral ossification advancement and, in the medial margin, a full-thickness cartilage defect was revealed in 88.6% of TS rats. However, the remaining articular surface was free from fibrillation. While urinary CTx-II was significantly increased during the experimental periods, serum pCol-II-C was significantly decreased at the early phase. There were significant correlations between the urinary CTx-II levels and tidemark MAR. Our results provided evidence that skeletal unloading increased ALP activity at the deep zone and temporally accelerated tidemark advancement associated with a decrease in proteoglycan content. In addition, skeletal unloading temporally accelerated subchondral ossification advancement in the medial part of the patella and finally induced a full-thickness patellar cartilage defect without any fibrillation at the remaining articular surface by additional subchondral bone modeling and possible retarded cartilage growth, which was through a different mechanism than overloading.

Nonviral retrograde gene transfer of human hepatocyte growth factor improves neuropathic pain-related phenomena in rats

Peripheral nerve injury occasionally causes chronic neuropathic pain with hyperalgesia and allodynia. However, its treatment is difficult. Here, we used a chronic constriction injury (CCI) model in rats to investigate the effects on experimental neuropathic pain of the human hepatocyte growth factor (HGF) gene delivered into the nervous system by retrograde axonal transport following its repeated intramuscular transfer, using liposomes containing the hemagglutinating virus of Japan (HVJ). CCI (control) rats exhibited marked mechanical allodynia and thermal hyperalgesia, and decreased blood flow in sciatic nerve and hind paw. All these changes were significantly reversed by HGF gene transfer. In the sciatic nerve in HGF-treated rats, the size-frequency distributions for myelinated and unmyelinated axons each showed a rightward shift, the number of myelinated axons >5 microm in diameter was significantly increased, and the mean diameter of unmyelinated axons was significantly increased (versus CCI rats). Levels of P2X3, P2X4, and P2Y1 receptor mRNAs, and of interleukin-6 (IL-6) and activating transcription factor 3 (ATF3) mRNAs, were elevated in the ipsilateral dorsal root ganglia and/or sciatic nerve by CCI, and these levels were decreased by HGF gene transfer. These results may point toward a potential new treatment strategy for chronic neuropathic pain in this model.

Superficial zone chondrocytes in normal and osteoarthritic human articular cartilages synthesize novel truncated forms of inter-alpha-trypsin inhibitor heavy chains which are attached to a chondroitin sulfate proteoglycan other than bikunin

OBJECTIVE

We have examined the occurrence of the inflammation-associated inter-alpha-trypsin inhibitor (IalphaI) components, bikunin, heavy chain (HC)1 and HC2 in normal cartilage and osteoarthritis (OA) cartilage and synovial fluids.

DESIGN/METHODS

Cartilage extracts from normal donors and late-stage OA patients, and synovial fluids from OA patients were studied by Western blot with multiple antibodies to bikunin, HC1 and HC2. Cell and matrix localization was determined by immunohistochemistry and mRNA by RT-PCR.

RESULTS

Bikunin.chondroitin sulfate (CS) and IalphaI were abundant in OA cartilages, but virtually undetectable in normal. In both OA and normal cartilages, HCs were largely present in a novel C-terminally truncated 50-kDa form, with most, if not all of these being attached to CS on a proteoglycan other than bikunin. Synovial fluids from OA patients contained bikunin.CS and full-length (approximately 90 kDa) HCs linked to hyaluronan (HA) as HC.HA (SHAP.HA). Immunohistochemistry showed intracellular and cell-associated staining for bikunin and HCs, consistent with their synthesis by superficial zone chondrocytes. PCR on multiple human normal and OA cartilage samples detected transcripts for HC1 and HC2 but not for bikunin. In OA cartilages, immunostaining was predominantly matrix-associated, being most intense in regions with a pannus-like fibrotic overgrowth.

CONCLUSION

The truncated structure of HCs, their attachment to a proteoglycan other than bikunin, PCR data and intracellular staining are all consistent with synthesis of HC1 and HC2 by human articular chondrocytes. The presence of bikunin.CS and IalphaI in OA cartilage, but not in normal, appears to be due to diffusional uptake and retention through fibrillated (but not deeply fissured) cartilage surfaces.

Sural nerve grafting for long defects of the femoral nerve after resection of a retroperitoneal tumour

Most injuries to the femoral nerve are iatrogenic in origin and occur during resection of large retroperitoneal tumours. When the defect is considerable a nerve graft is mandatory to avoid tension across the suture line. We describe two cases of iatrogenic femoral nerve injury which recovered well after reconstruction with long sural nerve grafts. The probable reasons for success were that we performed the grafting soon after the injury, the patients were not too old, the nerve repairs were reinforced with fibrin glue and electrical stimulation of the quadriceps was administered to prevent muscle atrophy. Good functional results may be obtained if these conditions are satisfied even if the length of a nerve graft is more than 10 cm.

Induction of hepatic Cyp2b and Cyp3a subfamily enzymes by nicardipine and nifedipine in mice

1. Nicardipine (Nic) or nifedipine (Nif) was given to male and female C57BL/6J mice by a single gavage at doses of 100, 200 and 400 micromolkg(-1), and changes in the levels of mRNA and apoprotein of hepatic cytochrome P450 (P450) enzymes, including Cyp2b9, Cyp2b10, Cyp3a11 and Cyp3a41, were examined by reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting, respectively. Furthermore, hepatic microsomal activities for pentoxyresorufin O-dealkylation (PROD) and nifedipine oxidation, which are mainly mediated by Cyp2b and Cyp3a subfamily enzymes, respectively, were measured. 2. Results from RT-PCR analysis revealed that Nic, but not Nif, showed a capacity for activating the Cyp3a11 gene in either sex of mice and that both chemicals could induce a male-selective activation of Cyp2b10 gene, although they had no capacity for activating the Cyp2b9 and Cyp3a41 genes in either sex. 3. Increased levels of the mRNAs of Cyp2b10 and Cyp3a11 were closely correlated with those of apoprotein and activity of the corresponding P450 subfamily enzymes. 4. The study demonstrated for the first time that Nic, but not Nif, showed the ability to induce Cyp3a11 in both sexes of mice, although both Nif and Nic led to a male-selective induction of Cyp2b10, and that Nic and Nif had no ability to induce Cyp2b9 and Cyp3a41 in either sex.

Effect of the brain-derived neurotrophic factor and the apolipoprotein E polymorphisms on disease progression in preclinical Alzheimer's disease

Genetic factors, such as apolipoprotein E (ApoE) polymorphisms, are thought to play an important role in the etiology of Alzheimer's disease (AD). Recent association studies have suggested that the Val66Met polymorphism in the brain-derived neurotrophic factor (BDNF) gene could play a role in the development of AD. To identify genotypic effects of the BDNF and the ApoE genes on disease progression in preclinical AD, we assessed morphological changes using serial magnetic resonance imaging during the preclinical period of AD in 35 individuals. When all subjects were analyzed as one group, progressive atrophy was noted in the limbic, paralimbic and neocortical areas. Individuals of the BDNF Val/Val genotype showed progressive atrophy in the left medial temporal areas, whereas the BDNF Met allele carriers showed additional changes in the anterior cingulate cortex (ACC), posterior cingulate cortex (PCC) and the precuneus. An interaction between the BDNF genotype and progressive morphological changes was found in the PCC. The noncarriers for the ApoE epsilon4 allele showed progressive atrophy in the bilateral medial temporal areas. In addition to changes in the medial temporal areas, epsilon4 carriers showed progressive atrophy in the PCC, ACC and precuneus. An interaction between the ApoE genotype and progressive morphological change was noted in the right medial temporal area. The present preliminary study indicates that polymorphisms of the ApoE and the BDNF genes could affect disease progression in preclinical AD and implies that the Met-BDNF polymorphism could be an additional risk factor for rapid disease progression in preclinical AD.

Deoxyspergualin in relapsing and refractory Wegener's granulomatosis

OBJECTIVES

Conventional therapy of Wegener's granulomatosis with cyclophosphamide and corticosteroids is limited by incomplete remissions and a high relapse rate. The efficacy and safety of an alternative immunosuppressive drug, deoxyspergualin, was evaluated in patients with relapsing or refractory disease.

METHODS

A prospective, international, multicentre, single-limb, open-label study. Entry required active Wegener's granulomatosis with a Birmingham vasculitis activity score (BVAS) > or =4 and previous therapy with cyclophosphamide or methotrexate. Immunosuppressive drugs were withdrawn at entry and prednisolone doses adjusted according to clinical status. Deoxyspergualin, 0.5 mg/kg per day, was self-administered by subcutaneous injection in six cycles of 21 days with a 7-day washout between cycles. Cycles were stopped early for white blood count less than 4000 cells/mm(3). The primary endpoint was complete remission (BVAS 0 for at least 2 months) or partial remission (BVAS <50% of entry score). After the sixth cycle azathioprine was commenced and follow-up continued for 6 months.

RESULTS

42/44 patients (95%) achieved at least partial remission and 20/44 (45%) achieved complete remission. BVAS fell from 12 (4-25), median (range) at baseline to 2 (0-14) at the end of the study (p<0.001). Prednisolone doses were reduced from 20 to 8 mg/day (p<0.001). Relapses occurred in 18 (43%) patients after a median of 170 (44-316) days after achieving remission. Severe or life-threatening (> or = grade 3) treatment-related adverse events occurred in 24 (53%) patients mostly due to leucopaenias.

CONCLUSIONS

Deoxyspergualin achieved a high rate of disease remission and permitted prednisolone reduction in refractory or relapsing Wegener's granulomatosis. Adverse events were common but rarely led to treatment discontinuation.