Nodular sclerosing Hodgkin disease with primary manifestation in the orbit

Hodgkin disease with primary manifestation in the orbit is extremely rare, and even when suspected can be very difficult to diagnose. Its clinical and histological presentation can be nearly impossible to differentiate from that of a benign inflammatory process, and it is necessary to utilize immunohistochemical techniques to confirm the diagnosis. This article focuses on a case of nodular sclerosing Hodgkin disease with initial manifestation in the orbit. A comparison of the clinical, histological, and immunohistochemical presentations associated with both Hodgkin disease and benign inflammation is discussed. A brief review of the immunohistochemistry specific for Hodgkin disease is also provided.

Histopathologic changes of the eyelid skin following trichloroacetic acid chemical peel

The use of trichloroacetic acid (TCA) as a periorbital and eyelid peel for skin rejuvenation is gaining significant acceptance among oculoplastic surgeons, dermatologists, and other surgery groups. In spite of the current enthusiasm, there remain potentially serious complications resulting from any periorbital peel. Cases of cicatricial ectropion have been reported in phenol-peeled patients, and lower eyelid ectropion has reportedly occurred in patients undergoing deep eyelid peel in conjunction with a blepharoplasty (1,2). To avoid this complication, it is necessary to better understand the depth of the wound produced by different strengths and combinations of peeling agents applied to living eyelid tissue and, more important, to determine the concentrations of TCA that are likely to lead to cicatricial ectropion when applied in a consistent fashion. We chose upper-eyelid skin because it is easier to obtain for histopathologic study than lower-eyelid skin and, in our experience, is more sensitive to hypertrophic changes after chemical peeling or carbon dioxide laser resurfacing. We applied TCA to the preseptal skin of 10 patients 48 h before standard upper-eyelid blepharoplasty. The acid was applied to produce a "frost," using varying concentrations of acid, ranging from 20 to 50%. The treated skin removed at the time of blepharoplasty was reviewed in a masked fashion by a dermatopathologist to determine the depth of necrosis. We found that superficial peels with necrosis involving 30% of the epidermis were produced by the lowest-concentration combination of TCA applied (20% followed by 0%). As the strength increased, so did the depth of peel. The combination of 50% followed by a second application of 50% produced the deepest peel, with necrosis into the papillary dermis. This finding would indicate that the chance of developing cicatricial ectropion with any of the tested combinations of TCA should be very remote.

Selecting linear-score distributions for modelling milk-culture results

The data for this cross-sectional retrospective study are from surveys of 65 dairy-cattle herds in central New York, USA sampled between February, 1993 and March, 1995. The objective was to identify probability distributions of logarithmically transformed somatic-cell counts (linear score) for use in a simulation model of mastitis and milk quality. Probability density functions were estimated using maximum-likelihood estimators for the linear score of individual-cow composite-milk samples culture negative and culture positive for the pathogens Streptococcus agalactiae, Streptococcus non-agalactiae, Staphylococcus aureus, and coagulase-negative staphylococci for the complete dataset and by bulk-tank somatic-cell count group (< 500,000, > or = 500,000 SCC/ml). Based on the rankings of three goodness-of-fit tests (Anderson-Darling, Kolmogorov-Smirnov and chi 2), the Weibull distribution (among the three top-ranking distributions for 14 out of 15 cases) may be used to model the individual-cow linear-score response by culture-result-specific bulk-tank somatic-cell count group. A beta distribution was among the three top-ranking distributions for nine out of 15 culture-result-specific bulk-tank somatic-cell count groups and has a logical relationship to linear score because it is defined on a fixed interval. On the other hand, the normal distribution had a poorer fit than the Weibull and at least two other distributions for all culture negative and coagulase-negative staphylococci samples. We do not assume that the underlying biological processes are fully explained by either Weibull or beta distribution--but modelling the linear score for the above culture results with these distributions provided an adequate fit to the survey data, reduced the need for two-sided truncation that open intervals needed, and had errors that did not appear to be systematically positive or negative.

Accuracy of reconstructed angular estimates obtained with the Ariel Performance Analysis System

BACKGROUND AND PURPOSE

Three-dimensional computerized gait analysis continues to grow in use among physical therapists and other clinical specialists interested in quantitative data regarding human ambulation. This study documented the accuracy of reconstructed angular estimates under static and dynamic conditions using the Ariel Performance Analysis System.

METHODS

Angular velocity was systematically increased by raising the release position of a T-shaped pendulum. Angular velocities were examined by releasing the pendulum from four angles (0 degree-static, 45 degrees, 90 degrees, and 120 degrees). Twelve reference angles were estimated over 20 autodigitized frames for 10 trials at each release position. Intraclass correlation coefficients (ICCs) and analysis-of-variance (ANOVA) procedures were used to test the hypothesis that the error of angular estimates grows with increasing angular velocity.

RESULTS

Mean errors of the reconstructed angles were consistently within +/- 1.0 degree, regardless of angular velocity. An ANOVA revealed a statistically significant angular velocity effect, characterized by release position. The 90-degree release position produced the greatest error, followed by the 120-, 45-, and 0-degree release positions. The error was not significantly different between the 120- and 45-degree release positions. Intraclass correlation coefficients greater than .90 were found for all frame-to-frame angular velocities, except for the 90-degree release position. The angle estimates consistently underestimated the reference angles, regardless of release position.

CONCLUSION AND DISCUSSION

The results suggest that clinically accurate angular estimates can be obtained across the range of angular velocities used in this study.

Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients

Preoperative assessment of the patient with moderate to severe COPD continues to be a difficult task. Pulmonary function tests cannot be the only deciding factor. Exercise testing is supported in the literature to improve the sensitivity and specificity in predicting perioperative morbidity and mortality rates. The presence of comorbid disease, especially COPD, increases the chances of postoperative pulmonary complications. Pulmonary rehabilitation in the nonsurgical COPD patient has been proven to be beneficial in improved exercise capacity and quality of life. The question which remains to be answered is whether a short-term, intense, and focused preoperative program in surgical candidates with resectable NSCLC and preexisting pulmonary dysfunction can influence outcome.

Bovine mastitis pathogens in New York and Pennsylvania: prevalence and effects on somatic cell count and milk production

Milk samples were collected from 108,312 dairy cows during 1601 farm visits made between January 1991 and June 1995. The herd visits were made by personnel from the Central Laboratory of the Quality Milk Promotion Services at Cornell University (Ithaca, NY) to farms located in central New York and northern Pennsylvania. Dairy Herd Improvement Association records were available for 32,978 cows in 327 herds. Intramammary infections, as defined by positive milk cultures, were present in 48.5% of all cows and in 36.3% of cows in herds enrolled in the Dairy Herd Improvement Association. Over 75% of the intramammary infections were caused by Streptococcus agalactiae, Streptococcus spp. other than Strep. agalactiae, Staphylococcus aureus, and coagulase-negative staphylococci. Mean days in milk at the time of diagnosis, linear score of the somatic cell count, cost of milk loss per lactation, and milk production effects were calculated for 24 etiologic agents of bovine mastitis.

Immunolocalization of bFGF in pterygia: association with mast cells

PURPOSE

To examine the expression of basic fibroblast growth factor in pterygia and determine whether mast cells contain basic fibroblast growth factor (bFGF) in this disease process.

METHODS

Formalin-fixed paraffin-embedded tissue samples of pterygia (n = 14) were used to study the expression of bFGF with immunohistochemistry. Seven samples were also double labeled with specific antibodies to bFGF and tryptase (a specific mast cell marker).

RESULTS

In all tissue samples examined, bFGF was specifically localized in blood vessels, epithelium, and a subset of connective tissue cells. The majority of bFGF-positive connective tissue cells were also tryptase positive (90.4 +/- 3.6%). Nearly all the tryptase-positive cells (mast cells) in the pterygia tissues coexpressed bFGF (98 +/- 1.5%).

CONCLUSIONS

These findings suggest that bFGF may have biologic effects on the epithelium and blood vessels in pterygia, with epithelial and endothelial cells as a possible source. In addition, mast cells contain bFGF in the pterygia tissues examined in this study. The mast cells may serve as an additional source of bFGF, possibly modulating a variety of cell types as well as the extracellular matrix in pterygia.

Visual hallucinations after enucleation

Visual phenomena are frequently reported in patients after ocular trauma, surgery or progressive visual degeneration. In particular, hallucinations are often seen by patients following enucleation. Whereas these visions can be verbally described to the physician, they can never actually be seen. This article focuses on the case of a female artist who experienced visual hallucinations after enucleation of her dominant right eye. In addition to her verbal descriptions, she was able to express these hallucinations visually on canvas. Her case offers insight to caregivers about the nature of visual hallucinations in patients with similar experiences. A review of the general characteristics and etiologies of such visual phenomena is also included.

Intravitreal methotrexate as an adjunctive treatment of intraocular lymphoma

OBJECTIVE

To develop a protocol for the treatment of intraocular lymphoma by the intravitreal injection of methotrexate.

METHODS

Patients whose results were negative for human immunodeficiency virus and who had pathologically confirmed intraocular lymphoma were eligible for participation in the study. A dose of 400 micrograms of methotrexate was given intravitreally twice weekly until the vitreous was clinically cleared of cells. Weekly injections were then given for 1 month, followed by monthly injections for 1 year.

RESULTS

Seven eyes of 4 patients were treated. Three patients have completed the protocol. To date, only 1 eye has suffered a significant loss of vision. No serious ocular toxic reaction has been identified.

CONCLUSIONS

Survival rates and time to relapse for patients with primary central nervous system lymphoma have improved. The role of ocular radiation therapy must be weighed against the potential drawbacks. Injecting chemotherapeutic agents into the vitreous is worthy of consideration. Four patients treated to date at our institution have had promising results. Intravitreal chemotherapy may result in improved treatment of intraocular lymphoma with reduced morbidity.

Lumbar spinal moments in chronic back pain patients during supported lifting: a dynamic analysis

OBJECTIVES

The main objective of this study was to test the hypothesis that peak L4/L5 moments (torque) placed on the lumbar spine by chronic back pain subjects are reduced using pain-reducing postural adaptations. A secondary objective was to determine the relation between lumbar moments while lifting and self-reported ratings of lower back pain.

STUDY DESIGN

Cohort using seven men with a history of chronic lower back pain. An inverse dynamic model was used to calculate L4/L5 forces and moments while performing five trials each of two lifting styles. Subjective ratings of lumbar back pain were taken before and after the lifts.

RESULTS

Significant (p < .001) differences were found between lifting postures on peak L4/L5 net reaction moments. Two distinct lifting profiles emerged characterized by the amount of lumbar spinal extensor musculature involved. Significant (p < .05) increases in pain were found after a bowed-back lifting style.

CONCLUSIONS

Peak L4/L5 net reaction moments were less (spine extensor loading) for a lifting posture that produced lower levels of self-reported lower back pain. The dynamic model proved reliable and useful for future study of the pathomechanics of lower back pain.

Efficacy of strength training in prepubescent to early postpubescent males and females: effects of gender and maturity

There has been considerable debate concerning the benefits of children participating in weight training programs. With the potential benefits of such training in specific rehabilitation regimens, the safety/efficacy of weight training is a topic in need of scientific study. Fifty-two experimental and 39 control subjects participated in this study. A 2 x 2 x 2 (gender by treatment by Tanner stage) ANOVA was used to examine pre- to post-test differences in six strength measures, eight anthropometric measures, five motor performance measures, and one flexibility measure associated with participation in a 12-week progressive resistance programme. In addition, safety of the weight training programme was examined. For strength differences, there were two significant main effects favouring strength gains in males and four favouring the experimental group. For anthropometric changes, 3-way interactions occurred that were not easily explained. However, the predominant main effect was treatment; the experimental group generally experienced gains in body segment girths with decreases in skinfold thickness. For motor performance, the experimental group had greater improvements in three of five parameters. The experimental group also had significantly greater gains in flexibility. The weight training programme was associated with only one injury. These findings support the general observation that physical benefits can be gained safely by children who participate in a weight training programme.

Association between management practices, dairy herd characteristics, and somatic cell count of bulk tank milk

OBJECTIVE

To determine whether particular dairy management practices and herd characteristics were associated with somatic cell count (SCC) of bulk tank milk.

DESIGN

Analysis of records.

SAMPLE POPULATION

Milk samples collected from 59,435 cows housed in 843 dairy herds between March 1992 and June 1994.

PROCEDURE

Results of bacterial culture of milk samples and data on farm housing, sanitation, milking system, and management were collected. Multiple regression analysis was used to determine sources of variation in bulk tank milk SCC among herds.

RESULTS

Prevalence of Streptococcus agalactiae and Staphylococcus aureus mastitis was associated with bulk tank milk SCC. In herds free of S agalactiae mastitis, prevalence of S aureus and Corynebacterium bovis mastitis were important. For herds without S agalactiae mastitis, use of sawdust bedding was associated with a decrease in SCC and a dirty loose housing area was associated with an increase. Increased milk production, repeated mastitis control visits, and use of particular predip compounds were significantly associated with reduced SCC in all herds, regardless of whether any cows in the herd had S agalactiae mastitis. In herds with S agalactiae mastitis, use of iodine (certain concentrations), chlorhexidine, peroxide, or sodium chlorite-lactic acid as a predip was associated with a decrease in SCC. Only use of sodium chlorite-lactic acid predip was significantly associated with a decrease in SCC in herds without S agalactiae mastitis.

CLINICAL IMPLICATIONS

Important factors associated with bulk tank milk SCC were prevalence of S agalactiae and S aureus mastitis, careful application of particular predip compounds, avoiding a dirty loose housing area, and use of a service to regularly monitor prevalence of mastitis in the herd.

Diversity of Streptococcus agalactiae and Staphylococcus aureus ribotypes recovered from New York dairy herds

OBJECTIVES

To develop a reference database for characterization of bovine Staphylococcus aureus and Streptococcus agalactiae strains by automated ribotyping and to use it to assess the discriminatory power of this typing procedure and the geographic distribution of Sta aureus and Str agalactiae strains in New York state dairy herds.

SAMPLE POPULATION

22 commercial dairy herds.

PROCEDURE

Isolates of Sta aureus and Str agalactiae from bovine milk were identified by standard bacteriologic procedures, then typed by automated ribotyping. Antimicrobial susceptibility of isolates was tested in vitro. Two indicators made from the data were percentage of farms with multiple ribotypes and percentage of single ribotypes found in several geographic regions. Standard bacteriologic diagnosis, automated ribotyping, and determination of antibiograms (Kirby-Bauer method) also were done.

RESULTS

Of 50 Sta aureus and 44 Str agalactiae isolates from composite milk samples of 12 and 10 herds, respectively, 18 and 14 ribotypes, respectively, were identified. The discriminatory power of automated ribotyping was approximately 0.96 (Hunter-Gaston's formula). A higher percentage of herds with Sta aureus had multiple ribotypes. The most common Sta aureus ribotypes tended to have broader geographic distribution. Some Sta aureus ribotypes were significantly associated with antibiotic resistance profiles.

CONCLUSIONS

Automated ribotyping appears to characterize bovine strains of bacteria associated with intramammary infections with a high discriminatory index. Potential applications include identification of strains that appear to have broad geographic distribution suggesting interfarm transfer, discrimination between recurrent versus new intramammary infections (ie, for control of Str agalactiae and Sta aureus), and evaluation of antibiotic therapy.

Effects of anesthesia of the palmar digital nerves on kinematic gait analysis in horses with and without navicular disease

OBJECTIVE

To determine the effect of local anesthesia of the palmar digital nerves on forelimb kinematics in Quarter Horses with and without navicular disease.

ANIMALS

12 adult Quarter Horses; 5 clinically normal (sound) and 7 with navicular disease.

PROCEDURE

Kinematic measurements were made on adult horses trotting on a treadmill, before and after palmar digital nerve block (PDNB). Twenty-three displacement, joint angle, and temporal gait measurements of the right forelimb and head were made for 5 strides in each horse. Initial (before local anesthesia) right forelimb measurements were obtained after a left forelimb PDNB. Kinematic measurements were compared before and after PDNB of the right forelimb by multiple ANOVA with an alpha = 0.05, adjusted for posthoc comparisons by Bonferroni correction.

RESULTS

In sound horses, the only significant change in kinematic measurements after PDNB nerve block was in the maximum extension of the metacarpophalangeal joint at mid-stance, which was decreased by an angle of 2 degrees. In horses with navicular disease, mean maximum extension of the metacarpophalangeal joint during stance phase and maximum flexion of the carpal joint during swing phase were significantly increased after PDNB. Also, total stance phase, cranial stance phase, and break-over durations were significantly shorter. In horses with navicular disease, differences between minimum head heights during stance phase of each forelimb and total vertical head excursion during a complete stride were significantly smaller after PDNB.

CONCLUSION

Several kinematic measurements of gait can be used to determine improvement of lameness in horses with navicular disease after PDNB block while trotting on a treadmill.

Kinematic changes following botulinum toxin injection after traumatic brain injury

The objectives of this study were to: (1) demonstrate the use of computerized, three-dimensional gait analysis as a functional assessment instrument following clinical intervention; and (2) objectively quantify the effects of focal muscle denervation via botulinum toxin type A (BTXA) injection in a hemiparetic patient with lower extremity spasticity following traumatic brain injury (TBI). A desired outcome of this intervention was to realize kinematics more closely resembling those reported for normal patients. The design was a single-subject case study. Ten trials of walking gait were analysed pre-injection (PI), 1 week post-injection (1PO) and 4 weeks post-injection (4PO). The PI and 1PO sessions were found to be appreciably different from the 4PO on the joint angles of the ankle and knee at each phase of the gait cycle. These differences resulted in a reduced asymmetry of ambulation. Stride time, stance time, percentage stance time, percentage swing time and walking speed improved, showing progress towards a more efficient gait pattern. Decreased stride time and increased walking speed supported improved functional ability. The inter-trial variability of the gait parameters showed the analysis to be a consistently reproducible protocol. Conclusions based on the results included encouraging findings for the efficacy of botulinum toxin A as a therapy for the reduction of spasticity.

Muscle patterning, differentiation and vascularisation in the chick wing bud

Adult muscle is highly vascularised, with blood vessels being essential for adequate oxygenation of the tissue and for supporting increased metabolic demands. Whether this is the case during muscle development has not been examined. Resin histology was used to map the muscle splitting process and conventional transmission electron microscopy to examine early muscle differentiation at the midlimb level or later at the mid radius/ulna level in the chick wing bud from stages 24 (4.5 d) to 36 (10 d) (Hamburger & Hamilton, 1951). Microinjection of India Ink into the extra-embryonic vasculature was used to visualise the patent muscle microcirculation. The results showed that the premuscle masses are present at stage 24 and initial splitting of the muscle masses commences at stage 28. The final muscle pattern is not established until stage 36. At stage 26 the cells within the premuscle masses exhibited a mesenchymal morphology, but at stage 28 overt muscle differentiation was evident with myofibrils present within myoblasts. Undifferentiated mononucleated cells were interspersed with the differentiating myoblasts. The ratio of mononucleated cells:myoblasts decreased and the myoblasts became plumper and increasingly packed with myofibrils with age. There was no evidence of secondary myotube formation at any of the stages examined. Vascular invasion of the limb occurred at stage 35 just prior to the establishment of the final muscle pattern. This was surprising as it was assumed that myogenic differentiation would be both oxygen and nutrient dependent. The results of this study provide descriptions of the splitting of the premuscle masses through to the establishment of the final muscle pattern at the midlimb or mid radius/ulna level of the chick wing bud together with the differentiation of the myogenic cells within the developing muscles. However, the relationship between muscle patterning at the tissue level and muscle differentiation at the cellular level with vascularisation remains unclear. It is hoped that the results of the study may provide the basis for future investigations into mechanisms involved in muscle patterning and the signalling mechanisms for vascular invasion.

The role of magnetic resonance imaging in the management of peripheral nerve tumours

Fourteen cases of peripheral nerve tumour which had been examined by MRI were reviewed. T1-weighted images showed the tumours to be of intermediate signal and T2-weighted images showed a high signal with some heterogeneity. These appearances are not specific to peripheral nerve tumours, although the diagnosis may be suggested if the lesion arises from a major nerve trunk. The association with a nerve trunk may be defined by MRI, thus assisting with surgical planning. Neurilemmomas, neurofibromas and malignant nerve sheath tumours could not be differentiated with certainty using MR alone. The MR features of lipofibromatous hamartoma are reported.

Different effects of calcium antagonists, nitrates, and beta-blockers on platelet function. Possible importance for the treatment of unstable angina

BACKGROUND

The three major classes of antianginal drug all inhibit platelet aggregation at high concentrations in vitro, but detecting clinically relevant effects has proved to be more difficult. We used whole-blood flow cytometry, a sensitive method that allows direct measurement of activation antigens on the surface of individual platelets in whole unfixed blood, to evaluate the effect of representative antianginal drugs on platelet function in vivo in healthy volunteers.

METHODS AND RESULTS

The effects of glyceryl trinitrate (GTN), amlodipine, and atenolol were studied in nine normal volunteers. Fibrinogen binding to activated GP IIb/IIIa and expression of P-selectin, GP Ib, and GP IIb/IIIa on the platelet surface were measured. In addition, fibrinogen binding and P-selectin expression were measured in response to ex vivo stimulation with the agonists ADP and thrombin. The three drugs had very different effects on platelets. GTN inhibited platelet fibrinogen binding and expression of P-selectin at rest and in response to agonist stimulation, whereas amlodipine enhanced P-selectin expression and atenolol increased fibrinogen binding in response to agonists. Atenolol did not block the stimulatory effects of epinephrine on ADP-induced platelet activation. GTN neutralized the proactivatory effects of amlodipine, whereas the effects of atenolol and amlodipine were not additive.

CONCLUSIONS

The three main classes of antianginal medication have different and possible clinically relevant effects on platelet behavior in vivo, nitrates causing inhibition of aggregation (fibrinogen binding) and degranulation (P-selectin expression), calcium antagonists enhancing degranulation, and beta-blockers enhancing aggregation.

A family of glycoproteins (GP55), which inhibit neurite outgrowth, are members of the Ig superfamily and are related to OBCAM, neurotrimin, LAMP and CEPU-1

We have previously identified a glycosylphosphatidylinositol-linked glycoprotein of 55 kDa (GP55) which inhibits neurite outgrowth. We now provide evidence that GP55, isolated from adult chick brain, consists of at least two bands, both of which are active, i.e., block outgrowth of neurites from chick dorsal root ganglion neurons. An antiserum raised against the adult proteins reverses the inhibition and preliminary experiments suggest that GP55 is restricted to the nervous system, increases during development from very low levels at embryonic day 10 and is most abundant after hatching. Immunofluorescence reveals that GP55 is expressed on neurons cultured from an embryonic day 14 chick brain but is barely detectable on embryonic day 10 dorsal root ganglion neurons or embryonic day 8 forebrain neurons; the neurons which respond to substrate-bound GP55. Peptide sequencing revealed considerable homology with OBCAM, a protein previously identified on the basis of binding opiates. Nested polymerase chain reaction using primers to the OBCAM sequence and internal primers to GP55 peptides produced two different polymerase chain reaction fragments with homology to OBCAM. A full length clone (E19S) corresponding to one polymerase chain reaction product and a partial length clone (E14S) corresponding to the second have been isolated from an embryonic chick brain library. Both are members of the immunoglobulin superfamily and have (or are expected to have) three C2 domains. E19S has 90% homology with LAMP at the amino acid level. This sequence only partially matches the peptides from the adult protein and hence is probably not a major component of the adult proteins. E14S (GP55-A) has 83% homology to OBCAM at the amino acid level over the region sequenced. The sequence matches several of the peptides from the adult protein and is hence likely to correspond to a major component of the adult proteins. Thus members of the GP55 family are related to OBCAM, neurotrimin, LAMP and a recently discovered chick protein CEPU-1. Our results suggest molecules within this family are capable of acting as cell adhesion molecules and inhibitors of neurite outgrowth.

Stroke normalized pressure: a useful parameter for the analysis of left ventricular outflow obstruction

A new method of presenting the in vivo left ventricular pressure-flow data is developed in the present study. This separates left ventricle ejection into unrestricted, progressively restricted and severely restricted cases. This method uses ejection volume and time to define a normalizing 'stroke' pressure, which is successful in collapsing the large variability of in vivo data to a few curves with characteristic shapes, depending on the degree of obstruction. Hypertrophic cardiomyopathy is shown to fall into both unrestricted and progressively restricted categories. Normal hearts form the unrestricted case, while a severe aortic valvular stenosis is characteristic of the severely restricted case.