Pulmonary embolism presenting as syncope in paraplegia: a case report

Syncope as an initial presentation of pulmonary embolism is unusual. A 16-year-old girl, with T7 paraplegia after a traumatic spinal cord injury, developed syncope on the 33rd hospital day. The episode occurred approximately 3 hours after her first tilting table training and just after her attendant had assisted passive range-of-motion exercise. Subsequent studies showed pulmonary embolism at the left lower branch of the left pulmonary artery, and the branch to lower segment of the lingual lobe. Doctors should be alert to possible diagnosis of pulmonary embolism in such high-risk patients, especially when new onset symptoms or signs appear.

Tissue distribution of absorbed humic acids

Distribution of humic acids (HA) in rats was studied using radioiodinated HA injected intraperitoneally. Distribution of (125)I was also studied for comparison. The distribution pattern of HA differed greatly from that of (125)I. Except in the thyroid and skin, (125)I was excreted from the body within 24 hours, whereas a large proportion of HA remained in the liver, kidney, skin, thyroid, bone and muscle. The difference in the distribution pattern and organ/serum radioactivity ratio suggests different kinetics for (125)I and (125)I-HA. The distribution pattern of HA correlated very well with the increased prevalences of organ diseases in the blackfoot disease endemic area, as reflected in epidemiologic studies. It is hypothesised that HA-metal complexes are possible etiological factors of diseases such as goitre, hepatoma, bladder cancer, vascular disease and diabetes mellitus, and that free radicals are the common causative factor.

cDNA cloning of prophenoloxidase from the freshwater crayfish Pacifastacus leniusculus and its activation

Prophenoloxidase (proPO), an enzyme that is the terminal component of the so-called proPO activating system, a defense and recognition system in crustaceans and insects, has been purified and cloned from a crayfish blood cell cDNA library. The deduced amino acid sequence codes for a polypeptide with a mass of 80,732 Da, which is close to 76 kDa, the apparent mass of the purified enzyme. proPO contains two copper atoms, and two putative copper-binding sites were found in the deduced amino acid sequence. Sequence comparisons show that these putative copper-binding sites are similar to the corresponding sites in arthropod hemocyanins and also, although the sequence similarities are less extensive, similar to tyrosinases from vertebrates and microorganisms. The purified enzyme is a typical tyrosinase because it hydroxylates monophenols and oxidizes o-diphenols but does not oxidize p-diphenols. If a homogeneous preparation of crayfish proPO were incubated with a homogeneous sample of the proPO activating enzyme, a serine proteinase, the cleavage of proPO by this trypsin-like enzyme was found to occur between Arg-176 and Thr-177.

A preliminary report on the correlation of vestibular Meniére's disease with electrocochleography and glycerol test

Objective evaluation of vestibular Meniére's disease has been difficult due to the lack of audiometric findings. Thus inevitably, the existence of vestibular Meniére's disease is constantly being challenged. In recent years, electrocochleography (ECochG) has proved to be a useful tool to verify the presence of endolymphatic hydrops electrophysiologically. To further clarify the nature of this disease, we collected 40 patients prospectively who met the following conditions as diagnostic criteria for clinical vestibular Meniére's disease: i) episodic vertigo, ii) aural fullness, and iii) normal hearing. We implemented the glycerol test and extratympanic ECochG in addition to routine survey in these cases. The diagnosis was confirmed if either test result was positive. A retrospective collection of 24 cases who underwent endolymphatic sac surgery was made to evaluate in retrospect the existence of endolymphatic hydrops indirectly proved by successful surgery. Results showed a positive SP/AP ratio in 25 cases (62.5%) of which 7 had bilateral positive responses. The glycerol test was positive in 5 cases including 3 who also had positive ECochG responses. In the retrospective group, 4 cases exhibited an abnormally large SP/AP amplitude ratio at preoperative baseline conditions after general anesthesia. Twenty cases showed an SP/AP ratio within normal limits. Only 7 cases (29%) showed a decrease in the SP/AP ratio at different surgical steps. Short-term surgical results showed a 96% success rate of relief of vertiginous symptoms. Symptoms of fullness were completely controlled in 22 patients (92%). Hearing was preserved in 18 patients (75%). We conclude that i) the above-listed clinical criteria combined with these objective tests may prove to be very useful in the diagnosis of vestibular Meniére's disease, and ii) a successful control of vertigo and aural fullness after endolymphatic sac surgery indirectly indicates that endolymphatic hydrops is involved in vestibular Meniére's disease, sharing as it does, a pathophysiology that is similar to that of classic Meniére's disease.

A further critical assessment of the efficacy of endolymphatic sac surgery

This paper further assesses the efficacy of two selected techniques of endolymphatic sac surgery (ELS) employing implants for the treatment of classic Meniere's disease and endolymphatic hydrops: the Arenberg inner ear valve implant and the newly developed Huang/Gibson inner ear shunt. Long-term (8-10 years) results for 57 patients given the Arenberg inner ear valve implant show that our demonstrated high success rate in achieving control of symptoms over the short term (1 year) is long-lasting and that although previously reported hearing gains have decreased in some cases, the overall long-term hearing results are better than for other surgical techniques. Preliminary results (less than 1 year) for 10 patients treated with the Huang/Gibson inner ear shunt indicate that it is comparable in efficacy to the Arenberg implant, while 4 out of the 10 patients have shown remarkable hearing gain, as detailed in case reports. These results again illustrate and substantiate the authors' previous conclusion that, in cases where there is a definitive delineation of the endolymphatic sac and its lumen, and where the sac is anatomically suitable, ELS is undoubtedly an effective modality and should be the standard primary choice for intractable Meniere's disease.

CT volumetric data-based left ventricle motion estimation: an integrated approach

This paper describes a novel approach to left ventricle motion analysis via the integration of image segmentation with shape deformation analysis using computerized tomography (CT) volumetric image data. This approach is different from traditional image analysis scenario in which the image segmentation and shape analysis were considered separately. The advantage of integrating the image segmentation with the shape analysis lies in the fact that the shape characteristics of the object can be used as effective constraints in the process of segmentation while original image data can be made useful along with the segmentation results in the process of shape analysis. In the case of left ventricle motion estimation, such an integration can be applied to obtain the estimation results that are consistent with both given image data and a priori shape knowledge. The initial segmentation of the images is obtained through adaptive K-mean classification and the region-of-interest is then identified based on the initial segmentation. The shape analysis is accomplished through fitting the boundary points of the region-of-interest to the surface modeling primitives. These two processes are integrated through the feedforward and feedback channels so that the surface fitting is constrained by the confidence measures of the boundary points and segmentation refinement is guided by the result of surface modeling. Global motion parameters are obtained by comparing the parameters of the fitted surface model at consecutive time instances. The segmentation and shape analysis results obtained show that the integrated approach is capable of providing promising improvement over traditional approaches.

Reversion of the transformed phenotypes of v-H-ras NIH3T3 cells by flavonoids through attenuating the content of phosphotyrosine

Fifteen flavonoids were employed to examine their effects on the morphological changes, foci formation in soft agar and cellular growth in v-H-ras-transformed NIH3T3 cells. The data presented here demonstrated that only three specific flavonoids--apigenin, kaempferol, and genistein--exhibited the reverting effect on the transformed phenotypes of ras-3T3 cells. For example, treatment with 25 microM of these flavonoids could effectively reverse the transformed morphology of ras-3T3 cells into flatter cells with contact inhibition. Colony formation in soft agar was decreased to 0.11%, 0.15%, and 0.35% by 25 microM apigenin, kaempferol, and genistein, respectively, as compared with control (0.92%). It was also found that the proliferation of ras-3T3 cells was significantly inhibited by these compounds in a dose-dependent manner. Finally, two biochemical parameters, the content of phosphotyrosine and cAMP, were examined to see whether affected by these compounds. The results showed the phosphotyrosine content in ras-3T3 cells was dramatically decreased by apigenin and kaempferol, but that was slightly reduced by genistein. By contrast, these three flavonoids all failed to significantly alter the level of cAMP within this transformant. Based on these observations, we suggest that some specific flavonoids are capable of reverting the transforming properties of v-H-ras transformed cells. The possible mechanism of this reversion is not mediated by activating the protein kinase A or its associated pathways, but rather inhibiting tyrosine kinases, subsequently leading to the blockage of p21ras-mediated signal transduction circuitry.

Effect of humic acids on thyroidal function

Humic substances (HS) have been implicated as environmental goitrogens. Increased prevalence of goiter has been recently noticed in the blackfoot disease endemic area on the southwest coast of Taiwan, where well water is rich in HS. This study investigated the in vivo effects of humic acids (HA) on the thyroid gland of rats and mice. Groups of mice and rats were fed regular or moderately iodine deficient (approximately 167 vs 700 micrograms l- per kg) chow and distilled water or HA water (1mg/ml) for 3 or 4 months. Serum T4, T3, reverse T3, and/or TSH were measured by radioimmunoassay. Thyroidal 125I uptake was measured in mice at 2 h after injection of 1 microCi125I ip. Treatment of the rat with HA was associated with a significantly (p < 0.05) reduced serum T4 without a change in other parameters of study. Treatment with low iodine diet was associated with a clear increase in serum T3 and a decrease in serum rT3. Rats treated with both HA and low iodine diet showed a significantly reduced serum T4, increased serum T3 and decreased serum rT3. In mice, treatment with low iodine diet significantly increased thyroidal 125I uptake and additional treatment with HA significantly enhanced the effect of low iodine diet. Treatment with HA did not influence thyroid weight of rats or mice given normal or iodine deficient diets. We conclude that HA per se do not induce goiter, but they may enhance the goitrogenic effect of low iodine.

A prospective study of hypothalamus pituitary function after cranial irradiation with or without radiosensitizing chemotherapy

Hypopituitarism can occur after cranial irradiation. Combined chemotherapy (CT) and radiotherapy (RT) have greatly improved the survival of patients with nasopharyngeal carcinoma (NPC). We studied 37 NPC patients who received RT and/or CT prospectively to determine if combined CT worsens the radiation damage. Patients were studied before, 6 months, 1 year and 2 years after treatment, with 4 combined hypothalamic releasing hormones stimulation test and insulin hypoglycemic test. Five developed hypothyroidism and 3 developed hyperprolactinemia after treatment. The TSH response to TRH progressively increased. In male patients who received RT only, the LH response to GnRH was reduced after RT. The FSH response to GnRH increased 6 months and 1 year after RT, and returned to pretreatment level 2 years after RT. In male patients who received RT and CT, after an initial rise 6 months after treatment, both FSH and LH responses to GnRH declined. The ACTH response to ovine CRH was decreased 6 months after RT and remained so later on, while the cortisol response became prolonged and enhanced progressively after RT. The peak GH response to GRH increased significantly 1 year after RT in patients who also received CT. The GH response to insulin hypoglycemia was also increased after RT while the cortisol response remained the same. In conclusion, cranial irradiation caused a progressive impairment of the hypothalamus-pituitary-endocrine axes. Combined CT may mask the radiation damage to GnRH neuron by inducing primary hypogonadism. There may be hippocampal damage in addition to hypothalamo-pituitary damage after cranial irradiation.

Humic substances shorten human plasma prothrombin time

The prothrombin time of the normal human pooled plasma was shortened by Aldrich humic acid well water humic substances and lignin at final concentrations ranging from 5 × 10(-3) mg mL(-1) to 5 × 10(-2) mg mL(-1), with a maxmum effect at 1 × 10(-2) mg mL(-1). At this concentration the shortening was 5.5 s, 4.4 s, and 3.5 s by Aldrich humic acid, well water humic substances and lignin respectively. However, monomeric components of humic acid such as syringic acid, protocatechuic acid, pyrogallol, vanillic acid, gallic acid, resorcinol, ferulic acid, catechol, caffeic acid and p-coumaric acid did not have such ability to shorten prothrombin time at the same final concentration ranges. Certain reducing agents such as t-butanol (2.5 × 10(-) -2.0 × 10(-2) mg mL(-1)), glutathione (8.0 × 10(-2)-1 .0 mg mL(-1)), ascorbic acid (4.2 × 10(-2)-5.0 × 10(-1) mg mL(-1)) and dithiothreitol (1.0 × 10(-2)-1.7 × 10(-1)mg mL(-1)) could prevent the shortening effects of humic substances or lignin on prothrombin time. These results suggested that humic substances and lignin with a polymerised structure had an ability to affect activities of some blood coagulating enzymes.

[A vocal treatment plan for voice disorders after phonosurgery--a preliminary study]

In this study, twenty-five subjects have received phonosurgery of benign vocal pathology but persistent voice disorders postoperatively, characterized by a hoarse, low-pitched, soft voice or efforted phonation. Each subject had filled out a self-evaluation questionnaire of vocal behaviors before surgery and his vocal cords examined by ENT doctor with indirect laryngoscope or direct fiberscope. Voice evaluations was done based on perceptual and acoustic parameters preoperatively and postoperatively. Twenty-five subjects were grouped into three post-operative vocal rehabilitation programs: voice rest group, vocal hygiene group, and direct voice therapy group. The criteria in grouping were according to the subjects' amount of vocal use, environmental pressures, vocal abuse or misuse behaviors and time flexibility. The therapy strategies included reducing amount of vocal use, changing life style, analyzing environmental pressures and treating voice problems with established facilitating techniques. The post-surgical vocal rehabilitation program lasted three to six months. Each subject's voice parameters were reevaluated six months after surgery. The results of three vocal rehabilitation groups were compared with those before rehabilitation. The implication of this study is to provide a holistic voice treatment plan and obtain better surgical intervention results.

Electrocochleographic monitoring in endolymphatic sac surgery for Menière's disease

OBJECTIVE

To determine the efficacy of intraoperative electrocochleographic monitoring during endolymphatic sac-ballooning surgery for Menière's disease.

DESIGN

At each of five surgical steps, the eighth nerve action potential (AP) amplitude and latency, summating potential (SP) amplitude, and SP/AP amplitude ratio were recorded. Data were analyzed using repeated measure analysis of variance.

PATIENTS

Electrocochleographs were successfully recorded in 97 patients during endolymphatic sac-ballooning surgery. Forty patients had an abnormal baseline ratio (group 1), and 57 patients had a normal baseline ratio.

RESULTS

Data showed that the SP/AP amplitude ratio reductions were significant only in group 1 patients. The SP/AP amplitude ratio was reduced in two thirds of the group 1 patients and unchanged in roughly the same proportion of group 2 patients. A significant reduction of SP/AP amplitude ratios was found to be always associated with prominent SP/AP ratios at the baseline, irrespective of glycerol test results, and only in cases of classic Menière's disease, indicating that this dominant ratio is a very reliable indicator of Menière's disease and endolymphatic hydrops. Importantly, reductions of SP/AP amplitude ratios were observed at every step to be consistently due to AP increase rather than SP decrease.

CONCLUSIONS

It is theorized that the dominant SP/AP amplitude ratio found in patients with Menière's disease and endolymphatic hydrops is caused by the inhibition of AP activity rather than by the enhancement of the SP resulting from the displacement of the basilar membrane toward the scala tympani owing to hydropic endolymph, as is generally believed. We conclude that electrocochleograpic monitoring is useful during endolymphatic sacballooning surgery to provide a definitive delineation of the endolymphatic sac and its lumen; this delineation is the key to the success of such surgery.

Endolymphatic sac ballooning surgery for Menière's disease

A newly developed technique (endolymphatic sac ballooning surgery [ESBS]), based on revisional sac surgery observations, was conducted on 135 patients with intractable Meniere's disease. The surgery involves the insertion and fan-folding of a thin Silastic sheet in the endolymphatic sac (ES) lumen to increase its volume. The results of this sac ballooning surgery proved more effective for treatment of incapacitating Meniere's disease symptom complex than did primary ES surgery (ESS) with either the nonballooning sac techniques we employed previously or ESBS revision operations in which primary surgery used nonexpansion techniques. It appears that ESBS, with its preservation of ES integrity and expansion of its lumen, may indeed prevent surgically induced damage and be more efficacious in the drainage of hydropic endolymph. The efficacy of ESS remains controversial because of the failure to understand its pathophysiologic basis. Nevertheless, we are confident that if the ES is definitively delineated, as evidenced by turbid or clear fluid or bubbles when entered, and enlargement of its lumen with maintenance of the sac's integrity is verified during surgery, ESS is undoubtedly efficacious treatment for intractable Meniere's disease. Furthermore, we maintain that equitable judgment may only be rendered when reports evaluating the efficacy of ESS include definitive identification, delineation, and drainage of the sac.

Corticotropin secretagogues facilitate recovery of the hypothalamus-pituitary-adrenal axis suppressed by prolonged treatment with dexamethasone

Prolonged use of glucocorticoids (GCs) can cause prolonged suppression of the hypothalamus-pituitary-adrenal (HPA) axis. This study examined the possibility that corticotropin or its secretagogues such as vasopressin, corticotropin-releasing hormone (CRH), or insulin accelerate recovery of the HPA axis after prolonged treatment with dexamethasone (DEX). Suppression of the HPA axis was induced in rats by DEX at a dosage of 250 micrograms/100 g body weight (BW)/d for 14 days, after which rats were administered saline, corticotropin (Cortrosyn 0.1 mg), ovine CRH (oCRH 6 micrograms), vasopressin (2 U), or insulin (2 U) each morning. Adrenal weight (AW), BW, plasma corticosterone, and corticotropin, as well as pituitary corticotropin content, decreased significantly after DEX treatment. The plasma corticotropin level was significantly elevated 7 days after discontinuation of DEX treatment (day 8) and remained so until day 11, whereas the pituitary corticotropin content had returned to normal on day 8. Plasma corticosterone was suppressed until day 8, but was not significantly different from normal on day 11. The AW was also decreased until day 4, but was not different from normal on day 8 or day 11. The BW of experimental rats remained subnormal during the study period. Treatment of DEX-suppressed rats with exogenous corticotropin induced adrenal hyperplasia, but suppressed the plasma corticotropin level and delayed the normalization of plasma corticosterone until day 11. The insulin-treated group differed in no respect from the saline-treated group. Treatment with oCRH or vasopressin for 8 days normalized plasma and pituitary corticotropin, as well as plasma corticosterone. Hypothalamic immunoreactive CRH (iCRH) did not differ among any treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital cholesteatoma: review of twelve cases

This report reviews 12 cases of congenital cholesteatoma of the middle ear, mastoid, and petrous pyramid seen mostly in adult and older juvenile patients between 1984 and 1992. Featured herein are two unique instances of purulent discharge external to an intact tympanic membrane via a fistula caused by extensive mastoidal erosion, three cases that illustrate the importance in Oriental populations of the use of high resolution computed tomography to obviate misdiagnosis when all other diagnostic techniques suggest unilateral otosclerosis, and two instances of multicentric cholesteatomas in well-separated portions of the same temporal bone associated with ossicular anomalies of possible congenital origin. The predilective sites and extent of involvement in this series reinforces the pattern for this age group noted by others. That is, although most of the lesions were too diffusely invasive to define possible formative sites, those that were relatively small and discretely located were found at locations other than the anterior tympanum. This would suggest that their sites of origin and pathogeneses may be different from those commonly found in the anterosuperior tympanum of very young children.

Panhypopituitarism caused by solitary parasellar metastasis from lung cancer

Clinical panhypopituitarism caused by cancer with parasellar metastasis and hypothalamic invasion is very rare. This report concerns a lung cancer patient who had solitary parasellar metastasis with diabetes insipidus and panhypopituitarism as an initial manifestation, which was documented by contrast-enhanced computed tomographic scan, Gd-DTPA-enhanced magnetic resonance imaging, and endocrinologic studies.

Clinical analysis of external laryngeal trauma

Thirty patients with external laryngeal trauma were analysed retrospectively. Injuries were mostly caused by motor vehicle accidents (car = 36.7 per cent; motorcycle = 23.3 per cent). The main presenting symptoms and signs were hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal injury included arytenoid swelling, vocal fold injury, soft tissue contusion or superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture, epiglottic fracture and mixed injuries. Treatment was varied depending on the severity of the injuries. Sixteen cases were managed conservatively by medical treatment; two cases received intubation; four cases were treated initially by tracheostomy; eight cases received surgical repair and/or reconstruction; cases made a full recovery of the voice and 18 cases fair voice recovery due to either sustained vocal fold swelling or limitation of vocal fold movement. One case was graded as poor. Twenty-eight cases had good airway patency and two cases fair airway patency. A delay in the early detection of laryngeal trauma may precipitate into life-threatening airway problems, therefore prompt and accurate diagnosis should be followed immediately by skillful airway management.

Serological, histological and polymerase chain reaction studies of Helicobacter pylori infection in patients with gastric adenocarcinoma

The association between Helicobacter pylori (H. pylori) and gastric adenocarcinoma remains controversial. However, the prevalence of H. pylori infection in gastric adenocarcinoma varies with the method of detection used, eg, serology, histology, culture, and polymerase chain reaction. However, studies on gastric adenocarcinoma by these methods remain inconclusive. We compared the results of serology, histology, and polymerase chain reaction for detection of H. pylori infection in 12 patients with gastric adenocarcinoma to investigate the actual status of H. pylori infection in gastric adenocarcinoma. IgG antibodies to H. pylori were examined in the sera, and histology and polymerase chain reaction were used for identification of H. pylori on the resected gastric tissues of 12 patients with gastric adenocarcinoma. Among them. H. pylori infection was verified by serology in eight, polymerase chain reaction in seven, and histology in five. In all positive cases, H. pylori was identified only in the non-tumorous part of the gastric tissue. In all four seronegative patients, H. pylori was not present in any of the tissues examined by histology and polymerase chain reaction. We conclude that: 1) polymerase chain reaction is more sensitive than histology; 2) a good correlation between serology and polymerase chain reaction is found; and 3) H. pylori infection is absent in a proportion of patients with gastric adenocarcinoma identified by these methods.

Merkel cell carcinoma: in vitro and in vivo characteristics of a new cell line

BACKGROUND

Few studies exist that describe Merkel cell carcinoma (MCC) growth characteristics in vitro, in vivo, or both.

OBJECTIVE

Our purpose was to evaluate the pathologic features of MCC implanted into athymic mice and to determine cytogenetic abnormalities in the established cell line.

METHODS

Tumor tissues from a patient with MCC were grown in culture. Cultured cells were karyotyped and inoculated subcutaneously into athymic mice. Nude mouse tumors were re-implanted into other athymic mice. Tissues from the primary skin tumor and the nude mouse tumor were processed for light and electron microscopy and immunocytochemistry.

RESULTS

The cell line showed a doubling time of 64.8 hours. Xenografts of 4 x 10(6) cells produced tumors in athymic mice with a doubling time of 16.1 days. The nude mouse tumors showed pathologic features similar to those of the primary skin tumor. Cytogenetic studies showed a t(1;17) (p36;q21) translocation in 100% of the cells.

CONCLUSION

MCC implanted into athymic mice retained the pathologic features of the primary skin tumor and behaved aggressively. The t(1;17) (p36;q21) translocation may be a marker of an aggressive phenotype.

Image processing: some challenging problems

Image processing can be broadly defined as the manipulation of signals which are inherently multidimensional. The most common such signals are photographs and video sequences. The goals of processing or manipulation can be (i) compression for storage or transmission; (ii) enhancement or restoration; (iii) analysis, recognition, and understanding; or (iv) visualization for human observers. The use of image processing techniques has become almost ubiquitous; they find applications in such diverse areas as astronomy, archaeology, medicine, video communication, and electronic games. Nonetheless, many important problems in image processing remain unsolved. It is the goal of this paper to discuss some of these challenging problems. In Section I, we mention a number of outstanding problems. Then, in the remainder of this paper, we concentrate on one of them: very-low-bit-rate video compression. This is chosen because it involves almost all aspects of image processing.

The skin, tongue, and brain as favorable organs for hog cholera diagnosis by immunofluorescence

Hog cholera virus antigens were found densely distributed in skin and tongue of pigs experimentally infected with hog cholera virus. The finding described here warrants the usage of ear biopsies for hog cholera diagnosis on a herd basis.

[A phoniatric treatment report for a dysphonia case with unilateral false cord bulging]

This case report was a 43-year-old male with phonation problem described as hoarseness, reduced loudness and with effort. Patient was examined by a laryngologist and a voice-speech pathologist. The laryngeal finding showed left false cord bulging under indirect laryngoscope and fiberscope. Patient's dysphonia was analyzed from perceptual and acoustic parameters. Patient was diagnosed as dysphonia with left cord bulging and under a phoniatric treatment. The goal of treatment was to eliminate vocal abuse and misuse behaviors, stimulate true cords function by Boone's "inhalation phonation" method then reduce compensatory behaviors of false cord involvement and balance life between work and after work. The results after the phoniatric treatment and underlying phonation mechanism were presented and discussed.

Pituitary-testicular and pituitary-thyroid axes in spinal cord-injured males

Thirty spinal cord-injured (SCI) males were studied for evaluation of their pituitary-testicular and pituitary-thyroid axes using combined luteinizing hormone-releasing hormone (LHRH) and thyrotropin-releasing hormone (TRH) tests and electroejaculated semen analyses. Thirty age-matched normal male volunteers served as controls. There were four subjects with low serum triiodothyronine (T3) levels, one with elevated serum follicle-stimulating hormone (FSH) level, eight with elevated serum testosterone levels, and 11 with elevated serum prolactin levels. There were significantly elevated luteinizing hormone (LH) responses to LHRH in SCI subjects when compared with normal controls. There were 16 (53.3%) SCI subjects who had exaggerated and/or prolonged LH responses. Among them, six subjects also had elevated FSH responses. There were eight and four subjects whose thyrotropin (TSH) and prolactin responses to TRH were exaggerated, respectively. Marked impaired motility was observed in 56 electroejaculated semen samples from 16 SCI subjects. There was a significant correlation between LH and total sperm count. Our data suggest that there is a reduced central dopaminergic tone in SCI subjects.

Monocyte-macrophage lineage of giant cell tumor of bone. Establishment of a multinucleated cell line

METHOD

A new neoplastic cell line, UISO-GCT-1, was established from a giant cell tumor of the right tibia in an 18-year-old man. Immunohistochemical, cytogenetic, ultrastructural, and growth studies were performed.

RESULTS

Multinucleated giant cells (> 4-6 nuclei/cell) persisted in a culture relatively late in passage (passage 17), which is unique in cell lines of giant cell tumor of bone. Mononuclear and multinucleated cells in monolayer culture expressed vimentin and tartrate-resistant acid phosphatase and reacted with monoclonal antibodies to CD13 and CD68, suggesting a monocytic-macrophage origin of these cells. Mononuclear and multinuclear cells also selectively expressed high molecular weight cell membrane antigens specifically associated with soft tissue sarcomas and osteosarcomas. Karyotypically, UISO-GCT-1 cells were hypodiploid, hypotetraploid, and multiploid, with more than 200 chromosomes per mitosis present in some cells. Other chromosomal aberrations observed included ring chromosomes, double minutes, translocations, multiple fragments, and multiradials.

CONCLUSION

Collectively, observations of this study suggest that karyotypically abnormal giant cell tumors of bone arise from a monocyte-macrophage lineage and subsequently express an antigenic profile similar to malignant mesenchymal tumors.