Amodiaquine induced agranulocytosis: inhibition of colony growth in bone marrow by antimalarial agents

Bone marrow was cultured in vitro for colonies of granulocytes and macrophages five months after a patient had recovered from amodiaquine induced agranulocytosis. The addition of amodiaquine, chloroquine, and sulfadoxine to the culture was followed by a dose dependent inhibition of colony growth in the patient's marrow but not in normal control bone marrow. Colony growth was, however, unaffected by proguanil, pyrimethamine, and quinine. These findings show that in vitro marrow culture may have important predictive value in some cases of drug induced agranulocytosis.

Steady flow velocity measurements in a pulmonary artery model with varying degrees of pulmonic stenosis

Velocity and flow visualization studies were conducted in an adult size pulmonary artery model with varying degrees of valvular stenosis, using a two dimensional laser Doppler anemometer system. Velocity measurements in the main, left and right branches of the pulmonary artery revealed that as the degree of pulmonic stenosis increased, the jet type flow created by the valve hit the distal wall of the LPA farther downstream from the junction of the bifurcation. This in turn led to higher levels of turbulent and disturbed flow, and larger secondary flow motion in the LPA compared to the RPA. The high levels of turbulence measured in the main and left pulmonary arteries with the stenotic valves, could lead to the clinically observed phenomenon of post stenotic dilatation in the MPA extending into the LPA.

Treatment of the juvenile bunion by Mitchell osteotomy

Twelve patients who had a total of 18 Mitchell bunionectomies were reviewed to assess the long-term results of the procedure. Although metatarsus varus correction was maintained in all cases, hallux valgus recurred in 11 of the 18 cases. Sixty-seven percent reported complete relief or improvement of preoperative pain. Although lateral metatarsalgia did occur, the most common area of persistent pain remained the first metatarsal. Six of 18 procedures had marked loss of active joint motion, associated with pain and an unsatisfactory result. Of 18 procedures, 11 (61%) were satisfied with the results of their osteotomy. Although the Mitchell osteotomy corrected the metatarsus primus varus in each case, the current series shows a discouraging incidence of later recurrence of hallux valgus and restriction of metatarsophalangeal motion causing the abandonment of this procedure for the management of juvenile bunion.

A clinical and ultrastructural study of osteogenesis imperfecta after flavonoid (Catergen) therapy

A trial of the flavonoid Catergen (Zyma) has been undertaken in 11 adults with osteogenesis imperfecta (Ol). The only significant clinical or metabolic side-effects were severe headaches, which necessitated the withdrawal of 3 patients from the trial. Patient compliance in terms of palatability of Catergen was good, and 3 of the 8 patients who completed the trial experienced subjective improvement. After 6 months' treatment with Catergen, the abnormally narrow collagen fibrils found in the osteoid region in a pretreatment bone biopsy specimen from a middle-aged man with the common type 1 (autosomal dominant) form of Ol showed a significant reversion to normal diameters. Post-treatment specimens from his 2 affected sons, who exhibited the same defect, showed a similar but less marked response.

Vertebral rim lesions in dorsolumbar spine

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Vertebral rim lesions in the dorsolumbar spine

The frequency, distribution, and histological characteristics of vertebral rim lesions have been studied at D11 and L4 in 117 post-mortem spines in subjects aged 13-96 years. Only one lesion was found in patients less than 30 years, but thereafter the frequency increased with age. At least one rim was affected in the majority of patients greater than or equal to 50 years. They were found more frequently in the upper than the lower rim and they were also more common anteriorly than posteriorly. Lesions were associated with focal avulsion of the annulus in an otherwise healthy disc or with annular tears running into the rim. Rim lesions can be recognised radiographically by the presence of the vacuum phenomenon, vertebral rim sclerosis with or without a cup-shaped defect in the rim and osteophytes confined to one side of the disc. The histological appearances suggest a traumatic aetiology, and since bone is known to be supplied with pain sensitive nerve endings the lesions may be important in the general context of low back pain.

Collagen defect of bone in osteogenesis imperfecta (Type I). An electron microscopic study

Osteogenesis imperfecta (OI) is an inherited disorder of connective tissue metabolism characterized by fragility of the bones, resulting in multiple fractures. In this study electron microscopic examination of the osteoid region of iliac crest bone biopsy specimens from a 55-year-old man and his three sons (18, 21, and 25 years of age) affected with the common Type I (autosomal dominant) form of OI revealed collagen fibrils consistently smaller in diameter than those from normal age-matched control subjects, with the majority of OI fibrils measuring 0.04-0.06 micron, as opposed to 0.06-0.08 micron in the control subjects. This defect may be due to the biosynthesis of Type III collagen, not normally found in adult lamellar bone or, more likely, to a failure of maturation of Type I fibrils to their normal diameters, possibly owing to the increased levels of hydroxylysine previously reported in OI collagen, a factor known to be inversely related to fibril diameter.

Detection and distribution of aluminium in bone

The distribution of aluminium has been investigated using a new histochemical technique in transiliac bone biopsy specimens from 20 patients with aluminium related bone disease and 17 with other metabolic bone diseases. The method, which employs solochrome azurine at acid pH (acid solochrome azurine), showed a wider distribution of aluminium within cortical and trabecular bone than other histochemical techniques. The results compared well with atomic absorption spectrophotometric analysis of these biopsy specimens. Wavelength dispersive electron probe analysis of serial sections validated the procedure. The method has certain advantages over both these analytical techniques.

The enthesopathy of ankylosing spondylitis

The enthesopathic lesion of ankylosing spondylitis consists of a nonspecific, nongranulomatous inflammatory lesion which leads to destruction of the attachment of ligament to bone. Resulting erosion leads to reactive bone formation which may form a new enthesis and around the outer fibres of the annulus may lead to syndesmophyte formation. What determines the distribution of the enthesopathy and ankylosis is not known.

Locus of control, self-serving biases, and attitudes towards safety in general aviation pilots

Of the three related survey studies that were conducted, two are summarized and one, which characterizes all three, is reported in detail. The studies attempted to determine how aviators compared with the general population on the personality dimension--locus of control (internal vs. external) and how this was related to aviators' attendance at FAA Safety Clinics. In addition, aviators were surveyed regarding their attitudes towards safety, their flying skill, and the likelihood that they would have an accident during the remainder of their careers. Results showed aviators to be significantly more internal in locus of control than the general U.S. population and to have strong self-serving biases regarding their skill and safety levels. Pilots who attended FAA Safety Clinics tended to have a more internal locus of control than those who did not.

Annular tears in the dorsolumbar spine

As part of a systemic study of the spine between D11 and S1 the distribution and severity of anterior and posterior annular tears has been assessed by charting the tears in sagittal slabs of 117 fresh specimens. No significant sex difference was seen. The number of cases with tears in multiple discs increases with age, but exceptions to this trend occurred in both young and elderly spines. Age adjusted correlation coefficients indicate that anterior and posterior tears at L4 and L5 do not predict tears at other levels. At L3 and above, significant positive correlations occur between multiple disc levels, particularly posteriorly. In patients 50o year old or more the mean anterior tear score rises sharply from L5 to peak at L2 and L1, but, in contrast, the mean posterior tear score falls from L4 to L1 in this age group. The increase in severity of anterior tears corresponds with increased mobility in the L4-L1 disc from 50-70 years. The data are compatible with 2 factors causing tears. One affects L4 and L5 in young adults and is possibly mechanical in nature; the second operates at a later age, promotes widespread disc involvement, and is primarily degenerative in nature. The increased prevalence and severity of anterior tears (and the associated increase in mobility) in the upper lumbar region in the middle aged and elderly may be a pathogenic factor in back pain for this age group.

A pathological study following bronchial artery embolization for haemoptysis in cystic fibrosis

A detailed post-mortem study is reported on an adult with cystic fibrosis who died in respiratory failure three weeks after selective bronchial artery embolization with gelatin sponge to treat severe haemoptysis. Bronchial arteriography during the procedure showed complete occlusion of the vessel supplying the righ upper lobe and following this the bleeding stopped. However, post-mortem angiography of the same vessel demonstrated disappearance of much of the injected material with contrast bypassing the remaining gelatin to fill the peripheral bronchial arterial bed. This report therefore adds pathological evidence to previous clinical reports which have suggested that this procedure may not produce permanent occlusion of the embolised bronchial artery.

Pulmonary leiomyosarcomas

Four cases of pulmonary leiomyosarcoma are presented. The characteristic histological features are described with specific reference to the criteria of malignancy. It is suggested that diagnosis by bronchoscopy provides insufficient material for histological grading and open lung biopsy is the diagnostic tool of choice. The available methods of treatment are discussed.

Perturbation of respiration in Candida utilis: induction of metabolic oscillations

The effects of potentially perturbating influences on the respiration of glucose-grown Candida utilis were studied using an open oxygen electrode system. Periods of anaerobiosis as short as 2 min produced an oscillation in respiration after the air supply was restored. Longer exposure to anoxia was followed by an overshoot in dissolved oxygen after switching back to a gas phase of air. Centrifugation, cold shock or nutrient starvation caused less disturbance to respiration rates than did anaerobiosis. The high frequency oscillations (period about 5 min) resulting from anaerobic-aerobic transitions are contrasted with the slow cell cycle-dependent oscillations previously observed in synchronous cultures.

Articular pathology of ankylosing spondylitis

The essential articular pathology of AS may be said to reflect the occurrence, severity, and overall bias of (a) synovitis which tends to produce articular erosion, and (b) an inflammatory enthesopathy which results in capsular ossification in diarthrodial joints and syndesmophyte formation in cartilaginous joints, both of which are primarily responsible for bony ankylosis. Nonspecific secondary mechanisms contribute to the final picture. These include enchondral ossification, which produces synostosis, osteoporosis and altered stress distribution which make the axial skeleton susceptible to trivial trauma, the destructive effects of which are sometimes described as spondylodiskitis.

In-vitro mobility of the lumbar spine

As part of a systematic study of the spine between D11 and S1 the response to stress has been assessed by measuring radiologically the total and segmental mobility of 103 specimens. The method was shown to be reproducible to within 10% of total mobility. No significant sex difference was seen. Total mobility varied widely, but mean total mobility fell with age. All lumbar segments became less mobile up to the fifth decade. Between the fifth and the eighth decade the mobility of the fifth lumbar segment continued to fall, whereas other lumbar segments became more mobile. The mobility of each segment also varied widely, but the mean segmental mobility fell progressively from L5 to D11. However, this smooth pattern of movement was seen in only 16 cases, mostly adolescents and young adults. Among the remainder, in which movement was irregularly distributed, there were 7 cases (4 aged less than 30 years) in which the mobility of at least 1 segment was more than 2 standard deviations above the mean. The cause of this hypermobility was not evident radiologically. It is suggested that segments with abnormally high mobility may be at risk.

Fracture of an ossified Achilles tendon

A case of rupture of an ossified Achilles tendon is described. It is suggested that the management of this condition is surgical. Previously undescribed histological appearances demonstrate osteogenic potential. The significance of subcutaneous Achilles tenotomy is discussed.

New knowledge of intervertebral disc disease

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Malignant round-cell tumours of bone: an analytical histological study from the Cancer Research Campaign's bone tumour panel

A study of 40 cases of malignant round-cell tumour of one was made from the files of the Cancer Research Campaign's Bone Tumour Panel. Five pathologists made a careful study of observer error, involving repeated examination of routine paraffin sections, to determine whether the cases were a homogeneous group or a collection of differing sub-groups. Cell outline, nuclear staining, nuclear pleomorphism, conspicuous nucleoli, reticulin pattern and intracellular glycogen were the histological features selected for study. For each feature, the results were analysed to assess the importance of differences between tumours, between samples of tissue from the same tumour, and between observers. It is concluded that round-cell tumours of bone are a heterogeneous group, although completely distinct sub-groups could not be identified. Certain histological features tend to be associated, and it is reasonable to distinguish on histological grounds between Ewing's sarcoma and reticulum-cell sarcoma, although some tumours are not typical of either group.

Minoxidil-induced hypertrichosis: treatment with calcium thioglycolate depilatory

Minoxidil is a new, effective, investigational antihypertensive drug. A serious, cosmetic side effect in women is hypertrichosis. Five female patients with this complication had successful removal of the excessive hair with a calcium thioglycolate depilatory agent.

Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine

The distribution of end-plate lesions (Schmorl's nodes) and their relationship to bone density and disc degeneration have been studied in 50 post-mortem spines below D9 in subjects aged 13-96 years. Lesions were present in 76% of cases with a predominance in males. They were found more frequently in the lower than in the upper vertebral end-plate. They were also more common and more severe in the dorsolumbar (D10-L1) region than in the lower lumbar (L2-L5 region). In adults they were unrelated to age and bone density. Lesions were significantly related to disc degeneration in the D10-L1 region but not in the L2-L5 region. It is suggested that end-plate lesions arising in adolescence (or before) may predispose the dorsolumbar spine to disc degeneration in later life.

Bilateral simultaneous rupture of the quadriceps tendons

A case of bilateral simultaneous rupture of the quadriceps tendons associated with intra-tendon diabetic arteriolosclerosis is described.