[Systematic strength training in the postmenopause: accompanying densitometric control with DXA]

Of all the forms of osteoporosis, the postmenopausal type is the most important in social medicine due to the potentially high fracture risk in aging. The positive effects of physical activity on bone density have been emphasized in several studies. In this study on 31 female volunteers (minimum age 50 years), who had been postmenopausal for at least 2 years, 16 underwent systematic strength building (training group). They were compared with a control group consisting of 15 female volunteers. The parameters of success were physical strength and bone mineral density (BMD) before and after training. BMD was measured by dual-energy X-ray absorptiometry. The subjects in the control group showed significant decrease in bone density after 6 months: between 6.7 and 22.3% of the values measured at the beginning. The loss was more evident in the proximal femur than in the lumbar spine. In contrast, the subjects in the training group only showed a marginal decrease in bone density in the proximal femur: 0.8 to 3.8% of the earlier values. In the lumbar spine there was even a slight increase (+0.3%) in bone density.

Patterns of vertebral ossification and pelvic abnormalities in paralysis: a study of 200 patients

To clarify the characteristics, extent, and frequency of spinal ossification and abnormalities of the sacroiliac joint, symphysis pubis, and hip in paralysis, routine radiographs of the lumbar spine, pelvis, and abdomen were retrospectively evaluated in 95 quadriplegic, 105 paraplegic, and 100 age-matched control patients, with attention to age and race and to spinal level and duration of paralysis. The spinal radiographs were evaluated for presence of osteophytes, syndesmophytes, paravertebral ossification, and flowing hyperostosis characteristic of diffuse idiopathic skeletal hyperostosis (DISH); the pelvic radiographs were used to measure the widths of the sacroiliac joint, hip, and symphysis pubis articulations and evaluate for presence of enthesopathy. Bone formation around vertebral bodies was often seen in quadriplegic (n = 41 [43%]) and paraplegic (n = 46 [44%]) patients. In quadriplegic patients, four distinct vertebral ossification patterns were evident: osteophytosis, paraspinal ossification resembling that found in psoriasis, syndesmophytosis, and flowing ossification similar to that in DISH. In paraplegic patients, osteophytosis was most frequent. Vertebral ossification in quadriplegic patients was significantly associated with age (P < .01) and increased in frequency and severity with increasing age.

Topical levocabastine compared with orally administered terfenadine for the prophylaxis and treatment of seasonal rhinoconjunctivitis

BACKGROUND

This study was designed to compare the efficacy and tolerability of a new topical (nasal spray and eye drops) H1-receptor antagonist, levocabastine, with that of orally administered terfenadine for the prophylaxis and treatment of seasonal allergic rhinoconjunctivitis.

METHODS

A total of 115 patients with documented birch pollen allergy were enrolled in this randomized, double-blind, double-dummy, parallel-group trial. Treatment was initiated immediately before the birch pollen season started and continued for a total of 8 weeks. Xylometrazoline (Otrivin) nasal spray was permitted as rescue medication.

RESULTS

The investigator's evaluation of symptoms showed similar effects for levocabastine and terfenadine. Both the patients' and the investigator's global evaluations of ocular and nasal symptoms disclosed a somewhat higher percentage of good or excellent results for levocabastine, but the differences were not statistically significant. Visual analog scale ratings from the patients' diaries showed better results for levocabastine. Levocabastine was significantly more effective than terfenadine in relieving sneezing, rhinorrhea, lacrimation, itch, and burning sensation (p < 0.05). For some symptoms, levocabastine was significantly more effective than terfenadine on days when the pollen count was high. There were no statistically significant differences in the use of rescue medication or in the incidence of adverse reactions reported in each treatment group.

CONCLUSIONS

In the present study topical levocabastine was frequently more effective than orally administered terfenadine for the treatment of seasonal allergic rhinoconjunctivitis. Both drugs were well-tolerated.

CT and MR accuracy in the detection of tumor recurrence in patients treated for ovarian cancer

OBJECTIVE

The aim of this prospective study was to evaluate the accuracy of clinical examinations (palpation/determination of serum tumor-associated antigen CA125 level), CT, and MRI in the detection of tumor recurrence in patients with treated ovarian cancer.

MATERIALS AND METHODS

Twenty-four patients who had been treated for ovarian carcinoma were prospectively examined by clinical means (palpation/serum tumor-associated antigen CA125 level), CT, and MRI to assess their accuracy in detecting recurrent disease; results were correlated with surgical/bioptic/pathoanatomic findings. Nine patients had relapse; 15 women were disease-free.

RESULTS

Examinations were true-negative in 14 patients (on palpation/CA125, CT, and MRI) and true-positive in 9 on palpation/CA125, in 6 on CT, and in 7 patients on MRI. False-positive examinations occurred in one patient on palpation/CA125, CT, and MRI and false-negative in zero on palpation/CA125, in three on CT, and in two on MRI, a sensitivity of 100% for palpation/CA125, 66.6% for CT, and 77.7% for MRI and a specificity of 93.3% for palpation/CA125, CT, and MRI. Accuracy of palpation/CA125 examinations was 95.8% in comparison with 83.3% for CT and 87.5% for MRI.

CONCLUSION

Our results suggest that in the follow-up of ovarian cancer patients, assessment of serum tumor-associated antigen CA125 level is accurate in the determination of patients with tumor recurrence. Computed tomography is the primary imaging modality to prove macroscopic disease recurrence and can spare these patients from invasive restaging second-look laparotomy; MRI should be performed in women with questionable macroscopic recurrent tumor and negative CT examination. Neither CT nor MRI can confidently exclude microscopic disease.

A large outbreak of gastroenteritis caused by diarrheal toxin-producing Bacillus cereus

An outbreak of diarrhea occurred after a university field day. Of 643 attendees who returned mailed questionnaires, 139 (22%) reported illness. Persons who ate barbecued pork, which was unrefrigerated for 18 h after cooking, were five times more likely to become ill than those who did not eat pork (26% vs. 5%; relative risk, 5.4; 95% confidence interval, 1.4-20.9). A leftover pork sample grew a Bacillus cereus isolate, > 10(5) cfu/g, that produced diarrheal toxin. Thirty-four percent of ill persons noted onset of illness outside the 6- to 24-h incubation period traditionally ascribed to B. cereus-mediated diarrhea, and an unusually high percentage (23%) noted fever. B. cereus may cause a wider spectrum of disease than previously described.

Evidence for channeled diffusion of pre-mRNAs during nuclear RNA transport in metazoans

We report studies using an enhanced experimental system to investigate organization of nuclear pre-mRNA metabolism. It is based on the powerful genetic system and polytene nuclei of Drosophila. We observe (at steady state) movement of a specific pre-mRNA between its gene and the nuclear surface. This movement is isotropic, at rates consistent with diffusion and is restricted to a small nuclear subcompartment defined by exclusion from chromosome axes and the nucleolus. Bulk polyadenylated nuclear pre-mRNA precisely localizes in this same subcompartment indicating that most or all pre-mRNAs use the same route of intranuclear movement. In addition to association with nascent transcripts, snRNPs are coconcentrated with pre-mRNA in this subcompartment. In contrast to constitutive splices, at least one regulated splice occurs slowly and may undergo execution remotely from the site of pre-mRNA synthesis. Details of our results suggest that retention of incompletely spliced pre-mRNA is a function of the nuclear surface. We propose a simple model--based on channeled diffusion--for organization of intranuclear transport and metabolism of pre-mRNAs in polytene nuclei. We argue that this model can be generalized to all metazoan nuclei.

Superparamagnetic particles as oral contrast medium in magnetic resonance imaging of patients with treated ovarian cancer--comparison with plain MRI

In 23 patients with treated ovarian cancer, 24 magnetic resonance (MR) examinations of the abdomen and pelvis were performed before and after administration of an oral superparamagnetic contrast medium. Depiction of bowel loops was judged sufficient in 47% with plain scans and in 85% with enhanced scans. Minor artefacts attributed to the agent were noted in 32% of examinations and were classified as disturbing in 8%. The diagnostic information obtained after contrast enhancement was estimated to be superior to that from plain MRI in 20% of patients. The use of oral contrast medium did not alter the MR diagnosis of "tumour recurrence" or "disease-free" in any patient. Our results suggest that superparamagnetic iron oxide is an effective and reliable approach to negative bowel contrast enhancement, increasing the confidence level when distinguishing intestines from solid structures.

Abnormalities of articular cartilage in the knee: analysis of available MR techniques

In an attempt to improve the detection of chondral abnormalities with magnetic resonance imaging, a fat-suppressed three-dimensional gradient-recalled acquisition in the steady state (GRASS) and spoiled GRASS (SPGR) sequence was optimized by study of five cadaveric knee specimens. Results with this optimized sequence then were compared with results with three spin-echo (T1-, proton-density-, and T2-weighted) and two three-dimensional gradient-recalled echo sequences (GRASS and non-fat-suppressed SPGR) in the assessment of naturally occurring abnormalities of the patellofemoral compartment in 10 cadaveric knees. Results with the optimized fat-suppressed SPGR sequence were significantly better (P < .02) than results with the other five sequences and had a sensitivity of 96%, a specificity of 95%, and an accuracy of 95%. In addition, normal cartilage consistently appeared as a trilaminar structure with the fat-suppressed SPGR sequence, a feature that appeared to help in identification of chondral lesions.

Inexpensive range camera operating at video speed

An optoelectronic device has been developed and built that acquires and displays the range data of an object surface in space in video real time. The recovery of depth is performed with active triangulation. A galvanometer scanner system sweeps a sheet of light across the object at a video field rate of 50 Hz. High-speed signal processing is achieved through the use of a special optical sensor and hardware implementation of the simple electronic-processing steps. Fifty range maps are generated per second and converted into a European standard video signal where the depth is encoded in gray levels or color. The image resolution currently is 128 x 500 pixels with a depth accuracy of 1.5% of the depth range. The present setup uses a 500-mW diode laser for the generation of the light sheet. A 45-mm imaging lens covers a measurement volume of 93 mm x 61 mm x 63 mm at a medium distance of 250 mm from the camera, but this can easily be adapted to other dimensions.

Transinhibition of C1 inhibitor synthesis in type I hereditary angioneurotic edema

To ascertain the mechanism for decreased synthesis of C1 inhibitor (C1 INH) in certain patients with the autosomal dominant disorder hereditary angioneurotic edema, we studied expression of C1 INH in fibroblasts in which the mutant and wild type mRNA and protein could be distinguished because of deletion of exon 7 (delta Ex7). In the HANE delta Ex7 cells, the amount of wild type mRNA (2.1 kb) was expressed at 52 +/- 2% (n = 5) of normal, whereas the mutant mRNA was 17 +/- 1% (n = 5) of normal. Rates of synthesis of both wild type and mutant proteins (11 +/- 3 and 3 +/- 1% of normal, respectively) were lower than predicted from the mRNA levels. There was no evidence of increased C1 INH protein catabolism. These data indicate that there are multiple levels of control of C1 INH synthesis in type I hereditary angioneurotic edema. Pretranslational regulation results in < 50% of the mutant truncated 1.9-kb mRNA. In addition, translational regulation results in decreased synthesis of both wild type and mutatn C1 INH proteins. These data suggest a transinhibition of wild type C1 INH translation by mutant mRNA and/or protein.

Knee flexor and extensor strength during concentric and eccentric muscle actions after anterior cruciate ligament reconstruction using the semitendinosus tendon and ligament augmentation device

The purposes of this study were to compare operated and nonoperated knees after anterior cruciate ligament reconstruction using the semitendinosus tendon and a polypropylene ligament augmentation device, and to determine the interrelationships among strength, knee stability, and current activity levels. Isokinetic tests for knee flexion (prone position) and extension (sitting position) strength during concentric-eccentric muscle action cycles were completed at 60 and 180 deg/sec angular velocities, and passive anterior displacement were determined for 15 male and 15 female patients (mean age, 27 +/- 8 years; mean time since surgery, 21 +/- 3 months). With the exception of eccentric muscle actions during knee extension, peak torque and work done were significantly greater on the nonoperated leg (P < 0.05). Passive anterior displacement was significantly greater in the operated than the nonoperated knee (P < 0.01). Strength measurements tended to be modestly related to current activity level (R > 0.40 in 24 of 32 correlations; P < 0.05), whereas anterior displacement was not related to current activity level (R = -0.19, operated knee; R = -0.09, nonoperated knee; P > 0.05). Greater emphasis should be directed toward strengthening the knee flexors and knee extensors after this surgery. Although joint-specific tests (completed actively via isokinetic dynameter) are more related to activity levels than are knee laxity tests (completed passively via knee arthrometer), neither test should be relied on as the only predictor of activity level in this patient population.

[MRI of the temporomandibular joint. Demonstrability and significance of the retro-articular vascular plexus]

The retro-articular vascular plexus of the temporomandibular joint (TMJ) is of great importance for the function of this joint. Aim of this study was to determine the amount of increase of signal intensity in the retro-articular vascular plexus after intravenous injection of contrast medium and to figure out potential advantages of this procedure. The posterior band of the articular disc--a landmark in the diagnosis of disc dislocations--becomes prominent after injection of contrast medium. Forty-five temporomandibular joints were studied before, and after intravenous injection of contrast medium with magnetic resonance imaging (MRI) using T1-weighted images in parasagittal plane. In all cases a measurable increase of signal intensity was demonstrable in healthy volunteers as well as in patients with normal or pathological TMJ findings. In 53.3% of cases the posterior band was better differentiable after administration of contrast medium. In patients with suspicion of pathological features in series without contrast medium, in 27.3% of those cases administration of contrast medium led to a more precise--"diagnostic"--evaluation of disc location. The study emphasizes the use of contrasts medium for evaluations of disc dislocation with MRI in cases of pathological or unclear findings in precontrast MRI series.

Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression

Bone-marrow oedema syndrome (BMOS) of the hip gives a characteristic MRI pattern, in association with severe pain, non-specific focal loss of radiological density and a positive bone scan. In our MRI-controlled study, nine patients with non-traumatic BMOS in ten hips all had core decompression. Bone-marrow pressure measurements and intraosseous venography in five cases showed pathological values. All patients had immediate relief of pain, with return of MRI signals to normal after three months. Regular review was continued for at least 24 months with serial clinical radiological and MRI assessment. At a mean follow-up of 33 months all patients remained free of pain with normal radiographs and MR scans. The histological evaluation of undecalcified sections obtained from eight core decompressions confirmed the presence of bone-marrow oedema, with necrotic and reparative processes involving bone and marrow similar to those of early avascular necrosis but with no evidence of 'osteoporosis'. These findings support the assumption that BMOS may be the initial phase of non-traumatic avascular necrosis. In most patients BMOS will have a self-limiting course, but the duration of symptoms may be reduced by core decompression treatment.

Eosinophilic pustular folliculitis in infancy and childhood

We describe nine patients with eosinophilic pustular folliculitis occurring in infancy. All patients had recurrent crops of pruritic papules primarily affecting the scalp and brow region of the face. Biopsy specimens revealed folliculitis with a predominant eosinophilic infiltrate. Bacterial and fungal cultures of pustules were negative. Most patients had leukocytosis and eosinophilia. Clinical response to topical corticosteroid and/or systemic antibiotic therapy was noted. Eosinophilic pustular folliculitis of infancy must be considered in the differential diagnosis of pustular disorders in infancy.

Haemorrhage in intracerebral arteriovenous malformations: detection with MRI and comparison with clinical history

Fifty-one patients with 59 angiographically proven cerebral arteriovenous malformations (AVMs) were examined by high-field MRI to detect blood breakdown products. Results were correlated with the history of intracranial bleeding. Evidence of previous episodes of haemorrhage was seen in 10 of 12 patients (83.3%) with verified bleeding, in 4 of 9 patients (44.4%) with symptoms which could suggest bleeding and in 6 of 30 patients (20%) with negative histories. Because of the known rebleeding rate and the increased risk of associated complications, identification of the subgroup who had had haemorrhage and should therefore be considered for surgery may be beneficial. MRI can make a contribution to management by demonstrating prior haemorrhage in patients with an inadequate clinical history.

Transaqueductal migration of a neurocysticercus cyst. Case report

The clearly documented transaqueductal migration of a solitary intraventricular neurocysticercus cyst is described. The cyst was fortuitously demonstrated on magnetic resonance imaging during migration through the aqueduct. The radiological appearance and clinical significance of this condition are discussed.

Pituitary adenomas: findings of postoperative MR imaging

Preoperative and postoperative magnetic resonance (MR) images obtained in 25 patients with pituitary macroadenomas (1.1-5.2 cm in diameter) were evaluated to determine normal (physiologic) and abnormal findings after transsphenoidal or subfrontal surgery. With a 1.5-T unit, T1-weighted sagittal and coronal images were obtained before and after administration of gadopentetate dimeglumine. The physiologic changes after surgery included resorption of packing material and sphenoid sinus opacifications, reexpansion of the pituitary gland, and lowering of the optic chiasm. Implanted gelatin foam appeared as an endosellar, circularly enhancing mass that was seen on follow-up studies to have decreased in size. Muscle-and-fat implants appeared as areas of high signal intensity. In 14 patients, residual tumors were found in the suprasellar (n = 4), retrosellar (n = 3), parasellar (n = 8), and/or endosellar (n = 3) space. Residual tumors were differentiated from implant materials by means of location, characteristic signal intensity, and enhancing pattern, which were identical to those of the corresponding preoperative adenoma in 13 cases (93%). Preoperative studies and clinical information are helpful in the evaluation of postoperative MR imaging examinations.

Bone marrow edema of the hip: MR findings after core decompression

Magnetic resonance imaging is an extremely sensitive technique for evaluation of bone marrow changes at an early stage of avascular necrosis (AVN) of the hip. We therefore examined 11 painful hips whose clinical symptoms led us to suspect idiopathic AVN. The radiographs of all of these either were normal or demonstrated a minimal decrease in radiodensity. Magnetic resonance demonstrated diffuse signal loss of the bone marrow at short TR/TE images of the femoral head in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions turned iso- to hyperintense on long TR/TE images compatible with bone marrow edema (BME). Focal abnormalities characteristic for AVN were not seen in any of the cases. Radionuclide studies performed in six cases were positive. All patients underwent core decompression treatment. Hydrostatic bone marrow pressure measurement and intraosseous venography were positive in five cases when measured. Histology available in eight cases confirmed the presence of BME. Furthermore, the bone changes corresponded to those of early AVN. Follow-up examinations after core decompression with MR showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for BME and can monitor the therapeutic success of core decompression. Whether BME of the femoral head constitutes a distinct transient syndrome or represents an early form of AVN is controversial at present. Our findings support those who believe that BME may represent an initial stage of idiopathic AVN.

MRI of spondylitis

MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous administration of Gd-DTPA, enhancement of the marrow and disc was seen. With progressive healing an increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. As healing progressed, the T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA administration. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.

Improved time-of-flight MR angiography of the brain with magnetization transfer contrast

The authors hypothesized that magnetization transfer contrast (MTC) could be used to improve flow contrast in time-of-flight (TOF) magnetic resonance (MR) angiography. Two- and three-dimensional flow-compensated gradient-echo images were obtained with and without MTC. MTC images were obtained by applying low-power radio-frequency (RF) radiation with a frequency offset from the bulk "free" water resonance frequency before the excitation RF pulse. The signal intensity of stationary tissue decreased as the power applied for the MTC pulse was increased. A smaller decrease occurred in venous signal intensity as measured in the superior sagittal sinus, and less change was seen in the arterial signal intensity as measured in the middle cerebral artery. Cerebrospinal fluid showed no MTC effect. The use of MTC improved small-vessel depiction on maximum-intensity projection images. The authors conclude that use of MTC can substantially enhance the quality of TOF MR angiography of the brain.

C1 inhibitor hinge region mutations produce dysfunction by different mechanisms

Heterozygosity for a mutant dysfunctional C1 inhibitor protein, a member of the serine proteinase inhibitor (serpin) superfamily, results in type II hereditary angioneurotic oedema. We identified a "hinge" region mutation in C1 inhibitor with a Val to Glu replacement at P14 Val-432. Recombinant C1 inhibitors P10 Ala-->Thr and P14Val-->Glu did not form stable complexes with fluid phase C1s or kallikrein. The P14 Val-->Glu mutant, however, was cleaved to a 96K form by C1s, while the P10 Ala-->Thr mutant was not. The recombinant P10 mutant also did not complex with C1s, kallikrein or beta-factor Xlla-Sepharose. The two mutations, therefore, result in dysfunction by different mechanisms: in one (P14 Val-->Glu), the inhibitor is converted to a substrate, while in the other (P10 Ala-->Thr), interaction with target protease is blocked.

The modified Scarf bunionectomy

The Scarf bunionectomy offers the surgeon the ability to correct a mild to moderate intermetatarsal angle with the stability inherent to this procedure. When an increased proximal articular set angle is encountered, this procedure could previously only address either the increased intermetatarsal angle or the increased proximal articular set angle. The authors' modifications will incorporate the best attributes of the Scarf, Reverdin, and McBride bunionectomies to allow for concomitant correction of the osseous and soft tissue components of the hallux abducto valgus deformity. The authors' experience with 27 of these procedures performed on 15 different patients from 1987 to 1991 is presented.

MRI of cartilaginous tumours of the larynx

Cartilaginous lesions of the larynx are uncommon, approximately 250 cases being documented in the literature. In general, these tumours grow slowly, exhibiting only local aggressiveness. Distant metastases are rare. Up until now CT has been the best diagnostic tool for the evaluation of these tumours because it demonstrates intratumoral calcification so well. To the best of our knowledge there are no reports of the use of MRI for these lesions. Three cases of cartilaginous laryngeal tumours are presented, emphasizing the MRI features.

MR contrast arthrography (MRA) in osteochondrosis dissecans

Osteochondrosis dissecans (OCD) is a lesion that characteristically affects the articular cartilage and subchondral bone with the potential of fragmentation and separation. Exact assessment of cartilaginous and subchondral bony changes is mandatory for the planning of adequate treatment. Therefore, we examined 25 knees using spin echo (SE) and gradient echo (GE) sequences on a 1.5 T superconducting unit prior to and following intraarticular administration of 40 ml of a 2 mmol/L Gd-DTPA solution (MR arthrography). For evaluation (staging) a modified Clanton and DeLee scheme was employed. Verification by arthroscopy or arthrotomy was available in 24 cases. A correct diagnosis of OCD with regard to its type prior to intraarticular injection of Gd-DTPA was possible in 39.3% using T1-weighted SE sequences and in 57.4% on GE sequences. After intraarticular administration of Gd-DTPA, the rate of correct diagnoses improved to 92.9% on T1-weighted SE sequences and 100% on GE sequences. Magnetic resonance arthrography appears to be helpful for the exact assessment of the articular cartilage overlying OCD lesions as well as for the differentiation between partial and complete separation of cartilaginous or osteocartilaginous fragmentations.

MRI in the diagnosis of primary lymphoma of bone: correlation with histopathology

Seven patients with primary non-Hodgkin lymphoma of the skeleton were examined with MRI. The results were compared to "small cell" primary malignant bone tumors. The latter showed marked hyperintensity on SE T2-weighted images; in contrast, the lymphomas appeared as inhomogeneous lesions of low signal intensity on T2-weighted images. Histologic examination with silver stains of specimens of these lesions revealed a high content of fibrous tissue, which could explain the signal behavior on MR. All seven lymphomas were located in the epiphysis or metaphysis of the appendicular skeleton; intraarticular tumor growth was demonstrated in five cases.

Molecular cloning, analysis, and chromosomal localization of a mouse genomic sequence related to the human papillomavirus type 18 E5 region

The E5 open reading frame (ORF) from bovine papillomavirus type 1 (BPV 1) as well as the E5 ORFs from human papillomaviruses (HPV) type 6 and type 16 have been reported to transform immortalized rodent cells. In an analysis of murine and human tumors for the presence of putative papillomavirus-related sequences, we cloned amplified cellular sequences from the mouse cell line Eb that cross-hybridized with the E5 ORF of HPV 18. A 2.1-kb fragment termed HC1 was sequenced. In normal murine cells, it was present as a single-copy genomic sequence located on chromosome 8. A region of 213 nucleotides corresponded to the E5 gene (HC1 E5), based on the best alignments and on the presence of direct and inverted repeats bearing a central sequence motif. These structural elements are also present in the HPV 18 E5 ORF. HC1 E5 contained an ORF that was transcribed bidirectionally. The transcription in the E5 direction was enhanced in RNA obtained from organs and tumors from carcinogen-treated animals and C127 cells. The polypeptide deduced from the sequence was related to E5 proteins from genital papillomaviruses, to the putative product of the Q300 mouse gene, and to several viral and human growth factors. The data suggest that there may be several cellular counterparts to the viral E5 proteins.

MR angiography of the extracranial carotid arteries using a two-slab oblique 3-D acquisition

PURPOSE

To describe an oblique, two-slab 3-D acquisition technique for MR angiography of the extracranial carotid arteries, an approach chosen to minimize saturation effects when the body coil is used as transmitter, as is often the situation when a dedicated neck coil is used as receiver.

SUBJECTS

Five healthy subjects and 17 patients in whom carotid artery disease was suspected underwent MR angiography using the above technique.

RESULTS

Flow contrast was much better than in direct sagittal acquisition. Comparisons between multislab transverse 3-D acquisition and the oblique approach showed that a greater length of the carotid arteries was depicted and scan time was less for oblique acquisitions.

CONCLUSIONS

Use of oblique imaging is a simple and effective solution to the problem of coil-related saturation effects.

Contrast-enhanced MRI for the staging of bronchogenic carcinoma: comparison with CT and histopathologic staging--preliminary results

Nineteen patients with potentially operable bronchial carcinoma were included in a prospective study to assess the staging capabilities of plain and contrast-enhanced magnetic resonance imaging (MRI) in comparison with computed tomography (CT) and to compare the results to post-operative histopathological staging (HS). The evaluation focused on the following T-staging criteria: (i) direct invasion of the pleura; (ii) neoplastic invasion of the mediastinum; (iii) differentiation of the primary tumour from alterations of the surrounding lung parenchyma such as inflammation or atelectasis; and (iv) intrathoracic lymph node involvement by tumour. MRI and CT produced similar results for pleural invasion (sensitivity of 0.4 and 0.75 respectively and a specificity of 0.86 and 0.93 respectively). Mediastinal invasion was overdiagnosed in four patients (no false negatives), whereas CT had only one false positive result (two false negatives). Our results showed CT to be superior to MRI for the preoperative evaluation of patients suffering from bronchogenic carcinoma.

High-resolution real-time sonography and MR imaging in assessment of osteocartilaginous exostoses

High-resolution real-time ultrasonography (US) and MR imaging, using both spin-echo (SE) and gradient-echo (GE) sequences, were performed prospectively in 14 patients with solitary osteocartilaginous exostoses to assess cartilage cap thickness and bursa formation. Results were compared to surgical and histopathologic findings in all cases. Both US and MR imaging were useful in evaluating exostotic cartilage cap thickness, which is supposed to be the most reliable sign of malignant transformation. Hyaline cartilage matrix had distinctive features in US and MR imaging caused by its specific histologic composition. The formation of bursae over the protruding exostoses, which results in pain and clinically could raise the suspicion of growth and malignant transformation, was demonstrated best using GE sequences. MR imaging was thus superior to US in the detection of bursa formation.

Sclerosis multiplex in gypsies

MS rarely occurs in gypsies in Hungary despite the high DR2 frequency. When it does occur, it has special features more resembling that of Asians than Central Europeans. In order to find correlation between the clinical observations and the immunogenetical data, the distribution of DQw1 subtypes was investigated by means of Eco RV - DQ beta RFLP in DR2 positive healthy gypsies and Hungarians, as well asin DR2-positive Hungarian and unselected gypsy MS patients. DQw6 correlated with MS susceptibility in Hungarians. This allotype was completely absent in healthy DR2-positive gypsies. DR2-positive gypsy MS patients, however, carried DQw6. No correlation of complement allotypes with the occurrence of MS was found in Hungarians, while a striking elevation of C4 Q0 occurred in gypsy MS patients compared with healthy individuals in the gypsy group. The absence of the DR2, DW2, DQw6 haplotype, and the frequency of C4A Q0 in healthy gypsies seems to be associated with the low MS prevalence, but genes outside this region might also influence the MS susceptibility.

Self-defeating personality, self-reinforcement, and depression

51 men who were more self-defeating were observed to use lower frequency of self-reinforcement and to be more depressed. The results were seen as supporting Beck's early work which proposed a relationship between depression and self-defeating patterns. They also provide construct validity for the measure of Self-defeating Personality used in the study.

Degenerative disorders of the cervical spine

Magnetic resonance imaging is the study of choice in patients with suspected degenerative discogenic disease. It is a sensitive diagnostic modality offering multiplanar imaging capability and excellent soft-tissue and spatial resolution without ionizing radiation. Physiologic information, primarily relating to water content, is provided as is a myelographic effect, without the risks of intrathecal contrast. Computed tomography remains a valuable adjunct in those patients with extensive bony degenerative changes.

Rheumatoid arthritis of the cervical spine

This article discusses the pathologic and radiologic changes in the cervical spine that occur with rheumatoid arthritis. The relevance of radiologic evaluation using radiographs, conventional tomography, myelography, computed tomography, computed tomography-myelography, and magnetic resonance imaging is discussed. Magnetic resonance imaging is the pre-eminent radiologic modality in the examination of cervical rheumatoid arthritis.

Differential regulation of the expression of proteinases/antiproteinases in fibroblasts. Effects of interleukin-1 and platelet-derived growth factor

We have previously reported that polypeptide growth factors had an anti-inflammatory effect by decreasing the cytokine-enhanced expression of factor B (FB), an activator of the alternative complement pathway, in human fibroblasts. To further characterize the role of cytokines and growth factors in the inflammatory/repair continuum, we have studied the effects of interleukin-1 (IL-1) and platelet-derived growth factor (PDGF) on the expression of metalloproteinases/antiproteinases of the extracellular matrix in cultured human fibroblasts. Co-incubation of IL-1 and PDGF synergistically increased the expression of stromelysin and interstitial collagenase to 23-fold (for both proteins) over background, while PDGF decreased the IL-1-enhanced expression of FB by 82%. PDGF, but not IL-1, alone or in combination, increased the synthesis of tissue inhibitor of metalloproteinases. RNA blot analysis indicated that the changes in protein synthesis were regulated at a pretranslational level. Cycloheximide treatment indicated that the effects of PDGF on the metalloproteinases/antiproteinases were not protein-dependent, in contrast to results obtained for FB. The effect of the three dimeric forms of PDGF (AA, AB, and BB) on the synthesis of metalloproteinases and FB was also analyzed. The effects were qualitatively similar for each of the dimeric forms; however, the BB and AB isoforms had considerably greater effects than PDGF-AA. It has been reported that the PDGF receptors found in human fibroblasts have higher binding affinity for the BB and AB isoforms of the growth factor. The results presented in this paper are in accord with the possibility that differences in the biological activity of the three isoforms of PDGF are due to differences in the number or affinity of the binding sites of the target cells, rather than to different activation pathways of the receptor. Thus, PDGF increased cytokine effects on metalloproteinases, while decreasing cytokine effects or complement activator FB. The net effect of these changes may be to decrease inflammation and enhance remodeling early in repair and to enhance matrix stability later in the repair process.

[Sudeck's disease--MRT as a new diagnostic procedure]

In this prospective study, we determined the value of MR as an imaging technique in diagnosis and therapy with the option of simultaneous assessment of bone and soft tissue. 20 patients with clinical diagnosis of reflex sympathetic dystrophy syndrome (RSDS) and positive results in radiogram and three-phase radionuclide bone scanning were examined by MR, using T1- and T2-weighted images before and after Gadolinium-DTPA i.v. Soft tissue and bone signal intensity changes can be classified in our diagnostic-therapeutic scheme and proven by histopathological changes. The differentiation between clinical stages is possible and allows an evaluation of course and therapy. The higher costs are justified by shorter examination time without using radiation.

Synthesis of C1 inhibitor in fibroblasts from patients with type I and type II hereditary angioneurotic edema

Patients with hereditary angioneurotic edema (HANE) have serum levels of functionally active inhibitor of the first component of complement (C1 INH) between 5 and 30% of normal, instead of the 50% expected from the single normal allele. Increases in rates of catabolism have been documented in patients with HANE and certainly account for some of decrease in C1 INH level. A possible role for a decrease in synthesis of C1 INH in producing serum levels of C1 INH below the expected 50% of normal has not been well studied. We studied the synthesis of C1 INH in skin fibroblast lines, which produce easily detectable amounts of C1 INH. In type I HANE cells, C1 INH synthesis was 19.6 +/- 4.0% (mean +/- SD) of normal, much less than the 50% predicted. In type II HANE cells, the total amount of C1 INH synthesis (functional and dysfunctional) was 98.9 +/- 17% of normal; the functional protein comprised 43% of the total. Thus, type II HANE cells synthesized functional C1 INH at a much greater rate than for the type I cells. In both type I and II HANE cells, amounts of steady-state C1 INH mRNA levels paralleled rates of C1 INH synthesis, indicating that control of C1 INH synthesis occurred at pretranslational levels. Both type I and type II fibroblasts synthesized normal amounts of C1r and C1s. These data suggest that the lower than expected amounts of functionally active C1 INH in type I HANE may be due, in part, to a decrease in rate of synthesis of the protein, and that the expressions of the normal C1 INH allele in HANE is influenced by the type of abnormal allele present.

Changes in self-concept, cardiovascular endurance and muscular strength of children with spina bifida aged 8 to 13 years in response to a 10-week physical-activity programme: a pilot study

The purposes of this study were to document the self-concept, cardiovascular endurance and isometric muscular strength of children with spina bifida, and to examine the changes in these variables in response to a structured 10-week exercise programme. Eight children trained for about 1 hour a week for 10 weeks, while the five control-group children did not participate in the physical-activity programme. The exercise group improved significantly on five of eight criterion means, while the control group showed no significant improvements. This programme represents an initial attempt to delineate the essential elements in a physical-activity programme to enhance physical fitness and self-concepts of children with spina bifida, and provides a framework for further study.

A marked drop in the incidence of the null allele of the B gene of the fourth component of complement (C4B*Q0) in elderly subjects: C4B*Q0 as a probable negative selection factor for survival

The incidence of allotypes of the genes of the fourth component (C4) and factor B of the complement system was compared in 252 persons under 45 years of age ("young" group) with 482 people between 61 and 90 years of age ("old" group). One hundred people older than 90 years of age (nonagenarians) were also investigated. A striking difference was found between the "young" and "old" groups in the incidence (16.1% and 5.4%, respectively) of a silent gene of the C4B allele (C4B*Q0). This difference was even more marked among "young" and "old" men (17.6% vs 3.4%). The incidence of the C4B*Q0 allele in women dropped to the level of the men only in the nonagenarian group. The most probable explanation for this finding is that people carrying the C4B*Q0 allele die from as yet unidentified disease(s) in their middle-age. Therefore, male (and to a lesser extent female) carriers of this allele may have a considerably shorter life expectancy than individuals without a silent gene in the C4B locus.

Potential markers of the atherosclerotic process in high-risk children

Children whose parents had early coronary heart disease were investigated. In order to assess high-risk parameters serum total cholesterol (TC), total triglyceride (TT), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), lipid peroxide (LP), prostacyclin (PGI2), thromboxane (TX) levels, and the distribution of the complement 3 (C3), protein phenotypes were measured. Compared to a group of control children, the offspring of high-risk subjects had increased LDLC, LP, TC, and TX levels, a higher incidence of fast-slow heterozygotes, and decreased HDLC and PGI2 levels. The measurement of serum PGI2, TX levels and the distribution of C3 protein phenotypes may give further information about the true risk of atherosclerosis.

Evolution of the major histocompatibility complex: molecular cloning of major histocompatibility complex class I from the amphibian Xenopus

Class I major histocompatibility complex (MHC) cDNA clones have been isolated from an expression library derived from mRNA of an MHC homozygous Xenopus laevis. The nucleotide and predicted amino acid sequences show definite similarity to MHC class I molecules of higher vertebrates. The immunoglobulin-like alpha-3 domain is more similar to the immunoglobulin-like domains of mammalian class II beta chains than to those of mammalian class I molecules, and a tree based on nucleotide sequences of representative MHC genes is presented.