Cushing's syndrome associated with ectopic production of corticotrophin-releasing hormone, corticotrophin and vasopressin by a phaeochromocytoma

We describe a case of Cushing's syndrome caused by a phaeochromocytoma secreting corticotrophin-releasing hormone (CRH) and corticotrophin (ACTH). A 49-year-old white woman presented with a 1-month history of lower limb oedema, polydipsia and polyuria. Physical examination revealed a patient with plethoric facies, lanugo-type facial hair, central obesity, red abdominal striae, lower limb oedema, and blood pressure of 210/115 mmHg. Laboratory studies showed high plasma ACTH and markedly elevated urinary cortisol excretion that suppressed more than 50% with high-dose dexamethasone administration. Computed tomographic scan of the abdomen showed a 4-cm left adrenal tumour. Catecholamines and metabolites were markedly increased in a 24-hour urine collection. Results of venous catheterization studies showed that CRH and ACTH were secreted by the tumour. In addition, with ovine CRH administration, inferior petrosal sinus sampling showed pituitary secretion of ACTH. Left adrenalectomy resulted in complete remission of Cushing's syndrome. Light microscopic and immunohistochemical studies revealed a phaeochromocytoma that produced CRH, ACTH and vasopressin. RNA studies showed that this tumour, in contrast to normal adrenal and other reported phaeochromocytomas, transcribed a lone pituitary-sized (1200 nucleotide) pro-opiomelanocortin mRNA. This is the second reported case of a CRH-secreting phaeochromocytoma.

Comparison of one-stage versus two-stage anterior/posterior spinal fusion for neuromuscular scoliosis

Twenty-six patients with progressive neuromuscular scoliosis underwent anterior/posterior (AP) spinal fusion. Thirteen of the patients underwent a one-stage fusion, and 13 underwent a two-stage fusion. Although one-stage AP spinal fusion provides adequate correction of severe curves and allows a more expeditious recovery without increasing patient morbidity or mortality, current third-party payor reimbursement policies provide little incentive for 1-day operations. In addition, the procedure is mentally and physically demanding and the apparent benefits must be weighed against the potential harm that can result from surgeon fatigue or lack of appropriate planning.

Postoperative physical therapy for podiatric surgery

The authors discuss several rehabilitation protocols for different surgical procedures on the foot. These are designed to be used as a reference for the podiatrist and therapist. In addition, various modalities are highlighted to familiarize the practitioner with their uses. Physical therapy can aid in decreasing the recovery period from foot surgery, which is particularly advantageous for the athlete.

Squamous cell carcinoma in southern and northern Australia

Squamous cell carcinoma (scc) of the skin was studied in two similar populations, one living in the temperate zone of Australia, the other living in the tropics. In the tropics, the patients were significantly younger, the man to woman ratio approached unity, and women had significantly more sccs on the legs. In the temperate zone, men had significantly more on the head and neck, but women had significantly more on the upper and lower limbs.

Familial occurrence of multiple nonmelanoma skin cancer

A survey of patients with histologically confirmed nonmelanoma skin cancer (NMSC) found 12 families in which several members developed skin cancers. The prevalence of NMSC in these families was far greater than in the normal population. The trait appeared to be dominantly inherited, and NMSC developed at an earlier age in succeeding generations, possibly because of a change in sun exposure habits.

Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin

We report the occurrence of cytopenia and hypothyroxinemia attributed to decreased levels of thyroxine-binding globulin in patients receiving nicotinic acid. We describe two patients in whom hypothyroxinemia developed while they were taking nicotinic acid; these patients also had decreased levels of thyroxine-binding globulin. Results of all thyroid function tests returned to normal when use of the nicotinic acid was discontinued. In one patient, leukopenia and thrombocytopenia developed during nicotinic acid therapy alone. These conditions were reversed after the drug regimen was discontinued. In another patient, leukopenia and thrombocytopenia developed during combination nicotinic acid and lovastatin therapy. When administration of both drugs was discontinued, the hematologic abnormalities, which could have been due to either nicotinic acid or lovastatin, diminished. We suggest that cytopenia may develop in patients receiving nicotinic acid; thus, thyroid function tests should be interpreted in light of a possible decreased level of thyroxine-binding globulin.

Basal-cell carcinoma in temperate and tropical Australia

The clinical features of patients with basal-cell carcinoma (BCC) living in temperate and tropical Australia were studied. In the temperate zone the patients were considerably older on average, men outnumbered women and there were differences between the sexes in the site of the prevalent BCC. In the tropics the patients were significantly younger on average, the male-to-female ratio approached unity and there were no differences between the sexes with regard to the site of the BCC.

Leg lengthening by the transiliac method

The transiliac method of leg lengthening uses a modification of Salter's innominate osteotomy. The bone graft increases the length of the hemipelvis distal to the sacro-iliac joint. Leg-length inequality in 23 patients was treated by this method with an average gain in length of 2.8 cm (2.0 to 3.5). Apart from one residual femoral nerve palsy there were no notable complications. The facility to redirect the acetabulum allowed by the technique, may be useful in cases of potential hip instability or acetabular dysplasia.

Motor neurone disease: a hospice perspective

OBJECTIVE

To describe and evaluate the management of patients with motor neurone disease from the perspective of a hospice.

DESIGN

Retrospective analysis of hospice medical and nursing notes.

SETTING

Established 62 bed teaching and research hospice.

SUBJECTS

124 patients with motor neurone disease cared for by the hospice between January 1980 and November 1990.

MAIN OUTCOME MEASURES

Patient profile; functional status; symptom control and use of opioids; insight; mode and management of death.

RESULTS

124 patients (67 women, 57 men) had a mean age 63.9 years. The median length of admission was 61.5 days (range 1 to 2147). 84 patients (68%) were aware of their diagnosis and its implications when first seen by a hospice doctor. Functionally, the patients were very dependent. Symptoms such as pain, dyspnoea, and insomnia were major problems that responded well to opioids. Many patients were noted to deteriorate "suddenly," and in 58% of cases death occurred within 24 hours of this deterioration. When dying, 106 patients (94%) were peaceful and settled. 101 patients (89%) received opioids during this dying period. No patient chocked to death.

CONCLUSIONS

Although motor neurone disease is an uncommon disorder, many of its symptoms occur commonly in medical practice and must be actively treated. Opioids are both safe and effective for such treatment. The term chocking is both inaccurate and inappropriate in describing the cause of death in motor neurone disease and its use should be abandoned.

Lower extremity cycling biomechanics. A review and theoretical discussion

An updated review of cycling biomechanics of the lower extremity is presented. Special attention is directed toward the known data pertaining to foot function. A theoretical discussion on foot function during cycling and its possible link to knee injury is also presented. It is suggested that supinatory and pronatory moments applied to the foot during cycling result in referral of adverse forces to the knee.

Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to beta-agonist therapy

STUDY OBJECTIVES

To determine the benefit of the addition of ipratropium bromide to beta-agonist therapy of acute exacerbations of chronic obstructive pulmonary disease.

DESIGN

The trial was randomized and double blinded.

SETTING

The study was conducted in the emergency department of Parkland Memorial Hospital, a busy, inner-city, county hospital.

INTERVENTIONS

Patients were treated in the medicine emergency department with either the standard regimen of nebulized isoetharine, 0.5 mL of a 1% solution (5.0 mg) diluted to 2.0 mL with normal saline every hour (control group) or with the same regimen plus ipratropium bromide, 54 micrograms (three puffs) after the first isoetharine treatment and 36 micrograms (two puffs) after the second and fourth (experimental group). A placebo metered-dose inhaler used in the same manner as the ipratropium blinded the study to both the patients and medical personnel.

MEASUREMENTS AND MAIN RESULTS

The group treated with the addition of ipratropium (30) was discharged from the ED an average of 91 minutes (P less than .05) sooner than the control group (25) and required on the average one less isoetharine treatment (P less than .05). The pulmonary functions tested, forced expiratory volume in the first second, and the forced vital capacity were the same in the two groups initially and on discharge, as identical discharge criteria were used in each group.

CONCLUSION

The addition of ipratropium to standard beta-agonist treatment of chronic obstructive pulmonary disease exacerbations shortens the duration of treatment required in the ED.

The changing face of skin cancer in Australia

A survey of patients with basal cell carcinomas (BCCs) revealed that major changes have occurred since the World War II. In the pre-World War II generations, men out-number women and most BCCs occur on the head and neck. Men had more BCCs on the ear and trunk, while women had more on the head and leg. In the post-World War II generation, women outnumbered men and most BCCs occurred on the trunk.

RNA polymerase II pauses at the 5' end of the transcriptionally induced Drosophila hsp70 gene

An RNA polymerase II molecule is associated with the 5' end of the Drosophila melanogaster hsp70 gene under non-heat shock conditions. This polymerase is engaged in transcription but has paused, or arrested, after synthesizing about 25 nucleotides (A. E. Rougvie and J. T. Lis, Cell 54:795-804, 1988). Resumption of elongation by this paused polymerase appears to be the rate-limiting step in hsp70 transcription in uninduced cells. Here we report results of nuclear run-on assays that measure the distribution of elongating and paused RNA polymerase molecules on the hsp70 gene in induced cells. Pausing of polymerase was detected at the 5' end of hsp70 in cells exposed to the intermediate heat shock temperatures of 27 and 30 degrees C. At 30 degrees C, each copy of hsp70 was transcribed approximately five times during the 25-min heat shock that we used. Therefore, once the hsp70 gene is induced to an intermediate level, initiation of transcription by RNA polymerase II remains more rapid than the resumption of elongation by a paused polymerase molecule.

Identification of a major peanut allergen, Ara h I, in patients with atopic dermatitis and positive peanut challenges

Peanuts are among the most common causes of immediate hypersensitivity reactions to foods. Serum from nine patients with atopic dermatitis and a positive double-blind, placebo-controlled, food challenge to peanut were used to begin the process of identification and purification of the major peanut allergens. Identification of a major peanut allergen was accomplished by use of anion-exchange column chromatography, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, ELISA, thin-layer isoelectric focusing, and IgE-specific immunoblotting. Anion-exchange chromatography revealed several fractions that bound IgE from the serum of the challenge-positive patient pool. By measuring antipeanut-specific IgE in the ELISA and in IgE-specific immunoblotting, we identified an allergenic component with two Coomassie brilliant blue staining bands by sodium dodecyl sulfate-polyacrylamide gel electrophoresis with a mean molecular weight of 63.5 kd. Examination of this fraction by the IgE antipeanut ELISA with individual serum and by the ELISA-inhibition assay with pooled serum, we identified this fraction as a major allergen. Thin-layer isoelectric focusing and immunoblotting of this 63.5 kd fraction revealed it to have an isoelectric point of 4.55. Based on allergen nomenclature of the IUIS Subcommittee for Allergen Nomenclature, this allergen is designated, Ara h I (Arachis hypogaea).

A case of pregnancy associated osteoporosis and empty sella syndrome

We report an unusual case of pregnancy associated osteoporosis and empty Sella Syndrome with normal pituitary function. Pregnancy associated osteoporosis has been described rarely in the literature. Primary empty Sella Syndrome may occur in 5.5% of all autopsies. Primary empty Sella Syndrome with normal pituitary function has not previously been reported in association with an uncomplicated pregnancy and delivery. The occurrence of these two conditions in our patient is probably coincidental.

The importance of standardised radiographs when assessing hip dysplasia

The reliability of radiological criteria in the diagnosis of congenital dislocation of the hip is discussed. In a review of 20 normal infant patients the variability of the radiographic relationship between the ossific nucleus of the proximal femoral epiphysis and the acetabulum is identified. Hip arthrography in 10 patients and pathological examination of femoral heads confirm that the ossific nucleus lies superiorly within the infant femoral head and may be displaced from the true centre of the femoral head by up to 40% of it's radius. As the ossific nucleus of the capital femoral epiphysis is shown to originate eccentrically within the spherical cartilaginous anlage it is suggested that standardisation of hip radiographs is required in the routine clinical assessment of the infant hip, particularly in the presence of dysplasia.

Autonomic dysfunction and silent myocardial ischaemia on exercise testing in diabetes mellitus

The incidence and mechanism of painless myocardial ischaemia on exercise testing in diabetic patients is not clear. Therefore, two studies were performed. Retrospectively, all exercise tests carried out in our hospital during the past 5 years were reviewed for silent ischaemia. Prospectively, diabetic patients with known or suspected coronary artery disease underwent autonomic function testing and a second exercise test. Of 1653 exercise tests reviewed, 247 were positive (ST depression greater than 0.1 mV). Of the 29 diabetic patients with positive tests 20 (69%) had painless ST depression, compared with 77 (35%) of the 218 non-diabetic patients (p less than 0.001). The diabetic patients with painful and painless ST depression were comparable for age, sex, therapy, but the 20 with no pain on exercise testing had a longer duration of diabetes and a higher incidence of microvascular complications than the 9 with pain (70 vs 22%, p less than 0.05). In the prospective study, 12 of 30 diabetic patients with positive exercise tests had pain in association with ST depression and 18 had no pain. Six patients had mild and 12 severe autonomic neuropathy on formal testing. Twelve had no autonomic dysfunction. Eleven (92%) of 12 patients with severe neuropathy had painless ST depression, compared with 7 (39%) of 18 without severe neuropathy (p less than 0.01). Thus, silent myocardial ischaemia on exercise testing is common among patients with diabetes mellitus and is associated with severe autonomic dysfunction.

The technique of gait analysis using a Coda-3 motion analysis system

Gait analysis using Code-3 provides information which allows individual gait to be characterised with little interference to the patient. It is an ideal method for analysing gait in patients with cerebral palsy. Because of the ease with which this information is now available using Coda-3, gait analysis can now be performed on all ambulant patients in whom surgery is contemplated.

Usefulness of biochemical screening of diabetic patients for hemochromatosis

We assessed the prevalence of previously unrecognized hemochromatosis among patients in whom diabetes mellitus was diagnosed after the age of 30 yr, and we evaluated the positive predictive value of biochemical screening tests for hemochromatosis in diabetic subjects. Thirty-eight of 572 patients screened (6.6%) had a serum ferritin level greater than 324 micrograms/L; 16 patients had normal levels on repeat testing. Four patients' serum ferritin levels fell to less than 400 micrograms/L. Seven of 18 patients with a persistently elevated serum ferritin level did not undergo a liver biopsy because of a recognized cause of hyperferritenemia (carcinoma, alcoholism, or systemic lupus erythematosus). The diagnosis of hemochromatosis seemed certain in 1 of 3 patients who were not biopsied for technical reasons. Of 8 patients biopsied, 2 had hemochromatosis, 4 had fatty liver, 1 had hemosiderosis, and 1 had a chronic inflammatory cell infiltrate with no iron deposition. Of 4 patients with a raised transferrin saturation level, 2 had raised serum ferritin levels and hemochromatosis, 1 had raised serum ferritin and hemosiderosis on liver biopsy, and 1 had a normal transferrin saturation level on repeat testing. Two of 3 cases of hemochromatosis had other clinical markers of the condition. Therefore, routine screening of diabetic patients for hemochromatosis is not necessary, because patients with hemochromatosis will often have other clinical features of the disease. When screening diabetic patients for hemochromatosis, it should be remembered that a persistently raised serum ferritin level has a low positive predictive value (16.6%) and that a normal transferrin saturation level does not exclude the diagnosis.

Anatomic dissection of the tibialis posterior muscle and its correlation to medial tibial stress syndrome

The authors attempt to redefine the anatomic origin of the tibialis posterior muscle, and correlate it with the location of medial tibial stress syndrome that occurs in the lower third of the tibia. Contrary to what is commonly described, the authors show on all ten dissected specimens, that the origin of the tibialis posterior does include a portion of the lower third of the tibia. The mean distance from tibialis posterior's origin to the medial malleolus was only 7.77 cm. In addition, to further explain lower leg pain, the authors investigated the crossing point of tibialis posterior and flexor digitorum longus; a mean distance for this to occur in the same ten specimens was 8.16 cm. proximal to the medial malleolus. These findings provide insight to anatomic reasons behind biomechanical factors responsible for medial tibial stress syndrome. This is also important to consider when performing surgery for a deep compartment syndrome.

Postoperative jejunal feedings following complicated pancreatitis

Some surgeons avoid placing a jejunostomy in patients with complications, fearing either exacerbation of the disease during enteral feedings or complications from the jejunostomies. Eleven patients with hemorrhagic pancreatitis (four), pancreatic abscess (five), or infected pseudocyst (two) underwent placements of needle (five) or Red Robinson (six) jejunal catheters during laparotomy. Five patients had been given 30.8 +/- 16 liters of TPN over 25 +/- 12 days preoperatively. Only two patients received TPN postoperatively because of progressive sepsis with enteral intolerance to feedings. One of these patients developed a jejunal leak near the placement of the Red Robinson catheter. Both patients died of complications from their pancreatic disease. The remaining nine patients received 35.6 +/- 8.6 liters of enteral feedings over 31 +/- 6.8 days before resuming oral intake. Glucosuria and hyperglycemia were common, but easily managed. No catheters were lost, and diarrhea necessitating slowing and diluting the diet was unusual after the first week. Enteral feeding did not elevate amylase values. Therefore, jejunal feedings can be given safely in patients with severe acute pancreatic disease to provide prolonged nutrition without aggravating the disease.

Biodegradable emboli and antibody targetting of colorectal and gastric hepatic metastases: a pilot study

The effect of degradable starch microspheres (DSM) on the passage of a low molecular weight marker through the liver of patients with metastases was compared with the passage of an anti-carcinoembryonic antigen monoclonal antibody. In all six patients studied DSM reduced the passage of the marker into the systemic circulation. In three patients who received labelled whole antibody, DSM had no effect. In two of three who received antibody fragments a similar delay to the low molecular weight marker was observed. This delay is likely to be a result of the smaller size of the fragments and may represent accumulation within the extravascular space.

Scutting: a dangerous pastime?

Scutting is a pastime which has taken place in Dublin for many years. To scutt is to gain a ride on the back of a moving vehicle holding onto it by any means possible. Injuries sustained while scutting have never previously been reported. A total of 38 children presented at the Accident and Emergency Department of The Children's Hospital, Temple Street during the period January 1985 to July 1987 with injuries sustained while scutting. The injuries were analysed with regard to type, pattern, severity and outcome; nine children died from their injuries and 34.2 per cent of the children were admitted to hospital with an average stay of 5 days. All of those admitted alive made a full recovery. Comparison is made with other more everyday sensible pastimes and with road traffic accidents involving children. Scutting is shown to be the most dangerous pastime and is responsible for more deaths than any other type of road traffic accident involving children. Suggestions are made to stop this pastime taking place.

Radiographic changes in the ossific nucleus in congenital dislocation of the hip

Twenty one patients with a delayed diagnosis of congenital dislocation of the hip were studied to assess the relevance of radiographic changes in the ossific nucleus of the proximal femur during the first year following treatment. All abnormal hips demonstrated sclerosis of the margins of the ossific nucleus with irregularity of its surface at three months following surgery. In nineteen patients a head within a head was identified. These common changes are interpreted as the radiographic appearance of a spherical growth disturbance line formed by the ossific nucleus. It is concluded that these radiographic changes which are often accepted as indicators of avascularity are of no detrimental significance in the absence of physeal injury.

Oxygen-dependent differences in exopolysaccharide production and aminoglycoside inhibitory-bactericidal interactions with Pseudomonas aeruginosa--implications for endocarditis

Antibiotic-induced growth inhibition and killing of a non-mucoid strain of Pseudomonas aeruginosa (PA-96) in vitro and ex vivo were studied at oxygen tensions approximating those of the right and left cardiac ventricles in vivo (pO2 = 40 VS. 80 mm Hg). This pseudomonal strain grew equally at the two oxygen tensions, yet only bacteria exposed to pO2 80 mm Hg revealed significant exopolysaccharide production as shown by PAS and ruthenium red staining. Similarly, scanning electron microscopy of pseudomonal cells within aortic (but not tricuspid) vegetations revealed surface excrescenses compatible with surrounding exopolysaccharide (glycocalyx). Amikacin at 10 x MIC caused significantly less in-vitro killing of pseudomonal cells at pO2 80 VS. 40 mm Hg. In vitro and ex vivo (within experimental aortic and tricuspid vegetations), post-antibiotic effect durations were about 50% shorter for cells exposed to amikacin at pO2 80 mm Hg than 40 mm Hg. These data demonstrate suboptimal aminoglycoside-induced growth inhibition and killing, as well as enhanced exopolysaccharide production of a non-mucoid P. aeruginosa strain at oxygen tensions reflective of the left side of the heart. These findings may in part explain the better results seen in aminoglycoside-treated right compared to left-sided pseudomonal endocarditis in man.

Salter-Harris type III fracture of the proximal humeral physis

Salter-Harris type III, IV and V injuries of the proximal humeral physis are rare. We report an undisplaced Salter-Harris type III injury of the humeral head physis in a 10-year-old girl. The fracture united with non-operative treatment.

Growth disturbance lines after injury of the distal tibial physis. Their significance in prognosis

We reviewed 26 fractures involving the distal physis of the tibia to identify the patterns of formation and displacement of the subsequent growth disturbance lines. Twenty-one patients showed a regular "normal" pattern of line and healed with no deformity. Three patients had medical physeal arrest revealed by abnormal lines. Two other cases had a minor central physeal arrest without subsequent deformity. The pattern and character of the growth disturbance line can provide an early warning of potential deformity.

Kinetic effects of adriamycin and bleomycin on two osteosarcoma models

Although chemotherapeutic drugs are frequently administered to patients with osteosarcoma, there has been little research into the effect of cytotoxic drugs on osteosarcoma cell biology. The effect of two drugs (Adriamycin and bleomycin) on cell cycle kinetics was investigated in vitro in an established line of human osteosarcoma cells and in vivo using the Dunn osteosarcoma model. The cell cycle changes were consistent with G2 arrest for both drugs in vivo and in vitro. The alteration in cell cycle distribution was correlated with inhibition of 3H-thymidine incorporation in vitro. In vivo, the greater change in cell cycle distribution caused by Adriamycin was reflected in the increased inhibition of tumor growth found with this drug.

Initial clinical experience with degradable starch microspheres

Four patients with advanced hepatic malignancy have been investigated with a view to intra-arterial treatment with degradable starch microspheres (DSM) and mitomycin-C (MMC). Computer-assisted interpretation of data gathered during the administration of technetium-labelled albumin allows the degree of arteriovenous shunting within the liver to be measured. In a similar way, the effectiveness of DSM in blocking hepatic arterial flow is determined. Two patients showed unacceptably high levels of shunting (75% and 100%) and were excluded from further study. One patient with hepatocellular carcinoma shunted only 24% of the macroaggregated albumin, and flow through the liver was reduced to 48% by DSM therapy. This patient has undergone four courses of MMC without significant toxic complications. The last patient had 25% shunting. The DSM titration and the first MMC administration had to be abandoned because of severe abdominal pain and nausea related to a fracture of the intra-arterial catheter. Complications directly associated with the procedures have been acceptable. The relationship between flow reduction and the amount of DSM administered is non-linear, and the appropriate dose of DSM for each treatment must be titrated against both the patient's symptoms and the computer-generated flow indices.

The early identification and classification of growth disturbances of the proximal end of the femur

An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.

Osteoid osteoma: localization by intraoperative magnification scintigraphy

Surgical localization of osteoid osteomas is a major problem in the diagnosis and therapy of this lesion. Visual, tactile, and radiographic localization is often equivocal and as a consequence incomplete excision of the tumor, or excessive removal of bone may result. We performed magnification intraoperative bone scintigraphy using a portable gamma camera and a radioactive pointer in six patients with osteoid osteoma. Accurate localization and complete removal of the tumor was achieved in all six with only minimal delays in the surgical procedure. The advantages of this technique and recommendations for its use are discussed.

Femoral head size in congenital dislocation of the hip

Observations on the size of the femoral head in congenital dislocation of the hip are presented. The long-term effects of open reduction and innominate osteotomy on the size of the femoral head are assessed. Innominate osteotomy does not cause overgrowth of the femoral head, although open reduction results in mild coxa magna. The pathophysiology and significance of coxa magna are discussed.

Growth-disturbance lines in congenital dislocation of the hip

In congenital dislocation of the hip, growth-disturbance lines as shown radiographically regularly occur in the proximal end of the femur after operative procedures are performed under general anesthesia. They can be seen in children who are between the ages of six months and four years and tend to disappear over several years. I think that the final shape of the femoral neck can be predicted by closely observing the development and displacement of the growth-disturbance lines that are induced at the time of surgical treatment.

Phorbol esters enhance spontaneous cytotoxicity of human lymphocytes, abrogate Fc receptor expression, and inhibit antibody-dependent lymphocyte-mediated cytotoxicity

Phorbol esters with tumor promoter activity enhance the spontaneous cytotoxicity of human lymphocytes against a variety of target cell lines, with an efficiency that correlates with their potency as tumor promoters or skin irritants. Analysis of surface marker expression of the lymphocytes cytotoxic after treatment with phorbol ester identified the cytotoxic cell subset as that containing natural killer cells. Although gamma-interferon (IFN gamma) is produced by T cells treated with phorbol esters, IFN gamma is probably not the mediator of enhancement of natural killer cell activity, because anti-IFN gamma antibodies failed to block this enhancement. Spontaneous cell-mediated cytotoxicity is inhibited when phorbol esters are present during the cytotoxic assay, but is enhanced when the effector cells are pretreated with these agents. On the other hand, antibody-dependent cytotoxicity mediated by lymphocytes is inhibited by phorbol ester pretreatment of the effector cells or by phorbol esters present during the cytotoxic assay. Treatment of lymphocytes with phorbol esters at 37 degrees C, but not at 4 degrees C, completely abrogates in 1 to 2 hr the expression of the receptor for the Fc fragment of IgG, as detected by rosette formation with IgG-sensitized erythrocytes and by reactivity with anti-Fc receptor antibodies. The inhibition of antibody-dependent cytotoxicity by phorbol esters is probably secondary to their effect on the Fc receptor.

Phorbol esters enhance spontaneous cytotoxicity of human lymphocytes, abrogate Fc receptor expression, and inhibit antibody-dependent lymphocyte-mediated cytotoxicity

Phorbol esters with tumor promoter activity enhance the spontaneous cytotoxicity of human lymphocytes against a variety of target cell lines, with an efficiency that correlates with their potency as tumor promoters or skin irritants. Analysis of surface marker expression of the lymphocytes cytotoxic after treatment with phorbol ester identified the cytotoxic cell subset as that containing natural killer cells. Although gamma-interferon (IFN gamma) is produced by T cells treated with phorbol esters, IFN gamma is probably not the mediator of enhancement of natural killer cell activity, because anti-IFN gamma antibodies failed to block this enhancement. Spontaneous cell-mediated cytotoxicity is inhibited when phorbol esters are present during the cytotoxic assay, but is enhanced when the effector cells are pretreated with these agents. On the other hand, antibody-dependent cytotoxicity mediated by lymphocytes is inhibited by phorbol ester pretreatment of the effector cells or by phorbol esters present during the cytotoxic assay. Treatment of lymphocytes with phorbol esters at 37 degrees C, but not at 4 degrees C, completely abrogates in 1 to 2 hr the expression of the receptor for the Fc fragment of IgG, as detected by rosette formation with IgG-sensitized erythrocytes and by reactivity with anti-Fc receptor antibodies. The inhibition of antibody-dependent cytotoxicity by phorbol esters is probably secondary to their effect on the Fc receptor.

The needle test for complete rupture of the Achilles tendon

Several difficulties may be encountered in making a definitive non-operative diagnosis of a complete rupture of the Achilles tendon. In this paper, I describe a new test that directly determines the integrity of the distal ten centimeters of the Achilles tendon. This test is compared with the test described by Thompson and Doherty, and the occasional discrepancy between them is explained by observations that are based on examination of anatomical specimens.

UV-induced reversion of his4 frameshift mutations in rad6, rev1, and rev3 mutants of yeast

The UV-induced reversion of two his4 frameshift alleles was much reduced in rad6 mutants of Saccharomyces cerevisiae, an observation that is consistent with the hypothesis that RAD6 function is required for the induction of all types of genetic alteration in misrepair mutagenesis. The reversion of these his4 alleles, together with two others of the same type, was also reduced in rev1 and rev3 mutant strains; in these, however, the extent of the reduction varied considerably with test allele used, in a manner analogous to the results in these strains for base repair substitution test alleles. The general features of UV-induced frameshift and substitution mutagenesis therefore appear quite similar, indicating that they may depend on related processes. If this conclusion is correct, greater attention must be given to integrating models which account for the production of nucleotide additions and deletions into those concerning misrepair mutagenesis.

Increased concentrations of immunoreactive leukotrienes in cutaneous lesions of eosinophilic cellulitis

A case of eosinophilic cellulitis is described. Tests of eosinophil function were normal. Radioimmunoassay identification of inflammatory mediators showed greatly increased concentrations of leukotrienes LTC4/D4 (components of slow-reacting substance of anaphylaxis) in the affected skin. These mediators may play a causal role in the inflammation seen with eosinophilic cellulitis.

An ultrastructural examination of non-lymphoid host cells of Moloney murine leukaemia virus of CFW/D mice

An ultrastructural examination of various tissues from CFW/D mice, neonatally injected with Moloney murine leukaemia virus (Mo-MuLV) revealed the presence of type C virus particles budding from the membranes of various bone marrow-derived cells, pancreatic acinar cells, beta cells, and submandibular gland acinar cells. These observations indicate that Mo-MuLV has the potential to replicate in non-lymphoid cell types even when acquired post-partum. In the pancreas, a large accumulation of immature and mature viral particles was observed between the cell membranes of the acinar cells and the basal lamina. A similar accumulation of viral particles was observed in the lumina of the acinus of submandibular glands. The role of murine leukaemia viruses as potential mediators of aberrations of non-haemopoietic tissues and an alternative mode of viral transmission are discussed.

Genetic linkage relationship between the Xg blood group system and two X chromosome DNA polymorphisms in families with Duchenne and Becker muscular dystrophy

The existence of linkage has been investigated between the Xg blood group system, two DNA restriction fragment length polymorphisms (RFLPs) located on the short arm of the X chromosome, Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). No linkage was found between the Xg locus and the more proximal RFLP (L 1.28); close linkage between Xg and the more distal RFLP (lambda RC8) was also excluded. Both RFLPs show linkage with DMD but are not closely linked with each other. Analyses of 11 families with DMD and ten with BMD, informative for the Xg blood group, reinforce the conclusions of others that there is no measurable linkage between the loci for Xg and for the X-linked forms of muscular dystrophy.

The use of linked DNA polymorphisms for genotype prediction in families with Duchenne muscular dystrophy

Two DNA restriction fragment length polymorphisms show genetic linkage to the Duchenne muscular dystrophy locus on the short arm of the X chromosome. Examples are given of families in which these polymorphisms can be used in the prediction of genotype for this disorder.