Insufficiency fracture of the sternum caused by osteopenia: plain film findings in seven patients

Sternal insufficiency fractures, whether nonbuckling (displaced or nondisplaced) or buckling, are rare and have been described in elderly osteopenic patients with accentuated kyphosis of the thoracic spine. We retrospectively analyzed the radiographs and clinical records in seven osteopenic patients with sternal insufficiency fractures and correlated the type of insufficiency fracture with the presence and degree of dorsal kyphosis, as well as the presence of chest pain, soft-tissue mass, and osteolysis. We found that displaced or nondisplaced nonbuckling fractures (five patients) may be associated with chest pain localized to the sternum (three patients), and may be present with (three patients) or without (two patients) associated thoracic kyphosis. This type of insufficiency fracture also may be accompanied by a soft-tissue mass and osteolysis (three patients), findings simulating pathologic fractures. All buckling insufficiency fractures (two patients) were associated with thoracic kyphosis and were asymptomatic. Our findings suggest that sternal insufficiency fractures may occur with or without exaggerated dorsal kyphosis. The fractures are an uncommon complication of osteopenia and may resemble pathologic fractures when osteolysis and soft-tissue swelling are present.

Demonstration of the scapholunate space with radiography

The importance of radiographic evaluation of the scapholunate space, which should not be wider than 2 mm, has been well established in cases of wrist injury. Unfortunately, the assessment of this space is not accurately determined with routine posteroanterior (PA) radiographs, because the scaphoid and lunate bones often overlap. Moreover, the exact portion of the scapholunate space that should be measured has never been clearly defined. Nine wrists with a scapholunate space no wider than 2 mm and without chondrocalcinosis were studied by means of plain routine views and special projections, transaxial and coronal computed tomographic scans, and dissection to determine the precise orientation and anatomy of this space. A PA radiograph with 10 degrees of tube angulation from the ulna toward the radius best demonstrated the scapholunate space. This space should be measured at the level of the midportion of the flat lateral facet of the scaphoid.

Osteophytosis of the knee: anatomic, radiologic, and pathologic investigation

Although the radiologic manifestations of degenerative disease of the knee have been investigated, the distribution of marginal and central osteophytes has not been defined. This study included (a) 50 consecutive patients with osteoarthritis of the knee in whom routine and specialized projections were obtained prospectively, (b) 25 patients with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease whose knee radiographs were retrospectively reviewed, and (c) four cadaveric knees that were dissected to assess pertinent anatomy. In this study the importance of the tunnel view in the evaluation of osteoarthritis and CPPD crystal deposition disease is demonstrated, the distribution of and the relationship between marginal and central osteophytes are discussed, and two new radiologic signs are described. As both marginal and central osteophytes may simulate intraarticular bodies, the recognition of these outgrowths is of clinical importance.

Is MR better than arthrography for evaluating the ligaments of the wrist? In vitro study

The purpose of this study was to determine the relative merits of MR imaging and three-compartment digital arthrography in the assessment of carpal ligaments in vitro. We performed MR imaging and arthrography in 10 normal wrists of fresh cadavers ranging in age from 48 to 71 years, and compared the appearance of the interosseous ligaments and triangular fibrocartilage complex with findings on anatomic sections of the joints. In six of the specimens, relatively T1-weighted MR images, 800/20 (TR/TE), preceded three-compartment digital arthrography performed with standard contrast material. In the other four specimens, arthrography, using an MR solution of iodinated contrast material mixed with cupric sulfate and gelatin, was performed before MR imaging. This was done to mimic the intraarticular fluid that might be seen in an injured wrist. MR allowed accurate assessment of the triangular fibrocartilage complex and scapholunate ligament in eight of 10 cases. Consistent MR visualization of the lunotriquetral ligament was difficult. Three-compartment digital arthrography allowed accurate assessment of the triangular fibrocartilage complex and scapholunate and lunotriquetral ligaments in all 10 cases. We concluded that MR is useful but inferior to arthrography in the evaluation of interosseous ligaments and the triangular fibrocartilage complex.

Sequence-specific functions of the early palindrome domain within the SV40 core origin of replication

The early palindrome domain within the SV40 core origin of replication is essential for the initiation of replication. Studies with single point mutants in this region suggested that the early palindrome domain does not function as a cruciform structure, but may be involved in the initiation of SV40 DNA replication in a sequence-specific manner. Two mutants, base-substituted at a primase initiation site nucleotide 5214, showed dramatic decreases in DNA replication in monkey cells. Despite earlier reports to the contrary, disruption of the cruciform configuration or polypyrimidine tract does not invariably lead to lack of replication function, as some mutants unable to form this structure replicate normally. Gel retention assays and DNase I footprinting with the nuclear proteins of monkey cells showed that the 5'GAGGC3' pentanucleotide repeats on either side of early palindrome domain interact with monkey nuclear protein. The early palindrome domain may affect the interaction of SV40 DNA with nuclear protein, and participate in SV40 DNA replication.

Intraosseous fat necrosis associated with acute pancreatitis: MR imaging

Necrosis of fatty bone marrow, caused by lipolytic enzymes, is a rare complication of several pancreatic disorders. A 44-year-old man with polyarthritis, subcutaneous nodules, and osteolysis associated with alcoholic pancreatitis underwent magnetic resonance (MR) imaging of the knees. In the marrow of the distal femur and proximal tibia, the images showed multiple foci of abnormal signal intensity compatible with the diagnosis of fat necrosis secondary to acute pancreatitis. Because MR imaging can depict abnormalities in fatty marrow that seem to precede necrosis, this modality may add early diagnostic information.

Microcholangiography. Normal microbiliary system and its alteration after extrahepatic bile duct obstruction

The authors used microcholangiography to demonstrate the feasibility of the technique and the features of the normal and the obstructed biliary systems. Furthermore, they attempted to explain the pathophysiology of cholangiography-related septicemia with this technique. Extrahepatic bile ducts (EHBD) of 40 rabbits were ligated, and microcholangiography was carried out with infusion of barium suspension immediately as well as one, three, and five days after ligation. Microradiographic technique was used and the findings were correlated with histopathologic features. The intrahepatic microbiliary system such as interlobular bile ducts and ductules were well visualized. After EHBD ligation, ductules were tortuously dilated. The histologically observed ductular proliferation in many hepatobiliary diseases could be attributed in part to the tortuosity of bile ductules, particularly when biliary obstruction is present. Regurgitation of barium into hepatic sinusoids was demonstrated in 36 rabbits (90%) and probably was caused by rupture of interlobular bile ducts and ductules.

[The effects of clinical application of a nursing diagnosis protocol]

This study was conducted to measure the effects of clinical application of a Nursing Diagnosis Protocol. The dependent variables were the degree of patient's satisfaction and the degree of nurse's satisfaction with the nursing activity. Analysis of the effect of the use of the nursing diagnosis protocol was based on the nursing record. The subjects for this study were 61 nurses (experimental group 31, control group 30) and 155 patients (experimental group 55, control group 100) on four internal medicine wards in K University Hospital in Seoul.

[The use of nursing diagnosis in practice]

This study was conducted to investigate the present situation and problems related to the use of nursing diagnosis in practice. The data were obtained from 332 subjects (27 director of nursing service, 302 staff nurses) who worked in university hospitals in Korea from July through August 1988 using a mailed questionnaire. Data were analyzed by frequency, X2 test and t-test. The findings were as follows: 1. Clinical use of nursing diagnosis by directors of nursing service and staff nurses. 1) The majority of the nursing departments (88.9%) conducted group education on nursing diagnosis during the last 5 years and 81.5% of them kept a record format for nursing diagnosis; 88.9% of them had had prior experience with the nursing diagnosis. 2) Most of nurses (97.0%) had received education on nursing diagnosis. 2. Factors related to the clinical use of nursing diagnosis in nursing service departments and by staff nurses. 1) The one factor related to the use of nursing diagnosis in the nursing service department was the existence of a record. 2) Factors related to the use of nursing diagnosis by the staff nurses were the organization style of the nursing service department, group education during the last 5 years, existence of a record, the attitude of the director of nursing service, and prior experience of the use of the nursing diagnosis as characteristics of nursing service department and educational experience of nursing diagnosis as a character of nurse. 3. Problems with the use of nursing diagnosis. 1) The primary problem was the lack of time and personnel (mean:3.757); the second problem was the lack of knowledge and will to use nursing diagnosis in practice by the staff nurses (mean:3.546). 2) There was no significant difference in problems expressed by the director of nursing services and the nurses. The majority of nurses who worked in the university hospitals expressed interest in and concern about the use of nursing diagnosis. Most of the nurses had had education about on nursing diagnosis but use in practice was limited. The primary problem was lack of time and manpower.(ABSTRACT TRUNCATED AT 400 WORDS)

A new arterial flap from the postauricular surface: its anatomic basis and clinical application

We studied the arterial pattern of the postauricular surface in 16 cadavers and compared them to the results of Doppler probing in the auricles of 15 human volunteers. The dissections revealed that the postauricular surface is mainly supplied by three to five sizable branches from the upper, middle, and lower divisions of the posterior auricular artery, traversing in a rather straight and cephalic direction toward the auricular rim. One or more branches of the middle division are constantly present and distribute over the upper two-thirds of the postauricular surface. These anatomic findings were compatible with the results of the Doppler probing. We have done four auricular reconstructions with postauricular arterial flaps with excellent postoperative results. It is worthwhile to use the postauricular arterial flap in restoring the middle third of the auricle.

Role of single-channel stochastic noise on bursting clusters of pancreatic beta-cells

To study why pancreatic beta-cells prefer to burst as a multi-cellular complex, we have formulated a stochastic model for bursting clusters of excitable cells. Our model incorporated a delayed rectifier K+ channel, a fast voltage-gated Ca2+ channel, and a slow Cai-blockable Ca2+ channel. The fraction of ATP-sensitive K+ channels that may still be active in the bursting regime was included in the model as a leak current. We then developed an efficient method for simulating an ionic current component of an excitable cell that contains several thousands of channels opening simultaneously under unclamped voltage. Single channel open-close stochastic events were incorporated into the model by use of binomially distributed random numbers. Our simulations revealed that in an isolated beta-cell [Ca2+]i oscillates with a small amplitude about a low [Ca2+]i. However, in a large cluster of tightly coupled cells, stable bursts develop, and [Ca2+]i oscillates with a larger amplitude about a higher [Ca2+]i. This may explain why single beta-cells do not burst and also do not release insulin.

Dorsal root ganglion neurons with central processes in both dorsal and ventral roots in rats

Axonal transport of fluorescent dyes, Diamidino yellow dihydrochloride (DY) and Fast blue (FB), applied to the cut distal ends of dorsal and ventral roots, respectively, was studied in order to determine whether any dorsal root ganglion (DRG) neurons have processes in both dorsal and ventral roots. A total of 359 DRG neurons are double labeled in 14 ganglia (L6 and S1) from 6 different animals, thus suggesting a possibility of many DRG neurons having multiple central processes. The somata of the double-labeled DRG neurons are small to medium in size with a mean diameter of 29 microns. These data are consistent with findings that the majority of ventral root afferent fibers are unmyelinated or small myelinated axons.

Mediastinal tuberculous lymphadenitis: CT manifestations

An analysis was done of computed tomographic (CT) scans of 23 Korean patients who had presented with a mediastinal or hilar mass on plain chest radiographs and had subsequently been found to have tuberculous lymphadenitis. Most patients were young adults. Findings of pulmonary tuberculosis were seen on plain radiographs in 14 patients. On CT, findings were of an overwhelming preponderance of involvement of the right paratracheal and tracheobronchial nodes. After injection of contrast medium, nodes larger than 2 cm in diameter invariably showed central areas of relative low density and peripheral rim enhancement. Enhanced walls were usually irregular in thickness. Some smaller nodes did not show low-density areas, but instead showed varying degrees of homogeneous enhancement. Although metastatic nodes can be of low density, experience in this study suggests that mediastinal lymphadenopathy in a young adult with the CT findings described above is characteristic enough to support a diagnosis of tuberculosis.

Complete nucleotide sequence of the penicillin G acylase gene and the flanking regions, and its expression in Escherichia coli

The pga gene coding for penicillin G acylase (PGA) in Escherichia coli ATCC11105 was cloned, and its complete nucleotide sequence including 5'- and 3'-flanking regions was determined. Two nonidentical subunits that constitute an active PGA enzyme complex are known to be formed by processing of a common precursor molecule [Böck et al., FEMS Microbiol. Lett. 20 (1983) 141-144]. This novel type of protein processing was confirmed by a nucleotide sequencing study together with amino acid sequencing of two PGA subunits. In addition, it was found that the initiation codon, AUG, is preceded by an authentic ribosome-binding site, a consensus promoter sequence and putative cAMP receptor protein (CRP)-binding sites, and that the termination codon, UAA, is followed by a putative transcriptional terminator. The promoter function was confirmed by galactokinase assay using galK fusion plasmids. A recombinant plasmid was constructed to overproduce the enzyme using phage lambda pL promoter. Unexpectedly, thermal induction led to accumulation of the 94-kDa polypeptide rather than active PGA in large amounts. Western immunoblot analysis showed that this large polypeptide is the real precursor of PGA. It is evident, therefore, that the synthesis of active PGA in E. coli is affected by growth temperature and that the precursor processing step(s) is temperature-sensitive.

Transcatheter renal arterial embolization with the mixture of ethanol and iodized oil (Lipiodol)

We induced experimental renal arterial embolization with the radiopaque solution of ethanol and iodized oil (Lipiodol) in 35 rabbits to evaluate the capability of the mixture to induce renal ablation. Serial renal angiography and plain abdominal radiography were performed immediately, one week and two weeks after embolization. Neither pure Lipiodol nor a 50% ethanol solution caused renal embolization. However, infusion of 50% and 75% ethanol-Lipiodol solutions resulted in embolization equal to that caused by absolute ethanol. The 50% ethanol-Lipiodol solution was so radiopaque that we could easily observe the embolization process during fluoroscopy. Renal arterial embolization with the 50% ethanol-Lipiodol solution was successful in three patients with hypernephroma. Our results suggest that a 50% ethanol-Lipiodol solution is radiopaque and an effective agent for renal arterial embolization.