Macrophagic myofasciitis plus (distinct types of muscular dystrophy)

Macrophagic myofasciitis (MMF) is a well-known lesion following vaccination with aluminium-containing vaccines. It has abundantly been reported in adults and several times in children, often in single patients or in rather small cohorts. Only few of these published reports on children have shown distinct myopathology of another neuromuscular disease except for MMF. Indications for biopsy often were nondescript clinical features in children, such as hypotonia or delay in motor development but, apparently, never that of suspected MMF. Thus, in previous reports as well as in our two patients, encountering MMF in the biopsied tissue specimens was coincidental. Our two unrelated patients with MMF also had two separate types of muscular dystrophy, a merosinopathy and dystrophinopathy, showing a combination of myopathologically well-defined neuromuscular diseases, muscular dystrophies and MMF. Detecting such a combination of two separate conditions may, in the future, be rare when non-invasive techniques, e. g., genetic, will have replaced muscle biopsy in ascertaining hereditary neuromuscular conditions, especially in children.

Fracture properties of the human mandible

A total of seven human mandibles were struck to breaking point under standardised conditions using a pendulum. The cortical deformation for two impact directions was measured with strain gauge strips located at eight defined sites. Fronto-median impacts led to mostly bilateral and always multiple fractures in the posterior area of the bone, especially in the collum and the condyle. The fracture threshold was between 2.5 and 3.1 kN. Lateral impact caused fractures near the impact area as direct fractures of the ipsilateral corpus. Mainly single and double fractures were observed. For lateral impact the fracture threshold was between 0.6 and 0.8 kN.

Deformation characteristics of the human mandible in low impact experiments

A total of 11 human mandibles were subjected to physical impacts under standardised conditions. Two impact sites and directions were tested and the impact load was varied in four steps. Two occlusional strengths were applied and the influence of simulated soft tissue covering was recorded. The deformation of the bones was measured using strain gauge strips located at eight defined sites. In a series of frontal to occipital impacts the frontal areas and the collum showed the largest length changes. Increasing impact intensities led to a proportional increase of the length changes. An increase of the occlusional strength was either protective (at the collum) or it increased the deformation (frontal area). The soft tissue covering was only partly protective. Lateral impact was characterised by a compression on the side of the impact and stretching on the other side only. The intensity and speed of deformation increased with increasing distance from the site of impact. A fixed occlusion caused an increase of compression at the site of impact and an increasing stretching in the frontal part of the bone and at the opposite collum.

The cloven hoof in legal medicine

The injury of a horse's leg needed to be investigated to answer the question whether the fracture had been caused by an accident or by intentional manipulation. By toxicology and using scanning electron microscopy with an energy dispersive X-ray spectrometer (SEM-EDX) the suspicion obtained by morphology could be confirmed. Toxicologically a short term anaesthetic was found, and by EDX ferric oxide particles could be detected in the wound indicating that the injury was caused by a sharp pointed metallic instrument and not as stated by the owner by a wooden bar. As the result of the interdisciplinary investigation using modern techniques, there is no doubt that the owner attempted to fraudulently claim on an insurance policy.

Trajectory reconstruction from trace evidence on spent bullets. I. Deposits from intermediate targets

Contact of a fired bullet with an intermediate target of sufficient resistance commonly causes the bullet to ricochet, fragment or perforate together with a deviation in trajectory. The transfer of intermediate target material to bullets and subsequent detection on the bullet surface after recovery from a bullet collector, were examined using a scanning electron microscope and an energy-dispersive X-ray spectrometer (SEM/EDS). A total of 76 gunshots (9 mm Luger FMJ RN bullets) were fired at various intermediate targets and at combinations of intermediate targets and tissue located in line. Elements already present on unfired bullets and elements from the bullet collector, the jacket, the charge and primer could be consistently detected as a "background". Abundant deposits of "fragile" (brittle) materials such as concrete, flat glass, asphalt and gypsum board could be visualised on every bullet by SEM. The transfer dynamics involved a direct imprint of target material on the bullet surface and thus preferential locations at the tip but also indirect deposition over the entire surface ("powder effect"). X-ray microanalysis demonstrated matching spectra of the elemental composition of these deposits and of the targets contacted. After perforation of "ductile" (flexible) materials such as wood and car body parts, the deposits on the bullets did not show characteristic spectra. If multi-layered car metal targets were hit, few and uncharacteristic fragments were scattered over the bullet surface and titanium indicative of paint-work could be determined on only a minority of bullets. The elemental composition of wood itself was heterogeneous but the fibrous morphology of the deposits was typical. The SEM/EDS findings in gunshots including subsequent perforation of tissue were similar. In particular, the trace evidence primarily transferred to the bullets was not eliminated by secondary contact and the determination of the fragile target materials was not affected. So when a person is killed or injured by a gunshot, the presence of a ricochet and the target material can be determined. This possibility needs to be considered before an evidential bullet is cleaned or contaminated.

188Re DD-3B6/22 Fab' for use in therapy of ovarian cancer: labelling and animal studies

A fast and high yielding method of 188Re radiolabelling DD-3B6/22 Fab' is described. An inert atmosphere [N2(g)] and ascorbic acid was essential for preparation and storage of therapeutic levels (< or =2 GBq/mg) for up to 24 h. Immunoreactivity was greater than 75%. Pharmacokinetic studies in nu/nu mice demonstrated localisation of 188Re DD-3B6/22 Fab' was equivalent and correlated well with the behaviour observed for 99mTc DD-3B6/22 Fab' used to image ovarian cancer. Excellent stability at the target site in vivo supports the potential use of 188Re DD-3B6/22 Fab' in the therapy of ovarian cancer.

Limitedly selective action of a delta-agonistic leu-enkephalin on the transmission in spinal motor reflex pathways in cats

1. The influence of the delta-opioid receptor agonist (D-Ser2)-leu-enkephalin (Thr6) (DSLET) on different spinal reflex pathways was investigated in anaemically decapitated, high spinal cats. Monosynaptic reflexes were tested to analyse excitatory and inhibitory flexor reflex afferent (FRA) pathways from nociceptive (from the skin of the central pad) and non-nociceptive (from skin, joint or group II muscle) afferents, as well as an excitatory nociceptive non-FRA pathway from the central pad to plantaris and intrinsic foot extensors and the inhibitory pathway from Ib muscle afferents. 2. DSLET suffused over the spinal cord (concentration 10(-3)-10(-6) M) caused a concentration-dependent depression of transmission in nociceptive and non-nociceptive FRA pathways. The excitatory FRA pathways including those from group II muscle afferents were more sensitive than the inhibitory ones. The nociceptive non-FRA pathway from the central pad to plantaris and intrinsic foot extensors was less affected than the FRA pathways. The inhibitory pathway from Ib muscle afferents remained almost unaffected. 3. Intravenous injection of DSLET (0.5-3.6 mg/kg) induced dose-dependent effects similar to those from local spinal application. The main difference was that I.V. injection more readily caused depression of the inhibitory FRA pathways to extensors. 4. The effects of local spinal application and of I.V. injection of DSLET were antagonized by I.V. injection of naloxone (0.1-1 mg/kg). 5. The effects of DSLET on spinal reflex pathways in many respects resemble that of monoamines. Possibly there is an interaction and a co-operation of enkephalins and monoamines in motor control.

Polyneuropathy due to acute arsenic intoxication: biopsy studies

A 41-year-old vintner attempting suicide ingested 8-9 g of arsenic and developed a symmetric polyneuropathy with acute Wallerian degeneration of myelinated fibers. Under treatment with modified British Anti-Lewisite (BAL; "Dimaval") his polyneuropathy slowly, but incompletely, subsided over three years at which time another sural nerve biopsy specimen showed regenerative proliferation of myelinated and unmyelinated axons but no signs of Wallerian degeneration. By laser microprobe mass analysis (LAMMA) arsenic was located in the first biopsied sural nerve specimen but not in the second specimen. These findings demonstrated: 1) arsenic induced serial morphometric and electron microscopic findings of nerve fiber degeneration and regeneration, 2) documentation of arsenic within myelinated nerve fibers, and 3) the usefulness of the LAMMA technique as a diagnostic procedure in this context.

Influence of the organophosphorus compound DFP on inhibitory motor systems and esterase activity in the spinal cord of cats

In high spinal cats, the acute time-dependent changes of both the activity of spinal reflex pathways and the activity of three different esterases (acetylcholinesterase, carboxylesterase and neurotoxicant target enzyme) in the spinal cord were investigated after intravenous application of the organophosphorus compound di-isopropyl phosphofluoridate (DFP). There is no general depression of spinal reflexes by DFP. While the recurrent inhibition is completely abolished for a long time and the reflexes to a flexor (PBSt) are depressed but with a shorter recovery time, the reflexes to an extensor (GS) are distinctly less depressed or even facilitated. Reflex pathways from skin afferents to motoneurones did not react in a uniform way to DFP, e.g. inhibitory nociceptive pathways were less affected than excitatory ones. Esterase activities were heavily depressed and recovered with different time courses. The acute DFP action cannot be explained by a uniform intoxication of all spinal functions but probably emerges from a differential action on different interneuronal systems.

The distribution of lead in human hemopoietic tissue and spongy bone after lead poisoning and Ca-EDTA chelation therapy. Observations made by atomic absorption spectroscopy, laser microbeam mass analysis and electron microbeam X-ray analysis

Two iliac crest needle biopsies were taken from a 43-year-old lead-poisoned woman during and after completion of a Ca-EDTA treatment. By atomic absorption spectroscopy the first and second biopsy were found to contain 56, respectively 41.6 micrograms lead/g wet tissue. In both biopsies 36% of the lead was extractable in 0.1 N HCl. Electron microbeam X-ray analysis proved to have too low sensitivity for quantitation of the lead in these biopsies. Laser microbeam mass analysis (LAMMA), performed only on the second biopsy, revealed a high and fairly constant residual lead concentration in all bone marrow cell nuclei (approximately 55 micrograms/g) and a low lead concentration in the cytoplasm of the same cells (4-12 micrograms/g). The extracellular bone matrix lead was greatly concentrated in the superficial 3-6 microns osteoid zone of the bony trabeculae and totally absent from deeper parts of the mineralized matrix. The LAMMA results are in good agreement with those of subcellular fractionation experiments and atomic absorption spectroscopy, provided that the relative volume fraction of nucleus and cytoplasm is accounted for. The high residual osteoid lead after completed chelation therapy indicates that lead has a stronger affinity for the organic than the mineral components of bone matrix.

Electron-microscopic and microprobe analyses on the pigmented and unpigmented enamel of Sorex (Insectivora)

Sorex belongs to the Insectivora and has a pigmented tooth enamel due to iron. The pigmented enamel (PE) has a mean Ca/P weight ratio, analyzed by quantitative electronprobe X-ray microanalysis, of about 1.9 (mean molar Ca/P ratio 1.46), and the unpigmented enamel (UE) a Ca/P weight ratio of about 2.0 (mean molar Ca/P ratio 1.59). The PE has a higher iron content (with a value of about 8%) than the UE, as shown by microanalysis of ultrathin sections. Laser microprobe mass analysis (LAMMA) has shown that the carbonate content in the UE is higher than in the PE. In the LAMMA spectrum of the negatively charged ions the carbonate lines could be compared directly with those of negatively charged iron ions. The pigmentation is associated with a low Ca/P ratio but may transfer mechanical strength and acid resistance strength to the PE.

Femoral hernia in children

The records of 26 children with femoral hernia are reviewed. In five patients, inguinal herniotomy had been performed previously. The correct diagnosis was made preoperatively in 7 (27%) of the cases only. The operation included a repair narrowing the femoral canal in all but 5 cases. At follow-up 1/2-19 1/2 years no recurrence was found. The importance of a careful pre- and peroperative examination is emphasized.

Potassium concentration in membrane-associated particles in the epiphyseal growth plate

Electron-dense particles with a diameter of 50-200 nm have been observed at the cell membrane of chondrocytes in the zone of the initiation and advance of mineralization, using the dark field STEM mode. Electron-probe x-ray microanalysis and laser microprobe mass analysis indicate that these particles contain predominantly K and Na. They appear only in dry thin sections of shock-frozen, freeze-dried embedded tissue and not in sections of water-treated samples; hence they contain water-extractable potassium and sodium. The function of the two elements at these special sites is not yet clear. On the one hand, they might reflect exocytotic processes connected with a Na-K-ATPase; on the other hand, they might exist as a transitory state before being replaced by Ca and phosphate in the mineralizing matrix and later transported elsewhere by the blood vessels.

The effects of a new serotonin receptor antagonist (ketanserin) on lower urinary tract function in patients with prostatism

Ten male patients with prostatism, median age 63 years (range 50 to 70 years) were given an intravenous injection of a new serotonin antagonist, ketanserin, at a dose of 10 mg., and were investigated urodynamically before and after injection. A statistically significant increase in maximum and mean flow rates and a statistically significant decrease in urethral pressure profile measurements was observed. Supine CO2 cystometry showed no significant decrease in volumes of first sensation and bladder capacity. No subjective side effects were registered, but we observed a statistically significant decrease in mean blood pressure of 6.5 mm. Hg (range 5 to 14 mm. Hg). The mechanism behind the beneficial effect of ketanserin on micturition in prostatism is not yet known, but the results could explain an alpha blocking effect of the drug.

Oxalate-induced encephalitic reactions to polyol-containing infusions during intensive care

Fifteen of 5800 neuropathologically examined brains showed oxalosis with an intense inflammatory reaction comparable to ethylene glycol intoxication. All patients had received intensive care therapy with infusions of high amounts of xylitol, sorbitol, mannitol, or fructose, mostly together with glucose. The encephalitic reaction induced by calcium oxalate crystals was manifested by clinical symptoms of cerebral damage. A genetically fixed polyol intolerance is hypothesized to explain polyol-induced oxaloses in brain, kidney, and partly also in myocardium.

Assessment of magnesium and aluminum in erythrocytes by the laser microprobe mass analyzer (LAMMA)

The erythrocyte magnesium content was determined using two different analytical systems (atomic absorption spectrometry and the laser microprobe mass analyzer) with specimens from 18 patients with normal renal function and from 10 patients with chronic renal insufficiency. There was a good correlation (r = 0.73) between the two analytical systems. Additionally, the laser microprobe mass analyzer was used to determine the aluminum content of plasma and erythrocytes in specimens from patients who ingested moderate quantities of aluminum hydroxide for several months. Results showed a significant elevation of the plasma aluminum concentration, but a normal erythrocyte aluminum content. The laser microprobe mass analyzer may be useful in studies of mineral metabolism in humans.

The use of a laser microprobe to identify calcium oxalate in histological material

Some birefringent renal deposits were found to give the usual histological reactions for calcium oxalate but were soluble in caustic alkalis. Comparison with known oxalate crystals using a laser microprobe mass analyser confirmed the presence of calcium oxalate. Similar crystals were found in liver tissue from a rat poisoned with ethylene glycol.

Secondary athrocytotic cardiomyopathy--heart damage due to Wilson's disease

Post-mortem atomic absorption spectrophotometry of the myocardium of a 14-year-old boy revealed a hundred-fold increase in copper. Further electrolyte analysis of the myocardium showed changes corresponding to metabolic heart muscle damage. Ultrastructural examination showed all the feature of a cardiomyopathy at the cellular level. Laser-Microprobe-Mass-Analysis demonstrated an inhomogeneous distribution of copper. An essential factor in the mechanism of death is heart damage.

Effects on reflex bladder activity of chemical stimulation of small diameter afferents from skeletal muscle in the cat

In anesthetized cats selective activation of fine muscle afferents of the hindlimb by KCl or bradykinin (Brad.) induced reflex changes in the urinary bladder. The nature of the reflex responses depended on the functional state of the bladder: they were excitatory when the bladder was quiescent and inhibitory during large, slow, rhythmic micturition contractions. Selective activation of large muscle primary afferents by succinylcholine was ineffective. All reflexes disappeared after cutting the sciatic or the pelvic nerves. Transection of the hypogastric nerves to the bladder had no effect.