Altered Cerebellar White Matter in Sensory Processing Dysfunction Is Associated With Impaired Multisensory Integration and Attention

Sensory processing dysfunction (SPD) is characterized by a behaviorally observed difference in the response to sensory information from the environment. While the cerebellum is involved in normal sensory processing, it has not yet been examined in SPD. Diffusion tensor imaging scans of children with SPD (n = 42) and typically developing controls (TDC; n = 39) were compared for fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) across the following cerebellar tracts: the middle cerebellar peduncles (MCP), superior cerebellar peduncles (SCP), and cerebral peduncles (CP). Compared to TDC, children with SPD show reduced microstructural integrity of the SCP and MCP, characterized by reduced FA and increased MD and RD, which correlates with abnormal auditory behavior, multisensory integration, and attention, but not tactile behavior or direct measures of auditory discrimination. In contradistinction, decreased CP microstructural integrity in SPD correlates with abnormal tactile and auditory behavior and direct measures of auditory discrimination, but not multisensory integration or attention. Hence, altered cerebellar white matter organization is associated with complex sensory behavior and attention in SPD, which prompts further consideration of diagnostic measures and treatments to better serve affected individuals.

Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

INTRODUCTION

Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs.

METHODS

A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher's exact test. Continuous variables were analyzed with Student's t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software.

RESULTS

Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001).

DISCUSSION

Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.

Characterizing cognitive and visuomotor control in children with sensory processing dysfunction and autism spectrum disorders

OBJECTIVE

Children with autism spectrum disorders (ASD) and sensory processing dysfunction (SPD) are reported to show difficulties involving cognitive and visuomotor control. We sought to determine whether performance on computerized, behavioral measures of cognitive control aimed at assessing selective attention, as well as visuomotor abilities differentiated children with ASD (n = 14), SPD (n = 14) and typically developing controls (TDC; n = 28).

METHOD

Cognitive control differences were measured by assessing selective attention-based abilities both with and without distracting stimuli, and visuomotor differences were measured by characterizing visuomotor tracking and tracing skills. Performance in cognitive control and visuomotor domains were investigated globally as composite scores, and specifically within each task.

RESULTS

Our results indicated that though the ASD group showed the most impaired selective attention performance, the SPD group had intermediate abilities-performing above the ASD group but below the TDC group. Furthermore, both the SPD and ASD groups demonstrated equally impaired visuomotor abilities relative to the TDC group. A correlational analysis between cognitive and visuomotor control suggest a relationship between these overlapping control networks.

CONCLUSIONS

This study supports the importance of direct, phenotypic characterizations of control-based abilities in children with ASD and SPD to personalize characterization and treatment interventions for at-risk children. (PsycINFO Database Record

Magnetoencephalographic Imaging of Auditory and Somatosensory Cortical Responses in Children with Autism and Sensory Processing Dysfunction

This study compared magnetoencephalographic (MEG) imaging-derived indices of auditory and somatosensory cortical processing in children aged 8–12 years with autism spectrum disorder (ASD; N = 18), those with sensory processing dysfunction (SPD; N = 13) who do not meet ASD criteria, and typically developing control (TDC; N = 19) participants. The magnitude of responses to both auditory and tactile stimulation was comparable across all three groups; however, the M200 latency response from the left auditory cortex was significantly delayed in the ASD group relative to both the TDC and SPD groups, whereas the somatosensory response of the ASD group was only delayed relative to TDC participants. The SPD group did not significantly differ from either group in terms of somatosensory latency, suggesting that participants with SPD may have an intermediate phenotype between ASD and TDC with regard to somatosensory processing. For the ASD group, correlation analyses indicated that the left M200 latency delay was significantly associated with performance on the WISC-IV Verbal Comprehension Index as well as the DSTP Acoustic-Linguistic index. Further, these cortical auditory response delays were not associated with somatosensory cortical response delays or cognitive processing speed in the ASD group, suggesting that auditory delays in ASD are domain specific rather than associated with generalized processing delays. The specificity of these auditory delays to the ASD group, in addition to their correlation with verbal abilities, suggests that auditory sensory dysfunction may be implicated in communication symptoms in ASD, motivating further research aimed at understanding the impact of sensory dysfunction on the developing brain.

A pilot study to determine the feasibility of enhancing cognitive abilities in children with sensory processing dysfunction

Children with Sensory Processing Dysfunction (SPD) experience incoming information in atypical, distracting ways. Qualitative challenges with attention have been reported in these children, but such difficulties have not been quantified using either behavioral or functional neuroimaging methods. Furthermore, the efficacy of evidence-based cognitive control interventions aimed at enhancing attention in this group has not been tested. Here we present work aimed at characterizing and enhancing attentional abilities for children with SPD. A sample of 38 SPD and 25 typically developing children were tested on behavioral, neural, and parental measures of attention before and after a 4-week iPad-based at-home cognitive remediation program. At baseline, 54% of children with SPD met or exceeded criteria on a parent report measure for inattention/hyperactivity. Significant deficits involving sustained attention, selective attention and goal management were observed only in the subset of SPD children with parent-reported inattention. This subset of children also showed reduced midline frontal theta activity, an electroencephalographic measure of attention. Following the cognitive intervention, only the SPD children with inattention/hyperactivity showed both improvements in midline frontal theta activity and on a parental report of inattention. Notably, 33% of these individuals no longer met the clinical cut-off for inattention, with the parent-reported improvements persisting for 9 months. These findings support the benefit of a targeted attention intervention for a subset of children with SPD, while simultaneously highlighting the importance of having a multifaceted assessment for individuals with neurodevelopmental conditions to optimally personalize treatment.

Characterizing cognitive control abilities in children with 16p11.2 deletion using adaptive 'video game' technology: a pilot study

Assessing cognitive abilities in children is challenging for two primary reasons: lack of testing engagement can lead to low testing sensitivity and inherent performance variability. Here we sought to explore whether an engaging, adaptive digital cognitive platform built to look and feel like a video game would reliably measure attention-based abilities in children with and without neurodevelopmental disabilities related to a known genetic condition, 16p11.2 deletion. We assessed 20 children with 16p11.2 deletion, a genetic variation implicated in attention deficit/hyperactivity disorder and autism, as well as 16 siblings without the deletion and 75 neurotypical age-matched children. Deletion carriers showed significantly slower response times and greater response variability when compared with all non-carriers; by comparison, traditional non-adaptive selective attention assessments were unable to discriminate group differences. This phenotypic characterization highlights the potential power of administering tools that integrate adaptive psychophysical mechanics into video-game-style mechanics to achieve robust, reliable measurements.

White Matter Microstructure is Associated with Auditory and Tactile Processing in Children with and without Sensory Processing Disorder

Sensory processing disorders (SPDs) affect up to 16% of school-aged children, and contribute to cognitive and behavioral deficits impacting affected individuals and their families. While sensory processing differences are now widely recognized in children with autism, children with sensory-based dysfunction who do not meet autism criteria based on social communication deficits remain virtually unstudied. In a previous pilot diffusion tensor imaging (DTI) study, we demonstrated that boys with SPD have altered white matter microstructure primarily affecting the posterior cerebral tracts, which subserve sensory processing and integration. This disrupted microstructural integrity, measured as reduced white matter fractional anisotropy (FA), correlated with parent report measures of atypical sensory behavior. In this present study, we investigate white matter microstructure as it relates to tactile and auditory function in depth with a larger, mixed-gender cohort of children 8–12 years of age. We continue to find robust alterations of posterior white matter microstructure in children with SPD relative to typically developing children (TDC), along with more spatially distributed alterations. We find strong correlations of FA with both parent report and direct measures of tactile and auditory processing across children, with the direct assessment measures of tactile and auditory processing showing a stronger and more continuous mapping to the underlying white matter integrity than the corresponding parent report measures. Based on these findings of microstructure as a neural correlate of sensory processing ability, diffusion MRI merits further investigation as a tool to find biomarkers for diagnosis, prognosis and treatment response in children with SPD. To our knowledge, this work is the first to demonstrate associations of directly measured tactile and non-linguistic auditory function with white matter microstructural integrity – not just in children with SPD, but also in TDC.

A clinicopathologic analysis of 88 lung resections of suspected metastatic carcinomas with proven primaries

BACKGROUND

The lung is the most common site for metastatic carcinomas. Very few studies have comprehensively analyzed all pulmonary resections for metastatic carcinomas.

AIMS AND OBJECTIVES

To analyze all lung resections for suspected metastatic carcinomas accrued over 10 years to evaluate: (i). The most frequent primary site,(ii). The interval between primary tumor diagnosis and lung metastases, and (iii). The proportion of inadvertently resected benign lesions, clinicoradiologically mistaken for metastatic deposits.

MATERIALS AND METHODS

Between 2002 and 2011, 88 pulmonary metastasectomies were done for suspected metastatic carcinomas, which form the basis of this study.

RESULTS

In 81 of 88 cases (92%) the diagnosis of metastatic carcinoma was histologically confirmed, whereas 7 cases (8%) were non-neoplastic. The mean interval between primary tumor and metastases was 2.5 years. The primary sites were colorectum (30; 37%), kidney and breast (14; 17.3% each), cervix (9; 10%), salivary gland carcinoma (3), thyroid carcinoma (2), squamous carcinoma (2, one each of mandible and larynx), papillary urothelial carcinoma (2), hepatocellular carcinoma (1), endometrioid adenocarcinoma (1), carcinosarcoma of endometrium (1), adrenocortical carcinoma (1), and neuroendocrine carcinoma (1). The 7 non-neoplastic lesions (8%) histologically revealed tuberculosis (4), bronchopneumonia (2), and aspergillosis (1).

CONCLUSIONS

Almost three fourths (71.6%) of the metastatic pulmonary resections comprised primaries from colorectum, breast and kidney. The interval between primary tumor and metastases ranged from zero months to 10 years (mean 2.5 years). Tuberculosis was the most common histologic diagnosis among the 8% of the non-neoplastic lesions, which were mistaken for metastatic carcinoma on clinical evaluation.

A year of anaplastic large cell kinase testing for lung carcinoma: pathological and technical perspectives

BACKGROUND

An in-frame fusion protein between echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic large cell kinase (ALK) genes is seen in some non-small cell lung cancer (NSCLC). EML4-ALK demonstrates constitutive kinase activity. These ALK-positive lung carcinomas have been shown to respond to ALK kinase inhibitors. ALK gene rearrangement is commonly detected using fluorescent in situ hybridization (FISH).

AIMS

To study the pathological features of ALK positive and negative NSCLC and evaluate the causes of uninterpretable FISH results.

MATERIALS AND METHODS

This is a retrospective, observational study. The molecular pathology records of patients on whom test for ALK had been performed in a period of 1 year (February 2012 to February 2013) were accessioned. A total 224 cases were identified. Histological features were reviewed. The in situ hybridization was performed using Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.). Signal interpretation under the fluorescent microscope was performed in accordance with College of American Pathologists guidelines.

RESULTS

Five patients showed ALK gene rearrangement, 182 were negative and 37 cases were uninterpretable. Five patients with ALK gene rearrangement had a mean age of 48 years and the male to female ratio was 2:3. In the ALK negative cases, the mean age was 54 years and male to female ratio was 3.2:1. Histologically, amongst the rearranged cases, three showed solid pattern, one showed acinar and one showed acinar with signet ring cells on histology.

CONCLUSION

The percentage of ALK gene rearrangement was 2.7% (excluding the uninterpretable cases). These ALK positive patients were relatively younger than ALK negative patients. Solid pattern on histology was associated with ALK positivity. In a quarter of the uninterpretable results, the material submitted was fixed and processed outside.

Autism and sensory processing disorders: shared white matter disruption in sensory pathways but divergent connectivity in social-emotional pathways

Over 90% of children with Autism Spectrum Disorders (ASD) demonstrate atypical sensory behaviors. In fact, hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment is now included in the DSM-5 diagnostic criteria. However, there are children with sensory processing differences who do not meet an ASD diagnosis but do show atypical sensory behaviors to the same or greater degree as ASD children. We previously demonstrated that children with Sensory Processing Disorders (SPD) have impaired white matter microstructure, and that this white matter microstructural pathology correlates with atypical sensory behavior. In this study, we use diffusion tensor imaging (DTI) fiber tractography to evaluate the structural connectivity of specific white matter tracts in boys with ASD (n = 15) and boys with SPD (n = 16), relative to typically developing children (n = 23). We define white matter tracts using probabilistic streamline tractography and assess the strength of tract connectivity using mean fractional anisotropy. Both the SPD and ASD cohorts demonstrate decreased connectivity relative to controls in parieto-occipital tracts involved in sensory perception and multisensory integration. However, the ASD group alone shows impaired connectivity, relative to controls, in temporal tracts thought to subserve social-emotional processing. In addition to these group difference analyses, we take a dimensional approach to assessing the relationship between white matter connectivity and participant function. These correlational analyses reveal significant associations of white matter connectivity with auditory processing, working memory, social skills, and inattention across our three study groups. These findings help elucidate the roles of specific neural circuits in neurodevelopmental disorders, and begin to explore the dimensional relationship between critical cognitive functions and structural connectivity across affected and unaffected children.

A clinico-morphological study of 95 cases of sarcomas with metastases to the lungs

BACKGROUND

Metastasis of soft tissue sarcoma most commonly occurs to the lungs. There are very few studies on histology of pulmonary metastatectomy and hardly any wherein the histology of the primary tumor has been compared with the metastasis.

AIMS AND OBJECTIVES

To review histologically all metastatic sarcomas to lung and compare with the primary where available.

MATERIALS AND METHODS

Ninety-five patients with pulmonary metastases from sarcoma were analyzed histologically for type of sarcoma, chemotherapy-related changes, and changes in adjacent lung. Various clinical parameters like laterality, multiplicity, and interval between primary and metastasis were also studied.

RESULTS

Osteosarcoma constituted half of the metastatic sarcomas (48 cases, 50.5%) followed by synovial sarcoma (16 cases, 16.8%) and high grade spindle cell sarcoma-NOS (10 cases, 10.5%). The histology of primary and the metastases was similar in 60% of cases of osteosarcoma.

CONCLUSIONS

Osteosarcoma is the commonest metastatic sarcoma to the lung. There is often a change to fibroblastic histology in patients of conventional osteosarcoma treated with chemotherapy.

Characterization of one-dimensional position sensitive detectors with improved efficiency and position resolution for neutron spectrometers

Development and characterization of one-dimentional (1D) position sensitive detectors (PSDs) with improved efficiency and position resolution for neutron scattering applications are reported. The PSDs are characterized for energy resolution, count rate capability, sensitivity, efficiency, position resolution, and uniformity of response over the sensitive length. The studies are carried out to verify the dependence of position resolution on detector geometry, electronic noise, and stopping power of the fill gas. One of the PSDs is mounted on the small angle neutron scattering spectrometer and spectra from CTAB micelle sample are recorded using 5.4 A neutrons. A gain of factors 1.1 and 1.2 is obtained compared to earlier in house made 1D PSD and LND-made 1D PSD, respectively. The diffraction patterns from standard vanadium, nickel, and silicon samples are recorded on a powder diffractometer using newly designed PSDs. Gain in efficiency obtained at shorter wavelength of 0.783 A is by a factor of 1.6. All high pressure PSDs show improvement in the position resolution by 2-3 mm. It is observed that 1D PSD filled with isobutane as stopping gas improves the gamma tolerance and position resolution at lower partial pressures as compared to Kr. It is advantageous to use two or more 36C-type PSDs stacked together. It is economic and gives better efficiency due to scanning more beam height.

Miller Fisher syndrome in adult onset Still's disease: case report and review of the literature of other neurological manifestations

Adult-onset Still's disease (AOSD) is a multi-system inflammatory disorder characterized by high spiking fevers, evanescent salmon-coloured rash, arthralgias or arthritis, hepatosplenomegaly, lymphadenopathy and sore throat. There is no specific test or combination of tests that can establish the diagnosis of AOSD and patients may present with other systemic involvement including neurological manifestations in 7-12% of cases. We present a complex case of a patient with AOSD who developed the Miller-Fisher variant of Guillain-Barré syndrome. This immunological disorder of the nervous system has not been described in association with AOSD before. We also review the literature on other neurological manifestations in AOSD. AOSD mimics different disease processes and its multi-system manifestations may complicate the picture further.

Orthodontic considerations in individuals with Down syndrome: a case report

The skeletal and soft tissue features, aberrations in dental development, and periodontal and caries characteristics of Down syndrome related to orthodontic treatment are discussed. A case report describing the successful orthodontic treatment of a 13-year-old boy with Down syndrome and a severe malocclusion is presented.

Angiotensin-converting enzyme inhibition reduces the effect of bromoethylamine-induced papillary necrosis and renal fibrosis

Rats injected with a single, 50-mg dose of bromoethylamine (BEA) developed papillary necrosis accompanied by sever interstitial fibrosis. At 1 mo, the creatinine clearance decreased (control 0.66 versus BEA 0.33 ml/min per 100 g body wt, P = 0.02), and the urine albumin-to-creatinine ratio increased markedly (control 0.19 versus BEA 0.51, P = 0.02). In a group of animals given the angiotensin-converting enzyme inhibitor enalapril (Enal; 100 mg/L) in their drinking water for 4 wk, beginning 1 wk before BEA injection, creatinine clearance improved significantly (BEA 0.33 versus Enal + BEA 0.52 ml/min per 100 g body wt, P = 0.01) and albumin excretion fell to zero. Histologic examination revealed an 88% decrease in the area of papillary necrosis and a decrease in the degree of interstitial fibrosis in the corticomedullary junction. To determine whether this was due to changes in urine flow rate induced by enalapril, a group of animals was injected with BEA, and enalapril at the above dose was begun 1 wk later. After 1 mo, the enalapril-treated animals showed the same improvement in creatinine clearance (BEA 0.33 versus BEA + Enal 0.50 ml/min per 100 g body wt, P = 0.03) and suppression of albumin excretion. The area of papillary necrosis was reduced by 67%. In the BEA animals treated with enalapril, ED-1-positive cells, alpha-smooth muscle actin, and transforming growth factor-beta1 were decreased compared with BEA alone. It is concluded that in this model of papillary necrosis, enalapril protects renal function and decreases interstitial fibrosis mediated at least in part through an angiotensin II/bradykinin-dependent mechanism.

Down syndrome: a review of the literature

This review of the literature on Down syndrome focuses on various systemic anomalies and oral anomalies, its clinical manifestations, and recommendations for persons with Down syndrome. From the time Down syndrome was diagnosed by phenotype to the present when karyotyping distinguishes chromosomal subgroups, increasingly sophisticated tests and treatments have influenced the lives of Down syndrome patients. Medical advances, special educational programs, and increasing social acceptance of disabled people in the community have resulted in current trends of normalization and deinstitutionalization of these patients. Once a dentist is familiar with a patient's medical history and takes needed precautions, these patients can be treated routinely in a dental office.

Erythrocyte depletion of human umbilical cord blood using dextran sedimentation

We report on the results of a study using high molecular weight dextran for depletion of red blood cells (RBCs) from cord blood. Our technique achieved efficient RBC depletion by sedimentation without a significant loss in haemopoietic stem cells. Cord blood units were fractionated for erythrocyte depletion by unit gravity sedimentation in 3 per cent high molecular weight dextran. Dextran sedimentation enabled recovery of more than 80 per cent of the total nucleated cells present and 100 per cent mononuclear cell (MNC) recovery as compared to unfractionated cord blood. A four-fold increase in the colony forming unit-granulocyte macrophage (CFU-GM) number per 2 x 10(5) cells was observed after dextran treatment suggesting that this step also resulted in the enrichment of stem cells.

Cytogenetic damage in exfoliated oral mucosal cells and circulating lymphocytes of patients suffering from precancerous oral lesions

One hundred patients suffering from oral submucous fibrosis (OSF), oral leukoplakia (OL) and oral lichen planus (OLP) were studied for the cytogenetic damage in oral mucosal cells and in circulating lymphocytes along with their habit patterns. It was observed that OSF was largely associated with betel nut containing masticants while OL was associated with chewing or smoking habit. It was further observed that their exfoliated oral mucosal cells had significantly higher numbers of micronucleated (Mn) cells as compared to these of healthy normal subjects without any chewing or smoking habit. Similar cytogenetic damage in the form of increased sister chromatid exchanges (SCE) was observed in circulating lymphocytes indicating that the carcinogenic agents produce damage not only in target tissue but also in other host cells such as circulating lymphocytes.

Complications of nonoperative and operative treatment of carpal tunnel syndrome

The popularity of treatment of carpal tunnel syndrome has resulted in a significant number of complications. A rational plan of therapy is available for each category of complications of carpal tunnel syndrome. This article presents 14 of the most frequently encountered complications of treatment. Prevention and management of these complications are discussed.

An ICAM-1 like cell adhesion molecule is responsible for CD34 positive haemopoietic stem cells adhesion to bone-marrow stroma

The microenvironment in the haematopoietic organs plays an important role in regulating and sustaining differentiation and self-renewal of haematopoietic stem cells. Although crucial for stem cell maintenance and homing, the stromal cell-stem cell interactions are poorly understood. Here we show that an ICAM-like molecule is responsible for stem cell adhesion to stromal cells in vitro. The molecule was characterized by a monoclonal antibody 3E10. Immunoblotting results indicated that the molecule had an electrophoretic mobility equal to that of intercellular cell adhesion molecule-1 (ICAM-1). Binding inhibition assays, however, showed that inhibition of binding of enriched CD34 cells by 3E10 was more prominent in comparison with that of ICAM-1.

Microsurgical reconstruction of the extensor system

Single stage transfer using a compound vascularized flap is sometimes necessary for severe dorsal defects. The use of vascularized tendon grafts in conjunction with the radial artery forearm flap and the dorsalis pedis flap is described.

Umbilical cord blood as a source of CD34 positive haematopoietic stem cells

In this paper we have used a monoclonal antibody to CD34 an antigen expressed solely on stem cells, and stem cell colony assays to show that umbilical cord blood has nearly the same number of functional stem cells as compared to normal bone-marrow. The number of CD34+ve cells in cord blood being 2 to 2.7 per cent, whereas bone-marrow had 3 to 3.5 per cent. The multi-potent colony forming cells (CFU-GEMM) were 60 +/- 18 in cord blood per 2 x 10(5) mononuclear cells (MNCs), whereas normal bone-marrow had 70 +/- 10 per 2 x 10(5) MNCs. Enrichment of these stem cells on Percoll gradients was successful for normal bone-marrow but not for cord blood.

Early diagnosis of spinal tuberculosis by MRI

MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. There were 11 males and 13 females and their average age was 24 years (11 to 60). 99mTc bone scans were done in 16 patients before MRI. Eleven patients had the diagnosis confirmed by biopsy and the remainder all responded rapidly to specific antituberculous chemotherapy. On T1-weighted images there was a decrease in signal intensity of the involved bone and soft tissues; on T2-weighted images there was increased signal intensity. Depending on the stage of the disease, three different patterns of infection were revealed: osteitis, osteitis with an abscess, and osteitis with or without an abscess plus discitis. The anatomical pattern of involvement, particularly of the soft tissues and the discs, is specific for tuberculous disease. The ability of MRI to detect tuberculosis of the spine earlier than other techniques could reduce bone destruction and deformity and diminish the need for surgical intervention. Despite the specificity of the patterns revealed by MRI, biopsy is recommended during the stage of osteitis to confirm the diagnosis.

Early diagnosis of spinal tuberculosis by MRI

MRI was performed at three centres in Bombay on 24 patients clinically suspected of tuberculosis of the spine but with normal radiographs. There were 11 males and 13 females and their average age was 24 years (11 to 60). 99mTc bone scans were done in 16 patients before MRI. Eleven patients had the diagnosis confirmed by biopsy and the remainder all responded rapidly to specific antituberculous chemotherapy. On T1-weighted images there was a decrease in signal intensity of the involved bone and soft tissues; on T2-weighted images there was increased signal intensity. Depending on the stage of the disease, three different patterns of infection were revealed: osteitis, osteitis with an abscess, and osteitis with or without an abscess plus discitis. The anatomical pattern of involvement, particularly of the soft tissues and the discs, is specific for tuberculous disease. The ability of MRI to detect tuberculosis of the spine earlier than other techniques could reduce bone destruction and deformity and diminish the need for surgical intervention. Despite the specificity of the patterns revealed by MRI, biopsy is recommended during the stage of osteitis to confirm the diagnosis.

The results of arthroscopic lateral release of the extensor mechanism for recurrent dislocation of the patella after 8 years

We reviewed 41 knees at a mean of 4 years after arthroscopic lateral release of the extensor mechanism. The operations were performed for recurrent complete dislocation, not for subluxation, maltracking, or lateral pressure syndrome. Thirty-three of these knees were reviewed again 8 years after operation. There were 39% excellent results according to the criteria of Crosby and Insall at 4 years and 30% at 8 years. Patellar stability improved between 4 and 8 years (p < 0.01). The results in patients with subluxation of the patella on extension of the knee or generalized ligament laxity were poor; five of seven patients with these conditions were worse and had undergone another operation. With these conditions excluded, the excellent results decreased from 50% after 4 years to 37% after 8 years. The results of lateral release are better than those reported after other procedures. It is concluded that arthroscopic lateral release is the procedure of choice for patients with recurrent complete dislocation of the patella unless there is abnormal ligament laxity or subluxation on extension. The operation should not be performed in the presence of these conditions.

Enhancement of haemopoietic stem cell adherence to bone-marrow derived stroma by phyto-haemagglutinin treated leucocyte conditioned medium (PHA-LCM)

Stem cell adhesion to bone-marrow derived stroma, plays a crucial role in haemopoiesis. However, there is very little information as to the nature of the adhesion molecule. In this paper we have shown that human bone-marrow derived stroma can be established in tissue culture. This stroma is able to adhere human bone-marrow mononuclear cells including the multipotent stem cell, viz. CFU-GEMM. Their adherence increases when the stroma is treated with lymphokines in the form of PHA-treated leucocyte conditioned medium (PHA-LCM). Triton X-100 extracts of the untreated and PHA-LCM treated stroma were analysed on single dimension PAGE. It was observed that PHA-LCM treated stromal extracts showed two extra bands and an increase in the density of a band of approximately 14 kDa. Whether these changes have anything to do with the increased adhesion of stem cell is not yet known.

Patellar tendon length after anterior cruciate ligament reconstruction

We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligament using either the medial third of the patellar tendon as a graft (n = 40) or a Leeds-Keio artificial ligament (n = 40). Both types of ligament replacement had been supplemented with a MacIntosh extra-articular lateral substitution. The mean change in length in the tendon graft group was 6% (SD 5.39); in the Leeds-Keio group it was 2.4% (SD 4.93). The change in length was significant in both groups, but shortening was more frequent and more severe in the tendon graft group. There was shortening of 10% or more in 25% of knees after patellar tendon graft and 7.5% after use of a Leeds-Keio prosthesis.

Patellar tendon length after anterior cruciate ligament reconstruction

We studied changes in patellar tendon length after reconstruction of the anterior cruciate ligament using either the medial third of the patellar tendon as a graft (n = 40) or a Leeds-Keio artificial ligament (n = 40). Both types of ligament replacement had been supplemented with a MacIntosh extra-articular lateral substitution. The mean change in length in the tendon graft group was 6% (SD 5.39); in the Leeds-Keio group it was 2.4% (SD 4.93). The change in length was significant in both groups, but shortening was more frequent and more severe in the tendon graft group. There was shortening of 10% or more in 25% of knees after patellar tendon graft and 7.5% after use of a Leeds-Keio prosthesis.

Long-term results of valgus osteotomy for congenital coxa vara

Twenty hips (12 patients) with congenital coxa vara, treated with valgus subtrochanteric osteotomy, were reviewed retrospectively. The average Hilgenreiner-epiphyseal (HE) and head-shaft (HS) angles at the initial evaluation were 66 degrees and 96 degrees, respectively. The average postoperative follow-up time was 20 years. Five of the 12 hips with trochanteric overgrowth had abductor weakness. A postoperative HE angle of 35 degrees or less and a HS angle of 130 degrees or more was correlated with consistently satisfactory results.

Locked thumb metacarpophalangeal joint caused by sesamoid entrapment

We report an unusual case of locked thumb in a 24-year-old man, caused by entrapment of the radial sesamoid in the metacarpophalangeal joint. Tomography clearly revealed sesamoid entrapment in the joint. Surgical exploration and cadaver dissection demonstrated that avulsion of the proximal portion of the palmar plate and some dissociation of the sesamoid from the palmar plate with intraarticular displacement were necessary for the sesamoid to be trapped in the joint.

Demonstration of a haemopoietic pluripotent stem cell adhesion molecule (HPSC-CAM) in mouse bone marrow

In this paper the probable mechanism of the haemopoietic pluripotent stem cell (PSC) homing into the bone-marrow is investigated. Experiments were done to understand the role of fibronectin hexapeptide and ubiquitin. Attempts to isolate the PSC adherence molecule were made. A new adherence assay for PSC has been described.

Role of countercurrent multiplication in renal ammonium handling: regulation of medullary ammonium accumulation

Ammonium (NH3 plus NH4+), produced predominantly in the proximal tubule, is transferred to the final urine by a process involving countercurrent multiplication of ammonium which generates an ammonium concentration gradient in the renal medulla. It was hypothesized that if urinary ammonium excretion rates are controlled in part by the medullary ammonium gradient, changes in hydration and acid-base state should cause changes in the medullary ammonium gradient consistent with expected changes in urinary ammonium concentrations. To test that hypothesis, rats were subjected to water diuresis, water deprivation, water deprivation plus furosemide, and dietary acid and base loads and corticomedullary ammonium gradients in their kidneys were then measured. Sections were cut along the corticomedullary axis to yield slices of cortex, outer stripe of outer medulla, inner stripe of outer medulla, and three levels of the inner medulla. The total ammonia content of homogenized slices was measured by either a membrane ammonia electrode or an enzymatic technique. Kidneys from water-deprived animals showed a distinct ammonium gradient along the corticomedullary axis, with the highest contents found at the tip of the papilla. The gradient was attenuated by water diuresis and abolished by furosemide. Acid loading enhanced the gradient, and base loading abolished it. These results indicate that the corticomedullary ammonium gradient is regulated in response to changes in hydration and acid-base state.

Serum total sialic acid and regan isoenzyme levels in patients with lung cancer

Serum total sialic acid (TSA), Regan isoenzyme (RI) (heat stable placenta like alkaline phosphatase) and TSA/Total protein (TP) ratio were estimated in 44 cases of Lung cancer using highly specific chemical methods to assess their efficacy as malignancy markers. Levels of the two markers were compared with 27 matched healthy controls. A significant increase (P less than 0.001) in both the bio-markers were compared with 27 matched healthy controls. A significant increase (P less than 0.001) in both the bio-markers was observed compared to controls. TSA/TP ratio was significantly higher (P less than 0.001) in lung cancer patients compared to controls. TSA levels were elevated in more cases of patients compared to elevations in RI. Mean values of TSA and RI were higher in epidermoid carcinoma than adeno carcinoma. The use of combination of these markers may be considered in the diagnosis of the disease in future trials.

Serum haptoglobin level in patients with malignant lymphoma and its clinical significance

Serum haptoglobin level and its phenotypes were studied in 208 normal people and 176 malignant lymphoma patients consisting of 112 Non-Hodgkin's Lymphoma (NHL) and 64 Hodgkin's Disease (HD) at Tata Memorial Hospital, Bombay and were correlated with the clinical stages of the lymphomas. Haptoglobin (Hp) levels were also estimated in the patients at different intervals during their chemotherapy. Hp level was found significantly increased to 147.83 +/- 8.67 in NHL and 173.57 +/- 13.31 in HD as compared to 67.46 +/- 2.53 in the controls. The phenotypic and gene frequencies in the lymphoma patients did not differ significantly from those of the controls. All the clinical stages, except stage I, of NHL and HD revealed significant rise in Hp level when compared with the controls. When different clinical stages of NHL and HD were compared separately, HD showed significant rise in HP level over the NHL only in Stage IV (p less than 0.05). Significant reduction in Hp level was observed when the disease regressed due to chemotherapy but it again increased with the relapse of the disease. Thus, the study of serum haptoglobin levels at intervals in lymphoma patients would help to understand the regression or relapse of the disease and also the prognosis.

Abnormalities of proximal femoral growth after severe Perthes' disease

We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.

Painful extensor digitorum brevis manus muscle

Diagnosis was confirmed of 10 extensor digitorum brevis manus muscles in 7 patients. The muscle is located on the dorsum of the hand, just distal to the wrist. It is most prominent with the wrist flexed to 30 degrees and the fingers fully extended. We propose that pain in the extensor digitorum brevis manus muscle is due to compression of the muscle in the rigid fibro-osseous fourth dorsal compartment. Extensor retinacular release is the treatment of choice.

Anomalous muscles of the first dorsal compartment of the wrist

Exertion-induced pain and swelling in the distal forearm and radial aspect of the wrist were seen in two patients. Exploration revealed an anomalous muscle belly extending into the first dorsal compartment in both cases--an anomaly that we believe has not been previously reported. Surgical release of the compartment resulted in complete relief of pain in both patients.

Comparison of femoral and innominate osteotomies for the treatment of Legg-Calvé-Perthes disease

The outcomes of forty-two femoral osteotomies and forty-nine innominate osteotomies for the treatment of Catterall grade-III or IV Legg-Calvé-Perthes disease were compared. The average length of follow-up was nine years (range, three to seventeen years). For the patients who were less than ten years old at the onset of the disease, there was no difference in the results of the two procedures, even when the results were analyzed according to age. However, the center-edge angle, neck-shaft angle, lengths of the limbs, range of abduction, and total range of motion were closer to normal after an innominate osteotomy. There was no difference in the ratings when the results of the two operations were compared according to the several parameters that have been proved to be associated with the long-term outcome for hips in patients who have Legg-Calvé-Perthes disease. However, the innominate osteotomy seemed to be the better procedure when involvement of the growth plate was likely to cause coxa vara or a substantial discrepancy in the lengths of the limbs. The patients who were more than ten years old at the onset of the disease had a poor result with either procedure.

Patellar metastases. A case report and review of the literature

A case of metastasis to the patella from adenocarcinoma of the lung is reported. The clinical presentation was similar to septic arthritis of the knee. Histopathologic examination established the metastatic nature of the lesion; this is the first case in which a patellar lesion was the only evidence of distant metastasis. Metastatic tumors of the patella are rare. Three cases of metastasis to the patella have been described from squamous cell carcinoma of the lung in the English literature. We report the first case of patellar metastasis from adenocarcinoma of the lung.

The intertrochanteric hip fracture. A retrospective analysis

One hundred intertrochanteric hip fractures were analyzed utilizing a computer-assisted digitization system to study the factors affecting postoperative stability. Fractures were evaluated by measuring shortening and angulation, collapse of telescoping device when utilized, and migration of the fixation device within the femoral head. Fractures were classified preoperatively according to their stability and postoperatively according to the type of operative reduction performed. The failure rate and postoperative stability were then compared according to the type of fracture, type of operative reduction, and internal fixation device utilized. Results indicate that the preoperative fracture classification is a strong and significant determinant of postoperative stability. Conversely, the type of operative reduction was not as significant a determinant of postoperative stability. In particular, medial displacement osteotomy had no advantage over anatomic reduction in the unstable fracture. The use of a fixed angle nail plate was associated with an increased failure rate.

Osteochondritis dissecans of the patella

We reviewed 13 cases of osteochondritis dissecans of the patella followed-up for 18 months to 19 years. Two were treated conservatively with excellent results, and 11 by operation with six excellent, four good and one fair result. There was complete radiographic healing of the defect in 10 cases and partial healing in three. The size of the osteochondritic lesion appeared to be of prognostic significance. Osteochondritis dissecans of the patella is the result of repeated minor injuries to the articular surface. Operation is indicated for persistent pain, intra-articular loose bodies and subchondral sclerosis; excision of the fragment and curettage of the crater, with or without drilling, is recommended.