Femoracetabular impingement treated with surgical hip dislocation: Short-term results

BACKGROUND AND OBJECTIVE

Most of the studies available in the literature related to the treatment of femoroacetabular impingement (FAA) with surgical hip dislocation (CLD) come from Europe and North America. This study describes the short-term results of the LQC technique for treating PFA in a cohort of Colombian patients.

PATIENTS AND METHODS

We retrospectively analysed 42 cases of PFA treated with LQC from 2006 to 2018. The same orthopaedic surgeon performed all surgeries. Clinical outcome was assessed using the Merle d'Aubigné scores, while radiological assessment was performed using the Tönnis score.

RESULTS

Fifteen women and 25 men were included in the study, with a mean age of 36.3 years. Two patients had bilateral symptomatic involvement. Of the 42 cases, there were 13 cam type, 11 pincer type and 18 mixed. Preoperatively, 31 hips were classified as poor and moderate, and 11 as good according to the Merle d'Aubigné scale. The preoperative Tönnis radiological classification showed grade 0 in half of the cases. The mean duration of follow-up was 24 months (12 to 37). The final postoperative Merle d'Aubigné scores classified 7 cases as poor or moderate, and 35 as good to excellent (p<0.05). The postoperative Tönnis score showed no significant variation. As complications, one patient had heterotopic ossification, and three had trochanteric nonunion requiring refixation.

CONCLUSION

Our results suggest that the LQC technique for the treatment of patients with PFA shows satisfactory short-term results with a low complication rate. To our knowledge, this is the first report of results of the surgical procedure for hip dislocation in our region.

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery

Aims

The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery.

Patients and Methods

This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates.

Results

The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics.

Conclusion

These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125–32.

Left ventricular hypertrophy and cognitive function: a systematic review

Cognitive impairment is common in patients with hypertension. Left ventricular hypertrophy (LVH) is recognised as a marker of hypertension-related organ damage and is a strong predictor of coronary artery disease, heart failure and stroke. There is evidence that LVH is independently associated with cognitive impairment, even after adjustment for the presence of hypertension. We conducted a systematic review that examined cognitive impairment in adults with LVH. Independent searches were performed in Ovid MEDLINE, Ovid psycInfo and PubMed with the terms left ventricular hypertrophy and cognition. Seventy-three studies were identified when both searches were combined. After limiting the search to studies that were: (1) reported in English; (2) conducted in humans; (3) in adults aged 50 years and older; and (4) investigated the relationship between LVH and cognitive performance, nine papers were included in this systematic review. The majority of studies found an association between LVH and cognitive performance. Inspection of results indicated that individuals with LVH exhibited a lower performance in cognitive tests, when compared to individuals without LVH. Memory and executive functions were the cognitive domains that showed a specific vulnerability to the presence of LVH. A possible mechanism for the relationship between LVH and cognition is the presence of cerebral white matter damage. White matter lesions occur frequently in patients with LVH and may contribute to cognitive dysfunction. Together, the results of this review suggest that memory impairment and executive dysfunction are the cognitive domains that showed a particular association with the presence of LVH.

Human leucocyte antigen (HLA)-DQB1*03:02 and HLA-A*02:01 have opposite patterns in their effects on susceptibility to HIV infection

OBJECTIVES

The objective of this study was to seek correlates of immune protection in HIV infection. We sought to elucidate the association between the presence of human leucocyte antigen (HLA) alleles, as well as killer immunoglobulin receptor (KIR) genotypes, and the susceptibility to HIV infection in a Spanish cohort of HIV-exposed seronegative (HESN) individuals.

METHODS

A total of 152 individuals were evaluated: 29 HESN individuals in stable heterosexual relationships with an HIV-infected partner admitting high-risk sexual intercourse for at least 12 months prior to inclusion in the study, 61 HIV-infected patients and 62 healthy controls. HLA class I and II alleles and KIR genotypes were assessed in genomic DNA from all individuals in the study by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) using bead array technology.

RESULTS

HESN individuals showed a higher prevalence of HLA-A3 (62%) and HLA-B44 (83%) supertypes compared with HIV-infected individuals (42% and 66%, respectively). Regarding specific HLA alleles, HESN individuals had a higher prevalence of HLA-A*33:01, DRB1*04 and DQB1*03:02 alleles (14%, 34% and 31%, respectively) and a lower prevalence of the HLA-A*02:01 allele (27%) than HIV-infected patients (3%, 15%, 11% and 52%, respectively; P < 0.05). Interestingly, in a multivariate analysis, only the presence of DQB1*03:02 and the absence of A*02:01 alleles were independently associated with HESN status [odds ratio (OR) 3.4 (95% confidence interval (CI) 1.1-10.5) and 0.4 (95% CI: 0.1-0.9), respectively; P < 0.05]. No KIR genotype was associated with susceptibility to HIV infection.

CONCLUSIONS

Our data showed that the presence of the HLA class II allele DQB1*03:02 was a correlate of immune protection against HIV infection, while the presence of the HLA class I allele A*02:01 was associated with being infected with HIV.

Risk factors for blood transfusion after shoulder arthroplasty

Aims

Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy.

Methods

We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient’s records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of < 7.5 g/dl if asymptomatic, < 9.0 g/dl if they had a significant cardiac history or symptoms of dizziness or light headedness. Multivariable regression analysis was undertaken to identify predictors of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve.

Results

Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p < 0.001) and shoulder arthroplasty undertaken for post-traumatic arthritis (p < 0.001). ROC analysis identified pre-operative haematocrit of 39.6% as a 90% sensitivity cut-off for transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit < 39.6% needed transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level.

Discussion

We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit < 39.6% should be advised that there is an increased risk for blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion. Take home message: The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (< 1%) of requiring a transfusion. Cite this article: Bone Joint J 2016;98-B:224–8.

European mitochondrial haplogroups are not associated with hepatitis C virus (HCV) treatment response in HIV/HCV-coinfected patients

OBJECTIVES

Mitochondria are multifunctional organelles with a key role in the innate immune response against viral infections. Mitochondrial DNA (mtDNA) haplogroups have been related to AIDS progression and CD4 T-cell recovery in HIV-infected patients, and to a delay in the development of liver fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients. We performed a study to investigate whether mtDNA haplogroups may be associated with HCV treatment response in HIV/HCV-coinfected patients on pegylated interferon (pegIFN) plus ribavirin (RBV).

METHODS

We performed a retrospective study in 304 patients who completed a course of HCV therapy. mtDNA polymorphisms were genotyped using Sequenom's MassARRAY platform. The interleukin-28B (IL-28B) polymorphism (rs12980275) was genotyped using the GoldenGate® assay. Sustained virological response (SVR) was defined as an undetectable HCV viral load at week 24 after the end of treatment. The statistical analysis was carried out using on-treatment data.

RESULTS

The SVR rates were 52.6% (160 of 304) for all patients, and 37.8% (46 of 201) for patients with HCV genotype 1 or 4 vs. 81.4% (83 of 102) for patients with HCV genotype 2 or 3 (P < 0.001). No significant associations were found between mtDNA haplogroup and SVR when all patients were included in the analysis and when patients were stratified by HCV genotype (i.e. those with genotypes 1/4 and 2/3 analysed separately) or IL-28B rs12980275 genotype.

CONCLUSIONS

European mtDNA haplogroups were not related to HCV treatment response in HIV/HCV-coinfected patients on pegIFN-α/RBV therapy.

Prevalence of sleep bruxism in children: a systematic review of the literature

The aim of the present investigation was to perform a systematic review of the literature dealing with the issue of sleep bruxism prevalence in children at the general population level. Quality assessment of the reviewed papers was performed to identify flaws in the external and internal validity. Cut-off criteria for an acceptable external validity were established to select studies for the discussion of prevalence data. A total of 22 publications were included in the review, most of which had methodological problems limiting their external validity. Prevalence data extraction was performed only on eight papers that were consistent as for the sampling strategy and showed only minor external validity problems, but they had some common internal validity flaws related with the definition of sleep bruxism measures. All the selected papers based sleep bruxism diagnosis on proxy reports by the parents, and no epidemiological data were available from studies adopting other diagnostic strategies (e.g. polysomnography or electromyography). The reported prevalence was highly variable between the studies (3·5-40·6%), with a commonly described decrease with age and no gender differences. A very high variability in sleep bruxism prevalence in children was found, due to the different age groups under investigation and the different frequencies of self-reported sleep bruxism. This prevented from supporting any reliable estimates of the prevalence of sleep bruxism in children.

IL28RA polymorphism is associated with early hepatitis C virus (HCV) treatment failure in human immunodeficiency virus-/HCV-coinfected patients

Due to the poor rate of response to hepatitis C virus (HCV) with pegylated interferon and ribavirin treatment in HCV/HIV coinfected patients, key factors for predicting failure would be useful. We performed a retrospective study on 291 patients on HCV treatment, who had early virological response (EVR) data. IL28B and IL28RA polymorphisms were performed using the GoldenGate(®) assay. Unfavourable genotypes at IL28B (rs12980275 AG/GG and rs8099917 GT/GG) and an unfavourable allele at IL28RA (rs10903035 G) were associated with early treatment failure. However, only the rs12980275 AG/GG genotype and rs10903035 G allele remained independently associated with early failure in the overall population (OR = 4.15 (95% CI = 1.64-10.54) and OR = 2.00 (95% CI = 1.19-3.36), respectively) as well as in GT1/4 patients (OR = 5.07 (95% CI = 1.81-14.22) and OR = 2.03 (95% CI = 1.13-3.66), respectively). Next, a decision tree showed early treatment failure increased from 37.1% to 65.5% when the unfavourable rs12980275 AG/GG and rs10903035 AG/GG genotypes and HCV-RNA≥ 500.000 IU/mL were taken into account in GT1/4 patients. In contrast, the failure rate decreased from 37.1% to 11.9% when the favourable rs12980275 AA and rs10903035 AA genotypes were detected. The percentage of patients correctly classified was 78.4%, and AUROC was 0.802 ± 0.028. Regarding GT3 patients, the presence of the GCGCA haplotype (all unfavourable alleles) was associated with early treatment failure, while no association was observed for the IL28B polymorphisms. In conclusion, the IL28RA polymorphism was associated with early treatment failure independently of the IL28B SNPs. The combination of IL28B and IL28RA polymorphisms might be a valuable tool for predicting early treatment failure before starting HCV treatment.

The prevalence of cam-type femoroacetabular deformity in asymptomatic adults

We performed a retrospective examination of the anteroposterior pelvic CT scout views of 419 randomly selected patients between April 2004 and August 2009 in order to determine the prevalence of cam-type femoroacetabular deformity in the asymptomatic population. The CT scans had all been undertaken for conditions unrelated to disorders of the hip. The frequency of cam-type femoroacetabular deformity was assessed by measuring the α-angle of each hip on the anteroposterior images. The α-angles were classified according to the Copenhagen Osteoarthritis Study. Among 215 male hips (108 patients) the mean α-angle was 59.12° (37.75° to 103.50°). Of these, a total of 30 hips (13.95%) were defined as pathological, 32 (14.88%) as borderline and 153 (71.16%) as normal. Among 540 female hips (272 patients) the mean α-angle was 45.47° (34.75° to 87.00°), with 30 hips (5.56%) defined as pathological, 33 (6.11%) as borderline and 477 (88.33%) as normal. It appears that the cam-type femoroacetabular deformity is not rare among the asymptomatic population. These anatomical abnormalities, as determined by an increased α-angle, appear to be twice as frequent in men as in women. Although an association between osteoarthritis and femoroacetabular impingement is believed to exist, a long-term epidemiological study is needed to determine the natural history of these anatomical abnormalities.

Digital imaging of patterns of dental wear to diagnose bruxism in children

OBJECTIVE

The aim of this study was to evaluate and compare the area, perimeter, and form (D factor and fractal dimension) of the dental wear among bruxist and nonbruxist children with mixed dentition in order to determine if the dental wear may be used as criteria to diagnose bruxism.

METHODS

The children were 8 to 11 years old and were classified as bruxist or nonbruxist, according to anxiety level and temporomandibular disorders. Dental casts of the upper arch were obtained for the bruxist (n = 24) and the control (n = 29) group. The dental wear was measured in digital format and processed automatically. The complete and pathological dental wear was compared between the two groups, using the Student's t-test and Mann-Whitney test.

RESULTS

Statistically significant differences were observed between the two groups, with a higher area, perimeter, and more irregular form of the pathological dental wear among the bruxist group. Regarding complete dental wear, differences were only significant for the D factor (an un-dimensional quantitative parameter which produces a relation between the area and the perimeter of an object).

CONCLUSION

Digital imaging of dental wear may be used as criteria to diagnose bruxism in children with mixed dentition after making an analysis of the area, perimeter, and irregularity of the form of pathological dental wear.

Patterns in body mass distributions: sifting among alternative hypotheses

Understanding how animals interact with their environment is critical for evaluating, mitigating and coping with anthropogenic alteration of Earth's biosphere. Researchers have attempted to understand some aspects of these interactions by examining patterns in animal body mass distributions. Energetic, phylogenetic, biogeographical, textural discontinuity and community interaction hypotheses have been advanced to explain observed patterns. Energetic and textural discontinuity hypotheses focus upon the allometry of resource use. The community interaction hypothesis contends that biotic interactions within assemblages of species are of primary importance. Biogeographical and phylogenetic hypotheses focus on the role of constraints on the organization of communities. This paper examines and organizes these various propositions about species body mass distributions and discusses the multiple competing hypotheses, how their predictions vary, and possible methods by which the hypotheses can be distinguished and tested. Each of the hypotheses is partial, and explains some elements of pattern in body mass distributions. The scale of appropriate application, relevance and interpretation varies among the hypotheses, and the mechanisms underlying observed patterns are likely to be multicausal and vary with scale.

Long-term induction and regression of diet-induced atherosclerotic lesions in rhesus monkeys. II. Morphometric evaluation of lesions by light microscopy in coronary and carotid arteries

Atherosclerotic lesions were induced in rhesus monkeys (Macaca mulatta) by feeding them a high-saturated fatty acid and high-cholesterol diet. After 5.4 years the extent of lesions in three major coronary arteries and the right carotid artery was evaluated morphometrically by light microscopy in one group of animals (group P). The remaining animals were switched to a low-cholesterol diet that remained high in saturated fatty acids and provided the same percentage of total calories as did the atherogenic diet. Lesion regression was then evaluated in one group of monkeys 1.9 years (group R4) and in another group of monkeys 3.7 years (group R5) after withdrawal of cholesterol alone from the diet. In group P, the mean intimal thickness varied between 26 and 47 microns, maximum intimal thickness between 70 and 92 microns, and luminal reduction between 9% and 12% in the three major coronary arteries. Luminal reduction varied between 1% and 11% in right carotid artery segments. After 1.9 years of consuming the basal diet, group R4 animals were no different from group P animals with respect to morphometric measures. Total intimal and medial areas of the left anterior descending (LAD) coronary artery in groups P and R4 were also similar. In contrast, after 3.7 years of consuming the basal diet, group R5 animals showed consistently although not statistically significantly lower values than those in group P for the morphometric measures in coronary arteries and total intimal area in the LAD. Similar results were obtained for the common carotid and external carotid arteries. Thus, our study shows that long-term diet-induced lesions in coronary arteries and in common and external segments of the right carotid artery regressed only when the animals were fed the basal diet for 3.7 years. We conclude that atherosclerotic lesions induced in coronary and carotid arteries can regress toward normal to a certain extent, but they require a longer time for regression than do other arterial segments. These findings support the results of clinical trials in human subjects.

Long-term induction and regression of diet-induced atherosclerotic lesions in rhesus monkeys. I. Morphological and chemical evidence for regression of lesions in the aorta and carotid and peripheral arteries

Atherosclerotic lesions were induced in rhesus monkeys by feeding a high-saturated fatty acid and high-cholesterol diet. After 5.4 years the extent of fatty streaks and raised lesions was evaluated in one group of animals (group P) by visual estimation in 10 arterial segments and chemically in four arterial segments. The remaining animals were switched to a basal regression diet low in cholesterol but high in saturated fatty acids for up to 3.7 years. Regression of lesions was evaluated in one group for 1.9 years (group R4) and in another for 3.7 years (group R5) after deleting cholesterol from the diet. The atherogenic diet increased serum cholesterol levels in all animals from a mean of 150 mg/dL to a mean of about 430 mg/dL. The atherogenic diet produced lesions in group P in all arterial segments (involving up to 50% of the arterial intimal surface) and increased cholesterol content in four arterial segments (varying between 443 and 506 micrograms/cm2). Switching to the basal regression diet decreased serum cholesterol levels to normal after 12 to 18 weeks. The switch to the basal diet significantly decreased the extent of fatty streaks in most arterial segments in both groups. Although differences in the mean extent of raised lesions among groups were not statistically significant, 7 of 10 arterial segments in group R4 and 9 of 10 segments in group R5 showed a lesser extent of raised lesions than in group P. Cholesterol content was lower (P < .05) in all four arterial segments in group R5 than in group P.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of serum lipid and apolipoprotein concentrations to predict extent of diet-induced atherosclerotic lesions in aortas and coronary arteries and to demonstrate regression of lesions in individual rhesus monkeys

In most studies, the assessment of lesion "regression" is based on comparisons of group means between the "progression" and regression groups. This comparison depends on the assumption that the extent and distribution of lesions produced by the end of the lesion-induction period in the regression animals are equal to those observed in the progression group. To determine whether significant regression of lesions occurs in an individual regression animal, it is necessary to obtain a measure of the lesions produced in these animals at the end of the lesion-induction period. We achieved this goal by developing models using multiple stepwise regression analysis that related steady-state serum cholesterol and apolipoprotein B and A-I concentrations measured during a lesion-induction period in 27 rhesus monkeys fed an atherogenic high-saturated-fat/high-cholesterol diet for 2 years. The models were developed to estimate the percent of intimal surface with lesions, the esterified cholesterol content (micrograms/cm2) for the artery segments, and three histomorphometric measures (mean intimal thickness, mean maximal intimal thickness, and mean percent stenosis) for the coronary arteries. In these models, multiple R2 ranged from 0.42 to 0.74 for the aortas and peripheral arteries, indicating that approximately one half to three fourths of the variance in lesions was accounted for. For the three histomorphometric measures in coronary arteries, however, the multiple R2 was 0.27 or 0.28, indicating that only approximately one fourth of the variance in lesions was accounted for.(ABSTRACT TRUNCATED AT 250 WORDS)

Single daily dose amikacin in paediatric patients with severe gram-negative infections

Twenty-five children with serious Gram-negative infections were treated in a prospective study with amikacin 20 mg/kg administered in a single daily dose as a 30 min iv infusion for 4 to 12 days. In nine cases the amikacin was combined with beta-lactam antibiotics. Escherichia coli were the most frequent bacteria isolated followed by K. pneumoniae, Providencia and Enterobacter spp. and Pseudomonas aeruginosa with MICs ranging from 1 to 16 mg/l. Mean (+/- S.D.) peak and trough concentrations of days 1 and 4 of therapy ranged from 49 +/- 13.5 to 53.6 +/- 13.4 mg/l and 6 + 1.4 to 7.7 +/- 4.1 mg/l respectively. All patients were clinically and bacteriologically cured. No significant adverse reactions were observed. The results suggest that administration of a single daily dose of 20 mg/kg amikacin should be considered practical and safe in children. Further studies are needed.

Is atherosclerosis increasing in Mexico City?

This report compares quantitative measures of atherosclerosis in aortas and coronaries from autopsies of deceased men from Mexico City collected during 1960 to 1964 and 1986 to 1987. The comparison of lesions in two different time periods provides an opportunity for determining whether the extent of atherosclerosis has changed over time in Mexico City. Three pathologists independently evaluated the extent of fatty streaks (FS), fibrous plaques (FP), calcified plaques (CA), and complicated lesions (CO) in 165 aortas and 120 sets of coronary arteries collected during 1986 to 1987 for comparison with similar gradings of 128 aortas and coronary arteries from the International Atherosclerosis Project in 1960 to 1964. Neither FS nor more advanced lesions differed significantly in either the descending thoracic or abdominal aorta between the two collection periods. In contrast, there were more extensive FP and raised atherosclerotic lesions (RL = FP + CA + CO) in the coronary artery segments evaluated in the younger age groups in 1986 to 1987 versus 1960 to 1964. Additional analyses, based on 75 pairs of aortas and 32 pairs of coronary arteries from age-matched cases, all regraded by the team of pathologists after blind coding, showed more FS in both aortic segments and more extensive involvement with RL in the three main branches of the coronary arteries in the more recent study. An overview of our findings suggests that atherosclerosis, particularly in the coronary arteries, is increasing in Mexico City. This hypothesis merits careful testing in parallel with consideration of possible changes in the risk factors that could be responsible for changes in extent of lesions.

Comparison of crowding and food restriction effects on growth, body weight gain and endocrine status in the rat

The present work compares the effects of post-weaning crowding and those of food restriction on growth, body weight gain and the levels of several hormones, in male Sprague-Dawley rats. Crowding resulted in reduced food intake and diminished body weight gain. Rats daily receiving the same amount of food as that eaten by crowded rats (food-restricted group) showed similar body weight gain as crowded rats, but higher growth rate. Neither crowding nor food restriction altered the pituitary-adrenal axis. In contrast, both treatments decreased serum insulin, growth hormone (GH), somatomedin C (Sm-C) and thyroid-stimulating hormone (TSH) as compared to control rats. The reduction of GH and Sm-C levels was similar in crowded and food-restricted rats but that of TSH was higher in food-restricted, rather than in crowded rats. The present data indicate that the effects of crowding could only be partially explained by the concomittant reduction of food intake and that the serum levels of the hormones studied could not explain the differences between the crowded and food-restricted rats with regard to growth.

Aschoff bodies of rheumatic carditis are granulomatous lesions of histiocytic origin

The histogenesis of the Aschoff body of rheumatic carditis is controversial. Proliferative Aschoff bodies in heart sections from 6 patients with acute rheumatic heart disease were tested by avidin-biotin peroxidase labeling methods for the presence of desmin, muscle-specific actin, S-100, neurofilament, leukocyte common antigen, receptor for Ulex europeus I lectin, Factor VIII-related antigen, vimentin, alpha 1-antichymotrypsin, and myeloid/histiocyte antigen. Lack of Aschoff body labeling for desmin and muscle-specific actin, S-100 and neurofilament, and Ulex europeus I and Factor VIII-related antigen is not consistent with histogenesis from smooth or striated cardiac muscle, nerve or nerve sheath, and lymphatic or vascular endothelium, respectively. Strong labeling of Aschoff body cells for vimentin is evidence for a mesenchymal origin, and labeling for myeloid/histiocyte antigen is consistent with a histiocytic origin. Furthermore, weak, variable labeling of Aschoff body cells for leukocyte common antigen suggests that at least some Aschoff body cells were originally derived from blood-borne monocytes. Both multinucleated Aschoff cells and "owl's eye," Anitschkow cells label identically, suggesting a common origin. Alpha 1-Antichymotrypsin, a widely utilized marker of histiocytes, was unexpectedly negative. Perhaps histiocytes that form Aschoff bodies do not express this lysosomal enzyme. Aschoff bodies appear to be a unique and distinctive form of granuloma.

Black-white differences in aortic fatty streaks in adolescence and early adulthood: the Bogalusa Heart Study

Although white adults have more extensive aortic surface involvement with fibrous plaques than do blacks, adolescent blacks have more aortic fatty streaks (FS) than do whites of similar ages. Possible determinants of these racial differences in aortic surface involvement with FS were therefore examined in 44 decedents who had previously been examined as part of the Bogalusa Heart Study. Ages at death ranged from 6 to 27 years (mean, 18 years); the median interval between the last risk factor examination and death was 3.5 years. More extensive aortic surface involvement with FS was observed in blacks (n = 11) as compared with whites (n = 33; 37% vs 16%, p = .0003). This racial difference was independent of age at death, and was seen in both male and female subjects. Black-white differences in several of the previously measured risk factors (serum lipids and lipoproteins, blood pressure, and obesity) were also observed, and in both races, aortic FS were related to several of these characteristics. (For example, the correlation between levels of low-density lipoprotein cholesterol and aortic FS was 0.49 in whites and 0.73 in blacks.) However, even after controlling for antemortem levels of risk factors, blacks had an additional 16% surface involvement with aortic FS as compared with whites (p less than .001). These findings suggest that the more extensive surface involvement of the aorta with FS in young blacks is not due to differences in clinical risk factors. Because more extensive raised lesions are found in white adults, the transition of FS to advanced atherosclerotic lesions may differ in whites and blacks.

Histopathological effects of intraoperative radiotherapy on pancreas and adjacent tissues: a postmortem analysis

Intraoperative radiotherapy (IORT) has been utilized in the treatment of resectable and unresectable pancreatic carcinoma at the National Cancer Institute. Detailed autopsy analyses of the radiation effects on the pancreas and adjacent tissues were performed on 13 patients dying at various times following therapy. IORT can induce a progressive retroperitoneal fibrosis and fibrosis of the porta hepatis in patients with resectable pancreatic carcinoma. In unresectable pancreatic carcinoma, the major expression of intraoperative irradiation with external beam irradiation is a progressive fibrosis of the pancreas with vascular sclerosis, nerve degeneration, atrophy of acinar cells, and atypical changes in the ducts of the pancreas, as well as degenerative changes of the pancreatic tumor.

Development of murine epidermal cell lines which contain an activated rasHa oncogene and form papillomas in skin grafts on athymic nude mouse hosts

We have developed four murine epidermal cell lines which form squamous papillomas when grafted to athymic nude mice in a reconstituted skin. Two of the lines, SP-1 and BP-4, were derived from pools of papillomas produced on SENCAR and BALB/c mouse skin, respectively, by initiation with 7,12-dimethylbenz(a)anthracene and promotion with 12-O-tetradecanoylphorbol-13-acetate. Line 308 was derived from BALB/c mouse skin initiated in vivo with 7,12-dimethylbenz(a)anthracene, culture of the epidermal cells, and selection of cells resistant to Ca2+-induced terminal differentiation. Line LC14 was derived from untreated, cultured newborn BALB/c mouse primary epidermal cells which spontaneously developed resistance to Ca2+-induced terminal differentiation. Each line has an activated rasHa gene with a mutation within codon 61. Cells from all four lines, in contrast to normal primary epidermal cells, survive in medium with Ca2+ levels greater than 0.1 mM. Clonal growth studies in culture showed a unique growth pattern for each of the four lines in medium with 1.4 mM and 0.05 mM Ca2+, with or without 12-O-tetradecanoylphorbol-13-acetate. Early passage cells of these lines should provide a valuable resource for detecting genes or genetic alterations which complement an activated ras gene to cause malignant conversion and for studying the biology of tumor promotion.

Disseminated extraintestinal isosporiasis in a patient with acquired immune deficiency syndrome

This report describes a 38-year-old male homosexual with acquired immune deficiency syndrome (AIDS) and a history of Isospora belli infestation treated with trimethoprim-sulfamethoxazole. At autopsy, intracellular and extracellular I. belli organisms were identified in the mucosa and lamina propria of small and large intestine as well as in mesenteric and tracheobronchial lymph nodes, where an associated granulomatous reaction was also present. Until now, Isosporiasis has been observed as intracellular parasites restricted to the columnar cells of the intestinal mucosa in humans hosts. This is, to the authors' knowledge, the first time that this protozoa has been observed invading beyond the intestinal wall. This patient's autopsy also demonstrated intestinal ulcerations proven microscopically to be caused by cytomegalovirus (CMV). In patients with AIDS and CMV enterocolitis, the authors have observed an unusual frequency of extraintestinal disseminated disease by microorganisms heretofore typically restricted to the intestinal mucosa (i.e., bacteremias resulting from Shigella species). The authors propose that, in AIDS patients, the profound immunodeficient state, possibly in conjunction with CMV-induced intestinal mucosal ulcerations, promotes access of other intestinal microorganisms, including I. belli, into lymphatic and vascular spaces, culminating in lymphohematogenous dissemination of their intestinal infestations.

Regression of experimental atherosclerotic lesions in rhesus monkeys consuming a high saturated fat diet

Atherosclerotic lesions were induced in rhesus monkeys by feeding them a high-fat, high-cholesterol diet for 2 years. Arteries were examined after autopsy of a subgroup of animals (group P) and cholesterol was removed from the diet of the remaining animals. Lesions were examined in other subgroups after 30 weeks (group R1) and after 52 weeks (group R2). A control group (group C) was fed the diet without cholesterol throughout the study. The mean total serum cholesterol concentration before, during, and after lesion induction was 151, 390, and 157 mg/dl, respectively. The mean percent of surface area with fatty streak or fibrous plaque and the free and esterified cholesterol content of the artery increased in all six arterial segments examined in group P. The means for percent of surface with fatty streak and for arterial cholesterol content or concentration (but not for extent of surface with fibrous plaque) were consistently less in groups R1 and R2 than in group P, although they remained greater in groups R1 and R2 than in group C. The mean intimal thickness for coronary arteries was 10-fold greater in group P than in group C and 60 percent less in groups R1 and R2 than in group P; there was, however, much variability among animals and these differences among groups were not statistically significant. By using several measures in several arterial systems, we have shown that there was regression of diet-induced atherosclerotic lesions in rhesus monkeys while they were fed a diet high in saturated fat but without cholesterol for 30 or 52 weeks.

Solid and papillary epithelial neoplasm of the pancreas. An ultrastructural and immunocytochemical study of six cases

Solid and papillary epithelial neoplasms of the pancreas from six female patients were studied using immunohistochemistry and electron microscopy to define better their histogenesis. The tumors ranged in diameter from 5 to 15 cm (average: 9 cm), and, on cross section, most had areas of hemorrhage and necrosis, sometimes extensive. Microscopically, there was a solid and pseudopapillary pattern, with tumor cells typically having ovoid nuclei with delicate folding and indistinct nucleoli. Of note were the following: a relatively low mitotic rate (range: 0-6/20 hpf), the presence of hyaline globules (four of six cases), and collections of foam cells (three of six cases). Staining for cytoplasmic argyrophil granules was negative in each case. Ultrastructurally, the solid and papillary epithelial neoplasms of the pancreas showed evidence of acinar or ductular differentiation. Two contained zymogen granules, one had intermediate filaments (probably keratin), and three had abundant rough endoplasmic reticulum and mitochondria. Immunostaining was positive for chymotrypsin (six of six cases), trypsin (four of six), and amylase (three of six). None was positive for alpha-1-antitrypsin, neuron-specific enolase, pancreatic polypeptide, gastrin, glucagon, somatostatin, or insulin. The findings support an origin from exocrine pancreas, and follow-up indicates a low rate of malignancy, with local recurrence in two of the six patients.

Chronic stress alters pituitary-adrenal function in prepubertal male rats

The effect of exposure to chronic stress on the pituitary-adrenal axis was studied in prepubertal rats. The chronic stress consisted of exposing the animals 6 days a week for 32 days to one stressor randomly chosen among several each day. Chronic stress did not alter either food intake or body weight gain. However, it was stressful for the rats, as they had increased adrenal weights. Chronically stressed rats showed normal pituitary-adrenal basal activity and normal ACTH responses to a novel, acutely applied stressor. However, this treatment resulted in higher corticosterone response to an acute stressor, as a consequence of enhanced adrenocortical response to ACTH. In addition, chronic stress induced increasing sensitivity of the adrenal to the inhibitory action of dexamethasone. Exploratory activity and defecation rate in a novel environment were not affected by the chronic stress. All these data indicate that behavioral and endocrine changes induced by chronic stress were somewhat different from those previously found in adult rats. Prepubertal rats appear to be less sensitive than adult rats to the chronic stress we used.

Age-dependent effects of acute and chronic intermittent stresses on serum metallothionein

Prepuberal and adult male rats were chronically stressed for a month with several acute stressors in a random schedule. Some of the animals were killed approximately 20 hours after the last stress session without any additional stress. Other animals from both control and chronic stress groups were subjected to an acute restraint stress for 15 min before being killed. While chronic stress did not alter hepatic metallothionein (MT) either in prepuberal or in adult rats, this treatment significantly increased serum MT levels in young but not in adult rats. Likewise, 15 min of restraint stress increased serum MT levels in young rats only, regardless of whether they were control or chronically stressed rats. The present data indicate that acute and chronic stressors may alter serum MT in an age-dependent fashion.

Differences in prolactin and LH responses to acute stress between peripuberal and adult male rats

Pituitary-adrenal, pituitary-gonadal and prolactin responses to acute stress (restraint) were studied in peripuberal and adult male rats. The pituitary-adrenal response to restraint stress did not differ in peripuberal and adult rats. Prolactin increase during stress was less marked in peripuberal animals. While an increase in LH during stress was observed in adult rats, peripuberal animals did not respond to stress. Testosterone levels were also lower in peripuberal than in adult rats. Diminished LH and prolactin responses to stress in peripuberal rats did not appear to be due either to increased pituitary-adrenal activity or to altered pituitary responsiveness to LHRH and dopamine respectively. Peripuberal rats were also more sensitive to the action of morphine on LH and prolactin release than were adult rats, suggesting that endogenous opioids may be involved in the LH and prolactin responses to acute stress. Differences in the maturation of central mechanisms rather than in pituitary response appear to be responsible for the differing responses to acute stress.

Pathological tissue changes following intraoperative radiotherapy

Ninety patients with a variety of advanced-stage malignancies were treated with surgical resection, when feasible, and with intraoperative radiotherapy. Certain patients received additional external beam radiotherapy. During clinical follow-up, 45 patients died. Twenty-two patients (49% of deaths) underwent detailed autopsies between 1 and 18 months after treatment, with special attention directed towards assessing radiation damage to various tissues. Histological changes related to radiation were generally manifested as fibrosis. Mild fibrotic changes in retroperitoneal soft tissues and mild hypocellularity in vertebral bone marrow were consistently present in patients treated for pancreatic carcinoma, gastric carcinoma, and retroperitoneal or pelvic sarcomas. Fibrosis of the soft tissues of the porta hepatis without narrowing of the bile duct was present in patients treated for pancreatic or gastric cancer. perineural fibrosis was present in retroperitoneal and pelvic nerve trunks in patients treated for abdominal or pelvic sarcomas and in patients treated for unresectable carcinoma of the pancreas. Significant radiation-related changes were generally not observed in major blood vessels, intestine, or ureter. Intact irradiated primary tumors consistently displayed necrosis.

Monoclonal antibody 45-2D9 recognizes a cell surface glycoprotein on a human c-Ha-ras transformed cell line (45-342) and a shared epitope on human tumors

A monoclonal antibody (45-2D9) produced after immunization of BALB/c mice with the c-Ha-ras NIH 3T3 tertiary transfectant (45-342) recognized a determinant expressed by the primary, three of three secondary, and one of three tertiary transfectants, but not by NIH 3T3 cells. The determinant was present on the cell surface and was distinct from murine leukemia virus gp70 by absorption studies. Biosynthetic labeling and immunoprecipitation studies with [35S]methionine and [3H]glucosamine demonstrated that 45-2D9 recognizes a 74,000 Mr glycoprotein with minor bands of 90,000 and 180,000 Mr on SDS-PAGE. Pulse chase studies demonstrated a 68,000 Mr precursor molecule that incorporated only [35S]methionine. The distribution of the epitope recognized by 45-2D9 was assessed by immunoperoxidase staining. The antigen was not detected on 10 primary and metastatic murine tumors or 11 transformed murine cell lines. However, a variety of surgically excised human tumors demonstrated intense staining, whereas staining of normal tissues was minimal or not detectable. Thus a human oncogene-transfected cell can express a new cell surface determinant apparently unrelated to the oncogene product, which is also selectively expressed by human tumors.

Monoclonal antibody 45-2D9 recognizes a cell surface glycoprotein on a human c-Ha-ras transformed cell line (45-342) and a shared epitope on human tumors

A monoclonal antibody (45-2D9) produced after immunization of BALB/c mice with the c-Ha-ras NIH 3T3 tertiary transfectant (45-342) recognized a determinant expressed by the primary, three of three secondary, and one of three tertiary transfectants, but not by NIH 3T3 cells. The determinant was present on the cell surface and was distinct from murine leukemia virus gp70 by absorption studies. Biosynthetic labeling and immunoprecipitation studies with [35S]methionine and [3H]glucosamine demonstrated that 45-2D9 recognizes a 74,000 Mr glycoprotein with minor bands of 90,000 and 180,000 Mr on SDS-PAGE. Pulse chase studies demonstrated a 68,000 Mr precursor molecule that incorporated only [35S]methionine. The distribution of the epitope recognized by 45-2D9 was assessed by immunoperoxidase staining. The antigen was not detected on 10 primary and metastatic murine tumors or 11 transformed murine cell lines. However, a variety of surgically excised human tumors demonstrated intense staining, whereas staining of normal tissues was minimal or not detectable. Thus a human oncogene-transfected cell can express a new cell surface determinant apparently unrelated to the oncogene product, which is also selectively expressed by human tumors.

Comparative pathology of cardiac neoplasms in humans and in laboratory rodents: a review

This review deals with the frequency, heredity, and morphology of 19 different histologic types of cardiac tumors that may affect humans, rat, mouse, guinea pig, and mastomys. Chemicals, durable fibrous materials, viruses, and probably irradiation have induced cardiac tumors in rodents. Apart from the involvement of asbestos in the induction of pericardial mesothelioma, no carcinogens have been identified in induction or promotion of cardiac tumors in humans. A hereditary tendency for the occurrence of myxoma and aortic paraganglioma has been indicated in humans as well as strain-specific heredity for rhabdomyoma in the guinea pig and for atriocaval node tumor in the rat.

Dissociation between adrenocorticotropin and corticosterone responses to restraint after previous chronic exposure to stress

The effect on emotional reactivity produced by a model for chronic stress in which different types of acute stresses were randomly combined for 29 days was studied in adult male rats. Chronically stressed rats showed a slight decrease in body weight gain and an increase in relative adrenal weight. Chronic stress did not modify defecation rate but reduced exploratory activity in the holeboard. Neither basal nor acute-stress induced levels of adrenocorticotropin (ACTH) were modified by previous chronic stress. Likewise, basal corticosterone levels were similar in both groups. However, corticosterone response to acute restraint stress was higher in chronically stressed than in control rats. The mechanisms underlying the dissociation between ACTH and corticosterone as well as its possible implications are discussed.

Patterns of recurrence in patients with high-grade soft-tissue sarcomas

From July 1975 to December 1982, 563 patients were referred to the Surgery Branch of the National Cancer Institute with the diagnosis of soft-tissue sarcoma. Three hundred and seven of these patients had fully resectable, localized high-grade soft-tissue sarcomas and were treated at the National Cancer Institute using standard protocols with surgery alone, or in combination with chemotherapy and/or radiotherapy. An aggressive surgical approach was undertaken in the management of patients who subsequently developed recurrent disease. These 307 cases have been reviewed, with a median duration of follow-up of 30 months, to determine the frequency of recurrent disease, the patterns of recurrence, and the impact of surgery on the survival of patients who developed recurrent disease. Disease recurred in one hundred seven patients (107/307, 35%), with a median disease-free interval of 18 months (range, 0.5 to 72.0 months). The frequency of recurrence by site of primary sarcoma was extremity, 31% (65/211); head and neck, 33% (4/12); trunk, 40% (17/42); retroperitoneum, 47% (17/36); and breast, 67% (4/6). Isolated pulmonary metastatic disease was the most common pattern of initial recurrence (56/107, 52%) followed by isolated local recurrence (21/107, 20%). Single other sites of recurrence and multiple concurrent sites of recurrence each accounted for 14% (15/107) of all initial recurrences. The relative frequency of each of these four patterns of recurrence varied with the site of the primary sarcoma. The outcome for patients with recurrent disease depended on the site of recurrence, rather than on the site of the primary sarcoma. Sixty-six patients (66/107, 62%) with recurrent disease were rendered surgically disease-free with the first recurrence, including 40 (40/56, 72%) patients with isolated pulmonary metastases, 20 patients (20/21, 96%) with isolated local recurrences, five patients (5/15, 33%), with isolated other sites of recurrence and one patient (1/15, 7%) with multiple sites of initial recurrence. Following surgical resection, the actuarial three-year survival for the 66 patients rendered disease-free was 51%. The median survival for the 41 patients not rendered surgically disease-free with the first recurrence was only 7.4 months. Thirty of the sixty-six patients (30/66, 45%) rendered disease-free with the first recurrence remained disease-free at follow-up, with a median follow-up of 28 months from the time of resection of the first recurrence. The remaining 36 patients (36/66, 55%) subsequently recurred, with a median disease-free interval of 7.3 months.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of antigenic expression by primary and autologous metastatic human sarcomas using murine monoclonal antibodies

The efficacy of monoclonal antibody therapy depends in part on the expression of the relevant tumor-associated antigens by both primary tumors and their metastases. Antigen expression by paired primary and autologous metastases from surgically excised osteogenic and soft-tissue sarcomas from 15 patients was studied using a panel of murine hybridoma monoclonal antibodies and indirect immunoperoxidase staining of formalin-fixed tissue sections. The panel included three antibodies (B3619, 17-9H3, OST6) recognizing sarcoma-associated antigens and an antibody recognizing an HLA-DR framework determinant (OKla1). In most cases, antibody binding to both primary and metastatic tumors was observed. However, marked heterogeneity of binding intensity between primary and metastatic tumors and of cells expressing antigens within tumors was noted. This occurred even though primary and metastatic tumors demonstrated homogeneous histology and cellular morphology. Differences were noted among patients as well as among metastases taken from an individual. A significant number of both primary and metastatic tumors contained cells that did not bind a particular antibody even in the presence of other cells that demonstrated significant antibody binding. Thus, strategies for single monoclonal antibody therapy may be limited by heterogeneity of intertumor and intratumor antigenic expression.

Immunocytochemical enhancement of basement membrane antigens by pepsin: applications in diagnostic pathology

Basement membrane zone antigens, laminin, Type IV collagen, and Type V collagen each are enhanced selectively in formalin-fixed, paraffin-embedded sections by pretreatment with pepsin (1 mg pepsin/mL 0.5 M acetic acid). Highly specific antibodies to laminin, Type IV collagen, and Type V collagen each demonstrate intense linear staining of epithelial and endothelial basement membranes in fresh tissue, but this staining is diminished markedly and often completely abolished in paraffin-embedded tissue. Pretreatment of this paraffin-embedded tissue with standard immunoperoxidase enhancement technics such as trypsin fails to increase immunoreactivity of these antigens. Pretreatment with other proteases with known collagenolytic activities such as bacterial collagenase and Type IV collagenase is likewise ineffective. In contrast, pepsin pretreatment markedly enhances immunoreactivity of laminin, Type IV collagen, and Type V collagen. Previous immunocytochemical studies of the basement membrane useful in the distinction of invasive tumors from their benign counterparts, for example, tubular carcinoma of the breast from sclerosing adenosis, which only could be done prospectively in fresh tissue now can be performed retrospectively in paraffin-embedded tissue.

Atherosclerosis and lipid composition of the abdominal aorta. Comparison of autopsied New Orleans and Guatemalan men

Abdominal aortas from 78 Guatemalan men and 79 New Orleans white men were examined for lipid composition and for the extent of grossly visible atherosclerotic lesions. In the specimens examined, atherosclerotic lesions were more extensive in New Orleans than in Guatemala, confirming findings of studies performed 10 and 20 years earlier. Lipid accumulation differed greatly between the geographic locations with new Orleans specimens having more chemically determined lipids. Differences in lipid accumulation between New Orleans and Guatemala are more striking when expressed in terms of content (milligrams per 100 square centimeters than when expressed as concentration (milligrams per gram of dry defatted weight). Chemical analyses indicate that lipid accumulation in the aorta results principally from the atherosclerotic process rather than from aging. In the 15- to 24-year age group, the gross extent of fatty streaks was similar in both populations, but content and concentration of free cholesterol was significantly higher in New Orleans specimens than in Guatemalan specimens. This finding might be related to the more extensive development of raised lesions at later ages in New Orleans subjects.

Microscopic morphometry of abdominal aorta from men in New Orleans and Guatemala

Morphometric light microscope measurements were made on 154 abdominal aortas from 77 Guatemalan Indian-white (ladinos) men and from 77 new Orleans white men, aged 15 to 54 years. In each case, means were derived from 12 points measured independently. A progressive increase in intimal lipid with increasing age was observed in men from both countries. Extracellular intimal lipid was consistently higher in men from New Orleans than in those from Guatemala, although not always significantly so. Intimal thickness followed a similar pattern to intimal lipid regarding age and geographic location. Foam cells and leukocytes (mainly monocytes) did not follow a consistent pattern. The smooth muscle cell count was the only variable that was significantly greater in New Orleans men than in Guatemalans aged 15 to 34 years. Morphometric microscopic measurements were significantly correlated with unaided visual estimates of atherosclerotic lesions and with chemical determinations of lipid fractions in the arterial intima. All three methods, gross grading, microscopy, and chemistry, agree in revealing little or nor measureable difference between new Orleans men and Guatemalans younger than 35 years, but an accelerated divergence of the populations over age 35.

[Familial incidence of post-streptococcal glomerulonephritis]

The investigation on siblings of AGN patients has shown a streptococcus carrier evidence of 45%, while glomerulonephritis incidence was 15%. These data allowed us to classify our population as highly susceptible to bacterial dissemination and to the development of non-suppurative complications. Renal compromise was clinical and histologically classified. Subclinical forms showed glomerular lesions of mesangial localization, while clinical forms exhibited variable degrees of cellular proliferation. All patients recovered except one who died of a rapidly progressive form.