Isolated volar dislocation of the distal radioulnar joint: a case series and systematic review

INTRODUCTION

Isolated volar dislocations of the distal radioulnar joint are reported as rare. We observed three such cases over a 12-month period. Literature to date consists of multiple case reports and case series with no structured reviews. There is debate as to incidence, mechanism, investigation, treatment and prognosis.

METHODS

A case series and formal systematic review was performed. This included an analysis of the demographics, mechanism, presentation, investigation, treatment and outcome of the cases identified from the wider published series.

FINDINGS

In total 99 cases of this injury were identified from 59 papers, with a further 9 cases having an associated ulna styloid fracture.

CONCLUSIONS

This is a rare injury, representing up to 0.02% of all bony injuries, which is diagnosed late in 36% of cases. Inability to obtain a true lateral radiograph may contribute to the diagnosis being missed. Computed tomography scans are useful in suspected cases without radiographic confirmation. Acute cases are successfully treated with closed reduction in 78% of cases; however associated soft tissue injuries may need to be surgically addressed. Delayed presentation is more likely to require open surgery and preoperative MRI scans are indicated to aid surgical planning. Chronic instability rarely occurs and may need treatment with reconstruction or salvage. A good, subjective, result is reported in the majority of patients.

Letter to the Editor: Healthy for Life: An Innovative and Collaborative Approach to COVID 19 Lockdown in New Zealand

Recently Boreskie and colleagues published an editorial in the Journal of Frailty and Aging on Preventing Frailty Progression During the COVID-19 Pandemic (1). In it they proposed the SAVE programme (Socialization, Adequate nutrition, Vitamin D, Exercise) to prevent frailty. They concluded that creative thinking and concerted efforts would be needed to disseminate health recommendations to maintain the health of pre-frail and frail older adults in unprecedented times, such as those posed by the COVID-19 pandemic.

Nonlinear plasma wavelength scalings in a laser wakefield accelerator

Laser wakefield acceleration relies on the excitation of a plasma wave due to the ponderomotive force of an intense laser pulse. However, plasma wave trains in the wake of the laser have scarcely been studied directly in experiments. Here we use few-cycle shadowgraphy in conjunction with interferometry to quantify plasma waves excited by the laser within the density range of GeV-scale accelerators, i.e., a few 10^{18}cm^{-3}. While analytical models suggest a clear dependency between the nonlinear plasma wavelength and the peak potential a_{0}, our study shows that the analytical models are only accurate for driver strength a_{0}≲1. Experimental data and systematic particle-in-cell simulations reveal that nonlinear lengthening of the plasma wave train depends not solely on the laser peak intensity but also on the waist of the focal spot.

MiR-200a Regulates CDK4/6 Inhibitor Effect by Targeting CDK6 in Metastatic Melanoma

The CDK4/6 pathway is frequently dysregulated in cutaneous melanoma. Recently, CDK4/6 inhibitors have shown promising clinical activity against several cancer types, including melanoma. Here, we show that microRNA-200a decreases CDK6 expression and thus reduces the response of CDK4/6 inhibitor in highly proliferative metastatic melanoma. Down-regulation of microRNA-200a expression in melanoma cells is associated with disease progression and a higher number of lymph node metastases. Furthermore, microRNA-200a expression is epigenetically modulated by both DNA methylation at the promoter region and chromatin accessibility of an upstream genomic region with enhancer activity. Mechanistically, overexpression of miR-200a in metastatic melanoma cells induces cell cycle arrest by targeting CDK6 and decreases the levels of phosphorylated-Rb1 and E2F-downstream targets, diminishing cell proliferation; these effects are recovered by CDK6 overexpression. Conversely, low microRNA-200a expression in metastatic melanoma cells results in higher levels of CDK6 and a more significant response to CDK4/6 inhibitors. We propose that microRNA-200a functions as a "cell cycle brake" that is lost during melanoma progression to metastasis and provides the ability to identify melanomas that are highly proliferative and more prompted to respond to CDK4/6 inhibitors.

Excitation and Control of Plasma Wakefields by Multiple Laser Pulses

We demonstrate experimentally the resonant excitation of plasma waves by trains of laser pulses. We also take an important first step to achieving an energy recovery plasma accelerator by showing that a plasma wave can be damped by an out-of-resonance trailing laser pulse. The measured laser wakefields are found to be in excellent agreement with analytical and numerical models of wakefield excitation in the linear regime. Our results indicate a promising direction for achieving highly controlled, GeV-scale laser-plasma accelerators operating at multikilohertz repetition rates.

Abstract P1-04-04: DNA methylation landscapes of breast cancer progression to brain metastasis: A pre-clinical study

Due to improvements in overall survival rates, breast cancer brain metastasis (BCBM) is a major life-limiting condition with rising incidence. The molecular mechanisms involved in breast cancer (BC) progression to brain metastasis are still poorly understood. We have demonstrated that DNA methylation, a key epigenetic regulatory mechanism, is involved in BC progression to metastatic disease. Here, we characterized the BCBM DNA methylation landscapes according to their molecular subtypes. Methods: This study included 22 BCBM specimens from 19 patients (ER+/PgR+/HER2-(n=6), HER2+(n=7), and ER-/PgR-/HER2-(TNBC; n=6)) and primary BC specimens with paired molecular subtypes. After microdissection, we generated genome-wide DNA methylomes using HM450K BeadChips. Results: Multidimensional scaling revealed that DNA methylation patterns specifically clustered BCBMs according to their respective molecular subtypes. Additionally, we observed that while ER+/PgR+/HER2- BCBM showed a significant global hypermethylation, HER2+ and TNBC BCBMs presented a significant global hypomethylation compared to the respective primary BC specimens. Hypermethylation on ER+/PgR+/HER2- BCBMs mainly affected CpG islands and was significantly enriched in regions overlapping tumor-related genes, such as APC2, CREB3L1, and GLI3; and a large number of developmental genes, including HOXA9, HOXA10, HOXB13, and PAX6 (Table1). On the other hand, hypomethylation on HER2+ and TNBC BCBMs significantly overlapped with conserved intergenic cis regulatory elements. Two significantly affected regions included enhancer elements associated with NEUROD1, a neurogenic differentiation factor, and MYT1L, a Pan-neural transcription factor associated with neuronal differentiation, suggesting an acquisition of brain-like properties (Table2). Conclusions: Our study suggests a significant role of DNA methylation reprogramming during BC progression to brain metastasis and describes the existence of molecular subtype-specific DNA methylomes. Altogether, this data offers new insight into the complexity of this clinical complication.

Table1: Hypermethylated CpG sites in ER+/PgR+/HER2- BCBMChrStartGeneCpG ContextDiff. MethFDR P-val1746802888HOXB13Island0.824.6E-061656666575MT1MIsland0.813.7E-101685160569IntergenicShelf0.773.7E-17742277807GLI3Island0.738.7E-0567728888BMP6Island0.713.1E-051811149470FAM38BIsland0.703.4E-081146317577CREB3L1Shore0.705.3E-17191467979APC2Island0.693.0E-05727213984HOXA10Island0.697.5E-061131826421PAX6Island0.677.4E-06727205381HOXA9Island0.651.7E-061396204854CLDN10Island0.642.1E-042176956678HOXD13Island0.632.3E-04

Table2: Hypomethylated CpG sites in HER2+ and TNBC BCBMsChrStartGeneCpG ContextDiff. Meth.FDR P-val1746619555IntergenicShore-0.583.2E-042182543233NEUROD1OpenSea-0.566.9E-0312132900938GALNT9Island-0.562.1E-051391827042IntergenicShore-0.558.7E-051746618614IntergenicShore-0.551.4E-0522119853MYT1LOpenSea-0.532.5E-041156623074BCANOpenSea-0.532.1E-0310128275008IntergenicOpenSea-0.521.6E-04480885981ANTXR2Island-0.515.2E-037157280331IntergenicShelf-0.516.9E-032059832924CDH4Shelf-0.512.7E-0241407858IntergenicIsland-0.513.7E-03592925721NR2F1Shore-0.513.1E-08

Citation Format: Orozco JIJ, Bustos MA, Nelson N, Hsu SC, Cheung G, Bostick PJ, Lucci A, DiNome M, Kelly DF, Hoon DSB, Marzese DM. DNA methylation landscapes of breast cancer progression to brain metastasis: A pre-clinical study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-04-04.

Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres

INTRODUCTION

This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database.

MATERIALS AND METHODS

Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation.

RESULTS

There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007.

CONCLUSIONS

Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an 'implant time-out' could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach

Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.

What are the key endodontic factors associated with oral health-related quality of life?

AIM

To determine the associations between endodontic factors and oral health-related quality of life (OHQoL), controlling for socio-demographics, pain and other oral health clinical factors.

METHODOLOGY

OHQoL assessments were conducted amongst a consecutive sample of 412 Chinese patients requiring endodontic treatment employing the short-form Oral Heath Impact Profile (OHIP-14). Information on (i) number of teeth requiring endodontic treatment, (ii) tooth type, (iii) retreatment requirements, (iv) periapical radiolucency assessment and (v) diagnostic classification was obtained. In addition, socio-demographic information (age, gender, educational attainment and family income), pain ratings on a visual analogue scale (VAS) and other clinical oral health status information were collected.

RESULTS

Bivariate analyses identified association between number of teeth requiring endodontic treatment and summary OHIP-14 score (P < 0.01) and four of its seven domain scores (P < 0.05). Need for endodontic retreatment was associated with summary OHIP-14 score (P < 0.05) and two of its seven domain scores (P < 0.05). In regression analyses having controlled for socio-demographics, other clinical factors and pain rating amongst 15 confounding variables, patients requiring endodontic treatment for multiple teeth were more than twice as likely to have poor OHQoL (upper quintile OHIP-14 scores) compared with those requiring endodontic treatment for a single tooth (OR = 2.16, 95% CI 1.17, 3.98, P < 0.05). Pain VAS rating and age also emerged as significant factors associated with poor OHQoL in the regression analysis.

CONCLUSION

OHQoL is compromised amongst patients requiring endodontic treatment. Number of teeth requiring endodontic treatment is associated with poor OHQoL, controlling for socio-demographic and other oral health clinical and pain factors.

Antenatal ovarian torsion: a "free-floating" cyst

This case report documents the unusual presentation of an antenatal ovarian torsion followed by auto-amputation of the ovarian tube complex, finally resulting in a free floating abdominal cyst. The differential diagnosis of antenatally diagnosed abdominal cysts is discussed and the surgical management outlined.

A hepaticojejunostomy: technical errors with 'twists and turns'

Excision of a choledochal cyst followed by biliary reconstruction with a Roux-en-Y hepaticojejunostomy is the treatment of choice for type I and IV choledochal cysts. We present a rare complication which was identified 8 years after the original reconstructive surgery. Conventional imaging modalities failed to identify the pathology. Only a contrast enhanced CT scan supported by image rendering software allowed for the visualization of the underlying chronic obstruction of part of the mesentery.

Ca3 neuronal activities of dorsal and ventral hippocampus are differentially altered in rats after prolonged post-ischemic survival

The aim of the present study is to explore the potential hyper-excitability of hippocampal CA3 neurons in rats after prolonged post-ischemic survival. We conducted 15-min four-vessel-occlusion ischemic episodes in rats, allowed these animals to survive for approximately 8 months and then examined the basic morphological features and population synaptic activities of CA3 neurons. In fixed tissue sections obtained from dorsal hippocampi of post-ischemic rats, we observed a complete loss of the CA1 neurons together with a shrunken CA1 sector. Extracellular recordings in slices revealed that the overall synaptic activities of dorsal hippocampal CA3 neurons were decreased in post-ischemic rats compared with sham-operated controls. Both sham control and post-ischemic ventral hippocampal neurons were capable of exhibiting intermittent spontaneous field potentials in slices. These spontaneous field potentials spread from the CA3 to the CA1 area and their generation relied on the activity of glutamate alpha-amino-3-hydroxy-5-methyl-4 isoxazole proprionic acid (AMPA) receptors. The propensity for displaying these spontaneous field potentials appeared to be greater in post-ischemic slices than sham control slices. Our data suggest that the hyper-excitability of the post-ischemic hippocampus, if it occurs, may preferentially take place in the ventral CA3 circuitry.

Finite element analysis of a femoral retrograde intramedullary nail subject to gait loading

Intramedullary nails are routinely used in the treatment of fractures of the femur. While their effectiveness has been demonstrated clinically, a number of complications, including bone refracture and implant failure, persist. This paper presents novel three-dimensional finite element (FE) models, at four stages of gait, of: (i) a realistic femur analogue known as third generation composite bone, and (ii) a system consisting of an intramedullary nail implanted in the femur of (i). A comparison of experimentally measured strains on the surface of the femur with those predicted by the FE model revealed good agreement. The models were then used to identify implant/bone load sharing patterns, and areas of stress concentration in both the intramedullary nail and the bone, when statically locked by one or two screws at either end. The results of this study can be used to guide future implant design and surgical procedure.

Intracranial arteriovenous malformations: real-time auto-triggered elliptic centric-ordered 3D gadolinium-enhanced MR angiography--initial assessment

Auto-triggered elliptic centric-ordered three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography was compared with 3D multiple overlapping thin-slab acquisition time-of-flight (TOF) MR angiography in the evaluation of intracranial arteriovenous malformations (AVMs) in 10 patients. Intraarterial digital subtraction angiography (DSA) was the reference standard. Gadolinium-enhanced MR angiograms were found to be equivalent to DSA images in AVM component depiction in 70%--90% of cases and were consistently superior to TOF MR angiograms.

Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis

BACKGROUND AND PURPOSE

The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure.

METHODS

We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%).

RESULTS

Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin.

CONCLUSION

Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.

Bit allocation for joint source/channel coding of scalable video

We propose an efficient bit allocation algorithm for a joint source/channel video codec over noisy channels. The approach is to distribute the available source and channel coding bits among the subbands in such a way that the expected distortion is minimized. The constructed distortion curves bound the performance degradation should the channel be estimated incorrectly. The algorithm can be used in other similar distortion minimization problems with two constraints, such as power or complexity.

Induction of epithelial chloride secretion by channel-forming cryptdins 2 and 3

Salt and water secretion from intestinal epithelia requires enhancement of anion permeability across the apical membrane of Cl- secreting cells lining the crypt, the secretory gland of the intestine. Paneth cells located at the base of the small intestinal crypt release enteric defensins (cryptdins) apically into the lumen. Because cryptdins are homologs of molecules known to form anion conductive pores in phospholipid bilayers, we tested whether these endogenous antimicrobial peptides could act as soluble inducers of channel-like activity when applied to apical membranes of intestinal Cl- secreting epithelial cells in culture. Of the six peptides tested, cryptdins 2 and 3 stimulated Cl- secretion from polarized monolayers of human intestinal T84 cells. The response was reversible and dose dependent. In contrast, cryptdins 1, 4, 5, and 6 lacked this activity, demonstrating that Paneth cell defensins with very similar primary structures may exhibit a high degree of specificity in their capacity to elicit Cl- secretion. The secretory response was not inhibited by pretreatment with 8-phenyltheophyline (1 microM), or dependent on a concomitant rise in intracellular cAMP or cGMP, indicating that the apically located adenosine and guanylin receptors were not involved. On the other hand, cryptdin 3 elicited a secretory response that correlated with the establishment of an apically located anion conductive channel permeable to carboxyfluorescein. Thus cryptdins 2 and 3 can selectively permeabilize the apical cell membrane of epithelial cells in culture to elicit a physiologic Cl- secretory response. These data define the capability of cryptdins 2 and 3 to function as novel intestinal secretagogues, and suggest a previously undescribed mechanism of paracrine signaling that in vivo may involve the reversible formation of ion conductive channels by peptides released into the crypt microenvironment.

Phase-matched excitation of whispering-gallery-mode resonances by a fiber taper

We show that high-Q whispering-gallery modes in fused-silica microspheres can be efficiently excited by an optical fiber taper. By adjusting the taper diameter to match the ropagation constant of the mode in the taper with that of the resonant mode of interest, one can couple more than 90% of the light into the sphere. This represents a significant improvement in excitation efficiency compared with other methods and is, we believe, the most efficient excitation of a high- Q microcavity resonance by a monomode optical fiber yet demonstrated.

A simple monoclonal antibody based ELISA for free protein S. Comparison with PEG precipitation

A simple monoclonal antibody based ELISA for free Protein S, compatible with out existing ELISA for total Protein S has been developed, and its performance compared with the conventional PEG precipitation method of free Protein S assay. The normal range (mean +/- 2 SD) was 0.19-0.54 iu/ml free Protein S. The mean intra assay variation was 5.24% and the mean inter assay variation was 5.50%. A total of 102 routine diagnostic samples from patients referred for prothrombotic investigation (six assays for each method) were assayed by PEG precipitation (mean 0.32 iu/ml, SD 10.60), and the monoclonal ELISA (mean 0.34, SD 0.9). Paired t-test analysis of the two data sets indicated no significant difference between them (P < 0.001). In this sample population, there was no significant difference in free Protein S values when assayed by monoclonal based ELISA or by PEG precipitation. The monoclonal assay has proved to be reliable, accurate and precise. The monoclonal ELISA is simpler, quicker and easier to perform in routine use. Data generated is directly comparable to that generated by PEG precipitation. This methodology would be suitable for laboratories currently measuring Protein S by ELISA.

Cavernous malformation presenting as an extra-axial cerebellopontine angle mass: case report

OBJECTIVE AND IMPORTANCE

We describe a rare case of an extra-axial cavernoma of the cerebellopontine angle without internal auditory canal involvement and with an unusual appearance on preoperative magnetic resonance imaging (MRI). Only three cases of cerebellopontine angle cavernomas have been previously reported, and none of these reports included preoperative MRI.

CLINICAL PRESENTATION

A young man presented with subacute left facial hypesthesia and chronic asymmetrical sensorineural hearing loss. MRI revealed a mass, which was isointense on T1- and T2-weighted images, with evidence of hemorrhage (methemoglobin and hemosiderin). The lesion did not enhance after the injection of gadolinium.

INTERVENTION

The lesion was removed without difficulty by a suboccipital approach, with intraoperative electrophysiological monitoring of facial and cochlear nerves. Facial paresis cleared postoperatively.

CONCLUSION

The present case suggests that the appearance of cerebelopontine angle cavernomas as revealed by MRI may be similar to that of intraparenchymal cavernomas. This is in contrast to previously reported cases of extra-axial cavernomas at other sites. Evidence of hemorrhage in an extra-axial lesion revealed by MRI suggests a possible diagnosis of cavernoma.

Amyotrophic lateral sclerosis: correlation of clinical and MR imaging findings

PURPOSE

To determine the magnetic resonance (MR) imaging characteristics of amyotrophic lateral sclerosis (ALS) and to evaluate possible correlations between the disease severity and the MR imaging findings.

MATERIALS AND METHODS

The authors retrospectively reviewed MR images of the head in 17 patients with ALS (14 men and three women) and 17 age-matched control subjects. The corticospinal tract (CST) was analyzed for the following features: size, signal intensity, and number of sections and regions in which the CST could be seen.

RESULTS

Patients with ALS demonstrated sharp, well-defined, round, symmetric lesions that were hyperintense to gray matter within the CST. The lesions were best seen at the level of the middle or lower internal capsule on T2-weighted images. Visualization of the CST on proton-density-weighted images (which occurred in eight ALS patients) is the most reliable MR finding. Low signal intensity was identified within the motor cortex in six patients. Positive MR findings correlated with average or rapid progression of the disease.

CONCLUSION

Increased signal intensity in the CST on proton-density-weighted MR images is diagnostic for motor neuron disease and correlates with the rate of disease progression. Subtle ALS changes can be differentiated from the normal CST. Low signal intensity in the motor cortex on T2-weighted images is a useful finding.

MR of the spine in Guillain-Barré syndrome

MR examination of the spine after injection of gadopentetate dimeglumine showed enhancement of the cauda equina in a case of Guillain-Barré syndrome. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.

Relationship of hippocampus and amygdala to coronal MRI landmarks

Magnetic resonance imaging is playing an increasingly important role in the evaluation of the hippocampus, particularly in epilepsy, schizophrenia, and Alzheimer's dementia. Because of the complex configuration of the hippocampus, it is difficult to compare from patient to patient. We developed a system to allow comparison of the hippocampus on coronal images. We performed 34 magnetic resonance studies on 29 normal subjects. Ten anatomic landmarks were identified. These landmarks have a consistent 5-mm periodicity regardless of usual head flexion. In the second phase of our investigation, we showed that the amygdala, hippocampal head, hippocampal body, and hippocampal tail have a consistent relationship to the coronal magnetic resonance imaging landmarks.

MRI of the temporal lobe: normal variations, with special reference toward epilepsy

Recent investigations of epilepsy, Alzheimer's disease, amnesia, and schizophrenia have used magnetic resonance imaging (MRI) to evaluate changes in temporal lobe structures. Normal variations in these structures need to be defined before one can use these structures to describe abnormal conditions. Twenty-nine normal volunteers were studied by coronal MRI. Frequent findings include notching of the uncus by the tentorium or adjacent vessels (22/29) and asymmetry of the temporal horns (20/29). This finding of uncal notching strengthens the evidence against "incisural sclerosis" as the basis for hippocampal sclerosis. Temporal horn dilatation occurred in four. However, mild asymmetry of the temporal horn was seen frequently at its anterior tip (16/29) and may be related to head rotation. Asymmetry of the choroidal fissure was never marked. Mild asymmetry was common at the hippocampal head (pes). Mild enlargement of the right temporal lobe by visual inspection is not uncommon. Subtle asymmetry of the white matter between the hippocampus and the collateral sulcus occurred in six. The collateral sulcus does not always point to the temporal horn. The occipitotemporal sulcus may point to the temporal horn. Asymmetric uncal protrusion (0/29) and Sylvian fissure dilatation (4/29) occur rarely.

MRI of the normal hippocampus

Before it is possible to use MR imaging to investigate changes in the hippocampus in disease processes such as epilepsy and memory disorders, it is imperative that normal variations are defined. Using specific anatomic locations, we evaluated the hippocampi of 29 normal volunteers with coronal MR studies. Mild variations occur with regard to hippocampal size and shape, and hippocampal fissure visualization. Hippocampal signal intensity is isointense to cortical gray matter. Recognition of normally occurring variations should help prevent over-interpretation of hippocampal changes in pathologic disorders.

Imaging findings in hippocampal sclerosis: correlation with pathology

We evaluated the ability of preoperative radiologic imaging to detect hippocampal sclerosis in 31 patients who underwent surgery for intractable epilepsy. Hippocampal sclerosis is commonly associated with surgically treatable temporal lobe epilepsy. It is pathologically described as neuronal cell loss with associated gliosis in the hippocampus. While previous reports have correlated imaging results with clinical or qualitative histologic findings, this study used quantitative pathologic criteria (neuronal cell density) to diagnosis hippocampal sclerosis. We focused our study on the 11 patients with cryptogenic temporal lobe epilepsy. Of these, nine had hippocampal sclerosis by pathologic criteria. MR findings included unilateral hippocampal atrophy, an increased signal in the hippocampus on long TR scans, and atrophy in the adjacent white matter and temporal lobe. Hippocampal atrophy was most frequently seen in the red nucleus plane on coronal scans, corresponding to the body of the hippocampus. We also compared hippocampal size on MR with neuronal density in surgical specimens of the 11 patients with cryptogenic temporal lobe epilepsy. A statistically significant correlation was found between MR size and neuronal density in CA3 and CA4 of the cornu ammonis and the granular cell layer of the hippocampus. Since temporal lobectomy eliminated seizures in seven of nine patients with hippocampal sclerosis, preoperative diagnosis by MR has important therapeutic consequences.

Omeprazole

Omeprazole is the first acid-pump inhibitor. With its unique mechanism of action, it represents a new class of drugs in treatment of GERD, reflux esophagitis, and hypersecretory conditions. Overall, its adverse effects are mild and transient and found to be well-tolerated. Thus, omeprazole will serve as an important new agent in the management of some gastrointestinal disorders.

Evidence for formaldehyde antibodies and altered cellular immunity in subjects exposed to formaldehyde in mobile homes

Eight symptomatic individuals chronically exposed to indoor formaldehyde (HCHO) at low concentrations (0.07-0.55 ppm) were compared to 8 nonexposed subjects with respect to: (1) presence of IgG and IgE antibodies to HCHO conjugated to human serum albumin (F-HSA); (2) the percentage of venous blood T and B cells by E and EAC-rosetting; and (3) the ability of T and B cells to undergo mitogen (PHA, PWM) stimulated blastogenesis as measured by the incorporation of tritiated thymidine. Anti-F-HSA IgG, but no IgE, antibodies were detected in the sera of the 8 exposed subjects; none were found in 7 of the unexposed controls. T lymphocytes were decreased in the exposed (48 +/- 11.5%) compared to the control (65.9 +/- 4.97%) subjects (p greater than .001 less than .01). B cells were 12.6 +/- 1.6% (HCHO group) and 14.75 +/- 2.1% (controls) (p greater than .02 less than .05). The incorporation of labeled thymidine by T cells (PHA) was decreased: 17,882 +/- 2,293 cpm (HCHO group) and 28,576 +/- 3,807 cpm (p greater than .001 less than .01). T and B cell blastogenesis (PWM) was 9,698 +/- 1,441 cpm (HCHO group) and 11,279 +/- 1,711 (controls) (p greater than .05 less than .1). Exposure to HCHO appears to stimulate IgG antibodies to F-HSA and decrease the proportion of peripheral T cells.

Facial asymmetry in healthy North American Caucasians. An anthropometrical study

This is a study of normal children, evaluating the degree of subtle asymmetry that can be expected in all of us. Asymmetry was found to be very common, but average differences between right and left measurements were mild (3 mm or 3%), with the right side usually the largest. The most common and largest asymmetries were found in the upper third of the face.

Prevention of aspirin-induced faecal blood loss by prostaglandin E2

Prostaglandins have been shown in animal laboratory studies to be capable of protecting the gastrointestinal tract against injury by exogenous agents. This study was conducted to determine if prostaglandin E2 (PGE2), which is native to the human gastric mucosa, could influence the increase in faecal blood loss associated with the ingestion of aspirin (ASA). A randomised double-blind study was performed on 27 healthy men. Faecal blood loss was measured by the 51Cr labelled red cell technique. ASA (600 mg four times daily) caused a significant increase in faecal blood loss. PGE2 (1 mg four times daily) had no effect on faecal blood loss when administered alone. When given in addition to ASA it resulted in a faecal blood loss not significantly different from control. No significant alteration in intestinal transit occurred. It is concluded that PGE2 protects man from the gastrointestinal injury associated with ASA.

Purification and properties of the hemagglutinin from Wistaria floribunda seeds

Extracts of Wistaria floribunda seeds contain separable erythroagglutinating and lymphocyte mitogenic activities. We wish to report the purification and characterization of the erythroagglutinating lectin of these seeds. A phosphate-buffered saline (PBS) extract of the ground seeds was made to 50% ethanol and the precipitate, which contained both the agglutinin and mitogen, was dissolved in PBS. The erythroagglutinating activity was adsorbed onto insoluble polyleycyl derivatized A + H active hog gastric mucin. After desorption with 0.2 M D-galactose and removal of the sugar by dialysis, the eluate displayed three protein bands on polyacrylamide gel electrophoresis. The major component represented 85% of the mixture. Immunoelectrophoresis of the mixture demonstrated immunochemical identity among the proteins. Gel filtration through Sephadex G-200 resulted in purification of the major component. Based upon the composition and subunit molecular weight, it was concluded that the three components represent a dimer, tetramer, and octamer of a single glycopolypeptide chain of 28 000. The erythroagglutinin has a pI at pH 5.4 and one cystine per dimeric unit.

Orbital measurements in the presence of epicanthi in healthy North American Caucasians

Anthropometric examination of 1,312 healthy North American Caucasians (654 boys, 658 girls) aged 6-18 years revealed epicanthus in 387 subjects (29.5%, 198 boys and 189 girls). Significantly more epicanthi were minor (232, 59.9%) than major, i.e., moderate or marked (155, 40.1%; SED = 3.5, diff. = 19.8). Only one quarter of major epicanthi were marked, i.e., covered the inner canthus (39, 3% of entire sample population). The prevalence of major epicanthi decreased significantly with age in both sexes. Surface measurements did not confirm the visual illusion that the interocular distance is wide in subjects with epicanthus. The nasal root was on average shallower and the eye fissure shorter and more tilted in subjects with major epicanthus than in those without. Though minor epicanthus in Caucasians is a statistical variation of normal eye lid structure, major epicanthus persisting in adulthood may indicate developmental disturbance. Anthropometry provides accurate measurements of orbital dimensions necessary to identify such developmental disturbances.

Immunological specificity and memory in a scleractinian coral

Tissue transplantation immunity with a specific memory component is demonstrated in populations of Montipora. This highly discriminating immunoreactivity derives from extensive allogeneic polymorphism of histocompatibility (H) markers. An H system of immunorecognition is postulated to have originated in multicellular invertebrates probably beginning with coelenterates.

Brain glucose utilization in undernourished rats

The in vivo incorporation of radioactivity from [U-14C]glucose was reduced in undernourished rat pups at ages 6, 10, and 17 days for brain lipids, and at age 10 days for brain amino acids. Brain glucose concentrations were lower at age 20 days (controls 1.58 +/- 0.26 vs. test 1.14 +/- 0.07 mumol/g) but other alterations in brain glucose, glycogen, ATP, or phosphocreatine concentrations were not found. Brain mitochondrial glutamate dehydrogenase activity was 21% and 30% lower in undernourished animals at ages 10 and 20 days, respectively. Brain mitochondrial and supernatant isocitrate dehydrogenase activities and pyruvate kinase activity were similar for undernourished and control animals. Brain glycogen levels were 2-4 times higher in late fetal and newborn control animals (13.6 and 15.3 mumol/g) than in older animals (4.2-5.7 mumol/g). Brain glucose, ATP, and phosphocreatine levels increased from the 15-day fetus to the newborn, but thereafter showed no further increase.