STRETCHING OF THE SCIATIC NERVE—A Means of Relieving Postoperative Pain Following Removal of Ruptured Lumbar Intervertebral Discs

Stretching the sciatic nerve for the relief of “sciatica” was frequently employed before 1900 and was subsequently abandoned, probably because it was done without sufficient scrutiny of the indications. The procedure has recently been employed in cases in which “sciatica” remains following the operative removal of ruptured intervertebral discs, and it has been instrumental in relieving postoperative “sciatica” when the cause was the formation of adhesions about the lumbar nerve roots. If the nerve root is compressed by recurrent disc protrusion or by adjacent bone, the manipulation usually increases the pain, a phenomenon that has been helpful from a diagnostic standpoint.     

SUBTOTAL GASTRIC RESECTION FOR PEPTIC ULCER—Preliminary Report of a Variation in Technique

Internists as well as surgeons agree that subtotal gastric resection is a satisfactory method of treatment for a selected group of patients with intractable or complicated peptic ulcer.A short historical review of the development of the operation is given.The importance of removing a large portion of the acid pepsin-secreting area of the stomach is stressed. A variation from the usual method of resection accomplishes this and at the same time leaves a satisfactory gastric pouch and lessens the incidence of the dumping syndrome.     

Involvement of TNF-α Converting Enzyme in the Development of Psoriasis-Like Lesions in a Mouse Model

TNF-α plays a crucial role in psoriasis; therefore, TNF inhibition has become a gold standard for the treatment of psoriasis. TNF-α is processed from a membrane-bound form by TNF-α converting enzyme (TACE) to soluble form, which exerts a number of biological activities. EGF receptor (EGFR) ligands, including heparin-binding EGF-like growth factor (HB-EGF), amphiregulin and transforming growth factor (TGF)-α are also TACE substrates and are psoriasis-associated growth factors. Vascular endothelial growth factor (VEGF), one of the downstream molecules of EGFR and TNF signaling, plays a key role in angiogenesis for developing psoriasis. In the present study, to assess the possible role of TACE in the pathogenesis of psoriasis, we investigated the involvement of TACE in TPA-induced psoriasis-like lesions in K5.Stat3C mice, which represent a mouse model of psoriasis. In this mouse model, TNF-α, amphiregulin, HB-EGF and TGF-α were significantly up-regulated in the skin lesions, similar to human psoriasis. Treatment of K5.Stat3C mice with TNF-α or EGFR inhibitors attenuated the skin lesions, suggesting the roles of TACE substrates in psoriasis. Furthermore, the skin lesions of K5.Stat3C mice showed down-regulation of tissue inhibitor of metalloproteinase-3, an endogenous inhibitor of TACE, and an increase in soluble TNF-α. A TACE inhibitor abrogated EGFR ligand-dependent keratinocyte proliferation and VEGF production in vitro, suggesting that TACE was involved in both epidermal hyperplasia and angiogenesis during psoriasis development. These results strongly suggest that TACE contributes to the development of psoriatic lesions through releasing two kinds of psoriasis mediators, TNF-α and EGFR ligands. Therefore, TACE could be a potential therapeutic target for the treatment of psoriasis.     

The Value of Countryside Elements in the Conservation of a Threatened Arboreal Marsupial Petaurus norfolcensis in Agricultural Landscapes of South-Eastern Australia—The Disproportional Value of Scattered Trees

Human activities, particularly agriculture, have transformed much of the world''s terrestrial environment. Within these anthropogenic landscapes, a variety of relictual and semi-natural habitats exist, which we term countryside elements. The habitat value of countryside elements (hereafter termed ‘elements’) is increasingly recognised. We quantify the relative value of four kinds of such ‘elements’ (linear roadside remnants, native vegetation patches, scattered trees and tree plantings) used by a threatened Australian arboreal marsupial, the squirrel glider (Petaurus norfolcensis). We examined relationships between home range size and the availability of each ‘element’ and whether the usage was relative to predicted levels of use. The use of ‘elements’ by gliders was largely explained by their availability, but there was a preference for native vegetation patches and scattered trees. We found home range size was significantly smaller with increasing area of scattered trees and a contrasting effect with increasing area of linear roadside remnants or native vegetation patches. Our work showed that each ‘element’ was used and as such had a role in the conservation of the squirrel glider, but their relative value varied. We illustrate the need to assess the conservation value of countryside elements so they can be incorporated into the holistic management of agricultural landscapes. This work demonstrates the disproportional value of scattered trees, underscoring the need to specifically incorporate and/or enhance the protection and recruitment of scattered trees in biodiversity conservation policy and management.     

The Diagnostic Value of CSF α-Synuclein in the Differential Diagnosis of Dementia with Lewy Bodies vs. Normal Subjects and Patients with Alzheimer’s Disease

The detection of α-synuclein (α-syn) in the cerebrospinal fluid (CSF) of patients with synucleinopathy has yielded promising but inconclusive results. The aim of the present study was to determine the diagnostic value of α-syn as a biological marker for Dementia with Lewy bodies (DLB) vs. normal subjects and patients with Alzheimer’s disease (AD), after strict control of several recognized confounders. Sixteen patients with DLB, 18 patients with AD and 22 age- and sex-matched normal controls (CTRL) were recruited. The levels of total α-syn in CSF were measured using a novel enzyme-linked immunosorbent assay. There was a significant increase of CSF α-syn levels in DLB patients as compared to the CTRL and AD groups (P= 0.049 and 0.01 respectively). ROC analysis revealed that increased α-syn was 81.8% specific for the discrimination of DLB vs. CTRL and 90% vs. AD. However, sensitivity was lower (56.2 % and 50% respectively). These findings provide evidence for a possible diagnostic role of α-syn as a surrogate biomarker for DLB.     

Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis – a probabilistic approach

Introduction

This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach.

Methods

One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale.

Results

The rheumatologists’ certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients.

Conclusion

Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.     

Somaclonal Variation in a Food Legume—Lathyrus sativus

Somaclones of Lathyrus sativus cv P-24 were obtained from leaf, internode and root derived callus cultures. These showed significantly decreased neurotoxin (ODAP) content up to 0.03% compared to that of parent cultivar P-24 (0.3%). The somaclones also showed higher seed yield than parent P24. In addition. somaclone Bio 1–22 showed significantly decreased time for flowering. Other heritable morphological variant features were leaf length, leaf breadth, internode length, flower colour, seed colour, 100 seed weight, neurotoxin content of leaves and red markings on the pods.     

Variation in the cell cycle time in the crypts of lieberkühn of the mouse

The durations of the phases of the cell cycle were measured at different levels in the jejunal crypts of male Balb/c mice. A mean cell cycle time of 12.3 h was found for the whole crypt. In cell positions 1 and 2, the cell cycle time was 16.7 h, and this time steadily decreased to a value of between 10 and 11 h for cell positions above 11. It is concluded that basally situated crypt cells in the mouse are cycling relatively slowly, and that they form the functional stem cell pool for the crypt. These cells may also compose the potential stem cell pool which repopulates the crypt after death of proliferative cells.     

Atypical Forms of Cerebral α-Activity in the Case of Lesions in Regulatory Structures of the Human Brain

The results of the EEG study of patients with tumor lesion of diencephalic (29 subjects) and limbic (25 subjects) structures with the focus on the analysis of structural and functional organization of α activity have been summarized. It has been found that diencephalic structure dysfunction is accompanied by disorder of α-rhythm spatial organization in the form of generalization or translocation of its focus to the frontal regions of the cerebral cortex. Distinctive features of “diencephalic” type alteration of α rhythm are determined by predominant integration of the thalamic or hypothalamic structures into the pathological process. Involvement of the limbic structures, especially at early stages of the disease, induces increase in α-rhythm intensity in the temporal region of the affected hemisphere. The nature of the response of the EEG pattern to the functional stress allows identifying it as a “hippocampal α rhythm”. Implementation of the automatic methods of analyzing plays an important role in the identification of these specified pathologic forms of the α rhythm that are often invisible during visual assessment. Detected atypical forms of α rhythm facilitates the interpretation of hemispheric asymmetry of the EEG in patients with cerebral pathology.     

BRONCHIAL CARCINOMA—Lobar Distribution of Lesions in 250 Cases

In a study of the lobar distribution of tumors in 250 consecutive cases of primary bronchial cancer, it was noted that 130 of the tumors originated in the upper lobes, 11 in the right middle lobe, and 49 in the lower lobes. Some 40 arose in the main bronchi, and most of the remainder were either “hilar” or unspecified in anatomic location.There was no apparent correlation of the lobar site of these tumors with the lobar location of childhood pneumonic lesions as observed in another group of patients in the same hospital.     

A Comparative Study of the Diagnostic Value of Contrast-Enhanced Breast MR Imaging and Mammography on Patients with BI-RADS 3–5 Microcalcifications

Objective

To retrospectively investigate the diagnostic value of breast MRI in patients with BI-RADS 3–5 microcalcifications in mammography.

Methods

Eighty-four patients with BI-RADS 3–5 microcalcifications on mammography underwent breast MR exams before surgical biopsy with a hookwire position under mammographic guidance. Two radiologists reviewed each lesion with BI-RADS by consensus. The diagnostic value of mammography and MRI was compared.

Results

Histopathological examination revealed 49 benign lesions and 42 malignant lesions. In the assessments of mammography, 21 lesions (23.1%) were assigned to category 3, 51 lesions (56.0%) to category 4, and 19 lesions (20.9%) to category 5. The area under the receiver operating characteristic(ROC) curve for mammography and MR assessment was 0.844, and 0.945, respectively (p<0.05). In cases of category 3 microcalcifications, the specificity of mammography and MR was 100%, and 95.2% (p = 1.000), respectively. In cases of category 4 microcalcifications, the specificity, PPV and accuracy of mammography was 0%, 45.1% and 45.1%; whereas those for MR was 82.1% (p<0.05), 80.8% (P = 0.003) and 86.3% (p<0.05). All microcalcifications of category 5 were correctly diagnosed by mammography and MR.

Conclusions

Breast MRI has the potential to significantly improve the diagnosis of category 4 microcalcifications on mammography. Among mammographic category 4 microcalcifications, about 82% of benign lesions can be degraded to BI-RADS 1∼3 by MRI. However for microcalcifications of category 3 and 5, MR exams do not show significant improvement over mammography.     

Variation with reproductive status of PGE₂receptor immunoreactivities in the Bostrichthys sinensis olfactory system

The role of PGE(2) as a putative sex pheromone in Chinese black sleeper Bostrichthys sinensis was investigated, using immunocytochemistry and how the immunoreactivities of the prostaglandin E(2) (PGE(2) ) receptor subtypes EP(1) , EP(2) , EP(3) and EP(4) varied with reproductive status in the olfactory system was determined. The results showed that PGE(2) receptors were present in the whole of the olfactory system of B. sinensis, and that the number of receptors was linked to the reproductive status of the fish. The densities of EP(1) immunoreactivity in the olfactory epithelium of mature fish were significantly (P < 0·01) higher than those in immature fish of both sexes, and the densities of EP(2) and EP(3) immunoreactivities in mature fish were higher (but not significantly) than those in immature fish of both sexes. In the olfactory nerve, the density of EP(2) immunoreactivity in mature fish was higher (but not significantly) than that in immature fish in both sexes. In the olfactory bulb, the densities of EP(1-4) immunoreactivities in mature females were significantly (P < 0·05 or <0·01) higher than those in immature females, and the density of EP(4) immunoreactivity in mature males was significantly (P < 0·01) higher than that in immature males. As far as is known, the present study is the first report of the immunoreactivities of PGE(2) receptor subtypes in the olfactory system of a teleost, and offers new findings regarding the role of PGE(2) as sex pheromone and hormone in the reproductive behaviour and pheromonal communication of B. sinensis.     

ABSCESSES OF THE BREAST—Recurring Lesions in the Areolar Area

Subareolar abscesses beginning either in infected skin glands or in breast ducts have an extraordinary tendency to recur and to be resistant to treatment. About three-fourths of 64 patients observed had from one to many recurrences of abscess after either spontaneous or surgical drainage, and many even after wide excision of scar in an interval of quiescence.The most successful of a number of methods of treatment used was wide removal of scar and underlying chronic abscess cavity combined with removal of the ampulla and mouth of a connecting duct.In a substantial number, after either drainage or unsuccessful excision, the process gradually subsided over a period of months or years.Cancer has not been observed in any of the 64 patients.