Modulation of phenotype and cytoskeleton architecture by interleukin-1 alpha in human osteoblast-like cells in vitro. Interleukin-1 alpha, a growth factor produced by macrophages as well as many other types of cells, is able to modulate biosynthetic activities in bone cells. In this work, the authors show that the administration of interleukin-1 alpha to osteoblast-like cells in vitro induces a marked change in cell morphology, which becomes dendritic, with a smaller cellular body and numerous prolongations. The morphological changes are also accompanied by an altered expression in the pattern of cytoskeleton proteins.


Increase of DNA synthesis in uterine adenomyosis in mice with ectopic pituitary isograft. Ectopic pituitary isografts (EPI) have been found to induce a high incidence of uterine adenomyosis in SHN mice. All the SHN mice given EPI in the right uterus at 40 days of age developed uterine adenomyosis, and more than 80% of mice showed the genesis of subserosal nodules, an advanced state of adenomyosis, 65 days after EPI. Activities of both thymidylate synthetase and thymidine kinase, i.e. DNA-synthesizing enzymes in de novo and salvage pathways of pyrimidine metabolism, respectively, were significantly increased in EPI-induced uterine adenomyosis to approximately 2-fold those in normal control uteri. Bromodeoxyuridine-immunoreactive cells were regarded as the cells in S phase, and the number in the endometrial epithelium and stroma in EPI-induced uterine adenomyosis was more than 1.5-fold that in normal control uteri. EPI may affect the genesis of uterine adenomyosis generally, but not locally, because there were no differences between the right uterus with EPI and the left without EPI in the incidence of adenomyosis, histology or DNA-synthesizing enzyme activities.


Identification of sugar residues in human fetal olfactory epithelium using lectin histochemistry. Lectin-binding histochemistry was used to investigate the distribution and the changes of the glycoconjugate saccharidic moieties in the olfactory epithelium of human fetuses ranging from 8 to 12 weeks of gestation. It was found that the basal cells, the sustentacular cells and the olfactory neurons exhibit differences in oligosaccharide cellular content and distribution. Differences in lectin binding was also demonstrated at the dendrite, cell body and axon of the receptor cells. From the 11th week onwards, Ulex europaeus agglutinin I was found to be a marker of the olfactory neurons.


Clomiphene citrate alters surface ultrastructure of uterine luminal epithelial cells. Scanning electron microscopy was used to evaluate the uterine luminal epithelium from ovariectomized rats treated with a single minimal physiological dose of clomiphene citrate, oestradiol-17 beta or progesterone. It was found that clomiphene treatment produced some ultrastructural surface features which were similar to those seen with both oestrogen and progesterone treatment, but in addition it produced features unique to clomiphene treatment.


Are Ranvier's nodes of the central nervous system also artifacts by preparation? Recent research on peripheral nerves of six species of vertebrates concluded that Ranvier's nodes may be artifacts by preparation. As a consequence, the question as to whether or not Ranvier's nodes of the central nervous system may also be artifacts was logically raised. The ultrastructural data concerning our field of research (the cerebellar cortex) support the notion that Ranvier's nodes are real features in the central nervous system; otherwise, the occurrence of vesicular outpockets establishing, along myelinated axons, well conspicuous en passant nodal synapses cannot be explained.


Isolated pancreatic islets of the rat: an ultrastructural study. Pancreatic islets from adult Wistar rats were isolated by an improved collagenase digestion technique. Examination of the preparations showed that they contained B cells possessing secretory granules, each having an eccentric electron-dense core surrounded by an electron-lucent halo; the Golgi bodies with their characteristic features were located in a juxtanuclear position. Roughly surfaced endoplasmic reticulum and mitochondria were present and were mostly normal in appearance. The cell possessed all the ultrastructural attributes indicating that they were fully functional and structurally intact.


[Quantitative analysis of the isthmo-optic nucleus and projection neurons to the retina in adult fowl (Gallus gallus domesticus)]. Quantitative analysis of the isthmo-optic nucleus (IO) and centrifugal projection to the retina in the fowl was made using Nissl preparation and retrograde horseradish peroxidase (HRP) methods. Seven adult fowls (Gallus gallus domesticus) were used for Nissl stain. Serial sections were cut on a freezing microtome at 60 microns and stained with cresyl violet. IO was situated just medial to the caudal part of the tectum and laterodorsal surface of the brain stem. Rostrocaudal extension of IO was about 800-1,000 microns. The average total volume and neuronal population of the IO was 280 x 10(-3) mm3 and 5,600 neurons, respectively. Eight animals were used for HRP study. One hundred microliters of 30% HRP solution in physiological saline was injected into the vitreous body of one eye of each hen. Serial transverse sections of 60 microns were treated with tetramethyl benzidine (TMB). Many labeled neurons were found in contralateral brain stem. Average total number of contralateral HRP-labeled cells in IO and peri-IO were 5,268 and 1,492, respectively. Labeled neurons peri-IO were mainly distributed ventrally and rostrally to IO. No labeled neurons in IO, and only a few labeled neurons peri-IO were found ipsilaterally. The number of HRP-labeled neurons in IO corresponded to the neuronal population of IO in Nissl preparation, which suggested that most of isthmo-optic neurons might be projecting to the contralateral retina. In contrast to the round and small IO neurons (long axis 15-20 microns, short axis 10-20 microns), peri-IO neurons were multipolar and longer (long axis 15-30 microns, short axis 10-25 microns).


[Cellular architecture of the sheep myocardium and heart conduction system as revealed with silver-impregnation method]. Morphological studies were carried out to delineate the cellular architecture of the myocardium and heart conduction system in adult sheep using the silver-impregnation method. Reticular fibers were heavily stained in a deep black color, while collagen fibers were less intensely silver-stained in a brownish color. Individual working myocardial cells were ensheathed by thin reticular fibers and showed a polygonal form, and were connected with adjacent cells mainly end-to-end and sometimes side-to-side. Thick collagen septa were distributed between masses of myocardial cells. The nodal cells in both the sinoatrial (SA) node and atrioventricular (AV) node were spindle shaped, smaller in size than myocardial cells, and surrounded by thin reticular fibers. The bundles of SA node cells were linearly oriented, while those of AV node cells formed a reticular pattern. The cells in the His bundle and Purkinje system were oval in shape, larger in size than myocardial cells and formed the strands composed of 4-8 cells. Each stand was surrounded by thick reticular fibers. These cells had both end-to-end and side-to-side contacts. Purkinje cells were followed by transitional cells which were in contact with myocardial cells. On the other hand, the reticular fibers and collagen fibers showed characteristic structures at the different portion of heart. The present study discusses the topographical relationship between cardiac muscle cells containing the conduction system and the connective tissue sheaths surrounding muscle cells.


[On the fenestration of the vertebral and basilar arteries]. The fenestration of the vertebral and basilar arteries was investigated macroscopically in 370 human cases. Altogether 43 fenestrations were found in 32 (8.6%) out of 370 cases. The fenestrations could be divided in three groups according to the position where the fenestration appeared. Group I was the fenestration observed along the vertebral artery (Fig. 1), and 7 such fenestrations were found in 6 (1.6%) out of 370 cases; 3 fenestrations among them were located on the right side, 2 were located on the left side and 1 was found on the bilateral vertebral arteries. In 4 out of 7 fenestrations in this group, the hypoglossal nerve was found passing through the fenestration. Group II was the fenestration observed along the basilar artery (Fig. 2), and 26 fenestrations of this type were found in 20 (5.4%) out of 370 cases: 23 fenestrations (88.5%) were located at the caudal half, 3 (11.5%) were located on the rostral half of the basilar artery (Fig. 5). A close relation was indicated between the side on which the fenestration appeared in the basilar artery and the largeness in caliber of the vertebral artery of either side. Group III was the fenestration observed at the lateral area of the vertebral and basilar arteries (Fig. 3), and 10 fenestrations of this type were found in 9 (2.4%) out of 370 cases; all the fenestrations were located on the right side. In this group, the hypoglossal nerve was observed passing through the fenestratin in 4 out of the 10 fenestrations.(ABSTRACT TRUNCATED AT 250 WORDS)


[The selachian terminal nerve].

[The selachian terminal nerve]. In order to clarify morphology and function(s) of the terminal nerve, gross examinations of the nerve were carried out in 9 species of selachians. The terminal ganglion was observed light- and electron-microscopically. FMRF-amide immunoreactivity of the terminal nerve was also examined in some species. The results were as follows: 1) The terminal nerve was divided into peripheral and central branches by interposed ganglion(s). Macroscopically, the peripheral branch appeared from an area between the nasal sac and the olfactory bulb. The central branch entered the telencephalon from either the rostral, dorsal, or ventral surface. The position seemed to differ from species to species. 2) The terminal nerve showed great species differences and individual variations in the macroscopic morphology, such as number and course of the peripheral branch, position, size and number of ganglia, and telencephalic areas where the central branch entered. Even in the same individual, there was a difference in left and right sides. 3) According to general histology, the ganglion was encapsulated and had no direct connection with the telencephalon through the capsule, even when the ganglion was situated on the telencephalon. The Bodian preparations showed that most ganglion cells were unipolar, and a few were bipolar or pseudounipolar. 4) All ganglion cells and the processes were FMRF-amide immunoreactive. Immunoreactive fibers of the central branch terminated in the septal and preoptic areas. FMRF-amide immunoreactive cells were also found in the olfactory nerves or the septal area of the telencephalon in some species. These neurons were thought to be ectopic ganglion cells. 5) Neuronal somata and the axons in the ganglion contained large dense cored vesicles.(ABSTRACT TRUNCATED AT 250 WORDS)


Magnetic resonance studies on brain dysfunction induced by organic solvents. A 38-year-old layer of parquet flooring was referred because of memory impairment, tiredness and diffuse headaches. His work involved using several neurotoxic organic solvents. Extensive laboratory, neuropsychological, clinical neurophysiological, neuroadiological, magnetic resonance (MR) imaging and spectroscopy studies were performed. The neuropsychological and behavioural assessments showed an organic brain syndrome. MR imaging and CT scanning of the brain revealed enlarged ventricles and generalized atrophy. 31P and 1H MR spectroscopic measurements did not show any abnormalities. Owing to recent improvements regarding sensitivity and facilitated assignment, MR spectroscopy may provide in the near future significant additional information on brain metabolism in patients with brain dysfunction presumably induced by organic solvents.


Treatment of idiopathic inflammatory myopathies with cyclophosphamide pulses: clinical experience and a review of the literature. Short-term cyclophosphamide pulse therapy was administered to five patients with idiopathic inflammatory myopathies (IIM) which were refractory to corticosteroids and, in two cases, to other aggressive therapies. Both disease remission and a reduction in corticosteroid dosage were obtained in four patients. Three of them have been in remission over since, taking only minimal doses of steroids during the subsequent two years. In the fourth patient a less intensive, maintenance pulse therapy could not be continued due to unacceptable side effects. On the basis of these results and of data from the literature, herein reviewed, cyclophosphamide pulse therapy may be recommended for adult patients with IIM who do not respond to or who do not tolerate conventional corticosteroid treatment, as well as when a steroid-sparing effect is desired.


Apraxia of eyelid opening secondary to right frontal infarction. Apraxia of eyelid opening is the incapacity of voluntarily eyelid opening in the absence of motor dysfunction or blepharospasm. It has mostly been described in extrapyramidal diseases and only very rarely in cortical lesions. We report a right-handed patient with a right frontal infarction exhibiting eyelid opening apraxia.


Sneddon's syndrome associated with anticardiolipin antibody: a case report. We report the case of a young man suffering from the rare combination of livedo reticularis and recurrent ischemic cerebrovascular disease (Sneddon's syndrome). He also had a circulating anticardiolipin antibody. in the absence of systemic lupus erythematosus, we suggest the likelihood of a primary antiphospholipid syndrome.


Epilepsy care in The Netherlands.

Epilepsy care in The Netherlands. In this article models of epilepsy care in the Netherlands are outlined. Mostly this care is aimed at people with uncontrolled epilepsy who may have suffered from the adverse effects of ignorance, prejudice and even discrimination. Many of these adverse factors should be avoidable in future as the educational programmes for people with epilepsy, professionals and the general public take full effect. Meanwhile there is a great deal that can be done to rehabilitate people whose seizures are a problem and whose social abilities fall short of the standards that are required for independent and self-fulfilling living in any society. The models of care described are very sophisticated and they have been developed over many years. They require well-trained and motivated staff and sometimes elaborate and expensive medical diagnostic equipment. But this should not put anybody off as the principles behind any model of care should be the same: Accurate diagnosis. Optimal drug and other treatment (this should be optimal treatment available in that country). Education of the patient and family about all aspects of epilepsy. Opportunity to share experiences. A multidisciplinary approach to identified problems (a multidisciplinary approach can be taken by one person, although a team of people from different disciplines is ideal.) Objectives agreed by all participants.


Current medical therapy of epilepsy.

Current medical therapy of epilepsy. The treatment of epilepsy firstly depends upon the correct diagnosis, with emphasis on considerations of etiology, seizure type, and epilepsy syndrome. Following an appropriate diagnostic conclusion, the patient may be started on the medication matched to the seizure type. A full understanding of the pharmacology of antiepileptic drugs will enable the physician to obtain maximum benefit from the available pharmaceutical armamentarium.


Extratemporal epilepsy: clinical presentation, pre-operative EEG localization and surgical outcome. To summarize, the most commonly encountered problems in the pre-operative EEG localization of the epileptogenic zone in patients with extra-temporal epilepsy are dependent upon: 1) Poor EEG localization of the interictal epileptic abnormality and poor localization of seizure onset. 2) Presence of a widespread epileptogenic area during interictal and ictal tracings, often involving two or more lobes synchronously or independently, thus suggesting a multilobar or a multifocal epileptic disorder. 3) Absence or paucity of interictal epileptiform discharges is not an uncommon finding and clinical seizures without accompanying ictal EEG manifestations are also not uncommon. 4) Different paths of seizure propagation might occur even in individual patients. This may reflect clinically as different seizure patterns resembling a multifocal seizure problem. From this review, one could envisage that the future research challenge in extra-temporal epilepsy resides in the development of a technology or system which will provide a better localization of the seizure generator, as well as a better identification of the mechanisms of seizure spread, ideally indicating anatomical pathways involved.


Neuron-associated class III beta-tubulin isotype, retinal S-antigen, synaptophysin, and glial fibrillary acidic protein in human medulloblastomas: a clinicopathological analysis of 36 cases. Surgical specimens from 36 medulloblastomas (25 classic and 11 desmoplastic) were studied by peroxidase-antiperoxidase (PAP) immunohistochemistry with antibodies against the class III beta-tubulin isotype (beta-tubulin), synaptophysin, retinal S-antigen (S-Ag), and glial fibrillary acidic protein (GFAP). We found that neoplastic cells expressed beta-tubulin in 91% of the tumors (23 classic and 10 desmoplastic), synaptophysin in 75% (19 classic and 8 desmoplastic), S-Ag in 44% (11 classic and 5 desmoplastic), and GFAP in 11% of medulloblastomas (2 classic and 2 desmoplastic). Synaptophysin and beta-tubulin positivities were observed in undifferentiated neoplastic cells, in cells forming neuroblastic rosettes, and in pale islands, while S-Ag immunopositivity was noted in undifferentiated cells, occasionally in beta-tubulin-negative neuroblastic rosettes, and exceptionally in pale islands. Large pale islands, in two desmoplastic medulloblastomas, exhibited distinct patterns of immunoreactivity to the above markers, suggesting neuronal and glial differentiation in the central area, and intense neuritic development in the peripheral zone. Our findings confirm the predominant capacity of medulloblastoma cells to differentiate along neuronal cell lines and indicate that large pale islands, in desmoplastic medulloblastomas, represent well-organized areas for neuronal and, to a lesser degree, astroglial differentiation. Furthermore, it appears, in our cases, that immunohistochemical features do not represent clear-cut prognostic indicators in patients with medulloblastomas.


Morphometric study of the sensory neuron and peripheral nerve changes induced by chronic cisplatin (DDP) administration in rats. We performed a morphological, morphometric and toxicological study on the spinal ganglia and peripheral nerves of the rat after chronic administration of cisplatin (cis-dichlorodiammineplatinum II; DDP) with two different schedules. Severe damage of the spinal ganglia neurons was demonstrated with predominant involvement of the nucleus and nucleolus associated with a decrease in the cell size. Morphological and morphometric changes also occurred in the sciatic and peroneal nerves with the features of axonopathy. All these changes were more marked in the group of rats which underwent the most intense DDP treatment and the tissue platinum concentrations were also higher in this group. This experimental model is the first available for chronic DDP administration in which concomitant spinal ganglia and peripheral nerve damage has been confirmed pathologically. Our study supports the hypothesis that DDP-induced peripheral nerve fiber degeneration may result from nuclear and nucleolar changes in the sensory ganglion cell perikaryon.


Amyotrophic lateral sclerosis with ophthalmoplegia and multisystem degeneration in patients on long-term use of respirators. We describe two patients with sporadic amyotrophic lateral sclerosis (ALS), who had developed progressive external ophthalmoplegia of a predominantly supranuclear type while they survived on respirators, and displayed histopathological abnormalities both typical and atypical of ALS. Patient 1 was a 43-year-old man with ALS of 5-year duration, who had initially exhibited fulminant ALS, and remained on a respirator for 4 years. Patient 2 was a 51-year-old man with ALS of 13-year duration, who remained on a respirator for 8 years. Both patients died in a "totally locked-in state". Autopsy of both patients revealed not only histopathological abnormalities consistent with ALS, but also multisystem degeneration which involved the pontine tegmentum, substantia nigra, Clarke's dorsal nuclei and spinocerebellar tracts. In addition, Patient 2 displayed intracytoplasmic neuronal basophilic inclusion bodies which exhibited marked immunoreactivity to anti-ubiquitin antibodies. Our case reports indicate that the longer survival which is possible through the use of respirators may make one subgroup of ALS patients prone to develop atypical clinical and neuropathological features which are not observed during the natural course of ALS.


The characteristics of blood-brain barrier in three different conditions--infarction, selective neuronal death and selective loss of presynaptic terminals--following cerebral ischemia. We investigated the extravasation of serum albumin using immunohistochemistry in three different conditions, i.e., infarction, selective neuronal death and selective loss of presynaptic terminals following cerebral ischemia in gerbils. In selective neuronal death, which is typically found in the CA1 neurons of the hippocampus after 5-min bilateral cerebral ischemia, selective damage of postsynaptic components with intact presynaptic sites was demonstrated by immunohistochemical examination for microtubule-associated protein 2 and synapsin I, and albumin extravasation did not become apparent before postsynaptic structures were destroyed. In cerebral infarction, which was consistently observed in the thalamus after 15-min forebrain ischemia, massive albumin extravasation was visible early after ischemia due probably to the ischemic endothelial necrosis. In selective loss of presynaptic terminals, which was detected at the molecular layer of the dentate gyrus in the contralateral, nonischemic hippocampus after unilateral cerebral ischemia, immunoreaction for albumin was not visualized. Since endothelium and glial cells were intact in morphological aspects in selective damage of both pre- and postsynaptic sites, it was thought that extravasation was facilitated by the stimulation of endothelial cells and glial cells with unknown factors that were induced by the destruction of post- but not presynaptic elements.


Immunohistochemical observations on rat radial glia: relationship with the origin of ethylnitrosourea-induced tumors. Gliomas induced in the rat by transplacental administration of ethylnitrosourea (ENU) are intensely immunoreactive for vimentin and scarcely for glial fibrillary acidic protein (GFAP). Since tumoral transformation takes place during the late fetal and early postnatal period, the sequential expression of the two glial antigens has been investigated in this age period in ENU-treated and control rats. Immunohistochemical and immunoelectron microscopical methods have been employed. Vimentin was widely expressed starting from embryonal day 14 (E 14) in the processes of radial glia; as long as radial glia was present, vimentin decorated it. GFAP was, at earliest, observed at E 20 and expressed by glial cells with a stellate, i.e., mature shape. No GFAP-positive radial process was observed. No difference was found between ENU-treated and control rats. Since ENU is most effective in producing tumors when administered at the 16-17th day of fetal life, vimentin-positive radial glia is a candidate target of ENU. The similarity of intermediate filament pattern between radial glia in the late fetal life and tumors induced by transplacental ENU suggests that radial glia might be the cell of origin.


Immunoelectron microscopic study of tubulin and microtubule-associated proteins after transient cerebral ischemia in gerbils. Differential vulnerability of microtubule components to cerebral ischemia has been reported previously. We investigated the disintegration of microtubules using immunoelectron microscopy for alpha-tubulin and microtubule-associated protein 1A and 2 (MAP1A and 2). Mongolian gerbils were subjected to bilateral carotid occlusion for 10 to 30 min and reperfusion for up to 72 h following ischemia for 10 min. After ischemia for 10 min, some dendrites in the stratum moleculare of the subiculum-CA1 region lost immunoreaction products for alpha-tubulin and MAPs. Loss of the reaction products spread to the medial CA1 region during progressive ischemia for 30 min. In some dendrites, electron-dense precipitates for MAPs were dispersed in the dendritic cytoplasm with little reaction product on microtubules and without alteration of the reaction for alpha-tubulin. After recirculation, loss of electron-dense precipitates for alpha-tubulin and MAPs, as well as disintegration of microtubules, propagated further to the medial CA1 region and to the proximal dendrites. The present study demonstrated prompt disintegration of microtubules with rapid disappearance of the reaction for MAPs which seemed to be caused by detachment of MAPs from the microtubule cores.


Spasmodic torticollis: severe compression neuropathy in rami dorsales of cervical nerves C1-6. In 28 patients with spasmodic torticollis dorsal branches of the cervical nerves C1-6, and in 25 of these patients fascicles of the contralateral accessory nerve were investigated by light and electron microscopy. Significant changes were noted in 15 patients. The alterations were not seen or were less prominent in the 5 control cases studied for comparison. Semiquantitative evaluation of light microscopic findings revealed in 12 cases prominent and numerous Renaut bodies; in 9 cases evidence of regeneration (in 3 of these postoperatively); and in 11 cases disproportionately thin myelin sheaths in relation to axon calibers. In conjunction with endoneurial edema and thickening of the perineurium, these changes were suggestive of compression neuropathy. Whether these changes were the cause, or a side effect of the abnormal muscle contractions in spasmodic torticollis could not be elucidated. Peripheral nerve compression, however, may trigger abnormal activity in the peripheral part of the involved interneuronal circuits and may, thus, be considered as one of the many possible causes of spasmodic torticollis.


Occurrence of acetylcholinesterase activity closely associated with amyloid beta/A4 protein is not correlated with acetylcholinesterase-positive fiber density in amygdala of Alzheimer's disease. To investigate the possible relationship between acetylcholinesterase (AChE)-containing fiber density and senile plaque density and between AChE-positive plaques and beta/A4 protein deposition, AChE histochemistry, the modified Bielschowsky's method and beta/A4 protein immunohistochemistry were performed on the amygdala of Alzheimer's disease (AD) and aged control cases. Abundant AChE-positive senile plaques were found in the amygdala and related structures in AD. These AChE-positive plaques were mainly of the primitive or diffuse type. In addition to senile plaques of typical morphologies a variety of AChE-positive structures were observed in the amygdala and related regions in AD. A comparison of serial sections stained alternatively with AChE histochemistry and beta/A4 protein immunohistochemistry has revealed that these AChE-positive structures with variable morphological appearances displayed beta/A4 protein immunoreactivity, indicating that AChE is localized in a variety of beta/A4 protein deposition including the diffuse plaque. Thus, it is suggested that AChE is present in some senile plaques at the earliest stage. However, there was no apparent correlation between the numerical density of AChE-positive fibers and senile plaque density. These findings suggest that the degeneration of cholinergic neurons is not attributed to the occurrence of AChE activity in beta/A4 protein.


Occurrence of active demyelinating lesions in children with hereditary motor and sensory neuropathy (HMSN) type I. In three children with dominant hereditary motor and sensory neuropathy type I, peripheral nerve biopsy showed the classical lesions of segmental demyelination with remyelination and onion bulb formations. In two cases, ultrastructural examination also demonstrated numerous characteristic features of active demyelination. The presence of active demyelinating lesions suggests an autoimmune attack superimposed on the course of a chronic genetic disease.


Cumulative white matter changes in the gerbil brain under chronic cerebral hypoperfusion. An animal model of chronic brain hypoperfusion has been developed by applying coiled clips to the bilateral carotid artery of Mongolian gerbils. The brain tissue damage was neuropathologically studied after 1, 4, 8, and 12 weeks of hypoperfusion. The hippocampus, basal ganglia, and cerebral cortex of the chronically hypoperfused gerbil showed lesions with various severity which are probably due to ischemic episodes. In the cerebral white matter, however, two types of lesions were observed; one similar to those in the gray matter, and the other observed only in the white matter after more than an 8-week duration of brain hypoperfusion. The lesion specific to the white matter showed rarefaction and gliosis without locally associated ischemic changes. This type of the white matter lesion was never found in the gerbil brain before 8 weeks and, significantly, increased in number and size by 12 weeks post operation. The accumulation of the white matter lesions is characteristic in the gerbil with chronic hypoperfusion. The observed white matter-specific lesion resembles the histological changes in aged brain with cerebrovascular diseases.


Ciliary claws: their existence in various epithelial cysts of the central nervous system. We describe claw-like projections and their associated structures as encountered at the tips of cilia in a cerebellar epithelial cyst, an intraspinal bronchogenic cyst and two colloid cysts of the third ventricle. Ciliary claws appear either as a single structure or as a cluster of two to five projections measuring 22-28 nm in length and 8-10 nm in diameter, extending from the plasma membrane of the ciliary tip. The transmembranous fibrils of the ciliary claws are bound to a multilayered electron-dense disc which is attached by the distal ends of axonemal microtubules. These observations suggest that ciliary claws are common in several types of epithelial cysts of the central nervous system; the presence of these structures supports the premise that the corresponding epithelium is of endodermal origin.


Immunohistochemical evidence of endothelin-1 in human choroid plexus. An immunohistochemical investigation was carried out on 17 specimens of human choroid plexus obtained post mortem, 1 biopsy of normal choroid plexus including part of the lateral ventricle and 1 papilloma of the choroid plexus removed surgically. The material was fixed in formalin. Paraffin and cryostat sections were used. A polyclonal antiserum to endothelin-1 served as a primary antibody. The avidin-biotin-peroxidase method was applied to demonstrate the immunoreaction. The epithelial cells of the choroid plexuses, the choroid papilloma and most ependymal cells of the lateral ventricle showed a distinct brown reaction product in their cytoplasm indicating antigenic sites to endothelin-1. The reaction was of lesser intensity in the ependymal cells. The connective tissue in choroid plexus was unstained. A positive immunoreaction was present in the walls of some vessels in the choroid plexus in cryostat sections. This is the first report on the presence of antigenic sites to endothelin-1 in the epithelial cells of the human choroid plexus. The role of endothelin in these cells should be investigated to ascertain if the cells synthesize this biologically active peptide or if it is merely bound to receptors in them.


Neuropathology of biotinidase deficiency. A patient with biotinidase deficiency and a progressive neurological disorder died just before the biochemical diagnosis was established. Post-mortem examination of the brain and spinal cord revealed necrotising lesions similar to those in Leigh's disease and Wernicke's encephalopathy. Unlike these two conditions, the regions affected included the hippocampus and parahippocampal cortex. In addition there was severe focal oedema in deep cerebral grey matter, the brain stem, and the spinal cord. These lesions appear to result from a number of severe metabolic disturbances, perhaps linked to an underlying disordered pyruvate metabolism. The nature of the pathology explains why a neurological deficit may persist despite treatment.


Subtraction radiography of interradicular bone lesions. Subtraction and conventional radiography were evaluated for their diagnostic potential to assess interradicular bone lesions in the mandibular premolar region. Both conventional radiographs and subtraction images were interpreted by 10 observers. The receiver-operating characteristic (ROC) technique was used to compare the two techniques. The diagnostic validity was higher for the subtraction technique, both for lesions confined to cancellous bone and for lesions including the cortical bone, than for the conventional technique. For bone defects confined to cancellous bone the diagnostic accuracy was lower than those reported from periapical bone lesions irrespective of whether subtraction or conventional radiography was used. We conclude that subtraction radiography improves the detectability of bone lesions, shallow ones in particular. Lesions in the interradicular bone are more difficult to detect than those in the periapical bone.


Dental caries in primary school children in Nairobi, Kenya. The purpose of this study was to record the caries status in children attending public primary schools in Nairobi. The sample comprised 513 children, 262 aged 6-8 years and 251 aged 13-15 years. The children were drawn from six randomly selected schools in the city. Clinical examination was carried out in a room with natural daylight, using the WHO (1977) criteria. Fifty-four per cent of the 6- to 8-year-olds and 50% of the 13- to 15-year-olds were caries-free. The mean dmft in the 6- to 8-year-olds was 1.7, and the mean dmfs was 3.5. The mean DMFT in the 13- to 15-year-olds was 1.8, and the mean DMFS was 2.9. The d- and D-components dominated and were mainly located in the occlusal surfaces. The f-component of the dmft and the F-component of the DMFT comprised 1% and 10%, respectively. There was no statistically significant difference (p > 0.05) in the prevalence of caries between males and females in the younger age group. In the older age group, however, females had a higher (p < 0.05) prevalence than males. In general, the study showed a low caries prevalence in Nairobi children.


An experimental model of osteoarthrosis in the temporomandibular joint of the rabbit. Degenerative changes in the temporomandibular joint were induced in 24 rabbits by surgical perforation of the disk. The incongruence obtained between the joint surfaces caused a gradual increase in macroscopic and microscopic changes, including gross remodeling, loss of tissue volume, and altered cell morphology within a 16-week observation period. These changes occurred concurrently with major alterations in the composition of the matrix, as demonstrated by increase in the glycosaminoglycan content of both condylar cartilage and disk and by loss of hydroxyproline in the disk. The lesions in the disk tissue were clearly discernible, whereas those in the condylar cartilage were less extensive. The described method is concluded to give alterations in the temporomandibular tissues, as seen in degenerative joint disease of an early stage.


Craniomandibular disorders in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. A clinical study. Sixty-one subjects with rheumatoid arthritis, 61 with psoriatic arthritis, 61 with ankylosing spondylitis, and 61 healthy controls were examined with regard to subjective symptoms and clinical signs of craniomandibular disorders (CMD). The frequencies of most subjective and clinical variables were higher in all three disease groups than in the control group. Subjects with rheumatoid arthritis and psoriatic arthritis showed more frequent and severe signs and symptoms than subjects with ankylosing spondylitis. It is concluded that subjective symptoms and clinical signs of CMD are common in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and are mainly caused by the respective general joint disease. None of the signs and symptoms is pathognomonic for rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.


Use of professionally administered fluoride among Danish children. The objective of this study was to determine the use of professionally administered fluoride in Denmark in 1991. Of the 275 addressed Danish municipalities 98% returned the questionnaire. Ten per cent of the municipalities with public clinics were using systematic mouthrinses with 0.2% fluoride, compared with 25% of the municipalities without public clinics (p < 0.01). In comparison, 93% of the municipalities reported having used mouthrinses in 1985. Fluoride swabbing was used by 69% of the municipalities not using mouthrinses and by 47% of the municipalities still using fluoride mouthrinses (p < 0.02). Duraphat lacquer was used in 92% of all municipalities, fluoride gel in 3% and fluoride tablets in 8% of the municipalities. It is concluded that during the past 6 years the use of professionally administered fluoride among Danish children has changed from mass-prophylactic mouthrinses to maneuvers aimed more at the specific needs of the individual.


Microleakage of indirect composite inlays. An in vitro comparison with the direct technique. Microleakage occurring around directly and indirectly made class-II composite restorations was evaluated on extracted human premolars. Before the evaluation was made, the teeth were thermocycled and stained with an organic dye. Direct class-II composite restorations demonstrated extensive microleakage at their dentin cavosurface margins. Indirect class-II composite inlays luted with a dual-curing composite cement displayed much less microleakage than restorations made using the direct technique. The use of glass-ionomer cement rather than composite cement as the luting material resulted in more microleakage. Rather than being a true microleakage, the leakage of glass-ionomer cement might be the result of a diffusion of the water-soluble organic dye in the water-based cement. The results suggest that the indirect composite technique is superior to the direct technique when it comes to reducing microleakage.


Skeletal maturity, dental maturity, and eruption in young patients with Turner syndrome. A major problem for patients with Turner syndrome is their small body height. The rapid biotechnologic development has now made treatment with growth hormone possible at a larger scale. The aim of this investigation was to evaluate skeletal maturity, dental maturity, and eruption in a group of young patients before hormone therapy. The material comprised 33 patients aged 7-16.7 years. The skeletal maturity, as judged from hand radiographs, was on an average 2.3 years retarded (p < 0.001) and showed increasing retardation with increasing age. The dental maturity, assessed from the formation stages of the permanent teeth on panoramic radiographs, was accelerated, with a mean value of 1 year (p < 0.001). The timing of clinical eruption did not differ significantly from that of our reference material; the Turner girls were on an average 3.7 months ahead. Several patients had local eruption problems, especially in the maxillary lateral segments. It is suggested that disharmony between tooth size and arch size may contribute to this problem.


Piezoelectricity in dental materials, a conceivable cause of postrestorative sensitivity. With the increased use of tooth-colored posterior inlays reports of postrestorative sensitivity have also increased. One of the symptoms the patients complain of is a sharp pain when the inlays are loaded through chewing and biting. Many explanations for the causes of dissimilar types of postrestorative sensitivity have been offered, but one conceivable explanation that has not hitherto been studied is the direct piezoelectric effect in dental materials. Direct piezoelectric effect means that when certain anisotropic crystals are mechanically loaded, a charge is generated on the surface. The aim of the present study was to examine whether this physical phenomenon occurs in certain materials intended for dental use. Specimens of four different dental ceramics and one indirect composite resin for inlays were mechanically loaded with various forces, and the current was directly recorded. Currents of up to 0.9 microA with a pulse duraton of 0.4 msec were extracted, and it cannot be excluded that the piezoelectric phenomenon and related properties may cause postrestorative sensitivity. This has to be taken into consideration when posterior inlays of the types concerned are used.


Team approach to tibial fracture. 37 consecutive type III cases reviewed after 2-10 years. During a 10-year period, we managed 35 patients with 37 cases of Type III open tibial fractures, 15 cases within 1 week and 22 as late referrals. In all cases, simultaneous assessment and management by a microvascular and an orthopedic surgeon were mandatory throughout the treatment period. 6 of the 15 acute cases had a primary amputation. Of the remaining 31 cases, limb salvage was possible in 27. 31 flaps, pedicle and microvascular free flaps were used. Major complications occurred in 6 cases, but in 27 cases infection-free solid union was obtained. At long-term follow-up, average 5 years, the function was good or acceptable in 23 cases. We conclude that: (1) patients with Type III tibial injuries should preferably be transferred within a week after injury to a hospital where major reconstructive procedures are commonly performed, (2) early soft tissue coverage is essential in the management of these injuries, (3) unilateral external fixation should be the preferred technique of stabilization, and, finally, (4) plastic surgery expertise is important in management of severe tibial fractures.


Free tissue transfer for type III tibial fractures. Microsurgery in 19 cases. We report 19 tibial fractures Types III B and C treated by free flaps. The fracture healed in 16 cases after 12 (3-54) months. In 3 cases a secondary amputation was carried out. Tibial malalignment or substantial shortening ensued in 1 case each. We conclude that coverage with free flaps, radical removal of dead bone, stable external fixation and transfer of vascularized bone may salvage the majority of Type III B and C tibial fracture with function superior to that after amputation.


Reconstruction of the Achilles tendon region by free microvascular flaps. 9 cases followed for 1-9 years. In 1981-89, 9 patients underwent reconstruction for complex injuries in the Achilles tendon region. 10 free microvascular flaps were used: 5 fasciocutaneous and 5 muscle or musculocutaneous flaps. In addition, 4 Achilles tendons and 1 tibial posterior nerve were reconstructed, 1 femoropopliteal bypass was performed, and 6 tibial fractures were treated. The patients were re-examined on an average 3.5 years after the reconstruction. The stability of soft tissues was good in all patients. Good contour was achieved in superficial defects with fasciocutaneous and in deep injuries with latissimus dorsi free flaps. The calcaneal tendon function was good in 5, fair in 2 and poor in 2 patients, depending on the severity of the underlying skeletal injury. We conclude that free microvascular transfer offers one-stage reconstruction of complex, infected wounds in the Achilles tendon region, promotes fracture healing, and allows simultaneous tendon or nerve repair.


Blood flow and mechanical properties of healing bone. Femoral osteotomies studied in rats. In male Wistar rats, a transverse osteotomy at the midshaft of the femur was made, and the acute effects on bone flow were measured before and after reaming. Flow and mechanical variables in the healing bones were measured at 4, 8, and 12 weeks following osteotomy. Osteotomy reduced total bone blood flow by about 50 percent, and cortical flow in the diaphysis by approximately 40 percent. Cortical flow was equally diminished in the mid-diaphysis and in the osteotomy area, and no differences between the proximal and distal diaphyseal flows were found. Reaming of the osteotomized bones did not lead to any further flow reduction. At 4 weeks, total bone flow was more than doubled; increases were found in every segment of the fractured bone, and a more than 10-fold increase in the callus area was seen. At the end of the experiment, the femurs had regained 83 percent of their normal strength, 88 percent of normal rigidity and 78 percent of normal fracture energy. At this time total bone flow was marginally increased, flows in the proximal and the distal diaphyses were almost normalized, while a nearly 3-fold increase was still found in the callus area. Flow in the callus area gradually decreased during healing, and regression analysis demonstrated a negative correlation between callus flow and mechanical properties.


Closed versus open medullary nailing of femoral fractures. Blood flow and healing studied in rats. In rats, bilateral closed femoral fractures were produced. On the left side, closed intramedullary nailing was done, and on the right side, the nail was inserted by an open procedure. The healing process of the fractures was evaluated at 4, 8, and 12 weeks, bone and muscle blood flows were also determined. Reaming had no acute impact on bone blood flow, while reaming and fracture halved total bone flow (P < 0.04), and reduced cortical diaphyseal flow to approximately one quarter (P < 0.01). No differences were found between the open and closed methods. At 4 weeks, the bending moment, rigidity, and fracture energy of the fractures treated by closed medullary nailing were greater than those treated by open nailing. The fracture energy was still greater at 8 weeks, while no differences were seen in bending moment and rigidity. At 12 weeks, however, there were no differences in the mechanical parameters. Bone blood flows in both the cortical diaphysis and callus area were increased at 4 and in the callus area at 8 weeks in bones treated by the open method. No differences were found at the end of the experiment. Muscle blood flow was not different in the two limbs, and was constant during the experimental period. We conclude that femoral fractures treated by closed nailing heal better in the initial phase compared with those that have been openly nailed. This difference cannot be explained by an impaired muscle or bone blood flow due to open surgery.


The radiographic classification of medial gonarthrosis. Correlation with operation methods in 200 knees. Ahlbäck's classification of gonarthrosis can be applied with improved precision by careful interpretation of anteroposterior varus stress and lateral radiographs of the knee. The tibial lesion in early gonarthrosis is located in the anterior and middle part of the medial plateau. In more advanced disease, when the anterior cruciate ligament is invariably damaged, the lesion extends to the posterior margin of the medial tibial plateau. We studied the preoperative radiographs of 200 knees with arthrosis. We were able to predict the integrity of the anterior cruciate ligament (and the use of unicompartmental arthroplasty) with 95 percent accuracy and rupture or damage to the anterior cruciate ligament (and the use of total condylar arthroplasty) with 100 percent accuracy. We believe that the Ahlbäck classification reflects the anatomic and pathologic progression of medial compartment gonarthrosis, and is of value in allowing more accurate comparisons to be made of different methods of treatment.


Devascularization of the anterior cruciate ligament by synovial stripping in rabbits. An experimental model. In rabbits, synovial stripping of the anterior cruciate ligament was performed, and histologic and mechanical changes were followed up to 2 months. The operation did not immediately affect the strength of the ligament or its histological structure. However, a gradual deterioration of mechanical properties, associated with collagen necrosis and an ineffectual reparative response, was evident. Thus, synovial stripping of the ligament with the attendant concomitant devascularization leads to ligamentary insufficiency despite the lack of structural damage to the ligament by the contusion itself.


Collagen ultrastructure in ruptured cruciate ligaments. An electron microscopic investigation. The ultrastructure of collagen fibrils was investigated in normal (n 39) and ruptured (n 23) human anterior cruciate ligaments. The normal ligament had a complex three-dimensional structure. Collagen fibrils predominantly had a undirectional course with parallel arrangement and a mean diameter of 75 (20-185) nm. Four days after anterior cruciate ligament rupture, the mean fibril diameter was increased; it later decreased, probably due to synthesis of young, thin 30-40 nm fibrils. Interfibrillar dysplastic collagen fibrils were detected in the extracellular matrix of ruptured ligaments. They were more frequently found later than 3 days after rupture and were seen also at a distance of 2-3 cm from the rupture zone. The presence of dysplastic fibrils may explain the functional insufficiency of the repair tissue in ruptured cruciate ligaments.


Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. 59 patients with 60 surgically treated acetabular fractures were followed up to 25 years. Coxarthrosis developed within 3 years in 23 fractured hips. There was a high correlation between nonanatomic reduction and posttraumatic arthrosis. The long-term results after an acetabular fracture can be predicted within 2-3 years of surgery.


The triradiate incision for acetabular fractures. A prospective study of 23 cases. 24 acetabular fractures, displaced in the dome, were operated on through the triradiate incision, and 23 were followed for at least 2 years. All but one fracture were anatomically reduced in the dome. At follow-up, 7 hips had developed arthrosis, all with comminuted fractures with separate osteochondral dome fragments. Heterotopic bone formation occurred in 13 hips: 10/14 with indomethacin prophylaxis had no heterotopic bone, whereas all 9 without indomethacin prophylaxis had. We conclude that the triradiate incision is suitable for surgical treatment of complex acetabular fractures, and that the heterotopic bone formation can be reduced by indomethacin prophylaxis.


Human growth hormone in polymethyl methacrylate. A controlled study of 15 hip arthroplasties. Growth hormone-loaded polymethyl methacrylate (PMMA) was used in 15 hip replacements. The levels of growth hormone and insulin growth factor-I from the hip and the blood were measured before, and after, implanting PMMA containing 20 mg of growth hormone. Low levels of growth hormone and insulin growth factor-I were found in the femur initially, but very high local levels were found after implanting the growth hormone-loaded PMMA. These results were compared with the low levels found in 15 patients in a control group undergoing cemented or cementless hip replacement without added growth hormone. The local levels of growth hormone and insulin growth factor-I declined rapidly during the first 72 hours and were near normal at the end of this time. Systemic levels of growth hormone and insulin growth factor-I were not affected by the implantation of growth hormone-loaded PMMA. No complications or adverse reactions were noted. However, randomized studies with long-term follow-up are mandatory before the use of growth hormone-loaded PMMA is justified.


Prognosis in Perthes' disease after noncontainment treatment. 106 hips followed for 28-47 years. The results in 96 patients (106 hips) with Perthes' disease who had had conservative noncontainment treatment were studied after 35 (28-47) years. At skeletal maturity, the radiographic result was poor in 65 hips. At the average age of 43 years, radiographic signs of arthrosis were found in 48 patients (51 hips); 5 patients had had hip replacement and 13 patients had symptoms justifying that procedure. At early phases of the disease, radiographs showed biocompartmentalization of the acetabulum in 24 percent of the hips, but the acetabulum normalized in the majority. There was no difference in long-term prognosis between Catterall's Groups III and IV; two or more signs of head-at-risk were not of prognostic value. The patients' age at diagnosis and the shape of the femoral head at skeletal maturity were the most reliable prognostic factors.


Effect of hyperbaric oxygenation on femoral head osteonecrosis in spontaneously hypertensive rats. We investigated the effects of hyperbaric oxygenation (HBO) on ischemic osteonecrosis and on ossification disturbance of the femoral heads in growing, spontaneously hypertensive rats (SHR). 10 male SHRs aged 5 weeks (Group A) and another 10 male SHRs aged 8 weeks (Group B) were treated with HBO at 2.8 atmosphere absolute (ATA) for 6 weeks in a total of 30 hours. The control animals, 10 male SHRs (Group C) and 10 male wistar Kyoto rats (WKY, Group D), were kept under normal laboratory conditions. All the rats were killed at the age of 17 weeks for microscopic examination. In Group A, there was no evidence of osteonecrosis, and only 2 femoral heads with ossification disturbance were observed. In Group B, there were 2 femoral heads with osteonecrosis and 1 with ossification disturbance. In contrast, there were 6 femoral heads with osteonecrosis and 4 with ossification disturbance in Group C. It was concluded that HBO prevented osteonecrosis and ossification disturbance of the femoral heads in SHR.


Treatment of hip fracture in Finland and Sweden. Prospective comparison of 788 cases in three hospitals. A prospective population-based study of hip fracture treatment was performed during 1989 in the regional hospitals of Oulu (Finland) and Sundsvall and Lund (Sweden). For cervical fractures hemiarthroplasty was preferred in Oulu and osteosynthesis in Sundsvall and Lund. For trochanteric fractures screw-plate was preferred in Oulu and Lund and Ender-nailing in Sundsvall. A shorter mean time at the orthopedic department in Oulu (13 days) was compensated by a lower (14 percent) fraction of patients directly discharged to own home. A somewhat longer mean orthopedic hospitalization time in Sundsvall (19 days) and Lund (17 days) was combined with a higher discharge to own home (49 percent and 35 percent). Prospective multicenter comparisons of treatment combinations (both operation and rehabilitation) permit identification of programs that are optimal for both patient and society.


Hip arthroplasty in Jutland, Denmark. Age and sex-specific incidences of primary operations. During the 10-year period 1981-90, 1752 primary total hip arthroplasties were performed in the County of South Jutland, Denmark. The annual number increased to a steady state during 1988-90. In this period, the incidence was highest in the age group 70-79 years for both women and men, with 485 and 410 arthroplasties per 100,000 inhabitants, respectively; the overall incidence was 82 per 100,000 inhabitants. During the next 30 years, the demand for primary hip arthroplasties in Denmark is expected to increase because of demographic changes.


Renal function after hip arthroplasty and isoxazolylpenicillin prophylaxis. Two different isoxazolylpenicillins (cloxacillin and dicloxacillin) were compared regarding impairment of renal function after total hip arthroplasty. 85 patients received dicloxacillin and 93 patients received cloxacillin as antibiotic prophylaxis. A total dose of 6 grams was given during a 36-hour period in doses of 1 gram pre-, per- and postoperatively. Creatinine in serum and beta 2-microglobulin in serum and urine were determined preoperatively and 2, 4, and 10 days after the operation. The dicloxacillin-treated patients had an increase in creatinine and beta 2-microglobulin in serum that was not seen in the cloxacillin group. The increase indicates a transient injury in the process of glomerular filtration. Although the increase was temporary and subclinical, a dose reduction is nevertheless recommended for older patients.


Acetabular cement temperature in arthroplasty. Effect of water cooling in 19 cases. In 19 patients who underwent total hip arthroplasty the temperature was studied at the bone-cement interface in the acetabulum during the polymethyl methacrylate curing process. To evaluate the effect of fluid cooling, the patients were randomized into two groups: one group with no irrigation, the other with continuous irrigation with Ringer solution during cement curing. The temperature was recorded with a thermocouple at the bone-cement interface. Without water cooling, the median maximum temperature was 49 (41-67) degrees C. In 9 out of 11 patients the temperature elevations were sufficient to cause impaired bone regeneration or thermal necrosis of bone. Continuous water irrigation reduced the amount of heat at the bone-cement interface; median maximum temperature was 41 (37-48) degrees C.


Hyperthermia during occipito-cervical fusion with acrylic cement. Epidural thermometry in 23 cases. In 22 patients, 23 posterior occipito-cervical fusions using acrylic cement were studied; 18 had seropositive rheumatoid arthritis and 4 traumatic atlanto-axial instability. The mean age was 60 (39-75) years. During the curing of the cement, epidural temperature measurements were performed over the cerebellum and between the foramen magnum and C1. Temperatures up to 69 degrees C were recorded. Cooling with profuse surface irrigation using normal saline solution or precooled 8 degrees C fluid did not influence the maximal temperatures recorded under the cement. Even though no gross neurological damage was noted, the epidural temperatures in occipito-cervical fusion with acrylic cement can be of sufficient degree to be hazardous; surface irrigation does not seem to be an effective way to reduce this risk.


Cement removal in revision hip arthroplasty. Experience with bone cement added to the cavity in 20 cases. A new technique for cement removal is presented where bone cement is added to the cavity after removal of a femoral component. The old and new segments of cement are then removed together by using a threaded extractor. In 16 of 20 patients, the method was successful; the entire cement mass was extracted in 35 (25-50) min without complications or bone loss. In 4 of the patients, the technique had to be combined with traditional methods for cement removal.


Colles' fracture associated with reduced bone mineral content. Photon densitometry in 74 patients with matched controls. In a prospective population-based investigation, we measured bone mineral density (BMD) of the forearm using single-photon absorptiometry at both a distal and a more proximal site in 74 Colles'-fracture patients who were compared with controls matched for age, sex, and years after menopause. For both groups there was a marked inverse relationship between age and bone mass. However, over the entire age range, the probands had 11 percent reduced BMD when compared with the controls. Our findings confirm that patients with fracture of the distal forearm have reduced BMD. They constitute an appropriate group for studies aimed at prevention of fracture in the elderly.


Capitate-hamate fusion for Kienböck's disease. Good results in 8 cases followed for 3 years. 8 patients with Kienböck's disease and without negative ulnar variance were treated with a modification of Chuinard's capitate-hamate fusion. All patients returned to their normal activities free of pain. The postoperative wrist motion was unchanged, but the grip strength was increased.


Stress fracture in the medial femoral condyle. A case report. An 88-year-old woman complained of pain in the medial part of her knee for 5 weeks. Plain radiography was normal. Clinical and scintigraphic findings were suggestive of spontaneous osteonecrosis of the medial femoral condyle. Magnetic resonance imaging showed a stress fracture of the medial femoral condyle. In 3 weeks pain had disappeared, confirming this diagnosis.


A case of intraosseous angioleiomyoma.

A case of intraosseous angioleiomyoma. We report a rare case of expansively growing angioleiomyoma in the proximal tibia of a 64-year-old woman. MRI revealed a well-defined area of low signal intensity on T1-weighted image and high intensity on T2-weighted image. Angiographs showed hypervascularity and vascular poolings. Microscopic examination after incisional biopsy showed an angioleiomyoma with bundles of nerve fibers.


[Experimental carpal displacement induced by ligamental lesions]. Ligamentous lesions were created experimentally in 40 fresh cadaver wrists. The precise localization of traumatic rupture of the ligaments and the subsequent carpal imbalance were defined by the comparison between the experimental results and the clinical displacements. The displacements may be permanent, sequential or induced by external forces. Lesions of capsular ligaments cause the displacement. There are 3 functional units; the distal scaphoid complex; the palmar ligaments which form a "belt", consisting of the lateral external ligament, the radiocarpal ligaments an the radiate ligament; the medial ligaments, which also form a "belt" consisting of the palmar triquetral ligaments on each side of the triquetrum. The sprains are caused by a lesion of a functional unit. The lateral sprain is characterized by a lesion of the distal scaphoid complex. The scaphoid moves into a horizontal position, causing a dorsal deviation of the lunate and a scapholunate diastasis. The central sprain is induced by a rupture of the palmar "belt", causing an anteroposterior radiocarpal or mediocarpal drawer movement. The medial sprain is induced by the rupture, of different extents, of the medial ligaments. On examination, there is either a click or a palmar deviation of the lunate, sometimes with a lunotriquetral diastasis. The dislocations of the wrist are caused by lesion of several ligamentous units.


Additional mechanical tests of bone cements. A revision of the ISO-standard for bone cement testing has been proposed to include compressive strength after 24 hours in air and 4-point bending testing after 50 hours in a 37 degrees water bath. Nine commercially available bone cements were tested in accordance with the new program. Compressive strength varied from 78 to 100 MPa, bending strength from 48 to 74 MPa and bending modulus from 2.2 to 2.8 GPa. The highest strengths, but also the highest stiffness, were encountered with Simplex brands and low-viscosity cements.


[Multidimensional analysis of reactive forces of the foot during normal walking]. The authors present the analysis of the three components of ground reaction forces on both left and right feet on 50 subjects. Fourier analysis shows that a 25-Hz sampling is sufficient to fully characterize the normal gait. The approach used in order to study the data tables built for each component consisted in principal component factor analysis. This multivariate method, which looses the least possible information in relation to raw data, has indicated a high variability between subjects. Concerning the intrasubject variability, great asymmetry occurred between the forward and back forces. With respect to the relationship, the three components, the medial-lateral force was very independent of the two others. Particular classes of normal gait have been proposed.


The development of discopathy in lumbar discs adjacent to a lumbar anterior interbody spondylodesis. A retrospective matched-pair study with a postoperative follow-up of 16 years. Of 46 patients who underwent a lumbar or lumbo-sacral anterior interbody fusion at one or two levels, 16 were available for a follow-up of 16-20 years. The indications for operation were instability, degenerative disc disease, pseudarthrosis of a posterior fusion, and spondylolisthesis. Preoperative roentgenograms were compared with those made at follow-up 16 years (or more) later. In only a minority of patients was discopathy or instability found. The roentgenographic findings of the operated patients at a follow-up of at least 16 years were compared with those of a group of age- and sex-matched controls not previously treated for backache. We found that most degenerative changes of the adjacent discs occurred at a rate nearly similar to that in the corresponding levels of the controls. These results may suggest that lumbar anterior interbody spondylodesis does not accelerate the development of degenerative changes in adjacent discs.


[Microradiography in the study of trabecular parameters]. The intermethod variation in measurement of trabecular bone volume (VTO) and the indirect estimation of its microstructure according to Parfitt MTPT (microns), MTPD (/mm) and MTPS (microns) were evaluated in seven undecalcified bone biopsies by analyzing the microradiograph of a 100-microns-thick section with an automatic method (IBAS II Zeiss, Munich) in addition to reference methods (manual and semiautomatic) described in the literature and performed on 7-microns-thick stained sections. Three consecutive 7-microns-stained sections and one 100-mu-thick microradiographed section were taken in each specimen. The 100 microns-thick section was also superficially stained. Trabecular bone volume was measured with both a manual integrating eyepiece and an automatic method. The automatic method on the microradiograph underestimated the VTO by 24.42%. There was a correlation (r = 0.75; p < 0.02) between the manual and computerized methods. Mean trabecular plate thickness (microns), mean trabecular plate density (/mm) and mean trabecular separation (microns) were measured with both semiautomatic and automatic methods. The automatic method on the microradiograph underestimated the MTPT (microns) by 18.98% and the MTPD (/mm) by 14.14% and overestimated the MTPS (microns) by 23.17%. For the MTPT (microns) there was a correlation (r = 0.88; p < 0.02), between both methods, and the correlation was good for MTPD (/mm) (r = 0.97; p < 0.001), and MTPS (r = 0.86; p < 0.002).


Retrosternal dislocation of the clavicle. Retrosternal dislocation of the clavicle is an uncommon injury which may affect the mediastinal structures in a life-threatening way. Therefore, computed tomography is mandatory. Manipulation in the acute situation is the treatment of choice. In case of failure or old dislocation, open reduction with stabilization of the joint is required. The literature on this subject has been reviewed and an additional two cases are reported.


[Compression neuropathy of the cubital nerve at the elbow]. Compression neuropathy of the ulnar nerve at the elbow has numerous known etiologies, and the anatomy of the ulnar nerve around the elbow leaves it vulnerable to compression at numerous sites. The compression may be extrinsic such as in occupational neuropathy or in cases of postanesthesia neuropathy. The so-called idiopathic compression may be favored by some anatomic variations. The cubital tunnel retinaculum may be loose, leading to ulnar nerve dislocation or subluxation or tight compression of the nerve during flexion of the elbow. Bulging of the synovium in the floor of the tunnel may be the cause of compression in rheumatoid arthritis, whereas osteophytes may be the cause in degenerative osteoarthritis. Cubitus valgus or instability due to a pseudarthrosis of the lateral epicondyle or to ligamentous injury may stretch the nerve. The choice of a surgical technique must be based on (i) the pathophysiology of chronic nerve compression at the elbow, (ii) an understanding of the etiology of the nerve compression in the particular patient's case, and (iii) the knowledge of the potential technical drawbacks of the various operative procedures. Simple decompression is the first choice in case of minimal compression without instability of the nerve. Decompression of the nerve with a medial epicondylectomy is indicated in case of instability of the nerve and is the first choice in case of pseudarthrosis or malunion of the medial epicondyle. Ulnar nerve transposition is technically the most demanding procedure. Inadequate surgical technique creates new sites of compression.(ABSTRACT TRUNCATED AT 250 WORDS)


Posterolateral bone grafting for nonunion of the tibia. Sixty-two tibial diaphyseal nonunions in 60 patients were treated with a posterolateral bone graft over an 18-year period (1969-1987). The majority were complicated by severe soft tissue damage or segmental bone loss. Thirty-four had a deep infection. Primary healing was achieved in 92%. Three types of bone grafts have been used: from 1969 to 1978 either a whole iliac bone graft (10 tibiae) or a nonvascularized fibular graft (11 tibiae) was used. Since 1978 small iliac cancellous bone chips (41 remaining tibiae) were applied to the posterior surfaces of tibia and interosseous membrane. In three tibiae with major bone defects, cancellous allografts were added to the autogenous bone. The use of cortico-cancellous bone chips resulted in a shorter healing time, compared to a nonvascularized fibular graft or a massive corticocancellous bone block.


[The treatment of rigid hallux using Swanson's silastic implant (single and double stem). Clinical, radiological and podobarographic review with a 16-year maximum follow-up]. Twenty-eight cases of hallux rigidus treated with the Swanson Silastic implant (single and double stem) were reviewed, with an 8-year follow-up. The skin complication rate was significant. Long-term patient satisfaction was good. Radiologic findings were alarming: implants seem to wear out quickly on the articular side, and granulomatous reactions develop around the stems. Dynamic pedobarography shows decreased pressure under the first ray, with transfer of the weight to the midmetatarsal heads, sometimes on the external edge of the foot. The authors review the international literature on the etiology, pathology and treatment of hallux rigidus. Surgical indications and techniques are specified.


Rational therapy for ingrown toenails. A prospective study. Partial phenolization of the germinal matrix is described as a simple and effective procedure for the treatment of ingrown toenails. It is illustrated in a summary of anatomy and pathophysiology as well as in a randomized prospective trial.


Osteosynthesis of pathologic fractures and prophylactic internal fixation of metastases in long bones. Osteosynthesis was performed in 36 pathologic fractures, and in 21 metastases prophylactic internal fixation was carried out. The principles of the operative technique consist of a rigid osteosynthesis with removal of metastatic tissue and filling up of the bone defect with allograft or methylmethacrylate. The indications and benefits of prophylactic internal fixation are discussed.


Intrapelvic intrusion of the lumbosacral spine. A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. Laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.


A patient with two upper lumbar disc herniations. Of all lumbar disc herniations, less than 5% occur in the upper lumbar area. Though protrusions are common at all levels, truly extruded disc herniations in the upper lumbar area from L1 to L3 are rare. Even more unusual is the multilevel occurrence of herniations in this area. The authors stress the importance of accurate diagnosis and clinically directed medical imaging work-ups.


Dorsolumbar spine duplication.

Dorsolumbar spine duplication. We report a case of dorsolumbar spine duplication in a female patient. She had several vertebral anomalies, such as fused vertebrae, hemivertebrae and butterfly vertebrae, together with duplication of the spinal column in the lower thoracic and the whole lumbar tract. Clinically, she had no control of the sphincters, but her gait was only slightly affected. This is probably the third reported case of this rare anomaly.


Chondromatosis of the fifth metacarpophalangeal joint. Case report and review of the literature. Synovial chondromatosis is extremely rare in small joints. The authors present a case of involvement of the fifth metacarpophalangeal joint, treated by removal of loose bodies and synovectomy.


Double-level spinal injury resulting in "en bloc" dislocation of the lumbar spine. A case report. We report the case of a 21-year-old man with a unilateral lumbosacral dislocation together with a fracture of L1 resulting in "en bloc" dislocation, which is difficult to classify from an anatomopathological and biomechanical point of view. Unilateral lumbosacral dislocation is likewise an infrequent injury with less than 10 cases previously reported. Its association results in an anterior displacement to the left of the whole lumbar spine. To our knowledge, this displacement "en bloc" of the lumbar spine represents a rotatory dislocation of the same, an injury which we have not seen described until now in the literature.


Ulnar approach to the wrist.

Ulnar approach to the wrist. An ulnar approach to the wrist is described. We used this technique for several reconstructive procedures in more than 30 cases.


Advantages of the enlarged middle cranial fossa approach in acoustic neurinoma surgery. A review. Utilizing an enlarged middle cranial fossa approach to the cerebello-pontine angle without destruction of the labyrinth or cochlea the authors have since 1981 operated on 263 unilateral acoustic neurinomas. Tumour sizes ranged between 3 mm intrameatal and 35 mm within the cerebello-pontine angle. Complete tumour removal was accomplished in 96%. There was one postoperative mortality, and only rarely neurological complications. Excellent function of the facial nerve was obtained in 78% (in small and medium sized neurinomas 90% House I and II) and severe paralysis persisted in only 6%. Preservation of hearing was possible in 70% of the small tumours, and in 50% of the total group. Against this background comparable data of the literature are reviewed, and the indications for the enlarged midfossa approach analyzed.


Initiation of sinusoidal tracking eye movements in man. Smooth pursuit eye movement was recorded with a DC amplifier during horizontal sinusoidal target motion at 0.3, 0.6, 0.8, 1.0 and 1.2 Hz and a peak-to-peak amplitude of 20 degrees. Eye movement was digitalized at 100 Hz and 12 bits. From the digitalized eye movements, the maximum position error, the correlation coefficient and regression coefficients between stimulus and eye position were calculated in each half cycle. The A/D conversion and calculation were performed using a 16 bit microcomputer (NEC PC 98). Thirteen healthy volunteers with normal smooth pursuit patterns were examined. The correlation coefficient increased, but the maximum position error and the two regression coefficients decreased as the target moved. However, all four stabilized from about the 3rd half cycle regardless of the target frequency. These findings indicate that the smooth pursuit of a sinusoidally moving target reaches the maintenance at about the 3rd half cycle after initiation of two half cycles from the beginning of the target motion. This might be due to a prediction (or learning) of periodicity.


Plasticity of the human otolith-ocular reflex. The eye movement response to earth vertical axis rotation in the dark, a semicircular canal stimulus, can be altered by prior exposure to combined visual-vestibular stimuli. Such plasticity of the vestibulo-ocular reflex has not been described for earth horizontal axis rotation, a dynamic otolith stimulus. Twenty normal human subjects underwent one of two types of adaptation paradigms designed either to attenuate or enhance the gain of the semicircular canal-ocular reflex prior to undergoing otolith-ocular reflex testing with horizontal axis rotation. The adaptation paradigm paired a 0.2 Hz sinusoidal rotation about a vertical axis with a 0.2 Hz optokinetic stripe pattern that was deliberately mismatched in peak velocity. Pre- and post-adaptation horizontal axis rotations were at 60 degrees/s in the dark and produced a modulation in the slow component velocity of nystagmus having a frequency of 0.17 Hz due to putative stimulation of the otolith organs. Results showed that the magnitude of this modulation component response was altered in a manner similar to the alteration in semicircular canal-ocular responses. These results suggest that physiologic alteration of the vestibulo-ocular reflex using deliberately mismatched visual and semicircular canal stimuli induces changes in both canal-ocular and otolith-ocular responses. We postulate, therefore, that central nervous system pathways responsible for controlling the gains of canal-ocular and otolith-ocular reflexes are shared.


Retinal ganglion cells related to optokinetic nystagmus in the rat. The nucleus of the optic tract (NOT) in the pretectum is the visuo-motor relay between the retina and preoculomotor structure in the pathway conveying signals responsible for optokinetic nystagmus (OKN) in both afoveate and foveate animals. Unilateral lesions of the NOT abolish OKN toward the side ipsilateral to the lesion. However, what parts of the retina and what kinds of retinal ganglion cells project their fibers into the NOT are still unknown. To examine this, horseradish peroxidase conjugated with wheatgerm agglutinin was injected into the NOT of the rat. Labeled retinal ganglion cells were diffusely documented in the contralateral side, whereas those situated only in the lower temporal crescent, were found in the ipsilateral side. Ganglion cells dominated in the range of small cells, i.e., W cells. Therefore, ganglion cells responsible for OKN are believed to be related to W cells. However, medium-sized and large cells were definitely labeled in the rat, suggesting possible participation of these cells in OKN.


Phase audiometry in neuroaudiological practice. Six groups of subjects, altogether 107 in number, were studied with phase audiometry. Three control groups were studied (normal-hearing healthy controls, persons with cochlear hearing losses, and patients with neurological disease not affecting the auditory system), and three patient groups were studied (patients with cerebellopontine angle tumours, with brainstem lesions, and with temporal lobe lesions). Two phase audiometers were used. The sensitivity was 85% for patients with cerebellopontine angle tumours, 71% for patients with brainstem lesions, and 69% for patients with temporal lobe lesions. There was good agreement between the phase audiometers, though one of them (BIAB Phase Audiometer) had better results for two of the patient groups. Phase audiometry can be recommended in neuroaudiological practice.


Threshold shift, hair cell loss, and hair bundle stiffness following exposure to 120 and 125 dB pure tones in the neonatal chick. One-day old chicks were exposed to one of two pure tone stimuli (0.9 kHz at 120 or 125 dB SPL) for 48 h. Three major results arose from a variety of tests that assessed the structural and functional consequences of the exposure on the peripheral auditory system at either 0 days or 12 to 15 days recovery. First, brainstem response data showed that the 120 and 125 dB groups had maximum evoked potential threshold shifts of 57 and 71 dB immediately after removal from the sound. Fifteen days post-exposure, the thresholds in the 120 dB group returned to near-normal levels, while in the 125 dB group, recovery was within 19 dB of control thresholds. Second, scanning electron microscopic measurements of hair cell density within the lesion showed that at 0 days recovery, the 120 and 125 dB groups had a 30% and 59% short hair cell loss, respectively, but by 15 days no differences could be identified between the exposed and control animals, regardless of exposure level. Finally, at 0 days of recovery, micromechanical stimulation data did not reveal any significant difference in stiffness between the control and surviving hair cells in the lesion area. Although the more intense exposure induced greater structural and functional damage in the chick cochlea, the birds retained or even enhanced their ability to replace lost hair cells and had partial hearing recovery by 15 days post-exposure.


Permanent, skin penetrating, bone-anchored titanium implants. A clinical study of host-reaction in bone and soft tissue. In 12 patients with a skin penetrating retroauricular titanium-implant (Brånemark) the reaction in bone and soft tissue was studied. Observation time was 6 to 36 months. All implants were "osseointegrated", as assessed by repeated manual test, X-ray examination and 99mTC-scintigraphy. Soft tissue reactions appeared to be slight and clinically insignificant. However, all patients produced crusts around the abutment. When the abutment was removed varying degrees of inflammatory reaction in the skin penetration could be observed in most patients. A theory for the development and cause of the soft tissue reactions is proposed and changes in the operative procedure and the design of the abutment to reduce the host reaction are suggested. It is stressed that the clinical significance of this host reaction is uncertain and above all has to be weighed against the important benefits this implant system offers to a severely handicapped group of patients.


Distribution of bone remodeling units in the otic capsule of the rabbit. A semiquantitative morphometric study. Distribution of bone remodeling units (BRU) in relation to the perilymphatic space was studied in undecalcified temporal bones from adult rabbits labeled in vivo with bone-seeking fluorochromes. Based on recordings of focal bone formation, relative densities of BRUs inside concentric tissue zones around the inner ear spaces were estimated. Zonal densities of BRUs were found to decline towards the perilymphatic space, lending further support to the existence of a local inner ear mechanism in control of capsular bone tissue dynamics. The possible nature of this mechanism is considered briefly with special reference to inner ear electromechanic activity.


Development of endolymphatic hydrops following immune response in the endolymphatic sac of the guinea pig. The present study investigated immune injury associated with endolymphatic hydrops (e.hydrops) following locally mounted immune reaction in the endolymphatic sac (e.sac) of guinea pigs. E.hydrops occurred, progressing rapidly within the first week post secondary Keyhole limpet hemocyanin (KLH) challenge in the e.sac and developed into two phases, acute and chronic. On the other hand, primary KLH challenge of the e.sac, PBS inoculation into the e.sac or intradural secondary KLH challenge were incapable of inducing e.hydrops. These results indicate that reversible and irreversible e.hydrops are induced by the immune response of the e.sac, suggesting that local immunological events of the e.sac may provide an animal model of Meniere's disease.


Dark cell pathology in Menière's disease. The dark cells in the cristae of the semicircular canals were studied histopathologically in 9 temporal bones from individuals with Menière's disease (MD group), 7 temporal bones with endolymphatic hydrops from individuals without a history of Menière's disease (non-MD hydrops group), and 10 normal temporal bones (control group). The density of the dark cells was significantly lower in specimens in the MD group versus the non-MD hydrops group (Wilcoxon's ranking test, t = 90.5, p less than 0.01) and control group (Wilcoxon's ranking test, t = 50.0, p less than 0.01), and many of the dark cells were found to be abnormal in the specimens from the MD group. The difference in dark cell density between the non-MD hydrops group and control group, however, was not significant (Wilcoxon's ranking test, t = 75.0), and few cells in these groups were abnormal. It is speculated that the differences in density and the abnormalities in dark cell morphology might be either factors in the etiology of endolymphatic hydrops or results of Menière's disease. Other, unknown, factors must be postulated to produce endolymphatic hydrops in ears with hydrops but without MD.


Central projections from singular parts of the vestibular labyrinth in the guinea pig. Primary afferent projections from singular parts of the vestibular labyrinth were studied in the guinea pig. The posterior ampullary nerve, the common trunk of the anterior and lateral ampullary nerves, as well as fibers innervating the macula sacculi or the macula utriculi were traced with crystals of horseradish peroxidase (HRP) lyophilisate. Posterior, as well as anterior and lateral ampullary fibers were found to project extensively to the superior vestibular nucleus, but also reached the other main vestibular nuclei. Saccular fibers projected mainly to the lateral parts of the lateral vestibular nucleus and to the adjoining descending and superior vestibular nuclei as well as to group y. Modest projections could be followed to the medial vestibular nucleus. Furthermore, a distinct saccular projection to the cochlear nuclei was evident. Utricular projections reached the four main vestibular nuclei with a denser accumulation of fibers within ventral parts of the lateral, descending and superior vestibular nuclei.


The embryologic development of the human external auditory meatus. Preliminary report. During the final period of embryogenesis, a funnel-shaped tube continues medially into the mesenchymal tissue forming a curved path. Although this may sound simple, the development occurring during early fetal life is in fact very complex. At first, ectodermal cells proliferate to fill the lumen of the meatus, forming the meatal plug, and then at 10 weeks the bottom of the plug extends in a disc-like fashion, so that in the horizontal plane the meatus is boot-shaped with a narrow neck and the sole of the meatal plug spreading widely to form the future tympanic membrane medially. At the same time, the plug in the proximal portion of the neck starts to be resorbed. In the 13-week fetus, the disc-like plug begins to show signs of its final destiny; the innermost surface of the plug in contact with the anlage of the malleus is ready to contribute to the formation of the tympanic membrane. In the 15-week fetus, the innermost portion of the disc-like plug splits, leaving a thin ectodermal cell layer of immature tympanic membrane. The neck of the boot forms the border between the primary and secondary meatus, and is the last part to split. In the 16.5-week fetus, the meatus is fully patent throughout its entire length, although the lumen is still narrow and curved. In the 18-week fetus, the meatus is already fully expanded to its complete form.


Otitis media with effusion: components which contribute to the viscous properties. Middle ear effusions from children undergoing myringotomy were classified into thick (mucoid) and thin (serous) on the basis of their flow properties. Their composition was analysed and their rheological properties measured. The viscosity of the effusions was measured using a Contraves low shear viscometer and expressed as specific viscosity per mg/ml of non-dialysable solids present. In order to measure the effusion viscosity it was necessary to solubilize the effusion by mild homogenisation in a phosphate buffer pH 6.7 containing a cocktail of proteolytic inhibitors. The viscosity of mucoid effusions was significantly greater than that of the serous effusions. There was a small but measurable amount of proteolytic activity in the effusions, range 0.05-1.79 micrograms/mg of non-dialysable solids. This proteolytic activity was not significantly different between the thick and thin effusions and was therefore unlikely to explain the difference in viscosity. Analysis of the constituents of the effusions showed that glycoprotein and DNA but not protein nor lipid were significantly higher in the mucoid effusions compared to the serous effusions. The viscosity of the effusions correlated with the glycoprotein concentration but not with the protein or lipid concentration. Under certain circumstances the DNA concentration did correlate with the viscosity of the effusion. However, digestion with a proteinase free DNase did not reduce the viscosity of the effusion. These results demonstrate that classifying effusions as thick and thin based on visual inspection and flow properties is valid and that the only constituent present in the effusions that determines viscosity is mucin.


Incidence and progression of myringo-incudo-pexy after secretory otitis. A cohort of originally 327 healthy children born in 1975 was followed by repeated otomicroscopies and tympanometries from age 5 to age 16 years, in total 9 otomicroscopies. Prevalence of drum pathology, especially myringo-incudo-pexy was investigated. Prevalence of myringo-incudo-pexy was 0.5% at age 5 years, 2.5% at age 7 and 4.2% at age 16. Forty percent of pexies were stable; 36% fluctuated and 26% disappeared. Hearing was surprisingly good at age 16, but the pexy represents a risk for progression.


Occurrence of antibodies to pneumococcal protein antigens in experimental acute otitis media. To study serological antibody response to pneumococcal protein antigens, experimental pneumococcal (type 3) acute otitis media (AOM) was induced in 6 rats, sera being analysed with the Western blot technique at different intervals after bacterial challenge. The most striking finding was a distinct antibody response to a protein of about 35 kDa visible in 5 of the rat sera within 14 days, and persisting throughout the remainder of the study (i.e., 56 days in all). Moreover, appear to be a phenomenon restricted to type 3 pneumococci. Both the pathogenetic importance of this protein and the immunological response it evokes are still unclear. However, as antibodies to protein antigens may contribute to inflammatory reactions in the middle ear (e.g., otitis media with effusion), this 35-kDa protein might be important for the development of sequelae to AOM.


Permeability of the normal round window membrane to Haemophilus influenzae type b endotoxin. Sensorineural hearing loss associated with otitis media may be due to passage of ototoxic substances such as bacterial toxins and antibiotics, from the middle ear into the inner ear. The round window membrane is the most likely route for such transport. The aim of this study was to analyze the extent of endotoxin passage through the normal round window membrane. The round window membranes of 19 chinchillas were exposed in vivo to Gelfoam soaked in purified Haemophilus influenzae type b endotoxin at a concentration of 45,000 endotoxin units per ml (EU/ml) during 3 to 24 h. Endotoxin levels in the perilymph were measured with Limulus Amaebocyte Lysate or Quantitative Chromogenic Limulus Amaebocyte Lysate. Endotoxin was detected in half of the inner ears at concentrations close to the detection limit (approximately 4 EU/ml). The results suggest that the normal round window membrane efficiently protects the inner ear against the passage of bacterial endotoxins from the middle ear cavity. It is unlikely that endotoxin at concentrations found in the middle ear secretion during otitis media can traverse the round window membrane in sufficient amount to cause inner ear deterioration.


Nasopharyngeal bacterial flora in otitis prone children treated with immunoglobulin. The present study was undertaken to evaluate possible beneficial effects of regularly given, long term immunoglobulin prophylaxis of children below 2 years of age with recurrent acute otitis media (RAOM). The nasopharyngeal bacterial flora and the frequency of acute otitis media (AOM) and secretory otitis media SOM were studied. Every second of 44 children with 3 or more periods of AOM during the last year received immunoglobulin intramuscularly (Gammaglobulin Kabi 165 mg/l, 0.45 ml/kg b.w.) every third week for 6 months, while the other 22 children served as controls. All children were followed for 12 months. Immunoglobulin prophylaxis neither influenced the nasopharyngeal flora, nor the frequency of AOM or SOM periods. Children with AOM or SOM more often harbored bacterial pathogens in their nasopharynx than children with normal middle ear status. Also, the immunoglobulin prophylaxis did not influence the increased frequency of bacterial pathogens in the nasopharynx of children attending public day care or family day care as compared to those taken care of at home.


Antigen reduces nasal transepithelial electric potential differences and alters ion transport in allergic rhinitis in vivo. The change of ion transport in acute allergic reactions in vivo was studied by measuring the nasal transepithelial potential difference (PD) in patients with nasal allergy to Japanese cedar pollens. Comparison of nasal PD in the pollen season revealed a lower PD in the allergic patients than in the normal control subjects. We challenged the patients with allergen in the non-pollen season and measured the time course change of nasal PD and rate of inhibition of PD by amiloride and indomethacin. Nasal PD reached the lowest value 15 min after nasal allergen challenge. Percent inhibition of PD by amiloride was greater without the allergen challenge than it was in those patients after allergen challenge (51.7% versus 29.4%, p less than 0.01). Indomethacin did not change PD without allergen challenge, whereas it depressed nasal PD by 25.1% after allergen challenge. These results suggest that decreased sodium absorption and increased chloride secretion occur in local allergic reactions. Both changes may contribute to the increase in fluid transport towards the lumen, and this may lead to abnormalities of nasal secretion during acute allergic reactions.


Mechanical properties of the vocal fold. Stress-strain studies. The viscoelasticity of the vocal and ventricular folds was experimentally assessed by analyzing the stress-strain relationships obtained using a newly developed measuring system. The degree of stiffness of the mid-membranous portion of the vocal fold was less than that near the anterior commissure or the vocal process. The ventricular fold was much less stiff and significantly more viscous than the vocal fold. At the membranous portion of the vocal fold, the degree of stiffness was less and that of viscosity greater at 2 mm above and below the free margin than at the free margin itself.


Effects of folinic acid on 5-fluorouracil induced cell lethality with or without cisplatin against head and neck laryngeal squamous carcinoma multicellular tumor spheroids. We evaluated the efficacy of folinic acid (Leucovorin, LV) on cell lethality induced by 5-fluorouracil (FU) alone or in combination with cisplatin (DDP) by using the HEp-2 laryngeal squamous carcinoma multicellular tumor spheroids (MTS) system. For LV, non-toxic concentration of 10(-5) M was used. For cells in the monolayer, 6 and 24 h exposure to LV increased FU-induced cell lethality approximately 7- and 2-fold, respectively, whereas LV did not influence the effect of FU for MTS. LV's lack of effect on cells in MTS may be interpreted to mean that LV cannot penetrate the MTS. For the monolayer, simultaneous exposure to 3 drugs, DDP, FU and LV, produced synergistic interaction. However, sequential exposures were marginally synergistic or antagonistic, irrespective of sequence of DDP first or last. In contrast, DDP followed by FU plus LV was most synergistic for MTS. Simultaneous exposure was also synergistic, however, FU plus LV followed by DDP was antagonistic. These results suggest that LV is unable to penetrate into the MTS core to potentiate FU activity. DDP appears to have enhanced LV penetration into the MTS core. The exploration of means to overcome limited penetration of LV appears important for successful treatment of head and neck carcinoma.


Effect of intravenous diazepam and thiopental on voluntary saccades and pursuit eye movements. The effects of diazepam and thiopental on voluntary saccades and pursuit eye movements were tested in 9 volunteers, with an interval of at least 2 weeks between tests. One, 4 and 8 h after intravenous injection of diazepam (0.3 mg/kg) or thiopental (6.0 mg/kg), voluntary saccades and pursuit eye movements were tested and blood samples taken for analysis of drug concentration. As compared to results of tests without drugs, a significant reduction both of saccadic peak velocity and gain of pursuit eye movements was found 1 h after injection of either drug, but not after 4 and 8 h. The amplitude of saccades elicited with the 60 degrees stimulus was significantly reduced 1 h after injection of diazepam. Latency of saccades increased significantly up to 4 h after injection of either drug. No significant correlation was found between peak velocity of saccades and blood concentration of either thiopental or diazepam 1 h after administration. The present results confirm that in man saccades and pursuit eye movements are reduced by benzodiazepines and barbiturates, but provide no support for the previously described efficacy of saccades in monitoring the effect of benzodiazepines. It is hypothesized that diazepam and thiopental also induce reduction of voluntary saccades and pursuit eye movements via a general sedation of the central nervous system (CNS), besides having specific effects on CNS structures important to the performance of voluntary eye movements.