Compression of the outlets of the leptomeningeal veins —the cause of intracranial plateau waves

Summary A case of otitic hydrocephalus, or intracranial hypertension secondary to inflammatory thrombosis of the left lateral sinus is described. Persistently elevated intracranial pressure, which did not respond to medical treatment, led to visual deterioration. A venous bypass graft was inserted between the left lateral sinus and jugular vein and was followed by rapid resolution of the raised intracranial pressure. The indications for this procedure are discussed.     

Emerging studies of the urinary proteome: the end of the beginning?

PURPOSE OF REVIEW: Urinary proteomics is a rapidly growing field, holding the promise of discovery of biomarkers of various disease processes and elucidation of pathophysiologic mechanisms of disease states. This may be true not only for renal disease but for diseases of other organs and systemic disorders. RECENT FINDINGS: Recent advances in separation technologies and rapid, high-throughput, and accurate protein detection and identification now permit rigorous examination of complex biological fluids. This review sketches the progress achieved in recent years and the existing hurdles in describing a normal urinary proteome, its aberrations in pathological conditions, and the search for biomarkers of several renal and non-renal diseases. SUMMARY: The first wave of urinary proteomic studies has now arrived and their results are summarized. Future lines of investigation are delineated.     

The aponeurosis of the “slacksole” of the foot

Summary A case is presented with folded sole of the foot caused by absence of the aponeurosis and hypertrophy of the muscles of the little toe. Operative treatment gave a good result.     

Dimensions of Growth? Examining the Distinctiveness of the Five Factors of the Posttraumatic Growth Inventory

Posttraumatic growth, defined as positive transformation following trauma, is commonly measured using the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) and is postulated to comprise five distinct domains: Changes in Relationships, Life Possibilities, Personal Strength, Spirituality, and Appreciation of Life. However, research has indicated that the model fit is not good and the factors are highly intercorrelated. Further, no studies have formally examined the heterogeneity of correlations of the five factors with external constructs. In an effort to examine the construct validity of the five‐factor model of the PTGI, the present study aimed to examine the degree to which the theorized five factors demonstrate meaningful differential associations with relevant external correlates. Participants were 400 undergraduate students who reported having experienced a stressful event and completed the Life Events Checklist for DSM‐5, PTGI, Posttraumatic Stress Disorder Checklist for DSM‐5, Grit Scale‐12, Connor‐Davidson Resilience Scale‐10, and Work and Social Adjustment Scale. We found few instances of significant differentiation, and effect sizes for pairwise comparisons were generally small, Cohen's qs = 0.01–0.35. Although factor analytic evidence suggests there are five distinct underlying constructs, our results indicated that these factors do not significantly differ in their associations with external correlates. Implications for use of the PTGI and future research directions are discussed.     

Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments?

The fabellofibular (FF) and arcuate ligaments are closely colocated at the posterolateral corner of the knee. However, a bony fabella is often absent in Japanese subjects. We investigated these structures morphometrically using 212 knees. A thick FF ligament was found in 38.1% (40/105) of knees with a hard fabella. When identified histologically, a bony fabella accompanied a thick FF in 82.8% (24/29). Conversely, a thin or indefinite FF ligament and an elastic-textured fabella co-existed in 77.9% (60/70) of knees. There were no strong correlations between the morphology of the fabella and the arcuate ligament. Thus, a hard or bony fabella seemed to relate to thickening of the FF ligament. In contrast, the thicknesses of the FF and arcuate ligaments were negatively correlated. When the FF ligament was more than 5mm thick, indicating that it was as strong as the lateral collateral ligament, no arcuate ligament could be identified. Conversely, a thin or indefinite FF ligament often accompanied a well-developed arcuate ligament (61.9%, 96/155). Our observations suggest that these ligaments act in a complementary manner to stabilize the posterolateral corner. A possible common function is fixation of the popliteal tendon on the joint capsule and lateral meniscus, rather than direct stabilization against rotation stress.     

Fractures of the hip: does the type of fall really affect the site of fracture?

The purpose of this study was to test accepted theories relating the characteristics of a fall to the anatomical site of hip fracture in the elderly. Twisting injuries are said to result in intracapsular fractures and falls directly onto the side are said to result in extracapsular fractures. 618 consecutive patients with a hip fracture were studied prospectively by being questioned with regard to the nature of their fall. After exclusions, 552 patients were left in the study. Of these, 324 patients sustained intracapsular fractures and 228 extracapsular fractures. More intracapsular fractures were associated with a fall onto the affected side than extracapsular fractures and rotation at the hip during the fall had a significant association with extracapsular fractures. In this study 84 per cent of all fractures occurred by falling directly onto the affected side. The clinical significance of this finding is that protective padding on the hip might be beneficial.     

Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc?

Degeneration of the intervertebral disc, seen radiologically as loss of disc height, is often associated with apparent remodelling in the adjacent vertebral body. In contrast, maintenance or apparent increase in disc height is a common finding in osteoporosis, suggesting the properties of the intervertebral disc may be dependent on those of the vertebral body or vice versa. We have investigated this relationship by measuring the radiological thickness of the subchondral bone and comparing it to the chemical composition of the adjacent disc. Sagittal slabs were sampled from lumbar spines obtained at autopsy and X-rayed microfocally. The thickness of the subchondral bone was measured and correlated with the composition of the adjacent intervertebral disc. Eighty-three cadaveric endplates were studied from individuals aged 17–85 years. There was regional variation in thickness of the subchondral bone, being greater adjacent to the annulus than the nucleus, and the endplates cranial to the disc were thicker than those caudal. There was a positive correlation between the thickness of the subchondral bone and the proteoglycan content of the adjacent disc, particularly in the region of the nucleus. A weaker correlation was seen here between water content and thickness, whilst there was no significant correlation at the annulus or between the bone thickness and collagen content. The positive relationship between the radiographic thickness of vertebral subchondral bone and the proteoglycan content of the adjacent disc seen in human cadaveric material could be due to the bone responding to a greater hydrostatic pressure being exerted by discs with higher proteoglycan content than by those with less proteoglycan present. It is suggested that while this is true in normal specimens, the relationship becomes altered in disease states, possibly because of changes to the nutritional pathway of the disc, with resultant endplate-bone remodelling affecting the flow of solutes to and from the intervertebral disc.     

Enzymuria and β2-Mikroglobulinuria in the assessment of the influence of proteinuria on the progression of glomerulopathies

The important role of the tubulo-interstitial system for the progression of glomerulonephritis (GN), is the cause of a continuous search for the proper markers of kidney tubules damage, which can be applied in clinical diagnosis.In the present work the activity ofN-acetyl--D-glucosamidase (NAG),its isoenzyme NAG-B, alanylaminopeptidase (AAP),-glutamyltransferase (GGT), concentration of ₂-microglobulin (₂M) and daily protein excretion in the urine of 37 patients with morphologically different glomerulopathies were measured. The serum creatinine was also controlled. The obtained results suggest that activity of NAG in the patients with GN has an intermediate connection with proteinuria and could be a cause of the inflammatory process of the kidney, but the activity of AAP is directly dependent on urine protein concentration. Systemic analysis of both partial and multiple correlation coefficients of the examined indicators creates new, additional possibilities in the estimation of activity and progress of GN.     

Dupuytren’s disease of the radial side of the hand

Dupuytren’s disease with involvement of the radial aspect of the hand is a clinical entity, which affects the thumb, the first web space, and the index finger. It can be primary or secondary. The palmar fascia anatomy and the clinical aspects of radial Dupuytren’s disease are described. The authors propose a new classification, which has the advantage in requiring only a clinical evaluation. One hundred and fifteen patients were examined for Dupuytren’s disease with radial involvement, primary or secondary, in the Hand Surgery Unit of the University of Modena between 1985 and 1994. Eighty-two (68.3%) of them were treated surgically as hand function was compromised by first web retraction. The most commonly used incisions of the first commissure are straight-line with Z-plasties or the Hirschowitz incision; either a zigzag incision or a Bruner incision is made over the thumb or index finger; Z-plasties described by Iselin are reserved for patients with severe contraction of the index finger. Results were assessed by improvement coefficient, calculated as the ratio of the difference between preoperative and postoperative scores to postoperative scores. Generally, Dupuytren’s disease with radial prevalence is not aggressive and progresses slowly and may be exclusively radial or associated with ulnar disease. In other patients, as the disease progresses, loss of function becomes apparent owing to retraction in adduction of the first commissure and flexion contracture of the thumb or index finger.     

An objective sign of the presence of a dislocation of the peroneal tendon?

If being necessary to diagnose a rupture of the external ligaments of the ankle joint one must produce special "forced" X-rays of both ankle joints in the ap-direction in the apperature of "Scheuba". In these X-rays we found a sign , typical for the luxation of the peronaeus tendons: The rims of the ankle joint are not dislarged in the external areas but they show a significant dislargement of the distance between the malleolus externus and the processus subfibularis tali on the hurt side - the range is always more than 10 mm and in significant difference to the sane side, were we found this difference never more than 10 mm. The new objektive significant sign for the luxation of the peronaeus tendons is described and a comparison to X-rays of some persons is demonstrated.