Vibrometry and uremic peripheral neuropathy.

The vibratory sensation threshold (VST) was measured with a vibrometer to assess the progression of neuropathy in patients with end-stage renal disease. Normal patients and patients receiving chronic hemodialysis were studied. We found that the longer the patients were dialyzed, the lower their VST (P less than 0.01). Regression equations were established to predict threshold values versus age of both groups, and VST versus months on dialysis in the patient population. Vibrometry was an important addition to the assessment of peripheral neuropathy in our dialysis patients. It offers low cost, little patient preparation, and requires little professional time for examination and interpretation.     

Objective quantification of spastic hypertonia: correlation with clinical findings.

To develop a reliable and objective technique for quantifying spastic hypertonia, ten chronically hemiplegic patients with varying degrees of spasticity were studied on three occasions during several weeks. The modified Ashworth scale, a clinical assessment of extremity tone, was performed before and after each of the following objective tests: (1) torque and EMG measurements during ramp and hold angular displacement about the elbow, (2) pendulum test of the lower extremity, and (3) H/M ratio studies of upper and lower extremities. Subject motor function was also quantified using the Fugl-Meyer motor assessment scale. A regression analysis was performed to determine how successfully each of the objective measures correlated with the clinical yardstick, the modified Ashworth scale. A similar correlation between the objective measures and the Fugl-Meyer motor assessment scale was performed. Temporal reproducibility of a test for a given subject was evaluated by performing an ANOVA of repeated measures for each test over the three study sessions in a given subject. We conclude that (1) both the ramp and hold threshold measurements and pendulum test offer acceptable objective measures of spastic hypertonia since they correlate closely with clinical perception, (2) the Fugl-Meyer motor assessment scale also correlates closely with the severity of spastic tone, and (3) objective measures of spastic hypertonia are often surprisingly reproducible when repeatedly applied to a selected group of chronic hemiplegic patients with long-standing spasticity.     

Cortical echogenicity in the hemolytic uremic syndrome: clinical correlation

The initial renal sonograms of 15 patients, aged 8 months to 5 years, with hemolytic uremic syndrome (HUS) were reviewed. Ultrasound studies were graded according to cortical echogenicity relative to the liver, they were compared to the severity of the clinical syndrome at admission and to the ultimate outcome of the disease. The degree of cortical echogenicity correlated with the clinical outcome of HUS in 12 of the patients, whereas clinical assessment alone predicted outcome in 13 patients. Sonography overestimated severity in three patients with mild disease correctly assessed clinically, whereas clinical assessment overestimated severity in two patients with moderate disease in whom the sonographic assessment proved correct. The sonographic changes are most likely multifactorial. They appear to reflect a combination of platelet-thrombus deposition in the renal cortex, as well as the general fluid status of the patient. Ultrasound is useful in ruling out other causes of acute renal failure such as obstruction or congenital diseases. It cannot replace laboratory tests and clinical judgement, but nevertheless provides another index of severity in patients with HUS.     

Seroepidemiology of viral hepatitis: correlation with clinical findings

Antibody to hepatitis A antigen (anti-HA) is detectable in the serum shortly after infection with hepatitis A virus. The presence of IgM antibody indicates acute infection; IgG signifies past infection. Hepatitis B surface antigen (HBsAg) indicates infectiousness and is usually present when hepatitis B virus causes active liver disease; its antibody (anti-HBs) is neutralizing and confers immunity. Antibody to core antigen (anti-HBc) is an index of hepatitis B viral replication when present in high titers; in low titers it reflects past infection. Early presence of e antigen (HBeAg) indicates a high degree of infectivity, whereas presence of its antibody (anti-HBe) indicates a lesser degree. Although markers of non-A non-B hepatitis have been described, the definitive nature and number of the virus or viruses are not yet clear.     

Sonographic findings in muscle strain injury: clinical and MR imaging correlation.

Both sonography and magnetic resonance imaging were performed in 57 patients with clinically suspected strain injury in lower extremity muscles. Sonography demonstrated normal findings in nine patients (16%), hyperechoic infiltration in 31 patients (54%), mass in nine patients (16%), and compound lesions of infiltration and mass in eight patients (14%). Clinically grade 2 lesions ranged from small infiltration to large compound lesions on both sonography and magnetic resonance imaging. Hyperechoic infiltration was not demonstrated on T1-weighted magnetic resonance images and with less than 50% cross-sectional muscle involvement. The mass and compound lesions were ascertained to be moderate or severe injury because the masses of the lesions had obvious hemorrhage or hematoma on magnetic resonance images.     

H-reflex latency and nerve root tension sign correlation in fluoroscopically guided, contrast-confirmed, translaminar lumbar epidural steroid-bupivacaine injections

OBJECTIVES: To examine the correlation between physical examination parameters, commonly referred to as "nerve root tension signs," and H-reflex latency measurements both pre- and postepidural steroid-bupivacaine (Marcaine) injection, and to propose mechanisms of pain alleviation. DESIGN: Prospective observational, with H-reflex latency measurement and physical examination at baseline and at 10 minutes postinjection. SETTING: Physical medicine and rehabilitation practice, outpatient surgical center, and community setting. PARTICIPANTS: Ten consecutively recruited patients (6 women, 4 men; age range, 40-71 y) with clinical radiculopathy and compatible magnetic resonance imaging findings, who were unaware of the outcome measures. INTERVENTIONS: Patients received a fluoroscopically guided, contrast-confirmed, paramedian translaminar lumbar epidural injection of 120 mg of methylprednisolone acetate (80 mg/mL) and 2.0 mL of .25% preservative-free Marcaine. MAIN OUTCOME MEASURES: Seated slump testing (SST), straight-leg raising (SLR), and H-reflex latency were measured bilaterally both pre- and postinjection. Differences were measured by using the paired t test in an A-B design. RESULTS: All SST of the affected (injected) side improved from pre- to postinjection, with 3 patients reporting discordant hamstring pain and 7 reporting no pain. SLR ability increased by an average of 29 degrees +/-12 degrees, corresponding to an average relative increase of 54% on the affected side. A statistically significant difference was found (Student t test, P=.02) between pre and post H-reflex latency on the affected side but not when comparing changes between affected and unaffected sides (Student t test, P=0.6). CONCLUSIONS: Significant improvements in SST and SLR result from low volume epidural injection of Marcaine, with questionable prolongation of the H-reflex to the gastrocnemius-soleus complex on the affected side.     

Benign lymphocytic infiltrate of the skin: correlation of clinical and pathologic findings.

In a retrospective study of 137 biopsy specimens of skin from 137 patients (69 men and 68 women) that had been obtained between 1972 and 1989 at our institution and that had perivascular and periappendageal lymphocytic infiltrates characteristic of those described as benign lymphocytic infiltrate (BLI), we determined the specificity of the histologic diagnosis and the correlation with clinical data. The final diagnoses, based on clinical and laboratory data and histologic findings, were BLI (59), possible BLI (7), lupus erythematosus (LE) (12), possible LE (7), procainamide-induced LE (1), insect bites (9), possible insect bites (3), polymorphous light eruption (4), lymphocytoma (4), urticaria (4), and indeterminate or miscellaneous diagnoses (27). BLI is a clinical and histologic syndrome that can be heterogeneous in origin. We recommend careful evaluation to exclude other disorders such as LE, polymorphous light eruption, lymphocytoma, and insect bites. Direct immunofluorescence microscopy and immunophenotypic studies may help distinguish BLI from LE.     

脑节细胞胶质瘤MRI表现与临床病理联系

目的：探讨脑节细胞胶质瘤的MRI与临床病理的特点。方法：回顾分析20例脑节细胞胶质瘤的MRI和临床病理特点。结果：病灶全部为单发,幕上18例,幕下2例。额叶8例,颞叶7例,顶叶、枕顶叶、额颞叶及小脑、延颈髓各1例。17例为术前检出肿瘤,3例为术后检出肿瘤,其中2例为原发灶复发,1例为非原发灶部位新发肿瘤。MRI上肿瘤信号呈多样性,根据MRI表现可分囊性为主型和实性为主型,增强后,肿瘤强化呈多样性,囊性为主型可无强化或伴壁结节强化,实性为主型可局灶强化、弥漫强化。瘤周水肿多较轻或无。脑电联合同步功能磁共振成像结果显示,最大激活区与病理灶位置一致。结论：脑节细胞胶质瘤的MRI表现具有一定特征性,结合应用脑电联合同步功能磁共振成像有助于临床术前评价。     

Nerve conduction studies and vibration perception thresholds in diabetic and uremic neuropathy.

Two parameters of nerve conduction studies (nerve conduction velocities and amplitudes of the evoked sensory and motor responses) were compared with quantitative vibration perception thresholds (VPT) in patients with peripheral neuropathy (diabetes mellitus and/or end-stage renal disease). VPT measurements were made using a "two-alternative, forced-choice" method in which the patient is required to identify which of the two rods is vibrating at progressively decreasing vibration intensities. VPTs correlated significantly with nerve conduction velocities in all upper and lower extremity sensory and motor nerves tested, and with the amplitudes of the evoked motor responses in three motor nerves: median and ulnar (motor components) and tibial. For the median and ulnar nerves (motor components) the amplitudes of the evoked motor responses were more sensitive than nerve conduction velocities in correlation with VPTs. Comparison of VPT values, based upon whether or not evoked sensory and motor responses were obtained, indicated that mean VPTs were consistently higher among subjects in whom these evoked responses were not elicited. VPT measurements is thus shown to be a valid and valuable method for evaluation of severity in peripheral neuropathy. It has the advantages of being simple, quick and painless. Patient cooperation and compliance with this form of testing are excellent.     

Sonohysterography combined with sonosalpingography: correlation with endoscopic findings in infertility patients.

The diagnostic accuracy of sonohysterography combined with sonosalpingography or sonohysterosalpingography was evaluated in 100 infertility patients who also underwent endoscopic (hysteroscopy with or without laparoscopy) procedures. In patients with normal endometrial biopsy results, single endometrial layer thickness ranged from 3 to 5 mm and varied up to 2 mm in some areas. Diagnostic accuracy was 98% for submucosal fibroids, 96% for polyps, and 81% for synechiae. Missed lesions, were less than 2 mm in diameter. Tubal patency was successfully assessed in 79% of women with saline solution and in 92% of those who received contrast agent. This study demonstrates the efficacy of the combined use of SHG and SSG in infertility patients with uterine or tubal factor disorders.     

Small echogenic foci in the ovaries: correlation with histologic findings.

OBJECTIVE: The purpose of this study was to determine the histologic correlate of small echogenic foci in the ovary and to assess for any association with endometriosis or endosalpingiosis. METHODS: Women planning to have a normal ovary surgically removed were scanned preoperatively with transvaginal sonography. If echogenic foci were present in either normal ovary on the preoperative scan, the removed ovary was scanned in a saline bath, and the surface was marked with india ink over an echogenic focus. Histologic sections were then obtained at the marked site. RESULTS: Echogenic foci were detected in 23 ovaries of 16 women. Possible causes were found in 17 of the 23 ovaries: hemosiderin in 6 cases, calcification in 5 cases, hemosiderin and calcification in 2 cases, clusters of inclusion cysts in 2 cases, 1 of which also had hemosiderin, and dense cortical nodules in 2 cases. Histologic findings were benign in all cases except in 1 patient who had primary peritoneal carcinoma unrelated to the echogenic foci. One ovary in another patient had both endosalpingiosis and endometriosis. One other patient had endometriosis involving a fallopian tube but not the ovary. There were no other cases of endometriosis or endosalpingiosis. CONCLUSIONS: Small echogenic foci in the ovaries are most frequently due to hemosiderin or calcification. A few small echogenic foci in the ovaries are associated with benign histologic changes and do not appear to be reliable indicators of endosalpingiosis or endometriosis.     

Polypoid adenomyomas: sonohysterographic and color Doppler findings with histopathologic correlation.

OBJECTIVE: This study was undertaken to describe the sonographic features of polypoid adenomyomas of the uterus and to determine the diagnostic role of sonohysterography and color Doppler sonography in the evaluation of these lesions. METHODS: The sonographic findings for 46 histologically proved cases of polypoid adenomyomas of the uterus, accumulated over 10 years, were reviewed retrospectively. The pathologic diagnoses included typical polypoid adenomyoma (n = 36), atypical polypoid adenomyoma (n = 7), and low-grade adenosarcoma arising in polypoid adenomyoma (n = 3). RESULTS: Of 46 total uterine tumors, 31 were in the corpus, 12 were in the fundus, and 3 were in the isthmus. The mean tumor size was 3.5 cm (range, 0.5-9 cm). The tumors were polypoid in 30 cases, pedunculated in 11 cases, and sessile in the remaining 5 cases. Of the pedunculated tumors, 5 protruded into the endocervical canal and 2 had prolapsed into the vagina. Three distinct sonographic patterns were identified with respect to the presence of cystic areas: a solid mass (pattern 1) in 12 cases, a solid mass with cystic areas (pattern 2) in 32 cases, and a predominantly cystic mass (pattern 3) in 2 cases. The characteristic sonographic features of polypoid adenomyomas included heterogeneous or homogeneous isoechogenicity relative to the myometrium, a smooth surface, a poorly defined margin with the underlying myometrium, hemorrhagic foci, posterior shadowing, a single vascular pedicle entering the mass, and associated adenomyosis in the myometrium. CONCLUSIONS: Knowledge of the sonographic appearance of polypoid adenomyomas may facilitate diagnosis and may help distinguish these tumors from other polypoid uterine tumors.     

MURCS association: ultrasonographic findings and pathologic correlation.

MURCS association is a rare, lethal and unusual constellation of nonrandom findings that includes mullerian duct aplasia, renal aplasia, and cervicothoracic somite dysplasia.1-3 It has been described in 30 patients by Duncan and coworkers2 in 1979, in which report the authors proposed an embryologic cause for these defects.3 Antenatal ultrasonographic findings included a massive, cystic umbilical cord related to a patent urachus, enlarged bladder, single small kidney, and suspicion of urethral obstruction in a fetus of female phenotype. These findings are rare in a case of MURCS and were all confirmed on pathologic examination.     

口腔癌中HSP-70表达和临床的关系

目的　探讨HSP-70的表达和口腔肿瘤临床的关系。方法　本研究采用免疫组化和酶联免疫吸附法检测HSP-70在口腔肿瘤细胞和血清中的表达,观察其临床相关性。结果　（1）48例口腔肿瘤组织中,高表达16例（34%）,低表达32例（66%）,其中38例HSP-70表达阳性,阳性率为78%;（2）HSP-70组织高表达在1、2期肿瘤中为16%,3、4期为45%,二者差异有显著性（P〈0.05）。HSP的表达在性别、年龄、淋巴结转移之间差异无显著性。HSP-70血清表达与各项临床病理特征之间差异均无显著性（P〉0.05）。结论　检测HSP-70可作为判断口腔肿瘤恶性程度的一个指标。     

Cathepsin D concentration in breast cancer cytosols: correlation with biochemical, histological, and clinical findings

Cathepsin D (CD, EC 3.4.23.5) is a lysosomal protease induced by estrogen in certain estrogen receptor (ER)-positive breast cancer cell lines but produced constitutively by ER-negative cell lines. Our aims in this investigation were to study the distribution of CD in human breast cancers and to relate its concentrations to various biochemical, histological, and clinical characteristics. The concentrations of CD were significantly higher in breast carcinomas than in either normal breast tissues or benign breast tumors. In primary carcinomas, CD concentrations did not correlate with the concentrations of ER or with the estrogen-inducible protease t-PA. However, CD concentrations did correlate weakly but significantly with both UK-PA antigen and UK-PA activity. Also, CD concentrations did not correlate with either tumor stage or axillary node status but did correlate significantly with tumor grade. Patients with cancers containing high concentrations of CD had a significantly shorter overall survival than did patients with low concentrations of the enzyme.