Postoperative intervertebral discitis

Discitis is a rare complication of disc operation. During a 10-year-period 1100 patients were operated for lumbar disc herniation and only eight patients developed postoperative discitis. The symptoms began 3 weeks after the operation and the most prominent clinical feature was back pain with muscle spasm. The sedimentation rate was highly elevated but the body temperature was slightly elevated for only a few days. Typical radiographic findings were narrowing of the affected disc space and end-plate resorption 3-4 weeks after the initial symptoms. In the early phase, CT showed hypodense disc material in the affected disc space, which may be the first radiological sign of discitis.     

Carotid stenosis by digital subtraction angiography: reproducibility of the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial measurement methods and visual interpretation.

PURPOSETo evaluate different carotid stenosis estimation methods with digital subtraction angiography.METHODSWe assessed the intraobserver reproducibilty and interobserver variability of visual interpretation and the measurement methods used by the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. Angiographic stenosis measurements according to both criteria were performed twice by a radiologist, a neurologist, and a vascular surgeon. Eighty bifurcations of consecutive symptomatic patients underwent 480 pairs of measurements. In addition, four radiologists estimated the stenoses visually.RESULTSIntraobserver consistency was slightly better by the European (kappa, 0.86 to 0.94) than by the North American (kappa, 0.68 to 0.91) trial criteria or by visual interpretation (kappa, 0.79 to 0.81). No significant interobserver variability was found, except in the subgroup of mild stenoses by the North American Trial criteria. By kappa statistic, the interobserver agreement was excellent by the European trial method (kappa, 0.72 to 0.86), good by the North American trial method (kappa, 0.59 to 0.77), and good to excellent by visual evaluation (kappa, 0.68 to 0.88). The visual estimation agreed more closely with the European (kappa, 0.73 to 0.92) than with the North American trial (kappa, 0.55 to 0.74) criteria measurements.CONCLUSIONSAll three methods have good reproducibility in digital subtraction angiography. Interobserver differences become more important in the estimation of mild stenosis.     

Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes

Summary Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6–8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.

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Zusammenfassung In einem Zeitraum von 11 Jahren wurden 15 Fälle von Ermüdungsfrakturen des Sesambeines am I. MTP-Gelenk diagnostiziert und behandelt. Das Durchschnittsalter betrug 22,3 Jahre, die Geschlechtsverteilung: 6 Frauen und 9 Männer. Alle Patienten waren Sportler, bei denen die Beschwerden während des Trainings auftraten, ohne direktes Trauma. In 8 Fällen befand sich die Fraktur im medialen, in 6 im lateralen Sesamoid und in einem Fall waren beide Sesambeine betroffen. Zur genauen Diagnose kam man durch die Anamnese, wie auch durch die Röntgen- und Isotopenuntersuchung. 10 Patienten wurden konservativ behandelt, Vermeidung excessiver Belastung und das Tragen von besseren Trainingsschuhen wurden vorgeschrieben. In 5 Fällen mußte chirurgisch vorgegangen werden, das fragmentierte, Schmerz verursachende Sesambein wurde entfernt. Die Nachbehandlung verlief komplikationslos und die Sportler konnten ihr Training nach 6 bis 8 Wochen post Op wieder aufnehmen. Die histologische Untersuchung der extirpierten Sesambeine ergab: fibrotisch veränderte Frakturflächen, was die Diagnose einer Stressfraktur bestätigte. 3 der konservativ behandelten Sportler haben immer noch leichte Beschwerden bei intensivem Training, die anderen sind beschwerdefrei.

     

Steroid methoximes I: Antifertility activity of methoxime derivatives of progesterone, estrone and 16-ketoestradiol in the rat.

Antifertility activity of methoxime derivatives of progesterone, est rone, and 16-ketoestradiol was studied in the rat. None of the 3 proges terone derivatives (progesterone-3-methoxime, progesterone-20-methoxime, and progesterone-3,20-dimethoxime) administered in daily doses up to 1 mg/animal showed any antifertility activity in female rats during the mating studies. And only progesterone-20-methozime displaced the parent steroid from the guinea pig uterine receptor. The 3 derivatives had no antifertility effect. An sc dose of 100 mcg of estrone-17-methoxime/day suppressed fertility whereas only 3 mcg of the estrone achieved the same result. However, when administered orally the compounds were similarly effective which indicates that methoxime is well abosrbed from the gastrointestinal tract. Uterine growth assay revealed the potency of estrone to be 30 times that of the methoxime. It appears that estrone-17-methoxime owes its antifertility activity to its estrogenic properties rather than to any antagonizing effect.     

Intranasal exposure to Stachybotrys chartarum enhances airway inflammation in allergic mice

RATIONALE: Exposure to building dampness, often associated with growth of microbes such as Stachybotrys chartarum, has been linked to respiratory symptoms. We have shown previously in a murine model that exposure to S. chartarum can induce lung inflammation characterized by infiltration of neutrophils and lymphocytes; this process is regulated by proinflammatory cytokines and leucocyte-attracting chemokines. OBJECTIVES: Because an atopic predisposition may influence the response to microbes, we examined the effects of S. chartarum on allergic mice in an experimental model. BALB/c mice were sensitized to ovalbumin by intraperitoneal injections and exposed for 3 wk to spores of S. chartarum. MEASUREMENTS AND MAIN RESULTS: Numbers of eosinophils and neutrophils were drastically increased in bronchoalveolar fluid from these mice as compared with the ovalbumin-sensitized/challenged mice or those exposed to S. chartarum without ovalbumin sensitization. Histologic sections showed severe granulomatous inflammatory cell infiltrates in all compartments of the lung, including peribronchial, perivascular, and alveolar spaces. The mRNA levels of proinflammatory cytokines interleukin-1beta and tumor necrosis factor alpha and the chemokine CCL3/MIP-1alpha were also markedly increased in the lungs. Despite the enhancement of the pulmonary inflammatory reaction, exposure to S. chartarum spores significantly down-regulated airway hyperresponsiveness and showed a tendency to decrease levels of Th2 cytokines in the lung. CONCLUSION: Exposure to S. chartarum modulates the inflammatory reaction and airway hyperresponsiveness, depending on the allergic status of the exposed mice.     

Chlamydia pneumoniae infection in IL-10 knock out mice: accelerated clearance but severe pulmonary inflammatory response

In interleukin-10 knock out (IL-10 KO) mice, accelerated clearance of pulmonary Chlamydia pneumoniae infection was observed. On the other hand, the histopathological changes in lung tissue were more pronounced in IL-10 KO mice at all time points after infection and repeated infection than in the wild type mice. Both ex vivo induced antigen-specific proliferation as well as production of proinflammatory cytokines by splenocytes were higher in IL-10 KO mice than in WT mice. Also, intrapulmonary proinflammatory cytokine levels were higher in IL-10 KO mice than in the WT mice. The lack of anti-inflammatory action of IL-10 is likely to contribute to the enhanced clearance but severe inflammation in this experimental model.