Osteoplastic laminoplasty for cervical myeloradiculopathy secondary to ossification of the posterior longitudinal ligament

Summary Forty-seven patients with cervical myeloradiculopathy due to ossification of the posterior longitudinal ligament were treated by laminoplasty. The spinal canal from C3 to C7 was opened en bloc unilaterally and a spacer bone graft inserted to separate the floating laminae. The average follow up was 7.3 years (range 5 to 11 years). Favourable results were obtained in 35 patients and even though they had serious postoperative symptoms those with advanced neurological symptoms before operation showed considerable improvement. Late results were poor in patients who had greater than 50% compromise of the spinal canal by the ossified lesion. Laminoplasty is a safer method of obtaining favourable late results in patients with involvement of more than 3 vertebrae, but in those with a more severe compromise of the spinal canal by ossification, additional anterior decompression may be necessary later.

---

Résumé Cet article présente les résultats à long terme de laminoplasties pratiquées pour myéloradiculopathie cervicale due à l'ossification du ligament vertébral commun postérieur, ainsi que les modifications observées dans les canaux rachidiens élargis. Habituellement le canal rachidien a été ouvert en bloc de C3 à C7, d'un seul côté, puis complété par une greffe osseuse afin de maintenir l'ouverture au niveau de la lame. On a utilisé la cotation de l'Association orthopédique japonaise, concernant la myélopathie cervicale, pour évaluer l'état des patients avant l'intervention chirurgicale, puis 2 ou 3 mois après la sortie et durant la période de surveillance. Les 47 patients de cette étude ont été suivis de 5 à 11 ans, soit en moyenne 7,3 ans. Les résultats finaux ont été favorables chez 35 patients et, même quand la symptomatologie postopératoire avait été assez préoccupante, les malades qui présentaient des symptômes neurologiques majeurs étaient notablement améliorés. Les résultats étaient mauvais chez les patients dont le rétrécissement du canal rachidien était supérieur à 50% (p<0.05). Il semble que la laminoplastie soit le moyen le plus sûr d'obtenir un résultat favorable mais une décompression antérieure complémentaire peut être nécessaire chez les patients atteints d'une sténose sévère due à une ossification du ligament vertébral postérieur.

---

---

Presented in part at SICOT 93, Seoul, Korea, 28 August–3 September, 1993     

Marked Suppression of T Cells by a Benzothiophene Derivative in Patients with Human T-Lymphotropic Virus Type I-Associated Myelopathy/Tropical Spastic Paraparesis

In a search for new anti-autoimmune agents that selectively suppress activation of autoreactive T cells, one such agent, 5-methyl-3-(1-methylethoxy)benzo[b]thiophene-2-carboxamide (CI-959-A), was found to be effective. This compound, which is known to suppress tumor necrosis factor alpha (TNF-α)-induced CD54 expression, inhibited the primary proliferative response of the T cell to antigen (Ag)-presenting cells (APCs) including allogenic dendritic cells (DCs), autologous Epstein-Barr virus-infected B cells, and human T lymphotropic virus type I (HTLV-I)-infected T cells. Autoreactive T cells from patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) spontaneously proliferate in vitro, and their activation is reported to be associated with CD54 expression. The spontaneous proliferation of T cells from patients with HAM/TSP was entirely blocked by CI-959-A. However, in this study, the T-cell proliferation in 15 patients with HAM/TSP was found to depend more extensively on major histocompatibility complex (MHC) class II and CD86 than on CD54 Ags. Since most important APCs for the development of HAM/TSP are DCs and HTLV-I-infected T cells, the effect of CI-959-A on DC generation and on the expression of surface molecules on activated T cells is examined. CI-959-A suppressed recombinant granulocyte-macrophage colony stimulating factor (GM-CSF)- and recombinant interleukin-4-dependent differentiation of DCs from monocytes and inhibited the expression of CD54 and, more extensively, MHC class II and CD86 Ags. CI-959-A showed little toxicity toward lymphoma or HTLV-I-infected T-cell lines or toward monocytes and cultured DCs. These results suggest that CI-959-A might be a potent anti-HAM/TSP agent.Human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is thought to be an autoimmune disease induced by HTLV-I infection (8, 9, 24). The T lymphocytes obtained from patients with HAM/TSP patients produce interleukin-2 (IL-2) in vivo and proliferate spontaneously in vitro without any additional stimuli or cytokines (35). This spontaneous proliferation of T lymphocytes (SPL) depends on the interaction of T cells with antigen (Ag)-presenting cells (APCs) such as dendritic cells (DCs) (17, 25) and HTLV-I-infected CD4⁺ T cells (15, 32). The DCs localized in the blood and nonlymphoid organs are considered to be functionally immature, in that they are optimized for the uptake and processing of Ag but not for the initiation of primary T-cell responses. However, after the uptake of Ag and exposure to inflammatory agents including tumor necrosis factor alpha (TNF-α) and IL-1, the DCs undergo a process of maturation and gain the ability to present Ag to T cells for their priming (22, 26). In addition to DCs, HTLV-I-infected CD4⁺ T cells directly stimulate autologous CD4⁺ T cells in a major histocompatibility complex (MHC) class II- and CD86 molecule-dependent fashion (32). Among the T cells stimulated with these APCs, some might cross-react with self Ags and closely associate with the development of HAM/TSP.We have been searching for compounds that inhibit the cellular interaction between APCs and T cells to suppress the activation of autoreactive and Ag-specific T cells. The molecules associated with the APC-T cell interaction may provide an effective target for therapy for autoimmune diseases. Binding of APCs and T cells is initiated by contact of adhesion molecules, such as CD54 and CD11a/CD18, expressed on both cells, and induction of sustained proliferation of T cells requires two independent signals provided by APCs: a T-cell receptor-mediated Ag-specific signal and a signal mediated by costimulatory molecules (CSMs) (10, 20) including CD86 and CD58 Ags (1, 11, 31). Blocking of their tight binding through adhesion molecules or interaction of the CSMs with CSM ligands effectively suppressed the abnormal expansion of disease-associated T cells in vivo and in vitro (19, 30, 32) and sometimes effectively induced a long-term unresponsiveness of T cells to recall stimuli.5-Methyl-3-(1-methylethoxy)benzo[b]thiophene-2-carbox-amide (CI-959-A) is known to inhibit CD54 expression, and its derivative is reported to inhibit casein kinase II (4). In the present study, we found that CI-959-A markedly suppressed SPL in patients with HAM/TSP. Furthermore, the compound suppressed the primary T-cell proliferative response to stimuli provided by various APCs, the differentiation of immature DCs from monocytes and their subsequent maturation, and the induction of expression of MHC class II, CD54, and CD86 Ags on activated CD4⁺ T cells.     

Reproducibility of the oxygen uptake efficiency slope in normal healthy subjects

BACKGROUND: To elucidate the intertest agreement of the oxygen uptake efficiency slope (OUES) in comparison with those of the maximal oxygen uptake (VO2max) and the ventilatory anaerobic threshold (VAT). METHODS: Experimental design: A comparative study. Setting: Institutional practice. A total of 19 healthy volunteers underwent two sessions of maximal exercise testing with an interval of no more than 7 days. The testing was conducted on a cycle ergometer with the work rate increased by either 20, 30, or 40 Watts (W)/min so that the subject would reach exhaustion within 9 to 12 min of exercise. VAT was defined as the level of oxygen uptake (VO2) at which either an increase in the ventilatory equivalent for oxygen without a concomitant increase in the ventilatory equivalent for carbon dioxide or a change in the slope of the linear relationship between carbon-dioxide production (VCO2) and VO2 occurred. OUES was determined by the following equation: VO2 = a log VE + b, where VE was minute ventilation and "a" was the OUES. Intertest reproducibility was assessed by coefficient of repeatability (COR). RESULTS: The intertest reproducibility of VO2max and OUES were excellent (COR = 570 ml/min [16%] and 740 [20%], respectively). VAT showed poor agreement between the two tests (COR = 650 ml/min [31%]). CONCLUSIONS: Results show that OUES is reproducible and reliable, supporting the clinical usefulness of this index.     

Coronary artery bypass grafting in two patients with single coronary artery

We experienced two patients with single coronary artery who underwent CABG using arterial grafts successfully. In two patients coronary angiography demonstrated a single coronary artery which was originated in left coronary sinus and was bifurcated to LAD and LCx, and then RCA branched off proximal LAD, passing in front of the right ventricular out flow tract (Sharbaugh Type L-IIa). To the first patient, a 52-year-old man who had angina on exertion due to long stenosis of RCA, CABG to RCA using RITA was carried out. To the second patient, a 57-year-old man who had inferior myocardial infarction due to 90% stenosis of proximal LAD, CABG to RCA using RITA and LAD using LITA was carried out. Single coronary artery without additional congenital cardiac anomalies may lead to myocardial ischemia, necessitating CABG as coronary reconstructions.     

A case of traumatic aneurysm of innominate artery with occlusion of right subclavian artery

A 42-year-old woman with history of chest blunt trauma from an automobile accident 250 days earlier had suffered easy fatigability of the right upper extremity. She had difference of blood pressure between upper extremities, 94/60 mmHg in the right and 126/70 mmHg in the left. Chest CT showed dilation of the innominate artery which compressed the trachea. Aortography showed an aneurysm of the innominate artery and occlusion of the right subclavian artery at its origin. The aneurysm of the innominate artery was resected and replaced with a 6 mm Dacron graft with aid of the external shunt. The right subclavian artery was also reconstructed with same graft. The aneurysm of the innominate artery should be suspected as a rare complication in blunt trauma of the chest.     

Importance of fluorescein angiographic study in evaluating early retinal changes in Takayasu disease

PURPOSE: To determine the usefulness of fluorescein angiography in studying Takayasu disease. METHODS: We examined 31 eyes in 16 patients with Takayasu disease using indirect ophthalmoscopy, color photography, and fluorescein angiography. Ophthalmoscopic and fluorescein angiographic findings were compared. RESULTS: Fluorescein angiography revealed no additional retinal changes in 10 eyes that had no retinal vein dilatation as seen by indirect ophthalmoscopy. Seven (33%) of 21 eyes that had dilated retinal veins also had additional abnormal findings, such as microaneurysms, arteriovenous shunts, retinal neovascularization, and avascular areas. Some differences in grading the stages of retinopathy were noted with these newly found retinal changes, as compared with the classifications determined by ophthalmoscopy alone. CONCLUSIONS: In Takayasu disease, studying the fundus of patients with fluorescein angiography is particularly important in correctly classifying the stages of retinopathy when the retinal vein appears dilated in ophthalmoscopic observation.     

A follow-up study on pulmonary functions of workers exposed to various forms of dust. Observation on the workers of pneumoconiosis in Kitakyushu

Serial spirograms of 121 dust workers whose chest X-rays were found to be "class 1" of the diagnostic criteria for pneumoconiosis were obtained during 1978-80. Yearly changes of pulmonary function variables (%VC, FEV1, FEV1/FVC%,V25/H, and V50/V25) by age, smoking habit, total years of exposure to dust, and work history were evaluated. The average age of the dust workers was 48.0 +/- 5.5 years, and the average years of exposure to dust was 21.6 +/- 6.8 years in 1978. Eighty-two dust workers smoked with the mean smoking history of 24.7 pack-years. No significant differences of spirograms were found between the smoking and non-smoking groups. Among the smokers, however, linear regression of FEV1/FVC% by age gradually decreased during 1978-80. All the pulmonary function variables showed no correlation with smoking history as well as total years of dust exposure. All the dust workers were classified into eight types of work by their histories; crushing and quarrying operators, brick mason, foundry and grinding operators, asbestos workers, underground miners, refractory material workers, pyrites roasters, and welders. The underground miners showed lower FEV1/FVC% and V25 than the average. However, the difference of such pulmonary function variables by eight types of work was not significant by analysis of variance. Since aging is the most dominant factor for pulmonary dysfunction, a longer observation on this group will be needed.     

Spectral analysis of cerebrospinal fluid pulse wave

The change of the cerebrospinal pressure wave from during the continuous monitoring of intracranial pressure is often experienced. We supposed that this phenomenon would be the result of the change of transmission of spinal fluid pulse through the cerebrospinal fluid (CSF) system. Our study was performed to determine the change of auto power spectrum of CSF pulse when CSF pressure was increased by the slow infusion of lactate linger solution. The spectrum of CSF pulse was found to be composed of four main waves; wave derived from the respiratory movement, fundamental wave of cardiac origin and its 2nd and 3rd harmonic waves. The power of waves derived from the cardiac beats were increased when CSF pressure was elevated by the slow infusion, but the degree of increment was larger in the fundamental wave than harmonic waves. Elevation of CSF pressure caused relative attenuation of the harmonic waves included in CSF pulse. From the result of this study we found that CSF system would have the function of "high-cut filter" and its cut-off frequency was lowered by the slow infusion of lactate linger solution.     

Investigation of the pathogenesis of glaucoma capsulare with special discussion of α1Lp and Cp in aqueous humor

The aqueous humor proteins of exfoliation syndrome were studied qualitatively by crossed immunoelectrophoresis and compared with normal controls. Two kinds of macromolecules (₁-lipoprotein and ceruloplasmin) were detected more frequently in exfoliation syndrome than in the normal controls. ₁Lp was detected in eight of ten patients with exfoliation syndrome, but in none of the eight controls. Cp was detected in seven of ten patients with exfoliation syndrome, but in only one of the eight controls.The presence of these macromolecules in the anterior chamber suggests high permeability of vessels in the exfoliation syndrome. This interpretation is also supported by the fact that neovascularization is sometimes present in the iris of the exfoliation syndrome.In the aqueous humor from a patient with diabetic retinopathy, ten kinds of aqueous humor proteins were identified.     

Alpha-synuclein inclusions in amygdala in the brains of patients with the parkinsonism-dementia complex of Guam

We investigated by immunohistochemistry the deposition of alpha-synuclein in the brains of deceased patients with the parkinsonism-dementia complex (PDC) of Guam. Five of 13 PDC brains showed numerous alpha-synuclein positive neuronal inclusions and abnormal neurites, chiefly in the amygdala. Similar alpha-synuclein positive lesions were observed, although to a lesser extent, in the entorhinal cortex and the dorsal vagal nucleus. No alpha-synuclein positive inclusions were observed in motor cortex or locus coeruleus, and only a small number of positive inclusions were found in the Sommer's sector, temporal cortex, or substantia nigra. Some of the alpha-synuclein positive inclusions were reminiscent of cortical Lewy bodies (LB), but many of those in the amygdala coexisted with tau-positive pretangles and/or neurofibrillary tangles (NFT) within the same neurons. In these neurons, tau-positive shells encapsulated alpha-synuclein positive central cores or irregularly shaped alpha-synuclein-positive deposition intermingled with pretangles/NFT. Thus, the present study suggests that a common mechanism may govern aggregation of alpha-synuclein and tau in the amygdala, and that aggregation of alpha-synuclein may play some role in the neurodegenerative process of a tauopathy (i.e. PDC) in which Abeta deposition is virtually absent.