A case-controlled MRI/MRA study of neurovascular contact in hemifacial spasm

BACKGROUND: Neurovascular contact (NVC) with the root exit zone (REZ) of the ipsilateral facial nerve is associated with hemifacial spasm (HFS), but unresolved issues remain. OBJECTIVES: To 1) determine the frequency of symptomatic and nonsymptomatic NVC, 2) determine the features of NVC associated with HFS, and 3) correlate severity of HFS to these features. METHODS: Two independent, blinded, prospective assessments of high-resolution MR and MR angiography (MRA) images were performed on Chinese cases (HFS: n = 44; age-matched control subjects: n = 20). RESULTS: Over 88% of 44 symptomatic sides in patients with HFS had NVC of the ipsilateral facial nerve. At least 80% of symptomatic sides involved NVC at the anterior aspect of the REZ [REZ(ant.)]. Although NVC was observed in approximately half of nonsymptomatic sides, at least 70% of them were not at REZ(ant.). NVC at the cisternal and intracanalicular portions of the facial nerve were not associated with HFS. Half of our patients with HFS had bilateral NVC, but none had bilateral symptoms. Most of our MR/MRA images showed that the size and position of the arterial branches of the vertebrobasilar system were markedly asymmetric. Of patients with bilateral NVC, over 83% had asymmetric NVC sites. The anterior inferior cerebellar artery was the most common vessel involved in NVC, but was not significantly associated with HFS. Most of the NVC involved one vessel at one contact point with no indentation. The development of HFS was significantly associated with nerve indentation in NVC. The development and severity of HFS were not associated with multiple contact points in NVC. No significant interobserver variability existed between the blinded assessments. CONCLUSIONS: MRI/MR angiography are accurate, fast, and safe in characterizing neurovascular contact (NVC) at the brainstem. The site of NVC and ipsilateral facial nerve indentation in NVC are significant determinants for the development of hemifacial spasm (HFS). The lack of bilateral NVC at the anterior aspect of the root exit zone of the facial nerve could explain in part the lack of bilateral symptoms. The development and severity of HFS are not associated with a specific blood vessel or multiple contact points in NVC.     

Hip fracture in Hong Kong over the last decade--a comparison with the UK.

BACKGROUND: Hip fracture is a major public health problem in Asia and the UK. The objectives of this study were to describe the trends of hip fracture in Hong Kong over the last decade, and to compare the incidence in Hong Kong with that from the Wessex Health Region of the UK in 1995. METHODS: The number of hip fractures was calculated using hospital discharge records for all public hospitals in Hong Kong in 1991 and 1995. Age-specific incidence rates were then calculated using the mid-year census population for the two years. These rates were presented with previously reported age-specific rates for Hong Kong in 1966 and 1985. These age-specific rates for Hong Kong in 1995 were compared with rates for the Wessex Health Region of the UK. The total number of hip fracture expected in 2010 was calculated by applying the age-specific rates of 1995 to the projected population for 2010. RESULTS: In 1995, a total of 1138 men and 2782 women in Hong Kong fractured their hip. The age-specific rates had remained static from 1985 to 1995, after substantial rise from 1966 to 1985. In 1995, the rates of hip fracture rates were 11/1000 in women and 5/1000 in men who were 70 years and older. These rates were almost identical to those observed in the Wessex Health Region of the UK. CONCLUSION: The age-specific incidence rates of hip fracture had not risen in Hong Kong in the last decade. The incidence of hip fracture in Hong Kong was similar to that in the UK in 1995. The total number of patients with hip fracture in Hong Kong will increase substantially in the future, as a result of the ageing of the population.     

A point mutation (W70A) in the rod PDE-gamma gene desensitizing and delaying murine rod photoreceptors

PURPOSE: To examine the corneal electroretinogram (ERG) of transgenic mice (W70A mice) carrying a point mutation (W70A) in the gene encoding for the gamma-subunit of rod cGMP phosphodiesterase (PDEgamma). METHODS: The ERG of W70A mice was compared with that of normal mice. Cone responses were separated from rod responses by light adaptation, whereas rod sensitivity was assessed by threshold stimulation with dim light. Spectral sensitivity curves of the ERG were obtained using a constant response criterion. RESULTS: The ERG of the W70A mouse has a desensitized, delayed rod b-wave at threshold, and a prolonged rod b-wave at higher flash intensities. The a-wave is absent even at maximal stimulation. The cone ERG of the W70A mouse is indistinguishable from that of normal mice. The spectral sensitivity of the W70A mouse is maximal in the UV spectrum, in contrast to the normal mouse, which is most sensitive in the green region of the spectrum. This supports the interpretation of the results as normal cone and abnormal rod function in the W70A mouse. CONCLUSIONS: The W70A mouse represents new model of stationary nyctalopia that can be recognized by its unusual ERG features.     

Oral condyloma acuminatum associated with human papillomavirus and p53 overexpression mimicking cyclosporine effect in a transplant patient

A case of human papillomavirus-associated condyloma acuminatum in the oral cavity, presumed to be fulminant cyclosporine-induced gingival hyperplasia, is reported in a 55-year-old cardiac transplant patient. Approximately 47 months following the transplant, the patient developed severe hyperplasia of the uvula and oral mucosa, resulting in difficulty swallowing. The histopathologic features of the lesion were typical of those of condyloma acuminatum. In situ hybridization of the paraffin-embedded material revealed infection with human papillomavirus types 6/11. This case lends further support to the putative role of long-term cellular immunosuppression in the development of human papillomavirus-associated squamous lesions. In addition, positive staining for p53 protein raises the possibility of concomitant p53 involvement in the pathogenesis of this oral lesion.     

Long-term results of valve replacement using antibiotic-sterilised homografts in the aortic position

Objective.

Antibiotic-sterilised homograft valves stored at 4 °C have been implanted in the subcoronary position in this unit since 1973. This study was undertaken in order to assess the longterm function of these valves.

Methods.

All 249 patients undergoing homograft aortic valve replacement (AVR) at the Wessex Cardiothoracic Centre between April 1973 and December 1994 were studied. Homograft valve sizes ranged from 15 mm to 28 mm internal diameter, 202 (81.1%) varying between 18 mm and 22 mm. The mean patient follow-up was 12.4 years with a total follow-up of 3096 patient-years. There were six early deaths (2.4%).

Results.

On actuarial analysis, survival was 78.5 ± 2.7% (1SE) at 10 years, 65.7 ± 3.3% at 15 years and 55.0 ± 3.9% at 20 years. The freedom from redo AVR was 87.9 ± 2.4% at 10 years, 71.7 ± 3.8% at 15 years and 49.7 ± 5.6% at 20 years. The freedom from structural degeneration was 85.5 ± 2.5% at 10 years, 63.6 ± 4.0% at 15 years and 41.9 ± 6.4% at 20 years. On multivariate analysis the risk of valve failure was significantly higher in younger patients (P < 0.0001) and in those who underwent aortic root tailoring (P = 0.024). The freedom from endocarditis was 98.4 ± 0.9% at 10 years, 96.2 ± 1.6% at 15 years and 95.1 ± 1.9% at 20 years. Of the 249 patients, 218 had an isolated homograft AVR and were not anticoagulated. In this group there were two possible thromboembolic events.

Conclusion.

As well as the established haemodynamic benefits, this study has shown that homograft AVR with antibiotic-sterilised 4 °C stored homograft valves implanted in the subcoronary position, offers good long-term results.     

Preliminary experience with the 1.32 μm neodymium-YAG laser in the treatment of tracheobronchial malignancy

Endoscopic laser treatment for tracheobronchial malignancy is usually given with the neodymium-YAG laser using the 1.064m output beam. However, recent experimental work suggests that the 1.32m output beam of this laser has more desirable tissue effects. We have now treated 55 patients with the 1.32m Nd-YAG laser (MBB-Medizintechnic) under general anaesthesia, using power settings of 10–20 W and pulse durations of up to 1 s. The indications for treatment were localized airway obstruction in each case. Airway calibre was improved in 46 (84%) patients and this was associated with an improvement in symptoms of cough and breathlessness. Patients with tracheal and carinal obstruction exhibited the most striking clinical improvements with up to four-fold increases in peak expiratory flow. In patients with more peripheral endobronchial obstruction, treatment improved airway calibre less frequently and resulted in a smaller clinical improvement. Of 11 patients with obstruction of a main bronchus and lung collapse, treatment led to partial or complete re-expansion in 10 cases (91%). The 1.32m wavelength allows treatment to be conducted efficiently and safely but at a considerably lower power than is required for the 1.064mwavelength. The ability to use low powers has the apparent advantage of generating only negligible quantities of smoke. Our experience with this new laser system demonstrates its considerable potential in the management of tracheobronchial malignancy.     

Marrow regeneration after mechanical depletion

The origin of marrow regeneration after mechanical depletion was reinvestigated in mouse chimeras. The results were compatible with the local origin of stem cells from remnants of incompletely removed marrow, but not with their origin from a common precursor of both bone and hemopoietic cell lines. In transplanted femurs depleted by a modified technique of in vivo evacuation of marrow, hemopoietic regeneration failed to occur. The presence of hemopoietic stem cells in the Haversian canals was thus excluded. The demonstration of ample hemopoiesis with minimal bone formation in nondepleted controls in which bone marrow initially became necrotic provided new evidence that osteogenesis was not a prerequisite of hemopoietic regeneration.     

Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities

In 1998, a case-control study was conducted in Hong Kong on hospital patients with osteoarthritis of the hip (n = 138) and osteoarthritis of the knee (n = 658). Age- and sex-matched controls were recruited consecutively from general practice clinics in the same region. The following three risk factors were found to be associated with osteoarthritis of both the hip and the knee: first, a history of joint injury: for osteoarthritis of the hip, the odds ratio = 25.1 (95% confidence interval (CI): 3.5, 181) in men and 43.3 (95% CI: 11.7, 161) in women; for osteoarthritis of the knee, the odds ratio = 12.1 (95% CI: 3.4, 42.5) in men and 7.6 (95% CI: 3.8, 15.2) in women; second, climbing stairs frequently: for osteoarthritis of the hip, the odds ratio = 12.5 (95% CI: 1.5, 104.3) in men and 2.3 (95% CI: 0.6, 8.1) in women; for osteoarthritis of the knee, the odds ratio = 2.5 (95% CI: 1.0, 6.4) in men and 5.1 (95% CI: 2.5, 10.2) in women; third, lifting heavy weight frequently: for osteoarthritis of the hip, the odds ratio = 3.1 (95% CI: 0.7, 14.3) in men and 2.4 (95% CI: 1.1, 5.3) in women; for osteoarthritis of the knee, the odds ratio = 5.4 (95% CI: 2.4, 12.4) in men and 2.0 (95% CI: 1.2, 3.1) in women. In addition, subjects whose height and weight were in the highest quartile were at increased risk of osteoarthritis of the hip and knee, respectively (p < 0.05).     

Pregnant adolescent and adult women have similarly low intakes of selected nutrients

OBJECTIVE: To examine the dietary intake of pregnant adolescents during the second and third trimester of pregnancy, and to compare their nutrient intake with that of pregnant adults. DESIGN: Two 7-day food records (14 days) from subjects participating in a larger randomized clinical calcium trial: the first at 19 to 21 weeks and the second between 29 and 31 weeks gestation. Intake of energy and selected nutrients were calculated and compared with dietary standards. SUBJECTS/SETTING: Fifty-nine pregnant adolescents and 97 pregnant adults recruited from prenatal clinics at a metropolitan university hospital. STATISTICAL ANALYSES: Two sample t tests, equality of variances, and repeated measures (analysis of variance). RESULTS: There was no difference in mean nutrient intakes between the second and third trimesters. Using two 7-day food records, we found mean intakes for energy, iron, zinc, calcium, magnesium, folate, and vitamins D and E to be below recommended standards in both groups. Other nutrients examined met or exceeded reference values. Total daily intakes for energy and 11 nutrients were significantly higher in the adolescent compared to the adult diets (P < .05). These differences were not evident when nutrient values were corrected for energy, indicating that increased energy intake in the teen-aged population was contributed by nutrient-dense foods. APPLICATIONS: This study indicates the need for continued dietary monitoring of pregnant adolescents and pregnant adults, including nutrition guidance that stresses food sources of calcium, magnesium, zinc, iron, fiber, folate, and vitamins D and E, the nutrients found deficient in their diets.