How useful is dual energy lateral vertebral assessment in a clinic setting?

Screening for osteoporotic vertebral fractures traditionally involves X-ray of the thoracic and lumbar spine. We evaluated use of dual energy X-ray technology in patients with osteoporosis. We found this technology useful in the clinic setting and it has advantages in that less radiation is delivered to the patient.     

Taxol treatment of experimental proliferative vitreoretinopathy

Taxol is a potent stabilizer of microtubules, and inhibitor of in vitro replication, migration, and contraction of fibroblasts. It has been found to limit the development of experimental tractional retinal detachments in nonvitrectomized rabbit eyes. We used taxol in vitrectomized, phakic rabbit eyes with experimentally induced proliferative vitreoretinopathy and tractional retinal detachments. Taxol was dissolved in 30% DMSO because of poor aqueous solubility. A single 0.1 ml intravitreal dose of 2 × 10^–4 M taxol in 30% DMSO was injected immediately after 250000 heterologous corneal fibroblasts had been injected; 0.1 ml of 30% DMSO was injected into control eyes. Taxol reduced the incidence of tractional retinal detachments seen 3–4 weeks later. When taxol injection was delayed for 3 days after the initial intravitreal injection of fibroblasts into nonvitrectomized eyes, the extent of retinal detachments was reduced, but the incidence of retinal detachment was unchanged from the untreated eyes at the end of 4 weeks. These data indicate that taxol may be most useful when given early in the course of proliferative vitreoretinopathy.Dr. Stewart Daniels was an Abe Meyer Fellow     

Effect of clonidine on gastric emptying of liquids

We have investigated the effects of clonidine on gastric emptying of liquids in 30 patients. In a double-blind, randomized design, clonidine 150 micrograms, morphine 10 mg or saline in 1 ml was given i.m. One hour later, the patient drank a paracetamol solution (1.5 g in 50 ml water). Venous blood samples were obtained every 15 min for 90 min thereafter. Plasma paracetamol concentrations were measured using high- pressure liquid chromatography and the area under the concentration- time curve was calculated. The degree of sedation and complications were recorded. The area under the curve for 0-60 min was significantly smaller in the morphine group than in the saline group (P = 0.002; 95% confidence interval (CI) for difference -1237 to -502 micrograms min ml- 1), whereas it was greater in the clonidine group compared with the saline group, although this was not significant (95% CI for difference - 423 to 1264 micrograms min ml-1). Arterial pressure was significantly lower in the clonidine group compared with the saline group. Both clonidine and morphine appeared to cause mild sedation. We conclude that clonidine 150 micrograms i.m. does not delay gastric emptying of liquids in a similar manner to morphine.      

Neuroendocrine differentiation and clinical behaviour in non-small cell lung tumours.

The present study examines the relationship between neuroendocrine (NE) differentiation and the clinical behaviour of non-small cell lung cancer (NSCLC). Retrospective (n = 315) and prospective (n = 44) cohorts of non-small cell tumours were obtained from surgically treated cases of lung cancer, comprising 218 squamous cell carcinomas, 65 adenocarcinomas, 51 adenosquamous carcinomas, and 25 large cell undifferentiated carcinomas. Paraffin wax embedded and fresh frozen tissue sections were stained for the NE markers neurone specific enolase, creatine kinase-BB, bombesin, neurotensin, chromogranin A, synaptophysin and UJ-13A. The expression of two or more markers was observed in 30% of cases, and was taken to identify NE-NSCLC. A statistically significant correlation between nodal status and NE differentiation (P = 0.05), and disease stage and NE differentiation (P = 0.04) was observed. However, there was no correlation between NE differentiation and survival. These findings suggest that NE-NSCLC, analogous to SCLC is more highly metastatic than non-NE-NSCLC.     

Recovery and probable persistence of cytomegalovirus in human inner ear fluid without cochlear damage

Cytomegalovirus (CMV) was recovered from a 5-month-old infant with probable congenital infection. In life, no hearing impairment had been observed. Auditory brain stem evoked responses were bilaterally intact. At necropsy, both temporal bones were morphologically normal, as demonstrated by light and electron microscopy. Sensory hair cells of the organ of Corti appeared intact. Cytomegalovirus was recovered from a mixture of perilymph and endolymph, but not the brain, CSF, or vitreous humor. This appears to be the first report of an individual with an inner ear CMV infection in which neither structural nor functional alterations of the inner ear were apparent. This case also suggests that CMV can persist within the inner ear for prolonged periods following congenital infection.     

Thyroid gland: US in patients with Hodgkin disease treated with radiation therapy in childhood

The authors retrospectively assessed with sonography the prevalence of thyroid gland abnormalities in 30 patients who underwent radiation therapy for Hodgkin disease between 1962 and 1984. Doses ranged from 3,000 to 4,500 rad (3,000-4,500 cGy). Abnormalities were found in the sonograms of 24 patients and included unilateral (n = 6) or bilateral (n = 2) atrophy; multiple hypoechoic lesions smaller than 0.75 cm (n = 18); and dominant cystic (n = 2), solid (n = 3), or complex lesions (n = 4) larger than 0.75 cm. The risk of development of an abnormality increased as the time from irradiation increased and was comparable between patients who did and did not receive chemotherapy as part of the treatment regimen. Although the pathologic correlates of the various abnormalities seen on sonograms may differ, the findings indicate a need for long-term follow-up of patients who underwent cervical irradiation for Hodgkin disease.     

Quantitative morphology of human glioblastoma multiforme microvessels: structural basis of blood-brain barrier defect

Summary Neoplastic invasion of the brain parenchyma results in a disruption of the ultrastructure of the blood vessel walls such that serum proteins extravasate into the surrounding tissue, resulting in cerebral edema. The structural changes involved are not well understood, since the pores through which serum constituents pass (permeability routes) in normal barrier vessels and in tumor vessels where the barrier is compromised, have not been extensively explored. In this study we investigate the ultrastructure of human brain microvessels in biopsied samples of control brain tissue and five glioblastoma multiforme tumors. Electron micrographs of a total of 78 vessels were analysed with computer assisted morphometry for ultrastructural evidence of permeability routes. Fenestrations in the endothelium were not seen. Pinocytotic vesicle number and arrangement did not differ significantly from that seen in control brain vessels. Interendothelial junctions with enlarged distensions (which may represent sections through transendothelial channels) were seen in some vessels from most tumors but not in control barrier vessels. In addition, large gaps in the endothelial layer were seen in less than two percent of tumor vessels. In conclusion, glioblastoma multiforme vessels in this study show subtle alterations in vessel morphology from that seen in controls. We suggest that the high vascular permeability and resultant brain edema seen in glioblastoma multiforme tumors is likely due to the presence of channels through interendothelial junctions, and rare but large breaks in the endothelial wall.     

Reflex sympathetic dystrophy in brain-injured patients.

One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.     

Complications of surgical endoscopy

Background: This study examines the notion that gastrointestinal endoscopy performed by supervised surgical residents is safe. Methods: We reviewed all gastrointestinal endoscopic procedures performed by surgical residents with faculty supervision for complications and deaths occurring up to 30 days following the procedures. Results: The overall complication rate for 9,201 upper and lower endoscopy procedures was 1.4% and 0.42%, respectively. Overall mortality rate was 0.76% for upper endoscopy and 0.6% for lower endoscopy. No mortality was a direct result of a procedure-related complication. Intestinal perforation, drug overdose, bleeding, and aspiration were the most common procedure-related complications. Each resident completed an average of 75 upper endoscopies and 79 lower endoscopies during their training period. Conclusions: Gastrointestinal endoscopy can be performed safely by surgical residents with appropriate supervision. The higher morbidity and mortality of upper endoscopy are most likely related to the underlying disease rather than the procedure. Awareness of common complications and application of appropriate precautions and instruction are critical for minimizing complications. Received 25 March 1996/Accepted: 24 April 1996