Lateral ankle ligaments: MR arthrography with anatomic correlation in cadavers

Objective

The purpose of our study was to use magnetic resonance (MR) imaging and MR arthrography to demonstrate the anatomy of the lateral ankle ligaments using standard and oblique imaging planes in cadavers.

Material and methods

MR imaging of ten cadaveric ankles was performed before and after intra-articular administration of contrast solution. Proton-density MR images were acquired in standard and oblique imaging planes. MR imaging was correlated with anatomic sections. Measurements using oblique imaging planes were obtained to characterize the morphology of the lateral ligaments.

Results

The anterior talofibular ligament (ATFL) had a variable number of bands in all specimens, separated by fat signal oriented obliquely parallel to the long axis of the ligament. The fibular attachment of ATFL was located in close proximity to the fibular attachment of the distal band of the anterior tibiofibular ligament (AITFL). The angle formed by the calcaneofibular ligament (CFL) and the fibular shaft varied with different ankle positions. Special axial oblique plane best demonstrated the CFL. The posterior talofibular ligament (PTFL) was multi-fasciculated in appearance. Dorsiflexion of the ankle joint helped elongate the PTFL and best depicted this ligament in its entirety in the axial plane.

Conclusion

Oblique imaging planes parallel to the long axis of the individual ligaments may improve visualization of the anatomy of the lateral ankle ligaments. The orientation of the lateral ankle ligaments is affected by the position of the talocrural and subtalar joints. Understanding the morphology of the lateral ankle ligaments can help radiologists diagnose abnormalities of these ligaments.     

Reflex choroidal blood flow responses of the eyeball following somatic sensory stimulation in rats

The effect of cutaneous mechanical stimulation on choroidal blood flow (ChBF) of the eyeball measured using a laser Doppler flowmeter was examined in anesthetized rats. Noxious pinching stimulation of a forepaw for 20 s produced increases in ChBF and mean arterial blood pressure (MAP), whereas brushing of a forelimb produced no changes in either parameter. After spinal transection at the fourth thoracic (T4) level, forepaw pinching stimulation did not produce any MAP changes in 9 of 11 spinalized rats. In these nine spinalized animals, pinching stimulation of a forepaw produced no significant responses in ChBF. After the cutting of cervical sympathetic trunks in five spinal rats, forepaw pinching showed no effect on MAP, but produced an increase in ChBF, which was abolished by an intravenous (i.v.) injection of 1-(2-trifluoromethylphenyl) imidazole (TRIM), a selective inhibitor of neuronal nitric oxide synthase (nNOS). In another four spinalized rats, whose cervical sympathetic trunks were intact and the superior salivary nucleus (SSN) was destroyed, forepaw pinching showed no effect on MAP, but produced a decrease in ChBF, which was abolished by an i.v. injection of phentolamine, an alpha-adrenoceptor antagonist. The present experiment shows that somatic afferent stimulation can produce reflex responses of the ChBF of the eyeball, either a vasodilative response using parasympathetic efferent fibers or a vasoconstrictive response using sympathetic efferent fibers, independent of systemic blood pressure. It was also shown that the somatically induced vasodilative response was due to a release of nitric oxide (NO) from parasympathetic nerves and the vasoconstrictive response was due to a release of noradrenaline from sympathetic nerves.     

Surgical resection using retroperitoneal approach for solitary fibrous tumor in the pelvis

This report concerns a case of solitary fibrous tumor (SFT) for which surgical resection was performed using a retroperitoneal approach. A 41-year-old man was referred to our hospital with urinary retention. Abdominal ultrasound sonography (US) and computed tomography (CT) showed a hypervascular mass lesion in the pelvis. Transrectal biopsy showed SFT. Surgical resection was carried out using a retroperitoneal approach and preserving the neural network related to urinary and erectile functions. Based on immunohistochemical findings, the tumor was diagnosed to be malignant SFT in the pelvic cavity. Urinary function improved post-operation. There was no change to IIEF-5 and it continued to function well. The patient showed no sign of recurrence 12 months after surgery and required no additional therapy.     

Value of metastin receptor immunohistochemistry in predicting metastasis after radical nephrectomy for pT1 clear cell renal cell carcinoma

KISS-1 is a metastasis-suppressor gene of human melanoma, and encodes metastin, which was identified as the ligand of a G-protein-coupled receptor (metastin receptor). The precursor protein is cleaved to 54 amino acids, which may be further truncated into carboxy-terminal fragments. Previous studies showed that lack of metastin receptor in clear cell renal cell carcinoma (RCC) is associated with tumor progression, but the prediction of metastasis in patients with pT1 clear cell RCC after radical nephrectomy is difficult. The objective of this study was to evaluate the usefulness of metastin receptor immunohistochemistry in predicting metastasis after nephrectomy for pT1 clear cell RCC. After verification of the correlation between immunostaining and mRNA expression, we evaluated the clinical value of metastin receptor immunohistochemistry. Fifty-four patients were enrolled in this study; following radical nephrectomy, seven patients were found to have lung metastasis. The sensitivity, specificity, positive predictive value, and negative predictive value with negative immunostaining of metastin receptor were 85.7, 97.6, 46.2, and 97.6 %, respectively. Metastasis-free survival rates were significantly higher in patients with positive staining (97.6 %) than in patients with negative staining (53.8 %) (P < 0.001). In univariate analysis for metastasis-free survival, negative immunostaining of metastin receptor was a significant risk factor for metastasis (P = 0.001). Furthermore, negative immunostaining of metastin receptor was an independent predictor for metastasis in multivariate analysis (hazard ratio, 3.735; 95 % CI 0.629–22.174; P = 0.002). In conclusion, our study suggests that negative expression of metastin receptor in clear cell RCC is significantly related to metastasis.     

Potential larvicidal and pupacidal activities of herbal essential oils against Culex quinquefasciatus say and Anopheles minimus (Theobald)

The larvicidal and pupacidal effects of eight herbal essential oils were tested against third instar (L3), fourth instar (L4), and pupal stages of Culex quinquefasciatus and Anopheles minimus. Probit analysis was used to analyze the data. The larval mortality was recorded at 1, 5, 10, 30, and 60 minutes, and 24 hours. Pupal mortality was also recorded at 24 hours intervals for 96 hours when completed mortality was achieved. Citronella grass oil #2 (Cymbopogon nardus) proved to have the greatest toxicity against 3rd instar Cx. quinquefasciatus and An. minimus with LT50 at 1.2 and <0.2 minute, respectively. It exhibited a high level of effectiveness against 4th instar Cx. quinquefasciatus (LT50 at 5.1 minutes) and An. minimus (LT50 at 0.9 minute). Regarding pupacidal activity, Cx. quinquefasciatus and An. minimus pupae were susceptible to Lemon grass oil (LT50 at 1.2 hours) and Citronella grass oil #1 (LT50 at 0.6 hour), respectively. These oils had larvicidal and pupacidal activities with 100% mortality against L3, L4 and pupal stage Cx. quinquefasciatus at 10 minutes, 30 minutes and 24 hours. They also caused 100% mortality of An. minimus at 5 minutes (L3, L4), and 24 hours (pupal stage).     

Salmonella lamphun: first isolation of a new Salmonella serovar in Thailand

Two isolates of a new Salmonella serovar, Salmonella Lamphun were discovered from animal feeds in Thailand, in 2003, which belongs to group C, with antigenic formula 6,8:y: 1,2. Both isolates were susceptible to all antimicrobials tested. The pulsed field gel electrophoresis pattern of both isolates comprises 11 DNA fractions sized 48, 65, 77, 105, 110, 170, 244, 330, 337,453 and 1,135 kbp. Up to April 2005, no human or animal infection by this new Salmonella serovar was reported.     

Hemorrhagic shock from breast blunt trauma

Background

Seat belt use has been associated with decreased life-threatening thoracic injuries. However, there has been an increase in soft-tissue injuries such as breast trauma.

Case report

We describe a case of a young healthy female who presented to a community hospital Emergency department without any trauma designation following a motor vehicle accident. The patient was found to have hemorrhagic shock from an intramammary hemorrhage and was treated with blood products and a temporizing external abdominal binder in preparation for a transfer to a level 1 center where she was successfully treated with angiographic embolization.

Objectives

The objective of this study is to report on a case hemorrhagic shock from a breast hematoma as well as a review of the literature on previous seat belt associated breast trauma and its management in the emergency department.

Conclusion

Seat belt associated breast trauma is uncommon in the emergency medicine literature. However, it can be associated with life threatening intramammary bleeding. Emergency physicians should be aware of these injuries and their proper management.

     

Septic pulmonary emboli caused by Tsukamurella inchonensis: A case report

The genus Tsukamurella is a fastidious, environmental organism that potentially causes various infections in humans. Due to the morphological and biochemical similarities to others pathogens, such as Gordona, Rhodococcus, Corynebacterium, Nocardia, and Mycobacterium, a molecular-based approach is indispensable to correctly identify them. Herein, we describe a case of Tsukamurella inchonensis bacteremia complicated with septic pulmonary emboli (SPE), which is the first in the literature. A 44-year-old Japanese woman diagnosed with tongue cancer had undergone partial tongue resection. While receiving chemotherapy and radiotherapy, she developed high fever. Chest computed tomography suggested multiple emboli at the bilateral, peripheral lungs, indicating SPE. Blood culture detected Gram-positive rods, to which matrix-assisted laser desorption/ionization-time of flight mass spectrometry failed to identify. Then, we attempted to characterize it by 16S rRNA sequence, which suggested the organism to be Tsukamurella species but resulted in low resonance of the species-level identification. Additionally, we employed a confidence gene targeting groEL, leading to 100% matching (753/753 bps) with T. inchonensis NCTC 10741 (GenBank accession no. LR131273.1), which has been incorrectly registered as wrong species name Tsukamurella paurometabola in the database. Under the diagnosis of T. inchonensis-associated SPE, we successfully treated the patient with imipenem/cilastatin administration for 4 weeks. Sequencing analysis of groEL was of great use in identifying the organism in this case. More clinical cases based on molecular diagnosis of the fastidious pathogens need to be accumulated to further understand the characteristics and appropriate treatment regimen.     

Improved screening for anal neoplasia by immunocytochemical detection of minichromosome maintenance proteins

PURPOSE: Early detection of anal intraepithelial neoplasia (AIN) and anal squamous cell carcinoma (SCC) by screening will improve clinical outcome. Assessment of anal cytology samples using routine Papanicolaou testing suffers from shortcomings in sensitivity and/or specificity, suggesting that screening tests based on biomarkers may be of value. We tested the suitability in this context of minichromosome maintenance (MCM) proteins, accurate markers of the deregulated cell cycle entry that characterizes malignancy and premalignancy. EXPERIMENTAL DESIGN: We undertook an initial immunohistochemical study of 54 anal tissue samples and validated our findings using an independent prospective cohort study of 235 anal cytology samples from 144 subjects. RESULTS: In the progression from normal anal epithelium through AIN to SCC, there was increasing expression of MCM2 and MCM5, including in the superficial epithelial third, the source of the majority of cells collected by anal swab. The median labeling indices (LI) for MCM2 and MCM5 in the superficial third of AIN2/3 and SCCs combined were 90.2% and 84.0%, respectively. MCM LIs in the superficial layers were significantly greater than LIs for Ki67, an alternative marker of cell cycle entry (P<0.0001). By immunocytochemistry using a mixture of anti-MCM2 and anti-MCM5 antibodies, immunopositive cells were readily identified in anal cytology samples, even at low magnification. MCM testing showed sensitivity for AIN2/3 of 84% (95% confidence interval, 75,93) and for AIN1/viral changes of 76% (68, 84), with overall specificity (for any lesion) of 77% (64, 90). CONCLUSIONS: MCMs are promising biomarkers for improving detection of AIN and SCC in anal cytology samples.