Midterm follow-up of young patients fused in situ for spondylolisthesis

To evaluate the results of posterolateral fusion alone (66 patients) and combined posterolateral and anterior fusion (39 patients) in situ, 105 consecutive patients younger than 25 years of age with spondylolisthesis, retrospectively were examined clinically and radiologically. The follow-up rate was 98% after a mean of 8.2 years (range, 2.0-15.3). Pre- and postoperative progression of slip was rare (6% and 1%, respectively), and no prognostic factors were found. The definite pseudarthrosis rate was 6%. In patients with low- and high-grade slip, 67% and 88% (respectively) were satisfied at follow-up, suggesting that the indication for operative treatment in patients with low-grade slip is relative.     

Oblique reformatting of multislice magnetic resonance images for improved visualization of coronary arteries

A technique for reformatting multislice magnetic resonance images into arbitrary oblique planes has been developed and implemented on a Toshiba MRT-35 (formerly Diasonics MT/S) imaging system (South San Francisco, CA). This method is designed to allow the user to easily define a new plane by marking with a cursor features of interest on two or three different image levels. These features are combined in the resulting oblique image. The reformatted image can have arbitrary angulation and is created with a pixel dimension equivalent to the original data set. Resolution ranges from the original in-plane resolution to the slice thickness, depending on angulation. An improvement in signal-to-noise ratio results from the effective averaging performed by interpolation. This method is optimally used to correct for small variations in alignment, such as the positioning of the intervertebral disks. It can also be used to generate reformatted images at many different angles from a single multislice data set. This method has been applied to the particular problem of improving the presentation of coronary arteries on a conventional set of multislice spin-echo cardiac images by increasing the visible length of individual coronary segments.     

Spinal epidural hematoma after a pathologic compression fracture: an unusual presentation of multiple myeloma.

BACKGROUND CONTEXT: Spinal epidural hematoma can result from traumatic and atraumatic etiologies. Atraumatic spinal epidural hematomas have been reported as an initial presentation of multiple myeloma. There are no other reports previously describing spinal epidural hematoma after a pathologic spinal fracture. PURPOSE: To present the first reported case of a spinal epidural hematoma after a pathologic fracture and a very unusual initial presentation of multiple myeloma in a young patient. STUDY DESIGN/SETTING: Case report. METHODS: A healthy asymptomatic 37-year-old male was struck in the head with a ball while playing soccer. Initial symptoms included severe back pain without neurologic symptoms. Complete motor paralysis developed over the next 24 hours in the lower extremities with a sensory level of T10. Magnetic resonance imaging evaluation of the spine revealed a T6 compression fracture with a dorsal T3 to T10 epidural hematoma. The patient underwent surgical T2 to T8 posterior spinal decompression with evacuation of the hematoma. Serum and urine electrophoresis and bone marrow biopsy were performed. RESULTS: The results of the electrophoresis revealed an immunoglobulin A monoclonal spike. The bone marrow biopsy was positive for plasma cell myeloma. Recovery of some motor function was noted in both lower extremities postoperatively. The patient was subsequently started on steroids and chemotherapy for myeloma. The patient has also undergone bone marrow transplant, and his myeloma is currently in remission. CONCLUSION: This is the first reported case of spinal epidural hematoma after a pathologic spinal fracture. Also, this case represents an unusual initial presentation of multiple myeloma in a young patient.     

Labeling in vivo of sigma receptors in mouse brain with [3H]-(+)-SKF 10,047: Effects of phencyclidine, (+)- and (−)-N-allylnormetazocine,and other drugs

The sigma receptor, so named because of the distinct pharmacolgical profile produced by its prototypic agonist SKF 10,047 (N-allynormetazocine), is believed to mediate mania and psychotomimetic effects in man. While this sigma receptor has received extensive biochemical and pharmacological characterization in vitro, little information is available on the nature of the sigma site in vivo. In the present study, we examined the binding of [³H]-(+)-SKF 10,047 to sigma receptors in mouse brain in vivo and to sigma receptors in mouse and guinea pig brain in vitro and determined the relative potencies of various drugs in displacing this ligand. Mice were injected with 5 μCi of [³H]-(+)-SKF 10,047 into the tail vein. After various time intervals, the mice were decapitated; their brains were rapidly removed, weighed, and homogenized in 50 mM Tris-HCI buffer, pH 7.7; and total and particulate bound radioactivity were determined. Specifically bound [³H]-(+)-SKF 10,047 in the particulate fraction was defined as the difference in total radioactivity in the particulate fraction obtained from vehicle-injected mice minus the radioactivity in the particulate fraction from haloperidol (2 mg/kg i.p.)-injected mice. Specifically bound [³H]-(+)-SKF 10,047 in the particulate fraction reached peak levels of 30 min after i.v. injection and constituted 90–95% of the total particulate radioactivity. Labeling of the sigma sites could be blocked in vivo by injecting mice i.p. with the drug 30 min before the i.v. injection of the ³H-ligand. Under these conditions, (+)-SKF 10,047, (+)-3-PPP, cyclazocine, pentazocine, and haloperidol were found to be the most potent compounds in reducing specific [³H]-(+)-SKF 10,047 binding. Neuroleptics such as thioridazine and chlorpromazine had good potency, while clozapine, spiperone, and sulpiride were very weak inhibitors in vivo. Specific [³H]-(+)-SKF 10,047 binding was also reduced in vivo by imipramine, dl-propranolol, bupropion, rimcazole, and phenoxybenzamine, but was not reduced by apomorphine and naloxone at doses of 50 mg/kg i.p. Phencyclidine, m-NH₂-PCP and (?)-3-PPP were only weak inhibitors of (+)-SKF 10,047 binding in vivo. The relative potencies of these agents obtained in vivo correspond well with their relative affinities obtained in vitro in mouse and guinea pig brain for displacing [³H]-(+)-SKF 10,047 but not with their relative affinities for displacing TCP in guinea pig brain. Comparison of the dose-response curves for the drug revealed the presence of perhaps two sites labeled by [³H]-(+)-SKF 10,047 in vivo.     

Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity.

BACKGROUND: Individuals with schizotypal personality disorder (SPD) share cognitive deficits with schizophrenic patients, suggesting that these deficits represent a core feature of the schizophrenia spectrum. We investigated the neuropsychological profile in SPD patients compared with two comparison groups: healthy volunteers (HV) and patients who met criteria for another non-schizophrenia spectrum personality disorder (NSS). METHODS: We tested 48 DSM-III-R SPD patients, 22 NSS and 32 HV on a neuropsychologic battery that included the California Verbal Learning Test (CVLT), Trail Making A and B, the DOT test of working memory, the Stroop Color-Word Interference, the Paced Auditory Serial Addition Test (PASAT), the Wechsler Memory Scale Visual Reproduction Test (WMSV-R), and the Wechsler Adult Intelligence Scale vocabulary and block design. RESULTS: Normative standards for performance were created using the HV group. SPD patients performed significantly worse compared with HVs; specifically, SPD patients demonstrated impaired performance on the PASAT and the WMSV-R immediate and delayed recall compared to HV. Moreover, SPD patients were impaired in the PASAT and the WMSV-R immediate condition compared with the NSS group. The NSS patients did not differ from HV on any of the cognitive tasks. The interpersonal factor of the schizotypal symptoms inversely correlated with the PASAT score (r = -.32, p <.006). CONCLUSIONS: Compared with HVs, SPD patients demonstrate modest cognitive impairment. These differences reached statistical significance for the PASAT (an auditory working memory task), and the WMSV-R immediate and delayed recall (a learning-recall test). In contrast, performance of NSS patients did not differ from that of HVs. The types of deficits observed in SPD patients are qualitatively similar to but milder than those seen in patients with schizophrenia.     

Beak and feather disease virus infection in cockatiels (Nymphicus hollandicus).

Psittacine beak and feather disease is known to occur in a wide range of psittacine species; however, there are no scientific or credible anecdotal reports of psittacine beak and feather disease occurring in the cockatiel (Nymphicus hollandicus) despite it being one of the world's most commonly kept companion bird species. Consequently, this has resulted in speculation that the species may have some innate resistance to beak and feather disease virus (BFDV) infection. To investigate this hypothesis we conducted a survey of cockatiels (n=88) at commercial aviaries to investigate whether BFDV infection occurs in cockatiels, and found that all birds were virus-free by polymerase chain reaction and haemagglutination assay and had no detectable antibody titre by haemagglutination-inhibition assay. In addition to this, we sequenced the genome of two BFDV isolates obtained from diseased cockatiel feathers and performed cross-reactivity assays using virus eluted from these feathers and sera from naturally immune psittacine birds. Serological cross-reactivity results and phylogenetic analysis of the nucleotide sequences indicated that the cockatiel virus isolates were serologically and genetically different to other BFDV isolates. This is the first paper to report evidence of an antigenically distinct BFDV in psittacine birds.     

Early diagnosis of hemochromatosis-related cardiomyopathy with magnetic resonance imaging.

The hallmark of hemochromatosis is the deposition of iron in multiple tissue types, most notably the skin, liver, pancreas, thyroid, and heart. Definitive diagnosis of iron deposition generally requires invasive methods, such as direct tissue biopsy. We describe a 40 year-old woman with end-stage liver disease secondary to hereditary hemochromatosis and alcohol abuse, who was referred to the cardiology service as part of an evaluation for orthotopic liver transplant. The patient had no cardiac history but a dobutamine stress echocardiogram, performed as a portion of the pre-operative cardiac evaluation, could not be completed due to intermittent, supraventricular tachycardia. Additional cardiac testing, including electrocardiography and resting echocardiography, raised suspicion for cardiomyopathy related to hemochromatosis but was non-diagnostic. Cardiac magnetic resonance (MR) of this patient revealed deposition of iron in the myocardium and established the diagnosis of hemachromatosis-related cardiomyopathy. These findings suggest that cardiac MR may be more sensitive than other non-invasive, diagnostic tools in the initial evaluation of hemochromatosis-related cardiomyopathy and may be used as an alternative to myocardial biopsy. We propose that conventional T1- and T2-weighted spin echo MR sequences can be used routinely as non-invasive modalities to assess the presence of iron deposition in the tissues of patients with hemochromatosis.     

Exercise Tolerance in Patients With Ebstein’s Anomaly

Objectives. The purpose of this study was to identify the determinants of exercise tolerance in patients with Ebstein’s anomaly.

Background. Patients with Ebstein’s anomaly of the tricuspid valve may have exercise limitation that improves after surgical repair.

Methods. One hundred seventeen patients performed cycle ergometry for a total of 124 tests (preoperative test in 76 patients, postoperative test in 23, test but no operation in 18, preoperative and postoperative test in 7). Multiple linear regression analysis was used to identify predictors of maximal oxygen uptake, oxygen saturation and heart rate at peak exercise.

Results. Age at the time of exercise ranged from 6 to 60 years (median 15). An atrial septal defect was present in 67 patients (88%) preoperatively. Compared with the preoperative group, the postoperative group had significantly higher maximal oxygen uptake (mean [±SD] 20.5 ± 7.4 vs. 25.3 ± 7.0 ml/kg body weight per min, p = 0.006). Postoperative rest and exercise blood oxygen saturation was higher than that measured preoperatively (p = 0.0001). Six of seven patients tested before and after the operation showed improved exercise tolerance. Preoperatively, major predictors of maximal oxygen uptake were oxygen saturation at rest (p = 0.01) and age (p = 0.0001). Preoperatively, the major predictor of oxygen saturation at peak exercise was rest oxygen saturation (p = 0.0001), and major predictors of peak exercise heart rate were rest heart rate (p = 0.01) and rest oxygen saturation (p = 0.01). In the postoperative group, predictors of maximal oxygen uptake included age at exercise testing, male gender and heart size.

Conclusions. Definitive operation for Ebstein’s anomaly results in improved exercise tolerance. Before the operation, rest oxygen saturation is the major predictor of exercise tolerance, oxygen saturation at peak exercise and peak heart rate. Postoperatively, age, gender and heart size influenced maximal oxygen uptake.

(J Am Coll Cardiol 1997;29:1615–22)     

Outcome of renal transplantation in patients treated with erythropoietin.

The introduction of treatment with recombinant human erythropoietin (rhEPO) has raised the possibility of deleterious effects on early kidney graft function. Due to renal anemia, the great majority of patients waiting for kidney transplantation until now have had a low hematocrit. It has been suggested that a low hematocrit is beneficial for early kidney graft function by protecting the transplanted kidney from so-called reperfusion damage, which results in delayed onset of renal function. We have retrospectively examined the early function of 26 kidney grafts transplanted to uremic patients with rhEPO corrected anemia. Compared with a randomized control group no significant differences were seen in the rate of immediate onset of graft function, graft survival or serum levels of creatinine one year after transplantation. We conclude that the reversing of anemia by rhEPO in recipients of cadaver kidneys does not impair early graft function.