Alterations in the supraspinatus muscle belly with rotator cuff tearing: Evaluation with magnetic resonance imaging

We studied the supraspinatus muscle in patients with full-thickness rotator cuff tearing by analyzing its architecture on magnetic resonance imaging. Forty-six shoulders with rotator cuff tears requiring surgical repair were scanned parallel to the long axis of the supraspinatus muscle. We calculated the ratio of the largest width of the supraspinatus muscle belly to the distance from the greater tuberosity to the proximal end of the supraspinatus muscle. We classified the linear bands in the supraspinatus muscle, variation in its signal intensity, and irregularity and vagueness of its margins. The larger the rotator cuff tear, the more atrophic the supraspinatus muscle became. With increased atrophy, linear bands in the suprosupinotus muscle belly increased, muscle signal intensity became less uniform, and its margins became more irregular and vague.     

RENAL TRANSPLANTATION – AN EARLY EXPERIENCE

Renal transplant (RT) is now a therapy of choice for end stage renal disease (ESRD). The Nephrology Unit, Asvini started functioning in Dec 90 and to date 1298 sittings of hemodialysis have been given to 45 patients. Of these, 35 were in ESRD and 11 patients underwent renal transplantation at this hospital during the period Jan 91 – Dec 93. One patient expired after 18 months of transplantation due to infection. Early experience in screening patients for RT, use of immunosuppression, management of rejection episodes and protocol are presented with special emphasis on its relevance to the Armed Forces.KEY WORDS: Transplantation, Renal Failure, Immunosuppression, Rejection     

PCNA immunostaining combined with AgNOR staining in esophageal squamous cell carcinoma to identify patients with a poor prognosis

Immunostaining of the proliferating cell nuclear antigen (PCNA) provides important information about cell kinetics and is easily performed on routinely obtained formalin-fixed, paraffin-embedded materials. We report herein the results of a retrospective study on PCNA staining in esophageal cancer undertaken to determine its significance. As this study indicated that immunoreactivity was preserved in specimens fixed within 24 h, only 31 specimens from surgical patients were available for this investigation. The mean PCNA index of the patients without invasion to the adventitia (35.7±17.9) was significantly lower than that of those with invasion to the adventitia or neighboring structures (49.7±14.5), while the PCNA index did not correlate with other clinicopathologic parameters such as histologic type, lymph node metastases, or prognosis. However, when an analysis of PCNA staining was combined with an analysis of argyrophilic nucleolar organizer region (AgNOR) staining, a correlation with prognosis was found. In fact, seven patients with a high PCNA index (44) and AgNOR count (6) had a significantly poorer prognosis than the remaining 22 (P=0.0014), and six of these seven patients died within 2 years. These results indicate that this combined evaluation may be useful for the identification of patients with a poor prognosis among those undergoing surgery for esophageal squamous cell carcinoma.     

Problems of intravenous lidocaine treatment in status epilepticus or clustering seizures in childhood

Lidocaine was administered intravenously as a substitute for diazepam, to 12 patients with status epilepticus or clustering seizures aged 26 days to 11 years. The medication was very effective in 3 cases with acute convulsions, which disappeared immediately after infusion of lidocaine without relapse. The medication was effective only temporarily in 4 patients; they experienced relapsing seizures during drip infusion of lidocaine intravenously for maintenance. All the relapsing seizures were secondarily generalized ones with diffuse ictal discharges. In 2 cases of localization-related epilepsy, complex partial seizures evolved to secondarily generalized seizures immediately after administration of lidocaine. It must be noticed that in a relatively large number of cases lidocaine is ineffective or even harmful.     

Intracranial primitive neuroectodermal tumor in an infant: a case report

A 2-month-old girl with a supratentorial primitive neuroectodermal tumor (PNET), which extended into the skull, is herein presented. The patient underwent total removal of the tumor and also received a course of postoperative chemotherapy. After a follow-up period of 12 months, the infant is alive without recurrence. Histologically, the tumor was composed of poorly differentiated neuroectodermal cells, and these neoplastic cells showed a mild immunohistochemical reaction for GFAP and synaptophysin, and a moderate reactivity for neuron specific enolase and vimentin. In addition, a moderate level of immunoreactivity for HBA71 antigen (p30/32M1C2), which is the product of the M1C2 gene and is found in peripheral PNETs but not in central PNETs, was noted in many neoplastic cells. Although this tumor was located intracranially, it may be classified as a peripheral PNET.     

Effects of irrigation fluid temperature on choroidal circulation during vitrectomy.

PURPOSE: To investigate the effects of irrigation temperature on choroidal circulation during vitrectomy. METHODS: After anesthetized albino rabbits underwent closed vitrectomy, choroidal blood flow was monitored while the vitreous cavity was irrigated with solutions (BSS plus) of various temperatures (6-42 degrees C). Irrigation pressure was maintained at 15 mmHg. A non-contact Doppler laser flowmeter was used to measure choroidal blood flow. Temperature change at the retina and mid-vitreous was also measured during irrigation. RESULTS: Choroidal blood flow showed a downward peak when perfused at 34 degrees C. As irrigation temperatures deviated above or below 34 degrees C, the blood flow increased. However, when irrigation temperature was below 16 degrees C, the blood flow decreased as the temperature declined. The temperature at the retina was maintained at a relatively constant level when irrigation was between 30 degrees C and 40 degrees C. CONCLUSION: The choroid acts as a thermostat to minimize intraocular temperature fluctuations by changing its blood flow.     

Autologous mixed lymphocyte reaction and postoperative prognosis in patients with gastric carcinoma

The autologous mixed lymphocyte reaction (AMLR) represents a self recognitive response, which is very important in the immunoregulatory network system. We investigated whether the AMLR activity of patients with gastric carcinoma could reflect the postoperative prognosis to clarify the significance of autoreactivity in anti-tumor immune system in cancer patients. The AMLR activity was suppressed both in the peripheral blood and in the spleen of patients with gastric carcinoma. The patients were divided into two groups; high responder and low responder group. The former consisted of patients whose AMLR activity was extremely suppressed, and the latter of patients whose AMLR activity was mildly suppressed. The survival rate and disease-free survival rate were generally higher in the high responder group than in the low responder group, especially in the spleen. Moreover, none of the patients in the high responder group for the AMLR activity in the spleen died within three years. These results indicated that the AMLR activity could reflect the prognosis of patients who received conventional curative operation. Therefore, it was suggested that the AMLR might be a useful parameter of postoperative prognosis in gastric cancer patients and that autoreactive T cells might play a pivotal role in auto-specific immunological control of tumor growth and metastases.     

Focal cortical bone loss at the inferior aspect of the glenoid: A new radiographic sign of anterior shoulder instability

This report describes the detection of localized cortical bone loss at the inferior glenoid with the use of anteroposterior radiographs of the shoulder. This bone loss was noticed in two of 100 patients who had recurrent anterior instability of traumatic origin. Double-contrast arthrography and the operative findings disclosed that this lesion coincided anatomically with the scapular insertion of the detached anterior capsule. A survey of 544 radiographs from patients who had various other shoulder disorders did not detect any similar bony changes. Thus this pattern of bone loss, although small and uncommon, appears to be a new radiographic sign of damage to the anterior capsular mechanism.