Rotator interval lesion

Arthrography and surgical exploration reveal the pathogenesis of a painful shoulder syndrome characterized by inferior instability in the rotator interval (RI). The RI is the space between the subscapularis and the adjacent supraspinatus interval. Two types of RI lesions can be identified. Type I, a contracted state, is characterized by inflammatory changes in superficial bursal area. In Type II, an unstable condition is associated with extensive inflammation of deeper tissues in the RI. In a series of 101 patients, including 106 shoulders with RI lesions, surgical repair of the RI was performed with the shoulder in an externally rotated position. This position ensured a close fit of the supraspinatus and the subscapularis attachments. Of 78 shoulders evaluated in a follow-up study, 96% were graded good or excellent, and 4% poor. This investigation presents evidence for the importance of diagnosis and treatment of RI lesions in patients with persistent pain in the shoulder.     

Evidence for dopaminergic innervation on kitten retinal ganglion cells

Effects of iontophoretically applied dopamine and its receptor antagonists on physiologically identified retinal ganglion cells were studied in the optically intact eye of pentobarbitone anaesthetised kittens (7-9 weeks of age) and the results were compared with the effects obtained from adult cats (18-22 weeks of age). In both the adult and the kitten, dopamine had an inhibitory effect on visually evoked and spontaneous activity of the retinal ganglion cells, irrespective of cell type. However, unlike in the adult, the effects of dopamine in kittens were variable and not dependent on retinal eccentricity. In adult cells, only L-sulpiride (a potent D2 receptor antagonist) reduced the inhibitory effect of exogenous dopamine, whereas in kitten cells, both alpha-flupenthixol (a potent D1 receptor antagonist) and L-sulpiride did so. When applied alone, neither alpha-flupenthixol nor affected the activity of ganglion cells in adults, but in kittens both antagonists produced an excitatory effect in some cells. Physiologically active dopaminergic innervation seemed, therefore, to be present on the immature ganglion cells, but was subsequently 'eliminated' during the course of postnatal development. Furthermore, in immature cells, both D1 and D2 type receptors are present but only D2 receptors remain in adult. Therefore, there is a mismatch between dopamine receptors and dopamine in the adult retina and this mismatch may be the consequence of a developmental event.     

Time and cost involved in the care of newly registered patients with diabetes mellitus and other lifestyle diseases at diabetes clinics in Japan (JDDM 4).

AIMS: To study the time and cost involved in the care of newly registered outpatients with Type 2 diabetes mellitus (DM), compared with patients with hypertension and/or hyperlipidaemia (HTL). METHODS: A total of 313 patients with DM and 58 patients with HTL without diabetes were registered on their first visits to 11 diabetes clinics across Japan. The time and cost involved in their care was recorded over the following 5 months. RESULTS: In the first 3 months, there was an extensive time commitment to both groups. The time spent by physicians was 1.5 times longer for DM than for HTL. The total care time spent by all the care providers for DM was twice that for HTL. The cost of DM care was twice that for HTL, with the cost of medicines excluded. However, half of the cost for DM was for laboratory tests. When these were excluded, and the remaining cost divided by the time spent, the amount for DM was half of that for HTL. Over the 5 months, mean glycated haemoglobin (HbA(1c)) in DM patients improved from 8.0% to 6.5%, and 72% of DM patients achieved the glycaemic target of HbA(1c) < or = 6.5%. CONCLUSIONS: DM care in a diabetes clinic requires a great deal more time and resources than HTL to achieve the best outcome. An educational system for self care, presently lacking in the primary care setting in Japan, would improve glycaemic control for DM patients in the community.     

发挥远程教育优势推进医学继续教育发展

《教育部关于加强高校网络教育学院管理提高教学质量的若干意见》中强调指出：高校网络教育学院要以在职人员的继续教育为主，要充分发挥网络教育的优势，为在职人员更新知识、增强技能、不断学习、不断提高提供良好的服务。然而，要使医学院校在开展继续教育中发挥更大的作用，推进医学继续教育的发展，远程教育不仅是解决这一问题的有效途径，而且将成为开展医学继续教育的强大动力。     

Molecular genetics and transfusion management in a child with Bernard Soulier syndrome.

We present a case of Bernard Soulier syndrome in a 9-year-old boy caused by a novel genetic mutation. This child was shown to be homozygous for a single nucleotide deletion (c.1077delG) in the GP1BA gene not previously reported. Clinically, the boy has become refractory to platelet transfusions with both allo-antibodies and iso-antibodies and a massive transfusion requirement for ongoing haemorrhage. We describe the critical role that the blood product transfusion continues to play in the management of Bernard Soulier syndrome and discuss therapeutic options in these patients.     

Cardiac metastasis of renal pelvic cancer

Abstract:   A 66-year-old man was referred to our hospital with chest discomfort and shortness of breath. Seven months previously he had undergone a laparoscopic left nephroureterectomy for a left renal pelvic tumor and was given two cycles of adjuvant chemotherapy (methotrexate, epirubicin and cisplatin). Echocardiogram showed an 8-mm sized mass extending from the right atrium into the right ventricle. On computed tomography, multiple lung tumors, as well as the right atrial and ventricular mass, were seen. The patient died of acute heart failure caused by right ventricular outflow obstruction. On autopsy, a right atrial and ventricular metastasis of the initial transitional cell carcinoma was found. The patient's cause of death was acute heart failure as a result of cardiac metastasis of his initial renal pelvic carcinoma.     

Nucleolar organizer regions in meningioma

Seventy-eight cases of meningioma and related tumors were examined independently using a simple and reproducible argyrophilic method for the demonstration of nucleolar organizer regions (AgNORs) and staining with bromodeoxyuridine monoclonal antibody. The mean number of AgNORs per cell and the bromodeoxyuridine labeling index were shown to be linearly related (r = 0.84, P less than 0.001). The mean AgNOR number was 2.99 for meningeal sarcoma, 2.29 for anaplastic meningioma, 2.08 for hemangiopericytic meningioma. 1.72 for recurrent meningioma without atypical histological findings, and 1.52 for nonrecurrent meningioma. We noted that the mean number of AgNORs reflected the cellular kinetics of a tumor and was related to histological grade and clinical behavior.     

Development of neurochemical separation of ON and OFF channels at retinal ganglion cells

Anatomical and physiological segregation of neurons into ON (brightening detector) and OFF (darkening detector) channels in the retina and subsequent visual system ensure the high sensitivity required for contrast detection and spatial discrimination. This segregation is finest at the visual axis. Neurochemically, ON and OFF ganglion cells at the visual axis seem to be distinguished by different inhibitory transmitters but not excitatory transmitters. Microiontophoretic studies of inhibitory transmitters on the retinal ganglion cells in kittens and adult cats suggest that this neurochemical distinction is poor in immature ganglion cells at the visual axis. Initially both ON and OFF cells seem to be supplied by GABAergic, glycinergic, and catecholaminergic amacrine cells, but in adults, ON cells remain supplied only by GABAergic amacrines, while OFF cells are supplied by glycinergic amacrines. Postnatal elimination of multiple inputs and strengthening of the appropriate inputs, as seen in the central nervous system, also seem to occur at the retinal neurotransmitter synapses during development.