The presence of citrulline in salivary glands is evidence that nitric oxide is mediator of inflammation in Sjögren acinar epithelia

Aim: The present study addresses the question whether nitric oxide (NO) plays a role in inflammation of salivary glands in Sjögren's syndrome. Methods: The expression of inducible nitric oxide synthase (iNOS) and the presence of citrulline, as a monitor of NO activity were studied by immunohistochemistry, in minor salivary glands from 24 patients with primary Sjögren syndrome. An equal number of control tissues were included. The presence of mRNA of eNOS (endothelial NOS) and iNOS in tissues was studied by fluorescent in situ hybridization. Results: All salivary glands displayed eNOS along the ductal epithelia, blood vessels and acini. In Sjögren disease iNOS enzyme was widely expressed along ductal epithelia, acini and in foci of lymphocyte infiltration; therefore by the extensive citrulline presence and iNOS, we infer that NO is related to inflammation. Control biopsies were negative for iNOS and citrulline. Conclusion: The present data suggest that local production of NO should contribute to salivary gland inflammation in Sjögren disease.     

Role of defecography in predicting clinical outcome of rectocele repair

PURPOSE: The aim of this study was to evaluate the role of defecography in predicting clinical outcome of rectocele repair. METHODS: Between January 1988 and July 1994, 74 consecutive patients (median age, 54 (range, 35–81) years) with a rectocele and symptoms of obstructed defecation were studied prospectively. After preoperative evaluation by a standardized questionnaire, physical examination, and defecography, a combined transvaginal/transanal rectocele repair was performed. At follow-up, all patients had defecography. Long-term results were qualified by an independent observer after a median follow-up of 58 (range, 14–89) months as excellent, good, or poor. RESULTS: Rectocele repair was considered excellent in 37 patients and good in 13 patients. Defecography six months after surgery did not show persistent or recurrent rectocele in any of the patients. Size of the rectocele, barium-trapping in the rectocele, internal intussusception, rectal evacuation, and perineal descent did not appear to influence clinical outcome. Radiologic evidence of anismus did not correlate with longterm results of rectocele repair. CONCLUSIONS: Combined transanal/transvaginal repair of rectocele is an efficient therapy in patients with obstructed defecation. Various defecographic parameters (size of rectocele, internal intussusception, rectal evacuation, perineal descent, radiologic signs of anismus) do not appear to influence clinical outcome of surgery. The main value of defecography is the objective demonstration of rectocele and any associated abnormalities such as an enterocele preoperatively and again in objective assessment of the postoperative results.     

Acute knee trauma: value of a short dedicated extremity MR imaging examination for prediction of subsequent treatment

PURPOSE: To assess the predictive value of a short magnetic resonance (MR) imaging examination, in addition to or instead of radiography, performed in patients with acute knee trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS: The randomized controlled trial and use of collected data for prediction modeling were approved by the institutional review board; informed consent was obtained. Patients with recent knee injury were included in the trial if radiography was ordered. They were randomized into a group undergoing only radiography and a group undergoing radiography plus immediate MR imaging. A 0.2-T dedicated extremity MR imager and four short pulse sequences were used. Univariable and multivariable logistic regression analysis was used to evaluate patient characteristics, trauma mechanism, and findings at radiography and MR imaging for their value in prediction of need for subsequent treatment within the 6-month follow-up. RESULTS: Data in 189 patients (123 male patients, 66 female patients; mean age, 33.4 years), 109 of whom underwent treatment after their initial visit, were analyzed. Age of 30 years or older, indirect trauma mechanism, radiographic results, and MR imaging results were significant predictors of need for treatment in univariable and multivariable analyses (P < .05). In the multivariable analysis, only abnormal MR imaging results were significantly predictive of need for treatment, and only when MR imaging replaced radiography (odds ratio, 2.61; 95% confidence interval: 1.12, 6.06). CONCLUSION: Implementation of a dedicated extremity MR imaging examination, in addition to or instead of radiography, performed in patients with traumatic knee injury improves prediction of the need for additional treatment but does not significantly aid in identification of patients who can be discharged without further follow-up. Value of a short MR imaging examination in the initial stage after knee trauma is limited.     

Acute ankle trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment

PURPOSE: To assess predictive value of a short magnetic resonance (MR) imaging examination with or instead of radiography performed in patients with acute ankle trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS: Informed consent was obtained from all participating patients, and the institutional review board approved the randomized controlled trial and use of data to create prediction models. In a prospective controlled trial, 197 patients with recent ankle trauma (92 women, 105 men) were randomized into two groups: those who underwent radiography and those who underwent a combination of radiography and MR imaging. Data about side of injury, trauma mechanism, and results of radiography and MR imaging were collected. Additional treatment was necessary in 109 of 197 patients after their initial hospital visit. With univariable and multivariable regression analysis, four models were created for prediction of treatment. RESULTS: In univariable analysis, age (odds ratio [OR], 1.02; 95% confidence interval: 1.00, 1.04), radiographic results (OR, 7.92; 95% confidence interval: 3.17, 19.8), and positive or uncertain results in patients who underwent MR imaging versus patients who did not (OR, 2.42; 95% confidence interval: 1.25, 4.70) were predictive of treatment. In the multivariable analysis, positive or uncertain MR imaging results (OR, 2.61; 95% confidence interval: 1.28, 5.30) contributed significantly to prediction of subsequent treatment. Negative MR imaging results did not contribute significantly (OR, 0.66; 95% confidence interval: 0.27, 1.61). CONCLUSION: A limited MR imaging examination in initial evaluation of acute ankle injury with radiography has additional predictive value in identification of patients who need treatment but does not add significant information in identification of those who can be discharged without further follow-up. A limited MR imaging examination cannot replace radiography for prediction of need for additional treatment.     

The active straight leg raising test and mobility of the pelvic joints

Objective signs to assess impairment in patients who are disabled by peripartum pelvic girdle pain hardly exist. The purpose of this study was to develop a clinical test to quantify and qualify disability in these patients. The study examined the relationship between impaired active straight leg raising (ASLR) and mobility of pelvic joints in patients with peripartum pelvic girdle pain, focusing on (1) the reduction of impairment of ASLR when the patient was wearing a pelvic belt, and (2) motions between the pubic bones measured by X-ray examination when the patient was standing on one leg, alternating left and right. Twenty-one non-pregnant patients with peripartum pelvic girdle pain in whom pain and impairment of ASLR were mainly located on one side were selected. ASLR was performed in the supine position, first without a pelvic belt and then with a belt. The influence of the belt on the ability to actively raise the leg was assessed by the patient. Mobility of the pelvic joints was radiographically visualized by means of the Chamberlain method. Assessment was blinded. Ability to perform ASLR was improved by a pelvic belt in 20 of the 21 patients (binomial two-tailed P = 0.0000). When the patient was standing on one leg, alternating the symptomatic side and the reference side, a significant difference between the two sides was observed with respect to the size of the radiographically visualized steps between the pubic bones (binomial two-tailed P = 0.01). The step at the symptomatic side was on average larger when the leg at that side was hanging down than when the patient was standing on the leg at that side. Impairment of ASLR correlates strongly with mobility of the pelvic joints in patients with peripartum pelvic girdle pain. The ASLR test could be a suitable instrument to quantify and qualify disability in diseases related to mobility of the pelvic joints. Further studies are needed to assess the relationship with clinical parameters, sensitivity, specificity and responsiveness in various categories of patients. In contrast with the opinion of Chamberlain, that a radiographically visualized step between the pubic bones is caused by cranial shift of the pubic bone at the side of the standing leg, it is concluded that the step is caused by caudal shift of the pubic bone at the side of the leg hanging down. The caudal shift is caused by an anterior rotation of the hip bone about a horizontal axis near the sacroiliac joint. Received: 7 November 1998 Revised: 6 July 1999 Accepted: 9 September 1999     

Cajal间质细胞研究进展

西班牙神经解剖学家Cajal首次在消化道肌肉层观察并描述了Cajal间质细胞的形态结构,发现他们在肠道内源性神经系统末梢发挥作用．后来人们进一步研究发现,他们是胃肠道起搏细胞,胃肠动力障碍性疾病与他们的分布和形态学异常有关．但在最近几年,人们在腺体、脉管系统、泌尿生殖系统中陆续鉴定出此类Cajal间质细胞,人们开始重视Caial间质细胞在胃肠道以外器官和组织中的作用,试图阐明他们的形态结构和生理功能．这些细胞在形态学上与胃肠道Cajal间质细胞十分相似,但也存在少量迥异之处,他们很可能属于Cajal间质细胞新的亚型．这些发现将会使人们对Cajal间质细胞产生新的认识,同时也对Cajal间质细胞重新分类有着重要影响．     

A healthy birth after intracytoplasmic sperm injection by using immotile testicular spermatozoa in a case with totally immotile ejaculated spermatozoa before and after Percoll gradients

Total asthenozoospermia is a severe problem, as only a micromanipulation technique can assist the couple, and even then fertilization and pregnancy rates are very low. The first healthy birth, achieved by using testicular immotile spermatozoa in a case with total asthenozoospermia before and after Percoll gradient preparation, is reported.      

Pelvic phleboliths: is there an association with diverticulitis?

Pelvic phleboliths are familiar structures to radiologists although their pathogenesis is not fully understood. The literature suggests a relationship between the prevalence of phleboliths and diverticular disease, and with a low-fibre diet. Phleboliths are said to be seen more frequently in women and on the left side in the pelvis. Their number seems to increase with advancing age. We have attempted to establish relations of phleboliths with diverticulitis, diverticulosis, sex, age and pelvic location. In this study the only statistically significant relation was an increase of the number of phleboliths with advancing age.     

Case report 724

A 15-year-old girl presented with the typical clinical, serological, and pathological lesions of yaws. The patient was a native of Sumatra. The important diagnostic criteria and the relationship to venereal syphilis were discussed.