3-Dimensional visualization of lesions in rat brain using magnetic resonance imaging microscopy

High-resolution (< 50 microm) magnetic resonance imaging microscopy (MRM) has been used to identify brain regions and localization of excitotoxin-induced lesions in fixed rat brains, subsequently confirmed using standard histology. The anatomical extent of lesions identified by MRM was identical to that seen in histological sections and various histopathological changes could be visualized. In contrast to the time involved in preparing and examining histological sections, lesions in intact brains could be rapidly identified and visualized in three dimensions by examining digitally generated sections in any plane. This study shows that MRM has tremendous potential as a prescreening tool for neurotoxicity and neuropathology. These observations suggest that MRM has the potential to affect pathology much as conventional MRI has influenced clinical imaging.     

Quadrilateral space syndrome: diagnosis, pathology, and treatment

Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.     

Durability of implant fixation after less-invasive total hip arthroplasty

Less-invasive techniques for total hip arthroplasty (THA) have sparked an increased interest among orthopedic surgeons and patients. There has been concern regarding decreased surgical exposure and compromise in prosthesis durability. We present the first long-term outcome of THA performed via the mini-incision posterior approach to show the durability of implant fixation. We compare the clinical and radiographic findings with previously published findings of authors using the same femoral implant and standard surgical techniques over a similar follow-up period. Ninety implants were followed for 10 to 13 years. Clinical evaluation revealed a Harris Hip Score of 92.3. Radiographic evaluation revealed proximal bone atrophy in 57% and lucent lines in 14% of femurs and 11% of cups. Osteolysis was noted in 10% and was associated with polyethylene wear. There were no cases of aseptic stem loosening. Eight polyethylene inserts were revised for wear. These 10-year minimum follow-up findings are consistently comparable with previously published studies using the same implant and larger surgical approaches followed for a similar period. Mini-incision THA technique did not compromise the long-term clinical and radiographic findings when compared with conventional techniques.     

Hypercoagulable State

Background

The hypercoagulable state results from a complex interplay of blood coagulation factors, coagulation-inhibitory factors, platelets and the vascular endothelium. Imbalance of the complex interplay between these factors results in thrombosis often complicated by embolism. The causes of thrombosis are varied and maybe congenital or acquired. The current interest is centered on the congenital deficiency of coagulation inhibitors as there is an increasing awareness of their involvement in thrombosis, especially in the young.

Methods

A total of 42 patients with thrombosis were studied. The most common clinical presentation was deep vein thrombosis. All the cases were evaluated for coagulation inhibitors Antithrombin, resistance to activated protein C, Protein C and Protein S using standard assay kits.

Results

Resistance to activated protein C (n=10) was seen to be the commonest cause of thrombophilia. This was followed by deficiency of Antithrombin (n-4), Protein C (n=3) and Protein S (n=2). Majority of our cases were in the third decade of life.

Conclusion

The identification of the underlying aetiology is important for instituting specific therapy and patient management.Key Words: Thrombophilia, Coagulation inhibitors     

Methamphetamine and Other Substance Use During Pregnancy: Preliminary Estimates From the Infant Development, Environment, and Lifestyle (IDEAL) Study

Objectives: Methamphetamine use is a continuing problem in several regions of the United States and yet few studies have focused on prenatal methamphetamine exposure. The purpose of this study was to estimate the prevalence and correlates of alcohol, tobacco, and other substance use—including methamphetamine—during pregnancy. Methods: The sample consisted of the first 1632 eligible mothers who consented to participate in a large-scale multisite study focused on prenatal methamphetamine exposure. This unselected screening sample included both users and nonusers of alcohol, tobacco, methamphetamine, and other drugs. Substance use was determined by maternal self-report and/or GC/MS confirmation of a positive meconium screen. Results: Overall, 5.2% of women used methamphetamine at some point during their pregnancy. One quarter of the sample smoked tobacco, 22.8% drank alcohol, 6.0% used marijuana, and 1.3% used barbiturates prenatally. Less than 1% of the sample used heroin, benzodiazapenes, and hallucinogens. Multivariate modeling results showed that tobacco smokers and illicit drug users were more likely to be single and less educated, have attended less than 11 prenatal visits, and utilize public financial assistance. Conclusions: This is the first large-scale investigation to report the prevalence of methamphetamine use during pregnancy in areas of the United States where methamphetamine is a notable concern. Follow-up research is ongoing to investigate the outcomes associated with prenatal methamphetamine exposure. Given that this research extends and confirms previous findings showing that high-risk groups of pregnant women can be identified on the basis of basic demographic characteristics, targeted interventions are greatly needed to reduce serious adverse outcomes associated with prenatal alcohol and tobacco use.     

Health measurement in the third era of health

When writing about “the second epidemiologic revolution,” Terris discussed 2 eras in health. The first era—the communicable disease era—began during ancient times and continues today; the second era—the chronic disease era—began during the 20th century, particularly among the industrialized nations.

Although neither revolution against these types of diseases is complete, we have made such considerable progress that substantial and growing segments of the population no longer regard disease as the only, or even the primary, health problem. Increasingly, the goal is a long and fruitful life, not simply the absence of disease. That potential and the effort to achieve it compose the third era of health, and a proposed new measure of health is outlined in this article.

     

What do stroke patients and their carers want from community services?

BACKGROUND: Previous research has focused on the longer term needs of 'new' stroke patients at fixed time intervals after the event, but neglected those of stroke patients who may have had the event many years earlier. OBJECTIVE: To identify the long-term support needs of patients with prevalent stroke, and their carers identified from practice stroke registers. DESIGN OF STUDY: Patients and their carers were invited to attend focus groups at the university, a nursing home or in the community. SETTING: Seven practices in South Birmingham. Adults (18+) with a validated record of stroke. METHODS: Focus groups were audio-taped and data analysed using a constant comparison method. RESULTS: Twenty-seven patients and six carers participated in the study. Three major themes emerged: emotional and psychological problems; lack of information available for patients and their families; the importance of Primary Care as the first point of contact for information or problems, even if these were non medical. CONCLUSIONS: Better methods of providing information for long-term survivors of stroke, and for addressing their emotional and psychological needs are required. Primary care could be a key setting for helping to provide more inclusive services for both patient and carer.     

Endolymphatic sac tumors in patients with and without von Hippel-Lindau disease: the role of genetic mutation, von Hippel-Lindau protein, and hypoxia inducible factor-1alpha expression

OBJECT: Endolymphatic sac (ELS) tumors are low-grade malignancies of the temporal bone that are associated with von Hippel-Lindau (VHL) disease but can also occur sporadically. The VHL gene product VHL protein is important in the regulation of hypoxia inducible factor (HIF)-1alpha, which controls expression of molecules that are important in angiogenesis and cell metabolism. In this study the authors examine the role of VHL and HIF-1 in ELS tumors. METHODS: The ELS tumors from three patients were examined using the following method: DNA from tumor tissue was isolated, amplified by polymerase chain reaction and the VHL gene sequence was compared with the known wild-type sequence. Loss of heterozygosity (LOH) studies were performed to confirm the sequencing data. Immunohistochemical evaluation for VHL, HIF-1alpha, vascular endothelial growth factor (VEGF), and carbonic anhydrase IX (CA IX) was performed. Snap-frozen tumor tissue was examined using Western blot and HIF-1 immunoassays for HIF-1alpha and VHL expression. Two patients had sporadic ELS tumors and the other one suffered from VHL disease. Results of VHL gene sequencing were normal in the tissue derived from the sporadic ELS tumors. The ELS tumor, pheochromocytoma, and spinal hemangioblastoma were heterozygous for the same C-to-A transversion found in the germline carried by the patient with VHL disease. No LOH was detected in the tumor tissue obtained in the patient with VHL disease. Expression of HIF-1alpha, VEGF, and CA IX evaluated using immunohistochemical studies was elevated in the VHL-associated tumors. Nevertheless, Western blots and immunoassays for HIF-1alpha did not show elevated expression in these tumors. CONCLUSIONS: The sporadic and VHL disease-associated ELS tumors in this study had normal VHL-mediated HIF-1 regulation. This is a result of normal VHL gene expression in the case of the sporadic ELS tumor. In the VHL-associated ELS tumor, this is due to one normal copy of the VHL gene and adequate VHL gene expression.