Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy

Long thoracic nerve palsy causes weakness of the serratus anterior muscle and winging of the scapula. It is usually traumatic in origin. Isolated long thoracic nerve palsy has not been recognized as the major manifestation of familial brachial plexus neuropathy, but I have studied the syndrome in four members of three generations of one family. One individual suffered an episode of facial paresis. The inheritance pattern was autosomal dominant.     

Transferrin receptors and natural killer cell lysis. A study using Colo 205 cells exposed to 60 Hz electromagnetic fields

The role of target cell transferrin receptors (TfR) in natural killer (NK) cell-induced cytolysis has been studied using Colo 205 cells in which prior exposure to 60 Hz electromagnetic fields produced constitutive expression of maximum numbers of TfR. It was found that NK cell cytolysis was decreased in those cells expressing the highest levels of TfR, while cells expressing the lowest level of TfR were lysed to the greatest extent. Furthermore, pretreatment of target cells with, and the continued presence in the assay medium of, iron transferrin produced, in general, only a slight decrease in cytolysis. Incubation of cells with apotransferrin also produced only a slight decrease in cytolysis, while incubation with zinc transferrin produced a greater decrease in cytolysis. This latter effect was particularly dramatic for cells that had been exposed previously to either a 60 Hz magnetic field alone (1.0 gauss) or to a combined electric + magnetic field (current density 300 mA/m2, 1.0 gauss). In addition to indicating a discordance between TfR expression on target cells and their sensitivity to NK cell cytolysis, the data presented provide a further indication of cellular membrane changes produced by exposure to 60 Hz electromagnetic fields.     

What do you do for a living? Toward a more succinct definition of health services research

This commentary discusses the need for, and the advantages of, a more concise, revised definition of the field of health services research. It argues for a definition that includes not only the topics on which health services research focuses but also the goals of health services research. A number of condensed definitions are provided for consideration.     

Uveal melanoma radiation. 125I brachytherapy versus helium ion irradiation

The optimum radiation therapy for uveal melanoma is uncertain. Both helium ion irradiation and 125I brachytherapy have been used to treat this neoplasm. This investigation analyzed the control and complication rates of uveal melanomas treated with helium ions of 125I plaques. In both a retrospective and a prospective dynamically balanced study, the control rates appeared to be similar. There were more posterior segment complications after 125I plaques and more anterior segment complications, including neovascular glaucoma, after helium ion irradiation. The follow-up period is too short to draw definitive conclusions on the radiation complications. Overall, approximately 89% of eyes were retained and less than 4% of treated eyes were removed because of failure to control the tumor.     

Controlled study of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourette's syndrome

The results of this controlled study of the treatment of 57 patients with Gilles de la Tourette's syndrome suggested that both haloperidol and pimozide were more effective than placebo, but that haloperidol was slightly more effective than pimozide. Adverse effects occurred more frequently with haloperidol vs placebo than with pimozide vs placebo, but the frequency was not significantly different for haloperidol compared with pimozide. Clinically significant cardiac effects did not occur at a maximum dosage of 0.3 mg/kg or 20 mg/d for pimozide and 10 mg/d for haloperidol. However, the QTc interval was prolonged during pimozide treatment compared with that during haloperidol treatment, although the values for both medications were not in an abnormal range.     

Assessment of extraocular muscles position and anatomy by 3-dimensional ultrasonography: a trial in craniosynostosis patients.

PURPOSE: To determine whether 3-dimensional ultrasonography (3D US) provides information about anatomy and position of extraocular muscles to better guide surgeons approaching strabismus in patients with craniosynostosis who often have anomalous or absent eye muscles. METHODS: The 4 rectus eye muscles were imaged using 3D US for 7 children with craniosynostosis before or after strabismus surgery. Reconstructed 3D images were interpreted as having normal or abnormal anatomy and position, based on comparison with images acquired from 6 normal eyes. Interpretation was validated against the intraoperative findings from strabismus surgery. RESULTS: A total of 34 scans from the study group were used for comparison and validation purposes. Accuracy of anatomical assessments was 85% +/- 12% (percentage +/- confidence interval) and of positional assessments was 62% +/- 16%. Sensitivity and specificity of anatomical assessments was 80% +/- 14% and 88% +/- 10%, respectively. Anatomic anomalies detected by 3D US included excessively thick, thin, scarred and fibrotic, and absent muscles. Sensitivity and specificity of positional assessments was 48% +/- 17% and 85% +/- 12%, respectively. Positional anomalies such as muscle displacement off the normal clock hour axis or posteriorly displaced insertion were also detected. CONCLUSIONS: The 3D US may have an adjunctive role in determining anatomy and position of rectus muscles in patients with craniosynostosis, although it was more accurate in assessing anatomic features rather than positional features of rectus muscles.     

Role of Multiple Scouting Biopsies before Mohs Micrographic Surgery for Extramammary Paget's Disease

Background. Extramammary Paget's disease (EMPD) frequently extends subclinically, resulting in high recurrence rates after surgical excision. Mohs micrographic surgery (MMS) improves cure rates but may require time-consuming reexcision of subclinical extension. A mechanism to estimate the location and extent of subclinical extension would be helpful.
Objective. To describe and evaluate a technique for multiple scouting biopsies before MMS for EMPD.
Method. A retrospective review of patients at Mayo Clinic who had multiple scouting biopsies before MMS for EMPD without dermal invasion.
Technique. The clinical extent of EMPD is identified. The scouting biopsy sites are determined and documented with photographs. The scouting biopsy specimens are sent for permanent sections. The results of the scouting biopsies help guide the extent of the initial Mohs layer. The tumor is cleared with MMS. An additional 1 mm peripheral margin of tissue is usually submitted for permanent sections.
Results. Multiple scouting biopsies were done in five patients. Four of the five patients had at least one true-positive result. At least one true-negative result was obtained in all five patients. Two patients had at least one false-negative result.
Conclusion. Multiple scouting biopsies before MMS for EMPD without dermal invasion can be a beneficial adjuvant technique.
DAVID L. APPERT, MD, CLARK C. OTLEY, MD, P. KIM PHILLIPS, MD, AND RANDALL K. ROENIGK, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.     

Response of the unattached 218Po activity size distribution in H2O-SO2-N2 atmospheres.

The response of the unattached 218Po activity size distribution to variations in H2O and SO2 concentration was investigated in a high-purity N2 atmosphere. Lognormal size distributions were reconstructed from screen diffusion battery data using a random search and optimization procedure. For relative humidities of 1% to 90%, SO2 concentrations of 0-6 ppm, and residence times of 38 s, median diameters of the unattached mode ranged from 0.50 (+/- 0.04) to 0.80 (+/- 0.06) nm, corresponding to diffusion coefficients of 0.1-0.05 cm2 s-1. Increases in water vapor concentration resulted in an enhanced rate of ion neutralization and suppression of ion cluster formation. Decreases in cluster diameter with increasing humidity were therefore observed. Addition of SO2 at constant relative humidity resulted in an initial increase in diameter, with a subsequent decrease. Geometric standard deviations averaged 1.05 (+/- 0.01) to 1.06 (+/- 0.01) in all cases, with the unattached fraction comprising 83% to 88% of the total distribution. Results suggest that increases in water vapor concentration enhance neutralization in the immediate vicinity of the recoil path through water radiolysis. Conversion of OH to H2OSO4 on addition of SO2 provides a binary condensable phase capable of clustering around the ion at low relative humidities, increasing particle size. High H2O and SO2 concentrations enhance neutralization through electron scavenging and subsequent ion collision near the end of the recoil path, decreasing the number of available cluster sites and suppressing cluster formation. This reduction is more significant than the increasing size of the stable ion cluster, with increasing H2O and H2SO4 concentrations as predicted by Raes, resulting in decreases in both median diameter and distribution spread.