Computed tomography in the postoperative patient

Summary Nine cases of patients in whom intracranial infection was suspected after operation are presented. Lesions with ring enhancement were seen in all of these patients. The differentiation of enhancement, seen as a normal postoperative phenomenon, from residual neoplasia and cerebral abscess can be difficult. This can be resolved by serial and sequential-delayed CT, and thus unnecessary re-exploration may be prevented.     

Hypothalamic growth hormone deficiency in a patient with ring chromosome 18

We report on a boy with a ring 18 chromosome associated with hypothalamic growth hormone (GH) deficiency. A 12-month trial of GH replacement therapy (0.5 U/kg/week) resulted in a marked growth acceleration. Our findings emphasise the need of evaluating GH secretion in patients with abnormalities of the 18 chromosome.     

Prediction of the non-specific cardiodepressant effects of beta-adrenoceptor blocking agents in vitro and in vivo by means of the Hansch analysis

Hydrophobicity (n-octanol/buffer partition coefficients) of six 1-alkylamino-3-(2-nitrilophenoxy)-propan-2-ol derivatives with different substituents at the amino group (Kö 1439, Kö 1561, Kö 1560, Kö 1313, Kö 1366, Kö 1500), and of five 1-isopropylamino-3-(alkylphenoxy)-propan-2-ol derivatives with different ring substituents (Kö 592, Kö 707, Kö 1030, Kö 1124, Kö 1292), with β-adrenoceptor blocking properties, was correlated with the non-specific cardiodepressant effects of the drugs. Influence on the conduction velocity of the frog heart was studied in vitro and influence of the drugs on dp/dt_max in anaesthetized cats after β-adrenoceptor blockade was measured in vivo. The physicochemical and pharmacological data were analysed by the method of Hansch.The partition coefficients of the β-adrenoceptor blocking drugs ranged more than three orders of magnitude. The differences in hydrophobicity were solely dependent on the sum of the hydrophobic substituents of the drug molecules at the phenyl ring and at the amino group. Slowing of conduction velocity in vitro was more pronounced the higher the partition coefficients of the two series of the Kö compounds investigated; multiple regression analysis revealed parabolic correlation equations between hydrophobicity and pharmacological effects, depending on the experimental conditions (incubation time, mode of stimulation of the preparation) used. A parabolic correlation was also observed between hydrophobicity and decrease of dp/dt_max in vivo. Similar correlation equations were obtained when the hydrophobic properties of the compounds were calculated according to the method of Hansch.From the physicochemical, pharmacological, and analytical data it is concluded that the non-specific cardiodepressant effects of β-adrenoceptor blocking drugs can be predicted for given pharmacological systems by determination or by calculation of the hydrophobicity of the drug molecules, irrespectively of the site of the hydrophobic substituents (whether at the ring system or at the amino group).     

The ultrastructure of ring fibres in dystrophic muscle

Summary A biopsy was taken from the vastus lateralis of a man of 49 years with slowly progressive myopathy largely confined to the quadriceps muscles. Both atrophic fibres and ring fibres were numerous. The atrophic fibres showed increase in glycogen and mitochondria and loss of myofilaments as the lesser changes, with fragmentation and gross disorganisation of myofilaments in the more severely affected fibres. Folds of basement membrane projected from their surfaces. Phagocytes occurred in a few degenerate fibres and in basement membrane tubes.All the ring fibres examined had an intact longitudinal core with a closely applied encircling band of myofibrils. Severe changes of the type found in the atrophic fibres were not seen in the ring fibres. Degenerative changes were confined to the circumferential myofibrils, which presented loss of myofilaments of varying degree and aggregations of glycogen and mitochondria. We believe that ring fibres are genuine structures and are not artefacts produced either by fixation or by the biopsy procedure.

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Zusammenfassung Eine Biopsie des M. vastus lateralis bei einem 49 jährigen Mann mit langsam progressiver Myopathie mit isoliertem Befall der Mm. quadriceps wurde untersucht. Es fanden sich zahlreiche atrophische Fasern und Ringbinden. Die atrophischen Fasern zeigten Zunahme an Glykogen und Mitochondrien sowie Verlust der Myofibrillen als geringere Läsionen sowie Fragmentierung und grobe Desorganisation der Myofilamente in den stärker betroffenen Fasern. Ausstülpungen der Basalmembran ragten aus ihrer Oberfläche vor. Phagocyten traten in wenigen degenerierten Fasern und in den Basalmembranschläuchen auf.Alle untersuchten Ringbinden hatten einen intakten Längskern mit einem eng anliegenden zirkulären Band von Myofibrillen. Schwere Veränderungen, wie sie in den atrophischen Fasern vorlagen, waren in den Ringbinden nicht anzutreffen. Die degenerativen Veränderungen beschränkten sich auf die umgebenden Myofibrillen, die Verlust der Myofilamente verschiedenen Grades sowie Anhäufungen von Glykogen und Mitochondrien aufwiesen. Die Verff. sind der Meinung, daß die Ringbinden originäre Strukturen und keine Artefakte durch Fixation oder bioptische Eingriffe darstellen.

     

Ring chromosome 7: Report of the fifth case

A 13-year-old boy with a 46,XY,r(7) karyotype presented with growth failure, microcephaly, achromic spots and multiple pigmented naevi. Psychomotor development was normal and no major malformations were present. Comparison with four previously reported patients with ring chromosome 7 shows that the most frequent findings in these subjects were short stature, microcephaly and dermatological abnormalities.     

Cytogenetic and comparative genomic hybridization studies of an esophageal giant fibrovascular polyp: a case report

Esophageal giant fibrovascular polyps are rare and are thought to represent redundant tumorlike or hamartomatous esophageal folds. Although most patients present with slowly evolving dysphagia, a minority present with acute respiratory distress or even death caused by asphyxia. We present the pathologic and cytogenetic findings of an 18-cm esophageal giant fibrovascular polyp in a 49-year-old woman who presented with odynophagia and dysphagia. The histologic findings are that of classic esophageal giant fibrovascular polyp as previously described in the literature. Cytogenetic study revealed an abnormal karyotype, and comparative genomic hybridization analysis showed regional amplifications of chromosomes 3 and 12 and a possible loss of 22q13.3-qter. The significance of these cytogenetic findings is unclear but may suggest a neoplastic process in the pathogenesis of esophageal giant fibrovascular polyps.     

不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响

目的评价不同植骨融合方式治疗胸腰椎爆裂性骨折的临床疗效,探讨最佳的植骨融合方式。方法 2000年6月-2009年6月,采用一期后路短节段内固定植骨融合治疗126例胸腰椎爆裂性骨折患者。均为急性脊柱脊髓损伤,损伤节段T11～L2;均合并不同程度脊髓神经功能损伤,Frankel分级在D级以下。将患者随机分成A、B、C 3组,分别辅以椎体加椎间植骨(A组)、后外侧植骨(B组)及360°环形植骨(C组)3种植骨融合方式进行治疗,观察各组患者术后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率、Oswestry功能障碍指数(ODI)及Frankel分级情况等的变化,评价不同植骨融合方式的疗效。结果 126例患者均获随访,随访时间24～32个月,平均28个月。C组手术时间和术中出血量均多于A、B组(P<0.05),A、B组间差异无统计学意义(P>0.05)。术后2年及末次随访时B组Cobb角及矫正丢失度均显著大于A、C组,比较差异有统计学意义(P<0.05),A、C组间差异无统计学意义(P>0.05)。末次随访时A组骨性融合率及内固定失效率分别为100%、0,B组分别为78.6%、21.4%,C组分别为97.5%、0,B组与A、C组比较差异均有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。术后各组ODI及Frankel分级均较术前有明显改善(P<0.05),末次随访时B组与A、C组比较差异有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。结论椎体加椎间植骨融合符合人体生物力学特点,能获得最佳的节段性骨性融合,是一种较优的骨性融合方式;后外侧植骨不符合人体生物力学特点,内固定失效率高,不是一种适宜的植骨融合方式;360°环形植骨并未表现出最佳的骨性融合率,而且性价比低,可能并不是一种必需的植骨融合方式。     

正中神经环指桡侧指神经支移植修复尺神经深支缺损的应用解剖

目的 为研究环指桡侧指神经支移植修复尺神经深支缺损提供解剖学基础. 方法 对16例32侧新鲜成人上肢进行观测.在10倍手术显微镜下对腕部尺神经深支、正中神经旋前方肌支和环指桡侧指神经支进行显微解剖及测量. 结果 正中神经旋前方肌支直径为(1.13±0.02)mm,正中神经环指桡侧指神经支直径为(1.17±0.05)mm,对掌肌管出口处尺神经深支直径为(1.75±0.07)mm.显微镜下分离环指桡侧指神经支,对掌肌管出口处尺神经深支至旋前方肌支入肌长度即移植段神经长度为(104.59±20.25)mm. 结论 环指桡侧指神经支移植为带血运的神经移植,属肌支对肌支的吻合,是修复尺神经深支缺损的有效方法.     

Ring chromosome 8 and trisomy 8 in a patient with acute myeloid leukemia

We describe a child with Acute Myeloid Leukemia (AML M7) with trisomy 8 and ring chromosome 8. Ring chromosome 8 associated with AML is uncommon and is reported to have a poor outcome. The combination of trisomy 8 and ring chromosome 8 has not been previously reported. This 15-month-old girl had presented with a history of fever, weight loss of 1 kg, gum bleeds and pallor. Clinical examinations revealed no nodes or organomegaly. Investigations revealed pancytopenia and elevated serum LDH. Bone marrow aspirate confirmed the presence of myeloid blasts positive only for CD 41 and CD 61 on flow cytometry. Chromosomal analysis from the bone marrow showed 46, XX [13]/ 47, XX, +8[2]/ 47, XX, +r (8) [5]. The child was treated as per UK MRC AML protocol (ADE 10+3+5). Bone marrow on day 21 post-induction was in morphological remission. Repeat karyotyping revealed 46,XX suggesting that the patient was in cytogenetic remission. Cytogenetic sub grouping in AML patients provides guidelines for the choice of optimal treatment strategy. There was no HLA matched family donor and hence an unrelated donor search was commenced as she was in the group with unfavourable cytogenetics. She developed acute myelofibrosis soon after the second cycle of chemotherapy with swinging fever and rapidly enlarging spleen. The marrow showed 11% blasts with intense fibrosis. She went through a stormy period during conditioning for unrelated stem cell transplantation. She passed away on day 11 post transplantation of veno-occlusive disease of liver and multiorgan failure. This case illustrates the poor outcome in paediatric AML with trisomy and ring chromosome 8.     

Prenatal diagnosis of ring chromosome 6 in a fetus with cerebellar hypoplasia and partial agenesis of corpus callosum: case report and review of the literature

Ring chromosome 6 (RC6) is a rare constitutional abnormality, with variable material loss, leading to a variable clinical phenotype: minimal physical anomalies and mild psychomotor retardation to severe physical and mental defects. Among the 22 published cases, only five have been prenatally detected. We describe here a RC6 prenatally diagnosed. Ultrasound follow-up showed growth retardation and cerebellar hypoplasia. Magnetic resonance imaging (MRI) confirmed this, but showed a partial corpus callosum agenesis, leading to amniocentesis and revealing the chromosomal abnormality. Imaging features were correlated with autopsy findings.