Increased occurrence of free immunoglobulin light chains in cerebrospinal fluid and serum in human immunodeficiency virus-1 infection

The presence of free immunoglobulin light chains (FLCs) in the cerebrospinal fluid (CSF) and sera of patients with human immunodeficiency virus-1 (HIV-1) infection, multiple sclerosis (MS), and neurologically healthy control individuals was investigated by paying special attention to ensure that only truly free light chains would be detected. The FLCs were extracted by specifically binding them to Sepharose-coupled anti-FLC monoclonal antibodies, and thereafter they were electrophoresed and immunoblotted with monoclonal antibodies to both light chain (LC) isotypes. A frequent occurrence of kappa and lambda FLCs was found in both CSF and sera of HIV-1 infected patients. In HIV-1 infection and in MS, the frequency of FLCs of the CSF was equal. In healthy controls, only occasional weak FLCs were observed in either CSF or serum. FLC bands of the CSF from patients with HIV-1 infection tended to be more intensive than those of the appropriately diluted sera. Both intrathecal synthesis of FLCs and their transudation from sera through the impaired blood-brain barrier (BBB) may contribute to this. Increasing severity of general HIV-1 infection was accompanied by an increase of FLC intensity in sera. A qualitative demonstration of FLC in the CSF may be meaningful only in the absence of altered BBB function.     

Peripheral nerve injury and Raynaud's syndrome following electric shock

A truck driver was injured by a high-voltage line of 10,000 volts when holding a metallic bar in both hands. Initially no neurological abnormalities were found, but during the following few weeks increasing sensory and minor motor symptoms developed in the right upper extremity. After one year numbness of the right thigh and leg appeared, as well as attacks of white finger in both hands. Repeated examinations showed progressive abnormalities of the median and ulnar nerves in both hands. No other cause for Raynaud's syndrome was discovered. The late high-voltage effects, presumably indirect, are suggested to be of multifactorial etiology.     

Image quality in radiography of midfacial trauma

Image quality in radiography of midfacial trauma was studied in 618 patients treated for midfacial injury. The visibility of key anatomic areas was related to essential technical factors influencing image quality as well as to the radiologic diagnostic performance. Regression analysis revealed that the visibility of the key anatomic areas was significantly dependent on the technical factors. However, the radiologic diagnostic performance was not significantly dependent on the visibility of the key anatomic areas. The results indicate that image quality was not a limiting factor for radiologic diagnostic performance in midfacial trauma.     

Disc herniation in the lumbar spine during growth: Long-term results of operative treatment in 18 patients

We studied 18 patients who had undergone surgery for herniated lumbar discs between the ages of 11 and 17 years. The inclusion criteria for girls was an age of 15 years or below and for boys 17 or below at surgery. The mean follow-up time was 10 years and the clinical outcome was good. Age at surgery and length of the follow-up had no effect on the result. The radiological disc height at follow-up did not correlate with the follow-up time or age of the patient at operation. MRI scans at follow-up from ten patients operated at less than 15 years of age revealed multilevel disc degeneration but favourable clinical results.     

Intracranial plasmacytoma: a case report

Multiple myeloma may have extraosseous manifestations in the cranial region. It may be a solitary intracranial tumour without any other signs of multiple myeloma, or intracranial disease may be a part of generalised disease, as in the present case. Our patient had received chemotherapy for multiple myeloma for 9 months, with good response. However, her condition suddenly deteriorated, with signs of increased intracranial pressure and a 5-cm-diameter tumour infiltrating the meninges and brain was found in the left temporal fossa. The radiological diagnosis, based on contrast-enhanced CT and angiography, was not straightforward or specific for plasmacytoma, as chemotherapy for the extracranial disease had been successful. Diseases such as meningioma, metastasis, lymphoma, chondrosarcoma or haemangioma had to be considered. Received: 1 November 1994 Accepted: 31 August 1995     

Superior mesenteric artery syndrome. A follow-up study of 16 operated patients

A series of 18 patients underwent surgery for upper abdominal symptoms and signs of superior mesenteric artery syndrome (SMAS). The diagnosis was made by simultaneous arteriography and barium meal. Findings at operation confirmed SMAS in every patient, and a duodenojejunostomy was performed. Duodenal and jejunal wall biopsy from 13 patients revealed normal myenteric and submucous plexuses. A follow-up study of 16 patients was performed after 7 years. At follow-up, the weight loss seen preoperatively had been corrected. However, symptoms were essentially similar to those found at the original examination. Only the frequency of the most distressing symptom, vomiting, was significantly decreased (p less than 0.05). The most striking features in the production of the "pincher mechanism" of the duodenum were found to be a short aortomesenteric distance together with sagittal parallelism between aorta and superior mesenteric artery. In conclusion, we recommend a conservative attitude in the treatment of SMAS. Surgical treatment with duodenojejunostomy may be indicated only if vomiting is a predominant symptom and proper conservative treatment has failed.     

Using simulated noise to define optimal QT intervals for computer analysis of ambulatory ECG

The ambulatory electrocardiogram (ECG) is an important medical tool, not only for diagnosis of adverse cardiac events, but also to predict the risk of such events occurring. The 24-hour ambulatory ECG has certain problems and drawbacks because the signal is corrupted by noise from various sources and also several other conditions which may alter the ECG morphology. We have developed a Windows based program for the computer analysis of ambulatory ECG which attempts to address these problems. The software includes options for importing ECG data, different methods of waveform analysis, data-viewing, and exporting the extracted time series. In addition, the modular structure allows for flexible maintenance and expansion of the software. The ECG was recorded using a Holter device and oversampled to enhance the fidelity of the low sampling rate of the ambulatory ECG. The influence of different sampling rates on the interval variability were studied. The noise sensitivity of the implemented algorithm was tested with several types of simulated noise and the precision of the interval measurement was reported with SD values. Our simulations showed that, in most of the cases, defining the end of QT interval at the maximum of the T wave gave the most precise measurement. The definition of the onset of the ventricular repolarization duration is most precisely made on the maximum or descending maximal slope of the R wave. We also analyzed some examples of time series from patients using power spectrum estimates in order to validate the low level QT interval variability.