Arthroscopic Latissimus Dorsi Transfer

The patient is placed in lateral decubitus. A 6-cm incision made in the axilla allows access to the latissimus dorsi tendon and its neurovascular pedicle. Holding the arm in internal rotation, the surgeon detaches sharply the tendon off the humeral shaft and then reinforces it with wrapping sutures. Pulling the free limbs of the sutures exposes the under surface of the muscle and helps to identify the neurovascular pedicle. Special lighting retractors suited for a large diameter scope are helpful. Mobilization is completed when 2 cm of the tendon crosses the posterior edge of the acromion. The standard lateral portal is used for visualization. A silicon drain tube stiffened by a Wissinger rod is advanced from the posterior portal under direct visualization in the space between teres minor and deltoid, exiting in the auxiliary incision. A suture loop passed down the tube retrieves the tendon sutures out the posterior portal. These are then moved out the anterior portal, thus pulling the tendon over the tuberosity. The first anchor is inserted at the anterior aspect of the greater tuberosity, close to the articular cartilage and long head of the biceps tendon. Two to 3 anchors are inserted fixing the tendon to the tuberosity until it is stable.     

Inhaltsstoffe von Fagaceae (Cupuliferae), 19. Mitt.: Triterpensaponine und Acylflavonoide aus Quercus robur var. stenocarpa Beck.

Constituents of Fagaceae (Cupuliferae), XIX: Triterpene Saponins and Acylated Flavonoids from Quercus robur L. var. stenocarpa Beck. In addition to four known glycosides from leaves of Quercus robur L. var. stenocarpa Beck. a new triterpene saponin has been isolted and identified as 28-β-d-glucopyranosyl ester of the 2α,3β,19α-trihydroxy-olean-12-ene-24,28-dioic acid ( I ).     

Coronary occlusion secondary to blunt chest trauma: a first attempt at balloon angioplasty

There have been only 58 angiographically documented reports of transmural myocardial infarction due to closed-chest trauma. None of these cases has been treated by percutaneous transluminal coronary angioplasty. We report the case of a 40-year-old man who developed an anterior-wall myocardial infarction secondary to blunt chest trauma suffered in an automobile accident. Angiographic study performed 2 months after the injury revealed an isolated total obstruction of the left anterior descending coronary artery. The patient was judged a good candidate for balloon angioplasty, but total reocclusion occurred within 24 hours of the procedure and a 2nd attempt did not restore patency. Surgical revascularization was performed a week later. A year after his injury, the patient remains asymptomatic and is back at work. Despite the failure of percutaneous transluminal coronary angioplasty in its 1st application to coronary artery repair after blunt chest trauma, we believe it to be the treatment of choice in young patients and in single-vessel disease.     

Relationship between levels of Clostridium difficile toxin A and toxin B and cecal lesions in gnotobiotic mice.

Various Clostridium difficile strains were studied with respect to their pathogenicity in monoassociated mice in relation to levels of toxin A and toxin B in vivo and in vitro. Two strains which were the most potent toxin producers in vitro induced mortality (100%); mice monoassociated with these strains were found to have high levels of both toxins in their ceca and an intense cecal epithelial ulceration together with a severe inflammatory process. No mortality was observed with the other strains. Strains which were moderately toxinogenic in vitro induced inflammation of the cecum but no ulceration, and no toxin A was found. Inflammation intensity was not related to toxin B levels. After 3 weeks, ceca returned to normal in spite of a chronic cytotoxin production. When compared with in vitro results, which showed a good correlation between the levels of the two toxins, toxin A amounts in vivo were found to be lowered relative to toxin B levels. The lack of detectable toxin A levels in animals infected with all but the two most highly toxinogenic strains prevented death. This work points out the importance of investigation of toxin A for the understanding of C. difficile pathogenicity.     

A fast and simple in situ PCR method to detect human papilloma virus infection in archival paraffin-embedded tissues

We describe a simple and fast method for the detection and localization of low copy numbers of HPV DNA in formalin-fixed and paraffin-embedded archival tissues. We have developed a protocol for direct bl situ-PCR in order to demonstrate its convenience in rapid and reproducible assessment of HPV infection in unknown biopsies. The morphological aspect of the tissues has been maintained, despite the multiple steps of fixation, permeabilization and thermal cycling, and positivity has been detected only in virus target cells.     

Tumor-necrosis-factor and DNA topoisomerase-ii inhibitors in human ovarian-cancer - potential role in chemotherapy

Seven ovarian and one cervical human cancer cell lines were examined far their sensitivity or resistance to tumor necrosis factor, to three topoisomerase II inhibitors and to cisplatin. Only one line exhibited the multidrug-resistance phenotype and another one an 'atypical'-MDR phenotype. The combination of TNF and topoisomerase-II inhibitors produced enhanced cytotoxicity and overcame the MDR and the atypical resistance. No potentiation of cisplatin cytotoxicity was observed. These findings suggest that TNF enhances the activity of DNA topoisomerase II both in TNF resistant and sensitive cells.     

MR angiography of internal carotid arteries: breath-hold Gd-enhanced 3D fast imaging with steady-state precession versus unenhanced 2D and 3D time-of-flight techniques

PURPOSE: The purpose of this work was to compare Gd-enhanced breath-hold fast imaging with steady-state precession (Gd-FISP) with unenhanced time-of-flight (TOF) sequences in evaluating internal carotid arteries (ICAs). METHOD: Thirty patients underwent three unenhanced TOF sequences [2D traveling saturation (Travelsat); 3D tilted optimized nonsaturated excitation (TONE); TOF 3D Multislab] and two breath-hold 3D Gd-FISP sequences with automated intravenous contrast agent injection (axial and coronal). ICAs were classified as normal (no stenosis); with mild (<30%), moderate (30-70%), or severe stenosis; or occluded (100%). Digital subtraction angiography (DSA) with aortic arch injection was used as a reference technique. RESULTS: DSA revealed 20 normal ICAs; 11 mild, 9 moderate, and 14 severe stenoses; and 2 occlusions. DSA and all MR angiography (MRA) sequences diagnosed the occlusion of four common carotid arteries. The TOF 2D overestimated 10 stenoses, TOF 3D TONE 9, and TOF 3D Multislab 5; Gd-FISP 3D overestimated only 2 of them, reaching the highest sensitivity and specificity for severe stenoses. Significant differences were found between the overestimation of Gd-FISP and each of the three unenhanced sequences (0.0020 < p < 0.0313, Wilcoxon and McNemar tests). Severe artifacts were observed with TOF techniques only. CONCLUSION: Gd-FISP is an interesting, largely artifact-free improvement for MRA of ICAs.     

Interferon-gamma enhances TNF sensitivity in A172 human glioblastoma cell line

Although human glioblastoma cell line A172 presents tumor necrosis factor (TNF) high affinity receptors, it is resistant to TNF-mediated cytotoxicity. Preincubation of cells with 10 ng/ml interferon (IFN)-gamma for 6 h causes a great increase in TNF receptor numbers (about 477%). IFN-gamma alone is not cytotoxic in A172 cells. Cells preincubated with 10 ng/ml IFN-gamma for 6 h became more sensitive to the TNF cytotoxicity (about 400%). In A172 cells the enhanced TNF receptor expression may contribute to the enhancement of TNF cytotoxicity. This observation may have importance in designing new more effective therapies for human gliomas.     

Dolichol-bound oligosaccharides and the transfer of distal monosaccharides in the synthesis of glycoproteins by normal and tumor mammary epithelial cells

Summary The main dolichol diphosphate-bound oligosaccharides present in primary cultures of both normal and tumor mouse mammary epithelial cells had the same size, yielded the same pattern after acetolysis and paper chromatography, had the same number of mannose residues susceptible to-mannosidase degradation, and were composed of the same monosaccharide residues. This is the first demonstration that normal and tumor mammary cells have dolichol diphosphate-bound oligosaccharides with very similar, if not identical, structures. These compounds are intermediates in the synthesis of asparagine-linked oligosaccharides. On the other hand, normal and tumor cells showed differences in the specific activities of the enzymes involved in the transfer of the distal monosaccharides from the sugar nucleotides to glycoproteins. Sialyl- and fucosyl-transferases were elevated and galactosyl- and N-acetylglucosaminyltransferases were diminished in mammary tumor cells. The intact tumor cells showed an increased fucosylation of glycoproteins of the asparagine-linkage type. Address for reprints: Roberto L. Ceriani, M.D., Ph.D., Bruce Lyon Memorial Research Laboratory, Children's Hospital Medical Center, 51st and Grove Streets, Oakland, CA 94609, USA.