Coccygectomy has a favorable effect on the intensity, manifestation, and characteristics of pain caused by coccygodynia: a retrospective evaluation of 34 patients followed for 3–18 years

Background  Coccygodynia can cause severe pain and disability in patients. There are contradictions in the literature regarding the final results of coccygectomy for coccygodynia. We evaluated the long-term effects of coccygectomy on the intensity, characteristics, and manifestation of pain caused by coccygodynia to determine the adequacy of operation among treatment modalities. Materials and methods  Thirty-four patients with coccygodynia were treated by coccygectomy. In 22 cases, trauma, and in one case childbirth was the cause. 11 cases were regarded as idiopathic. The intensity, characteristics of pain, and the most painful activities were evaluated at an average of 7.6 (3–18) years of follow-up time. Results  Before the operation, all 34 patients had pain while sitting, moreover, 26 of them had pain during standing, walking, at night or a combination of these. 21 patients had intolerable or very intensive, mainly acute, sharp or burning pain. 11 patients had dyschesia, 2 had dysuria and 6 had dyspareunia. At follow-up, 7 patients were completely free of pain, 15 others had moderate, 11 medium, and only one patient had severe, but none had intolerable pain. Only seven patients had acute, sharp or burning pain postoperatively. The decrease of average pain score from 8.0 to 3.2 was significant (P < 10⁻¹²). The number of the patients with dyschesia and dyspareunia decreased from 11 to 7 and from 6 to 3, respectively. Two patients had dysuria, but their complaints did not change after the operation. One of the two patients who needed reoperation had an excellent final result, while the other remained unchanged. 12 and 16 patients (together 82%) regarded the final result of the operation excellent and good, respectively. The condition of five others did not change, while one became worse. The patients with younger age, smaller body mass index, and less co-morbidities had better final result. There were no serious complications. Conclusion  Coccygectomy for coccygodynia is a safe method to decrease the intensity of pain and other complaints of the patients. The operation can be the choice of treatment if conservative measures fail.     

Intraperitoneal injection of cholecystokinin elicits sleep in rabbits

Cholecystokinin (CCK) reduces food intake and promotes non-rapid-eye-movement sleep (NREMS) in rats. The purpose of present experiments was to determine if CCK is somnogenic in rabbits; another species in which CCK suppresses feeding. White New Zealand rabbits were treated intracerebroventricularly (ICV; 0.05, 0.5 and 2 μg) or intraperitoneally (IP; 2.5, 10 and 40 μg/kg) with CCK or saline, and sleep-wake activity and brain temperature (T_br) were recorded for 6 h. Injections of 10 and 40 μg/kg CCK IP elicited a decrease in wakefulness and an increase in NREMS during the first hour postinjection. The hypnogenic effects were accompanied by a decrease in T_br. After the IP injection of a lower dose (2.5 μg/kg) a slight, nonsignificant increase in NREMS during the first hour postinjection was followed by a decrease in NREMS. ICV injections of CCK had relatively small inhibitory effects on sleep. We conclude that circulating, hormone CCK might be a hypnogenic signal with a peripheral site of action.     

Inhibition of tumor necrosis factor in the brain suppresses rabbit sleep

Tumor necrosis factor (TNF) is a cytokine that possesses many biological activities, including enhancement of non-rapid-eye-movement sleep (NREMS). The role of endogenous TNF in the regulation of spontaneous sleep is unknown. If TNF is involved in sleep regulation, then reduction of endogenous TNF should suppress spontaneous sleep. A soluble TNF-binding protein I (TNF-BP I) and a synthetic fragment of TNF-BP I, TNF-R-(159–178), that contains the biologically active region of TNF-BP I, were used. These substances bind TNF and possess TNF-inhibitory activity; their effects on rabbit sleep after intracerebroventricular injection were determined across a 6-h recording period. Two doses of TNF-BP I (0.05 g and 0.5 g) were administered; the higher dose of TNF-BP I significantly decreased NREMS. Four doses of TNF-R-(159–178) (0.25 g, 2.5 g, 25 g and 50 g) were used. The 25 g and 50 g doses significantly suppressed NREMS. The highest dose (50 g) also decreased REM sleep. These results are consistent with the hypothesis that endogenous brain TNF is involved in the regulation of normal sleep.     

Occurrence of hlyA and sheA genes in extraintestinal Escherichia coli strains

The association of a hemolytic phenotype with the carriage of the alpha-hemolysin gene (hlyA) and/or the silent hemolysin gene (sheA or clyA) among 540 extraintestinal clinical isolates of Escherichia coli and 110 fecal isolates from healthy individuals was investigated. Though HlyA is an important virulence factor in extraintestinal E. coli infection, the role of SheA is not completely clarified. Two hemolytic sheA+ E. coli strains that lacked hlyA and possessed no other hemolysin genes were identified. No hlyA+ sheA+ strains were identified, suggesting that there is possible incompatibility between hlyA and sheA in the chromosome of E. coli.     

Ribosomal DNA internal transcribed spacer sequences do not support the species status of Ampelomyces quisqualis, a hyperparasite of powdery mildew fungi

Phylogenetic relationships among Ampelomyces isolates, pycnidial hyperparasites and biological control agents of powdery mildews, were inferred from internal transcribed spacer (ITS) sequences of the ribosomal DNA (rDNA). Currently, these hyperparasites are considered to be a single species, A. quisqualis, despite observed morphological and cultural differences. Ten Ampelomyces isolates, representing seven previously defined ITS RFLP groups, were sequenced and analyzed. Sequence-divergence values among isolates belonging to different RFLP groups ranged from 4.3 to 22.4%, suggesting that these isolates may represent different taxa. When Ampelomyces ITS sequences were analyzed by cladistic methods with the sequences of other ascomycetous fungi, they formed two lineages in the Dothideales. Slow-growing Ampelomyces isolates formed a clade with Leptosphaeria microscopica and L. nodorum, whereas fast-growing Ampelomyces isolates formed a clade with Epicoccum nigrum. Sequence-divergence values between these two clades ranged from 17.3 to 22.4%, suggesting that the taxa in the two clades are not closely related and possibly not congeneric. The data presented here indicate that the identification of `A. quisqualis' isolates used in biological control experiments should be re-evaluated. Received: 10 March 1997 / Accepted: 13 February 1998     

Contraction history affects the in vivo quadriceps torque-velocity relationship in humans

We hypothesized that the history of contraction would affect the in vivo quadriceps torque-velocity relationship. We examined the quadriceps torque-velocity relationship of the human knee extensors at the descending and ascending limb of the torque-position relationship by initiating the knee extension at a knee angle position of 1.39 rad (80°) or 0.87 rad (50°) over a 0.52 rad (30°) range of motion under conditions of constant or linearly increasing velocity. Maximal voluntary isometric knee extension torque (M₀) was measured at 1.87 rad, 0.87 rad, and 0.35 rad, and concentric torque was measured. The subjects carried out ten maximal knee extensions at ten distinct velocities, each velocity ranging between 0.52 rad·s^–1 to 5.24 rad·s^–1 in steps of 0.52 rad·s^–1. Peak concentric torque was measured and mean torque calculated from the respective torque-time curves. Peak or mean torque, computed from the individual torque-time curves, and velocity data were fitted to the Hill equation under the four experimental conditions and the curve parameters computed. The M₀ was similar at 0.87 rad and 1.39 rad, but it was significantly lower at 0.35 rad. In the low-velocity domain of the torque-velocity curve where a plateau normally occurs, peak torque was always lower than M₀. Peak and mean torque were significantly greater under linearly increasing velocity conditions and the 1.39 rad starting knee position. Mean torque but not peak torque data could be well fitted to the Hill equation and the two computations resulted in significantly different Hill curve parameters including the concavity ratio, peak power, and maximal angular velocity. We concluded that the history of contraction significantly modifies the in vivo torque-velocity relationship of the human quadriceps muscle. Muscle mechanics and not neural factors may have accounted for the inconsistencies in the human torque-velocity relationships reported previously. Electronic Publication     

Intracellular signalling and cytoskeletal rearrangement involved in Yersinia pestis plasminogen activator (Pla) mediated HeLa cell invasion

Yersinia pestis, the etiologic agent of plague is a highly invasive organism being able to invade non-phagocytic epithelial cells. Its plasminogen activator (Pla), encoded by the pPCP1 plasmid plays a pivotal role in internalisation of bacteria by HeLa cells. The aim of this study was to analyse the intracellular signalling processes and cytoskeletal rearrangement events associated with invasion. Wortmannin caused a 50% decrease of invasiveness at 50nM concentration pointing to the involvement of phosphatidyl-inosinol-4 kinase (PtINs4). Pre-treatment with staurosporin, a potent inhibitor of protein kinases (PKs) and with genistein, a specific tyrosine kinase inhibitor decreased the number of internalised bacteria about seven-fold and two-fold, respectively, indicating the involvement of PKs including tyrosine kinases in Pla-mediated internalisation. Cytochalasin D, an actin polymerisation inhibitor, C3 exoenzyme of Clostridium botulinum, a specific inhibitor of small GTPase Rho, and NDGA, a 5-lipoxygenase inhibitor also involved in Rho activation strongly reduced the number of internalised bacteria revealing the role of cytoskeletal events in the invasion process. All the tested inhibitors changed the invasion but not the adhesion pattern of the Pla producing recombinant strain. Actin rearrangement could also be visualised also with rhodamin-phalloidin staining.     

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

The European Journal of Health Economics - Patient activation comprises the skills, knowledge and motivation necessary for patients’ effective contribution to their care. We adapted and...