Ankylosing spondylitis - specific aspects related to surgical treatment of cervical fracture - case report.

Ankylosing spondylitis (AS) or else Bechterews or Marie-Strümpells disease is a chronic inflammatory autoimmune disease affecting preferentially the spine in the form of sacroileitis and spondylitis [1,2]. Due to acquired skeletal fragility, compared to healthy spine there is a significantly different response of the organism to the mechanical load [3] and therefore in patients with AS, spinal trauma is much more dangerous. Unlike predominantly elastic injuries in healthy cervical spine in AS patients this elasticity is lost and the spine then behaves like a tubular bone [4,5]. A simple X-ray picture is often insufficient because these fractures are difficult to be found in the field of extensive bone alterations typical for AS [6,7,8]. We present a case report of cervical spondylogenic myelopathy in posttraumatic pseudoarthrosis with a prolapse of C6/7 in the field of an old fracture in an AS patient with a typical initial underestimation of diagnosis in minor trauma. The patient therefore experienced a typical late deterioration of the neurological condition. At our department, we have completed the diagnosis and proceeded to perform the surgery with which we have the greatest experience. Although slightly at variance with established procedures, the surgery provides a sufficient solution for the patient also in postoperative follow-up.

Developmental and tissue-specific expression of nuclear proteins that bind the regulatory element of the major histocompatibility complex class I gene.

Expression of MHC class I genes varies according to developmental stage and type of tissues. To study the basis of class I gene regulation in tissues in vivo, we examined binding of nuclear proteins to the conserved cis sequence of the murine H-2 gene, class I regulatory element (CRE), which contains two independent factor-binding sites, region I and region II. In gel mobility shift analyses we found that extracts from adult tissues that express class I genes, such as spleen and liver, had binding activity to region I. In contrast, extracts from brain, which does not express class I genes, did not show region I binding activity. In addition, fetal tissues that express class I gene at very low levels, also did not reveal region I binding activity. Binding activity to region I became detectable during the neonatal period when class I gene expression sharply increases. Most of these tissues showed binding activity to region II, irrespective of class I gene expression. Although region II contained a sequence similar to the AP-1 recognition site, AP-1 was not responsible for the region II binding activity detected in this work. These results illustrate a correlation between region I binding activity and developmental and tissue-specific expression of MHC class I genes. The CRE exerts an enhancer-like activity in cultured fibroblasts. We evaluated the significance of each factor binding to CRE. Single 2-bp mutations were introduced into the CRE by site-directed mutagenesis and the ability of each mutant to elicit the enhancer activity was tested in transient CAT assays. A mutation that eliminated region I protein binding greatly impaired enhancer activity. A mutation that eliminated region II binding also caused a lesser but measurable effect. We conclude that region I and region II are both capable of enhancing transcription of the class I gene. These results indicate that in vivo regulation of MHC class I gene expression is mediated by binding of trans-acting factors to the CRE.

[Complications of IPOM plasty--our experience]. / Komplikace IPOM plastiky--nase zkusenosti.

Laparoscopic IPOM (Intraperitoneal Onlay mesh, method of intraperitoneal placement of mesh) hernioplasty, using the artificial mesh and when the method is managed sufficiently, has been used mainly for larger ventral hernias either in linea alba or more for incisional and Spiegel hernias. IPOM hernioplasty were supposed to be the gold standard for these hernioplasties, mainly for their rapidity, total view during operation and good recovery after it. There have been performed these operations also for inguinal hernias at several Surgical departments. There is a lot of studies proving safety of this method. On the other hand there exist studies pointing out severe postoperative complications of this method. These are both inflammatory and adhesive and they make threat for their long-term manifestation after primary operation and also for every next abdominal operation. We have had patients with both of these complications in our set. Considering this method for hernioplasty, we stopped performing IPOM.

Recommendations for cerebrospinal fluid analysis.

Diseases of the central nervous system (CNS) mean for the human organism a potentially dangerous situation. An investigation of cerebrospinal fluid (CSF) provides important information about a character of CNS impairment in the decision-making diagnostic and therapeutic algorithm. The authors present a brief overview of available cerebrospinal fluid assays, shortened indication criteria, a recommended algorithm of CSF assessment in different suspected diseases, and a view of the external quality system. The whole portfolio of obtainable CSF methodology is further subdivided according to the adequate choice into the first and inevitable basic routine panel, and following complicated analyses of highly specialized character. The basic panel is considered for standard laboratories, the complete specialized assessment should be provided by a super-consulting laboratory.

A burst of c-fos gene expression in the mouse occurs at birth.

Expression of the c-fos gene during murine perinatal development was studied. Before birth, all eight of the prenatal organs tested expressed undetectable or low levels of c-fos mRNA. On the day of birth, there occurred a 10- to 100-fold increase in the level of c-fos message in all of these organs. The expression was transient, in that 1 day after birth, the level of c-fos mRNA precipitously dropped. The c-fos gene expression at birth is unrelated to the expression of the c-myc gene and major histocompatibility complex class I genes, which display distinct kinetics during the perinatal development. The c-fos gene was also expressed locally and transiently in the gravid uterus 1 to 2 days prior to delivery. These results indicate that an event associated with birth induced c-fos gene expression in the mother and newborn.

Identification, chromosomal mapping, and partial characterization of mouse InsI6: a new member of the insulin family.

A new member of the mouse insulin family, InsI6, was identified from mouse expressed sequence tags through the use of bioinformatics. A full length cDNA was sequenced and predicts a protein of 191 amino acids. The protein contains a signal peptide and has A and B peptides as well as a connecting peptide consistent with the contention that it is a member of the insulin family. Northern analysis demonstrates that the primary site of expression is the testis, but message is also found in the kidney, small bowel, heart, brain and thymus. The gene was mapped to mouse chromosome 19 by radiation hybrid mapping. The chromosomal location and primary structure of this protein suggest a functional relationship to relaxin and relaxin-related proteins.

Grtp1, a novel gene regulated by growth hormone.

An in vitro model of GH-responsive cells was subjected to microarray analysis to identify a novel gene regulated by GH. This 258 amino acid protein, we term GH Regulated TBC Protein-1 (GRTP1), contains the TBC signature motif of GTPase activator proteins of Rab-like small GTPases. Northern blot analysis revealed a 1.3 kb major mRNA species, most abundant in testes. TaqMan assay confirmed that in the mouse, Grtp1 is expressed at highest levels in testes, with lesser abundance in intestine, kidney, lung, and liver. In the testis, expression of Grtp1 significantly increases post-pubertally. Administration of GH to mice increased levels of GRTP1 mRNA in testes (140%), but decreased GRTP1 mRNA abundance in kidney (50%) and liver (25%). Grtp1 was localized to mouse proximal chromosome 8. Orthologs of this protein are present in human, mouse, rat, and drosophila suggesting that GRTP1 has an important biological role(s).

Rhabdomyolysis and myoglobinemia in neonates.

Serial myoglobin determinations were made in 20 neonates during the first week of life to determine whether birth asphyxia results in ischemic damage to muscle with the subsequent pathologic release of myoglobin. Serum myoglobin values were significantly elevated in asphyxiated infants compared with control infants. High myoglobin values correlated with a longer duration of oliguria in the neonatal intensive care unit population. The value of urine dipstick testing for myoglobinuria screening was also evaluated. Infants with elevated myoglobin values were more likely to have a strongly positive urine dipstick for occult blood in the first 48 hours of life. These data suggest that ischemic damage to muscle with pathologic release of myoglobin occurs in the neonatal period and that urine dipstick testing provides a reasonable screening examination for myoglobinuria.

Three novel paralogs of the rodent prolactin gene family.

The prolactin (PRL) family consists of a collection of genes expressed in the uterus, placenta and anterior pituitary. These cytokines/hormones participate in the control of maternal-fetal adaptations to pregnancy. In this report, we establish the presence of three new members of the PRL family. Novel expressed sequence tags (ESTs) with homology to PRL were isolated from embryonic and placental cDNA libraries. The cDNAs were sequenced and compared with those of other members of the PRL family. The three new cDNAs were assigned to the PRL family on the basis of sequence similarities and were referred to as PRL-like protein-J (PLP-J), PRL-like protein-K (PLP-K) and PRL-like protein-M (PLP-M). Both rat and mouse PLP-J cDNAs were identified. Rat PLP-J cDNA encodes for a predicted 211 amino acid protein containing a 29 amino acid signal peptide and two putative N-linked glycosylation sites, whereas the mouse PLP-J cDNA encodes for a 212 amino acid protein containing a 29 amino acid signal peptide with a single N-linked glycosylation site. Rat and mouse PLP-J proteins share approximately 79% and 70% nucleotide and amino acid sequence identity, respectively. A full-length rat PLP-K cDNA and a partial tentative mouse PLP-K cDNA were identified. The rat PLP-K cDNA encodes for a predicted 228 amino acid protein containing a 31 amino acid signal peptide and one putative N-linked glycosylation site; the mouse PLP-M cDNA encodes for a predicted 228 amino acid protein containing a 28 amino acid signal peptide and one putative N-linked glycosylation site. Genes for PLP-J, PLP-K and PLP-M are situated at the Prl family locus on mouse chromosome 13. PLP-J was exclusively expressed in decidual tissue from both the mouse and rat. PLP-K was expressed in trophoblast cells of the chorioallantoic placenta and showed an apparent species difference. In the mouse, virtually all trophoblast lineages expressed PLP-K, whereas in the rat, PLP-K expression was restricted to the labyrinthine trophoblast cells. Mouse PLP-M expression was restricted to the junctional zone of the chorioallantoic placenta. In summary, we have identified three new members of the rodent PRL gene family that are expressed in uterine and placental structures. Future experimentation is needed to determine the specific roles of each of these ligands in the biology of pregnancy.

Selenoprotein P expression in liver, uterus and placenta during late pregnancy.

To identify genes that exhibit increased expression in the placenta during late pregnancy, the technique of differential cDNA library screening was used to isolate a clone subsequently identified as the 3' untranslated region of the mouse selenoprotein p gene. Random primed radiolabelled cDNA probes were constructed from this clone and these probes were used to conduct Northern hybridizations against total RNA purified from mouse placenta, liver (maternal and fetal) and uterus collected sequentially during the latter third of pregnancy. Signal is present in the placenta and beginning 4 days before birth, the level of message increases, reaching maximal levels at term. The level of expression in the placenta at maximum is approximately 25 per cent of that observed in adult liver. In liver obtained from pregnant females, the level of message is increased compared to nonpregnant adults, but returns to normal shortly after birth. Message is also found in the fetal liver beginning at 4 days before birth and exhibits a pattern of expression similar to the placenta. The similarity of expression observed in fetal liver and placenta suggests a coordinated regulation of expression of this gene in these tissues. There is a minimal amount of signal present in the uterus and the expression does not appear to vary. We speculate that selenoprotein p may play a role in the transplacental transport of selenium to the fetus during late pregnancy.

Transferrin gene expression in maternal liver, fetal liver and placenta during pregnancy in the mouse.

Two clones that are homologous to the mouse liver transferrin gene were isolated from a differential screen performed on a mouse cDNA library constructed from placenta. Using an insert derived from the larger of these clones as a template for the generation of random primed cDNA probes, northern blots were conducted against total RNA collected sequentially from placenta (7 days before birth to birth), maternal liver (7 days before birth to birth) and fetal liver (5 days before birth to birth). An approximately 2.3 kb message was detected in all three tissues which was upregulated in late gestation. Message was very abundant in both maternal and fetal liver, and present, but weak, in placenta. The clones were partially sequenced and both clones contain sequence that is identical to mouse liver transferrin. The data presented demonstrate an increase in mRNA transferrin in late gestation in maternal and fetal liver. Additionally, the placenta expresses a gene homologous to liver transferrin and it also is upregulated in late gestation.

Kidney androgen-regulated protein gene is expressed in the uterus during late pregnancy.

Kidney androgen-regulated protein (KAP) is a unique protein of unknown function that is transcriptionally induced by sex steroids. KAP is thought to be predominantly a kidney-specific gene. After conducting a differential screen of a mouse uterus cDNA library, a clone was identified that is identical to KAP. Using this cDNA to generate radiolabeled cRNA probes, Northern blots were conducted against the following tissues collected sequentially during the latter third of pregnancy: kidney, uterus and placenta. Abundant message was present in all samples of the kidney tested and there was a slight, but apparent, increase (1.5-fold) in expression during the period surrounding birth. Message is also present in the uterus, at levels comparable to the kidney, but expression occurs only during the period surrounding birth. Message is not present in the uterus at any other time. Message is also not detected in the placenta or in several other tissues tested. In addition to the kidney, KAP gene is also transcribed at equivalent levels in the uterus. Unlike the kidney, expression in the uterus is limited to the perinatal period.

The concentration of tobramycin in bronchial secretions.

Fifteen noninfected patients received three consecutive doses of tobramycin (1.7 mg/kg intramuscularly). Serum and bronchial secretions were obtained during bronchoscopy. Microbiologic assay demonstrated that bronchial secretions containing tobramycin produced inappropriately small zone sizes when compared with serum. Also, it was shown that bronchial secretions frequently do achieve therapeutic concentrations of tobramycin at this dosage level and route of administration.

Effect of quinolone antimicrobials on theophylline pharmacokinetics.

The purpose of the research was to ascertain the comparative differences of quinolone antibiotics on theophylline pharmacokinetics. Eight healthy male volunteers were randomly assigned to four treatments. Each was administered norfloxacin (NOR) 800 mg/d, ciprofloxacin (C) 1 g/d, nalidixic acid (NAL) 2 g/d and placebo (P) for 7 days. On the seventh day of each treatment, theophylline (5 mg/kg) iv was administered. The elimination half-life (T 1/2), total body clearance (CL) and volume of distribution at steady state (Vss) of theophylline were calculated using model-independent methods. ANOVA for repeated measures was used for data comparisons. The mean (SD) theophylline results were: CL l/kg/h--NOR .038 (.006), C .033 (.006), NAL .045 (.008), P .044 (.007); T 1/2 h--NOR 9.2 (1.8), C 10.6 (1.8), NAL 8.3 (1.8), P 7.5 (1.4). Theophylline Vss differences by treatment were not significant. NOR and C significantly decreased theophylline's clearance and the clearance change can be of clinical significance.

The efficacy of inhaled beclomethasone in chronic obstructive airway disease.

The objective of this study was to examine the effectiveness of inhaled beclomethasone in the treatment of stable chronic obstructive airway disease (COAD). Eight patients completed a randomized, double-blind, placebo-controlled, crossover trial of inhaled beclomethasone and oral prednisone. Each patient received 3 treatment regimens given for 14 days: inhaled beclomethasone, prednisone, and placebo. There were no statistically significant differences in pulmonary function tests, oxygen cost diagram, or 12-minute walking distance test among the regimens. The only improvement in arterial blood gasses was partial pressure of oxygen, which was negligibly increased during prednisone treatment compared with beclomethasone and with placebo (p less than 0.05). Evaluation of 95% confidence intervals indicated that clinically significant mean differences were unlikely with either beclomethasone or prednisone. Larger studies are required to determine if a responsive subgroup exists, and to determine if this form of therapy has a role in treatment of COAD.

The pneumoconioses.

The pneumoconioses are by and large industrial diseases, although casual contact may be important on occasion, particularly with asbestos. The effect of dust on the lung ranges from only radiographic changes to severe functional impairment. Destruction and fibrosis of lung parenchyma may be the end result in severe disease. Great improvement has been made in recent years in the control of dust in the numerous situations where it may cause disease. We are still faced with evaluating existing standards of particle concentration in air breathed by workers and establishing safe limits and better control of the particles placed into the general environment. Undoubtedly, there are other particulates which potentially can cause lung disease of which we are not aware. Of even more concern is the realization that a latent period of 20 years or so may be necessary for physicians to become aware of the pathologic process. Every physician who sees patients with pulmonary problems must inquire regarding a history of dust exposure and be prepared to interpret that history.

Why tuberculosis is still a health problem in the aged.

Modern chemotherapy has made the treatment of tuberculosis effective and simple. What is required is a high index of suspicion for the disease, particularly in the older members of the population. When tuberculosis is suspected, a skin test should be performed and sputum examined for acid-fast bacilli. If the skin test is positive and the x-ray compatible, therapy with isoniazid and ethambutol should be initiated while evaluation of the patient continues. Therapy need not be complicated, and the patient can be returned to his usual environment promptly if a few simple rules are followed.

Therapy for chronic obstructive lung disease.

CAO is a chronic, degenerative disease of the lung that produces a number of serious physiologic abnormalities in respiratory function. It is progressive and, in general, responds poorly to medical therapy. Cigarette smoking is almost universally the cause of the disease, and stopping smoking clearly slows the progress of the disorder. Therapy is of marginal value at best in a substantial number of patients with this problem, and even in those who respond well, improvement in function is not great. A conservative approach to therapy is advised, but only when its value can be documented. As the illness progresses, chronic oxygen therapy in hypoxic patients may be of value in preventing or treating cor pulmonale.

Immunophenotypic analysis of cerebrospinal fluid cell populations with the Cell-Dyn Sapphire haematology analyser: method feasibility and preliminary observations.

Cerebrospinal fluid (CSF) samples (n=50) from patients with neurological disease (bacterial infection, viral infection, neuroborreliosis and multiple sclerosis) were analysed to characterize cell populations by fluorescent immunocytometry with the CD-Sapphire haematology analyser. Reagent combinations applied to all CSF samples comprised CD3/CD19/HLA-DR and CD4/CD8, with some being further analysed using CD3/CD4, CD3/CD16 and CD3/CD25 protocols. Of the 50 samples, 11 were excluded because of high proportions of nonviable cells (n=2) or insufficient cell numbers (n=9). Apart from bacterial infection with granulocytosis, all diagnostic groups showed high proportions (51.4-77.0%) of CD3+ T cells. There was a modest association between T-cell and B-cell counts, but absolute B-cell numbers exceeded 5 cells/microl in only 7/39 cases (neuroborreliosis, n=6; bacterial meningitis, n=1). CD3/Ia antigen (activation) co-expression was low and only exceeded 5% in 7/39 samples with no diagnostic correlation. Primary CD4+ and CD8+ T-cell subsets showed similar quantitative trends and CD4/CD8 co-analysis revealed the presence in all diagnostic groups (neuroborreliosis and multiple sclerosis in particular) of a CD4+CD8int fraction that was predominantly CD3+ and CD16- and had a morphological profile consistent with small lymphoid cells. Supplementary CD-Sapphire cellular immunological analysis of most CSF samples is feasible using the procedure detailed in this communication.