Percutaneous screw fixation for traumatic spondylolisthesis of the axis using iso-C3D fluoroscopy-assisted navigation (case report).

INTRODUCTION: Stable hangman's fractures are usually treated with a Halo vest fixation; however, this is not always effective in patients with polytrauma. These patients benefit from minimally invasive surgery because it allows for early rehabilitation and reduced nursing care. This is the case report on percutaneous screw fixation using three dimensional fluoroscopy-assisted navigation in a patient with polytrauma and a hangman's fracture. CASE REPORT: The patient was a 69-year-old woman involved in a traffic accident. Radiographs and CT showed bilateral fractures through the neural arch at the base of the C2 pedicles. External immobilization was difficult due to her polytrauma. INTERVENTION: A dynamic reference arc was attached to the spinous process of the axis through a small incision. After image acquisition, the fluoroscope workstation generated 3-dimensional reconstructions of the imaged anatomy. We made two small, lateral incisions for percutaneous screw insertion, and used an image-guided awl to create screw holes. A guide-wire was inserted through this screw pilot hole, and a cancellous lag screw was inserted over the guide-wire. At her final follow-up, the patient had no neurological deficits and bony union was achieved. CONCLUSION: Percutaneous screws fixation using three-dimensional fluoroscopy proved to be a useful technique for the treatment of hangman's fracture.

Potentiation of pentazocine conditioned place preference by tripelennamine in rats.

The effects of tripelennamine on place preference conditioning in rats with pentazocine were investigated. Pentazocine at a dose of 2 mg/kg (IP) slightly, but not significantly, induced a place preference. Concurrent dosing of pentazocine (2 mg/kg, IP) and tripelennamine (2.5 mg/kg, SC) significantly and prominently produced a place preference, although administration of tripelennamine (2.5 mg/kg, SC) alone did not. Chronic infusion of a dopamine D1 receptor antagonist, SCH23390 (1.0 mg/kg/day) during conditioning abolished the appetitive effect of pentazocine potentiated by the combination with tripelennamine. In conclusion, it is suggested that the dopaminergic system, especially at the D1 receptor, plays an important role in the potentiation effect of tripelennamine on the pentazocine-induced place preference.

Release of hepatic mitochondrial ornithine transcarbamylase into the circulation in D-galactosamine-treated rats. Identification of serum ornithine transcarbamylase as the intact form of the mitochondrial enzyme.

A single injection of D-galactosamine into rats caused acute liver cell injury, and the activity of ornithine transcarbamylase in the serum increased about 600-fold as compared with that in the normal serum. Some properties of the serum enzyme from galactosamine-treated rats have been studied together with those of the mitochondrial enzyme in liver. Both the enzyme activities gave similar pH profiles, showing an optimum of pH 8.5. Apparent Km values of the serum enzyme for ornithine under the standard conditions at pH 7.4 and pH 7.7 were 1.59 mM and 0.94 mM, respectively, and those of the mitochondrial enzyme were 1.69 mM and 0.97 mM, respectively. The Km value of the serum enzyme for carbamyl phosphate was 0.34 mM, which is similar to that of the mitochondrial enzyme. The mitochondrial enzyme was purified 78-fold to homogeneity with a 45% yield by ammonium sulfate fractionation, heat treatment, 2nd ammonium sulfate fractionation, and phenyl-Sepharose CL-4B and CM-Sephadex C-50 column chromatographies. The specific activity of the purified enzyme was 282 mumol of citrulline formed per mg of protein per min at 37 degrees C. The mitochondrial and serum enzymes have a molecular weight of 115,000 as determined by Sephacryl S-300 gel filtration. Antibody specific for the mitochondrial enzyme was raised, and the immunological properties of the serum enzyme were examined. In immunoinhibition experiments, a decrease of the serum enzyme activity as well as the mitochondrial enzyme was observed on increasing the amount of the antibody.

Profiles of plasma amino acids in fasted patients with various liver diseases.

We examined the level of plasma amino acids, glucose, immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) of patients in the fasted state with acute hepatitis in the actual acute stage (AHa), acute hepatitis in the convalescent stage (AHc), chronic active hepatitis (CAH), chronic persistent hepatitis (CPH) and liver cirrhosis (LC). In AHa patients, the plasma glucose (FPG), plasma alanine (Ala), tryptophan (Trp) and histidine (His) levels were significantly lower and plasma cystine (Cys) level significantly higher than the control levels. This however, was not the case in the other patients. The glutamic acid (Glu) concentration was significantly higher in AHa (p less than 0.02), CAH (p less than 0.001) and CPH (p less than 0.001) and the tyrosine (Tyr) concentration was significantly higher in AHa (p less than 0.02), CPH (p less than 0.001), CAH (p less than 0.001) and LC (p less than 0.001) than they were in the controls. The lysine (Lys) concentration was significantly raised in the AHa (p less than 0.02) and CPH (p less than 0.05) cases. The IRG level was significantly higher in AHa (p less than 0.001), in AHc (p less than 0.01) and LC (p less than 0.01). Valine (Val) showed a significant decrease in concentration in AHa (p less than 0.01) and LC (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in plasma amino acids during the oral glucose tolerance test in hepatic diseases.

We have measured the plasma concentration of neutral amino acids before and after an oral glucose tolerance test (100 g) in patients with liver cirrhosis (LC), chronic active hepatitis (CAH), chronic persistent hepatitis (CPH), acute hepatitis in the acute stage (AHa) and acute hepatitis in the convalescent stage (AHc) and normal controls. The ratio of the concentration of an amino acid to the sum of those of the other neutral amino acids that compete during transport through the blood brain barrier (BBB), which was reported to correlate well with the brain level of the amino acid, was compared in patients with various liver diseases. The ratios of Trp (Trp/Tyr + Phe + Ile + Leu + Val), Tyr, Phe, and Val increased after glucose loading in all subjects, except Tyr in normal controls, which slightly decreased. On the other hand, Ile and Leu ratios decreased (Trp; tryptophan, Tyr; tyrosine, Phe; phenylalanine, Ile; isoleucine, Leu; leucine, Val; valine). LC showed a characteristic pattern; the ratios of Trp and Tyr were highest among all diseases at 3 hours after glucose loading, and those of Ile, Leu and Val were lowest. We assumed that delta an amino acid ratio = the amino acid ratio at 3 hrs after glucose loading minus the amino acid ratio at 0 hr. In LC, delta Trp ratio and delta Tyr ratio were highest, while delta Val ratio was lowest. The delta Phe ratios in AHa and AHc were significantly higher than those in healthy controls. From these results, the uptake of Trp and Tyr might be supposed to be highest and that of Val was lowest in LC, after glucose loading.

Protothecosis in a patient with systemic lupus erythematosus.

A rare case of protothecosis in a 40-year-old Japanese woman with systemic lupus erythematosus, under long-term prednisolone treatment is presented. The patient developed extensive ulcerative skin lesions after injury. The characteristic histopathological findings and biochemical sugar assimilation tests indicated infection by Prototheca wicherhamii. The lesions improved following treatment with amphotericin B. The immunodeficient state of this patient seemed to contribute to the infection with Prototheca.

Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstring tendons with endoButton femoral fixation: A prospective study.

PURPOSE: This prospective study was conducted to compare the single-socket and the bi-socket anterior cruciate ligament (ACL) reconstruction techniques in terms of outcome. TYPE OF STUDY: Nonrandomized control trial. METHODS: There were 160 consecutive patients with unilateral chronic ACL insufficiency who underwent endoscopic single- or bi-socket ACL reconstruction alternately using multiple-stranded medial hamstring tendon and EndoButton (Smith & Nephew, Andover, MD) femoral fixation. All patients underwent the same postoperative rehabilitation protocol. Of them, 106 patients (57 single, 49 bi) were available for 2-year follow-up. RESULTS: According to the IKDC Knee Ligament Evaluation Form, 23 patients (40%) of the single-socket group were subjectively graded as normal, 30 (53%) as nearly normal, and 4 (7%) as abnormal. Twenty-six patients (53%) of the bi-socket group were graded as normal, 21 (43%) as nearly normal, and 2 (4%) as abnormal (P =.19). The mean side-to-side anterior laxity difference (KT-1000 manual maximum force) was 0.9 +/- 1.8 mm for the single-socket group and 0.7 +/- 1.2 mm for the bi-socket group (P =.44). Fifty-three of 57 patients (93%) in the single-socket group and all patients in the bi-socket group showed anterior laxity differences of +/-3 mm or less (P =.12). There were no differences in thigh muscle strength between the groups. CONCLUSIONS: Both single- and bi-socket ACL reconstruction using autogenous multiple-stranded hamstring tendons with EndoButton fixation provided satisfactory anterior stability, and there were no statistically significant differences in subjective results or measured restored stability between the 2 groups.

Diffuse calcification in gastric cancer.

The progressive expansion of calcification into the wall of the stomach and peritoneal metastatic foci was observed in a 31-year-old female with Borrmann type 4 calcified advanced gastric cancer. Despite treatment with systemic lentinan, uracil tegaful and mitomycin C, together with intraperitoneal injections of mitomycin C, OK-432 and prednisolone, the patient died 27 months after first presentation. The case provided a useful means of studying the mechanism of calcification.

Comparison of effects of xenobiotics on extrahepatic and hepatic microsomal drug-metabolizing enzymes in mice.

The content of microsomal protein is the same in both kidneys and small intestine, corresponding to 57% of the control value expressed as 100% in the untreated liver. The contents of P450 and cytochrome b(5), and the activity of NADPH-cytochrome c reductase in the kidney were higher than those in the small intestine, which were 17%, 22% and 41% of controls, respectively, in the former and 5%, 11% and 22% of controls in the latter. As compared with similar measurements made in the liver, the activities of substrate-metabolizing enzymes in these extrahepatic organs were very low. The activities of renal aniline hydroxylase, aminopyrine N-demethylase, 7-ethoxycoumarin O-deethylase, 7-methoxycoumarin O-demethylase and benzo(a)pyrene hydroxylase were 6%, 5%, 3%, 0.6% and 0.2% of controls, respectively. The activities of these enzymes in the small intestine were lower than those in the kidney or below the limits of detection. These results suggested that isoforms or their contents of P450 responsible for these substrate biotransformations are different among liver, kidneys and small intestine. Meantime, this study showed similar significant inductions by phenobarbital and rifampin of small intestinal and hepatic microsomal drug-metabolizing enzymes. In contrast, neither phenobarbital nor rifampin was capable of increasing renal microsomal enzymes, with the exception of benzo(a)pyrene hydroxylase which was induced by rifampin. These findings indicated that both liver and small intestine, but not kidneys contain the same phenobarbital- and rifampin-inducible P450 isoforms, cytochrome b(5) and NADPH-cytochrome c reductase. In addition, CCl(4) could be bioactivated by CYP2E1 to free radicals in the kidney which caused destruction of microsomal enzymes. In mice pretreated with phenobarbital, CCl(4) also attenuated the increase in content of P450 in the small intestine, which appeared to be a result of induction by phenobarbital of CYP2E1.

[Development of tetany in siblings suffered from Bartter's syndrome].

The present authors observed and treated a siblings case of normocalcemic tetany, which is considered as belonging to Bartter's syndrome. As far as we know, there are a number of familial cases of tetany in literature, but none of them spreads over more than two generations, so that the tetany appears to be recessive in hereditary characters including our patients. Both of them presented tetanic seizures in the course of Bartter's syndrome and they were regarded as one of various manifestations of the syndrome. In other words, the Bartter's syndrome or the hypopotassemia should be one of the fundamental disorders for developing tetanic symptom. The tetanic symptoms became extinct during the treatment with spironolactone against hypopotassemia. Of the two patients, younger sister had shown an agitated depression developed on her childish and over-sensitive personality, but the depression was improved in parallel to the recovery from tetany and hypopotassemia. Therefore, it appears to be certain that the patients would have some premorbid deviation of personality traits, where symptomatic psychoses could be attributed, in the case of Bartter's syndrome. Generally speaking the psychic disorders, such as personality deviation and psychotic episode, seem to by very important symptoms in patient with Bartter's syndrome as well as in patient with hypocalcemia or hypoparathyroidism.

The carcinostatic effects of 1-(2-tetrahydrofuryl)-5-fluorouracil and uracil (UFT) on tongue carcinoma induced by 4-nitroquinoline 1-oxide (4NQO) in rats.

UFT is a carcinostatic agent used in adjuvant chemotherapy for head and neck cancer. In the present study. UFT was given orally to treat tongue carcinoma in rats induced by 4-nitroquinoline 1-oxide. The antitumor effects of UFT were studied macroscopically and histologically. In addition, the antitumor effects of UFT were evaluated in relationship to lesions of the clinical and, invasive types, and to there vascular structure. In clinical lesions, the antitumor effect of UFT was higher in extrovert tumor-mass lesions and lower in ulcerous lesions. With regard to vascular structure, the effect was higher in cases demonstrating irregular net-like patterns and branch-like patterns and lower in cases in which the pattern had been destroyed. There was a correlation between antitumor effect and invasive type. As invasive tendency the 3H-thymidine labeling index, and mitotic index increased, antitumor effect and degree of tumor cell degeneration decreased.

[Evaluation of the biological malignancy in hepatocellular carcinoma by argyrophilic nucleolar organizer region (AgNOR) staining--morphological study of AgNOR using image analyzer].

Using the Colloid silver staining technique to reveal AgNOR and immunostaining for anti-PCNA monoclonal antibody, 23 resected specimens with hepatocellular carcinoma (HCC, < or = 3.5cm in diameter) were examined. These cases were divided into two groups; Group A [9 cases without vascular invasion and a satellite nodule] and Group B [14 cases with satellite nodules]. Comparison of AgNOR score, the morphological features of AgNOR (the area and roundness factor of AgNOR) and PCNA labeling index between Group A and Group B was made by a image analyzer (SP-500). The AgNOR scores and PCNA labeling indices of HCCs in Group B were significantly higher than those of HCCs in Group A. And a close correlation was shown between AgNOR score and PCNA labeling index. Further more, the area, form, and distribution of AgNORs within the nucleus were also different in the two study groups. In Group A, many AgNORs were regular and medium-sized brown dots (AgNOR-roundness factor; > or = 80%, AgNOR-area; 1.5-4.5 microns 2). But in Group B, AgNORs showed marked variation in size and form. These results suggest that HCCs with multiple, smaller, irregular, and widely dispersed AgNOR in combination with high AgNOR scores have a more aggressive potential. The morphological features of AgNOR may be useful indicators for evaluating the proliferative activity of HCC.

[Interferon-associated retinopathy].

During interferon (IFN) treatment for chronic hepatitis C, retinopathy develops in about one half of the patients. This "IFN-associated retinopathy" is characterized by cotton-wool spots (ischemic lesions) and superficial hemorrhage around the optic disc. It usually occurs 1 to 3 months after initiation of IFN therapy. Most of the patients with retinopathy have no symptoms, while some complain of impairment of visual acuity or flying specks. IFN-associated retinopathy tends to improve without any ophthalmic treatment and IFN therapy can be continued under careful observation. A complication of diabetes mellitus or a decrease in platelet count during IFN treatment may aggravate IFN-associated retinopathy. We emphasize that careful ophthalmologic follow-up is needed for all patients under IFN therapy.

The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability.

OBJECTIVES: To evaluate the applicability of MRI for the quantitative assessment of anterior talofibular ligaments (ATFLs) in symptomatic chronic ankle instability (CAI). METHODS: Between 1997 and 2010, 39 patients with symptomatic CAI underwent surgical treatment (22 male, 17 female, mean age 25.4 years (15 to 40)). In all patients, the maximum diameters of the ATFLs were measured on pre-operative T2-weighted MR images in planes parallel to the path of the ATFL. They were classified into three groups based on a previously published method with modifications: 'normal', diameter = 1.0 - 3.2 mm; 'thickened', diameter > 3.2 mm; 'thin or absent', diameter < 1.0 mm. Stress radiography was performed with the maximum manual force in inversion under general anaesthesia immediately prior to surgery. In surgery, ATFLs were macroscopically divided into two categories: 'thickened', an obvious thickened ligament and 'thin or absent'. The imaging results were compared with the macroscopic results that are considered to be of a gold standard. RESULTS: Agreement was reached when comparison was made between groups, based on MRI and macroscopic findings. ATFLs were abnormal in all 39 cases and classified as ten 'thickened' and 29 'thin or absent'. As to talar tilt stress radiography, a clear cut-off angle, which would allow discrimination between 'thickened' and 'thin or absent' patients, was not identified. CONCLUSION: MRI is valuable as a pre-operative assessment tool that can provide the quantitative information of ATFLs in patients with CAI. Cite this article Bone Joint Res 2014;3:241-5.