Ulnar deviation after volar subluxation of the proximal interphalangeal joint.

A rare case of irreducible and progressive ulnar deviation after volar subluxation of the proximal interphalangeal joint is presented. An immobilized proximal interphalangeal joint with remaining volar subluxation after improper reduction showed ulnar deviation at 3 weeks after injury. During surgery, the radial collateral ligament was found to be ruptured at its origin, with formation of concomitant scar tissues. There were no apparent lesions at the central slip, lateral band, and volar plate. Interposition of the ruptured ligament and infiltration of the surrounding scar tissues into the proximal interphalangeal joint were identified. Surgical incision of the capsule along the dorsal margin of the radial collateral ligament readily produced successful reduction. The irreducible and progressive ulnar deviation of the proximal interphalangeal joint seemed to result from gradual infiltration of the scar tissues, subsequent to remaining volar subluxation because of interposition of the ruptured collateral ligament.

Pancytopenia in tuberous sclerosis.

A 46-year-old woman with edema and pancytopenia was referred for further evaluation. She was diagnosed as tuberous sclerosis with clinical manifestations such as facial adenoma sebaceous, ungual and periungual fibroma, subependymal nodules and renal angiomyolipoma. Her edema seemed due to hypercardiac function induced by massive anemia. X-ray revealed extraordinary thickening of the cortex of long bones of the extremities as well as patchy osteosclerotic findings in vertebra, suggesting that hematopoietic space was significantly reduced. Pancytopenia improved after splenectomy. Histological examination revealed several intrasplenic hemangiomas but its relationship to hypersplenism was not clear. It seemed that her massive pancytopenia was induced by a combination of hypersplenism and significant reduction in hematopoetic space. In tuberous sclerosis, various systemic complications sometimes induce severe hematological abnormalities. According to previous literatures, the present case of tuberous sclerosis manifested the most outstanding hematological complications.

Factors affecting the variability of the torque curves at isokinetic trunk strength testing.

OBJECTIVES: To evaluate the relation between variability of the torque curves and factors such as age, gender, measurement speeds, and period from low back pain (LBP) onset at isokinetic trunk strength testing. DESIGN: Observational. SETTING: Hospital. PATIENTS: One hundred forty-three consecutive LBP patients (acute, subacute, and chronic) who received physical therapy, and 200 healthy volunteer subjects. MAIN OUTCOME MEASURES: The variability of the torque curves is an indicator of consistency of effort, and was measured as the coefficient of variance (CV) at different measurement speeds in isokinetic trunk flexion/extension strength testing. RESULTS: The CV was lower in men than in women at the faster measurement speed. LBP patients had higher CV values than healthy subjects. The CV was different according to gender and measurement speed, but not different according to age and periods from LBP onset. CONCLUSION: The CV was affected by measurement speed and gender, but not by age or period from LBP onset. Because the CV was higher in LBP patients than in healthy subjects, this value may be usable as an adjunctive index of LBP.

Hypoxia increases endothelin release in bovine endothelial cells in culture, but epinephrine, norepinephrine, serotonin, histamine and angiotensin II do not.

Calf coronary artery endothelial cells in culture were exposed to normoxic and hypoxic conditions (2% oxygen) for 4 hr and 24 hr. After 24 hr of incubation, there was a significant increase in the accumulation of immunoreactive endothelin (irET) in the media. Incubations with epinephrine, norepinephrine, serotonin, histamine and angiotensin II did not result in an increase in irET production. These studies indicate that hypoxia enhances endothelin release, however, the kinetics of this release suggest that the acute endothelium-dependent vasoconstriction occurring after hypoxia does not result from an increase in endothelin release.

Rat mesenteric artery endothelial cells in culture secrete ET-1.

Endothelial cells were harvested by the collagenase perfusion of isolated mesenteric arteries of rats and cultured. An endothelin peptide was detected in the supernatant of these cells by an antibody which recognizes ET-1 but not "rat" endothelin (ET-3). Culture media was extracted using a C-8 solid phase column and subjected to reverse phase HPLC using a system that separates all known endothelins and immunoreactive endothelins measured using another antibody which recognizes all endothelins. The main immunoreactive peak co-eluted with ET-1. We could not detect any ET-2, ET-3 or Vasoactive Intestinal Contractor. A smaller immunoreactive peak of unknown structure that eluted earlier than ET-1 was also detected. In conclusion, rat endothelial cells secrete a peptide of similar chromatographic and immunoreactive properties as ET-1.