An anomalous band originating from the fabella causing semimembranosus impingement presenting as knee pain: a case report.

BACKGROUND: The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee has a complex anatomy of muscles, tendons, and ligaments, with huge variation in the population. The fabella is one such structure, found in the posterolateral corner of the knee, which can serve as a common origin point of various ligaments. CASE REPORT: We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms. CONCLUSION: We propose that patients who present with posterior knee pain, without any history of trauma, and have no abnormalities on plain radiographs, should undergo magnetic resonance imaging of their knees. This will help in assessing the ligament complex in the posterior compartment of the knee, and exclude impingement of the semimembranosus as an, albeit rare, cause of posteromedial knee pain.

Computed tomography whole body imaging in multi-trauma: 7 years experience.

AIM: To assess the impact of the introduction of a computed tomography (CT) imaging protocol for multi-trauma patients on the workload, overall diagnostic yield, and effect on detection of cervical spine injury and pneumothorax. METHOD: Between February 1997 and April 2004, all patients presenting acutely to the Emergency Department (ED) with haemodynamically stable trauma (Abbreviated Injury Scale 3 or more) involving more than two body systems were imaged with a comprehensive pre-set helical CT protocol (including non-contrast head, cervical spine: cranio-cervical and cervico-thoracic junctions; and oral and intravenous contrast-enhanced thoracic, abdomen and pelvis) after initial triage and a standard trauma series of radiographs (chest, lateral C-spine and pelvis). Diagnosis of cervical spine fracture and pneumothorax was noted before and after the CT protocol was carried out and findings from all studies were recorded prospectively. RESULTS: Over the 7-year period 296 multi-trauma CT studies were completed of which 41 (13.8%) were negative. Of the positive cases there were 127 (43%) head injuries; 25 cervical spine fractures (8%); 66 pelvic fractures (22%);48 thoracic or lumbar spine fractures (16%); 97 pneumothoraces (33%); 22 mediastinal injuries (7%) and 49 intra-abdominal injuries (17%) with 19 (6%) splenic tears/ruptures. Positive findings included many unsuspected injuries, including 19 cervical spine fractures which were not demonstrated on the standard lateral radiograph from the resuscitation room. Of the 97 CT detected pneumothoraces, 12 were bilateral, 52 already had a chest drain in situ and 36 were not detected on initial supine chest radiography in the resuscitation room. One undetected case had bilateral tension pneumothoraces that were promptly drained on the CT table. Only three patients did not complete their multi-trauma examination because of deterioration in clinical condition and these were all immediately returned to the resuscitation room. CONCLUSION: Over the 7-year period in a large acute National Health Service (NHS) hospital trust currently averaging 85,000 ED attendances per year only 296 patients fulfilled the stated criteria for an immediate multi-trauma CT study. Although disruptive in the short-term, the overall impact on workload was small. A wide range of significant injuries were demonstrated rapidly, accurately and safely, including 19 cervical spine fractures and 26 pneumothoraces not detected on plain radiographs.

A simple method for the comparison of commercially available ATP hygiene-monitoring systems.

The purpose of this study was to evaluate a methodology which could easily be used in any test laboratory in a uniform and consistent way for determining the sensitivity and reproducibility of results obtained with three ATP hygiene-monitoring systems. The test protocol discussed here allows such comparison to be made, thereby establishing a method of benchmarking both new systems and developments of existing systems. The sensitivity of the LUMINOMETER K, PocketSwab (Charm Sciences) was found to be between 0.4 and 4.0 nmol of ATP with poor reproducibility at the 40.0 nmol level (CV, 35%). The sensitivity of the IDEXX LIGHTING system and the Biotrace UNILITE Xcel were both between 0.04 and 0.4 nmol with coefficients of variation (CVs) of between 9% at 0.04 nmol and 10% at 0.4 nmol for the IDEXX system and 17% at 0.04 nmol and 21% at 0.4 nmol for the Biotrace system. The three systems were tested with a range of dilutions of different food residues: orange juice, raw milk, and ground beef slurry. All three test systems allowed detection of orange juice and raw milk at dilutions of 1:1,000, although the CV of results from the Charm system (54 and 74% respectively) was poor at this dilution for both residues. The sensitivity of the test systems was poorer for ground beef slurry than it was for orange juice and raw milk. Both the Biotrace and IDEXX systems were able to detect a 1:100 dilution of beef slurry (with CVs of 17 and 10% respectively), whilst at this dilution results from the Charm system had a CV of 55%. It was possible by using the method described in this paper to rank in order of sensitivity and reproducibility the three single-shot ATP hygiene-monitoring systems investigated, with the IDEXX LIGHTNING being the best, followed by the Biotrace UNILITE Xcel, and then the charm LUMINOMETER K, PocketSwab.

Glial cells in transected optic nerves of immature rats. I. An analysis of individual cells by intracellular dye-injection.

The glial response to Wallerian degeneration was studied in optic nerves following unilateral enucleation in immature rats, aged 21 days old (P21). The three-dimensional morphology of dye-filled glia was determined in intact nerves, at post-enucleation day 21 in normal nerves from untreated P21 rats, by correlating laser scanning confocal microscopy and camera lucida drawings of single cells. In normal and transected nerves, the majority of dye-filled cells comprized astrocytes (54% and 65%, respectively). In normal P21 nerves, the predominant astrocyte form had a complex stellate morphology and had a centrally-located cell body from which branching processes extended randomly. Two other distinct forms were transverse and longitudinal astrocytes, which had a polarized process extension in a plane perpendicular or parallel to the long axis of the nerve, respectively. These forms were recognized in transected nerves also, but astrocytes in transected nerves had a simple morphology on the whole, and extended few, dense processes which branched infrequently. Quantitative analysis of astrocyte morphology confirmed that individual astrocytes underwent considerable remodelling in response to Wallerian degeneration. A prominent reaction was that astrocytes had withdrawn radial processes and extended a greater proportion of processes longitudinally, parallel to the long axis of the nerve and along the course of degenerated axons. A further, notable feature of transected nerves was the development of novel longitudinal forms and of hypertrophic astroglia. These results indicated that all astrocytes became reactive following enucleation and that glial scar formation was not the function of a single astrocyte subtype. Oligodendrocytes in transected nerves had lost their myelin sheaths and appeared as small cells with numerous bifurcating processes which extended radially, but a small number of oligodendrocytes were recognized which apparently supported myelin sheaths (9%, compared to 40% in normal nerves). In addition, there was a significant population of indeterminate cells in transected nerves (26%, compared to 6% in normal nerves) and, although some of these were identified as microglia/macrophages, it was concluded that many were likely to be dedifferentiated oligodendrocytes.

Detection of Escherichia coli in potable water using direct impedance technology.

Direct impedance measurement utilizing a medium previously described as being specific for Escherichia coli and which contains trimethylamine N-oxide (TMAO) and glucuronic acid was used to detect E. coli in water samples. The system was compared with the Colilert presence/absence test and the United Kingdom standard membrane filtration technique using membrane lauryl sulphate broth. The impedance method correlated well with both the traditional membrane method (93%) and the Colilert method (93.95%) for a number of different water types. No interference from Citrobacter spp. (as reported in previous studies) was detected in this study although some Salmonella spp. did give false-positive results. The data presented here suggest that the use of direct impedance may offer an alternative to conventional methods for the detection of E. coli in water.

A role for FGF-8 in the initiation and maintenance of vertebrate limb bud outgrowth.

BACKGROUND: The outgrowth of the vertebrate limb bud is the result of a reciprocal interaction between the mesenchyme and a specialized region of the ectoderm, the apical ectodermal ridge (AER), which overlies it. Signals emanating from the AER act to maintain the underlying mesenchyme, called the progress zone, in a highly proliferative and undifferentiated state. Removal of the AER results in the cessation of limb bud growth, thus causing limb truncation. The best candidates for this AER-derived signal are members of the fibroblast growth factor (FGF) family, in particular FGF-4, which can maintain limb bud outgrowth following removal of the AER. However, FGF-4 is only expressed after considerable outgrowth has occurred and a well-developed limb bud has formed, and then only in the posterior part of the AER. Likewise, the other FGFs studied to date are not candidates for this activity. RESULTS: We report evidence that a recently identified member of this family, FGF-8, is expressed in the ectoderm of the prospective limb territory prior to morphological outgrowth of the limb bud in both mouse and chick. Thereafter, expression is maintained throughout the AER during limb development. We have produced and purified the FGF-8 protein, and shown that it will substitute for the AER in maintaining limb bud outgrowth in mouse embryos from which the AER has been surgically removed. FGF-8 does not, however, maintain expression of the sonic hedgehog gene. CONCLUSIONS: These results indicate that FGF-8 is an AER-derived mitogen that stimulates limb bud outgrowth. Moreover, our data suggest that FGF-8 may also be an ectodermally derived mitogen that stimulates the onset of limb bud outgrowth (budding) in the absence of a morphological AER, and indicate the possible involvement of FGF-8 in the establishment of the limb field.

Three-dimensional morphology of astrocytes and oligodendrocytes in the intact mouse optic nerve.

The three-dimensional morphology of astrocytes and oligodendrocytes was analysed in the isolated intact mature mouse optic nerve, by correlating laser scanning confocal microscopy and camera lucida drawings of single cells, dye-filled with lysinated rhodamine dextran or horseradish peroxidase, respectively. These techniques enabled the entire process field of single dye-filled cells to be visualized in all planes and resolved the fine details of glial morphology. Morphometric analysis showed that the processes of all astrocytes had branches ending at the pial surface, on blood vessels, and freely in the nerve; branches ending in the nerve were described to end at nodes of Ranvier in the accompanying paper. Astrocytes were classified into a single morphological population in which each cell subserved multiple functions. The results of this study do not support the contention that astrocytes can be subdivided into two morphological and functional subtypes, namely type-1 and type-2, which have process ending either at the glia limitans or at nodes, respectively. Three-dimensional analysis of oligodendrocyte units, defined as the oligodendrocyte, its processes and the axons it ensheaths, showed the provision of single myelin segments for an average of 19 nearby axons (range 12-35) with a mean internodal length of 138 microns (range 50-350 microns). Mouse optic nerve oligodendrocytes were a homogeneous population and were markedly similar to those in the rat optic nerve. The results of our analysis of oligodendrocyte morphology are consistent with the view that the number and internodal length of myelin sheaths supported by a single oligodendrocyte are related to the diameter of the ensheathed axons.

Confocal imaging of glial cells in the intact rat optic nerve.

Astrocytes and oligodendrocytes in the isolated intact mature rat optic nerve have been computer imaged in three dimensions by laser scanning confocal microscopy of single cells, dye-filled with lysinated rhodamine dextran (LRD). Our results illustrate the first application of these techniques to an intact CNS white matter tract and provide comparative data for previous studies on neonatal rat optic nerve (Butt and Ransom: Glia 2:470-475, 1989; Butt and Ransom: J Comp Neurol 338:141-158, 1993). The combined use of intracellular injection of LRD and confocal imaging significantly improves the resolution of glial cell structure, particularly that of mature astrocytes, for a number of reasons. 1) Single mature dye-filled glia can be imaged, because LRD does not pass through gap junctions. 2) The entire process field of astrocytes can be visualized in a single two-dimensional image. 3) Cell images can be rotated through 360 degrees in all planes to provide a new perspective of glial cell structure in the intact tissue. 4) Reconstruction of optical sections, within a narrow focal plane, provides a high definition and resolution of the finer details of glial morphology. Using these techniques, three astrocyte subclasses were distinguished on morphological criteria. It is the conclusion of this study that the majority of these forms represent a single population of fibrous astrocytes which are well-suited to perform the multiple functions attributed to astrocytes in the CNS. The morphology of mature myelin-forming oligodendrocytes was also described.(ABSTRACT TRUNCATED AT 250 WORDS)

Control of breeding in the mare.

Six mares were studied over a period of two years under varying conditions of lighting from total darkness to normal ambient lighting. The mares continued to cycle during the winter under natural lighting and also when kept in total darkness. Circulating melatonin, progesterone and oestrogen concentrations were determined and related to clinical changes in the reproductive tract.

Plasma prolactin concentrations in non-pregnant mares at different times of the year and in relation to events in the cycle.

Plasma prolactin concentrations were measured in mares using an homologous radioimmunoassay. An annual rhythm in plasma prolactin was found, with concentrations higher during the summer than during the winter. In addition to this seasonal pattern, occasional high concentrations of prolactin were seen when concentrations were otherwise basal. Blood samples taken from mares during an oestrous cycle in October-November showed that prolactin values were basal for most of the cycle, with a marked rise in prolactin shortly before the onset of oestrus. This prolactin peak was associated with an increase in the size of the largest follicle, and with a peak of PGFM in some mares, but did not appear to be related to the LH surge. In oestrous cycles in March and May-June, there was a wide variation in the baseline of prolactin secretion, in accordance with the seasonal pattern already mentioned. However, the peak of prolactin seen around oestrus in October-November was less obvious in March and May-June. Post-partum mares showed a high but irregular profile of prolactin concentrations with no clear-cut pattern in relation to the oestrous cycle.

A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer.

Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.

Equine whole saliva: variability of some major constituents.

Whole saliva was collected from six horses over a period of five weeks in sufficient volume for the analysis of 10 constituents. There was considerable variation in the concentration of the analytes both between horses and between different days in the same horse. The most variable constituent was sodium, and the least variable was glucose, but this was derived from the sweet used to stimulate salivation. The use of whole saliva as a fluid for investigation would depend on achieving the minimum variability possible.

Mortality, morbidity and survival after colectomy for colon cancer.

Between 1971 and 1980, 346 patients had a carcinoma of the colon resected. Seventy-seven patients had an urgent operation with a hospital mortality of 13.3%; 269 patients had an elective operation with a mortality of 3.8%. Three patients died as a result of anastomotic leakage. Other complications were thromboembolism (2%) and wound infection (14.5%). The overall median survival was 28.4 months and 57 months following curative resection. The clinicopathological staging system used identified 28% of patients as incurable at the time of resection.

Local recurrence following curative resection for carcinoma of the rectum.

One hundred ninety-three patients had curative resections for carcinoma of the rectum between January 1971 and December 1979. Nineteen patients developed local recurrence (9.8 per cent): 5/95 after abdominoperineal excision (5.2 per cent) and 14/98 after anterior resection (14.3 per cent). There was no difference in the overall survival rate between the two operations, but there was a trend toward decreased survival for patients who developed local recurrence. Metastatic spread to the lymph nodes increased the risk of local recurrence.