[Intercostal nerve syndrome]. / Das Intercostalnerven-Syndrom.

The intercostal nerve syndrome is caused by an impingement of the intercostals nerve at the level of the anterior rectus sheath. It may lead to acute or chronic abdominal pain, it should therefore be considered in the differential diagnosis of the acute or chronic abdomen. A positive Carnett-test and an effective local anaesthesia at the point of maximal tenderness allow the correct diagnosis. In our retrospective study 14 patients with 15 entrapment syndromes are described. If, sometimes after a few diagnostic and therapeutic detours, the diagnosis is established, surgical intervention with resection of the altered nerve at it's exit of the anterior rectus sheath can usually abolish the pain with little side effects.

Profiling of genes which are differentially expressed in mouse liver in response to adenoviral vectors and delivered genes.

The effects of transgene delivery by adenoviral vectors were studied by probing a 588 gene, mouse cDNA array with mRNA derived from infected liver. The liver tissues were obtained from naive mice and mice infected with replication-deficient adenovirus, adenovirus expressing transforming growth factor beta1 (TGFbeta1), and adenovirus expressing connective tissue growth factor (CTGF). Expression of 98 genes was detected in the array analysis. The increased expression of the transcripts for Stat1, gamma interferon-induced monokine (MIG) and interferon regulatory factor 1 (IRF1) clearly demonstrated the immune response induced by infection with a first generation, replication-incompetent adenovirus. In vivo expression of TGFbeta1 led to a down-regulation of genes involved in the immune response. The increased expression of u-PAR1, laminin receptor and BMP-1 confirms the importance of CTGF and TGFbeta1 in angiogenesis, and tissue repair. Expression of the serine protease inhibitors, Spi 2.4 and Spi 2, is also increased in response to AdTGFbeta1 and AdCTGF.

Long-term results of the external fixation of distal radius fractures.

OBJECTIVE: To evaluate the long-term results of external fixation of distal radius fractures. METHODS: A retrospective follow-up study (median follow-up, 5.3 years) of 49 patients with 50 distal radius fractures treated with an external fixator was carried out. An external fixator (Minifixator, Stratec Medical, Waldenburg, Switzerland) was used. The operative procedure is described in detail. A personal evaluation including clinical and radiologic assessment of both wrists was performed. RESULTS: The functional results, including the parameters strength, daily activities, range of motion, and presence of pain, as well as an anatomic score, the presence of osteoarthritis, the quality of reduction, and complications were recorded. Functional and anatomic results indicated excellent to good ratings in more than 80% of the cases. CONCLUSION: The external fixator is a versatile tool in the treatment of intra-articular and extra-articular fractures of the distal radius. The rate of algodystrophy (reflex sympathetic dystrophy) was 6%, and wrist stiffness was not found in our series.

Computerized polymorphic marker identification: experimental validation and a predicted human polymorphism catalog.

A computational system for the prediction of polymorphic loci directly and efficiently from human genomic sequence was developed and verified. A suite of programs, collectively called POMPOUS (polymorphic marker prediction of ubiquitous simple sequences) detects tandem repeats ranging from dinucleotides up to 250 mers, scores them according to predicted level of polymorphism, and designs appropriate flanking primers for PCR amplification. This approach was validated on an approximately 750-kilobase region of human chromosome 3p21.3, involved in lung and breast carcinoma homozygous deletions. Target DNA from 36 paired B lymphoblastoid and lung cancer lines was amplified and allelotyped for 33 loci predicted by POMPOUS to be variable in repeat size. We found that among those 36 predominately Caucasian individuals 22 of the 33 (67%) predicted loci were polymorphic with an average heterozygosity of 0.42. Allele loss in this region was found in 27/36 (75%) of the tumor lines using these markers. POMPOUS provides the genetic researcher with an additional tool for the rapid and efficient identification of polymorphic markers, and through a World Wide Web site, investigators can use POMPOUS to identify polymorphic markers for their research. A catalog of 13,261 potential polymorphic markers and associated primer sets has been created from the analysis of 141,779,504 base pairs of human genomic sequence in GenBank. This data is available on our Web site (pompous.swmed.edu) and will be updated periodically as GenBank is expanded and algorithm accuracy is improved.

A method for genome comparisons and hybridization studies using known megabase-scale DNA sequences as a reference.

We present a method for genome comparisons and high-resolution hybridization analyses using megabase stretches of known DNA sequences as a reference. The method employs two-dimensional gel electrophoresis, separating genomic segments cut with different restriction endonucleases in the first and second dimensions, to generate filters suitable for image analysis and repeated nucleic acid hybridizations. The corresponding two-dimensional pattern is computed from the reference nucleotide sequence and matched to the observed pattern, thereby identifying each fragment on the filter; at the same time the technique uncovers discrepancies from the reference sequence. This permits genome comparisons as well as automated identification and quantification of hybridization patterns with various probes. The technique is illustrated by an analysis of Saccharomyces cerevisiae chromosome IX.

PRIMO: A primer design program that applies base quality statistics for automated large-scale DNA sequencing.

PRIMO is a computer program that designs walking primers for large-scale DNA sequencing projects. Oligonucleotide primers are predicted automatically, using quality information associated with each base call, eliminating the need for manually viewing the sequence traces or inspecting contig assemblies to determine appropriate locations for primer design. This allows PRIMO to run in batch mode on an arbitrarily large number of templates. For shotgun sequencing, PRIMO reads assembled sequence contigs with corresponding base quality statistics and automatically designs walking primers as needed to extend and join contigs, or improve their overall quality. In the opposite extreme of single-pass or completely directed sequencing, PRIMO reads the unassembled sequence for each template and designs walking primers for extending each read. If the base-calling software does not provide base quality statistics, PRIMO assigns its own measure of base quality determined by the shapes of individual peaks in the trace data for each template. In this way, PRIMO can be used in the finishing stages of a shotgun sequencing project, in sequencing by directed primer walking, or in some intermediate strategy. The code is written in ANSI C and maintained in two versions: one for the Macintosh and the other for UNIX.

Physical mapping of complex genomes by sampled sequencing: a theoretical analysis.

A method for high-throughput, high-resolution physical mapping of complex genomes and human chromosomes called Genomic Sequence Sampling (GSS) has recently been proposed (Smith et al., 1994, Nature Genet. 7: 40-47). This mapping strategy employs high-density cosmid contig assembly over 200-kb to 1-Mb regions of the target genome coupled with DNA sequencing of the cosmid ends. The relative order and spacing of the sequence fragments is determined from the template contig, resulting in a physical map of 1- to 5-kb resolution that contains a substantial portion of the entire sequence at one-pass accuracy. The purpose of this paper is to determine the theoretical parameters for GSS mapping, to evaluate the effectiveness of the contig-building strategy, and to calculate the expected fraction of the target genome that can be recovered as mapped sequence. A novel aspect of the cosmid fingerprinting and contig-building strategy involves determining the orientation of the genomic inserts relative to the cloning vectors, so that the sampled sequence fragments can be mapped with high resolution. The algorithm is based upon complete restriction enzyme digestion, contig assembly by matching fragments, and end-orientation of individual cosmids by determining the best consistent fit of the labeled cosmid end fragments in the consensus restriction map.

[Long-term follow-up of acute pancreatitis--significance of cholecystectomy for the biliary form]. / Langzeitverlauf nach akuter Pankreatitis--Bedeutung der Cholezystektomie für die biliäre Form.

Of 83 patients with acute pancreatitis it was possible to control 79 of them 5-16 years later, 33 on the basis of case histories and 46 personally. In 43 cases (54.4%) it was pancreatitis caused by gallstones. After an operative procedure, there followed in each case an auspicious progress without recurrence. By the patients who were not operated, there was a recurrence rate of 45.5%. In cases of pancreatitis not caused by gallstones the late progress is marked by a high recurrence and complication rate.

[Long-term results after neurolysis and palmar transposition of the ulnar nerve]. / Langzeitresultate nach Neurolyse und Palmarverlagerung des Nervus ulnaris.

We reviewed 41 patients with 43 proximal ulnar nerve compression syndromes. The usual procedure was neurolysis of the ulnar nerve und subcutaneous transposition. The average follow-up period was 5 1/2 years (15 1/4 years to 3 months). The M/F ratio is 2.4:1. Most of the patients are hard manual workers, the dominant arm is most often affected, and 60% have some form of an injury in their history. About half of the patients followed-up have extensive relief of pain, loss of sensibility and weakness of the hand. But only 8 patients feel to have a perfect result. A few do complain of some tenderness in the scar region, some sensibility loss and a Tinel sign along the anterior route of the transposed nerve. Regaining of strength last months or even years. There is a general tendency to better final results in younger patients.

[10 years' experience using a modified Shouldice surgical technic for inguinal hernia in adults. II. Which factors modify the recurrence of inguinal hernia?]. / 10 Jahre Erfahrung mit einer modifizierten Operationstechnik nach Shouldice für Inguinalhernien bei Erwachsenen. II. Welche Faktoren beeinflussen die Rezidivgenese von Inguinalhernien?

Many factors seem to influence the recurrence rate after adult inguinal hernia repair. A statistical analysis of data derived from 726 transversalis fascia repairs examined by the authors (with a follow-up rate of 82.5% and a mean follow-up time of 5.5 years) revealed a significantly higher recurrence rate in patients with chronic bronchitis (p less than 0.05) or with postoperative complications (p less than 0.001). Lower recurrence rates were found after resection of lipomas of the cord (p less than 0.01) or cremasteric muscle resection (p less than 0.05). No significant difference of recurrence rate could be established for following parameters: Sex, side, age distribution, profession, prostatism, obesity, type of hernia (direct, indirect, combined, sliding), suture material (silk, polyglycolic acid), surgeon, anesthesia (local, spinal, full), elective or emergency operation, and whether the repair was unilateral or simultaneously bilateral. Recurrent repairs showed no significantly higher recurrence rate than primary repairs.

Palmar dislocation of scaphoid and lunate as a unit: case report with special reference to carpal instability and treatment.

A case of palmar dislocation of scaphoid and lunate as a unit is reported with a 3 1/2-year follow-up. Closed reduction was followed by redislocation after a week. Secondary open reduction could not prevent a dorsiflexed intercalated segmental instability deformity, which ended with arthritic changes in the wrist. A plea is made for early open reduction and internal fixation.

[Results following surgical repair of the ankle ligaments]. / Resultate nach Bandnaht am Aussenknöchel.

From a total of 133 patients with acute traumatic rupture of the lateral ligaments of the ankle 118 patients (88%) have been followed up for a period of 6 months to 8 years (average 2 years) after operative repair. According to the patients own statements, 88% reported good or very good results (minimal or no complaints). 12% referred to occasional pain and/or swelling. The objective results obtained by clinical and radiological examinations were excellent in 79% and unsatisfactory in 21%. The operative risk is minimal, thus we recommend early operative treatment of acute traumatic rupture of the lateral ligaments of the ankle.

[Hypoproteinemia causing postoperative "interstitial" paralytic ileus]. / Hypoproteinämie als Ursache eines postoperativen "interstitiellen" paralytischen Ileus.

On the basis of recent pathophysiological data and clinical observations in three patients, this paper draws attention to the commonly neglected importance of postoperative hypoproteinemia as the cause of an edema of the intestinal wall with a consequent "interstitial" paralytic ileus. The characteristic features of this syndrome are its onset between the third and the eighth postoperative day; the absence of other known causes of intestinal hypomotility; the benign, but protracted course without treatment; and the therapeutic success achieved by the correction of a hypoproteinemic fluid overload with concentrated albumin and a diuretic. In addition, parenteral hyperalimentation and Rheomacrodex-Sorbit may be indicated, but the hypoproteinemia should at any rate be corrected.

Agitated psychotic depression associated with severe hypomanic episodes: a rare syndrome.

The authors present detailed clinical and follow-up data on 12 patients with agitated psychotic depressions who developed serious hypomanic or manic episodes. In six patients, each type of affective episode seemed to merge into the others, while in the other patients there was always a clear temporal distinction between each type of episode. The authors suggest that the older ages of their patients may have contributed to the syndrome. They also offer several possible theoretical explanations: the patients 1) had mixed affective states and were trapped in the "switch" state from depression to mania, 2) inherited both unipolar and bipolar diseases, 3) represent a subgroup of bipolar patients, and 4) were schizoaffective.