Radiograph-based study of gender-specific vertebral area gain in healthy children and adolescents as a function of age, height, and weight.

This study reports gender-specific vertebral area gain data from children and adolescents. Vertebral area was measured on lateral and anteroposterior thoracic and lumbar spine radiographs from 100 female and 100 male subjects aged 7-28 yr. T9, T11, T12, L1, and L2 X-ray area calculation was based on calculation of the area of the geometric figure of a trapezoid whose 2 nonparallel sides were equal in length, taking account of the waisted shape of the vertebrae. Both the boys and girls of our study population showed statistically significant dependence (p<0.001) of vertebral area gain on chronologic age, height, and weight right through the end of puberty, and especially so up to age 15 yr. However, height and weight were clearly better predictors of lateral and anteroposterior vertebral area gain than was chronologic age. Once vertebral growth is complete by age 18 yr or so, the lateral vertebral areas of the male subjects-regardless of body weight and height-are, on average, 25% larger, and the anteroposterior areas up to 30% larger than those of their female counterparts. After adjusting for chronologic age, height, and weight however we did not find significant differences, between gender, in vertebral area of male and female subjects, neither among children younger than 11 yr nor adolescents ages of 12-14 yr and young adults older than 18 yr.

[In vivo diagnosis of epithelial changes of the oropharynx using confocal microscopy]. / In-vivo-Diagnostik von Epithelveränderungen des Oropharynx mittels konfokaler Mikroskopie.

BACKGROUND: Confocal laser scanning microscopy enables the visualization of the anterior regions of the oropharynx mucosa. The specific aim of this investigation was to evaluate whether this in vivo tool supplies essential information for the surgeon prior to operation or not. PATIENTS AND METHODS: The laser scanning microscope HRT II and Rostock Cornea Module were used in this in vivo study. To obtain comparable images, the specifications of this tool used for all investigations were maintained (63 x water immersion objective lens). The investigations were performed on 9 patients with tongue cancer with primary tumor site and stage I (AJCC) and on 12 patients with head and neck cancer who underwent radiochemotherapy (RCT). Data from 21 patients were compared to those of healthy subjects. RESULTS: The following parameters can be detected using LSM: nuclear density, nuclear size, nucleus/cytoplasm relation, number of nuclei, regularity of cell layers, morphology of cells of a cell layer, and occurrence of cellular junctions. In regard to these parameters, dysplastic and cancerous lesions reveal significant differences compared to healthy tissue of the oropharynx. After RCT several epithelial changes were found, such as keratosis, mild dysplasia, increased vascularization and more cell edema and necrosis. CONCLUSIONS: Consistent differences exist between LSM findings of healthy subjects and those of patients with dysplastic, keratotic and cancerous lesions. Both strong hyperplasia and leukoplakia prevent a visualization of the basement cell layer in the oropharynx. The combination of LSM technology and endoscopy and following further investigations are needed for evaluation of LSM technology in the field of otorhinolaryngology.

Elevated IL-6 levels in the synovial fluid of osteoarthritis patients stem from plasma cells.

OBJECTIVE: To analyse the levels of interleukin-6 (IL-6) in the synovial fluids and sera of patients with osteoarthritis (OA) and to identify the IL-6-secreting cells. METHODS: Serum, synovial fluid, synovial tissue, and articular cartilage samples were collected from 49 OA patients with end-stage knee or hip OA who underwent joint replacement surgery. Serum and synovial fluid levels of IL-6 were measured by enzyme-linked immunosorbent assay (ELISA) and IL-6-secreting cells were identified by immunohistochemistry. RESULTS: Eight out of 49 patients (16%) exhibited elevated IL-6 levels in the synovial fluids, averaging at 2022+/-526 pg/mL, while the levels in the rest of the patients averaged at 132+/-19 pg/mL. The sera levels of all patients were comparable in the 10 pg/mL range. Immunohistochemical analyses revealed plasma cells in the synovial lining of the high producers as the source of IL-6. CONCLUSIONS: Synovial fluid IL-6 levels may help to classify OA patients and may point to a subgroup with a particular impact from their immune system.

[Confocal microscopic evaluation of epithelia of the larynx]. / Konfokalmikroskopische Untersuchungen des Kehlkopfepithels.

BACKGROUND: To evaluate mucosal changes of the true vocal cord, e. g. leukoplakia, microlaryngoscopy is needed to obtain tissue for histopathologic investigation. But there is a discrepancy between the amount of representative tissue necessary for pathology and the postoperative voice function. Thus, a diagnostic procedure that enables the surgeon to differentiate inflammation from dysplasia and carcinoma in situ intra-operatively is urgently needed. We are now reporting on our results using laser scanning microscopy to visualize larynx epithelia. METHODS: The laser scanning microscope used in this ex vivo study is a combination of the Heidelberg Retina Tomograph HRTII and the Rostock Cornea Module. A 63 x water immersion objective lens was used for imaging. PATIENTS: Seven larynx preparations of patients (age 54 to 62 years) with a T4 larynx carcinoma who underwent laryngectomy between 2003 and 2006 were examined. RESULTS: Areas of epithelia of the true vocal cord of macroscopically normal appearance supplied images of healthy, but also inflamed laryngeal epithelia. The corresponding histopathologic sections prepared horizontally confirmed the regularity and homogeneity of the mucosa. The different layers of the lamina propria can be separated. In contrast to healthy and inflamed laryngeal mucosa, dysplasia, precancerous lesions and carcinoma-atypical cells were visible. In the latter entity a loss of cellular junctions characterized by lack of visualization of the cell membrane was apparent. CONCLUSIONS: LSM supplies information of healthy, inflamed, but also pre-malignant and malignant mucosa changes of the larynx. The pilot study shows that both hyperkeratosis and extensive hyperplasia confine the visualization of the basement cell layer. Research projects have been initiated with the objective to develop a rigid endoscope with integrated LSM technology.

Anastomotic stenting in a porcine aortoiliac graft model.

The purpose of the study was to evaluate the feasibility of anastomotic stent application in a porcine aortoiliac graft model. In a total of 10 pigs, a polytetrafluoroethylene aortobi-iliac graft was implanted through a midline abdominal incision. The lower edge of the iliac vessel was graft-inverted about 1 mm to produce irregularities at the downstream anastomosis. After transverse graft incision, six stainless-steel stents, six poly-L-lactic acid (PLLA) stents and four PLLA stents with 10% polycaprolactone (PCL) were implanted at the iliac anastomotic site using a 6 mm balloon dilatation catheter. Four anastomotic sites were left untreated. After two weeks, the patency of graft limbs was evaluated by contrast-enhanced computed tomography (CT). Both metal and polymeric stent designs provided adequate flexibility to manoeuvre across the anastomotic site for expansion in the chosen position. After deployment, the stent-arterial wall contact was complete on a macroscopic view. On CT scan, all metal and PLLA-stented graft limbs were free of stenosis, whereas all PLLA/PCL stents were occluded. The non-stented graft limbs showed a stenosis of 50-70%. In summary, this model is feasible to assess preclinically the deployment and patency rate of an anastomotic stent and to test future stent developments.

[Bladder rupture caused by spontaneous perforation of an infected urachal cyst]. / Blasenruptur durch spontane Perforation einer infizierten Urachuszyste.

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.

Quality control of "one touch" II blood glucose meters used by nurses in clinical departments.

Most analyses of blood glucose concentrations in our hospital are performed bedside by nurses with One Touch II blood glucose meters. The laboratory is responsible for the test results and therefore a quality control system which includes the performance by the nurses, is necessary. Human serum, spiked sterilised horse blood and (spiked) human blood were tested with 39 One Touch II blood glucose meters for usefulness in extra-laboratory quality control schemes. Serum gave high imprecision (CV > 9%) and leaked through the strips, contaminating the meters. Horse blood gave unacceptable imprecision (CV = 6.7%) and human blood could not be used due to an unpredictable time course of the glucose values in the distributed samples. Addition of NaF increased the CV of the measurements by more than 2%. Only the One Touch control solutions (3 levels) resulted in satisfactory precision (CV = ca. 4%) and are therefore suitable for extra-laboratory quality control of precision. However, accuracy control has to be done within the laboratory with fresh human blood.

The immunofluorometric TSH assay as first-line test for suspected thyroid dysfunction.

In this study of 103 patients with suspected thyroid dysfunction, the diagnostic value of a single basal immunofluorometric (IFMA) TSH measurement was evaluated and compared with the classical TRH test with RIA-TSH measurements, plasma TT4 concentrations and FT4I. A single basal TSH determination accurately predicted the TRH-stimulated TSH response, making the TRH test redundant in most patients. Because undetectable basal TSH did not always exclude a small rise in TSH, the TRH test could still be indicated in patients receiving thyroxine suppression therapy for thyroid cancer. Basal TSH differentiated accurately between euthyroidism and thyroid dysfunction, especially at the decision values of 0.20 and 4.0 mU/l, as proposed in this study. For diagnosis of clinical and subclinical hypo- and hyperthyroidism, additional measurement of TT4 and/or FT4I is necessary. A 2-yr follow-up of patients with subclinical thyroid dysfunction did not show progression to clinical disease. In some of the patients with subclinical hypothyroidism, substitution therapy with thyroxine had been started after initial testing. Indications for treatment of subclinical thyroid dysfunction are discussed.

Analytical evaluation of four sensitive assays of thyrotropin, including effects of variations in patient sampling.

Four immunometric kits for thyrotropin with detection limits below 0.1 milli-int. unit/L were evaluated with respect to accuracy, precision, specificity, matrix effects, and high-dose "hook" effect. We also studied variations of values related to the patients' sex and age and time of the day and season when samples were collected. Correlation among the four methods was excellent, except for a few samples, and the interference in these samples could be abolished by adding mouse serum or "suppression medium." These phenomena can also be expected to occur in other immunometric assays involving monoclonal antibodies. With some modifications all tests are suitable for a clinical study of the usefulness of the thyrotropin assay as a primary test for thyroid function.

Kinetic measurement of total amylase and isoamylase activities with a centrifugal analyzer.

We evaluated a new kinetic assay for alpha-amylase (Phadebas IsoAmylase Test), using modified starch as the substrate and a CentrifiChem 400 centrifugal analyzer system. We determined isoamylase activities by using a selective inhibitor. Results were compared with those obtained with the chromogenic Phadebas dyed-starch technique. The method for total amylase appeared to be rapid and precise (CV = 4%) and results correlated well with the chromogenic method. Samples with activities up to 3000 arb. units/L can be analyzed without dilution. Glucose and pyruvate interfere with the assay, but hemoglobin and bilirubin do not. Pancreatic (P) and salivary (S) isoamylase activity can be determined with acceptable precision (CVP = 8%, CVS = 10%) by an automated routine procedure with commercially available reagents.

Turbidimetric determination of haptoglobin.

A specific, accurate and simple determination of haptoglobin is described with an antiserum against the antigenic determinants of the three haptoglobin phenotypes 1-1, 2-1 and 2-2. Antihaptoglobin is the determining factor in the formation of an antigen-antibody complex with maximal light absorption properties. Haptoglobin concentration is expressed as hemoglobin binding capacity. For the three haptoglobin phenotypes we found similar correlation between the turbidimetric method and the direct measurement of hemoglobin binding capacity by agar-electrophoresis.

An immunological turbidimetric method for serum transferrin determination.

The described method for the turbidimetric determination of serum transferrin concentration has the following features: the ionic strength of the medium is very low, the antiserum used is purified by the manufacturer, 25 mul antiserum per determination is sufficient, excess antibody or antigen has no influence. We studied the relation between transferrin concentration and total iron binding capacity for human normal and variant transferrins. Furthermore, our results are compared with the radial immunodiffusion technique.