Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion.

OBJECTIVE: Various methods are utilized in daily practice to obtain optimal information on effusion in the knee. Our aim is to investigate which scanning position provides the best information about synovial fluid in the knee by using ultrasound and to evaluate the magnitude of difference for measuring synovial fluid in 3 major recesses (suprapatellar, medial parapatellar, and lateral parapatellar) of the knee according to various degrees of flexion. METHODS: Sonographers in 14 European centers documented bilateral knee joint ultrasound examinations on a total of 148 knee joints. The largest sagittal diameter of fluid was measured in scans corresponding to the 3 major recesses at different (0°, 15°, 30°, 45°, 60°, and 90°) degrees of flexion of the knee. The difference of measurement of effusion according to transducer position, knee position, and the interaction between them was investigated by analysis of variance followed by Tukey's test. RESULTS: No correlation was noted between patient characteristics and ultrasound detection of effusion. The sagittal diameter of synovial fluid in all 3 recesses was greatest at 30° flexion. Analysis of variance and Tukey's test revealed that the suprapatellar scan and 30° flexion is the best combination for detecting effusion as confirmed by receiver operator characteristic curve analysis. CONCLUSION: The suprapatellar scan of the knee in 30° flexion was the most sensitive position to detect fluid in knee joints. Sagittal diameter of fluid in all 3 recesses increased with the knee in the 30° flexed position as compared to the extended position.

Which knee and probe position determines the final diagnosis of knee inflammation by ultrasound? Results from a European multicenter study.

PURPOSE: To investigate which knee and probe position best identifies knee inflammation and to determine a cut-off level for abnormal synovial effusion. MATERIALS AND METHODS: 18 experienced sonographers (all rheumatologists) performed ultrasound examinations of the knee joint in patients with knee symptoms and in healthy controls. Each sonographer performed longitudinal suprapatellar ultrasound scans using 9 different configurations at each knee: Midline, parapatallar lateral and parapatellar medial from midline in neutral position (0°) with and without quadriceps muscle contraction and in 30° flexion of the knee. The presence of synovial effusion (SE), the effusion measured in millimeters and the presence of synovial hypertrophy (SH) was noted. RESULTS: A total of 298 knees of 149 subjects (129 patients and 20 controls) were examined. The detection of SH is more sensitive and specific than the detection of SE, independently of the knee and probe position, for the final diagnosis of abnormality. The detection of both synovial hypertrophy and effusion in the knee in neutral position (0°) with quadriceps contraction and with the probe in the midline position, are the best independent predictors for knee abnormalities. Knee effusion > 3.2 mm measured with the probe in the lateral aspect of the knee is the best diagnostic characteristics for predicting pathological SE. CONCLUSION: The best combination for detecting SH and SE is obtained by placing the probe in the midline position with the knee in 0° with quadriceps contraction. A cut-off value for pathological effusion may be obtained in the lateral aspect of the knee.

Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates.

In the United Arab Emirates, coronary heart disease has emerged as the leading cause of mortality over a 20-year period of rapid socioeconomic development. CHD risk factors of non-insulin dependent diabetes mellitus (NIDDM), obesity and hypertension were investigated by community based survey among a bedouin-derived Emirati population sample of 322 subjects (> or = 20 years). Diagnosis of diabetes was based on a random capillary blood glucose level > or = 11.1 mmol l-1. Overall diabetes prevalence was 6% (11% in male and 7% in female subjects aged 30-64 years). Urban residence was associated with higher blood glucose levels (P = 0.000), and with higher Body Mass Index (BMI) values (P = 0.002): 27% of all urban residents were obese (BMI > or = 30). The Shamsi were positively associated with higher blood glucose levels compared with other tribal groups (P = 0.000). Female gender was associated with higher BMI values (P = 0.000). Between 19 and 25% of all subjects (male or female; urban or rural residents) have systolic hypertension (> 140 mm Hg). Male gender was associated with raised diastolic BP (P = 0.023). Diabetes was associated with higher mean systolic (P = 0.0274) and diastolic (P = 0.0132) BP levels. Differences in lifestyle between urban and rural residents are becoming blurred with further socioeconomic development and it is expected that the incidence of these CHD risk factors will continue to rise. Further studies are needed to specify changes associated with urbanization. Tribal influence also merits further study given the tradition of consanguinity in the UAE and the genetic basis to NIDDM.

Urinary beta-HCG in benign and malignant urinary tract diseases.

Detectable levels of HCG have been reported in conditions other than normal pregnancy, including threatened abortion, ectopic pregnancy, trophoblastic tumors, carcinomas of the stomach, liver, pancreas and breast as well as multiple myeloma and melanoma. The present study was conducted to estimate urinary beta-HCG in bladder cancer and benign urinary tract disorders. 163 individuals were included, 68 with bladder cancer (60 males and 8 females), 64 with benign urinary tract diseases (55 males and 9 females) and 31 normal healthy controls (26 males and 5 females). Urinary beta-HCG was estimated by the ELISA technique using the reagents supplied by DRG International Inc., Germany. Results of the study revealed an overexpression of beta-HCG in malignant and benign urinary tract diseases. 60.3% of the cancer patients and 29.7% of patients with benign diseases showed urinary beta-HCG values above the upper limit of the control group (2mIU/ml).

Activity of the morpholino anthracycline 3'-deamino-3'-morpholino-13-deoxo-10-hydroxycarminomycin (MX2) against human tumor colony-forming units in vitro.

In several preclinical systems, the morpholino anthracycline MX2 has greater antitumor activity than doxorubicin, is less cardiotoxic, and is effective against multidrug resistant cancer cells. We used a human tumor soft-agar cloning assay to test the cytotoxicity of MX2 against single cell suspensions from freshly obtained human tumors. Tumor cells were exposed to MX2 at 0.05 and 0.5 micrograms/ml either for 1 hour (2-1 specimens; 77 [38%] assessable) or continuously (231 specimens; 91 [39%] assessable). Superior antitumor activity was observed with continuous exposure (19% in vitro response at 0.05 micrograms/ml and 69% at 0.5 micrograms/ml) than with 1-hour exposure (1.3% at 0.05 micrograms/ml and 12% at 0.5 micrograms/ml). Activity was seen against all types of cancer tested including renal (91%), melanoma (88%), ovarian (73%), breast (71%) and non-small-cell lung (67%) cancer at a MX2 concentration of 0.5 micrograms/ml after continuous exposure. If appropriate plasma levels can be achieved in patients, MX2 could have significant clinical activity with those tumors.

In vitro evaluation of the antineoplastic activity of combretastatin A-4, a natural product from Combretum caffrum (arid shrub).

Combretastatin A-4 is a natural product which was isolated from the South African tree Combretum caffrum. In this study, the cytotoxic activity of combretastatin A-4 was tested in radiometric and human tumor cloning assays against eight different tumor cell lines and against 15 patient tumors in the human tumor cloning assay. To test the preferential cytotoxicity of combretastatin A-4 against tumor cells versus non-tumor cells, it was also tested in the radiometric assay against both normal human diploid fibroblasts and human bone marrow cells. Of the eight cell lines used, combretastatin A-4 showed preferential cytotoxicity for six of them. In addition, combretastatin A-4 showed a concentration-dependent cytotoxicity against a variety of human tumors. Based on the data generated in this study, combretastatin A-4 should be further tested in in vivo preclinical models.

Preclinical leads for innovative uses for etoposide.

Amplification of oncogenes in human tumors has been associated with a poor prognosis. Microscopically visible amplified oncogenes can be located either within chromosomes in homogeneously staining regions, or in an extrachromosomal compartment in double minutes (DMs). The DMs are composed of submicroscopic circular DNA (episomes), which have multimerized to form the microscopically visible DMs. When amplified oncogenes are located in an extrachromosomal location, they are vulnerable to loss from the cell. In this study we have found that the topoisomerase II inhibitor etoposide, in concentrations easily achievable clinically, causes a significant decrease in the number of DM-containing amplified oncogenes in three different human tumor cell lines. The elimination of amplified oncogenes from the cell could be accompanied by less aggressive tumor behavior.

Isolation of a sexual sporulation hormone from Aspergillus nidulans.

Psi factor is a substance produced by Aspergillus nidulans that induces premature sexual sporulation. Chromatographic analysis of psi-active extracts showed that psi activity resides in several different forms. Two of the forms, psiA1 and psiB1, have been isolated and have been shown to have closely similar compositions. The most abundant form, psiA1, reacts with alcohols in acidic solution by the addition of one entire molecule of the alcohol. This reaction, which is reversible, suggests that psiA1 may be a lactone whose ring is opened by alcohol addition. At high concentration, psiA1 is antagonistic to the response exhibited by the other forms of psi, but this antagonism is lost by the alcoholic derivatives. At least one unpurified psi species can be converted to psiA1 by acid catalysis. We suggest that psiA1 may be the metabolic precursor of at least some of the other more active psi components and that this conversion during Aspergillus development may be part of the process that triggers sexual sporulation.

Adaptation of lactic streptococci for growth with their homologous bacteriophage.

The adaptation of lactic streptococci for growth with their homologous bacteriophage was studied through the addition of bacteriophage filtrate to skim milk medium inoculated with Streptococcus lactis or Streptococcus cremoris. Both S. lactis and S. cremoris attained their adaptability for growth with their homologous bacteriophage after 5 and 2 transferes, respectively, and did not lose it after a storage period of 30 days at 0 degree C.

Physiologic studies of menstrual blood loss. II. Physiologic variables affecting the magnitude of menstrual blood loss.

The effect of marital status, age, parity, age at menarche, maternal size, arterial blood pressure, position and size of the uterus and hematologic parameters on the magnitude of menstrual blood loss was investigated in 745 randomly selected women in normal physiologic condition, aged 14-49 years, from a city population (Cairo). Menstrual blood loss was found to be related to parity, weight and body surface area and systolic and pulse pressure and to depend mainly upon the hematologic indices reflecting the state of iron balance and anemia in the body.

Physiologic studies of menstrual blood loss. I. Range and consistency of menstrual blood loss in and iron requirements of menstruating Egyptian women.

Two physiologic studies of menstrual blood loss in Egyptian women are presented below. In the first, an attempt was made to establish the normal range of menstrual blood loss of Egyptian women, to test their individual consistency in the amount of menstrual blood loss and to determine the iron requirements needed to compensate for iron loss and prevent iron deficiency anemia in menstruating Egyptian women. In the second, physiologic and other variables affecting the magnitude of menstrual blood loss in Egyptian women were investigated.

Histophysiological studies of prostaglandin F2alpha on isolated organs. I. Effect of prostaglandin F2alpha on the heart.

The physiological and histochemical effects of PGF2alpha on isolated rabbit hearts were examined. The results showed a positive inotropic effect. The coronary flow increased. From the histochemical studies, adenosine triphosphatase (ATP-ase) and succinic dehydrogenase activities were increased while that of alkaline phosphatase was decreased. Glycogen granules were depleted. These findings were discussed on a histophysiological basis.