Factors affecting the pores of the inner wall endothelium of Schlemm's canal

PURPOSE: A linear relationship between the density of pores in the inner wall of Schlemm's canal and aqueous outflow facility has been reported previously in a study in which investigators examined only eyes fixed at constant pressure, so that fixative flow rates differed from eye to eye. Because pores may form as a function of flow rate, the purpose in the current study was to verify the previous findings, using constant flow perfusions. METHODS: Outflow facility was measured in enucleated human eyes. Eyes were fixed under either constant flow or constant pressure conditions, microdissected to expose the inner wall of Schlemm's canal, and prepared for scanning electron microscopy. The density and diameter of pores in the inner wall were measured. RESULTS: Statistical analysis showed no correlation between outflow facility and either the density or the diameter of pores. Pore density decreased significantly during the hours after death. Examining only eyes for which experimentation was started within 20 hours of death, we found that pore density increased significantly with the volume of fixative that had been perfused through the outflow pathway. CONCLUSIONS: The correlation found by Allingham et al between outflow facility and pore density in the inner wall endothelium was not confirmed. However, the relationship between pore density and volume of fixative perfused is consistent with and may be responsible for the finding in the previous study. Because fixation conditions can influence the apparent pore density in the inner wall endothelium significantly, the conclusion reached previously, that pores contribute only 10% of the aqueous outflow resistance, may require reevaluation.     

Sonographic determination of the thickness of the peritoneum in healthy children and paediatric patients on CAPD

BACKGROUND: Prolonged peritoneal dialysis and frequent episodes of peritonitis lead to structural changes and thickening of the peritoneum. Ultrasonography investigations may provide the opportunity to detect morphological changes early, but no systematic investigations have been performed yet. METHODS: Normal values of peritoneal thickness were obtained by systematically examining 131 healthy children (0-15 years) by ultrasound. Parietal peritoneal thickness was best measured at the sternal-umbical line distal from the xiphoid. Growth charts with 95% intervals were prepared. The data of 26 patients with end-stage renal failure (5-18 years) were compared to those of the normal children. RESULTS: The variation coefficient for the consecutive measurements was only 5%, interobserver error was approximately 7%. Whereas gender did not have any influence, peritoneal thickness was significantly correlated to age, weight and most obviously to height (r = 0.81; P<0.001). Children treated only by haemodialysis had normal values, while an increased thickness, loss of movement, and adhesion of the two peritoneal layers were found in children on CAPD. These changes were only noted in patients who had a history of peritonitis. CONCLUSION: Ultrasound examination is a simple, noninvasive and precise method to measure the peritoneal changes in children on CAPD.     

Riedel's thyroiditis: a case report and review of the literature

Riedel's thyroiditis is a very rare disease of unknown aetiology, occasionally associated with retroperitoneal and mediastinal fibrosis. It is a benign condition, but may be confused with an anaplastic carcinoma of the thyroid. The differential diagnosis with anaplastic carcinoma is assured only by intraoperative biopsy. The Authors report a clinical case: symptoms were a progressive enlargement of the thyroid gland, left recurrential palsy, dyspnoea and dysphagia. The surgical treatment was total thyroidectomy, performed with bilateral neurolysis of recurrent nerves. The patient was also under adjuvant corticosteroid treatment.     

Effects of postischemic halothane administration on outcome from transient focal cerebral ischemia in the rat

BACKGROUND: Serologic methods to detect Helicobacter pylori in infants, especially in developing countries, may be limited because of decreased immune response caused by malnutrition. The true prevalence may therefore be underestimated in this age group. Urea breath test is considered to be a good screening method in children but is expensive and therefore is not suitable for screening in developing countries. Simple, inexpensive, and accurate noninvasive methods to detect H. pylori in infants and young children are needed. METHODS: Enzyme immunoassay (EIA) and immunoblot (IB) serologic analyses, 13C-urea breath test (UBT), and immunomagnetic separation--polymerase chain reaction (IMS-PCR) were performed on stool specimens, to detect H. pylori in 68 children between 4 and 24 months of age (mean, 11.5 months) in an endemic area in Bangladesh and the results compared. RESULTS: The occurrence of H. pylori was 57% (n=39) using only UBT, 60% (n=41) using only IMS-PCR, and 78% (n=53) using UBT and IMS-PCR together. The concordance between UBT and IMS-PCR results was 62%. Immunoblot was positive in only 9% (n=6). Results in all 68 children were negative using EIA. DISCUSSION: The prevalence of H. pylori infection in this periurban community and age group was high. Only serologic methods seem to be unsatisfactory for screening of H. pylori infection in infants and may not reflect the true prevalence. Immunomagnetic separation-PCR is a simple and rapid method for detection of H. pylori in stool and is an attractive method for analysis of colonization in infants. However, it may reflect a different stage of disease than UBT. Further studies are needed to clarify this.     

Detection of free malignant cells in the peritoneal cavity before and after resection of colorectal cancer

PURPOSE: This study was designed to select the best monoclonal antibody to stain malignant cells in peritoneal wash fluid, and to investigate the incidence of free malignant cells in preresection and postresection colorectal cancer peritoneal washings using a combination of conventional cytology and immunocytochemistry. METHODS: Peritoneal washings were taken from 35 consecutive patients undergoing colorectal cancer resection. RESULTS: Malignant cells were isolated on a density gradient and identified by conventional cytology and an indirect immunoperoxidase stain. Malignant cells were identified in peritoneal washings from 15 patients (preresection only n = 3, postresection only n = 4, both n = 8). The origin of free malignant peritoneal cells in 11 preresection-positive washings must be the serosa. The origin of these cells in the four postresection-positive patients is uncertain: serosal and luminal spillage were considered unlikely and no circulating cells were found in the mesenteric vessels near the tumor. CONCLUSION: Tumor cells may have leaked out from lymphatics cut during the dissection.     

Use of the Univent System tube for difficult intubation and for achieving one-lung anaesthesia

BACKGROUND: One-lung ventilation in major thoracic surgery is the most commonly accepted technique, not only for surgery on the lung but also in procedures involving the oesophagus, mediastinum and thoracic aorta. Conventional double-lumen tubes may sometimes be difficult to place correctly in patients in whom intubation is difficult. In such cases, the Univent System tube may be of help. It has a curved movable blocker of small calibre, and is designed to slide inside the bronchial tree and occlude all or part of the target lung. CASE REPORT: We describe a new application of the Univent System tube in three cases where intubation was presumed to be difficult, and in another with unexpected difficult intubation. The laryngeal approach was carried out with the distally displaced blocker, inserting it through the sub-epiglottis or the posterior commissure visible orifice. The tube was firmly held and slid through the length of the blocker, rotating slowly until fully introduced. The advantages and criteria for its use are discussed. CONCLUSION: Although the double-lumen tube is the first choice for one-lung ventilation, the Univent tube is a good option for selective bronchial intubation and in patients in whom difficult intubation is predicted.     

Extra osseous tumors of the spine in children and adolescents. Spinal complications

PURPOSE OF THE STUDY: The delay in diagnosis of spinal tumors is not rare. The chief complaint may include pain, walking disability, and spinal or limb deformities. The purpose of our study is to analyze the spinal deformities associated with non osseous intraspinal tumors, to assess the complications of treatment, and to set out a preventive protocol. MATERIALS: We reviewed retrospectively 40 consecutive cases of non osseous intraspinal tumors treated between 1972 and 1991. There were 32 intradural, 2 extradural, and 6 intra and extradural combined tumors. At the first consultation, the age ranged between 4 months and 15 years, and only 16 patients showed neurologic deficit. Spinal deformity existed in 9 patients, 7 of which had no neurologic deficit. All the tumors were treated surgically. Laminectomy was done in 28 cases, and osteoplastic laminotomy in 12 cases. The number of levels included in the laminectomy ranged from 3 to 18. Bilateral arthrectomy at least at one level was undertaken in 15 cases. A postoperative brace was worn in all cases for an average period of 4 months. An adjuvant radiotherapy was undertaken in 12 cases for an incomplete resection. METHODS: The incidence and pattern of spinal deformity was assessed before tumor treatment and ultimately after laminectomy or osteoplastic laminotomy (or laminoplasty). RESULTS: Among the 9 cases with preexisting spinal deformity, the curve magnitude increased after laminectomy in 4. A kyphotic, kyphosoliotic or scoliotic deformity developed in 18 cases after surgery for tumor resection. Among these 18 patients, only one had had an adequate osteoplastic laminotomy. The treatment of spinal deformities was surgical in 12 cases, and done by either posterior or anterior and posterior combined arthrodesis. DISCUSSION: Spinal deformity may be the main complaint of a patient who has intraspinal tumor. Prevention of postlaminectomy spinal deformity is mandatory, and could be done by osteoplastic laminotomy and the use of a brace during a minimum period of 4 to 6 months after surgery. CONCLUSION: Diagnosis of intraspinal tumors in children and adolescents should be done early, and laminoarthrectomy should be replaced by osteoplastic laminotomy.     

Comparison of methods to determine the prevalence and nature of oral mucositis

PURPOSE: Chemotherapy-induced oral mucositis may cause considerable patient morbidity. Its prevalence has been reported as ranging from 30% to 39%, although a prevalence as high as 75% has been reported with 5-fluorouracil. This variation may be a function, in part, of the methods of measurement used across different studies. The first purpose of this study was to determine the prevalence of oral mucositis in a sample of 127 patients receiving specific chemotherapy. The second purpose was to compare different instruments and techniques for assessing oral mucositis. DESCRIPTION OF STUDY: A longitudinal design was used to collect data at four monthly chemotherapy cycles during drug nadir. The methods of measuring oral mucositis included interview (conducted monthly x 4); Eiler's Oral Assessment Guide (monthly x 4); Chemotherapy Knowledge Questionnaire and Behavior Checklist (both at the fourth month); Self-Care Behavior Log (ongoing over 4 months); and medical record review (collected at 4 months). RESULTS: The mucositis prevalence in this one sample ranged from 30% to 69% depending on the method of measurement. The use of multiple instruments and techniques captured a clinical picture of oral mucositis far more detailed than published reports--a picture not revealed with any one instrument or technique. The chart record severely underdocumented the prevalence of mucositis compared to the interview. This discrepancy could reflect under-reporting by the patients, inadequate history taking at provider visits, or perhaps the documentation of only the more severe mucositis or mouth problems in the medical record. CLINICAL IMPLICATIONS: Clinicians and researchers must choose their method of measurement carefully in relation to the purpose of assessment. For subjective tolerance of symptoms, the interview technique may be most useful. To test interventions, the use of a quantitative rating instrument is desirable. Intervention studies using multiple measures may require a combination of subjective and objective measures.     

Late results of patch repair of coarctation of the aorta in adults using autogenous arterial wall

BACKGROUND: Interposition grafting or patch repair of adult coarctations of the aorta are the standard methods of surgical treatment. Both involve use of prosthetic material, and patch repair using prosthetic material may lead to aneurysm formation in the long term. METHODS: Four patients aged 17 to 29 years had been investigated for systemic hypertension and had coarctation of the aorta diagnosed on cardiac catheterization. Between March and November 1984, all 4 underwent a corrective operation. The lesions were widely incised and a broad patch of ipsilateral mammary or Abbott's artery was fashioned across the narrowing. The arteries had been enlarged in diameter because of prolonged exposure to high blood pressure as collateral vessels, although none was intrinsically diseased. RESULTS: After 12 years of follow-up, only 1 patient remains on antihypertensive therapy. Spiral computed tomographic reconstructions revealed only very mild residual stenosis in 1 patient, confirmed by subsequent aortography. CONCLUSIONS: In adult patients with coarctation of the aorta, the use of the enlarged internal mammary artery as a patch graft is a simple, quick procedure, which may give lasting relief of obstruction. Spiral computed tomographic scanning is an ideal noninvasive method of follow-up.     

24-hour ambulatory blood pressure and renal disease in young subjects with type I diabetes

OBJECTIVES: The clinical data on individuals who were diagnosed to have juvenile myoclonic epilepsy (JME) on the basis of myoclonic jerks alone has been analysed. The points in favour and against individuals with only myoclonic jerks being classified as "affected" for research on JME are discussed. MATERIALS AND METHODS: We studied 15 persons diagnosed with JME on the basis of only myoclonic jerks in a series of 161 patients with JME and their relatives. Detailed information on the seizure types in JME patients and their family members was collected. All affected individuals were examined by one person and had at least one conventional scalp EEG. CT/MRI of the brain was done as and when indicated. RESULTS: Nine of these were probands while 6 were the relatives of JME patients. The EEG was abnormal in 8 of 9 probands and 1 of 6 relatives with only myoclonic jerks. All the 9 probands and 2 relatives with only myoclonic jerks were treated with anti-epileptic drugs. Three of the 4 relatives had spontaneous remission of jerks after variable intervals. Four of 15 persons with only myoclonic jerks had a first degree relative with definite JME. CONCLUSIONS: It appears that persons with myoclonic jerks alone may represent a benign subgroup of JME that may be genetically distinct from classic JME and the jerks may even spontaneously remit in a few cases. It is suggested that those persons with only myoclonic jerks and a first degree relationship with a definite diagnosis of JME can be classified as "affected" for inclusion into molecular studies, till molecular tools are available to settle the issue of phenotypic variations in hereditary neurological disorders like JME.     

The effect of leukotriene D4 on the patency of nasal passage in the guinea pig

BACKGROUND: Demodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D. folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique. METHODS: Thirty-eight patients with rosacea and 38 age-and-sex-matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2. RESULTS: The mean mite count in the rosacea group (6,684) was significantly higher than that in controls (2,868; p < 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p > 0.05). CONCLUSIONS: Rosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response to Demodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea, together with other triggering factors.     

Malignant hemangioendothelioma of the thyroid gland: new results on pathogenesis, therapy and prognosis

BACKGROUND: Malignant hemangioendothelioma of the thyroid is a rare tumor predominantly described in areas with endemic goiter like the Alpine regions. The estimated incidence of the disease is between 0.15 and 0.25 per 100,000 inhabitants per year for Western Austria. The prognosis is reported to be dismal. MATERIALS AND METHODS: Between 1982 and 1995, 10 cases with immunohistochemically confirmed malignant hemangioendotheliomas of the thyroid were referred to our department for postoperative or palliative treatment. Two patients with clear margins at surgery received no adjuvant radiotherapy and were only observed. By surgery, clear margins (R-0 resection) were achieved in 5, microscopic residuals (R-1) were left in 3, and gross residual disease in 1 patient. One patient had an inoperable primary tumor. Postoperative radiotherapy was administered in 6 cases, 4 of them additionally received the radiosensitizer razoxane. Total tumor doses ranged between 58 and 65 Gy. RESULTS: Local tumor control was achieved in 9 of 10 patients; 4 of 10 lived longer than 4 years. The median survival time has not yet been reached and is presently between 7.5 and 21+ months.--Noteworthy is a complete regression of 2 lung metastases in a 72-year-old man by a combination of vindesine, razoxane and radiotherapy. The patient is still in complete remission under a maintenance therapy with vindesine and razoxane since 14 months.--It may also be of interest that 4 of the 10 patients were strongly exposed to vinyl chloride and other polymeric materials during their occupational life. CONCLUSIONS: This small series may indicate that the outcome of this disease may not be uniformly deleterious, and that the resistance to radiotherapy reported in the literature may be questioned.--The data offer new evidence of the occurrence of vinyl chloride-induced angiosarcomas outside the liver, and support observations which have already been published in case reports.     

Molecular cloning and physical mapping of the daptomycin gene cluster from Streptomyces roseosporus

BACKGROUND: Local macrophage proliferation has been described in several animal models of glomerulonephritis (GN), but its significance in human disease is unknown. METHODS: Double immunostaining for CD68 and the proliferating cell nuclear antigen (PCNA) was used to identify macrophage proliferation in 84 biopsies from a variety of glomerulonephridities. RESULTS: A small resident population of glomerular and interstitial CD68+ macrophages was identified in normal human kidney, of which only 1 to 2% showed evidence of proliferation on the basis of PCNA expression. A mild macrophage infiltrate, with only occasional proliferating macrophages, was seen in the less aggressive forms of GN (minimal change disease, non-IgA mesangioproliferative GN and IgA nephropathy). This was in sharp contrast to the more aggressive forms of disease (lupus class IV, vasculitis-associated GN, crescentic GN and mesangiocapillary proliferative GN), in which the prominent macrophage infiltrates contained many proliferating macrophages, accounting for 28 to 47% of the total macrophage population. Macrophage proliferation was largely restricted to areas of severe tissue damage (glomerular segmental proliferative lesions, crescents and foci of tubulointerstitial damage), suggesting that local proliferation is a mechanism for amplifying macrophage-mediated injury. Glomerular and interstitial macrophage proliferation gave a significant correlation with loss of renal function (P < 0.0001) and histologic lesions (P < 0.0001), but not with proteinuria. Interstitial T-cell proliferation also gave a significant correlation with loss of renal function and histologic damage, even though proliferation within the T-cell population was much lower than in the macrophage population. CONCLUSIONS: This study demonstrates that macrophage proliferation is a feature of the more aggressive forms of human GN. Local proliferation may be an important mechanism for amplifying macrophage-mediated renal injury. In addition, the degree of local macrophage proliferation may be a useful diagnostic and prognostic indicator for human GN.     

The coverage of vaccines systematically administered and of a vaccine against Haemophilus influenzae type b prior to its inclusion in the vaccinal calendar in the Valencian Community

PURPOSE: A case of deafness is reported in a patient undergoing bilateral nephrectomy after single irrigation of the peritoneal cavity with a neomycin containing solution for surgical prophylaxis. CLINICAL FEATURES: In this patient, profound, late-postoperative deafness was heralded by prolonged neuromuscular blockade and respiratory insufficiency. Additional risk factors for ototoxicity in this particular patient included the presence of end-stage renal disease requiring daily peritoneal dialysis and, possibly, the concomitant use of clonazepam and clindamycin. CONCLUSIONS: Antibiotic irrigation solutions containing neomycin may produce unwanted adverse systemic effects of deafness and prolonged neuromuscular blockade, even with only brief application within the peritoneal cavity. Concurrent end-stage renal disease, visceral inflammation from chronic dialysis and laparotomy, and the concomitant use of other medications may have contributed to these unwanted effects.     

Hemoptysis in a patient with acquired anomaly of the arterial vascularization of the lung

An anomalous systemic pulmonary supply may be acquired and present only one symptom: hemoptysis. The incidence of this pathology is unknown. A case of acquired systemic pulmonary arterialization was observed after surgical intervention of myocardium vascularization with the left mammary artery. The diagnosis was obtained through an arteriography of the left mammary artery. In this case, the therapy consists in ablating the affected parenchyma followed by the interposition of a bovine pericardium patch between the mammary artery and the remaining pulmonary tissue.     

Comparison of digital rectal examination and biopsy results with the radical prostatectomy specimen

PURPOSE: Digital rectal examination is integral to staging prostate cancer. Ultrasound guided biopsy establishes the diagnosis, and it may provide useful information regarding disease grade and extent. Treatment decisions are largely based on information gained from digital rectal examination and biopsy but this information is only useful if it correlates with the radical prostatectomy specimen and prognosis. We correlated digital rectal examination and transrectal ultrasound guided biopsy results with a detailed analysis of the radical prostatectomy specimen. MATERIALS AND METHODS: The accuracy of an abnormal digital rectal examination for predicting the location and extent of cancer was assessed in 89 patients thought to have clinical stage T2 disease. We evaluated 155 patients with clinical stages T1c and T2 disease to correlate the location of positive biopsies with the tumor site in the prostate. Radical prostatectomy specimens were completely sectioned at 2 mm. intervals, and tumor extent and location were recorded. RESULTS: In 85 patients a unilateral lesion was suspicious on digital rectal examination, that is stage cT2. The final pathological review revealed cancer on the suspicious side in 82 cases (96%) with tumor confined to the same lobe in only 23 (27%), bilateral disease in 59 (69%) and tumor confined to the contralateral lobe in 3 (4%). In 4 patients with a palpable bilateral abnormality a bilateral lesion was confirmed on final pathological evaluation. Digital rectal examination demonstrated a 36 and 31% incidence of extracapsular tumor extension and positive surgical margins, respectively, on the clinically benign side. In 100 patients only unilateral biopsy was positive. The final pathological evaluation revealed cancer in the biopsy positive side in 95 cases (95%) with tumor confined to the ipsilateral lobe in only 26 (26%), bilateral disease in 69 (69%) and tumor confined to the contralateral lobe in 5 (5%). In 46 of the 55 patients (84%) with bilateral positive biopsies tumor involved both sides but the pathologist did not identify cancer in both lobes in 9 (16%). While 100 patients had a unilateral negative biopsy, analysis of the prostatectomy specimen revealed carcinoma in the benign lobe in 74 (74%). Moreover, extracapsular tumor extension and a positive surgical margin were observed on the biopsy negative side in 31% of the patients. The degree to which digital rectal examination and biopsy results confirmed the final pathological evaluation was assessed using the kappa statistic, which revealed only slight agreement with each factor. The correlation of digital rectal examination and biopsy results with the location of extracapsular extension and positive margins was evaluated by the Spearman coefficient of correlation, which indicated poor agreement. When patients with unilateral versus bilateral positive biopsy were compared with respect to prognostic parameters, the difference was statistically significant for initial serum prostate specific antigen, the percentage of surface involved by tumor, biopsy and final Gleason scores, and the incidence of extracapsular extension of tumor. CONCLUSIONS: Digital rectal examination and the interpretation of prostate biopsy are not accurate clinical tools for defining the location and extent of prostatic carcinoma. Bilateral positive biopsy may be useful as an adjunct to the current clinical staging system.     

Studies on prevalence of Strongyloides infection in Holambra and Maceió, Brazil, by the agar plate faecal culture method

OBJECTIVE: To test the hypothesis that the anti-apoptotic ability of Epstein-Barr virus (EBV) may result in altered expression of apoptosis-associated proteins in oral hairy leukoplakia (HL), we evaluated HL tissue and normal epithelium for these proteins by immunohistochemistry. MATERIALS AND METHODS: Twenty formalin-fixed, paraffin-embedded specimens of HL lesions and six specimens of normal control mucosa were selected from archived tissue specimens. Bcl-2, Bcl-x, Bax and p53 apoptosis-associated proteins were evaluated in immunohistochemically stained tissue sections according to staining intensity and pattern. The percentage of p53-positive basal cells was estimated in sequential fields. RESULTS: Generally, there were only slight differences in the expression of Bcl-2 and Bcl-x proteins in the epithelium of HL and control tissue. The staining for Bcl-2 was weaker in keratinocytes than in putative melanocytes and Langerhans cells. Equivocal diffuse cytoplasmic staining of prickle cells was also noted. Keratinocytes throughout the epithelium stained positively for Bcl-x protein, although upper layers were more weakly stained. The 'balloon' keratinocytes in HL were infrequently positive for Bcl-x. Bax staining in HL differed from that in control tissue in being more heterogeneous. The staining reaction in HL was weak to negative in upper epithelial levels where 'balloon' keratinocytes were located. Weak to moderate nuclear p53 protein staining was detected in a mean of 25.3% of basal keratinocytes in all but one of the HL specimens; weak staining was seen in only two control specimens. CONCLUSIONS: We found only slight immunohistochemical evidence that expression of the apoptosis-associated proteins is altered in HL. p53 appears to over-expressed in HL; we speculate that this may be related to up-regulation or stabilization of wild-type p53 protein related to EBV infection.     

Invasive squamous cell carcinoma arising from asymptomatic choristomatous cysts of the orbit. Two cases and a review of the literature

BACKGROUND: Epithelial choristomatous cysts are common orbital lesions, the most frequent of which are dermoid or epidermoid tumors. Massive enlargement or extraorbital extension of these benign lesions may occur. Malignant transformation of the epithelial lining of epidermoid cysts is rarely reported. METHODS: Two patients are presented in whom the epithelial lining of a previously asymptomatic choristomatous cyst of the orbit underwent malignant transformation to produce invasive squamous cell carcinoma. The unusual origin and clinical presentation of the lesions caused a delay in the diagnosis and therapy in both patients. Metastatic workup was negative in both patients, who underwent resection of their tumors via orbital exenteration with craniofacial resection. Reported cases of malignant transformation in analogous choristomatous cysts elsewhere in the cranium are reviewed. RESULTS: One patient is alive and well without recurrent disease 40 months postoperatively. The second patient died of a pulmonary embolus 2 months postoperatively. Autopsy showed no residual tumor. Overall, only 3 of 18 reported patients with epidermoid choristoma of the head and orbit with malignant transformation were alive when reported. CONCLUSIONS: Malignant squamous metaplasia is believed to be a rare complication of orbital dermoid or epidermoid cysts, with only two previously reported cases. However, malignant transformation is relatively frequent in analogous epidermoid cysts found elsewhere in the cranial vault, especially after incomplete excision. These reports encourage the complete removal of epithelial choristomas of the orbit.     

Antibiotic resistance and putative virulence factors of Serratia marcescens with respect to O and K serotypes

Recent revision of the O serotyping scheme for Serratia marcescens has allowed the definitive serological identification of a collection of 511 epidemiologically distinct strains in terms of both lipopolysaccharide (O) antigens and capsular (K) antigens. High levels of typability were achieved, 88% and 91% respectively, with only 2% failing to type with either method. In most cases, non-typability was due to a lack of antigen, i.e., the strains produced only rough LPS or were acapsular, suggesting that typability would be little improved by the discovery of additional serotypes. The distribution of the 58 O:K serotypes was very uneven, with O14:K14 accounting for 30% of the 423 clinical strains in the collection, but only 5% of the 88 non-clinical, environmental strains. Thus, the prevalence of O14:K14 strains in hospitals is not reflected in the environment. Similar conclusions were valid for O27:K14, O21:K3 and O21:K14 strains, as well as those with rough lipopolysaccharide. Conversely, the proportions of O6:K3, O6:K14, O8:K14 or O28:K28 strains were significantly lower among the clinical collection than among their environmental counterparts (12% in total rather than 65%). This suggests that O14:K14 may have a selective advantage in colonising or infecting hospitalised patients and, therefore, that the O14 and K14 polysaccharides themselves may contribute towards the apparent pathogenicity of these serotypes.     

Lumbosacral movement in the sit-and-reach and in Cailliet's protective-hamstring stretch

STUDY DESIGN: This study analyzed movement characteristics of subjects as they performed two different hamstring stretching activities. OBJECTIVES: The study determined if there were differences in lumbosacral movement as the subjects performed the two stretches. SUMMARY OF BACKGROUND DATA: Cailliet contends that his protective hamstring stretch is less apt to be stressful to the structures of the spine than is a more commonly done sit-and-reach stretching activity. No previous biomechanical investigation has tested his contention. METHODS: Lumbosacral movement was measured with an Ady-Hall lumbar monitor as 40 university students (20 males, 20 females) performed a popular sit-and-reach test and a sit-and-reach test that subscribed to Cailliet's protective hamstring stretch protocol. RESULTS: Lumbosacral movement was almost identical in the two stretching activities. CONCLUSIONS: If lumbosacral movement is the only criterion to consider in evaluating the safety of these two stretching activities, it makes little difference which activity is chosen. If moment of inertia were the dependent variable rather than lumbosacral movement, possibly one activity may be less stressful to the structures of the spine than the other.