Proximal median and ulnar resections. Results of primary and secondary repairs

PURPOSE OF THE STUDY: Recovery after median and ulnar nerve proximal repair is widely appreciated. The place and time for secondary functional reconstruction remains controversial. MATERIAL AND METHOD: From January 1983 to January 1990, 66 patients suffering from proximal injury of the median or ulnar nerves underwent nerve repair. Forty-five patients had a postoperative follow-up of more than 24 months: 24 isolated ulnar nerve lesions, 12 isolated median nerve lesions, and 9 combined median and ulnar nerve lesions. Ten patients were given a primary microsurgical nerve suture in our department. Thirty-eight patients underwent a delayed or secondary nerve repair of one or both nerves: 8 secondary nerve sutures, and 35 nerve grafts in 31 patients. RESULTS: Muscular strength, sensitivity, motion, and pain were better after primary nerve sutures (when technically possible) or after shortly delayed secondary sutures, although 40 per cent of patients treated with nerve grafts get final "good" or "very good" results. The time between the injury and nerve repair was the most significant prognosis factor. Results of ulnar nerve repairs at the elbow were statistically better with anterior transposition as compared to in situ repairs (p < 0.005). Fourteen patients required secondary functional reconstruction. Tendon transfers were performed at least 24 months after nerve repair. DISCUSSION: Nerve repair of proximal lesion to the median or ulnar nerves depends on the type of injury, but is advised even when delayed. Residual deficit following nerve repair should require functional transfers depending on hand sensitivity and extrinsic function.     

A closed culture system for the ex vivo transduction and expansion of human T lymphocytes

The purpose of this qualitative study was to explore traditional beliefs and practices related to pregnancy and childbirth among Native American women and examine the relationship of these beliefs and practices to current use of prenatal care. Focus groups of elders and young women were held and the data analyzed with the Ethnograph software. The central theme was the breakdown in transmission of cultural wisdom among Native American women. The major causes described by women were federal assimilation policies and deaths of elders. Major factors influencing young women's nonutilization of prenatal care were this breakdown, the "Western model" of prenatal care, substance abuse, and domestic violence. Recommendations for improving the use of prenatal care are grounded in the reality that Native American women live in two different worlds. Prenatal care should be reconceptualized as traditional cultural wisdom, with the majority of care provided by natural helpers in the Native American community, including tribal elders, grandmothers, and aunts in collaboration with licensed providers.     

A decade of fertilizer research on groundnuts (Arachis hypogaea L) in the savannah zone of Nigeria

Field experiments on fertilizer requirements of groundnuts carried out between 1970 and 1980 were reviewed and discussed. Results of the various studies seem to suggest that existing recommendations which are based on short term annual trials carried under non-intensive or semi-intensive traditional farming systems are becoming inadequate under a system of continuous intensive cultivation. Besides phosphorus and sulphur which have long been known to be deficient in the Nigerian savannah soils, the availability of the other nutrients in these soils can no longer be taken for granted. Potash and micronutrient deficiencies, notably those of B and Mo, hitherto rare, are now showing up with increasing frequency.As a P source, single superphosphate appears to be the most suitable fertilizer for groundnuts in the Nigerian savannah at present partly because it also contains S and partly because of its solubility. Nitrogen fertilizer application tends to depress pod and kernel yield although it enhances haulm production. Groundnut haulm constitutes an important livestock feed in the West African savannah and the role of fertilizer N may have to be viewed in this context. Calcium as a nutrient does not appear to cause any serious fertility problem. Where gypsum application has produced large increases in kernel and haulm yields the dominant effect has been attributed to the sulphate component. Magnesium response has so far not been reported on groundnuts in Nigeria.It is suggested that soil fertility research in the savannah zone of West Africa should move away from short-term annual trials to long-term studies designed to tackle problems that are likely to arise under continuous cultivation in these poorly buffered sandy soils.     

99Tcm-MDP scintigraphy in high-voltage electrical burn patients

In high-voltage electrical burn injuries (> 1000 V), it is difficult to identify the site and extent of non-viable deep tissue damage for debridement to avoid further tissue injury from wound infection and the risk of sepsis. This prospective study was designed to evaluate the usefulness of 99Tcm-methylene di-phosphonate (99Tcm-MDP) scintigraphy in detecting the extent of tissue injury and determining the level of amputation required for electrical burn patients. Over a 5 year period, 33 high-voltage electrical burn patients were studied. Blood flow and blood pool studies revealed absent perfusion in 37 limbs, all of which eventually were amputated. In addition to a routine three-phase bone scan, images were obtained at 30-60 min (early images) to evaluate whether soft tissue injury could be detected better at that time. For comparison of the detection rate from the early images and bone (delayed) images, 164 corresponding spot views of both images were reviewed. Eighty-three and 125 tissue necrotic lesions were demonstrated by the early images and bone images respectively. All of the 83 lesions found by the early images were more clearly identified by the bone images. All but one of the 125 lesions underwent surgical debridement or amputation. We concluded that the blood flow and blood pool images correlated well with the level of amputation required. The site and extent of tissue necrotic lesions can be clearly identified on 99Tcm-MDP bone scans. Because the early images were less sensitive in detecting tissue necrosis, we suggest that early imaging is not necessary.     

Immunological detection of membrane-associated human luteinizing hormone correlates with gene expression in cultured human cancer and fetal cells

We have demonstrated the expression of membrane-associated hCG and its subunits and fragments by cells from 78 human cancer cell lines of different types and origins, indicating that such expression is a common phenotypic characteristic of cultured human malignant cells. Because human (h) LH beta has 80% homology with hCG beta and is coded by one of the seven genes in the gene cluster located in chromosome 19, it was important to determine whether hLH and its beta-subunit are also expressed as membrane-associated proteins by cells from human cancer cell lines. Thus, 11 cancer cell lines of different types and origins were adapted to grow in serumless medium, with Nutridoma-HU or SP as serum substitute, and analyzed by flow cytometry using two monoclonal antibodies directed to different conformational epitopes of intact hLH and a monoclonal antibody reacting with an epitope of hLH beta-free. The cells were also analyzed simultaneously for the expression of hCG and its subunits and fragments. Determination of translatable levels of hLH beta and hCG beta messenger RNAs (mRNAs) was performed in cells from some of the cancer cell lines, including the JEG-3 choriocarcinoma cell line, and in cells from a human fetal lung cell line. The analytical flow cytometry studies showed that in addition to the expression of membrane-associated hCG in all of its forms, expression of membrane-associated intact (holo) hLH and its free beta-subunit occurred in every case. These findings were corroborated by the presence of translatable levels of hLH beta and hCG beta mRNAs in all of the cancer cell lines analyzed, indicating that the expression of these membrane-associated glycoproteins is a phenotypic characteristic of human cancer cells and that the activation of the hCG beta-hLH beta gene cluster is nonselective. The presence of translatable levels of hCG beta-hLH beta mRNAs in the cultured human fetal lung cells punctuates once more the in vivo and in vitro biochemical similarities between fetal and cancer cells.     

Distinguishing Cowper''s glands from neoplastic and pseudoneoplastic lesions of prostate: immunohistochemical and ultrastructural studies

beta-Glucosidase of indigo plant (Polygonum tinctorium) has a high substrate specificity for indican (indoxyl beta-D-glucoside). To examine the localization of this beta-glucosidase, we fractionated the cells of the leaves and analysed them immunocytochemically. Immunoelectron micrographs with specific antibodies against the beta-glucosidase clearly showed that the beta-glucosidase was localized in the stroma of the chloroplasts in mesophyll cells, but not in the thylakoid membrane. Chloroplasts were isolated from the crude homogenate of the fresh leaves by Percoll density gradient centrifugation and then subjected to suborganellar fractionation. beta-Glucosidase activity was specifically detected in the stromal fraction, but not in the thylakoid membrane. This was also supported by the result of an immunoblot of the fraction with anti-beta-glucosidase antibodies. The beta-glucosidase was immunocytochemically localized in the chloroplasts of mesophyll cells, but not in any chloroplasts in marginal cells of the vascular bundle or epidermal cells; ribulose 1,5-bisphosphate carboxylase (Rubisco), a typical stromal protein, was observed in all chloroplasts in these cells. These results suggest that beta-glucosidase is tissue specific in its expression in the leaves of the indigo plant.     

The induction and characterization of antiserum against human placenta 17-beta-hydroxysteroid dehydrogenase

17-beta-Hydroxysteroid dehydrogenase was purified from human placenta. The purification process included the following steps: 50% saturated ammonium sulfate precipitation; heat treatment; affinity column chromatography; and preparative SDS gel electrophoretic elution. This enzyme was also characterized by HPLC gel filtration and two dimensional gel electrophoresis with isoelectrofocusing. The results indicate that the molecular weight of these enzymes in their native condition is around 68 kDa and 34 kDa in SDS PAGE. Therefore, the active form of the enzyme is an identical dimmer in nature. There are three charged isomers as demonstrated by isoelectrofocusing. The antiserum against the 17-beta-HSD was induced by injection of purified human placenta 17-beta-HSD in rabbits. The antiserum was collected and characterized by ELISA, immunohistochemistry, immunoblot and immunoprecipitation tests. The results showed that the antibody titer was over 1:12,800, and specificity against human placenta 17-beta-HSD was also observed.     

Sudden deafness: a randomized comparative study of 2 administration modalities of hyperbaric oxygenotherapy combined with naftidrofuryl

The pharmacokinetics of a single, oral dose of 750 mg of ciprofloxacin were studied in 35 subjects with various degrees of renal function (Group 1, Clcr > or = 80 ml/min; Group II, Clcr 50-79 ml/min; Group III, Clcr 10-49 ml/min) and on hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Blood, urine and CAPD dialysate samples were collected over a period of 48 hours after dosing. Data were fitted using non-linear, least squares regression. The mean Cmax was 3.4 +/- 1.0 mg/l and tmax was 2.3 +/- 0.9 hours. The mean AUC in Group I was 14.7 mg.h/l, Group II was 33.7 (p < 0.001), Group III 63.8 (p < 0.001), HD 57.9 (p < 0.0001) and CAPD 44.3 (p < 0.001). Half-life in Group I was 4.6 h, and was shorter than Group III (11.1 h, p < 0.001), HD (13.4 h, p < 0.001) and CAPD (8.9 h, p < 0.001). Total body clearance and renal clearance demonstrated significant differences also. The dialysis clearance in CAPD patients was 0.53 +/- 0.39 l/h. Peritoneal effluent concentrations varied from 0.6 mg/l during the first exchange, to a peak of 2.2 mg/l during the second, to 0.13 mg/l in the 48 hour (9th) exchange. Dosage adjustments of ciprofloxacin in the presence of renal insufficiency are indicated for subjects with a Clcr < 20 ml/min/1.73m2.     

New substituted 1,4-benzoxazine derivatives with potential intracellular calcium activity

Substituted 1,4-benzoxazines bearing an amino side chain at the 2-position were prepared and were found to have a moderate activity on intracellular calcium. Of the compounds studied it was found that those which possess a homoveratrylamino moiety exhibited superior potency. The chain length and the nature of the amine (4-fluorophenylpiperazine, 4-fluorobenzhydryloxyethylamine, N-substituted homoveratrylamine) is discussed. The 4-benzyl-3, 4-dihydro-2-[3-[[2-(3,4-dimethoxyphenyl)ethyl]amino]propyl]-2H-1, 4-benzoxazine (3c) is the most potent derivative of the series with a ratio of IC50 values against PE (phenylephrine) and K+ of 2.1. Under these test conditions a ratio near 1 indicates potential intracellular calcium activity while a ratio greater than 100 an action on extracellular calcium influx.     

Molecular properties of the proteasome activator PA28 family proteins and gamma-interferon regulation

The information processing capabilities of biomolecular excitable media based on nonlinear dynamic mechanisms are discussed. Given even the simplest medium geometry, dynamics and information processing features inherent in biomolecular excitable media proves to be diverse and sophisticated. For the case of pseudo two-dimensional versions these media can be described in terms of neural networks having lateral connections. The main responses of shunting on-center off-surround feedback neural networks and pseudo two-dimensional excitable systems to the external excitations are surprisingly similar. The excitable media are capable of short-time memory, of contour enhancement and quenching or amplifying small features depending on medium state. The analogies discussed reaffirm specific neural net characteristics of excitable media and give the opportunity to estimate more accurate excitable medium characteristics.