Rotational displacement of the lower tibial epiphysis due to trauma

A rare form of injury to the distal tibial growth plate is described. Only two patients with such an injury have been reported previously. The injury, rotational displacement of the distal tibial epiphysis with posterior displacement of the fibula but without fracture, can be reduced easily and appears to have no lasting ill-effects.     

The open surgical approach to subglottic hemangioma

The monthly distribution of relapses in ulcerative colitis was analysed retrospectively to assess seasonal variation. In 338 patients who were regularly followed up at the colitis clinic, 1013 relapses occurred during the period 1977 to 1988. A peak of relapses occurred in the spring and autumn, with a decrease in the summer; the ratio of the observed to expected number of relapses was 201:255.3 for the summer, 289:252.6 for the autumn, 243:249.8 for the winter, and 280:255.3 for the spring. In contrast, month of diagnosis was evenly distributed without seasonality. The data support the concept that exacerbations in ulcerative colitis are influenced by seasonal factors.     

In vivo cerebral metabolism and central benzodiazepine-receptor binding in temporal lobe epilepsy

Positron emission tomography measured interictal cerebral glucose metabolism with [18F]fluorodeoxyglucose and central benzodiazepine-receptor binding with [11C]flumazenil in 10 mesial temporal lobe epilepsy (TLE) patients and in normal subjects. Eight TLE patients had mesial temporal, lateral temporal, and thalamic hypometabolism ipsilateral to EEG ictal onsets, with additional extratemporal hypometabolism in four. One had unilateral anterior mesial temporal hypometabolism only, and one had normal metabolism. Each patient had decreased benzodiazepine-receptor binding in the ipsilateral anterior mesial temporal region, without neocortical changes. Thus, interictal metabolic dysfunction is variable and usually extensive in TLE, whereas decreased central benzodiazepine-receptor density is more restricted to mesial temporal areas. Metabolic patterns in TLE may reflect diaschisis, while benzodiazepine-receptor changes may reflect localized neuronal and synaptic loss that is specific to the epileptogenic zone. [11C]Flumazenil imaging may be useful in presurgical evaluation of refractory complex partial seizures.     

Evaluation of a chronic pain programme by referring physicians

A neglected source of treatment outcome evaluation is the opinion of the referring physicians. We report on 179 patients with chronic pain who were admitted to a 6 week inpatient inter-disciplinary pain programme. A retrospective 2 page mail questionnaire accompanied by initial letters of referral was sent to the referring physicians. We hypothesized that the main reason family physicians referred patients was to establish a management plan. The physician response rate was 70%, encompassing 72% of the patients. Intra-observer reliability was tested by a second mailing 3 months later (68% response rate). Test-retest reliability, and correlations between questions were significant and are reported for: reasons for referral, the utility of the discharge summary, coping, and behavioural changes at discharge and at time of the questionnaire. This appears to be the first report of a survey of the evaluation of a pain programme by referring physicians.     

Gene transfer therapy for heritable disease: cell and expression targeting

Gene therapy is defined as the delivery of a functional gene for expression in somatic tissues with the intent to cure a disease. Different gene transfer strategies may be required to target different tissues. Adenosine deaminase (ADA) deficiency is a good gene therapy model for targeting a rare population of pluripotent hematopoietic stem cells capable of self-renewal. We present evidence for the highly efficient gene transfer and sustained expression of human ADA in human primitive hematopoietic progenitors using retroviral supernatant with a supportive stromal layer. A stem cell-enriched (CD34+) fraction was also successfully transduced. Duchenne muscular dystrophy (DMD) is also a good model for somatic gene therapy. Two of the challenges presented by this model are the large size of the gene and the large number of target cells. Germline gene transfer and correction of the phenotype has been demonstrated in transgenic mdx mice using both a full-length and a truncated form of the dystrophin cDNA. We present here a deletion mutagenesis strategy to truncate the dystrophin cDNA such that it can be accommodated by retroviral and adenoviral vectors useful for somatic gene therapy.     

Pancreatic disease: does "itis" lead to "oma"?

OBJECTIVE: Our goal was to evaluate trends in the use of radiology with inpatients in the 10-year period of 1984-1993. MATERIALS AND METHODS: We retrospectively reviewed administrative data from a 751-bed, tertiary care hospital between October 1, 1983, and September 30, 1993 (Fiscal years 1984-1993). We coded each study by imaging technique: CT, MR imaging, sonography, nuclear medicine, or conventional studies (plain films and fluoroscopy). Echocardiography, cardiac catheterization, and angioplasty procedures were omitted. The number of admissions per year was adjusted for severity of disease (case-mix-adjusted admission [CMA]). We used relative value units to evaluate workload changes during the study period. We assessed significance of trends using linear regression analysis. RESULTS: The total number of imaging studies per CMA decreased during the study period (p = .0001). This was due to a decrease in the number of conventional studies (p = .0001) and sonograms per CMA (p = .02), despite significant increases in the numbers of CT (p = .005) and MR imaging (p = .0001) studies per CMA. No significant change existed in the number of nuclear medicine studies per CMA (p = .11). The global, professional, and technical relative value units per CMA rose during the latter half of the study. CONCLUSION: The overall number of imaging studies per CMA decreased during the decade, despite a significant rise in the use of CT and MR imaging, suggesting that these new imaging techniques are replacing older ones. To control further increases in overall imaging costs, priority should be placed on understanding the patterns of use for CT and MR imaging techniques and curbing their inappropriate use.     

Evolution of syncytium-inducing and non-syncytium-inducing biological virus clones in relation to replication kinetics during the course of human immunodeficiency virus type 1 infection

To investigate the temporal relationship between human immunodeficiency virus type 1 (HIV-1) replicative capacity and syncytium-inducing (SI) phenotype, biological and genetic characteristics of longitudinally obtained virus clones from two HIV-1-infected individuals who developed SI variants were studied. In one individual, the emergence of rapidly replicating SI and non-syncytium-inducing (NSI) variants was accompanied by a loss of the slowly replicating NSI variants. In the other subject, NSI variants were always slowly replicating, while the coexisting SI variants showed an increase in the rate of replication. Irrespective their replicative capacity, the NSI variants remained present throughout the infection in both individuals. Phylogenetic analysis of the V3 region showed early branching of the SI variants from the NSI tree. Successful SI conversion seemed a unique event since no SI variants were found among later-stage NSI variants. This was also confirmed by the increasing evolutionary distance between the two subpopulations. At any time point during the course of the infection, the variation within the coexisting SI and NSI populations did not exceed 2%, indicating continuous competition within each viral subpopulation.