Infection after total elbow arthroplasty

The purpose of this study was to review our experience with the treatment of twenty-five infections (in twenty-five patients) after total elbow arthroplasty and to examine indications for salvage of the prosthesis compared with those for resection arthroplasty. The patients were divided into three groups on the basis of treatment. Group I comprised fourteen patients who were managed with multiple, extensive irrigation and debridement procedures with retention of the original components. The primary indication for retention of the prosthesis was evidence that it was well fixed as determined both radiographically and intraoperatively. Group II comprised six patients who had removal of the prosthesis and debridement followed by immediate or staged reimplantation. Group III comprised five patients who were managed with resection arthroplasty. The infection was successfully eradicated in seven of the fourteen elbows that had salvage of the prosthesis with irrigation and debridement. The results were strongly dependent on the causative organism; attempts at debridement failed in the four elbows that were infected with Staphylococcus epidermidis compared with three of the ten that were infected with another organism. Four of the six patients in Group II had successful reimplantation of a prosthesis; in three, the infection had been caused by an organism other than Staphylococcus epidermidis. Only one of the three patients who had a Staphylococcus epidermidis infection had a successful reimplantation. None of the five patients who had a resection arthroplasty had signs of infection at the latest follow-up examination. We concluded that salvage of the prosthesis with extensive irrigation and debridement in the presence of an infection about the elbow can be reasonably successful if the infecting organism is not Staphylococcus epidermidis and if the components are well fixed. When removal of the components is warranted, staged reimplantation can also be highly successful when the infecting organism is not Staphylococcus epidermidis. However, the repeated operations necessary to retain a prosthesis and the high rates of complications seen with this approach--and the relatively good rates of satisfaction obtained with resection arthroplasty--suggest that resection arthroplasty remains the procedure of choice in medically frail patients or in patients for whom function of the elbow is less of a concern.     

Relative occurrence of flow limitation and snoring during continuous positive airway pressure titration

OBJECTIVE: To distinguish between the existence of detached ciliary tufts (DCTs) and the possibility of protozoa in the sputum of asthma patients. STUDY DESIGN: One hundred six samples of sputum obtained from 97 patients hospitalized with either asthma or other respiratory diseases were examined blindly. The combination of such criteria as movement, absence of basal plate, existence of red granules, positivity for ultraviolet light and Heidenhain's iron hematoxylin stain (for protozoa) was employed to distinguish between DCTs and true protozoa. RESULTS: The presence of ameboflagellates in sputum has a diagnostic accuracy of 86% in predicting or ruling. out the possibility of acute asthma. CONCLUSION: The presence of ameboflagellate forms is closely related to the existence of bronchial asthma, and these result reflect some etiopathogenic significance in asthma.     

Peak bone mineral accrual and age at menarche in adolescent girls: a 6-year longitudinal study

To study the effect of a high radiation background on the structure and function of the T-complex, we used laboratory mice carrying t-haplotypes of four complementation groups (t0, t12, tw1, and tw5). In 1987-1989, the animals were kept each year for a month within a 30-kilometer zone of Chernobyl Nuclear Power Station in regions with different degrees of pollution. Subsequent genetic analysis revealed a decrease in fertility, fecundity, and the index of preferable transmission of t-carrying chromosomes in radiated animals and some of their progeny. The effect of different radiation doses on these parameters was different in animals with various t-haplotypes. A lack of complementation or a decrease in the complementation effect was revealed in a number of crosses involving the progeny of irradiated animals. The frequency of complementation distortion was about 8 x 10(-2), which is more than an order higher than the usual recombination frequency characteristic of these t-haplotypes.     

Localization of the ROMK potassium channel to the apical membrane of distal nephron in rat kidney

BACKGROUND: The apical potassium (K+) channels mediate K+ recycling in thick ascending limb (TAL) and K+ secretion in cortical collecting duct (CCD). Recently, the cDNAs for a family of renal K+ channels, ROMK1, -2 and -3, were identified. Based on the biophysical properties and mRNA distribution, it is believed that these ROMK cDNAs encode the apical K+ channels of TAL and CCD. However, the information for cellular and subcellular localization of the ROMK proteins in these tubules is still not available. METHODS: Paraffin or frozen kidney sections from adult Sprague-Dawley rats were stained by polyclonal antibodies against the N- and C-terminal domain of ROMK. Immunoreactive staining was visualized by color development from horseradish peroxidase reaction. Membrane homogenates from kidney were analyzed by Western blot analysis. RESULTS: The polyclonal antibodies against cytoplasmic epitope of ROMK recognized a approximately 42 kD protein in the membrane homogenates from kidney, but not from liver. Staining by immunocytochemistry revealed that ROMK channels were localized to the apical membranes of the distal nephron in cortex and outer medulla, including thick ascending limb and collecting tubule. ROMK staining was absent in glomerulus, proximal tubule and inner medulla. Double staining of the tissue section with both ROMK-specific and H+-ATPase-specific antibodies revealed labeling of ROMK in the principal cells of the collecting tubules. CONCLUSIONS: These results further strengthen the idea that ROMK channels play important roles in the recycling of K+ in TAL and the secretion of K+ in CCD.     

Natural killer cell-mediated eradication of neuroblastoma metastases to bone marrow by targeted interleukin-2 therapy

Targeted interleukin-2 (IL-2) therapy with a genetically engineered antidisialoganglioside GD2 antibody-IL-2 fusion protein induced a cell-mediated antitumor response that effectively eradicated established bone marrow and liver metastases in a syngeneic model of neuroblastoma. The mechanism involved is exclusively natural killer (NK) cell-dependent, because NK-cell deficiency abrogated the antitumor effect. In contrast, the fusion protein remained completely effective in the T-cell-deficient mice or immunocompetent mice depleted of CD8+ T cells in vivo. A strong stimulation of NK-cell activity was also shown in vitro. Immunohistology of the leukocytic infiltrate of livers from treated mice revealed a strong staining for NK cells but not for CD8+ T cells. The therapeutic effect of the fusion protein was increased when combined with NK-cell-stimulating agents, such as poly I:C or recombinant mouse interferon-gamma. In conclusion, these data show that targeted delivery of cytokines to the tumor microenvironment offers a new strategy to elicit an effective cellular immune response mediated by NK cells against metastatic neuroblastoma. This therapeutic effect may have general clinical implications for the treatment of patients with minimal residual disease who suffer from T-cell suppression after high-dose chemotherapy but are not deficient in NK cells.     

Site-directed mutagenesis of phosphorylation sites of the branched chain alpha-ketoacid dehydrogenase complex

Regulation of the branched chain alpha-ketoacid dehydrogenase complex, the rate-limiting enzyme of branched chain amino acid catabolism, involves phosphorylation of 2 amino acid residues (site 1, serine 293; site 2, serine 303). To directly assess the roles played by these sites, site-directed mutagenesis was used to convert these serines to glutamates and/or alanines. Functional E1 heterotetramers were expressed in Escherichia coli carrying genes for E1 alpha and E1 beta under control of separate T7 promoters in a dicistronic vector. Mutation of phosphorylation site 1 serine to glutamate inactivated E1 activity, i.e. mimicked the effect of phosphorylation of site 1. Replacement of the site 1 serine with alanine greatly increased Km for the alpha-ketoacid substrate but had no effect on maximum velocity. The site 1 serine to alanine mutant was phosphorylated at site 2, but phosphorylation had no effect upon enzyme activity. Mutation of site 2 serine to either glutamate or alanine also had no effect upon enzyme activity, but phosphorylation of these proteins at site 1 inhibited enzyme activity. E1 mutated to change both phosphorylation site serines to glutamates was without enzyme activity. The binding affinity of E1 to the E2 core was not affected by mutation of the phosphorylation sites to glutamates, suggesting no gross perturbation of the association of E1 with the E2 core. The results provide direct evidence that a negative charge at phosphorylation site 1 is responsible for kinase-mediated inactivation of E1. Site 2 is silent with respect to regulation of activity by phosphorylation.     

An improved shift-invariant artificial neural network for computerized detection of clustered microcalcifications in digital mammograms

A shift-invariant artificial neutral network (SIANN) has been applied to eliminate the false-positive detections reported by a rule-based computer aided-diagnosis (CAD) scheme developed in our laboratory. Regions of interest (ROIs) were selected around the centers of the rule-based CAD detections and analyzed by the SIANN. In our previous study, background-trend correction and pixel-value normalization were used as the preprocessing of the ROIs prior to the SIANN. A ROI is classified as a positive ROI, if the total number of microcalcifications detected in the ROI is greater than a certain number. In this study, modifications were made to improve the performance of the SIANN. First, the preprocessing is removed because the result of the background-trend correction is affected by the size of ROIs. Second, image-feature analysis is employed to the output of the SIANN in an effort to eliminate some of the false detections by the SIANN. In order to train the SIANN to detect microcalcifications and also to extract image features of microcalcifications, the zero-mean-weight constraint and training-free-zone techniques have been developed. A cross-validation training method was also applied to avoid the overtraining problem. The performance of the SIANN was evaluated by means of ROC analysis using a database of 39 mammograms for training and 50 different mammograms for testing. The analysis yielded an average area under the ROC curve (A(z)) of 0.90 for the testing set. Approximately 62% of false-positive clusters detected by the rule-based scheme were eliminated without any loss of the true-positive clusters by using the improved SIANN with image feature analysis techniques.     

Increased expression of stromelysin 3 mRNA in leiomyomas (uterine fibroids) compared with myometrium

We set out to validate the concept of three-dimensional (3D) angiography. We evaluated the sensitivity and the quality of morphological analysis mode possible by an experimental system for imaging cerebrovascular disease versus standard digital subtraction angiography (DSA). The system, the 3D Morphometer, is a computerised X-ray angiography unit capable of acquiring a set of two-dimensional (2D) projections during a rotation and then reconstructing a 3D volume from them. We studied 78 patients with suspected cerebrovascular disease. 3D and 2D images (standard 2D DSA performed during the same procedure), were reviewed blindly to assess detection and display of morphological characteristics of cerebrovascular diseases. We found 53 aneurysms, 22 arteriovenous malformations and two venous angiomas. On 3D angiography we detected two aneurysms we missed on 2D angiography. In 47 aneurysms on which further data were obtained during surgery or embolisation, the 3D angiography allowed more accurate analysis of the neck and surrounding vessels in cases in which the 2D angiographic findings were doubtful. Assessment of arteriovenous malformations was equivalent with both techniques. Under the conditions of our study, the technical constraints being the same for both methods, 3D angiography was superior to 2D angiography. Implementation on C-arm vascular systems is being evaluated.