Tenosynovial chondromatosis of the wrist presenting with acute carpal tunnel syndrome: A case report.

We report a case of synovial chondromatosis of the wrist that manifested as acute carpal tunnel syndrome. The patient successfully underwent carpal tunnel release, tenosynovectomy and resection of dorsal and volar ossified bodies embedded in the tenosynovium overlying the wrist. Final histopathology confirmed the diagnosis of synovial chondromatosis. The patient's symptoms of pain, numbness, and paresthesia in a median nerve distribution resolved completely and the patient resumed full-time work in the service industry 4-weeks postoperatively with no functional limitations. This case highlights the importance of maintaining a broad differential in the approach to wrist pain and the role of magnetic resonance imaging in the diagnosis of synovial chondromatosis given its variable degree of ossification.

No harm done? Psychological assessment in the A&E department of patients who deliberately harm themselves.

OBJECTIVE: To determine whether psychosocial assessments of patients presenting to the Accident and Emergency (A&E) Department at Addenbrooke's Hospital, Cambridge, with deliberate self-harm are recorded adequately in the case notes, using the criteria of the 1994 Royal College of Psychiatrists' consensus statement on managing adult deliberate self-harm in hospital. DESIGN: A cross-sectional study of case notes. SUBJECTS: A total of 338 patients (accounting for 404 episodes of deliberate self-harm) who presented consecutively between 1 January and 30 June 1996. RESULTS: 56% of episodes resulted in admission to a general hospital bed. In only 11% of conscious patients were adequate psychological assessments recorded in the case notes. Little psychosocial information was recorded in the notes of those patients discharged without follow-up from accident and emergency. CONCLUSIONS: In the A&E department of this teaching hospital, there is inadequate recording of important psychological information in the case notes of patients who present with deliberate self-harm.

Lithium in the over-65s: who is taking it and who is monitoring it? A survey of older adults on lithium in the Cambridge Mental Health Services catchment area.

OBJECTIVES: To determine the prevalence of lithium therapy in the over-65s in the Cambridge Mental Health Services catchment area, to obtain a profile of this group and to find out how well and by whom lithium treatment is being monitored. METHODS: A census was carried out of patients over the age of 65 in the Cambridge Mental Health Services catchment area who were on lithium therapy on 1 February 1995. The records of these patients were examined retrospectively for demographic details, details of lithium therapy, information about lithium monitoring and risk factors associated with lithium treatment. RESULTS: One hundred and forty-eight patients were identified representing a point prevalence of 0.27%. GPs carried out lithium monitoring for the majority of this group and 47% had not been seen by a psychiatrist in the 12 months leading up to the census date. Thirty-two per cent of the group were on thyroxine treatment or had raised TSH levels. CONCLUSIONS: The prevalence of lithium therapy in this study was greater than the prevalences reported in studies of patients of all ages. Standards of monitoring varied widely and were not always better where psychiatrists monitored the treatment, although psychiatrists were more likely than GPs to monitor renal function. There was a high rate of thyroid dysfunction in the study group.

Risk factors associated with parvovirus enteritis in dogs: 283 cases (1982-1991).

OBJECTIVE: To determine breed, sex, and seasonal predisposition for development of canine parvovirus (CPV) enteritis in dogs. DESIGN: Retrospective case-control study. SAMPLE POPULATION: Medical records from 283 dogs with confirmed CPV enteritis and from 834 age-matched control dogs that were healthy or had been admitted with nonenteric illness. PROCEDURE: Effects of season, breed, sex, and neutering on the risk of developing CPV enteritis were examined by calculation of unadjusted odds ratios and performance of multivariate analysis. Stratified and contingency table analyses were performed to identify interactions and confounding among variables. RESULTS: Rottweilers, American Pit Bull Terriers, Doberman Pinschers, and German Shepherd Dogs were at increased risk and Toy Poodles and Cocker Spaniels were at decreased risk for developing CPV enteritis, compared with that for mixed-breed dogs. For dogs more than 6 months old, sexually intact males were twice as likely as intact females to develop CPV enteritis. Dogs were 3 times more likely to be admitted with CPV enteritis in July, August, and September, compared with the rest of the year. Dogs were 12.7 times more likely to be admitted with CPV enteritis if they had not been currently vaccinated. CLINICAL IMPLICATIONS: Lack of vaccination is a significant risk factor for development of CPV enteritis. Seasonal, sex, and breed predispositions for the development of CPV enteritis also exist.

Fat emulsion particle-size distribution in total nutrient admixtures.

The fat particle-size distribution in and physical stability of two commercially available lipid emulsions before and after their use in total nutrient admixtures (TNAs) are reported. Four TNAs without electrolytes and four TNAs with electrolytes were prepared; each type of TNA was prepared with Liposyn II and with Intralipid. Particle size was measured in the < 1-micron range by using photon correlation spectroscopy and in the 2-60-microns range by using light blockage. Admixtures with or without electrolytes were stored for two or nine days at 4 degrees C followed by one day at 25 degrees C. For the fraction of fat particles of < 1 micron in diameter, Intralipid and Liposyn II had a mean particle size of 374 and 313 nm, respectively. The admixtures containing electrolytes showed a decrease in mean particle size of about 7%. Admixtures with Intralipid contained 2 x 10(7) particles larger than 2 microns per milliliter (1.7% of total fat), compared with 1 x 10(6) particles per milliliter (0.05-0.15% of total fat) for admixtures with Liposyn II. The addition of electrolytes increased the particle counts for Liposyn II-containing admixtures. Upon storage, Intralipid-containing admixtures with electrolytes showed an initial increase followed by a decrease in the mean diameter of particles of < 1 micron. All the admixtures were stable in terms of pH and visual appearance. Intralipid-containing admixtures with electrolytes showed a decrease in the number of particles in the 2-60-microns size range, while Liposyn II-containing admixtures with electrolytes showed an increase.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoclonal-antibody studies of creatine kinase. The proteinase K-cleavage site.

Proteinase K cleaves a small peptide from native muscle-specific creatine kinase. We present evidence, from the binding of two monoclonal antibodies to formic acid-cleavage fragments and proteinase K-digest fragments of chick muscle creatine kinase, that the proteinase K-cleavage site is in the C-terminal region of the molecule. This specificity of proteinase K, which is not normally a highly specific enzyme, and the continued association of the two peptide fragments after cleavage suggest an unusual conformational feature in the cleavage-site region. By applying predictive methods for hydrophobicity and secondary structure to an amino acid sequence in this region, we suggest possible structural features at the cleavage site that are evidently conserved across avian and mammalian species. The most likely site is next to, or within, a beta-turn on the surface of the molecule.

Monoclonal antibodies against a nucleolar protein from differentiating chick muscle cells.

Two monoclonal antibodies, NORM and NORA, bind specifically to a 37 000 molecular weight protein in total protein extracts of chick skeletal muscle cell cultures. They have been used to follow changes in the amount and distribution of this protein during terminal differentiation and the associated cessation of cell division. Immunofluorescence microscopy shows that the antigen is found almost exclusively in the nucleolus in interphase cells and is dispersed in the cytoplasm during mitosis. Low doses of actinomycin D cause segregation of nucleoli into DNA fibrils and ribonucleoprotein granules, and the antigen is clearly associated with the latter. High doses of actinomycin D cause shrinkage of the nucleolus and the antigen is dispersed within the nucleoplasm, but not released into the cytoplasm. The amount and distribution of antigen is similar in all cell types (myoblasts, myotubes and fibroblasts) and there are no major changes during muscle differentiation. From known changes in ribosomal RNA metabolism during myogenesis and after actinomycin D treatment, we suggest that the 37 000 Mr protein is involved in some post-transcriptional aspect of ribosome production and that its concentration and distribution may be related to the concentration of ribosomal RNA in the nucleolus.

Monoclonal antibodies to intermediate filaments in chick muscle cell cultures.

Two monoclonal antibodies, FIFI and PHIL, have been prepared using detergent-washed myogenic cells as immunogen. On Western blots of total protein extracts of muscle cells, both antibodies bind to vimentin (52 kD) and its degradation products (major band at 42 kD), but do not bind to mouse proteins or to actin (42 kD). Specificity for a determinant common to vimentin and desmin was confirmed by 2-D gel electrophoresis of muscle cell extracts and purified desmin. Western blots with FIFI reveal particularly well the extreme sensitivity of intermediate filaments (IFs) to proteolysis, which was preventable in brain tissue only by boiling in 1% SDS, although it could be reduced in both brain and muscle by less extreme methods. Western blots suggest a large increase in IF content of differentiating myoblast cell cultures at the time of cell fusion and an increase of at least 4-fold is confirmed by a quantitative immunoassay using a direct ELISA method. Immunofluorescence microscopy shows that this increase is due to the appearance of high concentrations of the intermediate filament antigen at the ends of early myotubes, preceding the appearance of cross-striations in myofibrils. Furthermore, whereas the polar filaments detected by FIFI run right to the ends of the early myotubes and only sparingly penetrate the central area, cross-striated myofibrils (as detected by the monoclonal antibody, SAM) run the length of the myotube but do not reach the ends. Colcemid and colchicine cause the vimentin filaments in fibroblasts to collapse into perinuclear rings or caps, but do not have this effect on the polar fluorescence in early myotubes. Heat shock (2 h at 45 degrees C) has a similar differential effect. The results suggest that early in muscle differentiation intermediate filament proteins accumulate rapidly at myotube ends, where they are organized differently from those in fibroblasts.

The effects of test difficulty on undergraduates' state anxiety and perception of test difficulty.

The finding of a previous study that student perception of difficulty level may be just as important as the actual difficulty levels was reinterpreted. A specially developed Educational Psychology Recognition Test and Test Perception Inventory assessed task difficulty and perception of exam difficulty, respectively, in 30 American undergraduates. A modified version of the State-Trait Anxiety Inventory assessed state anxiety. Results indicated, that 1) test difficulty did not significantly affect state anxiety but did significantly affect perception of exam difficulty, 2) students administered the high-difficulty test exhibited a perception of higher exam difficulty than those taking the medium- and low-difficulty tests, and 3) there was no significant difference for the perception of exam difficulty between students taking the medium- and low-difficulty tests.

Immunoassay of muscle-specific creatine kinase with a monoclonal antibody and application to myogenesis and muscular dystrophy.

A competition e.l.i.s.a. (enzyme-linked immunosorbent assay) is described that enables direct measurement of the muscle-specific polypeptide of chick creatine kinase (M-CK) in extracts of differentiating muscle-cell cultures and in blood plasma samples, even in the presence of embryonic, or brain-type, creatine kinase. The characteristics of the assay can be considerably improved by the use of a monoclonal antibody, CK-ART, instead of rabbit antisera, and we offer an explanation for this in terms of heterogeneity of antibody affinities in polyclonal antisera. In addition to native enzyme, the assay will measure creatine kinase unfolded and inactivated by 8 M-urea treatment. During chick muscle differentiation in vitro, M-CK increased from 7.5% of the total creatine kinase at 24h to 76.0% at 143h, in good agreement with isoenzyme separation data. As a percentage of the total cell protein, M-CK increased by 156-340-fold over the same period and constituted 0.38-0.56% of the total protein in late cultures. E.l.i.s.a. measurements on 17-20-day embryonic thigh-muscle extracts, which contain almost exclusively M-CK, agree well with enzyme activity and radioimmunoassay. M-CK constituted 0.7-1.6% of the total protein in 17-19-day embryonic thigh muscle. Plasma M-CK concentrations in normal 2-8-week-old chickens were found to be in the range 0.5-0.9 micrograms/ml. Plasma concentrations of 32-56 micrograms/ml were found in 8-week-old dystrophic chickens by both e.l.i.s.a. and enzyme-activity measurements. The results suggest that inactive or unfolded forms of M-CK do not normally exist, in any significant amounts, in cell and tissue extracts or in freshly prepared samples of plasma.

Induction of differentiation in a rat mammary epithelial stem cell line by dimethyl sulphoxide and mammotrophic hormones.

Rama 25 is a clonal epithelial cell line derived from a dimethylbenzanthracene-induced rat mammary adenocarcinoma. In the presence of the mammotrophic hormones, insulin, hydrocortisone, estrogen and prolactin, Rama 25 produces small amounts of casein and forms domes at a low rate. The rates of both these processes can be greatly increased by the addition of dimethyl sulphoxide or hexamethylenebisacetamide which are also known to induce the differentiation of Friend erythroleukemia cells. Other compounds which stimulate the differentiation of Rama 25 cells include linoleic acid and 6-thioguanine. The intracellular pathways triggering changes in the two markers of differentiation are partially separable using different combinations of hormones, prolactin and hydrocortisone being the most important for the production of casein and the formation of domes respectively. The kinetics of differentiation, as judged by the appearance of these two markers, are characterised by two phases, a fixed period of 8 h (lag phase), the length of which is independent of the dimethyl sulphoxide concentration and a second phase where their rates are dependent on the concentration of dimethyl sulphoxide. Rama 25 cells do not become committed to differentiate during this lag phase but increasing numbers of cells do so after this period. We suggest that the differentiation processes occur in two stages. The first stage, involving the inducer, commits Rama 25 cells to a new differentiated state. The second stage, involving the hormones, modulates the expression of different markers of this state. Both casein production and dome formation can be blocked by inhibitors of DNA synthesis and show reciprocal changes with the rates of cellular DNA synthesis. Thus, in its hormonal and DNA synthetic requirements for differentiation, Rama 25 cells appear to resemble some of the mammary epithelial cells of mature virgin rats.

The effects of trait anxiety and test difficulty on undergraduates' state anxiety.

The purpose of this study was to determine the effects of trait anxiety (stable anxiety resulting from personality characteristics which predisposes an individual to anxiety) and test difficulty on state anxiety (transitory anxiety that results from particular situations which are regarded as difficult or dangerous) of 32 undergraduates. The Test Anxiety Inventory assessed trait anxiety, a modified version of the State-Trait Anxiety Inventory assessed state anxiety, and a specially developed Educational Psychology Recall Test assessed task difficulty. Results indicated that trait anxiety and test difficulty level affected state anxiety. Trait anxiety and test difficulty level did not interact to affect state anxiety.