Ankylosing spondylitis - specific aspects related to surgical treatment of cervical fracture - case report.

Ankylosing spondylitis (AS) or else Bechterews or Marie-Strümpells disease is a chronic inflammatory autoimmune disease affecting preferentially the spine in the form of sacroileitis and spondylitis [1,2]. Due to acquired skeletal fragility, compared to healthy spine there is a significantly different response of the organism to the mechanical load [3] and therefore in patients with AS, spinal trauma is much more dangerous. Unlike predominantly elastic injuries in healthy cervical spine in AS patients this elasticity is lost and the spine then behaves like a tubular bone [4,5]. A simple X-ray picture is often insufficient because these fractures are difficult to be found in the field of extensive bone alterations typical for AS [6,7,8]. We present a case report of cervical spondylogenic myelopathy in posttraumatic pseudoarthrosis with a prolapse of C6/7 in the field of an old fracture in an AS patient with a typical initial underestimation of diagnosis in minor trauma. The patient therefore experienced a typical late deterioration of the neurological condition. At our department, we have completed the diagnosis and proceeded to perform the surgery with which we have the greatest experience. Although slightly at variance with established procedures, the surgery provides a sufficient solution for the patient also in postoperative follow-up.

Recommendations for cerebrospinal fluid analysis.

Diseases of the central nervous system (CNS) mean for the human organism a potentially dangerous situation. An investigation of cerebrospinal fluid (CSF) provides important information about a character of CNS impairment in the decision-making diagnostic and therapeutic algorithm. The authors present a brief overview of available cerebrospinal fluid assays, shortened indication criteria, a recommended algorithm of CSF assessment in different suspected diseases, and a view of the external quality system. The whole portfolio of obtainable CSF methodology is further subdivided according to the adequate choice into the first and inevitable basic routine panel, and following complicated analyses of highly specialized character. The basic panel is considered for standard laboratories, the complete specialized assessment should be provided by a super-consulting laboratory.

Immunophenotypic analysis of cerebrospinal fluid cell populations with the Cell-Dyn Sapphire haematology analyser: method feasibility and preliminary observations.

Cerebrospinal fluid (CSF) samples (n=50) from patients with neurological disease (bacterial infection, viral infection, neuroborreliosis and multiple sclerosis) were analysed to characterize cell populations by fluorescent immunocytometry with the CD-Sapphire haematology analyser. Reagent combinations applied to all CSF samples comprised CD3/CD19/HLA-DR and CD4/CD8, with some being further analysed using CD3/CD4, CD3/CD16 and CD3/CD25 protocols. Of the 50 samples, 11 were excluded because of high proportions of nonviable cells (n=2) or insufficient cell numbers (n=9). Apart from bacterial infection with granulocytosis, all diagnostic groups showed high proportions (51.4-77.0%) of CD3+ T cells. There was a modest association between T-cell and B-cell counts, but absolute B-cell numbers exceeded 5 cells/microl in only 7/39 cases (neuroborreliosis, n=6; bacterial meningitis, n=1). CD3/Ia antigen (activation) co-expression was low and only exceeded 5% in 7/39 samples with no diagnostic correlation. Primary CD4+ and CD8+ T-cell subsets showed similar quantitative trends and CD4/CD8 co-analysis revealed the presence in all diagnostic groups (neuroborreliosis and multiple sclerosis in particular) of a CD4+CD8int fraction that was predominantly CD3+ and CD16- and had a morphological profile consistent with small lymphoid cells. Supplementary CD-Sapphire cellular immunological analysis of most CSF samples is feasible using the procedure detailed in this communication.

[Complications of IPOM plasty--our experience]. / Komplikace IPOM plastiky--nase zkusenosti.

Laparoscopic IPOM (Intraperitoneal Onlay mesh, method of intraperitoneal placement of mesh) hernioplasty, using the artificial mesh and when the method is managed sufficiently, has been used mainly for larger ventral hernias either in linea alba or more for incisional and Spiegel hernias. IPOM hernioplasty were supposed to be the gold standard for these hernioplasties, mainly for their rapidity, total view during operation and good recovery after it. There have been performed these operations also for inguinal hernias at several Surgical departments. There is a lot of studies proving safety of this method. On the other hand there exist studies pointing out severe postoperative complications of this method. These are both inflammatory and adhesive and they make threat for their long-term manifestation after primary operation and also for every next abdominal operation. We have had patients with both of these complications in our set. Considering this method for hernioplasty, we stopped performing IPOM.

Eosinophilic meningitis - an immunophenotyping recording of a very rare clinical entity - brief Report.

A very rare clinical entity, so-called eosinophilic meningitis, classified by prevalence of eosinophils in cerebrospinal fluid (CSF), with the presence of pleiocytosis, has been recorded in our laboratory four times only in the last 24 years. A low glucose level, elevation of total protein and lactic acid in CSF were detected in all the clinical cases. The last two cases were made possible by using flow cytometry method; surprisingly, the presence was found in mature T-cells in CSF, predominantly helpers (CD3+, CD4+) and, practically, none is B-cells (CD19+), plasma cells (CD138+) and NK-cells.

Cryptococcal meningitis--a follow-up study of a serious clinical entity: quick cytological and microbiological diagnostics using a special staining procedure in cerebrospinal fluid specimens.

A routine diagnostic procedure of cryptococcal meningitis using Alcian Blue and Nuclear Fast Red staining is described in a group of 16 patients. Cerebrospinal fluid findings, including clinical cytology, routine biochemistry and protein fractions, are presented.

Grtp1, a novel gene regulated by growth hormone.

An in vitro model of GH-responsive cells was subjected to microarray analysis to identify a novel gene regulated by GH. This 258 amino acid protein, we term GH Regulated TBC Protein-1 (GRTP1), contains the TBC signature motif of GTPase activator proteins of Rab-like small GTPases. Northern blot analysis revealed a 1.3 kb major mRNA species, most abundant in testes. TaqMan assay confirmed that in the mouse, Grtp1 is expressed at highest levels in testes, with lesser abundance in intestine, kidney, lung, and liver. In the testis, expression of Grtp1 significantly increases post-pubertally. Administration of GH to mice increased levels of GRTP1 mRNA in testes (140%), but decreased GRTP1 mRNA abundance in kidney (50%) and liver (25%). Grtp1 was localized to mouse proximal chromosome 8. Orthologs of this protein are present in human, mouse, rat, and drosophila suggesting that GRTP1 has an important biological role(s).

Three novel paralogs of the rodent prolactin gene family.

The prolactin (PRL) family consists of a collection of genes expressed in the uterus, placenta and anterior pituitary. These cytokines/hormones participate in the control of maternal-fetal adaptations to pregnancy. In this report, we establish the presence of three new members of the PRL family. Novel expressed sequence tags (ESTs) with homology to PRL were isolated from embryonic and placental cDNA libraries. The cDNAs were sequenced and compared with those of other members of the PRL family. The three new cDNAs were assigned to the PRL family on the basis of sequence similarities and were referred to as PRL-like protein-J (PLP-J), PRL-like protein-K (PLP-K) and PRL-like protein-M (PLP-M). Both rat and mouse PLP-J cDNAs were identified. Rat PLP-J cDNA encodes for a predicted 211 amino acid protein containing a 29 amino acid signal peptide and two putative N-linked glycosylation sites, whereas the mouse PLP-J cDNA encodes for a 212 amino acid protein containing a 29 amino acid signal peptide with a single N-linked glycosylation site. Rat and mouse PLP-J proteins share approximately 79% and 70% nucleotide and amino acid sequence identity, respectively. A full-length rat PLP-K cDNA and a partial tentative mouse PLP-K cDNA were identified. The rat PLP-K cDNA encodes for a predicted 228 amino acid protein containing a 31 amino acid signal peptide and one putative N-linked glycosylation site; the mouse PLP-M cDNA encodes for a predicted 228 amino acid protein containing a 28 amino acid signal peptide and one putative N-linked glycosylation site. Genes for PLP-J, PLP-K and PLP-M are situated at the Prl family locus on mouse chromosome 13. PLP-J was exclusively expressed in decidual tissue from both the mouse and rat. PLP-K was expressed in trophoblast cells of the chorioallantoic placenta and showed an apparent species difference. In the mouse, virtually all trophoblast lineages expressed PLP-K, whereas in the rat, PLP-K expression was restricted to the labyrinthine trophoblast cells. Mouse PLP-M expression was restricted to the junctional zone of the chorioallantoic placenta. In summary, we have identified three new members of the rodent PRL gene family that are expressed in uterine and placental structures. Future experimentation is needed to determine the specific roles of each of these ligands in the biology of pregnancy.

Identification, chromosomal mapping, and partial characterization of mouse InsI6: a new member of the insulin family.

A new member of the mouse insulin family, InsI6, was identified from mouse expressed sequence tags through the use of bioinformatics. A full length cDNA was sequenced and predicts a protein of 191 amino acids. The protein contains a signal peptide and has A and B peptides as well as a connecting peptide consistent with the contention that it is a member of the insulin family. Northern analysis demonstrates that the primary site of expression is the testis, but message is also found in the kidney, small bowel, heart, brain and thymus. The gene was mapped to mouse chromosome 19 by radiation hybrid mapping. The chromosomal location and primary structure of this protein suggest a functional relationship to relaxin and relaxin-related proteins.

A cDNA cloned from pregnant mouse uterus exhibits temporo-spatial expression and predicts a novel protein.

A cDNA was cloned from a pregnant mouse uterus cDNA library. On conceptual translation, the cDNA has one long open reading frame that predicts a novel protein of 606 amino acids. This protein is principally composed of two CUB domains and a ZP domain; motifs found in proteins implicated in egg-sperm recognition. Probes derived from the cDNA were used to conduct Northern hybridizations. The expression of this mRNA is temporal; message first appears in the uterus 6 days prior to birth, it increases each subsequent day to attain maximal levels at 3 days prior to birth and then abruptly decreases during the last 3 days of pregnancy. The expression of this mRNA is restricted; message is abundant in the uterus during late pregnancy, but it is not found in non-pregnant uterus or in a variety of adult or fetal tissues. The temporo-spatial expression of this pregnant uterus specific mRNA and the consolidation in the predicted protein of two motifs implicated in early pregnancy events suggests that the product of the gene represented by this mRNA may play an important role in events that transpire during late pregnancy.

A novel complementary deoxyribonucleic acid is abundantly and specifically expressed in the uterus during pregnancy.

OBJECTIVE: Our purpose was to identify novel genes expressed by the uterus during late pregnancy. STUDY DESIGN: A complementary deoxyribonucleic acid library constructed from late pregnancy mouse uterus was screened by differential hybridization with complementary deoxyribonucleic acid probes constructed from late pregnancy mouse uterus and nonpregnant mouse uterus. Radiolabeled complementary deoxyribonucleic acid probes derived from one of the complementary deoxyribonucleic acids isolated were used in northern hybridizations against ribonucleic acid collected from pregnant and nonpregnant uterus and a variety of other mouse tissues. RESULTS: A total of 40 positive clones were isolated; half were identified as cytotoxic T-lymphocyte antigen-2 alpha (a putative inhibitor of the protease cathepsin L) and the other half represented a novel complementary deoxyribonucleic acid. Conceptual translation of the complementary deoxyribonucleic acid predicted a novel protein of 154 amino acids that is proline rich and acidic (pregnancy-specific uterine protein). Northern hybridizations demonstrated that message is abundant in the uterus during late pregnancy. After birth expression rapidly decreased and message was no longer found in the uterus by the third day. A minimal amount of message is present in placental ribonucleic acid, but expression is otherwise not detected in a variety of adult and fetal tissues surveyed, suggesting that expression of this gene is limited to the pregnant uterus. CONCLUSIONS: The abundance of message and expression apparently limited to the pregnant uterus suggests that the protein represented by this complementary deoxyribonucleic acid may play an important role in pregnancy.

There is an increase in expression of the cytotoxic T-lymphocyte antigen-2 alpha gene during pregnancy.

OBJECTIVE: Our purpose was to identify genes that exhibit increased expression in the uterus during pregnancy. STUDY DESIGN: A differential screen was performed against a pregnant mouse uterus complementary deoxyribonucleic acid library by use of probes derived from pregnant and nonpregnant uterus. Multiple clones related to the cytotoxic T-lymphocyte antigen-2 alpha gene were isolated. RESULTS: Northern hybridization disclosed that message is present in both the gravid and nongravid uterus, but there is a substantial increase in expression during pregnancy. Expression is not found in a variety of other fetal and adult tissues evaluated (excluding placenta). CONCLUSION: The uterus (or cells present within the uterus) constitutes a major site of in vivo expression for the cytotoxic T-lymphocyte antigen-2 alpha gene, and expression of this gene is increased during pregnancy.

An increase in expression of the lipocalin 24p3 is found in mouse uterus coincident with birth.

OBJECTIVE: To provide novel insights into the molecular events associated with parturition, a differential screen was made of a mouse uterine complementary deoxyribonucleic acid library to identify selectively expressed genes in late pregnancy. STUDY DESIGN: A differential hybridization was used to screen a mouse complementary deoxyribonucleic acid library prepared from late pregnancy uterus. A 1 kb clone was isolated that was subsequently identified as 24p3, a member of the lipocalin family. By use of radiolabeled complementary deoxyribonucleic acid probes prepared from this clone Northern hybridizations were conducted against total ribonucleic acid purified from mouse uterus collected during late pregnancy and the first week after birth and a variety of other mouse tissues to determine whether this gene is selectively expressed in the uterus coincident with parturition. RESULTS: Low levels of message for the 24p3 gene could be detected in uterine ribonucleic acid, but there was a massive increase in the level of message for this gene on the days surrounding birth. Northern hybridizations conducted against additional tissues collected from both pregnant and nonpregnant mice did not detect message to a similar degree as found in the uterus. CONCLUSIONS: The uterus constitutes a major site of expression of this gene, particularly near birth. The expression of this gene coincident with birth suggests a potential physiologic role of the neutrophil with the induction of labor.

Selenoprotein P expression in liver, uterus and placenta during late pregnancy.

To identify genes that exhibit increased expression in the placenta during late pregnancy, the technique of differential cDNA library screening was used to isolate a clone subsequently identified as the 3' untranslated region of the mouse selenoprotein p gene. Random primed radiolabelled cDNA probes were constructed from this clone and these probes were used to conduct Northern hybridizations against total RNA purified from mouse placenta, liver (maternal and fetal) and uterus collected sequentially during the latter third of pregnancy. Signal is present in the placenta and beginning 4 days before birth, the level of message increases, reaching maximal levels at term. The level of expression in the placenta at maximum is approximately 25 per cent of that observed in adult liver. In liver obtained from pregnant females, the level of message is increased compared to nonpregnant adults, but returns to normal shortly after birth. Message is also found in the fetal liver beginning at 4 days before birth and exhibits a pattern of expression similar to the placenta. The similarity of expression observed in fetal liver and placenta suggests a coordinated regulation of expression of this gene in these tissues. There is a minimal amount of signal present in the uterus and the expression does not appear to vary. We speculate that selenoprotein p may play a role in the transplacental transport of selenium to the fetus during late pregnancy.

Transferrin gene expression in maternal liver, fetal liver and placenta during pregnancy in the mouse.

Two clones that are homologous to the mouse liver transferrin gene were isolated from a differential screen performed on a mouse cDNA library constructed from placenta. Using an insert derived from the larger of these clones as a template for the generation of random primed cDNA probes, northern blots were conducted against total RNA collected sequentially from placenta (7 days before birth to birth), maternal liver (7 days before birth to birth) and fetal liver (5 days before birth to birth). An approximately 2.3 kb message was detected in all three tissues which was upregulated in late gestation. Message was very abundant in both maternal and fetal liver, and present, but weak, in placenta. The clones were partially sequenced and both clones contain sequence that is identical to mouse liver transferrin. The data presented demonstrate an increase in mRNA transferrin in late gestation in maternal and fetal liver. Additionally, the placenta expresses a gene homologous to liver transferrin and it also is upregulated in late gestation.

Kidney androgen-regulated protein gene is expressed in the uterus during late pregnancy.

Kidney androgen-regulated protein (KAP) is a unique protein of unknown function that is transcriptionally induced by sex steroids. KAP is thought to be predominantly a kidney-specific gene. After conducting a differential screen of a mouse uterus cDNA library, a clone was identified that is identical to KAP. Using this cDNA to generate radiolabeled cRNA probes, Northern blots were conducted against the following tissues collected sequentially during the latter third of pregnancy: kidney, uterus and placenta. Abundant message was present in all samples of the kidney tested and there was a slight, but apparent, increase (1.5-fold) in expression during the period surrounding birth. Message is also present in the uterus, at levels comparable to the kidney, but expression occurs only during the period surrounding birth. Message is not present in the uterus at any other time. Message is also not detected in the placenta or in several other tissues tested. In addition to the kidney, KAP gene is also transcribed at equivalent levels in the uterus. Unlike the kidney, expression in the uterus is limited to the perinatal period.

Compliance with medical practice guidelines: the case of home oxygen.

Standard and straight forward practice guidelines for administration of home oxygen therapy have been long established and widely accepted. Medical records for 418 patients prescribed home oxygen through hospital-based programs at seven Veterans Administration medical centers (VAMCs) were reviewed to determine compliance with practice guidelines at the time of initial and current prescriptions. Rates of appropriate prescription at some VAMCs were very high but were too low at other VAMCs, especially given the criteria's simplicity and clarity. Practice guidelines should be implemented in conjunction with regular review mechanisms or other controls in place to ensure compliance.

Effect of quinolone antimicrobials on theophylline pharmacokinetics.

The purpose of the research was to ascertain the comparative differences of quinolone antibiotics on theophylline pharmacokinetics. Eight healthy male volunteers were randomly assigned to four treatments. Each was administered norfloxacin (NOR) 800 mg/d, ciprofloxacin (C) 1 g/d, nalidixic acid (NAL) 2 g/d and placebo (P) for 7 days. On the seventh day of each treatment, theophylline (5 mg/kg) iv was administered. The elimination half-life (T 1/2), total body clearance (CL) and volume of distribution at steady state (Vss) of theophylline were calculated using model-independent methods. ANOVA for repeated measures was used for data comparisons. The mean (SD) theophylline results were: CL l/kg/h--NOR .038 (.006), C .033 (.006), NAL .045 (.008), P .044 (.007); T 1/2 h--NOR 9.2 (1.8), C 10.6 (1.8), NAL 8.3 (1.8), P 7.5 (1.4). Theophylline Vss differences by treatment were not significant. NOR and C significantly decreased theophylline's clearance and the clearance change can be of clinical significance.