An association between lunate morphology and scaphoid-trapezium-trapezoid arthritis.

The purpose of this study was to determine if an association exists between scaphoid-trapezium-trapezoid arthritis and lunate morphology. Plain neutral posteroanterior radiographs were evaluated for 48 patients with STT arthritis and 96 patients from a control group. Lunate type was determined using capitate-triquetrum (C-T) distance. A type I lunate was defined as a C-T distance < or =2 mm. A type II lunate was defined as a C-T distance > or =4 mm. Lunate type was recorded and compared between those with STT arthritis and a control group. The groups were similar with regard to age, gender and handedness. Type II lunates were found in 83% of cases with STT arthritis and in 64% of controls. STT OA was associated with type II lunate wrists (P = 0.02; OR = 0.35; CI: 0.15-0.82). We postulate that variations in scaphoid motion secondary to lunate morphology may contribute to the development of STT OA.

Subacute encephalomyelitis presenting as stiff-person syndrome: clinical, polygraphic, and pathologic correlations.

A 60-year-old woman presented with stiff-person syndrome (SPS). Treatment with diazepam controlled her painful spasms initially. Two and one-half years after the onset of SPS, new spells of paroxysmal leg jerking and apnea developed. A spell was recorded with simultaneous video and polygraphic techniques that revealed simultaneous firing of motor unit potentials in several muscles (paraspinal, internal hamstring, and abdominal muscles). Apnea was associated with arterial oxygen desaturation. An increase in the dose of diazepam decreased the number and severity of these episodes. Seventeen months later, the patient began to taper the diazepam dose. Shortly thereafter, she had a cardiorespiratory arrest and subsequently died. Autopsy showed small chronic inflammatory foci in the pancreas (some associated with islets) and findings of diffuse encephalomyelitis characterized by perivascular cuffing in the spinal cord, brainstem, thalamus, hippocampus, and amygdala and a dense mononuclear infiltrate in the anterior horns of the lumbar and cervical cord, with relative preservation of axons and myelin. Cell typing showed this infiltrate was polyclonal and reactive. There have been rare cases of SPS associated with encephalomyelitis reported previously. Although the prolonged course in our patient suggested that SPS may have preceded encephalomyelitis, the more likely explanation is that the patient had an unusually long course of encephalomyelitis alone.

Myelopathy associated with fibrocartilaginous emboli (FE): review and two suspected cases.

BACKGROUND: Myelopathy secondary to fibrocartilaginous emboli is rarely reported and has been documented antemortem only once. The pathophysiology of fibrocartilaginous emboli lacks consensus, although the role of trauma has been previously entertained. METHODS: We reviewed the reported cases of myelopathy secondary to fibrocartilaginous emboli. We extensively evaluated two cases of myelopathy in otherwise healthy individuals using myelography and serial magnetic resonance imaging (MRI). Evaluation for underlying systemic disease was conducted in both cases. RESULTS: No evidence of infectious, autoimmune, inflammatory, or neoplastic disease was found in either patient. Furthermore, no other lesions were found in the neuroaxis. Findings on serial MRIs were consistent with vascular lesions thought to be venous strokes. CONCLUSIONS: We report two cases of acute myelopathies associated with heavy lifting, in otherwise healthy young men. Serial MRI studies in each case demonstrated lesions consistent with venous infarcts. We postulate that migration of disc material into the perivertebral venous system was the result of increased intervertebral disc pressure and simultaneous excessive Valsalva associated with heavy lifting. We further postulate that this may be a more prevalent cause of acute myelopathy than previously recognized.

Changes in the rat lymphoid tissues after Leydig cell destruction by ethane-1,2-dimethanesulphonate.

Since ethane-1,2-dimethanesulphonate (EDS) causes Leydig cell destruction which may elicit an immune response the lymphoid tissues of sexually mature male rats were examined after an intraperitoneal injection of EDS. The changes observed in the testicular regional lymph nodes confirm an immune response while those observed in the thymus may indicate involvement in the immunological response or be a toxic reaction to EDS.

Cellular proliferation in the lymphoid tissues of an inbred (RT1a) rat strain during the oestrous cycle.

Changes in body weight, uterine weight and tissue weight, cell content and cellular proliferation of the thymus and uterine regional and popliteal lymph nodes were examined at daily intervals during the oestrous cycle of the DA (RT1a) inbred rat strain. Thirty-nine sexually mature virgin animals, aged between 13 and 15 weeks were used in this investigation. During dioestrus body weight and uterine weight fell significantly, while intrathymic and intranodal cellular proliferation increased significantly. These findings are discussed in relation to ovarian hormone secretion and it is suggested that increased thymocyte and lymphocyte proliferation occurs in response to rising oestrogen levels. This proliferative response prepares the female for the immunological challenge with allogeneic spermatozoa should mating occur during the subsequent oestrous phase.

A dioestrous increase in thymocyte proliferation during the oestrous cycle.

Coitus, which precedes internal fertilisation, is a unique physiological event which allows motile allogeneic spermatozoa to enter the female host and invade her tissues. The cyclic cellular proliferation observed in the thymus of the female rat may be an important preparation of her immune system for this event.

MRI of cerebral vein thrombosis in infancy: a case report.

We diagnosed primary idiopathic cerebral vein thrombosis in an infant by MRI. The relative noninvasiveness of the scan, ease of imaging in multiple planes, and good image resolution suggest that the scan may be useful in this disorder.

Vertebral artery rupture associated with closed head injury. Report of two cases.

The authors report two patients with closed head injury who suffered laceration with rupture of the third portion of the vertebral artery. One patient died suddenly, with angiographic evidence of bilateral vertebral artery rupture. The mechanism of injury to the C1-2 segment of the vertebral artery relating to head and neck injury is discussed.

The cell content and proliferative response of the rat thymus during first syngeneic and allogeneic pregnancy, and the effects of strain difference.

Two hundred female rats, 91-101 days of age, were used in this investigation which provided data on cell content and proliferative response of the thymus. The observations began in oestrous phase virgin females from two highly inbred strains AO(RT1u/AgB2) and DA(RT1a/AgB4), continued at five day intervals throughout syngeneic and allogeneic pregnancy in both strains and were completed in the immediate post-partum period. This experimental protocol permitted sequential observations throughout gestation and allowed syngeneic: allogeneic and interstrain comparisons to be made. The syngeneic: allogeneic comparisons demonstrated significant differences in the thymic proliferative responses while the AO:DA comparisons demonstrated significant differences in the thymic cell contents.

Seminal plasma abrogates the postcoital T cell response to spermatozoal histocompatibility antigens.

The T-cell responses to spermatozoal histocompatibility antigens were studied in the uterine regional lymph nodes of female rats by a specific cytoadhesion assay. The antigenic challenge was introduced either by artificial insemination with syngeneic or allogeneic epididymal spermatozoa or coitus. The uterine regional T-cell response to allogeneic spermatozoa following artificial insemination was measureable after 2 days and continued undiminished until day 5. In contrast, the measurable response to allogeneic coital challenge peaked on day 3 and disappeared by days 4-5. Since the difference between the two stimuli involved the presence of seminal plasma, these results indicate a possible immunoregulatory (suppressive) effect of seminal plasma on the cellular immune reaction of the female to the male alloantigens after mating.

Antigenic stimulation regulates the level of expression of interleukin 2 receptor on human T cells.

Antigen-specific, interleukin 2 (IL-2)-dependent human T-cell lines and clones were utilized to study the relationship between IL-2 receptor expression and antigenic stimulation. T cells that had not been exposed to antigen for 2 wk or more expressed a stable low level of the IL-2 receptor. After reexposure to antigen, a 10- to 30-fold increase in the level of the IL-2 receptor was rapidly induced, with the peak level of IL-2 receptor expression occurring at 15-30 hr. This peak preceded the peak in cell proliferation [( 3H]thymidine incorporation), which was at 48-72 hr. Within 2-14 days after peak IL-2 receptor expression, it returned to a low base-line level. The transient elevation in IL-2 receptor level was antigen specific because it occurred in response to specific allogeneic stimulator cells but not after exposure to cells expressing irrelevant HLA allotypes. The levels of other cell-surface proteins, including those related to T-cell activation (HLA-DR, T10, 4F2, A-1A5) as well as T3, which has been proposed to be a component of the T-cell receptor complex for antigen, did not change in response to antigen exposure or deprivation. Because IL-2 was maintained at a consistently high level throughout these experiments, the antigen-induced changes in the IL-2 receptor appear to be independent of changes induced by IL-2 itself. Both cloned T cells and mixed populations containing T4 and T8 subsets showed similar IL-2 receptor responsiveness, indicating that this finding is generalizable to most, if not to all, antigen-responsive T cells.

Neuromyopathy of cyanide intoxication due to "laetrile" (amygdalin). A clinicopathologic study.

A 67-year-old woman with lymphoma presented with a neuromyopathy following "laetrile" (amygdalin) treatment. She had significant elevation of blood and urinary thiocyanate and cyanide levels. Sural nerve biopsy specimen revealed a mixed pattern of demyelination and axonal degeneration, the latter being prominent. Gastrocnemius muscle biopsy specimen showed histochemically a mixed pattern of denervation and myopathy with Type II atrophy. It is concluded that cyanide toxicity secondary to laetrile therapy and nutritional deficiency caused the neuromyopathy, as the changes in peripheral nerve are similar to changes described in ataxic polyneuropathy occurring in Nigeria attributed to high cyanide content in the diet and nutritional deficiency. Although this patient received vincristine initially, the development of the neuromyopathy had no temporal relationship to its administration. The clinical profile, as well as peripheral nerve and muscle changes were not similar to either vincristine neuromyopathy or neuromyopathy due to paraneoplastic manifestation of lymphoma. Clinical improvement following discontinuation of "laetrile" by the patient further supports the toxic etiologic results for the neuromyopathy in this patient.

Sound levels in emergency medical service.

Sound levels in an emergency medical service vehicle were measured during the summer of 1981. Excessive levels were found in the driver's compartment with the siren operating. Personnel measured showed low frequency hearing loss in the same range as the siren's operating frequencies.

A specific cytolytic T cell response induced by subcutaneous challenge with allogeneic rat epididymal spermatozoa.

Groups of virgin female rats were killed on days 2-5 after footpad injection with either thoracic duct lymphocytes or epididymal spermatozoa from allogeneic male rats and the cellular response in the regional lymph nodes determined by the specific cytoadhesion technique. After challenge with both thoracic duct lymphocytes and epididymal spermatozoa a specific cytolytic T cell response to the male strain histocompatibility antigens was evident on the second day and increased until the fifth day. The weight and total lymphocyte content of the nodes were significantly greater than the unimmunized control values throughout the observation period. These results provide further evidence for the expression of histocompatibility antigens by epididymal spermatozoa.

Weight and lymphocyte content of the female rat's thymus following first mating.

Eleven groups, each of ten Sprague-Dawley female rats, were sacrificed at 12 to 13 weeks of age; one group of virgins, the others at two-day intervals during the first ten days after either inbred or outbred mating. Observations were made on thymus weight, total white cell count, and thymic white cell density. Compared with the virgin group no significant differences were observed in the thymic weight at any stage after either inbred or outbred mating. In contrast the total white cell counts were significantly greater than the virgin count on the second postcoital day after both inbred and outbred mating. These increased total counts were maintained until the end of the observation period and were associated with significant increases in the thymic white cell densities. These observations suggest that mating and implantation initiate and sustain a mechanism of lymphocyte accumulation in the rat thymus.

Accumulation and proliferation of lymphocytes in the lymph nodes of the female rat following first mating.

Iliac and popliteal lymph nodes were removed from Sprague-Dawley female rats killed at 12-13 weeks of age in groups of 10 animals: one group of virgin controls and 10 groups at intervals of two days until the tenth day after either 'inbred' or outbred mating. The iliac lymph nodes on the second post-coital day after outbred mating were significantly heavier than those of virgin animals and on the fourth postcoital day were significantly heavier after outbred mating than 'inbred' mating. The total lymphocyte counts in the iliac and popliteal lymph nodes were significantly less in the virgin animals than those made on ;the second post-coital day after both 'inbred' and outbred mating. These increased counts were sustained until the tenth post-coital day and were associated with significantly increased lymphocyte cell densities in the nodes. Such lymphocyte accumulation probably results from an endogenous or exogenous hormonal stimulus. The proportions of proliferating cells in the lymphocyte population of the iliac and popliteal lymph nodes from the fourth until the tenth post-coital day were significantly greater after outbred mating than after 'inbred' mating. These observations indicate that after outbred mating the female animal mounts an immune response to the allogeneic spermatozoa and semiallogeneic products of conception within her reproductive tract.

Immune response to first mating in the female rat.

The iliac and popliteal lymph nodes were removed from 110 Sprague Dawley female rats taken from a closed colony. All were killed at age 12-13 wk in groups of 10 animals; one group of virgin controls, the others at 2-day intervals during the first 10 days of either inbred or allogeneic poregnancy. Every tenth section of the lymph nodes was stained with methyl green pyronin and counts were made of the large pyroninophilic cells in the thymus-dependent area of the cortex for evidence of T cell proliferation and the plasma cells in the medulla for evidence of B cell proliferation. After allogeneic mating significant T cell proliferation was evident in both the iliac and popliteal lymph nodes by the second post-coital day and this proliferative response was sustained until the sixth postcoital day and recurred on the tenth post-coital day. After inbred mating transient T cell proliferation was observed on the fourth post-coital day in the iliac lymph nodes. Significant B cell proliferation occurred in the iliac lymph nodes on the second day of allogeneic pregnancy and on the fourth day of inbred pregnancy, being sustained in both until the end of the observation period. These results suggest that allogeneic mating and possibly semi-allogeneic implantation induce an immune response in the female rat.