Diagnostic arthroscopy in the treatment of minimally displaced lateral humeral condyle fractures in children.

INTRODUCTION: In minimally displaced pediatric lateral humeral condyle fractures, plain radiography cannot be used for accurate differential diagnosis of the cartilage lesion, and other imaging methods have demerits in their accuracy and their accessibility. The purpose of this study was to investigate the usefulness of arthroscopy to diagnose cartilage displacement in minimally displaced fractures. MATERIALS AND METHODS: Nine children with minimally displaced lateral humeral condyle fractures, an average of 6.6 years old, underwent combined arthroscopy and fixation surgery. Percutaneous fixation was performed with nondisplaced articular surface according to the arthroscopic findings, while in case of displaced fracture under arthroscopy, open fixation was preferred. The difference between the arthroscopic and radiographic findings was investigated. RESULTS: Articular surface could be arthroscopically visualized in all patients. Under arthroscopy, cartilage hinges were maintained in seven cases and disrupted in two. Nondisplaced cartilage disruption was noted in one of these two cases, and percutaneous fixation was performed. A displaced articular surface was noted in the other one, where the patient underwent open surgery. At the last follow-up, an average of 14.7 months postoperatively, union and wide range of motion had been achieved without any complications. CONCLUSION: Diagnosis of fracture displacement by merely using plain radiography was considered to be insufficient for minimally displaced cases. Diagnostic arthroscopy aided in the appropriate selection of either a percutaneous or open fixation method. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed.

There is no clear consensus about the best management of intra-articular distal ulnar fractures associated with distal radial fractures in older adults. We describe a treatment wherein the distal radial fractures were securely fixed with a palmar plate, leaving the associated ulnar fractures unfixed. The wrists of 14 patients with a mean age of 74 years were reviewed at an average of 18 months after surgery. The results were excellent in 11 cases and good in three, according to the modified Gartland and Werley score. All fracture sites displayed union, and there was no instability of the distal radioulnar joint. A widening of the distal radioulnar joint space was present in one wrist. Angular deformity of the distal ulnar metaphysis was seen in five wrists. This treatment could be an alternative to open reduction with internal fixation for intra-articular distal ulnar fractures in older adults.

Tumorous calcification causing carpal tunnel syndrome.

PURPOSE: There is little information on solitary tumorous calcification causing carpal tunnel syndrome in the literature. This study describes our experience with surgically treated cases of solitary tumorous calcification causing carpal tunnel syndrome. METHODS: Seven patients with symptomatic carpal tunnel syndrome who had tumorous calcification in the carpal tunnel confirmed by radiographical examinations and had then undergone open incisional carpal tunnel release were reviewed. The precise location and the appearance of the calcified mass were confirmed with the preoperative radiographic examinations and the operative records. The additional histology and the composition analysis of the calcified mass were also reviewed in five removed calcifications. RESULTS: Radiographs of each hand revealed a mass of calcification lying anterior to the capitate bone in the carpal tunnel. Intraoperatively, an oval calcified nodule, measuring 10 x 10 x 10 - 18 mm, was observed overlying the capitate, attached firmly to the palmar radiocarpal extrinsic ligament. A composition with an average of 60 % basic calcium phosphate was revealed by infrared absorption spectrometry. Histological sections showed a calcified deposit surrounded by fibrocartilagenous tissue in three cases. CONCLUSION: These facts suggest that the pathogenesis of tumorous calcification causing carpal tunnel syndrome is comparable with that of calcifying tendinitis of the rotator cuff in which a cell-mediated reactive process plays an important role at the tendon insertion.

The attentional modulation of the flash-lag effect.

If a dot is flashed in perfect alignment with a pair of dots rotating around the visual fixation point, most observers perceive the rotating dots as being ahead of the flashing dot (flash-lag effect). This perceptual effect has been interpreted to result from the perceptual extrapolation of the moving dots, the differential visual latencies between flashing and moving stimuli, as well as the modulation of attentional mechanisms. Here we attempted to uncouple the attentional effects brought about by the spatial predictability of the flashing dot from the sensory effects dependent on its visual eccentricity. The stimulus was a pair of dots rotating clockwise around the fixation point. Another dot was flashed at either the upper right or the lower left of the visual field according to three separate blocked situations: fixed, alternate and random positions. Twenty-four participants had to judge, in all three situations, the location of the rotating dots in relation to the imaginary line connecting the flashing dot and the fixation point at the moment the dot was flashed. The flash-lag effect was observed in all three situations, and a clear influence of the spatial predictability of the flashing dot on the magnitude of the perceptual phenomenon was revealed, independently of sensory effects related to the eccentricity of the stimulus in the visual field. These findings are consistent with our proposal that, in addition to sensory factors, the attentional set modulates the magnitude of the differential latencies that give rise to the flash-lag phenomenon.

The attentional modulation of the flash-lag effect

If a dot is flashed in perfect alignment with a pair of dots rotating around the visual fixation point, most observers perceive the rotating dots as being ahead of the flashing dot (flash-lag effect). This perceptual effect has been interpreted to result from the perceptual extrapolation of the moving dots, the differential visual latencies between flashing and moving stimuli, as well as the modulation of attentional mechanisms. Here we attempted to uncouple the attentional effects brought about by the spatial predictability of the flashing dot from the sensory effects dependent on its visual eccentricity. The stimulus was a pair of dots rotating clockwise around the fixation point. Another dot was flashed at either the upper right or the lower left of the visual field according to three separate blocked situations: fixed, alternate and random positions. Twenty-four participants had to judge, in all three situations, the location of the rotating dots in relation to the imaginary line connecting the flashing dot and the fixation point at the moment the dot was flashed. The flash-lag effect was observed in all three situations, and a clear influence of the spatial predictability of the flashing dot on the magnitude of the perceptual phenomenon was revealed, independently of sensory effects related to the eccentricity of the stimulus in the visual field. These findings are consistent with our proposal that, in addition to sensory factors, the attentional set modulates the magnitude of the differential latencies that give rise to the flash-lag phenomenon

[A case of pulmonary eosinophilic granuloma with extrapulmonary involvement treated effectively with steroid hormone].

A 21-year-old female was admitted to Tamono City Hospital with chief complaint of dyspnea due to spontaneous pneumothorax. The patient was transferred to our clinic for further examination of abnormal chest X-ray findings together with skin lesions and other symptoms of polyuria, amenorrhea and narrowed visual fields. Histochemical and electron microscopic examination of lung tissue obtained by open lung biopsy led to the diagnosis of eosinophilic granuloma. Furthermore, enhanced computed tomography and magnetic resonance images showed the existence of an intracranial tumor in the supra-hypophyseal region which was interpreted as the cause of hormonal and visual disturbances. Because of dyspnea and enlargement of intracranial tumor, treatment with steroid hormone was commerced followed by tapering of the dose. Chest X-ray findings and skin lesions improved markedly and the intracranial tumor regressed significantly with this steroid therapy, indicating that the intracranial tumor represented involvement with eosinophilic granuloma.

[Studies on the T-cell subset in lung tissue and BALF from patients with interstitial pneumonia].

The cellular components in bronchoalveolar lavage fluids (BALF) have been analyzed to obtain information on cellular kinetics in lung tissues of patients with diffuse pulmonary diseases. While various cells, alveolar macrophages, lymphocytes, and granulocytes appear in BALF, an increase in the percentage of lymphocytes has been noted in a variety of interstitial pneumonia. The T-cell subset of lymphocytes in BALF and biopsied lung tissues was, therefore, examined in patients with hypersensitivity pneumonitis (HP), sarcoidosis (Sar), idiopathic interstitial pneumonia (IIP) and rheumatoid arthritis with interstitial pneumonia (RA+IP) to compare the ratios of CD4/CD8 in BALF and lung tissues. The T-cell subset in BALF was analyzed by flow cytometry and the T-cell subset in lung tissues was detected with fresh frozen and thin-sliced specimens using an avidine-biotin complex (ABC) kit (Vecta Co. Ltd). The mean CD4/CD8 ratio in BALF was 0.36 in HP, 3.1 in Sar, 1.07 in IIP and 2.59 in RA+IP, while the mean CD4/CD8 ratio in lung tissues was 0.52 in HP, 2.59 in Sar, 1.11 in IIP and 2.25 in RA+IP, respectively. The ratios of CD4/CD8 in BALF and lung tissues from patients with these various interstitial pneumonia showed a positive correlation indicating that the changes of cellular components in BALF would reflect the changes in the lung tissues. Furthermore, CD4/CD8 ratios of lymphocytes infiltrating the alveolar portion and granuloma in lung tissues of HP were analyzed separately, because the CD4/CD8 ratios varied considerably from part to part of the lung tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

[The significance of soluble IL-2 receptors in rheumatoid arthritis with interstitial pneumonia].

Interstitial pneumonia is well known as one of the complications of rheumatoid arthritis (RA). While interleukin-2 (IL-2) regulates the immune response through IL-2 receptor (IL-2R), the exact role of the soluble form of IL-2R (sIL-2R), recognized as a part of the alpha chain or IL-2R, is still obscure. So, the immunological significance of sIL-2R in serum and in bronchoalveolar lavage fluid (BALF) of those of RA patients with or without interstitial pneumonia was studied. The sIL-2R was measured with an ELISA kit (T-Cell Science Ltd). The levels of sIL-2R in the sera of RA patients without interstitial pneumonia were significantly higher than those of normal controls. Furthermore, the levels of sIL-2R showed a statistically significant correlation with ESR and Lansbary's index. The levels of sIL-2R of RA patients with interstitial pneumonia were higher than in those without interstitial pneumonia although the evaluation of class and stage of arthritis in those RA patients with or without interstitial pneumonia revealed no significant difference. A high sIL-2R/albumin ratio in BALF of RA patients with interstitial pneumonia was shown in comparison with those of normal control. These data indicate that the estimation of sIL-2R in RA patients could be useful in estimating the disease activity and that high levels of sIL-2R reflect the active immune response in the lungs of RA patients with interstitial pneumonia.

[The cellular kinetics in BAL fluid of hypersensitivity pneumonitis and pulmonary function].

The cellular components of bronchoalveolar lavage (BAL) fluid of patients with hypersensitivity pneumonitis were analyzed in regard to the inhalation period of antigen in the environment before BAL procedure. BAL fluid in early phase of antigen inhalation contained increased percent of neutrophils as well as lymphocytes while low percent of neutrophils and prominent increase of lymphocytes in chronic antigen inhalation. Furthermore, the increased neutrophils in BAL fluid decreased rapidly after admission as cessation of antigen inhalation while the lymphocyte percent decreased gradually. In relation to respiratory function the lymphocyte percent showed statistically significant negative correlation with %TLC, %VC and %DLco. On the other hand the percent of neutrophils showed some relationship with the airway damage and inflammatory changes in early phase of this disease.

Increased neuropeptide Y concentrations in cerebrospinal fluid from patients with aneurysmal subarachnoid hemorrhage.

We investigated the possible relation between neuropeptides and cerebral vasoconstriction in samples of ventricular or cisternal cerebrospinal fluid from 14 patients with subarachnoid hemorrhage. Neuropeptide Y, calcitonin gene-related peptide, atrial natriuretic peptide, and pituitary polypeptide 7B2 were present in the cerebrospinal fluid of these patients. Concentrations of calcitonin gene-related peptide and 7B2 were not significantly different from those in control subjects, but that of atrial natriuretic peptide was significantly lower. Although the mean concentration of neuropeptide Y was not significantly higher than control, consecutive determinations showed an increase 6-11 days after the onset of subarachnoid hemorrhage. An initially high 7B2 concentration decreased gradually, although half the patients showed a second increase greater than 10 days after the onset. Considering the well-recognized vasoconstrictive effect of neuropeptide Y, it is possible that this increase in its concentration in the cerebrospinal fluid plays a role in the pathogenesis of the cerebral vasospasm that is often seen after subarachnoid hemorrhage.

Pituitary protein 7B2-like immunoreactivity in cerebrospinal fluid: comparison with other neuropeptides.

A pituitary protein, designated 7B2, was demonstrated to be present in the cerebrospinal fluid (CSF) obtained from control subjects and patients with various cerebrovascular accidents (CVAs). Although there was not any significant difference in mean immunoreactive 7B2 concentrations among various CVA groups, the CSF immunoreactive 7B2 levels in control subjects were 10 to 100 times higher than those in control plasma samples. Immunoreactive calcitonin gene-related peptide (CGRP) and immunoreactive atrial natriuretic peptide (ANP) levels in the CSF were comparable to those in corresponding normal plasma samples. The CSF ANP concentrations in patients with cerebral bleeding and subarachnoid hemorrhage were significantly lower than those in control subjects. Gel chromatography or high-performance liquid chromatography indicated that the main immunoreactivities of 7B2, CGRP, and ANP coeluted with corresponding standard material. The high CSF concentrations of immunoreactive 7B2 observed might indicate a functional role of 7B2 in the central nervous system.

[The role of drugs and lymphocytes in granulocyte-macrophage colony formation in patients with drug induced agranulocytosis].

The in vitro effects of the causative drugs and lymphocytes from the patients with agranulocytosis were tested against granulocyte-macrophage colony formation (CFU-C) of bone marrow cells from normal individuals and the patients in recovery stage. A semisolid culture system was used for CFU-C assay. The drug concentrations were adjusted to the therapeutic levels in sera, and the lymphocytes were obtained from the patient's peripheral blood. Three patients with agranulocytosis and one patient with pancytopenia caused by disopyramide, methimazole, sodium valproate, and Towasaal, respectively, were examined. Each of the four drugs except disopyramide suppressed the CFU-C of normal and patient's bone marrow cells in a dose-dependent manner. When the patient's bone marrow cells were cultured with respective drugs and their own lymphocytes or with the culture supernatant of the drug and lymphocytes, CFU-C suppressions was significantly augmented. Phenacetin, an agent of Towasaal, significantly suppressed CFU-C and also CFU-E. These results indicate that humoral factor(s) produced from patient's lymphocytes by reacting with the drugs may function as an immunological mechanism in the patients with drug-induced agranulocytosis.

Giant cell tumor of the skull.

A 23 year-old female had a giant cell tumor originating in the right temporal bone. A diagnosis was maed by biopsy. Microscopically it was sarcomatous in part. Two courses of radiation therapy, each total dose being 6000 rads and 3000 rads in air, were employed with good subjective response for a short duration. However, the tumor involving the petrous bone and the mastoid process extended, invading the epipharynx and the clivus. The patient died one year after onset.