PRES with asymptomatic spinal cord involvement. Is this scenario more common than we know?

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by neurologic symptoms such as headaches, altered mental status, seizures and visual changes, and it is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain. CASE REPORT: A 19-year-old patient developed PRES after the use of chemotherapy for a testicular teratocarcinoma and after the development of a blood pressure elevation. DISCUSSION: Few cases described the involvement of the spinal cord in this syndrome. In the majority of these cases, the spinal cord involvement was asymptomatic or with few symptoms of spinal cord disease.

The watershed labral lesion: its relationship to early arthritis of the hip.

This study examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were performed by the senior author (J.C.M.). In addition, 54 acetabula were harvested from human adult cadavers and 10 hips underwent microangiography to determine labral blood supply. Of the 436 arthroscopic patients, 241 (55.3%) had a total of 261 labral tears, all located at the articular, not capsular, margin of the labrum. Stereomicroscopic examination of the 54 cadaver acetabula revealed a total of 52 labral lesions. Overall, there was no significant difference between the arthroscopic and cadaver populations in terms of the incidence of labral tears (P=.315). There was a high association between labral lesions and adjacent acetabular chondral damage. Arthroscopic and anatomic observations support the concept that labral disruption and degenerative joint disease frequently are part of a continuum of joint pathology.

Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN) study.

BACKGROUND: Type 2 diabetes is a cardiovascular risk factor. It remains to be elucidated in a large, population-based sample whether diabetes is associated with changes in left ventricular (LV) structure and systolic function independent of obesity and systolic blood pressure (BP). METHODS AND RESULTS: Among 1950 hypertensive participants in the HyperGEN Study without overt coronary heart disease or significant valve disease, 20% (n=386) had diabetes. Diabetics were more likely to be women, black, older, and have higher BMI and waist/hip ratio than were nondiabetics. After adjustment for age and sex, diabetics had higher systolic BP, pulse pressure, and heart rate; lower diastolic BP; and longer duration of hypertension than nondiabetics. LV mass and relative wall thickness were higher in diabetic than nondiabetic subjects independent of covariates. Compared with nondiabetic hypertensives, diabetics had lower stress-corrected midwall shortening, independent of covariates, without difference in LV EF. Insulin levels and insulin resistance were higher in non-insulin-treated diabetics (n=195) than nondiabetic (n=1439) subjects (both P:<0.01). Insulin resistance positively but weakly related to LV mass and relative wall thickness. CONCLUSIONS: In a relatively healthy, population-based sample of hypertensive adults, type 2 diabetes was associated with higher LV mass, more concentric LV geometry, and lower myocardial function, independent of age, sex, body size, and arterial BP. structural and functional abnormalities in addition to, and independent of, atherosclerosis.(13) (14) In the Framingham cohort, diabetes was associated with higher LV mass in women but not men.(15) High blood pressure (BP), obesity, and abnormal lipid profile, which often coexist with diabetes, tend to be associated with preclinical cardiovascular abnormalities(16) and may contribute to the association of diabetes with cardiovascular events. Cardiac features of diabetic and nondiabetic hypertensive subjects remain incompletely described in population-based samples. Therefore, we compared clinical and metabolic characteristics, LV geometry, and systolic function between diabetic and nondiabetic hypertensive participants in the Hypertension Genetic Epidemiology Network (HyperGEN) Study.

The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease.

The current authors examined the hypothesis that labral lesions contribute to early degenerative hip disease. Between 1993 and 1999, 436 consecutive hip arthroscopies were done by the senior author. In addition, 54 acetabula were harvested from human adult cadavers. Two hundred forty-one of the 436 (55.3%) patients who had arthroscopies had a 261 labral tears, all located at the articular, not capsular margin of the labrum. Stereomicroscopic examination of the 54 acetabula from cadavers revealed 52 labral lesions. Overall, there was no significant difference between the arthroscopic and cadaveric populations in terms of the incidence of labral tears. (Overall, 73% of patients with fraying or a tear of the labrum had chondral change. Arthroscopic and anatomic observations support the concept that labral disruption and degenerative joint disease are frequently part of a continuum of joint disease.

Spin-cast planarization of liquid-crystal-on-silicon microdisplays.

A simplified method for planarizing liquid-crystal-on-silicon (LCOS) backplanes is presented. The method relies on the planarizing capability of spin-cast benzocyclobutene (BCB) polymeric resin. BCB planarization shows a sixfold reduction in step height on the surface of a typical LCOS backplane. Contact with the underlying pixel circuitry is made by dry etching through openings in the BCB layer. Reflective metal (87% reflectivity) is deposited over the planarized surface and patterned to form high-aperture-ratio pixel mirrors (84%). An average resistance of 0.75 Omega per via was achieved with 3.6-microm-diameter vias in 2-microm-thick BCB. The method and the results of this LCOS backplane planarization and postprocessing are described.

Development of equal-interval task rating scales and task conflict matrices as predictors of attentional demand.

The use of a multidimensional metric for the subjective evaluation and prediction of workload has been proposed by a number of researchers, including McCracken and Aldrich (1984) in their attentional demand methodology. This model appears well suited for the prediction, using network simulation, of levels of attentional demand and of task conflicts placed upon operators. This paper examines the development of multidimensional task rating scales and task conflict matrices and introduces a new process of development of these workload prediction tools. It also presents two studies in which the method is applied, and the resulting equal-interval rating scales and task conflict matrices. These studies indicate that while these tools may be useful within a specific operational environment, their utility as a general purpose predictor of workload is questionable.

Intrathoracic and subconjunctival petechiae in sudden infant death syndrome (SIDS).

The frequency and density of intrathoracic and subconjunctival petechiae was studied in 250 cases of SIDS and 69 controls. The control group included 37 infants with natural and 32 infants with traumatic causes of death. Intrathoracic petechiae were found significantly more frequently in the SIDS group (91.2% SIDS; 42% controls; p < 0.001) and were present at a higher density (p < 0.001). Subepicardial and thymic petechiae were detected at high density in older SIDS infants. Subconjunctival petechiae were low in density and found only in 2.4% of the SIDS group but they were detected in 8.1% of the natural death group and 21.9% (p < 0.05) of the lethal trauma group. Subconjunctival petechiae were found at highest density in strangulation. Intrathoracic petechiae are commonly found in SIDS but are not specific for SIDS. Subconjunctival petechiae are typical but not specific for strangulation. In SIDS, subconjunctival petechiae are rare and appear at low density.

The use of auditory feedback in the design of touch-input devices.

In workspaces with complex displays and controls, and limited space in which to mount them, the use of touchscreen displays as input devices offers significant advantages. To overcome the lack of tactile feedback on touchscreen input devices, auditory feedback has been suggested. This paper examines the results of an experiment looking at the effect of auditory feedback on typing performance. While error rates were not affected by the feedback, the addition of auditory feedback to a typing task did improve typing speeds under all tested conditions. This indicates that the addition of auditory feedback to touchscreen input devices provides a measurable benefit and should be considered, where possible.

MR imaging related to p.m. findings in angiodysgenetic myelomalacia. A case report.

In a 65-year-old patient with slowly progressive myelopathy of the lower spinal cord MRI revealed slight thickening of the conus medullaris and discrete serpiginous areas of low signal intensity in contact to the surface of the myelon. The T2-weighted axial images demonstrated a zone of high signal intensity within the center of the lumbosacral cord. These findings corresponded to the results of autopsy: cord enlargement, dilatation of wall thickened and partially thrombosed pial veins, edema, damage of the myelin sheath with development of foam cells, areas of hemorrhage and necrosis. Although myelography and spinal digital subtraction angiography had been normal in this case we assume that perhaps a spinal dural av-fistula may have been the cause of MR- and pathological findings which indicate an angiodysgenetic myelomalacia (Morbus Foix-Alajouanine). The pathogenesis of spinal dural av-fistulas is discussed in order to explain why angiography has been negative.

Regulation of autoimmune anti-platelet antibody-mediated adhesion of monocytes to platelet GPIIb/GPIIIa: effect of armed monocytes and the Mac-1 receptor.

Platelet autoantigen-autoantibody-monocyte interaction was studied by utilization of a specific monoclonal antibody (MoAb) 10E5 to trap and immobilize the GPIIb-GPIIIa complex on microtiter plates. Peripheral blood mononuclear cells (PBMC) or purified monocytes formed distinct morphologic clusters after incubation with immobilized antigen for 18 hours at 37 degrees C. PBMC of 18 and 19 patients with autoimmune thrombocytopenic purpura (ATP) formed 48 +/- 6.8 (SEM) clusters/well compared with 7.4 +/- 1.0 for control subjects, P less than .001. The number of clusters per well correlated inversely and exponentially with platelet count, r = -.8, n = 21, indicating that the GPIIb-GPIIIa autoantigen is pathophysiologically relevant. Binding of ATP PBMC to immobilized GPIIb-GPIIIa could be inhibited by F(ab')2 fragments of immunoglobulin (Ig) G of ATP patients, indicating that monocyte IgG bound to autoantigen by its F(ab')2 domain. Optimal cluster formation could be obtained with normal monocytes if preincubated with ATP IgG but not with F(ab')2 fragments of ATP IgG, indicating that ATP IgG binds to monocytes by its Fc domain. Armed monocytes (ie, normal monocytes preincubated with ATP IgG) bound to immobilized autoantigen 5.8-fold greater than normal monocytes incubated with immobilized autoantigen opsonized with ATP IgG. Armed monocyte adhesion could be inhibited 81% from 18.9 +/- 1.6 to 3.6 +/- 0.5 clusters/well by prior fixation with 0.1% formalin, whereas fixation of IgG before arming of monocytes was not inhibitory. MoAb MM41, directed against the alpha m-chain of the Mac-1 adhesive protein receptor of monocytes, inhibited cluster formation by 79%. Thus, (1) armed monocyte interaction with autoantigen is considerably more effective than monocyte interaction with opsonized autoantigen; (2) armed monocyte interaction requires specific F(ab')2-antigen recognition; and (3) monocyte-autoantigen interaction requires a secondary nonimmunologic adhesive event.

[Symptomatic aneurysms of the abdominal aorta]. / Symptomatická aneurysmata brisní aorty.

In the years 1981-1985 21 patients were operated upon for symptomatic abdominal aortic aneurysms. Atypical symptoms such as acute pancreatitis, weight loss, blood in the stool or urine, incorrect interpretation of abdominal pain and physical examination findings caused erroneous initial diagnosis and delay in referring the patient to surgical treatment in nine cases. Long history prior to admission was noted even in patients with ruptured aneurysms; mortality in these patients was high, 66%. Best results were achieved with aneurysm resection; indirect aneurysm occlusion in combination with axillofemoral bypass attempted in two patients was not successful.

[Detection of saliva traces using test strips]. / Nachweis von Speichelspuren Mittels Teststreifen.

The test strip Rapignost-Amylase (Behring) for the rapid determination of alpha-amylase in the urine is also suitable for the determination of salivary amylase in stains stored up to 6 weeks at room temperature. The stains are extracted with physiological saline (extraction time 30 min), then the application zone of the strip is wetted with the extract. Positive amylase-reaction is recognised as a reddish-violet colouration of the reaction zone. Biological stains with low amylase concentrations (urine semen, vaginal secretion, mucus) react amylase negative. The method is uncomplicated and can be completed within 30 min. The test strips are easily available and stable during storage. Therefore the determination of saliva with test strips should be preferred to the clinical methods if the storage times of the stain are not longer than 4-6 weeks. It is a suitable procedure to determine salivary stains for use in forensic biology.