Marked lateral deviation of the phrenic nerve due to variant origin and course of the thyrocervical trunk: a cadaveric study.

Phrenic nerve impairment can often lead to serious respiratory disorders under various pathological conditions. During routine dissection of an 88-year-old Japanese male cadaver, a victim of heart failure, we recognized an extremely rare variation of the right thyrocervical trunk arising from the subclavian artery laterally to the anterior scalene muscle. In addition to that, the ipsilateral phrenic nerve was drawn and displaced remarkably laterad by this vessel. We examined all of the branches arising from subclavian arteries, phrenic nerves and diaphragm muscles. The embryological background of this arterial variation is considered. The marked displacement with prolonged strain had a potential to cause phrenic nerve impairment with an atrophic change of the diaphragm muscle. Recently many image diagnostic technologies have been developed and are often used. However, it is still possible that rare variations like this case may be overlooked and can only be recognized by intimate regional examination while keeping these rare variations in mind.

Nanobacteria-like particles in human arthritic synovial fluids.

We investigated the existence of nanosize particles in synovial fluids of rheumatoid arthritis and osteoarthritis patients. These specimens were cultured under mammalian cell culture conditions (37 degrees C; 5% CO2/95% air) for a long period. After about 2 months, many nanoparticles appeared and they gradually increased in number and in size. The nanobacteria-like particles exist in synovial fluids of arthritis patients. The possibility of their existence and pathogenesis in various diseases should be verified cautiously.

Serum YKL-40 levels in rheumatoid arthritis: correlations between clinical and laborarory parameters.

OBJECTIVE: To clarify the significance of YKL-40, also called human cartilage glycoprotein-39, in the serum of patients with RA, we studied serum YKL-40 in relation to clinical and laboratory parameters. METHODS: Seventy-two patients (16 men and 56 women) with RA and 40 age-matched healthy persons (14 men, 26 women) were included in this study. Serum levels of YKL-40, insulin-like growth factor-I (IGF-I) and interleukin-6 (IL-6) were measured by ELISA. Radiological changes reflecting joint destruction and the joint score for pain or swelling were assessed by taking into account the joint surface area. Serum CRP levels and the functional disability of patients were also determined. RESULTS: YKL-40 levels in the serum of patients with RA were significantly higher than those of controls (p < 0.0001), and showed positive correlations with serum levels of IL-6 (r = 0.301, p = 0.011) and CRP (r = 0.326, p = 0.006), but negative correlations with serum levels of IGF-I (r = -0.340, p = 0.004). The radiological score, but not joint pain, also correlated with YKL-40 levels (r = 0.364, p = 0.002). As the functional disability of patients became severe, the serum YKL levels increased. CONCLUSION: Serum YKL-40 levels partially reflect the degree of inflammation and also reflect the joint destruction in patients with RA.

Comparative study of fat-suppressed Gd-enhanced MRI of hands in the early stage of rheumatoid arthritis (RA) and non-RA.

Abstract The object of this work was to evaluate the usefulness of fat-suppressed gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) for the diagnosis of early-stage rheumatoid arthritis. Forty wrists of patients who had suffered from stiff or swollen hands for 1-12 months were examined prospectively by MRI. Rheumatoid arthritis (RA) was proven in 21 patients, and the other 19 patients were not classified as having RA. Hypertrophy of the synovial membrane and tendon sheaths were evaluated by fat-suppressed Gd-enhanced MRI, and bone erosions were also evaluated by T1-enhanced MRI. These results were compared between two groups. Seventeen of 19 patients (89.5%) in the non-RA group showed little or no synovial hypertrophy, while 17 of 21 patients (81%) in the RA group showed moderate to severe hypertrophy of the synovial membrane. Little or no tenosynovitis was found in 14 of 19 patients (73.7%) in the non-RA group, while 14 of 21 patients (66.7%) in the RA group had moderate to severe tenosynovitis. No bone erosion was found in the non-RA group, while a few bone erosions were found in 10 of 21 patients (47.6%) of the RA group. Fat-suppressed, Gd-enhanced MRI was useful in differentiating early-stage RA from non-RA when all patients had some symptoms in their hands.

Differential effects of IGF-binding proteins, IGFBP-3 and IGFBP-5, on IGF-I action and binding to cell membranes of immortalized human chondrocytes.

Insulin-like growth factor-I (IGF-I) is an important anabolic factor for cartilage tissue and its action is, in part, regulated by IGF-binding proteins (IGFBPs). The object of this study was to investigate the effects of IGFBPs on IGF-I action and on binding of IGF-I to cells using a reproducible immortalized human chondrocyte culture model. Treatment of the C-28/I2 cells with IGF-I or des(1-3)IGF-I in serum-free medium stimulated cell proliferation in a dose-dependent manner. However, the effect of des(1-3)IGF-I was more potent, thereby suggesting that endogenously produced IGFBPs inhibited IGF action. The stimulatory effect of IGF-I was inhibited significantly by addition of IGFBP-3 but enhanced slightly by IGFBP-5. However, neither IGFBP-3 nor IGFBP-5 had an effect on basal cell growth. Binding of (125)I-labeled IGF-I to the cells was displaced by both IGFBP-3 and IGFBP-5, although higher concentrations of unlabeled IGFBP-5 were required to displace IGF-I to the same extent as IGFBP-3. Treatment of the cells with IGF-I increased the levels of IGFBP-5 protein measured by Western ligand blotting, and stimulated a corresponding increase in IGFBP-5 mRNA while increasing type II collagen mRNA. Our findings indicate that the balance between IGFBP-3 and IGFBP-5 influences IGF receptor binding and its action on chondrocyte proliferation, and may thereby modulate cartilage metabolism.

Osteitis fibrosa cystica generalizata with adult T-cell leukaemia: a case report.

We report on a 62-year-old female initially suffering from extreme pain in both her lower extremities. Plain radiographs revealed multiple osteolytic lesions. Laboratory analyses indicated high levels of serum calcium and parathyroid hormone related protein (PTHrP) and detected HTLV-1 antibody. Histological examination of biopsied specimens which were obtained from osteolytic lesions indicated osteitis fibrosa cystica (OFC) without tumour cells. After the initial biopsy, a subcutaneous mass developed in the left thigh. Microsections of the biopsied mass disclosed adult T-cell leukaemia (ATL) neoplastic cells. Immunohistochemical findings revealed that PTHrP secreted from ATL neoplastic cells induced the OFC.

A new method of socket wear measurement in Charnley total hip replacement.

A new technique of wear measurement of the Charnley type socket is developed and introduced with an evaluation of its advantages and reliability. The principle in this technique is as follows: the X-ray projection angle of the radiograph taken before wear is corrected by some calculations on the basis of the second radiograph taken after wear has occurred. Then, on the identical X-Y coordinate axes made on these films, the shift of the femoral head's center (that is the wear vector) reveals the amount and direction of socket wear. When experimental wear of a socket was measured with this technique, the amount of wear was found accurate independent of varying socket fixating angle or irradiating direction. This technique has certain problems including technical complexity and the need for a new radiograph. However, it is useful clinically, because two-dimensional evaluation of socket wear both in amount and direction is possible.