Bubble Coalescence at Wormlike Micellar Solution-Air Interfaces.

Surfactants in aqueous solutions self-assemble in the presence of salt, to form long, flexible, wormlike micelles (WLM). WLM solutions exhibit viscoelastic properties and are used in many applications, such as for cosmetic products, drag reduction, and hydraulic fracturing. Understanding the coalescence stability of bubbles in WLM solutions is important for the development of WLM based products that require a stable dispersion of bubbles. In this paper, we investigate the thin film drainage dynamics leading up to the coalescence of bubbles at flat WLM solution-air interfaces. The salts and surfactant type and concentrations were chosen so as to have the viscoelastic properties of the tested WLM solutions span over 2 orders of magnitude in moduli and relaxation times. The various stages in drainage and coalescence, the formation of a thick region at the apex (a dimple), the thinning and washout of this dimple, and the final stages of drainage before rupture, are modified by the viscoelasticity of the wormlike micellar solutions. As a result of the unique viscoelastic properties of the WLM solutions, we also observe a number of interesting fluid dynamic phenomena during the drainage processes including elastic recoil, thin film ripping, and single-step terminal drainage.

Perineal hypospadias: back to the future Chordee Excision & Distal Urethroplasty.

PURPOSE: Perineal hypospadias correction has swung from two-stage repair in the 1960s to one-stage repair in the 1980s and back to two-stage repair in the 2000s. The author's experience with a technique in which Chordee Excision and Distal Urethroplasty (CEDU) was performed at the first operation leaving a 1-cm segment as perineal urethrotomy to be reconstructed at the second operation is presented. PATIENTS AND METHODS: Between January 2013 and December 2016, the CEDU technique was performed in 63 patients with perineal hypospadias. The records of 59 patients who maintained regular follow-up were reviewed. The principle is to excise the hypoplastic urethral plate, atretic corpus spongiosum, and longitudinal layer of tunica albuginea; split the glans in the midline; and reconstruct a healthy urethral plate using preputial and lateral skin flaps to the tip of the glans. Distal urethroplasty was performed leaving 1 cm at the proximal end to be reconstructed 3-6 months later. This principle was used by Duplay in the 1880s. Patient age ranged between 6 months and 2 years (mean 8 months). All the patients had perineal hypospadias and bifid scrotum with severe deep chordee. Follow-up period ranged from 17 to 53 months (mean 36). A transurethral Silastic catheter was inserted for 4 days. Three months later, the remaining 1 cm of the new urethra was reconstructed, and final adjustment of the glans and foreskin was performed. RESULTS: Satisfactory results were obtained in 54 patients (90%). Three children experienced glans dehiscence that was corrected in the second stage, one child developed fistula after the second operation, and one developed diverticulum. The fistula and diverticulum were corrected at the third operation successfully. DISCUSSION: It was necessary in this series to divide the urethral plate and excise the hypoplastic corpus spongiosum and the outer longitudinal layer of tunica albuginea to correct the associated deep chordee. The lateral skin flaps receive double blood supply from the base of the penis and the preputial vessels. This natural urinary diversion allows early removal of the catheter, reduces the discomfort of the patient, and allows the new urethra to heal without urine irritation for 3 months. Long-term follow-up for 15 years is necessary to assess the technique objectively. CONCLUSIONS: The CEDU technique diverts urine away from the site of urethroplasty for 3 months without a catheter. It reduces the hospital stay and patient discomfort. It produces satisfactory results and has become a the standard technique in perineal hypospadias.

NORMALIZATION OF SERUM VITAMIN D IMPROVES SEMEN MOTILITY PARAMETERS IN PATIENTS WITH IDIOPATHIC MALE INFERTILITY.

CONTEXT: Idiopathic male infertility is evident in half of infertile males. Vitamin D receptors are expressed throughout male reproductive tract, including spermatozoa, promoting motility. Epidemiological studies revealed the positive association between serum vitamin D and semen quality. However, there are no clinical studies examining the differential role of vitamin D in idiopathic male infertility. OBJECTIVES: 1) To investigate the association between vitamin D deficiency and idiopathic male infertility, and 2) To determine whether vitamin D deficient males would show restoration of semen quality parameters upon supplementation with vitamin D. DESIGN: This was a year-long case-control study from November 2015 to November 2016. A therapeutic intervention cohort for 2 months was also performed. SUBJECTS AND METHODS: 117 Jordanian males were enrolled. Following a clinical evaluation by a urologist, baseline serum vitamin D and semen fluid analyses were collected. Participants were stratified into 3 groups: controls (n=30), idiopathic infertility (n=67), and secondary infertility (n=20). Idiopathic infertility patients with low vitamin D (n= 45) were supplemented with oral vitamin D, 5000 IU, once daily for two months. Thereafter, serum vitamin D and semen fluid analyses were reassessed (n= 34; 11 patients were lost to follow up). RESULTS: Vitamin D was significantly lower in patients with idiopathic infertility than in both controls and men with secondary infertility. Significant improvement of progressive and total sperm motility was observed after vitamin D treatment. Vitamin D correlated significantly with semen quality in the study population. However, no correlation was found between vitamin D and any of the semen quality parameters in the idiopathic infertility group. CONCLUSIONS: Vitamin D supplementation improves sperm motility in idiopathic male infertility patients with low vitamin D. Larger and longer clinical trials are warranted to validate the use of vitamin D in these cases.

Identification of an AR Mutation-Negative Class of Androgen Insensitivity by Determining Endogenous AR Activity.

CONTEXT: Only approximately 85% of patients with a clinical diagnosis complete androgen insensitivity syndrome and less than 30% with partial androgen insensitivity syndrome can be explained by inactivating mutations in the androgen receptor (AR) gene. OBJECTIVE: The objective of the study was to clarify this discrepancy by in vitro determination of AR transcriptional activity in individuals with disorders of sex development (DSD) and male controls. DESIGN: Quantification of DHT-dependent transcriptional induction of the AR target gene apolipoprotein D (APOD) in cultured genital fibroblasts (GFs) (APOD assay) and next-generation sequencing of the complete coding and noncoding AR locus. SETTING: The study was conducted at a university hospital endocrine research laboratory. PATIENTS: GFs from 169 individuals were studied encompassing control males (n = 68), molecular defined DSD other than androgen insensitivity syndrome (AIS; n = 18), AR mutation-positive AIS (n = 37), and previously undiagnosed DSD including patients with a clinical suspicion of AIS (n = 46). INTERVENTION(S): There were no interventions. MAIN OUTCOME MEASURE(S): DHT-dependent APOD expression in cultured GF and AR mutation status in 169 individuals was measured. RESULTS: The APOD assay clearly separated control individuals (healthy males and molecular defined DSD patients other than AIS) from genetically proven AIS (cutoff < 2.3-fold APOD-induction; 100% sensitivity, 93.3% specificity, P < .0001). Of 46 DSD individuals with no AR mutation, 17 (37%) fell below the cutoff, indicating disrupted androgen signaling. CONCLUSIONS: AR mutation-positive AIS can be reliably identified by the APOD assay. Its combination with next-generation sequencing of the AR locus uncovered an AR mutation-negative, new class of androgen resistance, which we propose to name AIS type II. Our data support the existence of cellular components outside the AR affecting androgen signaling during sexual differentiation with high clinical relevance.

Long term predictors of success after laparoscopic sleeve gastrectomy.

BACKGROUND: To evaluate early, mid and long term efficacy of laparoscopic sleeve gastrectomy as a definitive management of morbid obesity and to study factors that may predict its success. MATERIALS AND METHODS: A retrospective study was conducted by reviewing the database of patients who underwent LSG as a definitive bariatric procedure, from April 2005 to March 2013. Univariate and multivariate analysis were performed. RESULTS: 1395 patients were included in this study. Mean age was 33 years and women:men ratio was 74:26. The mean preoperative BMI was 46 kg/m(2). Operative time was 113 ± 29 min. Reinforcement of staple line was done only in 447 (32%) cases. 11 (0.79%) cases developed postoperative leak, with total number of complications 72 (5.1%) and 0% mortality. Percentage of excess weight loss (%EWL) was 42%, 53%, 61%, 73%, 67%, 61%, 59% and 57% at 6 months, 1-7 years. Remission of diabetes (DM), hypertension (HTN) and hyperlipidaemia (HLP) occurred 69%, 54% and 43% respectively. 56 (4%) patients underwent revision surgery, for insufficient weight loss (n = 37) and severe reflux symptoms (n = 19). Mean follow up was 76 ± 19 (range: 6-103) months. Smaller bougie size and leaving smaller antrum were associated with significant %EWL. Bougie ≤36F remained significant in multivariate analysis. CONCLUSION: This study supports safety, effectiveness and durability of LSG as a sole definitive bariatric procedure. Smaller bougie size and shorter distance from pylorus were associated with significant %EWL.

Central mucoepidermoid carcinoma in a previously enucleated radiolucent lesion in the mandible. A case report.

Central muco epidermoid carcinomas (CMC) are rare tumours, representing about 2 to 3% of all mucoepidermoid carcinomas. Usually affecting the mandible, they appear as uni- or multilocular radiolucent lesions. We report a case of CMC in a 52-year-old Middle Eastern woman who presented with pain, limitation of jaw movement and tingling sensation of the tongue, related to a radiolucent lesion in the angle of the mandible. The lesion was first detected but not diagnosed in another hospital three years earlier. We describe the progression of the lesion over the past three years and describe the clinical, radiographic, histopathological, and surgical aspects of the case.

Long oesophageal gaps - a new surgical technique: an experimental study on lambs.

AIM: The management of long gap oesophageal atresia remains a major challenge for the paediatric surgeon. In this experimental study on neonatal lambs, a Silastic tube was used to bridge a gap in the oesophagus. The Silastic tube was not fixed to the oesophageal edges but half a centimetre from the edge of the oesophagus. The oesophageal edges were left free to grow over the Silastic tube and bridge the gap. The aim of the study was to see whether the oesophageal edges would grow over the Silastic tube and form a continuous oesophagus. METHODS: Twelve neonatal lambs were included in the study. They were divided into 3 groups: Group A (control group) included 3 lambs where the oesophagus was transacted and anastomosed without excision of an oesophageal segment. Group B included 6 lambs where a wedge of the oesophagus was excised and a Silastic tube fixed to the inner mucosa. The oesophageal edges were in contact on one side. In group C (3 lambs), a 2-cm cylinder of the oesophagus was excised, a Silastic tube was fixed to the inner mucosa and a gap of 2 cm was left between the oesophageal edges. The lambs were sacrificed at two weeks to five weeks postoperatively. RESULTS: There was no mortality, no anastomotic leakage and no wound infection in any of the lambs. The oesphageal edges grew and bridged the gap and formed a continuous tube. Histological examination showed new muscle fibres underneath the new mucosa. All lambs with Silastic tubes gained weight. Two lambs developed moderate to severe stricture. CONCLUSION: The present study demonstrated the possibility of oesophageal growth over a Silastic tube to form a continuous oesophagus. Histological examination confirmed oesophageal growth and not healing through fibrous tissue. Further studies are needed to evaluate the technique in the thoracic oesophagus with long-term follow-up.

An external device for faecal incontinence.

AIM: The aim of the study was to describe a simple external device that enables the incontinent patient to control the time, frequency and place of defecation. PRINCIPLE: The device is based on the principle of a "ball & socket" valve. The "ball" is an inflatable silastic balloon while the "socket" is the anorectal junction. The device can be used with minor modifications in patients with terminal colostomy to make them continent and avoid the need for colostomy bags. PATIENTS AND METHODS: The inflatable plug has been used successfully in eighteen incontinent children for a period ranging from six months to 8 years. The child decides the amount of air inside the inflatable plug that is comfortable and yet adequate to prevent soiling. This usually ranged between 10 to 25 cm of air. RESULTS AND COMPLICATIONS: To date, the device has been manufactured manually. All the children tolerated the plug without discomfort. Deflation of the balloon occurred after 3 - 5 days of use due to defective manufacturing. None of the patients developed ischaemia of the bowel or skin excoriations. CONCLUSION: This conservative, simple, inflatable plug enhances both qualitative and quantitative faecal continence in children with faecal soiling. An improvement in quality of life was also perceived by the patients and their parents. Better manufacturing may improve the results.

A technique to improve vascularity in colon replacement of the esophagus.

OBJECTIVE: The aim of this study was to present a simple method to improve the results of colon replacement of the esophagus in children with post-corrosive esophageal stricture or long gap esophageal atresia. TECHNIQUE: At the gastrostomy operation, the abdomen and colon are explored and the segment of colon to be used for replacement is chosen. The trunk of the middle colic artery supplying the transverse colon is ligated and divided proximally to the marginal artery or, if another segment of the colon is chosen, the corresponding vessel is ligated. METHODS: Between November 1999 and October 2002, 11 children had their middle colic vessels ligated during a gastrostomy operation. They were six boys and five girls. Five neonates had long gap esophageal atresia with or without fistula. The other 6 had long segment esophageal stricture due to swallowing caustic potash. Their ages ranged from one day to 40 months. The hospital stay ranged from 10 to 14 days. The interval between vascular ligation and the replacement was one to three months, depending on the general condition of the patient. The follow-up period was between 21 and 56 months. RESULTS: After the definitive operation for colon replacement of the esophagus, the children resumed feeding through the gastrostomy on day five. They were fed by mouth from day eight and all had returned home by day 15. COMPLICATIONS: There was no wound infection, no fistula, or chest complications. One patient developed stricture at the colo-esophageal anastomosis two months after surgery. The esophageal anastomosis was excised six months after the colon interposition surgery and re-anastomosis was performed through the same neck incision, after which the patient was sent home seven days later. CONCLUSIONS: Ligation of the middle colic vessels during the gastrostomy operation increases the blood supply to the transverse colon through the left upper colic and marginal vessels. This adds an extra ten minutes to the gastrostomy operation. This technique has increased the success rate in colonic replacement and minimized morbidity in our unit. Although the principle is commonly used in plastic surgery in pedicled flap reconstruction and in pediatric surgery for high abdominal testis (Fowler Stephens procedure), to our knowledge, this has never been applied in intestinal surgery before.

The trans-cervical plane (TCP): A new anatomical landmark for minimally invasive neck surgery

The currently used subdivisions of the neck are not helpful in neck surgery. In addition, the wide use of minimally invasive neck surgery has made it necessary to find reference points that make these procedures easier and safer. Here, clinical, anatomical and radiological study was undertaken to determine the relationships between the trans-cervical plane (TCP) and important neck structures. One hundred and ninety healthy volunteers were examined to determine the surface anatomy of the TCP together with 17 CT scans on the same plane and, five cadavers were dissected in an attempt to describe the anatomy of the mid-cervical region. The distance between the submental point and the sternal notch was measured, and the important anatomic features at this level were recorded. The anatomical location of the TCP was confirmed. TCP was opposite to the lower border of thyroid cartilage in 90% of the cases, and in 10% it was at the cricothyroid membrane. The average distance from the submental point to the TCP in the hyperextended neck was (6.5-11.5 cm). In spite of the wide range of variation of the distance between the submental point and sternal notch (13-23 cm), the middle of this distance is constant and often related to important anatomical structures: the junction between the upper 1/3 and lower 2/3 of the thyroid lobes, superior parathyroid, and the body of the 6th cervical vertebra. It is concluded that the trans-cervical plane is an important landmark in the neck region that enables accurate and rapid localization of the cricothyroid membrane for emergency cricothyroidotomy and the tracheal rings for percutaneous dilatational tracheostomy and provides a reference point to mark skin incisions necessary for minimally invasive neck surgery (AU)

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Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors.

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years (range 29-95). The most common stroke subtype was lacunar infarct (51.5%), but frequency of cardioembolic stroke was low (8.0%). Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis (> 50% narrowing). Lacunar strokes presented predominantly as pure motor stroke (67/103) and were mainly in the internal capsule (34/ 103). The favourable outcome (85% discharged home) may be due to the relatively young age and the predominance of lacunar infarcts.

Ischaemic stroke in Jordan: a 2-year hospital-based study of subtypes and risk factors

A retrospective study was made of 200 consecutive patients with first-ever ischaemic stroke, admitted to Jordan University Hospital over a 2-year period. The mean age was 61.2 years [range 29-95]. The most common stroke subtype was lacunar infarct [51.5%], but frequency of cardioembolic stroke was low [8.0%]. Hypertension, diabetes mellitus and smoking were the most common risk factors for atherosclerotic non-cardioembolic stroke. Chronic atrial fibrillation was the most common risk factor for cardioembolic stroke. No patient had severe extracranial carotid or vertebral artery stenosis [> 50% narrowing]. Lacunar strokes presented predominantly as pure motor stroke [67/103] and were mainly in the internal capsule [34/ 103]. The favourable outcome [85% discharged home] may be due to the relatively young age and the predominance of lacunar infarcts

Transanal endorectal pull-through for Hirschsprung's disease: experience with 68 patients.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the indications, results, and complications of transanal endorectal pull-through (TEPT) in the management of recto-sigmoid Hirschsprung's disease (HD). METHODS: Between November 1998 and March 2002, 68 TEPT procedures were performed in infants and children. The patients' ages ranged from 6 days to 13 years. The primary diagnosis in all 68 patients was Hirschsprung's disease confined to the recto-sigmoid region. All children had their operations done without construction of preoperative colostomy except for one. Follow-up period ranged from 3 to 39 months (mean, 21 months). RESULTS: The mean operating time was 90 minutes, and average length of bowel resected was 25 cm. Sixty-two patients had satisfactory results without complications. Blood transfusion was needed in only 11 patients. Recovery was very fast, and patients often were hungry within 24 hours. Feeding was resumed within 48 hours. One patient required laparotomy during the procedure owing to injury to the urethra. Two patients required colostomy 3 and 5 days after surgery respectively, because of delayed leakage. Three patients suffered from attacks of enterocolitis 6 to 9 months postoperatively. There was increased frequency of defecation (5 to 15 times daily) for 4 to 6 weeks after surgery in all the patients. There was no constipation, no incontinence, no cuff abscess, and no mortality in any of the patients. Average frequency of defecation was 1 to 3 times daily after 3 months. The cost of the TEPT technique was almost half that of the open surgery. CONCLUSIONS: TEPT takes less time, has less bleeding, shorter hospital stay, less morbidity, and earlier recovery than similar open pull-through procedures. The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung's disease confined to the recto-sigmoid region. Careful long-term follow-up is required to assess continence and sexual function.

Magnetic resonance cholangiopancreatography in patients with upper abdominal pain: a prospective study.

BACKGROUND/AIMS: To determine the role of magnetic resonance cholangiopancreatogram with conventional abdominal magnetic resonance examination in patients presenting clinically with upper abdominal pain and abnormal liver function tests and to compare the findings with endoscopic retrograde cholangiopancreatogram results. METHODOLOGY: Magnetic resonance cholangiopancreatogram and endoscopic retrograde cholangiopancreatogram were done in 77 patients. Conventional magnetic resonance examination of the liver and upper abdomen was done first followed by magnetic resonance cholangiopancreatogram using a half fourrier single shot turbo spin echo sequence. Conventional endoscopic retrograde cholangiopancreatogram was done by direct intraductal injection of radiographic contrast material through a duodenoscope under fluoroscopy control. RESULTS: Endoscopic retrograde cholangiopancreatogram failed in 7 patients (9%) and Magnetic resonance cholangiopancreatogram images were inadequate in 3 patients (4%). The findings of adequate magnetic resonance exams in 74 patients were: choledocholithiasis in 24 patients (32%), bile duct stricture in 19 patients (26%), normal biliary ducts in 29 patients (39%) and dilated biliary ducts with no definite cause in 2 patients (3%). The findings of successful endoscopic retrograde cholangiopancreatograms in 67 patients after exclusion of inadequate magnetic resonance cholangiopancreatograms were: choledocholithiasis in 25 patients (37%), bile duct stricture in 18 patients (27%), normal biliary ducts in 21 patients (31%) and dilated biliary ducts with no evident cause in 2 patients (3%) and hemobilia in 1 patient (2%). CONCLUSIONS: Magnetic resonance cholangiopancreatogram is a non-invasive technique, its accuracy is increased if it is combined with conventional abdominal magnetic resonance exam and it can replace the endoscopic retrograde cholangiopancreatogram.

Transanal endorectal pull-through for Hirschsprung's disease: a comparison with the open technique.

AIM: To evaluate the indications, results, and complications of Transanal Endorectal Pull-Through (TEPT) in the management of rectosigmoid Hirschsprung's disease (HD) compared with the open technique. PATIENTS AND METHODS: Between November 1998 and March 2002, 68 Transanal Endorectal Pull-Through (TEPT) procedures were performed in infants and children. The patients' ages ranged from 6 days to 13 years. The primary diagnosis in all 68 patients was Hirschsprung's disease confined to the rectosigmoid region. All children were operated without construction of a pre-operative colostomy except for one patient. Follow-up period ranged from 6 - 46 months (mean 32 months). These patients were compared with fifty patients who had undergone open pull-through for HD during the period from November 1995 to October 1998. RESULTS AND COMPLICATIONS: For the TEPT group, the mean operating time was 90 min and the average length of resected bowel was 25 cm. Sixty-two patients had satisfactory results without complications. Blood transfusion was needed in eleven patients only. Recovery was very fast and patients were often hungry within 24 hours. Feeding was resumed within 48 hours. One patient required laparotomy during the procedure due to injury to the urethra. Two patients required colostomy 3 and 5 days after surgery because of delayed leakage. Three patients suffered from attacks of enterocolitis 6 - 9 months postoperatively. There was increased frequency of defecation (5 - 15 times daily) for 4 - 6 weeks after surgery in all patients. There was no constipation, no incontinence, no cuff abscess and no mortality in any of the patients. Average frequency of defecation was 1 - 3 times daily after 3 months postoperatively. For the open technique group, mean operating time was 150 min, the length of the average resected segment was 29 cm. Forty-one patients had satisfactory results without complications. The cost of the open technique was almost double that of the TEPT (6300 vs. 3200 pounds). CONCLUSIONS: Transanal Endorectal Pull-Through (TEPT) is characterized by a shorter operating time, less bleeding, shorter hospital stay, less morbidity and earlier recovery than similar open pull-through procedures. The hazards and morbidities associated with laparotomy and colostomy may be avoided with a one-stage technique in Hirschsprung's disease confined to the rectosigmoid area (70-80 %). Careful long-term follow-up is required to assess continence and sexual function.

A novel multiplex RT-PCR probe capture hybridization (RT-PCR-ELISA) for simultaneous detection of six viroids in four genera: Apscaviroid, Hostuviroid, Pelamoviroid, and Pospiviroid.

A rapid and sensitive assay was developed for the detection and identification of viroids by standard or multiplex reverse transcription-polymerase chain reaction (RT-PCR)-probe capture hybridization (RT-PCR-ELISA). The assay was applied successfully for the detection and identification of the following six viroid species from infected tissues: Potato spindle tuber viroid (Pospiviroid), Peach latent mosaic viroid (Pelamoviroid), Apple scar skin viroid (Apscaviroid), Apple dimple fruit viroid (Apscaviroid), Pear blister canker viroid (Apscaviroid), and Hop stunt viroid (Hostuviroid). Total RNA was obtained from infected tissue by the Qiagen RNeasy kit and, then viroid cDNA was synthesized using viroid specific complementary DNA primer. To identify and differentiate the amplicons of the six viroids, each amplicon was digoxigenin (DIG)-labelled during the amplification process, and then detected by a colorimetric system using a biotinylated cDNA capture probe specific for each viroid. The results revealed that each capture probe hybridized only to its complementary DIG-labelled amplicon. Thus the six viroids can be detected and differentiated in a multiplex RT-PCR-ELISA assay. In the multiplex assay, cDNAs of six viroids were synthesized simultaneously in one tube, DIG-labelled during amplification, then a portion of the DIG-labelled amplified products was hybridized with selected capture probe. All the six viroid capture probes hybridized to their respective complementary DIG-labelled RT-PCR-amplified product. These findings are important for viroid detection and identification for studying host-viroid interactions and for management and control viroid diseases.

Magnetic resonance imaging of normal lumbar intervertebral discs.

OBJECTIVE: To study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. METHODS: A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. RESULTS: The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. CONCLUSION: The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed.

Bleeding tendency in Wolfram syndrome: a newly identified feature with phenotype genotype correlation.

Wolfram syndrome (WS) is a recessively inherited disorder associated with recognised clinical features. Bleeding tendency was noticed in some of our patients, although this has not been reported before. We therefore studied this problem in all our WS patients and tried to postulate a possible pathogenesis. At the same time, a genetic linkage study provided evidence of locus heterogeneity of this syndrome and showed that the majority of our patients belong to the second WS locus identified in that study. Our study group consisted of 13 WS patients, belonging to WSF2 locus (group I). Controls consisted of 4 healthy siblings of WS patients (group II) and 7 diabetics who do not have WS (group III). Relevant clinical data were obtained, and a coagulation screen was carried out for all groups. All individuals in the three study groups have normal platelet count, thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (aPTT), clot retraction, Factor VIII activity (FVIIIc) and von Willebrand factor antigen (vWAg). Eleven of the WS patients have prolonged template bleeding time (BT) compared with both control groups. Patients with WS have a longer BT (mean 9.6 min, 95% CL 8.61-10.53 min) than the siblings group (mean 6.75 min, 95% CL 5.52-7.98 min) and the diabetic group (mean 5.49 min, 95% CL 4.56-6.42 min). The differences between the study group and controls are statistically significant, p = 0.02 and 0.0002, respectively. In the three groups, platelet aggregation studies were normal using adenosine diphosphate (ADP), ristocetin and epinephrine. Aggregation with collagen was either absent or impaired, with failure of secondary wave being noticed in 11 of the WS patients (85%) and normal in the control groups. The pathogenesis of this problem is not known, but could be due to an inhibitory effect of vWAgII, deficiency of thrombospondin or a defect in the platelet membrane GPIa/IIa. Bleeding diathesis is a new additional feature to the clinical spectrum of WS, which is probably a feature of the disorder WFS2 and not WFS1, as bleeding has never been reported in the latter. This provides further evidence for the phenotypic and genotypic heterogeneity of this complex disorder and may provide clues to the search for the second gene responsible for this phenotype.

Sensitive detection of the Egyptian species of sugarcane streak virus by PCR-probe capture hybridization (PCR-ELISA) and its complete nucleotide sequence.

A rapid and sensitive assay for the specific detection of Sugarcane streak virus (SSV) using PCR-probe capture hybridization (PCR-ELISA) was developed. Nucleic acids suitable for PCR were extracted from SSV-infected tissue using organic solvents or Fast DNA kit. SSV cDNA was amplified using viral specific primers and the amplified SSV cDNA (amplicon) was DIG-labelled during the amplification process. The amplicon was then detected in a colorimetric hybridization system by a microtiter plate using a biotinylated cDNA (22 nt), cDNA (789 nt) or cRNA (789 nt) capture probe. This system combines the specificity of molecular hybridization, the ease of the colorimetric protocol, and is 10-100 fold more sensitive than agarose gel electrophoretic analysis in detecting the amplified product. Long cDNA or cRNA capture probe was 2-7 fold more sensitive than the oligo cDNA probe for the detection. Complete nucleotide sequence of SSV from Naga Hammady, Egypt, revealed that SSV-EG is a new species of SSV that shares 66% nucleotide identity with the virus species from Natal, South Africa.