Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report.

STUDY DESIGN: A case report and a review of literature. OBJECTIVES: To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst. SETTING: General Orthopedics, Japan. METHODS: A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion. RESULTS: The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst. CONCLUSIONS: Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.

Surgical treatment of lumbar disc herniation in elderly patients.

Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%). The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.

Characterization of the stromal protease(s) degrading the cross-linked products of the D1 protein generated by photoinhibition of photosystem II.

When photosystem (PS) II-enriched membranes are exposed to strong light, cross-linking of the intrinsic D1 protein with the surrounding polypeptides and degradation of the D1 protein take place. The cross-linking of the D1 protein with the alpha-subunit of cytochrome b(559) is suggested to be an early event of photoinduced damage to the D1 protein (Barbato et al., FEBS Lett. 309 (1992) 165-169). The relationship between the cross-linking and the degradation of the D1 protein, however, is not yet clear. In the present study, we show that the addition of stromal extract from chloroplasts degrades the 41 kDa cross-linked product of D1/cytochrome b(559) alpha-subunit and enhances the degradation of the D1 protein. Incubation of the preilluminated PS II-enriched membranes with the stromal extract at 25 degrees C causes the degradation of the cross-linked product by more than 70%. The activity of the stromal extract showed a pH optimum at 8.0, and was enhanced by the addition of ATP or GTP. Consistent with the nucleotide effect, this stromal activity was eliminated by the preincubation of the stromal extract with apyrase, which hydrolyzes nucleotides. Also, the stromal activity was nearly fully inhibited by a serine-type protease inhibitor, 3,4-dichloroisocoumarin, which suggests participation of a serine-type protease(s).

Turnover of the aggregates and cross-linked products of the D1 protein generated by acceptor-side photoinhibition of photosystem II.

It is known that the reaction-center binding protein D1 in photosystem (PS) II is degraded significantly during photoinhibition. The D1 protein also cross-links covalently or aggregates non-covalently with the nearby polypeptides in PS II complexes by illumination. In the present study, we detected the adducts between the D1 protein and the other reaction-center binding protein D2 (D1/D2), the alpha-subunit of cyt b(559) (D1/cyt b(559)), and the antenna chlorophyll-binding protein CP43 (D1/CP43) by SDS/urea-polyacrylamide gel electrophoresis and Western blotting with specific antibodies. The adducts were observed by weak and strong illumination (light intensity: 50-5000 microE m(-2) s(-1)) of PS II membranes, thylakoids and intact chloroplasts from spinach, under aerobic conditions. These results indicate that the cross-linking or aggregation of the D1 protein is a general phenomenon which occurs in vivo as well as in vitro with photodamaged D1 proteins. We found that the formation of the D1/D2, D1/cyt b(559) and D1/CP43 adducts is differently dependent on the light intensity; the D1/D2 heterodimers and D1/cyt b(559) were formed even by illumination with weak light, whereas generation of the D1/CP43 aggregates required strong illumination. We also detected that these D1 adducts were efficiently removed by the addition of stromal components, which may contain proteases, molecular chaperones and the associated proteins. By two-dimensional SDS/urea-polyacrylamide gel electrophoresis, we found that several stromal proteins, including a 15-kDa protein are effective in removing the D1/CP43 aggregates, and that their activity is resistant to SDS.

Prenatal diagnosis of thanatophoric dysplasia by mutational analysis of the fibroblast growth factor receptor 3 gene and a proposed correction of previously published PCR results.

Thanatophoric dysplasia (TD) is the most frequent form of neonatal lethal skeletal dysplasia. Recently. mutations in the fibroblast growth factor receptor 3 (FGFR3) gene that cause two subtypes of this disorder, type I (TDI) and type II (TDII), have been identified. This discovery has now made it possible to make a definite diagnosis of TD by molecular methods. To date, prenatal diagnosis of TD has been accomplished by ultrasonography in the second trimester. However, it is not always possible to distinguish TD fetuses it utero from the other osteochondrodysplasias by ultrasonography or radiography. We report on the prenatal diagnosis of a TD fetus, showing severe shortness of limbs and polyhydramnios, by identification of a mutation in the FGFR3 gene. Genomic DNA was isolated from the amniotic fluid and then subjected to PCR amplification. The common TDI mutation, C-->T transition at nucleotide 742 in the FGFR3 gene, was identified using restriction enzyme analysis. This information was critical in obstetric management decisions later in pregnancy. However, although the mutation responsible for TDI was detected previously, we noticed some inconsistencies in the published PCR results and have proposed a correction.

[Study on risk factors for central visual field loss in advanced open angle glaucoma].

53 eyes of 53 advanced open angle glaucoma (stage 5 of Aulhorn-Greve's classification) were studied regarding the risk factors for central visual field loss by the Cox proportional hazards model. The cases of foveal threshold under 20 dB were defined as central visual field loss group (9 eyes), and the cases over 20 dB were defined as no visual field loss group (44 eyes). The following clinical factors were statistically analyzed between the two groups: gender, age, family history of glaucoma, refraction, intraocular pressure, blood pressure, visual field measured by static perimetry, optic disc, retinal nerve fiber layer, treatment, and systemic disease. Foveal threshold, mean deviation, pattern standard deviation, corrected pattern standard deviation, and retinal nerve fiber layer defect showed significant difference between the two groups, and diastolic blood pressure and diastolic blood pressure minus intraocular pressure showed a tendency to be related. From the results obtained, intraocular pressure and these other clinical factors should be considered for the management of advanced open angle glaucoma patients.

Foramen magnum schwannoma with an unusual clinical presentation: case report.

This case report illustrates a patient with a unilateral localized epidural schwannoma at C1-2 level, showing contralateral spinal cord symptoms and signs. The clinical presentation was compared with the neuroradiological examinations showing an epidural cord tumor at the right C1-C2 level. However, the neurological examination revealed contralateral hemiparesis and ipsilateral hemihypoalgesia, indicating a contralateral Brown-Sequard syndrome. We presumed with this slow growing tumor, contralateral cord involvement may result from counter pressure on the spinal cord, which may be generated by cord deviation and by frequent neck rotation.

Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture.

This report reviews a case of radial nerve palsy associated with a supracondylar fracture of the right humerus. The patient was a four-year-old boy. Radiographs of the injury showed simple extension and a slightly angulated fracture. Complete radial nerve palsy was observed at the first consultation. After three months of conservative treatment without any obvious improvement, an operative exploration of the right radial nerve was conducted. Intraoperatively, the nerve was found to be transected, with both ends of the ruptured nerve buried in scar tissue at the fracture site. Five months after the nerve suture operation, the palsy was cured completely. This case shows that even a minimal displacement fracture can be associated with severe nerve injury that requires surgical treatment.

[Seasonal variation in intraocular pressure].

Generally speaking, physicians have the impression that intraocular pressure (IOP) in winter is higher than in summer, but it is very difficult to evaluate the difference between summer and winter IOP statistically, because the treatments of glaucoma patients are changed according to their conditions. We compared the winter and summer IOP of normal subjects and of several glaucoma patients who had no therapy or no change in therapy. The subjects were divided into four groups, i.e., 20 eyes of the normal group, 17 eyes of the ocular hypertensive group, 24 eyes of the primary open angle glaucoma group, and 52 eyes of the low tension glaucoma group. The difference in mean IOP between summer and winter were evaluated for each subject. In all groups, the mean difference in mean winter IOP was significantly higher. The ups and downs of IOP were greater in the ocular hypertensive group and the primary open angle glaucoma group than in the normal group and the low tension glaucoma group. These results suggest that the seasonal variation of IOP should be taken in consideration when treating glaucoma patients.

Application of an oily gel formed by hydrogenated soybean phospholipids as a percutaneous absorption-type ointment base.

We investigated the possibility of developing an oily gel formed by hydrogenated soybean phospholipids (HSL) as a percutaneous absorption-type ointment base. Liquid paraffin (LP) was used as the oil, and indomethacin (IM), ketoprofen (KP), flurbiprofen (FP) and ibuprofen (IP) were used as model drugs. IM did not dissolve in LP, but solubilized when heated with HSL at a concentration of about 1% with 15% HSL at 95 degrees C. IM gel was thus prepared as follows: IM and HSL were mixed, added into LP, capped tightly, heated in a water bath and cooled. The consistency of the gel increased with increasing IM concentration, indicating some kind of interaction between IM and HSL. The release of IM from the IM gel was faster than that from a preparation in which IM was mixed in gel at room temperature (Gel + IM). The release rate of IM from IM gel was proportional to IM concentrations up to 1%, but became constant above that. Permeation of IM through hairless rat abdominal skin from IM gel was higher than that from the Gel + IM. The permeation rate was proportional to IM concentrations in the range of 0.1 to 0.5% in 15% HSL gel. KP and FP also solubilized in gel when subjected to the same procedure as IM, and their release and permeation increased when they were formulated as gels. However, no evident improvement of permeation was observed in the case of IP, which had high LP solubility. It was suggested that HSL showed no enhancing effect, but solubilized IM, KP or FP, leading to high permeation from the gel. After 3 months' storage, the permeation rate did not change for 0.5% IM in 15% HSL gel, but decreased for 1% IM in 15% HSL gel. This indicates that in the case of 1% IM in 15% HSL gel, IM is in a supersaturated state immediately after preparation and then recrystallizes with time.

[The clinical evaluation of UF-021, a new prostaglandin related compound, in low tension glaucoma patients].

We administered UF-021 isopropyl unoprostone (Rescula) ophthalmic solution, a new prostaglandin-related compound developed as an anti-glaucoma agent, to 13 low tension glaucoma patients for 24 weeks, and clinically evaluated the effect of the intraocular pressure (IOP) reduction, visual field change, and side effects of the agent. Intraocular pressure was reduced in 11 out of 12 patients who were studied for statistical analysis. In these 12 patients, significant IOP reduction was recognized in the mean IOP for 24 weeks after the administration of UF-021. No side effects were detected in any of the 13 patients. From these results, UF-021 could be used as a new anti-glaucoma agent for low tension glaucoma, and also safer than many other anti-glaucoma agents.

Periosteal epithelioid hemangioendothelioma with leptomeric fibrils.

A case of recurrent periosteal epithelioid hemangioendothelioma of the right femur in a 66-year-old woman is reported. Microscopic examination showed epithelioid tumor cells with frequent intracytoplasmic vacuoles arranged in small nests or cords in hyalinized stroma. Immuno- and lectin-histochemical studies for factor VIII-related antigen and ulex europaeus I lectin indicated the endothelial nature of the tumor cells. Ultrastructurally, a few tumor cells contained leptomeric fibrils and crystalline filamentous aggregates in addition to showing certain features of endothelial cells. There seems to be no previous report of a vascular tumor containing leptomeric fibrils, which are often noted in normal striated muscle cells and their tumors. The bland appearance of the epithelioid tumor cells, poor vasoformative nature and prolonged clinical course differentiated this tumor from conventional angiosarcoma and so-called hemangioendothelioma of bone.

[Stability of sulbenicillin and cefacetrile in bile (author's transl)].

The antibiotic activity of sulbenicillin and cefacetrile was determined after storage at -20 degrees C for up to 7 days in human gall-bladder and common duct bile. In gall-bladder bile, both drugs could not retain their initial activity after 3 days. The decay curves in antibiotic activity in the ductal bile revealed large variations, as given in Figs. 5 and 6. The 7th day activity of both drugs decreased with the rise in initial pH level of bile. Significant correlation was noted between bile acid concentration in bile and cefacetrile activity on the 7th day.

Endoscopic aspiration biopsy of the pancreas.

Preoperative endoscopic aspiration biopsies were performed on 51 patients with pancreatic lesions using either a duodenal or gastric fiberscope and a newly designed biopsy needle. The accuracy of this method in the diagnosis of carcinoma of the pancreas was 84.0%. Although there were three false-negative diagnoses, there were no false-positives. No complications that could be attributed to this procedure were encountered.

Viridenomycin, a new antibiotic.

Viridenomycin, a new crystalline antibiotic, was isolated from the culture broth of Streptomyces viridochromogenes strain No. T-24146. Viridenomycin is a weakly acidic and lipophilic substance, which exhibits a strong absorption maximum at 310 nm and shows strong activity against Trichomonas vaginalis and gram-positive bacteria.