Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment.

OBJECTIVES: To investigate the actual time of onset of osteonecrosis (ON) after high dose corticosteroid treatment in systemic lupus erythematosus (SLE). METHODS: 72 patients with active SLE, who received high dose corticosteroid for the first time, for the development of ON at hips and knees were monitored by magnetic resonance imaging for at least 12 months. RESULTS: ON lesions were detected in 32/72 patients (44%) between one and five months (3.1 months on average) after starting high dose corticosteroid treatment. No osteonecrotic lesion was newly detected from the sixth month of treatment until the end of the follow up period. CONCLUSION: The findings suggested that the actual time of onset of ON in SLE is within the first month of high dose corticosteroid treatment.

Diastereoselective ruthenium-Cp complexation of enantiopure arene compounds possessing stereogenic benzylic alcohol functionalities.

[reaction--see text] Enantiopure (arene)ruthenium compounds possessing a stereogenic benzylic alcohol functionality were stereoselectively synthesized by diastereoselective ruthenium-Cp complexation to a distinct arene face. This diastereoselective ruthenium-Cp complexation was further extended to biaryl compounds linked with a six-membered lactone bridge for the synthesis of enantiomerically pure, axially chiral biaryls.

Comparison of antimycobacterial activity of grepafloxacin against Mycobacterium avium with that of levofloxacin: accumulation of grepafloxacin in human macrophages.

The bactericidal activity of two new quinolones, grepafloxacin and levofloxacin, against five strains of Mycobacterium avium was investigated in vitro. The minimum inhibitory concentrations (MICs) of these two quinolones, determined by the broth microdilution method, were comparable for all strains tested. In contrast, grepafloxacin suppressed the intracellular growth of all the strains in monocyte-derived macrophages more strongly than levofloxacin, when the cells infected with these strains were incubated for 7 days in the presence of various concentrations of the two new quinolones. To find the reason for the strengthened intracellular killing activity of grepafloxacin, we determined the ratio of the concentration of the new quinolones in the cells to that in the medium (C/M concentration ratio). The C/M concentration ratio of grepafloxacin was increased to 34.7 by 7 days, whereas that of levofloxacin at 7 days was only 12.3. These data suggested that a higher level of intraphagocytic accumulation of grepafloxacin endows it with greater mycobactericidal activity.

Stereoselective synthesis of the axially chiral A-B ring system of vancomycin utilizing a planar chiral arene chromium complex.

[reaction: see text] The axial biaryl ring system of vancomycin was stereoselectively synthesized by utilizing a planar chiral tricarbonyl(arylhalide)chromium complex. Both enantiomers of the planar chiral (arylbromide)chromium complexes, (+)-9 and ent-(-)-9, can be stereoselectively transferred to an absolutely identical key intermediate 23 for the vancomycin A-B ring system by the diastereoselective Suzuki-Miyaura cross-coupling reaction as key step.

Catalytic asymmetric vinylation of ketone enolates.

[see reaction]. A protocol for the catalytic asymmetric vinylation of ketone enolates has been developed. Key to the success of this process was the development of new electron-rich chiral monodentate ligands.

Differential effects of oxidised and non-oxidised polyethylene particles on human monocyte/macrophages in vitro.

Sterilisation by gamma irradiation in the presence of air causes free radicals generated in polyethylene (PE) to react with oxygen, which could lead to loss of physical properties and reduction in fatigue strength. Tissue retrieved from failed total hip replacements often has large quantities of particulate PE and most particles associated with peri-implant osteolysis are oxidised. Consequently, an understanding of the cellular responses of oxidised PE particles may lead to clarification of the pathogenesis of osteolysis and aseptic loosening. We have used the agarose system to demonstrate the differential effects of oxidised and non-oxidised PE particles on the release of proinflammatory products such as interleukin-1beta (IL-1beta), IL-6, and tumour necrosis factor-alpha (TNF-alpha) from monocytes/macrophages (M/M). Oxidised PE particles were shown to stimulate human M/M to phagocytose and to release cytokines. Oxidation may alter the surface chemistry of the particles and enhance the response to specific membrane receptors on macrophages, such as scavenger-type receptors.

Sustained hemostatic abnormality in patients with steroid-induced osteonecrosis in the early period after high-dose corticosteroid therapy.

To determine whether the development of steroid-induced osteonecrosis in collagen disease patients was related to hemostatic abnormality after corticosteroid administration, we examined levels of thrombin-antithrombin III complex (TAT) and plasmin-alpha2-plasmin inhibitor complex (PIC) in 32 patients who were treated with high-dose corticosteroid. All were prospectively followed for osteonecrosis, with serial magnetic resonance imaging (MRI), for at least 12 months from the beginning of corticosteroid therapy. MRI was performed on bilateral hips and knees. Of the 32 patients, 17 (53.1%) had osteonecrosis in the hip or knee. Osteonecrosis was detected on MRI at an average 3.1 months after the start of high-dose corticosteroid therapy. PIC levels were significantly higher in the group of 17 patients with osteonecrosis (ON group) than in the group of 15 patients without osteonecrosis (non-ON group) (P < 0.0001). The difference in PIC levels was most prominent 20 days after the start of the high-dose corticosteroid therapy. Moreover, the number of osteonecrotic joints was significantly correlated with PIC levels (P < 0.0001). The sustained hemostatic abnormality after corticosteroid therapy in the ON group suggests that microvascular coagulation participates in the development of osteonecrosis.

Acetabular labrum: abnormal findings at MR imaging in asymptomatic hips.

PURPOSE: To determine the prevalence of abnormalities of the acetabular labrum in asymptomatic hips by means of magnetic resonance (MR) imaging and to correlate such abnormalities with age and the portion of the labrum. MATERIALS AND METHODS: MR imaging was performed in 71 asymptomatic hips that were radially sectioned perpendicular to the acetabular labrum at 30 degrees intervals. RESULTS: The shape of the labrum was triangular in 80% (304 of 382) of the labral segments, round in 13% (49 of 382), irregular in 7% (27 of 382), and not identified in 1% (two of 382). A homogeneous low signal intensity was observed in 56% (212 of 382). The frequencies of labral irregularity or its absence and of high signal intensity increased both with subject age and with a more anterior anatomic labral location. CONCLUSION: In asymptomatic hips, abnormal findings regarding the shape and signal intensity of the acetabular labrum can be detected by means of MR imaging. The fact that the findings vary according to age and labral portion should be considered in interpreting MR images in patients suspected of having a labral lesion.

[A case of reflex sympathetic dystrophy following a retinous surgery].

We present a case of a 54-year-old female with post-operative severe continuous ocular pain which occurred 3 months after retinal operation. Her general and mental conditions were good. We diagnosed it reflex sympathetic dystrophy and treated with stellate ganglion blocks (SGB) and continuous cervical epidural blocks. SGB and continuous cervical epidural blocks were effective. With increasing numbers of retinal surgery in recent years, more patients will suffer from postoperative ocular pain. We conclude that SGB or epidural block is useful for the therapy of ocular pain which can not be controlled by drugs and other therapy.

[von Hippel-Lindau disease--hemangioblastoma associated with pheochromocytoma].

The association of a pheochromocytoma with von Hippel-Lindau disease is uncommon. We had a family with eight patients affected by von Hippel-Lindau disease, of whom five had hemangioblastoma of the central nervous system and seven had pheochromocytoma. As other lesions, retinal angiomatosis, spinal A-V malformation and spinal hemangioma were included in this family. In this paper five hemangioblastomas, four of whom had the association of hemangioblastoma and pheochromocytoma, are presented and clinical features of hemangioblastoma associated with pheochromocytoma are discussed, comparing to the 16 reported cases that had the association of hemangioblastoma and pheochromocytoma. The mean age of our own five cases at the onset of clinical symptoms was 32.2 years (ranging from 24 to 41 years) and that of reported 16 cases was 33.9 years (ranging from 18 to 55 years). These ages are slightly younger than that of sporadic hemangioblastoma. On the other hand, the mean age at the onset of pheochromocytoma was 28.3 years in our cases and 31.0 years in reported cases. This may suggest that hemangioblastoma when it is associated with pheochromocytoma presents its symptoms several years after the signs and symptoms of pheochromocytoma are manifested. In our cases a male to female ratio was 4:1 and in reported ones it was 9:7, showing that hemangioblastoma associated with pheochromocytoma as well as sporadic hemangioblastoma is likely to occur more in male.(ABSTRACT TRUNCATED AT 250 WORDS)

Enhanced intestinal absorption of amino acids and amino acid-like drug by possible formation of enamine in administered solution by the presence of ethylacetoacetate.

Ethylacetoacetate promoted the colonic and the jejunal absorption of amino acids such as L-phenylalanine and D-phenylalanine when administered in aqueous solution. Enhanced absorption of these isomers of amino acid might occur via a formation of enamine, which was observed in aqueous solution by monitoring ultraviolet absorbance at 288 nm. Since mixture of L- or D-phenylalanine and ethylacetoacetate in aqueous solution enhanced colonic absorption of cefmetazole while the solution did not affect so much on the jejunal absorption of cefmetazole compared to the colonic absorption of it, enhancing action of enamine probably produced in aqueous solution may be more effective at the colonic compartment.

[Fractionated intracavitary radiation for glioblastoma with remote afterloading system].

Three patients harboring glioblastoma were treated by fractionated intracavitary radiation using remote afterloading system. For this therapy, a special intracranial applicator was designed and used. Radiation schedule was planned to deliver 3000 rads to the margin of the tumor in 3 fractions over 10 days. The advantages of this treatment are that complete elimination of all unnecessary radiation exposure is possible, and that placing a radioactive source in the tumor provides maximal delivery of radiation to the tumor with relative sparing of surrounding normal brain. The method of treatment is presented and discussed with the reports of the clinical cases.

Partial hydrocephalus with chronic subdural hematoma.

Two adult patients with unilateral chronic subdural hematomas are reported because of the presence of dilatation of the lateral ventricle opposite the hematoma. In both cases, dilatation was limited to the contralateral atrium and the occipital and temporal horns. The selective dilatation, we believe, is explained on the basis of the anatomy of the skull base and the falx. This phenomenon may contribute to an increase of the supratentorial pressure, originally elevated by the hematoma. This characteristic finding on computed tomographic scans should be regarded as critical in cases of chronic subdural hematoma.

Prevention of postoperative complications after a transoral transclival approach to basilar aneurysms. Technical note.

The authors describe the techniques employed in three patients with basilar artery aneurysms that were treated via the transoral transclival approach. To prevent the formation of cerebrospinal fluid fistulas and the risk of consequent meningitis, complete postoperative closure of the nasopharyngeal mucosa is essential. Long-term nasopharyngeal packing and continuous spinal drainage were found to be effective in these cases.