Recombination in Mycoplasma hominis.

Mycoplasma hominis has been previously described as a heterogeneous species, and in the present study intraspecies diversity of 20 M. hominis isolates from different individuals was analyzed using parts of the unlinked gyrase B (gyrB), elongation factor Tu (tuf), SRalpha homolog (ftsY), hitB-hitL, excinuclease ABC subunit A (uvrA) and glyceraldehyde-3-phosphate dehydrogenase (gap) genes. The level of variability of these M. hominis genes was low compared with the housekeeping genes from Helicobacter pylori and Neisseria meningitidis, but only few M. hominis isolates had identical sequences in all genes indicating the presence of recombination. In order to test for intergenic recombination, phylogenetic trees were reconstructed for each of the genes but no well-supported bifurcating phylogenetic trees could be obtained. The genes were tested for intragenic recombination using the correlation between linkage disequilibrium and distance between the segregating sites, by the homoplasy ratio (H ratio), and by compatibility matrices. The gap gene showed well-supported evidence for high levels of recombination, whereas recombination was less frequent and not significant within the other genes. The analysis revealed intergenic and intragenic recombination in M. hominis and this may explain the high intraspecies variability. The results obtained in the present study may be of importance for future population studies of Mycoplasma species.

Cloning, sequencing and variability analysis of the gap gene from Mycoplasma hominis.

The gap gene encodes the glycolytic enzyme glyceraldehyde 3-phosphate dehydrogenase (GAPDH). The gene was cloned and sequenced from the Mycoplasma hominis type strain PG21(T). The intraspecies variability was investigated by inspection of restriction fragment length polymorphism (RFLP) patterns after polymerase chain reaction (PCR) amplification of the gap gene from 15 strains and furthermore by sequencing of part of the gene in eight strains. The M. hominis gap gene was found to vary more than the Escherichia coli counterpart, but the variation at nucleotide level gave rise to only a few amino acid substitutions. To verify that the gene was expressed in M. hominis, a polyclonal antibody was produced and tested against whole cell protein from 15 strains. The enzyme was expressed in all strains investigated as a 36-kDa protein. All strains except type strain PG21(T) showed reaction to a 104-kDa band in addition to the expected 36-kDa band. The protein reacting at 104 kDa is a M. hominis protein with either an epitope similar to one on GAPDH, or it is an immunoglobulin binding protein.

[Surgery of lumbar disk prolapse in Scandinavia. A questionnaire study in Scandinavian neurosurgical departments in 1993]. / Operation for lumbal diskusprolaps i Norden. En spørgeskemaundersøgelse på de nordiske neurokirurgiske afdelinger i 1993.

This article consists in a review of treatment for lumbar disc prolapse in 1993, as reported by all 22 neurosurgery units in the Nordic countries, serving a total population of 23.5 million. Of surgical operations for the condition, 37 per cent were performed by neurosurgeons-using standard lumbar discectomy in 61.3 per cent of cases, microsurgical techniques in 36 per cent of cases, and percutaneous lumbar discectomy in the remaining 2.7 per cent. Chemonucleolysis is no longer considered a viable therapeutic alternative. In the Nordic countries as a whole, the annual incidence of lumbar disc prolapse surgery is 52.5 per 100,000, though the figure varies from one country to another.

[Incarceration of spinal nerve roots]. / Incarceratio radicis spinalis lumbalis.

The aim of this study is to evaluate the prognosis of motor function in patients that experience the combination of a sudden disappearance of radicular pain and severe motor paresis. Eight patients were identified over a ten year period. Operative decompression of the affected lumbar root with removal of a disc prolapse seems to have a good prognosis if the patient is not paralytic before surgery. Patients treated conservatively for radicular pain should be advised to call their doctor immediately if they experience progressive motor paresis and diminishing pain.

[Surgical treatment of epilepsy in Denmark a century ago]. / Epilepsikirurgi i Danmark i forrige århundrede.

Surgery for epilepsy in Denmark has been slowed down officially the larst decade. The reason for that is suggested to be an unfortunate combination of this kind of surgery with psychosurgery. Other European countries have been given much more credit to modern scientific development. In that concept it is worth to mention that Denmark in reality started epilepsy surgery in the Nordic countries a century ago Cooperation between the first epileptologist F. K. Hallager and the skilled surgeron P. W. Heiberg made that possible. In the period 1883 to 1900 they together treated 4 patients with nontraumatic epilepsy with primary good results.

[The art of delivering a lecture. Thoughts at a Scandinavian congress]. / Kunsten at holde et foredrag. Tanker ved en nordisk kongres.

During a Nordic scientific meeting 29 lectures were evaluated according to the written instructions about how to present a paper. Three speakers (10 per cent) were able to fulfil all rules. Nordic Conferences should continue to be a forum, where young scientists are invited to present their work but senior co-authors are advised to give better instructions about the art of oral presentation.

[The partial cauda equina syndrome]. / Det partielle cauda equina-syndrom.

In order to reduce the number of patients with a complete cauda equina-syndrome we reviewed the records of 63 surgically treated patients with lumbar root compression and bladder symptoms. Patients with a complete cauda equina-syndrome were excluded. Twenty-seven (43%) patients were admitted to the neurosurgical department more than 24 hours after the onset of bladder symptoms, an unacceptable delay mainly due to the reluctance of the patients to seek medical attention. The bladder symptoms remitted completely in 61 patients (97%). In spite of this the partial cauda equina-syndrome can still progress to a complete syndrome, so we recommend that all patients receiving conservative treatment for a lumbar disc prolapse should be advised to seek medical attention should voiding problems arise.

Complications to the use of vicryl-collagen dural substitute.

The authors describe 3 cases of postoperative infection as a complication after the use of vicryl-collagen dural substitute. The substitute had already partially dissolved 2 weeks after surgery with the remnant so densely adherent to the brain surface that it could not be removed without damaging the cortex. This was confirmed microscopically.

Hans Sølling: Danish pioneer neurosurgeon.

Hans Adolf Sølling (1879-1945), working completely on his own in the small town of Horsens, was Denmark's first neurosurgeon. Sølling was an admirable and talented man who performed major intracranial operations on more than 130 patients suffering from trigeminal neuralgia, as well as treating epilepsy, craniotrauma, brain tumors, glossopharyngeal neuralgia, and myelomeningoceles. Although not in the same league as Harvey Cushing (1869-1939), Vilhelm Magnus in Norway (1871-1929), and Herbert Olivecrona in Sweden (1891-1980), Sølling was a true Danish pioneer.

Selective sacral rootlet neurectomy in the treatment of detrusor hyperreflexia. Technique and long-term results.

Selective sacral neurectomy was performed in 12 patients with intractable urge incontinence of long duration (mean 12 years) caused by detrusor hyperreflexia. There was great variation in the innervation of the bladder, but resection of an S-3 root or rootlet was carried out in all patients. Six of the patients, who were followed for a mean period of 5.8 years, were cured, and symptoms recurred in two patients after 1 1/2 and 2 years. In patients whose detrusor hyperreflexia recurred, the amplitude of the bladder contractions was significantly lower. This treatment appears reasonable in patients with severe intractable voiding dysfunction caused by detrusor hyperreflexia.

Lumbar disc surgery and variations in C-reactive protein, erythrocyte sedimentation rate and the complement split product C 3 d.

Lumbar disc surgery was performed in fifty consecutive patients and variation in erythrocyte sedimentation rate (ESR), complement C 3 d, and C-reactive protein (CRP) levels before and after surgery were recorded. Preoperative values were within normal limits in all patients. Postoperatively, CRP increased immediately, with a maximum of 28.5 mg/l on the 2nd day and were normalized within 6 days. The maximum ESR elevation occurred after the 6th day and was followed by a slow decrease. After 12 weeks some patients still had an elevated ESR. Plasma C 3 varied pari passu with the ESR. Uncomplicated recovery after lumbar disc surgery seems to be indicated by a normalization of CRP, regardless of ESR values. Therefore, ESR may not be so useful as an indicator of disc space inflammation as previously accepted.

Obstructive hydrocephalus treated by ventriculocystocorticostoma.

The present report describes the late treatment of obstructive hydrocephalus in a patient in whom all conventional drainage techniques failed due to foreign-body reaction. A combination of subdural autodrainage and the ventriculostoma principle carried out by means of laser surgery was successful in achieving adequate drainage. The patient subsequently showed considerable improvement both clinically and psychologically after the operation. Sixteen months postoperatively the patient is in good health and a computed tomography scan confirmed well-functioning autodrainage.

Legionnaires' disease and brain abscess.

Neurologic symptoms are common in Legionnaires' disease, but the pathogenesis of these symptoms is not known. Brain scintigraphy or CT shows no abnormality that can account for the symptoms. We present the first evidence of cerebral abscess in a patient with serologically proven acute infection with Legionella.

When Nordic neurosurgery was still in its infancy.

Olof af Acrel, the father of Swedish Surgery, operated in 1768 upon a young nobleman who had experienced an increasing swelling on the skull, due to a tumour which also turned out to be growing deep into the brain parenchyma. The patient survived the operation for 3 days. Edvard Bull in 1877, after diagnosing a ruptured internal carotid artery aneurysm in a young female who temporarily recovered after her first hemorrhage, emphasised that the risk of a second, fatal haemorrhage--which in fact occurred--was immediate. He predicted that carotid ligation might be a way to reduce the risk of repeated haemorrhage from such aneurysms. Virtually unknown to modern neurosurgeons are many remarkable Nordic pioneers who, in the 1800's and early 1900's, rendered major contributions to the birth of modern neurological surgery. Thus early neurosurgical operations were performed by Carl Daniel von Haartman in Finland and by Christopher Withusen and Gundelach Møller in Denmark. von Haartman and Withusen had both visited Sir Astley Cooper in London in 1816. Vilhelm Magnus of Oslo was a neurosurgical giant, who had been trained by Victor Horsley during visits to London in 1903 and 1904. Magnus performed his first two-stage operation for a tumour located deep in the left cerebral hemisphere in 1903. By 1921, he had operated upon 112 cases of intracranial tumour with an 8.1% surgical mortality. His results were certainly fully comparable with those of his contemporary American pioneer--Harvey Cushing. Vilhelm Magnus, who worked alone under primitive conditions in small private hospitals, published altogether 70 scientific papers. In 1925 his series comprised 189 patients operated upon for brain tumours with 7.7% surgical mortality in supratentorial, and 17.8% mortality in infratentorial tumours. Magnus was congratulated on his brilliant achievements by a Swedish colleague 20 years his junior, Herbert Olivecrona, the man who was to carry on his pioneering work in Sweden.