THE ERECT LATERAL LUMBAR ROENTGENOGRAM IN THE EVALUATION OF “LOW BACK” PAIN

A study was made of the potential value of the erect lateral flexion lumbar roentgenogram in a series of 50 adults, some with symptoms of low back pain and some without such symptoms. The film was made in addition to the standard antero-posterior, lateral and sometimes oblique views taken in the recumbent position.In 11 of 37 patients with low back pain, some narrowing of lumbar discs was visible in both horizontal and erect lateral films, the degree being not significantly different between the two positions. In one patient, localized anterior narrowing of a lumbar disc, which was not visible in the recumbent lateral film, was observed. This finding was confirmed at a subsequent examination.In one of 13 patients without lumbar area symptoms, slight anterior narrowing of a lumbar disc could be seen in the erect lateral film but not in the horizontal. The reason for this is not known; it may be physiologic in this particular patient.The value of the routine erect lateral flexion lumbar roentgenogram was not confirmed by this preliminary study.     

Pneumoperitoneum in perforated peptic ulcer; factors in roentgenographic demonstration

Evidence compiled in review of data on 324 cases of perforated gastric or duodenal ulcer indicated that pneumoperitoneum is more likely to be demonstrated in roentgen films made within six hours after perforation than in films made after a longer interval. In several cases films made early did not show intraperitoneal gas and later films did. There appeared to be no constant relationship between the size of the perforation and the incidence of demonstrable pneumoperitoneum. Pneumoperitoneum was less often demonstrated in cases of posterior perforation than it was when the lesion was at an anterior site. In many cases roentgen examination was performed with the patient in both the erect and the left lateral decubitus positions. These two roentgenographic views were equally reliable and there was agreement between them in 94 per cent of the cases. Clinical factors, however, may influence decision as to which position should be used in each case. Occasionally when intraperitoneal gas is not demonstrated in one view, it may be observed in films made with the patient in the other position.     

PNEUMOPERITONEUM IN PERFORATED PEPTIC ULCER—Factors in Roentgenographic Demonstration

Evidence compiled in review of data on 324 cases of perforated gastric or duodenal ulcer indicated that pneumoperitoneum is more likely to be demonstrated in roentgen films made within six hours after perforation than in films made after a longer interval. In several cases films made early did not show intraperitoneal gas and later films did. There appeared to be no constant relationship between the size of the perforation and the incidence of demonstrable pneumoperitoneum. Pneumoperitoneum was less often demonstrated in cases of posterior perforation than it was when the lesion was at an anterior site.In many cases roentgen examination was performed with the patient in both the erect and the left lateral decubitus positions. These two roentgenographic views were equally reliable and there was agreement between them in 94 per cent of the cases. Clinical factors, however, may influence decision as to which position should be used in each case. Occasionally when intraperitoneal gas is not demonstrated in one view, it may be observed in films made with the patient in the other position.     

Cerebral vascular occlusion; angiographic diagnosis

Cerebral arterial occlusion is a fairly frequent condition. We have diagnosed nine cases by cerebroangiography in the past two years, and there are many patients not given this special examination.Precise diagnosis has become more important as advances in therapy make prognosis more hopeful. The symptoms are various according to the location and degree of occlusion and the amount of collateral circulation.Angiographic diagnosis is not difficult, but repeated demonstration of the block should be insisted on. This is best done with multiple exposures after a single injection of contrast medium. We use 7 cc. of 50 per cent Hypaque(R) and one exposure per second through the arterial, capillary and venous phases. The films should cover the entire head and neck lest an occlusion in the common carotid be overlooked. We have found the Schonander biplane apparatus very satisfactory, using films 14 inches square and exposing them in anteroposterior and lateral projections simultaneously.     

The Lateral Hypothalamus Is Involved in the Pathway Mediating the Hypotensive Response to Cingulate Cortex-Cholinergic Stimulation

1. The injection of acetylcholine (ACh) into the medial prefrontal cortex (MPFC) caused marked hypotensive response in either unanesthetized or anesthetized rats.2. The present experiment was designed to investigate anatomical connections of the ACh injection site in the MPFC with putative autonomic-related brain nuclei, as well as their possible involvement in the mediation of the hypotensive response to ACh.3. For the above purpose, the bidirectional neuronal tracer biotinylated dextran amine (BDA) was injected into Cg1 and Cg3 areas, within the MPFC of male Wistar rats. Five days later the animals were sacrificed and brain slices were processed and analyzed to determine neuronal projections efferent from as well afferent to the MPFC.4. Neuronal staining was more prominent in regions ipsilateral to the BDA injection site. Prominent efferent projections of the MPFC were observed in the contralateral MPFC; ipsi- and contralateral amygdala and hypothalamus; ipsilateral septal area, diagonal band, and zona incerta.5. Similar but not equal patterns of neuronal labeling were observed when BDA injections were performed within the two adjacent MPFC areas. BDA injections centered in the ACh injection site in the Cg3 area caused strong labeling in the septal area and diagonal band as well as an overall hypothalamic labeling. Within the hypothalamus an intense cortical projection was observed in the lateral hypothalamus (LH). BDA injections into the Cg1 area caused a more evident labeling of the amygdaloid complex.6. Neuronal cell bodies were evident throughout the MPFC as well as in the sensory-motor cortex when BDA was injected into the LH, thus indicating a massive ipsilateral cortical projection from the Cg3 to the LH.7. Bilateral NMDA-induced lesions within the LH caused a significant attenuation of the depressor responses to ACh injection in the MPFC, whereas unilateral lesions were marginally effective. These results indicate the involvement of the LH in the mediation of the hypotensive response to ACh injection into the MPFC as well as the bilateral distribution of the hypotensive pathway.     

A Case of Human Hepatic Alveolar Echinococcosis Accompanied by Lung and Brain Metastases

Alveolar echinococcosis (AE) is considered as a fatal zoonosis caused by the larvae of Echinococcus multilocularis. The lungs and brain are the most common metastatic organs. We report a human case of hepatic alveolar echinococcosis accompanied by lung and brain metastasis. In particular, the patient had a history of tuberculosis and the lung lesions were easily misdiagnosed as lung abscesses. The lesions of liver and lung underwent radical resection and confirmed as alveolar echinococcosis by pathological examination. The patient had no surgical complications after operation and was discharged after symptomatic treatment. Unfortunately, the patient later developed multiple intracerebral AE metastases. We required the patient to take albendazole orally for life and follow up.     

Discontinuation of cervical spine immobilisation in unconscious patients with trauma in intensive care units--telephone survey of practice in south and west region.

OBJECTIVE: To study how the cervical spine is assessed before discontinuation of cervical spine immobilisation in unconscious trauma patients in intensive care units. DESIGN: Telephone interview of consultants responsible for adult intensive care units. SETTING: All 25 intensive care units in the South and West region that admit victims of major trauma. MAIN OUTCOME MEASURES: The clinical and radiological basis on which the decision is made to stop cervical spine immobilisation in unconscious patients with trauma. RESULTS: In 19 units cervical spine immobilisation was stopped in unconscious patients on the basis of radiology alone, and six units combined radiology with clinical examination after the patient had regained consciousness. Sixteen units relied on a normal lateral radiological view of the cervical spine alone, five required a normal lateral and anteroposterior view, and four required a normal lateral, anteroposterior, and open mouth peg view. CONCLUSIONS: There are inconsistencies in the clinical and radiological approach to assessing the cervical spine in unconscious patients with trauma before the removal of immobilisation precautions. There is an overreliance on the lateral cervical spine view alone, which has been shown to be insensitive in this setting.     

On the variability of velopharyngeal valve anatomy and function: a combined peroral and nasendoscopic study.

The oropharynx stripped of the tonsils and the excessive mucosal folds after the uvulopalatopharyngoplasty operation allows a closed observation of the outline of the pharyngeal muscles. Forty-two consecutive patients undergoing uvolopalatopharyngoplasty were subjected to peroral examination of the oropharynx combined with nasendoscopic examination of the velopharyngeal valve. At rest, the oropharynx of the patients with coronal closure patterns was found to be flat relative to the oropharynx of the patients with the other closure patterns. During closure of the velopharyngeal valve, an anteroposterior movement of the velum, forming the nasendoscopic coronal closure pattern, was observed in patients with a flat oropharynx. On the other hand, a medial movement of the pharyngeal walls was found, forming the circular or sagittal closure pattern seen in patients with a deep oropharynx. Our conclusion is therefore that a different muscular orientation is responsible for both the different pharyngeal configuration at rest and the different contribution of the lateral and posterior pharyngeal walls to velopharyngeal valve closure.     

Orientation of wheat seedling organs in relation to gravity

Seedlings of wheat (Triticum aestivum L.) were grown in special holders that permitted the coleoptile and early roots to develop in moist air. The orientation of the organs of seedlings erect to gravity was compared with that of organs produced on a horizontal clinostat. Orientation was described by the angular position of each organ tip with reference to the axis of the embryo. Comparative tests were also made with barley, rye, and oat seedlings.

The coleoptile of all species developed curvatures in 3 dimensions when geotropic responses were eliminated. The primary root was not precise in its positive geotropism. Seedlings grew on clinostats with much greater variations in the lateral orientation of the central root and with a tendency for it to curve away from the endosperm to a greater degree than in erect seedlings.

The symmetry of root system in wheat was found to depend on a specific mechanism. Under the influence of gravity the earliest lateral roots were oriented in a plane at characteristic angles of about 57.5° with the ideal primary root. The corresponding angles for lateral roots growing on clinostats were greater by about 47.5° as a result of epinasty not previously reported in roots. This force also appeared to be active in the seminal roots of barley and rye but not of oats.

The curvatures in coleoptiles grown without the directional effects of gravity correspond to the results of growth imbalance in Coleus stems in the absence of lateral transport of their auxin by gravity. Root epinasty appears to be based on auxin imbalance. Curvatures in the primary root are also interpreted as results of asymmetrical distribution of growth hormone.

     

The area octavo-lateralis in Xenopus laevis

Summary Central projections of afferents from the lateral line nerves and from the individual branches of the VIIIth cranial nerve in Xenopus laevis and Xenopus mülleri were studied by the application of HRP to the cut end of the nerves.Upon entering the rhombencephalon, the lateral line afferents form a longitudinal fascicle of ascending and descending branches in the ventro-lateral part of the lateral line neuropile. The fascicle exhibits a topographic organization, that is not reflected in the terminal field of the side branches. The terminal field can be subdivided into a rostral, a medial and a caudal part, each of which shows specific branching and terminal pattern of the lateral line afferents. These different patterns within the terminal field are interpreted as the reflection of functional subdivisions of the lateral line area. The study did not reveal a simple topographic relationship between peripheral neuromasts and their central projections.Two nuclei of the alar plate with significant lateral line input were delineated: the lateral line nucleus (LLN) and the medial part of the anterior nucleus (AN). An additional cell group, the intermediate nucleus (IN), is a zone of lateral line and eighth nerve overlap, although such zones also exist within the ventral part of the LLN and the dorsal part of the caudal nucleus (CN). Six nuclei which receive significant VIIIth nerve input are recognized: the cerebellar nucleus (CbN), the lateral part of the anterior nucleus, the dorsal medullary nucleus (DMN), the lateral octavus nucleus (LON), the medial vestibular nucleus (MVN) and the caudal nucleus (CN).All inner ear organs have more than one projection field. All organs project to the dorsal part of the LON and the lateral part of the AN. Lagena, amphibian papilla and basilar papilla project to separate regions of the dorsal medullary nucleus (DMN). There is evidence for a topographic relation between the hair cells of the amphibian papilla (AP) and the central projections of AP fibers. The sacculus projects extensively to a region between the DMN and the LON. Fibers from the sacculus and the lagena project directly to the superior olive. Fibers from the utriculus and the three crista organs terminate predominantly in the medial vestibular nucleus (MVN) and in the adjacent parts of the reticular formation, and their terminal structures appear to be organotopically organised. Octavus fiber projections to the cerebellum and to the spinal cord are also described.     

The erect abdominal radiograph in the acute abdomen: should its routine use be abandoned?

The value of erect and supine abdominal radiographs and erect chest radiographs was analysed prospectively in 102 consecutive patients admitted to hospital with acute abdominal symptoms. The radiographs were reported on initially by junior surgeons of the admitting team, special note being made of the value of the erect abdominal radiograph over the combination of the supine abdominal radiograph and erect chest radiograph. On the basis of information obtained from the erect abdominal radiograph alone no changes in patient management were recorded. A consultant radiologist reported on the same radiographs at a later date. In five cases the erect abdominal radiograph was thought to have contributed useful or additional information, although in four of these cases abnormal features were visible in the supine film. In three of the five cases important but subtle information was missed by junior surgeons. In five of the 102 patients information obtained from the erect abdominal radiograph was potentially misleading. The small yield of positive information, potentially misleading features, and lack of effect on surgical management suggest that the routine use of the erect abdominal radiograph in the acute abdomen should be abandoned.     

The development of the hindbrain afferent projections in the axolotl: evidence for timing as a specific mechanism of afferent fiber sorting

The aim of this study is to reveal the timing and growth pattern of central octavolateral projection development in the Mexican axolotl, Ambystoma mexicanum. In this amphibian species the development of the inner ear occurs first, followed by mechanosensory lateral line organs, and finally by ampullary electroreceptors. Several hypotheses have been proposed about how the development of peripheral organs, including differential projections of the ear, might relate to the development of central projections. Our data suggest that the sequence of maturation of the ear, mechanosensory lateral line, and ampullary electroreceptive organs is closely accompanied by the timed development of the trigeminal, inner ear, mechanosensory lateral line organs, and the ampullary electroreceptor afferent projections in the axolotl. Our data suggest that segregation of central termination within the alar plate is a function of time and space: later forming organs are likely innervated by later forming ganglia that project centrally later and to more dorsal areas of the alar plate that have not yet received any other afferents. Later forming ganglia of the same type may grow along existing pathways of earlier formed neurons.     

Comparative view of the central organization of afferent and efferent circuitry for the inner ear

In all vertebrates, eighth nerve fibres from the inner ear distribute to target nuclei situated in the dorsolateral wall of the rhombencephalon. In amniotes, primary auditory and vestibular nuclei are readily delineated in that acoustic nuclei lie dorsal and sometimes rostral to vestibular nuclei. Fishes and aquatic amphibians have, in addition to labyrinthine organs, hair cell receptors in the lateral line system. Eighth nerve and lateral line fibres from these sense organs project to the octavolateralis region of the rhombencephalon. In this region, the primary nuclei cannot be easily divided into functionally distinct units. However, modality-specific zones seem to be present for auditory as well as lateral line projections lie dorsal and sometimes rostral to those from vestibular organs. Projections from the primary auditory and vestibular nuclei to higher order centres follow pathways which are conservative in their architecture among vertebrates. Ascending auditory fibres project either directly or via relay nuclei to a large midbrain center, the torus semicircularis (inferior colliculus) and hence to the forebrain. In fishes and aquatic amphibians, the lateral line system also sends a projection to the midbrain and information from this system may be integrated with auditory input at that level. The organization of vestibulospinal and vestibulo-ocular pathways shows little variation throughout vertebrate phylogeny. The sense organs of the inner ear of all vertebrates and of the lateral line system of anamniotes receive an efferent innervation. In anamniotes and some reptiles, the efferent supply originates from a single nucleus (Octavolateralis Efferent Nucleus) while that of "higher" vertebrates arises from separate auditory and vestibular efferent nuclei. The biological significance of this innervation for all vertebrates is not yet understood. However, an important feature common to all is the association of the efferent system with the motor centres of the hindbrain.     

THE APPLICATION AND EVALUATION OF PERITONEOSCOPY

Peritoneoscopic examination has now been accepted throughout the world as a safe diagnostic procedure in lieu of laparotomy in selected cases.Laparotomies for diagnostic purposes alone should be condemned.Peritoneoscopy should not be done without a definite purpose and the procedure should not be expected to accomplish more than the purpose for which it is done. Indications for the procedure are set forth in detail. Experience has established definite contraindications, which are reviewed.The procedure is especially indicated for patients who are aged, emaciated, anemic, or poor surgical risks for any reason.All patients having ascites of undetermined cause should be examined by peritoneoscopy.The method is especially indicated for examination of patients with liver disease of all types, for pelvic examinations, for use to determine existence of ectopic pregnancy, and for tumor localization.Considerable use was made of the procedure during World War II to determine the extent and site of intra-abdominal injuries caused by crushing, explosions, and falls from high places.The procedure permits early and correct diagnosis, early decision as to the advisability of operation, and determination as to operability in cases of malignant gastric lesions. It is a safe method for obtaining biopsy specimens from intra-abdominal tissue and organs.Accuracy of diagnosis in cases in which the method can be used is considerably greater with peritoneoscopic examination than with clinical information alone.     

Preliminary description of lesions in juvenile largemouth bass injected with largemouth bass virus

Juvenile largemouth bass Micropterus salmoides were intraperitoneally injected with largemouth bass virus (LMBV), a member of the genus Ranavirus, family Iridoviridae. Moribund fish which had been injected with 10(6.2) tissue culture infectious doses, 50% endpoint (TCID50), were sampled 4 d after injection; other largemouth bass injected with this dose died between 3 and 5 d after injection. Fish injected with 10(2.8) TCID50 of LMBV were also examined after 4 d and had lesions similar to those of fish injected with the high dose. Clinical signs included darker pigmentation, inflammation and necrosis at the site of injection, distended abdomen, corkscrew swimming, and lateral recumbency. Internally, fish had focally pale livers, bright red spleens and reddened intestinal ceca. Histologically acute fibrinous peritonitis affected the surface of all organs in the peritoneal cavity, but deeper portions of organs appeared normal. There was also necrosis of the gastrointestinal mucosa. Except for the injection site, lesions were confined to the peritoneal cavity.     

Spontaneous lesions in cynomolgus monkeys used in toxicity studies.

Spontaneous lesions in wild-caught, laboratory-maintained cynomolgus monkeys used in drug-toxicity studies were examined histopathologically in an effort to better distinguish toxic changes from spontaneous lesions and assess the toxicity of drugs more exactly. In the liver and kidney, where toxic changes are observed frequently, many spontaneous lesions were observed. Infiltration of mononuclear cells, vacuolization of the hepatocytes, dilatation of the renal tubules, and vacuolization of the renal epithelia were observed at a relatively high frequency. It is considered important to examine these changes carefully, because they closely resemble the changes recognized as toxic. Deposition of brownish pigment was observed in various organs such as the liver, kidney, spleen, intestinal tract, lung and brain, however the type of pigment differed among the organs, and histochemical examination revealed anthracosis or accumulation of hemosiderin, or melanin. Since the monkeys were caught in the wild, many parasitic lesions were observed especially in the large intestine and liver. Helminthous worms were frequently observed in the granulomas in the large intestine, however, no parasites were observed in the granulomas in the liver. Such lesions in the liver may be misinterpreted as toxic changes, when only scars or inflammatory lesions are observed.     

Mitosis and body patterning during morphallactic development of palleal buds in ascidians

Spatiotemporal distribution of mitosis and anteroposterior body patterning during morphallactic development of palleal buds in the ascidian, Polyandrocarpa misakiensis, have been studied histologically in the presence or absence of 1.5 mM colchicine. Local cell division became evident at the proximal end of the inner, atrial epithelium of 1.5-day intact buds. This and other histological evidence showed that the primary cell activation took place at that region. In 2-day intact buds, mitotic activity spread out from the proximal end toward the lateral epithelial wall that had the lower (more anterior) positional information, referred to as the secondary cell activation. These primary and secondary activation sites were the presumptive domains of the gut and pharyngeal rudiments which specified the anteroposterior body pattern of a bud. Surgical manipulations to induce the reversal of bud polarity caused the conversion of the secondary activation site and of the pharyngeal domain, but had no effect on the primary cell activation. Thus, positional information in ascidians contributes to the formation of the pharynx by specifying the secodary cell activation site. On the other hand, a large discontinuity in positional information enhanced the primary cell activity. When two positional information gaps were constructed in a single bud, the primary cell activation occurred at two sites, resulting in an additional gut rudiment. The results of this study are discussed in the context of the possible basic mechanism that the budding in ascidians shares with epimorphic fields.     

A Case of Cutaneous Mycosis Caused by <Emphasis Type="Italic">Scedosporium dehoogii</Emphasis> on an Immunocompromised Patient

This report describes a 77-year-old man with cutaneous mycosis caused by Scedosporium dehoogii while taking oral betamethasone and tacrolimus for the treatment of rheumatoid arthritis. At examination in our clinic, the patient had multiple cystic lesions and nodules with slight tenderness, varying in size up to 4 cm, on his left knee and shin. He had not noticed any traumatic injury at the site of the lesions. Fungal cultures of samples taken from the abscesses, scales, and crusts of the lesions yielded white, later grayish brown, fluffy surfaced colonies. Partial sequencing of the β-tubulin gene confirmed the species of the isolate. The patient was initially treated with oral voriconazole and local hyperthermia, but experienced hepatic injury 2 weeks later. His treatment was changed to itraconazole (ITC) and local hyperthermia, followed by a combination of ITC and terbinafine. The patient recovered completely during the 12-month course of treatment.     

Regulation of dally, an integral membrane proteoglycan, and its function during adult sensory organ formation of Drosophila.

In Drosophila, imaginal wing discs, Wg and Dpp, play important roles in the development of sensory organs. These secreted growth factors govern the positions of sensory bristles by regulating the expression of achaete-scute (ac-sc), genes affecting neuronal precursor cell identity. Earlier studies have shown that Dally, an integral membrane, heparan sulfate-modified proteoglycan, affects both Wg and Dpp signaling in a tissue-specific manner. Here, we show that dally is required for the development of specific chemosensory and mechanosensory organs in the wing and notum. dally enhancer trap is expressed at the anteroposterior and dorsoventral boundaries of the wing pouch, under the control of hh and wg, respectively. dally affects the specification of proneural clusters for dally-sensitive bristles and shows genetic interactions with either wg or dpp signaling components for distinct sensory bristles. These findings suggest that dally can differentially regulate Wg- or Dpp-directed patterning during sensory organ assembly. We have also determined that, for pSA, a bristle on the lateral notum, dally shows genetic interactions with iroquois complex (IRO-C), a gene complex affecting ac-sc expression. Consistent with this interaction, dally mutants show markedly reduced expression of an iro::lacZ reporter. These findings establish dally as an important regulator of sensory organ formation via Wg- and Dpp-mediated specification of proneural clusters.