Islet-activating protein (IAP) is a new active substance purified from the culture medium of Bordetella pertussis. The active protein possesses a molecular weight of 77,000 and an isoelectric point of pH 7.8. The nature of IAP-action is characterized by enhancement of insulin secretory response to glucose and other stimulants. A single injection of IAP into spontaneous diabetes rats resulted in normalization of their glucose intolerance over a period of a month. Acute and chronic animal toxicity tests showed that LD50 of IAP was 127 micrograms/kg in mice and 144 micrograms/kg in rats. After these animal experiments, phase 1 studies were designed and undertaken to establish dosage, duration of action and other factors. IAP of 0.5 micrograms/kg or 1.0 micrograms/kg did not bring about any serious toxic or adverse effects in five volunteers. On the 4th day of a single injection of IAP, insulin secretory response was proved to be enhanced. Follow-up studies showed that the IAP-action continued over a month or at most two months. Two features of IAP, i.e., the enhancement of insulin secretory response and the long duration of the action, was confirmed in healthy persons as well as in animals. As expected, IAP has a strong antigenic reaction resulting in formation of IgG antibody and possibly IgE antibody. The antigenicity of IAP causes some hindrance to clinical usefulness. For avoidance of anaphylactic reaction, IAP should be given repeatedly with care. The problem concerning antigen-antibody reaction should be overcome as soon as possible before the clinical use of IAP as a medicament.
Recently, lumbar degenerative disease with instability or malalignment has been treated using various internal fixation systems. The Simmons plating system offers the surgeon many advantages in ease and simplicity of insertion as well as safety and confidence in fixation performance and capability.In this series, fifty-nine patients with spondylolisthesis causing instability were treated using this system. Patients were followed clinically and radiographically over 16-45 months. Fusion rate was 96.4% and only one case showed a broken screw.This study obtained acceptable clinical results in most of the patients withlow back pain and leg pain. We recommend instrumental surgery using this system for treating instability caused by spondylolisthesis. We now await long term follow-up results.
Few studies describe the interrelation between the thoracic outlet syndrome (TOS) and whiplash injury. A prospective study was carried out to determine the pathogenic significance of trauma or injury to the upper body in the development of neurovascular compression at the thoracic outlet. 29 cases of cervical strain injuries (N-group), 30 cases of probable TOS with positive Morley-test alone (PT-group), and 52 patients of definite TOS with further positive Roos & wright stress test (T-group) were compared on sex, age, weight, symptom, various clinical and radiographic findings, The PT-and T-groups had more elderly patients with headache, arm numbness, lumbago, and shoulder stiffness. The history from the onset of accident, duration of symptom, and treatment indicated significant difference in the TOS patients. Radiography of TOS cases also showed a higher percentage of neck-lengh/height ratio, and demonstrated the midbottom line of T1 vertebral body at the lowest part of the cervical spine. The presence of persons susceptible to traumatic TOS should be well-understood through correct initial treatment for patients with trauma.
Femoral heads of spontaneously hypertensive rats (SHR) were investigated histologically and radiologically in comparison with those of Wistar Kyoto (WKY) rats as a control.Incidence of osteonecrosis was much higher in SHR than WKY.In the 10wks old SHR, the necrotic lesion was first seen without reparative reaction.In the SHR older than 20wks, many necrotic lesions were seen with reparative reaction.Radiographs of SHR demonstrated coxa plana and short neck in comparison with WKY.
Two cases of typical ochronotic arthropathy were reported.Case 1; A 70-year-old man had had a considerable pain in the large joints for about ten years and a gait disturbance for eighteen months. The dark pigementation was noticed in sclera and ear cartilage, and his urine turned dark when a strong alkali was added to it. The ragiological examination showed disc calcification and bamboo spine, characteristic sign of ochronotic arthropathy. And the shoulder, hip and knee joints showed marked osteoarthrosis, but not ankylosis.Case; A 71-year-old woman had low back pain and right caxalgia. The findings of sclera, ear cartilage and urine were the same as Case 1. The ragiological examination showed marked disc degeneration and calcification without vertebral fusion, and moderate osteoarthrosis in the right hip.
Myositis ossificans is a term used to describe non-neoplastic heterotopic bone formation within muscle or soft tissue. Most cases are clearly related to trauma or neuromus-cular disease. However, a circumscribed heterotopic bone formation may develop without any history of trauma. This form is quite rare and may be easily mistaken for malignant lesions. We report a clinico-pathological study of myositis ossificans developed without a history of trauma in the hand. The case; A 35-year-old man, developed swelling in the right hand with no history of injury in August 1984. A foreign body was suspected and excised with the adjacent tissue. Swelling of the affected lesion increased and he came to our hospital.
A prospective study of 110 patients was carried out to determine the pathogenic significance of trauma to the upper body in the development of neural compressive irritation at the thoracic outlet. Twenty-nine patients were reviewed as cervical strain injuries (N group), 25 patients as probable neurogenic thoracic outlet syndrome (NTOS) (PT group), 39 patients as definite NTOS (T group), and 17 patients as NTOS associated with cervical disc disease (CD-T group). The time lapse between accident and diagnosis and the duration of treatment were significantly longer in T patients or CD-T patients than those in the N group. Radiography of NTOS patients also showed a higher percentage of cervical spine-length/height ratio. Traumatic NTOS would suggest two types related to direct damage of scalene muscles that included some physical aspects of cervical disc disease. Pathogenesis provided a key to the resolution of more complex posttraumatic problems of whiplash injury.
Sciatic neurogenic motor-evoked potentials (sciatic-NMEP), spinal-evoked potentials (spinal-EP), and somatosensory-evoked potentials (SEP) were recorded in the lumbar cord during progressive ligation of segmental arteries. Relationship between electrophysiologic assessment and clinical status was studied.In 12 anesthetized dogs that had arterial ischemia of the lumbar cord produced by ligation of segmental arteries, the aforementioned evoked potentials were recorded, and their presence or absence was compared with the clinical status of repeated wake-up tests.Both sciatic-NMEP loss and ligation level producing cord ischemia were not associated with severity of wake-up test. Sciatic-NMEPs were lost earlier than spinal-EP and SEPs after progressive ligation. The false-negative rate of sciatic-NMEP, SEP at high spine and at low spine was 12.5%, 20.8%, and 41.7%, respectively. The waveform morphology of potentials by cord ischemia decreased in amplitude and in the number of peaks without a shift of latency.First, baseline NMEPs and SEPs were obtained, lumbar arteries were ligated, evoked potentials were recorded continuously, and wake-up test was administered. If sciatic-NMEPs were not lost, intercostal arteries were ligated, and potentials and clinical status were reassessed.Though these results were complicated, sciatic-NMEP was more sensitive to the spinal cord ischemia and a better predictor of clinical outcome than spinal-EP and SEP. However, the presence was not a guarantee of normal function. Somatosensory-evoked potentials are not a good predictor of clinical motor status. The initial morphologic change of these potentials secondary to ischemia consisted of a decrease in amplitude and in the number of peaks without a shift of latency.The peripheral-NMEP is a better warning system to spinal cord ischemia and its adoption may prevent cord ischemia during surgery, whereas SEP and spinal-EP can not be indicies.
We report a rare case of Osteopoikilosis associated with ichthyosis vulgaris and Crohn's disease. A 26-year-old man who was told of an “abnormal” radiograph was referred to our department. A skeletal survey was performed which revealed multiple oval and round densities measuring 3-7mm in diameter. The lesions were bilaterally situated in the epiphysio-metaphyseal region. The bones involved were the long bones and the small bones of the hands, feet, and pelvis. The ribs, skull and vertebral column were not involved. 99mTc-methylen diphosphate bone scan was performed and found to be normal. We describe here a case with osteopoikilosis, Crohn's disease and ichthyosis vulgaris. The etiology of the conditions was unknown, but we subsequently turned our attention to a possible link among these three conditions. The combination of osteopoikilosis, ichthyosis vulgaris, and Crohn's disease is considered a syndrome which is possibly inherited.
