Total resection procedure (Mikulicz) was performed in 27 patients under 10 years of age with typical congenital muscular torticollis. Postoperative clinical assessment was carried out in 20 of these 27 patients. Resected sternomastoid muscles were studied histologically in 14 other patients. The operative procedures and histological findings were compared in a discussion of the relative values of conservative and operative treatment. Neck contracture due to torticollis improved immediately after operation and no recidivations followed. Skeletal deformity of the face and spinal column completely subsided within two or three years after the operation. Plagiocephaly remained and seemed not to be directly related to the torticollis. There were no patients with scar formation such as disfiguration or keratosis. Subcutaneous adhesion probably of the platysma with the deeper layer was palpable in three patients, but did not affect the clinical course. Accessory nerve injury during operation occurred in one patients, causing slight weakness of the trapezius muscle. On the other hand, disappearance of the sternomastoid muscle relief was cosmetically acceptable subjectively and objectively. The resected sternomastoid muscle in 14 patients with typical congenital muscular torticollis were studied histologically in specimens sectioned longitudinally. Hematoxylin-eosin, Masson's and van Gieson's stains were used and the distribution of the fibrosis throughout the muscles was examined. Fibrous changes were detected in almost the whole length and breadth. The changes were similar in all operated patients, although the ages were different. The findings by naked eye examination were usually less than those by histological examination. This follow-up study confirmed that total resection procedure gives good clinical results of congenital muscular torticollis. Histological studies suggested the need for removal of the fibrous changes involving the whole muscular tissue, as such changes can lead to recidivations.
The isolation of monocytes in human peripheral blood by discontinuous density gradients was studied. Discontinuous density gradients were obtained by successive layering of bovine serum albumins into three layers in 10ml glass tubes. Buffy coat cells were layered on top of a gradient and centrifuged under various conditions of centrifugation. Optimal isolation was achieved by centrifugation on a three layer of 35-32-28% bovine serum albumin at 490g for 60 minutes. The purity, yield and recovery of monocytes at the interface between 35% and 32% bovine serum albumin were 54.0%, 7.0×10(5) and 22.0% respectively. After centrifugation on Conray-Ficoll mixtures, the interface fraction containing lymphocytes was removed and the bottom fraction containing monocytes and other cells was centrifuged under various condition. The optimal condition was on a three layer of 35-32-28% bovine serum albumin at 400g for 40 minutes. The purity of monocytes by this method increased to 75% but the yield and recovery declined to 2.5×10(5) and 4.5% respectively. From these data I concluded that isolation of monocytes from blood only on density gradients was difficult because of a partial overlap between monocytes and lymphocytes in the density distribution profiles.
In order to clarify the pulmonary involvement in rheumatoid arthritis (RA), bronchoalveolar lavage (BAL) was performed in 52 RA patients, in conjunction with pulmonary function test (PFT) and high-resolution CT (HRCT) of the chest. The results were as follows: 1. Out of nine RA patients with no evidence of lung involvement on HRCT, six (66.7%) showed abnormal differentials of the cells obtained through BAL. 2. RA patients with advanced interstitial lung disease on HRCT had significantly higher BAL fluid (BALF) cellular concentrations, increased percentage of BALF neutrophils and decreased BALF CD 4/CD 8 ratio, as compared with those with no or mild lung involvement. 3. In the non-smoking RA patients who also demonstrated no obstructive patterns on PFT, positive correlations were observed between %VC and the BALF CD4/CD 8 ratio (R = 0.481) as well as the BALF CD4+Leu8- (helper T) cell ratio (R = 0.497). On the other hand, a negative correlation was detected between %VC and the BALF CD8+CD11b- (cytotoxic T) cell ratio (R = -0.533). 4. In those with the increased percentage of BALF eosinophils and/or with increased BALF CD4/CD8 ratio, V25/Ht was depressed significantly, as compared with other patients. Likewise, those with severely depressed value of V25/Ht tended to have significantly elevated BALF CD4/CD8 ratio, as compared with other patients with normal V25/Ht value. Thus, through these detailed studies of BAL cellular differentials and BALF lymphocyte subsets, the diversity of pulmonary involvement was well demonstrated in RA.
Most follow-up studies of patients with rheumatoid arthritis demonstrate no increase in the incidence of cancer apart from approximate doubling of the incidence of lymphoproliferative malignancies. A consecutive series of 1832 Japanese patients with rheumatoid arthritis seen at the center was studied to determine their cancer morbidity. Overall, 35 cancers were diagnosed in the series from 1982 through 1995 and were not significantly in excess of the expected number. No association was found between rheumatoid arthritis and subsequent development of cancer at any site, either.
