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We have studied the ability of a range of antibiotics to penetrate intervertebral disc tissue in vitro, using a mouse disc model. Equilibrium concentrations of antibiotics incorporated into the entire disc were determined by bioassay using a microbial growth-inhibition method. Uptake was significantly higher with positively-charged aminoglycosides compared with negatively-charged penicillins and cephalosporins. Uncharged ciprofloxacin showed an intermediate degree of uptake. Our results support the hypothesis that electrostatic interaction between charged antibiotics and negatively-charged glycosaminoglycans in the disc is an important factor in antibiotic penetration, and may explain their differential uptake.

The pathogeneses of parathyroid disease in patients with uremia and nonfamilial primary parathyroid hyperplasia are poorly understood. Because of multigland involvement, it has been assumed that these common diseases predominantly involve polyclonal (non-neoplastic) cellular proliferations, but an overall assessment of their clonality has not been done. We examined the clonality of these hyperplastic parathyroid tumors using X-chromosome inactivation analysis with the M27 beta (DXS255) DNA polymorphism and by searching for monoclonal allelic losses at M27 beta and at loci on chromosome band 11q13. Fully 7 of 11 informative hemodialysis patients (64%) with uremic refractory hyperparathyroidism harbored at least one monoclonal parathyroid tumor (with a minimum of 12 of their 19 available glands being monoclonal). Tumor monoclonality was demonstrable in 6 of 16 informative patients (38%) with primary parathyroid hyperplasia. Histopathologic categories of nodular versus generalized hyperplasia were not useful predictors of clonal status. These observations indicate that monoclonal parathyroid neoplasms are common in patients with uremic refractory hyperparathyroidism and also develop in a substantial group of patients with sporadic primary parathyroid hyperplasia, thereby changing our concept of the pathogenesis of these diseases. Neoplastic transformation of preexisting polyclonal hyperplasia, apparently due in large part to genes not yet implicated in parathyroid tumorigenesis and possibly including a novel X-chromosome tumor suppressor gene, is likely to play a central role in these disorders.

Study design: A case report of Neisseria sicca/subflava discitis in a healthy elderly female. Objective: To report a rare case, which is usually seen exclusively in children. Setting: Stoke on Trent, England. Method: Case report, a 65-year-old female with a 6 month history of back and bilateral leg pain. X-rays showed collapse of L4/5 disc. No neurological deficit. Magnetic resonance imaging supported the clinical suspicion of discitis. Percutaneous biopsy followed 2 weeks later by open biopsy with bilateral root decompression was performed. Culture of L4/5 disc tissue produced Neisseria sicca/subflava. The patient was treated with a 4-week course of intravenous amoxycillin. Follow-up at 3 months confirmed clinical resolution of original symptoms. Conclusion: Any organism cultured from biopsy needs to be interpreted within the context of the clinical case. If clinical suspicion is high, further weight must be added to the finding of unusual or environmental organisms and culture of a repeat aspirate or biopsy may clarify the significance.

The causes of gastrointestinal hemorrhage in children were detailed in 1964 by Spencer. We investigated the causes of gastrointestinal hemorrhage in 165 children seen at our institution over a 13-year period. The most common causes of gastrointestinal hemorrhage in the hospitalized patients were necrotizing enterocolitis (44%), anal fissures (23%), and guaiac-positive stools of unknown cause (16%). The mortality rate was 5.4%. Necrotizing enterocolitis was the most common cause of death. Only 16 patients required surgery. Gastrointestinal hemorrhage is an infrequent cause of mortality and morbidity in hospitalized pediatric patients.

Cystic lesions of the mesentery, omentum, and retroperitoneum are rare; from 1956 to 1990, 22 patients had operative treatment for such lesions at our institution. They ranged in age from 1 month to 14 years; 75% were younger than 5 years. All had either an acute abdomen or, more commonly, a silent abdominal mass. In all cases, the histologic diagnosis was lymphangioma. Abdominal ultrasonography was done in all cases after 1977 except for two patients who had an acute abdomen requiring emergency exploration. A cystic abdominal mass was diagnosed in 94% of these cases, but the correct diagnosis of lymphangioma was made prior to surgery in only 24%. Mesenteric cysts are most common in the small bowel mesentery. Omental cysts usually occur singly and are easily resected, but multiple cysts predominate in the mesentery and retroperitoneum. Complete resection was accomplished in 82% of our cases. Two patients required partial bowel resection, and four had partial excision with marsupialization of the cysts. With a mean follow-up of 23 months, we have had three recurrences, but none necessitated reexploration. Extra-abdominal lesions, mainly cutaneous lymphangiomas, developed in two cases. Prognosis is good after surgical excision, but long-term follow-up is advisable because of the possibility of recurrence, even during adulthood.

A fracture is the bony manifestation of an injury to part of the body, usually a limb, and is necessarily associated with a soft tissue injury. The severity of the overall injury may bear little relation to, for example, the radiographic appearance of the fracture itself. The degree of disruption of the soft tissues affects the degree of interference with the blood supply of the injured area, and this is influenced by such factors as the velocity of injury.

Sir, I read with interest the article by Ng and Sell[1][1] in the May 2004 issue entitled “Predictive value of the duration of sciatica for lumbar discectomy”. It is a rigorous assessment of this much debated question, but to call it a prospective, cohort study, despite the fact that the

Structural characteristics of aged (10 days) bovine longissimus and semitendinosus muscles as affected by thermal treatment were evaluated with scanning electron microscopy (SEM) and transmission electron microscopy PEM). Steaks were oven roasted at 177°C to internal temperatures of either 63, 68, or 73°C. At 63°C both muscle samples exhibited coagulation and denaturation of the perimy-sium and sarcolemma and progressively increased to near complete coagulation and denaturation at 73°C. Well-defined myofibrillar surface features were present in semitendinosus samples at 63°C and increased sarcomere denaturation and shrinkage were observed at the higher temperatures. Whereas, the overall topographical features of longissimus myofibrils were not well-defined and exhibited a granular appearance even at 63°C. TEM of samples heated to 63°C revealed less distinct myofibrils in longissimus than in semitendinosus samples. Disintegration of filaments in the I-band and shrinkage of filaments in the A-band occurred at 63°C. Increased disintegration of actin filaments in the I-band at the junction of the Z-disc and shrinkage and disruption of the A-band material occurred as temperatures were increased. Z-disc material remained intact with some evidence of disruption at the higher temperatures. Although progressive disruption of muscle fiber ultrastructure occurred as steaks were heated to higher internal temperatures, these changes did not result in increased muscle tenderness. Instead the samples became progressively less tender as internal temperatures were increased likely due to the shrinkage and hardening of filamentous material in the A-bands. Increased disintegration of filaments in the I-band as temperature was increased apparently did not contribute to an improvement in tenderness.

Extract Auto-immune, haemolytic anacmias (AHA) of man (Dacie, 1963) and domestiicated animals (Schalm, 1965; Farrelly et al., 1966; Lapras and Oudar, 1971) are classified either as idiopathic or secondary to an underlying disease process (Pirofsky, 1969). In both categories antibodies active against the indivual's own erythrocytes are formed. These auto-antibodies are of two types being either warm or cold-acting. Warm-acting antibodies are most effective at 37°C, belong to the IgG class of immunoglobulins, and are incomplete in that, generally, they do not cause autohaemagglutination. Coldacting, or cryopathic, antibodies show maximum activitv at 4°C, are of the IgM immunoglobulin class and are capable of effecting autohaemagglutination. The two types of antibodies also differ in their prevalence. In man warm-acting antibodies occur infrequently and are always pathological (Dacie, 1963) while low titres of cold antibodies occur in most normal sera (Finland et al., 1945; Ellenhorn and Weiner, 195...

Human synovial tissues have been assayed for the production of cartilage degrading activity (CDA). This activity is thought to be homologous with catabolin/interleukin 1 (IL1) produced by porcine synovium and leucocytes and by human leucocytes. The CDA of 26 rheumatoid (RA) and 41 non-rheumatoid synovia was measured on a dry weight basis. The rheumatoid synovia showed a threefold increase in activity over the non-rheumatoid, but there was no significant overall difference on a deoxyribonucleic acid (DNA) basis. The rheumatoid synovia appeared to consist of two populations; in over half the samples CDA was not related to cellularity, but eight patients had a high CDA and a high cellularity.