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We evaluated the construct validity of the Musculoskeletal Tumour Society rating scale (Enneking score) as a functional measure for patients with sarcoma involving the upper limb. We compared the Enneking score by examining the correlation between two patient-derived outcome measures, the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Medical Outcomes Study Short Form-36 (SF-36) as indicators of functional status in 40 patients with malignant or aggressive benign bone and soft-tissue tumours of the upper limb who had undergone surgical treatment. The frequency distributions were similar among the three scoring systems. As for the validity, Spearman’s rank correlation coefficient of the Enneking score to the DASH questionnaire was −0.79 and that of the Enneking to the SF-36 subscales ranged from 0.38 to 0.60. Despite being a measure from the surgeon’s perspective, the Enneking score was shown to be a valid indicator of physical disability in patients with malignant or aggressive benign tumours of the upper limb and reflected their opinion.

Thirty-five patients with prostate cancer were examined for micrometastases to the bone marrow using reverse transcription-polymerase chain reaction (RT-PCR) with primers specific for the prostate-specific antigen (PSA) gene. Of nine patients with bone metastases detectable by bone scan imaging, five patients had PSA mRNA expression in the bone marrow detectable by RT-PCR. Of 26 patients with negative bone scan findings, seven patients had PSA mRNA expression detectable in the bone marrow. RT-PCR could detect micrometastatic prostate cancer cells in the bone marrow that were not detectable by bone scan imaging. Of 16 patients with a serum PSA concentration of 25 ng ml(-1) or greater, only nine (56.3%) had bone metastases detected by bone scans. Of the remaining seven patients, five had micrometastases to the bone marrow detected by RT-PCR. Overall, 14 of 16 patients (87.5%) with a serum PSA concentration of 25 ng ml(-1) or greater had metastatic bone diseases including bone marrow micrometastases. Of 19 patients with a serum PSA concentration of less than 25 ng ml(-1), two (10.5%) had only micrometastatic disease detected by RT-PCR. A significant correlation was observed between the incidence of bone involvement and the serum PSA concentration. This study suggests that RT-PCR will potentially develop into a relevant tool to assess bone involvement including bone marrow micrometastases and establish a precise correlation between serum PSA concentration and metastatic bone disease in patients with prostate cancer. Images Figure 1

We reviewed 10 patients with symptomatic malunion of a carpal scaphoid fracture. All had displacement with dorsiflexed intercalated segment instability, and suffered from pain, restricted range of movement at the wrist and decreased grip strength. The restriction of flexion-extension and the decreased grip strength correlated with the severity of the DISI deformity. Seven patients had a corrective osteotomy, using an anterior wedge-shape bone graft with internal fixation by Herbert screw, and all had satisfactory results. We believe that symptoms associated with scaphoid malunion are related to consequent carpal deformity.

The ability of single-injection radiocarpal arthrography and magnetic resonance imaging (MRI) to detect full-thickness tears of the triangular fibrocartilage were compared with wrist arthroscopy in 102 patients with wrist pain. The sensitivity of arthrography was 85%, and of MRI was 73%. Specificity was 100% for arthrography and 72% for MRI. Accuracy was 92% for arthrography, and 73% for MRI. Although future advances in MRI technology will probably improve its usefulness, single-injection wrist arthrography currently is superior to routine MRI for the detection of full-thickness triangular fibrocartilage tears.

To assess the reliability of the size-overestimation ratio obtained from spiral CT arterial portography (CTAP) and spiral equilibrium-phase CT (EPCT) in distinguishing malignant focal hepatic lesions from benign ones.The CTAP images and EPCT images obtained five minutes after CTAP in 39 patients with focal hepatic lesions were retrospectively analyzed. Fifty-eight lesions (hepatocellular carcinoma [HCC], 33; metastasis, 10; liver cyst, 10; cavernous hemangioma, 2; adenomatous hyperplasia [AH], 2; focal nodular hyperplasia [FNH], 1) had their sizes measured on CTAP and EPCT images using the calipers on the CT console.The size-overestimation ratios (CTAP/EPCT) were 1.24+/-0.15 in HCC, 1.28+/-0.26 in metastasis, 1.02+/-0.23 in liver cyst, 0.98+/-0.34 in cavernous hemangioma, 0.94+/-0.39 in AH, and 1.00 in FNH. Mean size-overestimation ratios for benign- and malignant-lesion groups were 1.00+/-0.37 and 1.25+/-0.18, respectively (p0.0001). When a cutoff level was set at 1.05, sensitivity and specificity for malignancy were 91% and 93%, respectively.In comparison with EPCT, CTAP significantly overestimates the size of malignant hepatic tumors. This phenomenon may be an indicator of hepatic malignancy.

A 37-year-old woman with severe aplastic anemia underwent allogeneic bone marrow transplantation following cyclophosphamide (CY) and total lymphoid irradiation (TLI). On day +30, a CT scan was carried out because of a mild elevation in liver enzymes, and it revealed a low density area with a sharp border in the left lobe corresponding to the irradiated area. MRI showed a hypersignal intensity on both T1 and T2-weighted images and suggested that hepatic damage was mainly severe fatty change. These abnormalities resolved with no treatment. CY with TLI for adult patients with severe aplastic anemia may induce hepatic injury.

A retrospective review of 28 patients with 29 trans-scaphoid perilunate dislocations who underwent open reduction and Herbert screw fixation is presented. The majority of the patients had satisfactory results at 24 months of follow-up. A significantly better range of wrist motion was obtained in postoperative patients treated with cast immobilization for 4 weeks compared with those treated for longer than 5 weeks. The scaphoid fractures united well, with proper alignment of the carpal bones, regardless of the length of cast immobilization. We recommend open reduction, internal scaphoid fixation using a Herbert screw, carpal ligament repair and early cast removal in the management of trans-scaphoid perilunate dislocations.

A 78-year-old man presented huge hydronephrosis with a calculus in the left kidney, and underwent left nephroureterectomy under the diagnosis of renal pelvic and ureteral tumor. Histological examination disclosed renal pelvic and ureteral tumors featuring mixed histologic types of carcinoma. Magnetic resonance (MR) imaging was superior to computed tomography (CT) in its complete, detailed demonstration of the renal pelvic lesions. The imaging characteristics of CT, MR imaging, ultrasonography, and retrograde ureterography were discussed in the report.

2D-TOF MR angiographies were performed in seven patients of liver cirrhosis with hepatocellular carcinoma to investigate three-dimensional anatomical relationships of the right hepatic vein and first order of right portal vein branch. The puncture course was set up in three-dimensional rectangular coordinates, and the bend angle and turning angle of the modified Ross needle, and puncture distance were calculated of the data measured on the A-P and L-R projection images of MR angiograms. The utility and limitation of 2 D-TOF MR angiography to determine the puncture course on TIPS were discussed in this study.

A case of hilar lung adenocarcinoma was treated by superselective bronchial arterial infusion therapy with cisplatin and epirubicin hydrochloride, mitomycin C-iohexol-Lipiodol emulsion (EMILE) using Tracker -18 infusion catheter. The tumor size was reduced on follow-up CT scans. However, EMILE was also distributed to nontumorous lung tissues around the tumor, and a shrinkage of the right upper lobe and elevations of the right hilus and diaphragm followed. No major complaints and clinical complications during and after the treatment occurred. This therapy was safe and effective for local tumor reduction in a case of hilar lung adenocarcinoma.

Thirty-seven joints in 36 patients with a fractured carpal scaphoid were evaluated by three-phase bone scintigraphy. They were classified into two groups according to their progress. Some were in good clinical condition and some in a non-union condition. Increased blood flow in the radial arteries and ample perfusion on and around the scaphoid bones on blood flow images suggested a good clinical course. The activity and the effectiveness of remodeling correlated well with the degree of scaphoid uptake on blood pool images taken more than seven days after the injury. Scaphoid uptake was more localized or there was almost none on blood pool images in cases with nearly complete recovery while it was amply visualized on static images. Blood pool images were indispensable for analyzing lesions and evaluating the clinical course. Two typical findings of scaphoid fractures were found on both blood pool and static images. One was diffusely increased scaphoid uptake seen in cases with a good clinical course, and the other was decreased uptake at proximal fragments seen in cases with non-union. It is concluded that three-phase bone scintigraphy provides useful information for evaluating the process of scaphoid fractures which cannot be obtained by means of conventional bone scintigraphy.

The thumb is a mechanical unit consisting of strong ligaments and dynamic muscles, providing the resistance to the fingers and palm during pinch and grip. Each thumb joint has a mechanical equivalent that helps explain elements of thumb stability. The trapeziometacarpal joint is potentially the most unstable but has adapted to its unique position by special joint geometry and, in particular, a combination of support ligaments that permit a wide range of motion yet stability. New anatomic and mechanical studies demonstrate the key support structures that must be duplicated by reconstructive surgical procedures if thumb stability is to be maintained.

On the basis of their biological properties (cell morphology, staining reaction, cellular inclusions, guanine plus cytosine content of deoxyribonucleic acid, genome size, degree of deoxyribonucleic acid homology with Corynebacterium diphtheriae [Approved Lists, 1980] strain PW8, pattern of enzymic capacities) and chemical structures (peptidoglycan type, major cell wall polysaccharide, characteristic fatty acids, major phospholipids and glycolipids), two brevibacteria are transferred to the genus Corynebacterium. Brevibacterium vitarumen (Bechdel, Honeywell, Dutcher, and Knutsen) Breed (Approved Lists, 1980) is transferred as Corynebacterium vitarumen (Bechdel, Honeywell, Dutcher, and Knutsen) comb. nov., and Brevibacterium liquefaciens Okabayashi and Masuo (Approved Lists, 1980) is transferred as Corynebacterium liquefaciens (Okabayashi and Masuo) comb. nov.

Deoxyribonucleic acid relatedness between Mycobacterium leprae or Mycobacterium lepraemurium and other selected bacteria was studied by both dot blot and spectrophotometric deoxyribonucleic acid hybridization assays. The results obtained by the two methods were similar, except for the relatedness values between M. leprae and two corynebacterial strains. Among the mycobacterial species examined, acid-fast organisms isolated from armadillos and a mangabey monkey with leprosy-like disease showed 100% relatedness with M. leprae grown experimentally in armadillos, suggesting their common origin. In this study we demonstrate the usefulness of the dot blot hybridization technique as a screening method for mycobacterial taxonomy.

Relatively stable L-phase colonies were isolated from old cultures of a selected clone of Mycobacterium phlei. The colonies grew at 52 degrees C and were composed of rod-shaped, oval or spherical cells. Large amoeba-like cells were occasionally present. These were usually limited by a double-layered membrane and devoid of normal cell-wall components such as bacteriophage receptors. The large amoeba-like bodies sometimes showed both outer and inner double-layered membranes, especially in pseudopodium-like cellular extensions. An unusual feature of rod-shaped cells was retention of the original shape despite the loss of their cell walls. Two types of walled cells occurred during successive transfers of L colonies. One was the true revertant which had characteristics in common with the wild-type M. phlei, such as growth at 52 degrees C and ultrastructural organisation. The other, designated as the "atypical-cell-wall variant", was characterised by growth at 52 degrees C, thick cell walls, and disordered septation. Wild-type M. phlei, L variants, revertants and atypical-cell-wall variants released mycobacteriophage particles. These bacteriophages were almost identical in respect to morphology, host range, and neutralisation by antiserum. The results obtained suggest strongly that all types of cells examined were derived from M. phlei.

Bulk chromosomal deoxyribonucleic acids (DNAs) of Mycobacterium smegmatis strains 607+ (wild type) and 607-1 (Strr) and orange-red pigmented variants (OR) were separated into two distinct bands (types 1 and 2) by cesium chloride density gradient centrifugation. Thermal denaturation analyses showed that type 1 and 2 DNA fragments of these strains possessed guanine plus cytosine contents averaging 69.2% and 60.8%, respectively. Type 1 and 2 DNAs from all strains tested were recovered in relatively equal quantities upon isolation and were found to have similar molecular weights (3.0 x 10(7)). Spectrophotometric assay of DNA reassociation showed that homology between any type 1 and 2 DNA fragments was always very low (29 to 33%), even within the same strain. Homologies among type 1 DNAs isolated from any strain were always high (92 to 98%), whereas homologies between type 2 DNA isolated from OR strains and that from their parental strain 607-1 were lower (51 to 55%). Transformation experiments revealed that methionine, leucine, folic acid, and streptomycin markers were found exclusively in type 1 DNA fragments. In addition to the two types of chromosomal DNA, plasmid DNA possessing a molecular weight of about 4 x 10(6) was found in strain 607-1.

Summary Heat-killed whole cells, purified cell walls, and the three main polymers isolated from cell walls of Mycobacterium sp. atcc 607, M. smegmatis atcc 14468 and M. phlei atcc 11758, were examined to find the receptor sites for phage GS-7. Among heat-killed whole cells of insusceptible species, M. smegmatis adsorbed the phage at a higher rate than the susceptible Mycobacterium sp. atcc 607, whereas M. phlei did not adsorb the phage at all, suggesting a distinction between phage-resistance (absence of receptor) and phage-immunity (presence of both receptor and repressor). Each of the three polymers of the cell wall (the lipopolysaccharide of the outer layer, the lipopolysaccharide-lipoprotein complex of the middle layer and the lipopolysaccharide-mucopeptide or mucopeptide complex of the inner layer) contain receptor substances. The lipopolysaccharide moiety isolated from the lipopolysaccharide-lipoprotein complex adsorbed phage at the same rate as the whole complex; implying that the possible receptor substances were the lipopolysaccharide moieties of the three polymers. Delipidation of both cell wall and the lipopolysaccharide-mucopeptide complex resulted in a loss of phage-adsorbing capacity, suggesting that the lipid portion of the lipopolysaccharides may constitute the phage receptors.

SUMMARY: A study of the ultrastructural characteristics, the physiological properties and an analysis of hydrolysates of phenol-treated cell walls of Corynebacterium rubrum were made. While the arabinogalactan-peptidoglycan complex found in the cell-wall hydrolysates was that common to the genera Corynebacterium, Mycobacterium and Nocardia, the ultrastructural patterns found, the physiological reactions observed, the sensitivity to nocardiophages but not to corynebacteriophages or mycobacterial phages, and the (previously reported) presence of nocardomycolic acids, combined with the absence of corynemycolic acids and mycolic acids, indicate that this species belongs in the genus Nocardia rather than in the genus Corynebacterium. It is proposed, therefore, that Corynebacterium rubrum be renamed Nocardia corynebacteriodes nomen novum.

Deoxyribonucleic acid of Mycobacterium lepraemurium grown in mice was isolated and analyzed spectrophotometrically. The genome molecular weight and guanine-plus-cytosine content of this M. lepraemurium deoxyribonucleic acid were 1.8 × 109 and 65.5 mol%, respectively. Among selected strains of mycobacterial species, four strains of Mycobacterium avium showed the highest degree of deoxyribonucleic acid homology (74.2 to 92.9%) with M. lepraemurium, suggesting a close genetic relatedness.

Mycobacterium smegmatis, its orange-red – pigmented (OR) variants, and back mutant strains were examined by electron microscopy using ultrathin sectioning, negative or positive staining, and freeze-fracture – etching methods. The parental and back mutant strains showed almost identical ultrastructures. Specifically, thick ramified fibers measuring about 15 nm in diameter were always visible in the positively stained cell wall, although they were not readily visualized with negative staining or freeze-fracture-etching. In contrast, the cell walls of OR variants contained fibrous networks measuring about 11 nm in diameter, which could be observed by positive and negative staining as well as freeze-fracture-etching. Although cytoplasmic structures appeared similar among the four strains examined, mesosomes were significantly more abundant in the OR variants. The basal layer of the cell wall obtained as a phenol residue consisted of a dense membranous matrix containing scattered fibrous structures in the parental and back mutant strains, and fibrous networks in the OR variants. Chemical analyses showed that the basal layers of all four strains contained the same neutral sugars, amino sugars, and amino acids, i.e., arabinose, galactose, muramic acid, glucosamine, alanine, glutamic acid, and diaminopimelic acid. The α-branched β-hydroxylated fatty acids contained in the basal layers differ among the four strains, however, with nocardomycolic acids being present in the OR variants and mycolic acids in the parental and back mutant strains. Our previous conclusion that OR variants of M. smegmatis have characteristics similar to those of nocardia is supported by the present study.

DNA derived from Mycobacterium leprae (grown in armadillos) was isolated, purified, and analyzed spectrophotometrically. The genome size and the guanine-plus-cytosine content of M. leprae were 1.3 x 10(9) and 55.8%, respectively. Among selected strains of mycobacterial, nocardial, and corynebacterial species, Corynebacterium sp. 2628 LB, isolated from a human leprosy patient, showed the highest DNA homology with M. leprae. Of the DNAs derived from mycobacteria, those of M. tuberculosis and M. scrofulaceum showed a comparatively high reassociation with the DNMA of M. liprae.

SUMMARY: Seventeen strains of mycobacteria, recovered from six armadillos experimentally infected with Mycobacterium leprae, were examined in ten different laboratories. This collaborative study included use of conventional bacteriological tests, lipid analyses, determination of mycobactins and peptidoglycans, characterization by Py-MS, and immunological, metabolic, pathological and DNA studies. These armadillo-derived mycobacteria (ADM) formed five homogeneous groups (numbered ADM 1 to 5) on the basis of phenetic analyses. However, DNA studies revealed only four homogeneous groups since group ADM 1 and one of the two strains in group ADM 3 showed a high level of DNA relatedness. The phenetic and DNA studies confirmed that the ADM strains differed from all other known mycobacteria. Cultural, biochemical, metabolic and pathogenic properties as well as DNA-DNA hybridizations clearly differentiated these ADM from M. leprae.

A taxonomic study has been made on a mycobacterial strain isolated from skin ulcer lesion of a 19 year-old Japanese girl who has lived only in Japan. By numerical classification, in which 108 characters were used, 6 isolates of this strain formed one cluster together with Mycobacterium ulcerans strains. However, the isolates were distinguished from the M. ulcerans strains, forming a subcluster. The isolates were differentiated by the characters shown in Table 2 from authentic M. ulcerans strains. The mycolic acids of the strain ATCC 33788 isolated from Japanese girl were distinguished from those of the type strain ATCC 19423 of M. ulcerans. The number of carbon atoms of alpha-mycolate of the former centered at 80, whereas those of the strain ATCC 19423 at 76. The number of carbon atoms of the alpha-unit was 24 in both strains and the number of double bonds was 2 in both strains. The strain ATCC 33788 showed a 100% similarity with the strain ATCC 19423 in DNA hybridization. In view of the above results, we have concluded that the strain belongs to a new subspecies of M. ulcerans (M. ulcerans subsp. shinshuense). Until now, M. ulcerans infection has occurred only in three area of the world, Africa, Oceania, and South and Middle America. Our case is the first case of M. ulcerans infection discovered in an area other than the above. However, the strain was not the same as the M. ulcerans described previously but differed from it in mycolic acids and some biological and biochemical characteristics.

Cutaneous nerves in lepromatous lesions from ninety-six patients were observed by electron microscopy. The regenerative process of myelinated fibers was evident within lepromatous tissues. Intact or degenerative forms of Mycobacterium leprae were surrounded by the electron transparent substance within the axoplasm and Schwann cell cytoplasm. In contrast, the microenvironment of M. leprae in macrophages was characterized with fusing lysosomes and foamy structures. These results suggest that the electron transparent substance may be derived from bacterial metabolites and also that the foamy structure may originate from lysosomal substance.

Chromosomal deoxyribonucleic acids of Corynebacterium genitalium and Corynebacterium pseudogenitalium were isolated and analysed spectrophotometrically. Their genome molecular weights ranged from 1.1 × 109 to 1.6 × 109. The guanine-plus-cytosine content of C. genitalium ranged from 60.0 to 63.3%, whereas that of C. pseudogenitalium ranged from 56.1 to 58.7%. Five strains of C. genitalium showed relatively low levels of DNA relatedness to each other ranging from 35 to 64%. In contrast, most strains of C. pseudogenitalium showed high levels of DNA relatedness to each other ranging from 71 to 89%. Selected strains of C. genitalium and C. pseudogenitalium showed low levels of DNA relatedness (49 to 60%) to other corynebacterial species involved in urinary tract infection. Data obtained in this study indicate that all strains of C. genitalium consist of genetically divergent organisms while the most strains of C. pseudogenitalium belong to a single species.

A case of HCC with a huge tumor thrombus in the right atrium is reported. CT and celiac angiography revealed HCC in the liver. Inferior vena cavography and cardiac blood pool scintigraphy demonstrated a large defect in the right atrium, and 67Ga-citrate scintigraphy showed a lesion of abnormal accumulation in the right atrium. With these findings, diagnosis of HCC with a tumor thrombus in the right atrium was made, and the clinical diagnosis was confirmed by autopsy.