Prenatal sonographic diagnosis of skeletal dysplasias

OBJECTIVE: To assess the types and numbers of cases, gestational age at specific prenatal diagnosis and diagnostic accuracy of the diagnosis of skeletal dysplasias in a prenatal population from a single tertiary center. METHODS: This was a retrospective database review of type, prenatal and definitive postnatal diagnoses and gestational age at specific prenatal diagnosis of all cases of skeletal dysplasias from a mixed referral and screening population between 1985 and 2007. Prenatal diagnoses were grouped into 'correct ultrasound diagnosis' (complete concordance with postnatal pediatric or pathological findings) or 'partially correct ultrasound diagnosis' (skeletal dysplasias found postnatally to be a different one from that diagnosed prenatally). RESULTS: We included 178 fetuses in this study, of which 176 had a prenatal ultrasound diagnosis of 'skeletal dysplasia'. In 160 cases the prenatal diagnosis of a skeletal dysplasia was confirmed; two cases with skeletal dysplasias identified postnatally had not been diagnosed prenatally, giving 162 fetuses with skeletal dysplasias in total. There were 23 different classifiable types of skeletal dysplasia. The specific diagnoses based on prenatal ultrasound examination alone were correct in 110/162 (67.9%) cases and partially correct in 50/162 (30.9%) cases, (160/162 overall, 98.8%). In 16 cases, skeletal dysplasia was diagnosed prenatally, but was not confirmed postnatally (n = 12 false positives) or the case was lost to follow-up (n = 4). The following skeletal dysplasias were recorded: thanatophoric dysplasia (35 diagnosed correctly prenatally of 40 overall), osteogenesis imperfecta (lethal and non-lethal, 31/35), short-rib dysplasias (5/10), chondroectodermal dysplasia Ellis-van Creveld (4/9), achondroplasia (7/9), achondrogenesis (7/8), campomelic dysplasia (6/8), asphyxiating thoracic dysplasia Jeune (3/7), hypochondrogenesis (1/6), diastrophic dysplasia (2/5), chondrodysplasia punctata (2/2), hypophosphatasia (0/2) as well as a further 7/21 cases with rare or unclassifiable skeletal dysplasias. CONCLUSION: Prenatal diagnosis of skeletal dysplasias can present a considerable diagnostic challenge. However, a meticulous sonographic examination yields high overall detection. In the two most common disorders, thanatophoric dysplasia and osteogenesis imperfecta (25% and 22% of all cases, respectively), typical sonomorphology accounts for the high rates of completely correct prenatal diagnosis (88% and 89%, respectively) at the first diagnostic examination.

Effect of MGA on Performance, Sexual Behavior, Carcass Quality and Tenderness in Mixed-Sex Pens of Cattle

The effect of MGA in mixed pens of steers and heifers was evaluated over a three-year period at the ISU Armstrong Research Farm near Lewis, Iowa. Two pens of approximately 40 head were fed diets with or without MGA in each of three replications. Estrus and riding activity was monitored using the Heat Watchâ system. At slaughter, in addition to routine carcass data collection, a rib sample was collected from each carcass for tenderness evaluation. There was no effect on dry matter intake due to MGA treatment. Mixed-sex pens that were fed MGA were 4% more efficient than controls. MGA-fed steers gained similarly to control steers. MGA fed heifers gained 8% faster than control heifers. MGA highly reduced measures of estrus and riding activity throughout the feeding period. MGA feeding improved marbling and tenderness measured in both steers and heifers. These data suggest that MGA has potential to improve performance, quality grade and tenderness in mixed pens of steers and heifers.

Comparison of Round and Square Cores in the Determination of Beef Tenderness by Warner- Bratzler and Instron

Seven rib-eye rolls, lip on (112A), were each cut into eight 2.54 centimeter thick steaks starting from the blade end. Steaks were randomly assigned to one of four treatment groups; 1) round versus square cores using Instron [inst1], 2) round versus square cores using Warner- Bratzler [inst2], 3) Instron versus Warner-Bratzler using round cores [rdsq1], and 4) Instron versus Warner- Bratzler using square cores [rdsq2]. Subsequently, steaks from each group were broiled in a General Electric industrial broiler grill to an internal temperature of 63 §C. Steaks were held overnight at 2 §C. Two steaks from each rib were placed into each instrument/core treatment group. Steaks were then divided into three sections identified as: a) lateral, b) medial, and c) central. Three 1.27 centimeter cores from each section were taken from each steak for a total of nine cores per steak and sheared once through the center. The results indicated that there was a significant difference ( p> .05) between round and square cores for both Warner- Bratzler and Instron. In all mean groups tested, square cores had higher shear values than did round cores. There was no indication of differences between instruments, and no significant interactions between instruments and core types.

Growth Response and Carcass Characteristics of Yearling Steers Subjected to Differing Implant Strategies

A 106-day demonstration utilizing yearling steers to measure feedlot performance and carcass response to implant strategies was conducted at the ISU Allee Demonstration Farm. Treatments were: 100 mg progesterone + 10 mg estradiol benzoate (ComponentÒ EC) on day 0 followed by 120 mg trenbolone acetate + 24 mg estradiol (ComponentÒ TES) implant 57 days later, or 120 mg trenbolone acetate + 24 mg estradiol (ComponentÒ TES) only on day 0. The control group received no implant. The steers were weighed every 28 days and ultrasound data were collected from demonstration initiation until slaughter. The cattle were marketed as one group on d 106 of the demonstration. Implanted cattle had higher average daily gains, heavier carcass weights, larger rib eye areas, and tended to have improved feed efficiency over control steers. Additionally, the reimplanted steers had higher marbling scores than controls, but no differences existed between once and twice-implanted steers.

Encore® Implant Use in Feedlot Steers

A feedlot demonstration utilizing Encore®, a new longterm implant product, was completed at the Allee Demonstration Farm at Newell, Iowa in 1999. Seventyone steers (697 lbs.) were allotted by weight and hide color and assigned to one of three treatments: 1) Encore® (43.9 mg estradiol = E) on day 0; 2) Encore® plus Component® TS (140 mg trenbolone acetate = ETS0) on day 0; or 3) Encore® on day 0 followed by Component® TS (ETS100) on day 100. Due to wide standard deviation in the weight of steers at the beginning of the demonstration, cattle were harvested in two groups. Approximately half of each treatment group was sorted by visual appraisal as to market readiness. Statistical interactions existed within treatment group between first and second harvest dates, therefore data were split and analyzed accordingly. In the first harvest group, ETS0 steers had higher marbling scores than ETS100 steers, and lower average daily gain than E steers and ETS100 steers. In the second harvest group, ETS0 steers had more fat at the 12th/13 rib than ETS100 steers, but did not differ from E steers. Marbling scores were also higher for ETS0 steers than either ETS100 or E steers in the second harvest group. Pooled data reveal that ETS0 steers had higher marbling scores than ETS100 steers and tended to have higher marbling scores than E steers. First harvest E and ETS100 steers had greater average daily gain than ETS0 steers. In the second harvest group, ETS0 steers had heavier final ending weights than E steers but did not differ from ETS100 steers. Final ending weights, rib eye area, fat thickness at the 12th/13th rib, KPH fat, and calculated yield grades did not differ among treatment groups in the pooled data.

Effects of Feeding Calcium Salts of Conjugated Linoleic Acid (CLA) to Finishing Steers

Thirty crossbred steers were randomly assigned to three treatment groups and fed corn-based finishing diets (88% concentrate) containing 0, 1.0 or 2.5% conjugated linoleic acid (CLA) for an average of 130 days. Steers fed 2.5% CLA consumed less feed and had lower daily gains than control steers. Carcass weights tended to be reduced, and marbling scores were decreased by feeding 2.5% CLA. There were no significant effects of feeding CLA on dressing percentages, yield grades and backfat measurements. The rounds from each animal were physically separated into tissue components. Rounds from steers fed CLA contained a higher percentage of lean tissue and a lower percentage of fat. Feeding CLA increased concentrations of CLA in lipids from fat and lean in rib steaks and rounds. Increasing CLA in beef had no effects on shelf life, tenderness, juiciness, flavor or flavor intensity of rib steaks. Although results indicated that feeding calcium salts of CLA to beef steers decreased performance, concentrations of CLA in tissues could be increased offering the availability of a leaner, more healthful meat product.

Functional analysis of MRF4 during mouse embryogenesis

MRF4 is one of four skeletal muscle specific regulatory genes, (the other three genes being MyoD, myf5, and myogenin), each of which has the unique ability to orchestrate an entire program of muscle-specific transcription when introduced into diverse cell types. These findings have led to the notion that these factors function as master regulators of muscle cell fate. Analysis of mice lacking MyoD, myf5, and myogenin have further defined their roles in the commitment and differentiation of myotomal progenitor cells. Current data strongly supports the model that MyoD and myf5 share functional redundancy in determining the muscle cell lineage, while myogenin acts downstream of MyoD and myf5, to initiate myoblast differentiation. Unlike other myogenic bHLH genes, MRF4 is expressed predominantly in the adult, suggesting that it may function to regulate adult muscle maturation and maintenance. To test this hypothesis and to eventually incorporate MRF4 into a general model for muscle specification, differentiation, maturation and maintenance, I deleted the MRF4 gene. MRF4-null mice are viable and fertile, however, they show mild rib anomalies. In addition, the expression of myogenin is dramatically upregulated only in the adult, suggesting that myogenin may compensate for the loss of MRF4 in the adult, and MRF4 may normally suppress the expression of myogenin after birth. MRF4 is also required during muscle regeneration after injury.^ To determine the degree of genetic redundancy between MRF4-myogenin; and MRF4-MyoD, I crossed the MRF4-null mice with MyoD- and myogenin-null mice respectively. There are no additional muscle phenotypes in double-null progeny from a MRF4 and myogenin cross, suggesting that the existence of residual fibers in myogenin-null mice is not due to the presence of MRF4. MRF4 expression also cannot account for the ability of myogenin-null myoblasts to differentiate in vitro. However, the combination of the MRF4-null mutation with the myogenin-null mutation results in a novel rib phenotype. This result suggests that MRF4 modifies the myogenin-null rib phenotype, and MRF4 and myogenin play redundant roles in rib development.^ MRF4 also shares dosage effects with MyoD during mouse development. (MyoD+/$-$;MRF4$-$/$-$)mice are fertile and viable, while (MyoD$-$/$-$;MRF4+/$-$) mice die between birth and two weeks after birth, and have a small skeletal structure. The double homozygous mice for MRF4 and MyoD mutations are embryonic lethal and die at around E10.5. These results suggest that MRF4 and MyoD share overlapping functions during mouse embryogenesis. ^

Functional studies of the homeobox gene {\it Goosecoid\/} during mouse embryogenesis

A fundamental question in developmental biology is to understand the mechanisms that govern the development of an adult individual from a single cell. Goosecoid (Gsc) is an evolutionarily conserved homeobox gene that has been cloned in vertebrates and in Drosophila. In mice, Gsc is first expressed during gastrulation stages where it marks anterior structures of the embryo, this pattern of expression is conserved among vertebrates. Later, expression is observed during organogenesis of the head, limbs and the trunk. The conserved pattern of expression of Gsc during gastrulation and gain of function experiments in Xenopus suggested a function for Gsc in the development of anterior structures in vertebrates. Also, its expression pattern in mouse suggested a role in morphogenesis of the head, limbs and trunk. To determine the functional requirement of Gsc in mice a loss of function mutation was generated by homologous recombination in embryonic stem cells and mice mutant for Gsc were generated.^ Gsc-null mice survived to birth but died hours after delivery. Phenotypic analysis revealed craniofacial and rib cage abnormalities that correlated with the second phase of Gsc expression in the head and trunk but no anomalies were found that correlated with its pattern of expression during gastrulation or limb development.^ To determine the mode of action of Gsc during craniofacial development aggregation chimeras were generated between Gsc-null and wild-type embryos. Chimeras were generated by the aggregation of cleavage stage embryos, taking advantage of two different Gsc-null alleles generated during gene targeting. Chimeras demonstrated a cell-autonomous function for Gsc during craniofacial development and a requirement for Gsc function in cartilage and mesenchymal tissues.^ Thus, during embryogenesis in mice, Gsc is not an essential component of gastrulation as had been suggested in previous experiments. Gsc is required for craniofacial development where it acts cell autonomously in cartilage and mesenchymal tissues. Gsc is also required for proper development of the rib cage but it is dispensable for limb development in mice. ^

Extraspinal ossifications after implantation of vertical expandable prosthetic titanium ribs (VEPTRs).

INTRODUCTION Though developed for thoracic insufficiency syndrome, the spinal growth-stimulating potential and the ease of placement of vertical expandable titanium ribs (VEPTRs) has resulted in their widespread use for early-onset spine deformity. Observation of implant-related ossifications warrants further assessment, since they may be detrimental to the function-preserving non-fusion strategy. PATIENTS AND METHODS Radiographs (obtained pre and post index procedure, and at 4-year follow-up) and the records of 65 VEPTR patients from four paediatric spine centres were analysed. Ossifications were classified as type I (at anchor points), type II (along the central part) or type III (re-ossification after thoracostomy). RESULTS The average age at the index procedure was 6.5 years (min 1, max 13.7). The most prevalent spine problem was congenital scoliosis (37) with rib fusions (34), followed by neuromuscular and syndromic deformities (13 and 8, respectively). Idiopathic and secondary scoliosis (e.g. after thoracotomy) were less frequent (3 and 4, respectively). Forty-two of the 65 (65 %) patients showed ossifications, half of which were around the anchors. Forty-five percent (15/33) without pre-existing rib fusions developed a type II ossification along the implant. Re-ossifications of thoracostomies were less frequent (5/34, 15 %). The occurrence of ossifications was not associated with patient-specific factors. CONCLUSIONS Implant-related ossifications around VEPTR are common. In contrast to harmless bone formation around anchors, ossifications around the telescopic part and the rod section are troublesome in view of their possible negative impact on chest cage compliance and spinal mobility. This potential side effect needs to be considered during implant selection, particularly in patients with originally normal thoracic and spinal anatomy.

Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

PURPOSE Thoracoscopic sympathetic surgery is nowadays a broadly accepted technique in the treatment of primary hyperhidrosis as well as facial blushing. The objective of this study was to compare the two currently most commonly used methods for thoracic sympathicotomy: transection (ETS) and clipping (ETC.). METHODS This is a retrospective study on a total of 63 patients, who underwent rib-oriented sympathicotomy, either by transection (n = 36, 57 %) or by clipping (n = 27, 43 %). Moreover, the up-to-date international literature is reviewed concerning which level(s) of the sympathetic trunk should be addressed, depending on the patients underlying condition. Furthermore, the highly controversial topic of reversibility of sympathetic clipping is debated. RESULTS Our results confirm that clipping is at least as effective as transection of the sympathetic chain in the treatment of hyperhidrosis and facial blushing. Furthermore, the analysis of all larger studies on unclipping in humans shows a surprisingly high reported reversal rate between 48 and 77 %. CONCLUSIONS Depending on the symptoms of the patient, different levels of the sympathetic chain should be addressed. When a higher rib level such as R2 is approached, which more likely will result in moderate to severe compensatory sweating, clipping should be preferred as it seems that this technique has indeed a potential for reversibility. As demonstrated, this method is at least as effective as an irreversible transection of the sympathetic chain.

Neurogenic thoracic outlet syndrome due to subclavius posticus muscle with dynamic brachial plexus compression: a case report.

BACKGROUND Neurogenic thoracic outlet syndrome is an underestimated cause of brachial weakness and pain. The subclavius posticus muscle (SPM) is an aberrant muscle originating from the medial aspect of the first rib reaching to superior border of the scapula, which may cause, depending on its activation, dynamic compression of the brachial plexus. CASE PRESENTATION In the present study, we report about a 32-year-old male caucasian patient with weakness in radial deviation of his left hand. An isolated macrodactyly of his left middle finger had been operated twice. Electroneurography showed a carpal-tunnel-syndrome (CTS) on the left side. MRI of the brachial plexus revealed an additional muscle in the costoclavicular space, identified as SPM. To our knowledge, this is the second case report of a neurogenic thoracic outlet syndrome due to SPM, and the first case described with isolated macrodactyly and CTS in the same patient. CONCLUSION If complaints about hand weakness are only reported in cases of distinct hand positions, a dynamic compression of the brachial plexus by SPM may be the cause. A neurogenic thoracic outlet syndrome may facilitate the development of CTS.

Tuberculosis in early medieval Switzerland - osteological and molecular evidence

Lesions consistent with skeletal tuberculosis were found in 13 individuals from an early medieval skeletal sample from Courroux (Switzerland). One case of Pott’s disease as well as lytic lesions in vertebrae and joints, rib lesions, and endocranial new bone formation were identified. Three individuals with lesions and one without were tested for the presence of MTBC aDNA, and in two cases, evidence for MTBC aDNA was detected. Our results suggest the presence of tuberculosis in the analyzed material which is in accordance with other osteological and biomolecular research that reported high prevalence of tuberculosis in medieval skeletons.

Metamorphosis of human lumbar vertebrae induced by VEPTR growth modulation and stress shielding

INTRODUCTION Distraction-based spinal growth modulation by growing rods or vertical expandable prosthetic titanium ribs (VEPTRs) is the mainstay of instrumented operative strategies to correct early onset spinal deformities. In order to objectify the benefits, it has become common sense to measure the gain in spine height by assessing T1-S1 distance on anteroposterior (AP) radiographs. However, by ignoring growth changes on vertebral levels and by limiting measurement to one plane, valuable data is missed regarding the three-dimensional (3D) effects of growth modulation. This information might be interesting when it comes to final fusion or, even more so, when the protective growing implants are removed and the spine re-exposed to physiologic forces at the end of growth. METHODS The goal of this retrospective radiographic study was to assess the growth modulating impact of year-long, distraction-based VEPTR treatment on the morphology of single vertebral bodies. We digitally measured lumbar vertebral body height (VBH) and upper endplate depth (VBD) at the time of the index procedure and at follow-up in nine patients with rib-to-ileum constructs (G1) spanning an anatomically normal lumbar spine. Nine patients with congenital thoracic scoliosis and VEPTR rib-to-rib constructs, but uninstrumented lumbar spines, served as controls (G2). All had undergone more than eight half-yearly VEPTR expansions. A Wilcoxon signed-rank test was used for statistical comparison of initial and follow-up VBH, VBD and height/depth (H/D) ratio (significance level 0.05). RESULTS The average age was 7.1 years (G1) and 5.2 year (G2, p > 0.05) at initial surgery; the average overall follow-up time was 5.5 years (p = 1). In both groups, VBH increased significantly without a significant intergroup difference. Group 1 did not show significant growth in depth, whereas VBD increased significantly in the control group. As a consequence, the H/D ratio increased significantly in group 1 whereas it remained unchanged in group 2. The growth rate for height in mm/year was 1.4 (group 1) and 1.1 (group 2, p = 0.45), and for depth, it was -0.3 and 1.1 (p < 0.05), respectively. CONCLUSIONS VEPTR growth modulating treatment alters the geometry of vertebral bodies by increasing the H/D ratio. We hypothesize that the implant-related deprivation from axial loads (stress-shielding) impairs anteroposterior growth. The biomechanical consequence of such slender vertebrae when exposed to unprotected loads in case of definitive VEPTR removal at the end of growth is uncertain.

A DESCRIPTIVE STUDY OF ANIMAL BITES TO HUMANS IN HOUSTON, TEXAS, JANUARY 1, 1982 - JULY 30, 1982 (RABIES)

This study describes animal bites which occurred within the city of Houston, Texas from January 1, 1982, through July 30, 1982. The Rabies Investigation Branch (RIB) recorded 2,047 bite cases. The study has as its foundation a data base management system that was developed to improve the planning and evaluation of the activities of the Rabies Investigation Branch of the Animal Control Center of the City of Houston Health Department. The study provides information which will allow for the development of a more effective animal bite program to meet the needs of the citizens of Houston. ^

William Osler: Original Papers 1907-1919

Part 1: 1907-1908 The Royal Medical Society of Edinburg, 1907 On the Library of a Medical School, 1907 On Telangiectasis Circumscripta Universalis, 1907 A Clinical Lecture on Abdominal Tumours Associated with Disease of the Testicle, 1907 A Clinical Lecture on Erythraemia, 1908 Vienna after Thirty-Four Years, 1908 Endocardites Infectieuses Chroniques, 1908 Part 2: 1909 Chronic Infectious Endocarditis, 1909 What the Public Can Do in the Fight Against Tuberculosis, 1909 Annual Oration on the Occasion of the Opening of the New Building of the Medical and Chirurgical Faculty of the State of Maryland, May 13, 1909 The Medical Library in Post-Graduate Work, 1909 The Treatment of Disease, 1909 Part 3: 1910-1911 The Pupil Symptoms in Thoracic Aneurysm, 1910 The Lumleian Lectures on Angina Pectoris, 1910 Certain Vasomotor, Sensory, and Muscular Phenomena Associated with Cervical Rib, 1910 An Address on the Hospital Unit in University Work, 1911 Sulle Telangiectasie Emorragiche Ereditarie, 1911 Transient Attacks of Aphasia and Paralyses in States of High Blood Pressure and Arterio-Sclerosis, 1911 The Pathological Institute of a General Hospital, 1911 Part 4: 1912-1914 An Address on High Blood Pressure: its Associations, Advantages, and Disadvantages, 1912 Specialism in the General Hospital, 1913 Syphilis of the Liver with the Picture of Banti’s Disease, 1913 An Introductory Address on Examinations, Examiners, and Examinees, 1913 The Medical Clinic: a retrospect and a Forecast, 1914 Part 5: 1915-1919 Remarks on the Diagnosis of Polycystic Kidney, 1915 The War and Typhoid Fever, 1914/15 The Cerebro-Spinal Fever in Camps and Barracks, 1915 Remarks on Arterio-Venous Aneurysm, 1915 Nerve & “Nerves”, 1915 Intensive Work in Science at the Public Schools in Relation to the Curriculum, 1916 Creators, Transmuters, and Transmitters, 1916 Annual Oration on the Campaign Against Syphilis, 1917 The First Printed Documents relating to Modern Surgical Anaesthesia, 1918 Observations on the Severe Anaemias of Pregnancy and the Post-Partum State, 1919 Typhoid Spine, 1919