Unsuspected lower extremity deep venous thrombosis simulating musculoskeletal pathology.

Objective: The purpose of this study was to highlight the critical role that MRI may play in diagnosing unsuspected lower extremity deep venous thrombosis and to stress the importance of scrutinizing MRI studies of the lower extremity showing apparently non-specific muscle edema for any evidence of intramuscular venous thrombosis.

Design And Patients: The imaging studies of four patients in whom deep venous thrombosis was unsuspected on clinical grounds, and first diagnosed on the basis of MRI findings, were reviewed by two musculoskeletal radiologists in consensus. In all four patients the initial clinical suspicion was within the scope of musculoskeletal injuries (gastrocnemius strain, n=3; ruptured Baker cyst, n=1), explaining the choice of MRI over ultrasound as the first diagnostic modality.

Flexor carpi radialis tendinopathy: spectrum of imaging findings and association with triscaphe arthritis.

Objective: To present the spectrum of pathology affecting the flexor carpi radialis (FCR), and its anatomical, functional and clinical relationship with conditions affecting the triscaphe or scapho-trapezium-trapezoid (STT) compartment, and particularly osteoarthritis.

Design: The study comprised two men and four women aged between 23 and 79 years (mean age, 49 years). Two musculoskeletal radiologists in consensus evaluated MRI findings.

Insulin sensitivity of splanchnic and peripheral adipose tissue in vivo in morbidly obese man.

Epidemiologic studies demonstrate an association between increased waist to hip ratio ([WHR] android obesity, central obesity) and diabetes mellitus in man. To study the relative insulin sensitivity of splanchnic versus peripheral adipose tissue, portal vein catheterization via the collapsed umbilical vein was performed in 14 morbidly obese subjects at the time of surgery. Catheters were also placed in a peripheral artery and antecubital vein such that simultaneous arterio-venous (A-V) differences (glycerol, free fatty acids [FFA], and lactate) could be determined.

In vivo evidence for hepatic autoregulation during FFA-stimulated gluconeogenesis in normal humans.

To examine the effect of increased gluconeogenesis [by increasing free fatty acids (FFA)] on hepatic glucose output (HGO) and on the first substrate (glucose) cycle, a primed continuous infusion of [2-3H]- and [6-14C]glucose was infused to isotopic steady state in 12 normal male volunteers after an overnight fast. Blood samples for the determination of glucose specific activity were obtained before and after an infusion of saline (n = 6) or 10% Intralipid and heparin (90 mU.kg-1.

Evidence for dual control mechanism regulating hepatic glucose output in nondiabetic men.

We previously reported a fall in hepatic glucose output (HGO) during sleep accompanied by reductions in glucose utilization (Rd) and free fatty acids (FFAs). This study was undertaken to determine the potential role of changes in Rd and FFA on HGO in nondiabetic men. To determine if the fall in HGO during sleep could be reversed by FFA elevation, seven nondiabetic men underwent [3-3H]glucose infusions from 2200 to 0800, with heparin (90 mU.

Elevated plasma levels of hyaluronate in patients with osteoarthritis and rheumatoid arthritis.

Plasma levels of hyaluronate (HA) in patients with rheumatoid arthritis (RA) and patients with osteoarthritis (OA), measured by enzyme-linked immunosorbent assay, were compared with levels in a healthy, age-matched non-arthritic control group, in a retrospective study. Compared with the controls, the mean level of plasma HA was sevenfold higher in the RA group and twofold higher in the OA group. There was no statistically significant correlation between HA levels and 7 other clinical and biochemical parameters in patients with RA.

Effects of media conditions, insulin, and dexamethasone on insulin-receptor mRNA and promoter activity in HepG2 cells.

Numerous physiological agents and conditions modulate cellular insulin sensitivity by downregulating or upregulating total cellular insulin receptors. In this study, we examined the effects of replacing complete medium in the absence or presence of insulin on the regulation of insulin-receptor gene expression in cultured human hepatoma cells (HepG2). Failure to replace complete medium resulted in growth arrest of HepG2 cells and a six- to sevenfold increase in insulin-receptor mRNA due to the prolongation of insulin-receptor mRNA half-life.

Accelerated decline in hepatic glucose production during fasting in normal women compared with men.

Plasma glucose values have been reported to be lower in women than in men after a 72-hour fast. However, a comparison of glucose kinetics in fasting men and women has not been described. Therefore, five normal men and five normal women underwent sequential 3-3H-glucose infusions after both a 14- and a 64-hour fast.

Protein-bound homocyst(e)ine in patients with rheumatoid arthritis undergoing D-penicillamine treatment.

Protein-bound homocyst(e)ine was measured in the plasma of 38 nonhomocystinuric patients with rheumatoid arthritis. Nineteen of them were treated orally with D-penicillamine 100-1,500 mg/d for a period of one month to 15 years. For these patients, the mean +/- standard deviation level of plasma protein-bound homocyst(e)ine was 1.

Comparison of pain properties in fibromyalgia patients and rheumatoid arthritis patients.

Pain properties of 50 fibromyalgia patients were examined and compared with pain properties of 50 rheumatoid arthritis patients. In both fibromyalgia and rheumatoid arthritis, pain was bilateral, involved multiple sites, and was of equal intensity (60.8 versus 58.

Quantification of keratan sulfate in blood as a marker of cartilage catabolism.

We have developed an enzyme-linked immunosorbent-inhibition assay which makes use of a monoclonal antibody specific for keratan sulfate to quantify keratan sulfate present as single chains in adult human serum. In adults hospitalized with conditions not thought to affect the turnover of keratan sulfate-containing tissues, the serum levels varied from individual to individual (53-1,009 ng/ml) but did not show significant differences with respect to age, sex, or disease category. There were no significant differences between the serum levels of adult hospitalized patients and those of nonhospitalized normal adults.

Fibrositis and psychologic disturbance.

Thirty patients with fibrositis and 2 control groups, one of rheumatoid arthritis patients and the other of arthritis patients with other than rheumatoid arthritis, were compared on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) to assess the role of psychologic factors in fibrositis. Patients with fibrositis differed in both elevation and variability in their MMPI profiles, indicating that they were more psychologically disturbed than patients with rheumatoid or other types of arthritis. The fact that almost all of the fibrositis patients' MMPI scales were higher suggests that we might be dealing with a number of different psychologic disturbances that have stiffness and musculoskeletal pain as principal and common symptoms.

Diabetic vacuolation of the iris pigment epithelium.

In a postmortem study of 57 diabetic patients, 19 of 23 patients with blood glucose levels greater than 200 mg/100 ml in the 72-hour period before death showed the characteristic histologic findings of "lacy" vacuolation of the iris pigment epithelium as well as vacuolation of the renal tubules (Armanni-Ebstein nephropathy). Conversely, 33 of the remaining 34 patients with blood glucose levels below 200 mg/100 ml in the 72-hour period prior to death showed no vacuolation in the iris or kidney.