C2 Lesions Research Articles

Upper cervical involvement in rheumatoid arthritis.

Atlanto-axial dislocation and upward migration of the odontoid were studied in patients with rheumatoid arthritis treated conservatively and those treated by atlanto-axial posterior fusion. Upward migration of the odontoid was evaluated by Ranawat's and Redlund-Johnell's methods after determining the normal range in healthy Japanese adults. Of the 100 patients treated conservatively, atlanto-axial dislocation was found in 49% and upward migration of the odontoid in 26% by the former method, and in 8% by the latter method. The detection rate of these lesions increased with the increase in the duration of the disease and progression of rheumatoid lesions. Abnormal Ranawat values are associated with lesions in the C1-C2 segment and abnormal Redlund-Johnell values with 0-C2 lesions. The latter suggests severe conditions and seems to be a useful indicator for the diagnosis of upward migration of the odontoid in our study. Though rheumatoid lesions in the upper cervical spine mainly involved the C1-C2 level, marked deterioration of the atlanto-occipital joints was also occasionally observed. Therefore, in surgical treatment, attention should be paid also to this region. Patients with abnormal Redlund-Johnell values require spinal fixation including the occipital bone.

Effect of different spinal cord lesions on visually guided switching of target-reaching in cats

It has previously been shown that when a target is moved, cats can change the direction of ongoing target-reaching with brief latency suggesting a tectal relay. Switching of target-reaching has now been investigated after spinal lesions: (1) dorsally in C5 interrupting cortico- (CS) and rubrospinal (RS) fibres to forelimb segments; (2) more ventrally in C5 interrupting axons of the C3-C4 propriospinal neurones (PNs) to forelimb motoneurones; and (3) ventrally in C2 interrupting tectospinal and tecto-reticulospinal fibres. Short-latency switching of target-reaching remained after lesions 1 and 2. A subsequent lesion 3 after lesion 1 or 2 prolonged the switching latency. The results show that fast switching, presumably relayed in tectum, can be made when the cat utilizes C3-C4 PNs or interneurones in the forelimb segments for target-reaching. For both neuronal systems, the longer-latency switching after ventral C2 lesion is assumed to be cortically relayed and mediated by the CS and RS tracts.

Carcinoembryonic Antigen

Letters and Corrections1 May 1986Carcinoembryonic AntigenWILLIAM L. WOLFSON, M.D.WILLIAM L. WOLFSON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-5-724_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: I am delighted that a series on diagnostic testing is underway, but a point in the first article (1), on carcinoembryonic antigen, needs clarification.Dr. Fletcher refers to a Dukes "D" lesion. There is no such animal. In the first Dukes classification (2), rectal carcinomas were classified as A, B, or C. This list was subsequently modified (3) to include C1 and C2 lesions, which differ in the location of positive node groups. Others have since added groups and changed Sir Cuthbert's original definitions, but it behooves us to use the Dukes classes correctly if we use...

Lesions of epinephrine neurons in the rostral ventrolateral medulla abolish the vasodepressor components of baroreflex and cardiopulmonary reflex.

Epinephrine-containing neurons of the rostral ventrolateral medulla (RVL) (the C1 group of Hökfelt) in the rat are primarily unilaterally innervated by neurons in the nucleus tractus solitarius (NTS) and in turn project to autonomic spinal neurons. In this study, we investigated whether the C1 area of the RVL mediates the vasodepressor responses (VDR) induced by either electrical stimulation of the vagus nerve or carotid sinus stretch. In all experiments, C1 neurons were localized immunocytochemically with antibodies to phenylethanolamine N-methyltransferase (PNMT). Bilateral lesions of the C1 area decreased arterial pressure (AP) and heart rate (HR) to spinal cord transection levels and blocked the VDR induced by vagal stimulation and carotid sinus stretch. Combined lesions of the contralateral NTS and C1 area ipsilateral to the stimulated vagus nerve maintained AP and HR at normal levels, and totally blocked the VDR to vagal stimulation and carotid sinus stretch. Since projections from the vagus nerve to NTS are bilateral and those from NTS to C1 unilateral, the combined contralateral NTS/ipsilateral C1 lesions isolated and interrupted the ipsilateral NTS-C1 pathway and, therefore, blocked the baroreceptor reflex. The results are consistent with the hypothesis that neurons in the NTS synapsing in or projecting through the C1 area mediate the baro- and cardiopulmonary mechanoreceptor reflex.

Traumatic Spondylolisthesis of the Axis

The lesions of C2 seen in hyperextension injuries of the cervical spine following motor vehicle accidents, diving accidents, and headlong falls resemble the cervical lesion found in judicial hangings. Although the mechanism of injury in these cervical fractures is different, the distinction is significant. The fracture seen in motor vehicular accidents today usually seems to be one of hyperextension and axial compression rather than hyperextension and distraction. This distinction is responsible for the low incidence of neurologic involvement seen in the fracture caused by motor vehicle accidents. The incidence of face and scalp injuries associated with axis pedicle fractures appears significant. Union of this fracture can generally be expected, and it rarely produces late sequelae. Management of this fracture is generally preferable on an ambulatory basis utilizing a cervicothoracic brace or a halo and caudal support in more unstable fractures. A period of 12 weeks of immobilization is recommended for satisfactory union of this fracture. Occasionally the treatment of this fracture may require traction or operative intervention. If operative intervention is required, an anterior route employing interbody fusion is suggested.

Studies on isolation of Streptococcus mutans from the human tooth surfaces with or without caries

Isolation experiments of Streptococcus mutans were conducted in 136 Japanese subjects in respect to the question of whether its incidence, isolated cell number and prevalency among the total streptococci are different between the caries-free tooth surfaces and carious lesions. By conducting several series of experiments, the following results were obtained.(1) S. mutans could be isolated from both the materials of caries-free and -active tooth surfaces in 20 test individuals. However, the incidence (70%), number of cells (104.7) and prevalency (53%) of S. mutans in the materials of the caries-active surface were much higher than those of the caries-free surface (30%, 102.8 and 2.0%, respectively).(2) Isolation of S. mutans in 116 specimens from the occlusal, interproximal and smooth surfaces with or without caries of 87 persons were carried out. In caries free teeth, test materials as low as 0, 3 and 4 from 13 occlusal, 14 interproximal and 14 smooth surface specimens, respectively, were found positive for S. mutans. In contrast, with the carious lesions, 24 of 39 maetrials from the occlusal surface, 15 of 25 from the interproximal and 9 of 11 from the smooth were found positive. The number of S. mutansisolated (104.2 to 104.6) and its prevalency (42 to 56%) in carious lesions were also much higher than those (101.9-108.1 and 0.2-5.5%) of caries-free surface.(3) In the age-matched groups (7 or 8 years old in average), isolation of S. mutans from the materials of occlusal surface without caries or with caries of different grades C0, C1 or C2 were carried out. Although no S. mutans were isolated from 13 specimns of thc caries-free surfaces, they were isolated from 18 of 34 C0, 7 of 20 C1 and 14 of 14 C2 carious lesions. However, with C0, C1 and C2 carious lesions, no significant differences in the isolated cell number and prevalency of S. mutans were observed.(4) More advanced carious lesions (C3 and C4) were examined for the prevalency of S. mutans in their materials. Although number of S. mutans in C3 and C4 lesions was much higher than those of C0-C2, their prevalencies were not different with other.These results strongly suggest the possibility that the growth and establishmet of S. mutansin the dental plaque are ethiologically correlated with the caries development on the tooth surface, particularly in an early phase of caries induction. A possible mechanism of S. mutans in inducing the caries was discussed.Studies of biological and biochemical properties of the isolates revealed that a majority of isolates from the tooth surface regardless of caries-free or-active are of semi-mucous (m) type which is capable of fermenting almost all carbohydrates tested but incapable of hemolysing the sheep red cells. Almost all the isolates of mucous (M) type which were infrequently isolated from the plaques showed an α hemolytic activity and some genetic defect in nature of fermenting the carbohydrates.

Vertical atlanto-axial subluxation in rheumatoid arthritis.

In a prospective survey of 476 hospital in-patients with rheumatoid arthritis, vertical atlanto-axial subluxation (AAL) was found in 13 patients (3.7 per cent). All were women with severe rheumatoid arthritis. Neurological signs were found in ten patients, and in seven they appeared to be due to vertical AAL. The signs caused by vertical AAL were diminished pain and temperature sensation in the upper divisions of the trigeminal nerve, sensory loss in the areas supplied by C2, nystagmus and pyramidal lesions. Disabling involvement due to vertical AAL was not found although it may occur and the lesion may be fatal. The lower cervical spine was involved in all patients and severe lesions were seen in nine. The most severe neurological lesions appeared to be due to subaxial subluxation. Corticosteroid therapy may have been a contributing factor in four patients.