Patients with neonatal-onset nonketotic hyperglycinemia have high-glycine content in cerebrospinal fluid (CSF) which is believed to be a cause of intractable neurologic manifestations. The glycine receptor was believed to be inhibitory in the central nervous system; however, a newly discovered glycine receptor is of the excitatory N-methyl-D-aspartate (NMDA) receptor type, which cannot be antagonized by strychnine. The NMDA receptor antagonist, ketamine, was administered to a patient with nonketotic hyperglycinemia; he demonstrated some improvement in hyperirritability, voluntary movement, and electroencephalographic findings. Strychnine therapy had been administered before this trial of NMDA antagonist, but without improvement. The respiratory condition improved with the reduction of the CSF glycine level after withdrawal of sodium valproate. Our findings indicate that high-glycine content in CSF may affect the brain in different ways via NMDA and classic glycine receptors.

Brain↗

PubMedDate not supplied

Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis.

The anatomic relation between the proximal attachment of the medial collateral ligament of the elbow joint and the humero-ulnar joint axis has not been clearly shown in a published study. We examined cadaveric specimens to find the exact relation between them. The medial collateral ligament was microscopically dissected to isolate specific fiber bundles. The length of each bundle was measured with a charge-coupled device camera system that faced the medial side of the elbow joint. The measurements indicated that the projected length of the deep middle bundle of the anterior oblique ligament, which is the strong cord-like part of the medial collateral ligament, is isometric during elbow flexion. The proximal end of the deep middle bundle was thus considered to be located almost on the humero-ulnar joint axis.

Cadaver↗