[Acute aortic syndromes]

The term acute aortic syndrome comprises in addition to classic dissection also two recently described entities--penetrating ulcer and intramural haematoma. Forty-two necropsy cases of acute aortic syndrome were encountered during the last six years--41 dissections and one penetrating ulcer; the intramural haematoma was not seen. According to the DeBakey classification, there were 26 dissections of type I, 8 of type II, 1 of type IIIA, and 4 of type IIIB; in 2 cases the dissection was confined to the abdominal aorta. The dissection had a chronic character in four cases. Aortic rupture was found in 24 cases (59%), most frequently (19x) into the pericardial cavity. The aortic dissection continued into aortic branches in 25 patients (61%), causing stenosis/obstruction of coronary arteries in 7, of branches of the arch in 20, of abdominal arteries in 12, and of renal arteries in 17 patients, respectively. Histologically, there were degenerative lesions of the Erdheim type in the media of 10 aortas (from 21 completely examined). As possible risk factors for aortic dissection there appeared hypertension in 32 patients, anuloaortic ectasia in 11, saccular aneurysm ot the abdominal aorta in 6, family history of dissection in 2, Marfan syndrome in 2, prolaps of the mitral valve in 2, and bicuspid aortic valve in 2 patients, respectively. The aortic dissection was iatrogenic in 7 patients, presenting as a complication of a cardiosurgical or invasive cardiological procedure.

[A hitherto unknown priority of Jan Ev. Purkyne--myocardial sleeves of the pulmonary veins. Contribution to the pathogenesis of atrial fibrillation]

According to recent electrophysiological discoveries, atrial fibrillation is triggered by ectopic beats which in most cases originate in the pulmonary veins, in extensions of left atrial myocardium upon these veins, so called myocardial sleeves. In the relevant literature it is stated that this anatomical structure was first described by Ferdinand Raeuschel in 1836 in the publication "De arteriarum et venarum structura". This publication appeared as Raeuschel's dissertation thesis at the faculty of medicine in Breslau (now Polish Wroclaw) at the department of physiology under the leadership of Jan Ev. Purkyne. In the introduction, the author thanks his tutor for introducing him into the problematic and for the continuous help, stating that all new discoveries in the dissertation should be ascribed to Purkyne. Thus, the description of myocardial sleeves of pulmonary veins appears as a yet further priority of the great Czech scientist.

Rasmussen encephalitis with active inflammation and delayed seizures onset

Severe focal epilepsy is regarded as a clinical hallmark of Rasmussen encephalitis (RE). The authors report two children with progressive hemiparesis, contralateral hemispheric atrophy, and pathologic features characteristic for RE. At histologic diagnosis and over several months, neither patient experienced seizures. The report enlarges the clinical spectrum of RE and suggests that seizures are not an obligatory presenting symptom of the disorder.

[Pulmonary embolism--temporal aspects]

The post-mortem incidence of pulmonary embolism (PE) in the years 1960-2000 was retrospectively reviewed. In five reference years 1960, 1970, 1980, 1990 and 2000 there was a total of 582 necropsy patients with PE encountered in 3420 autopsies of adults (> 18 y.)--an incidence of 17.0%. The incidence had a steadily declining trend--from 19.2% in 1960 to 14.2% in the year 2000. The incidence was higher in females (20.4%) than in males (14.4%). We have also followed the seasonal variation of PE incidence; this was the highest in autumn (September-November) 18.6%, and the lowest in spring (March-May) 14.3%. The average age of patients who died with PE increased from 63.7 y. in 1960 to 67.8 y. in 2000; it was higher in females (66.9 y.) than in males (64.2 y.). Our results confirm those of most pathological studies that the post-mortem incidence of PE is declining.

[Carcinoid heart disease]

Demonstrated are eight cases of carcinoid heart disease (7 females, 1 male; average age 63.4 y.). The primary tumor was localized in the ileum in 5, and in the cecal area in 3 patients, with liver metastases in each case. The characteristic heart lesion appears as an endocardial plaque composed of loose intercellular matrix with scattered smooth muscle cells, covered by an endothelial layer. The plaques are apposed on an otherwise normal valvular, or mural endocardium of the right heart. The resulting combined valvular lesions show a predominance o tricuspid incompetence, or of pulmonary stenosis. In one case with a widely patent foramen ovale there was involvement of left-heart valves in addition. Local effect of serotonin appears to play the main role in pathogenesis of the endocardial plaques.

Mitochondrial cardiomyopathy--case report

A male infant developed progressive neuromuscular disease, hypertrophic cardiomyopathy and brain atrophy since the birth. Increased level of lactate with increased lactate/pyruvate ratio suggested a disturbance in the mitochondrial energy metabolism. The activities of respiratory chain complexes III, IV and II + III, of pyruvate dehydrogenase complex and of citrate synthase in isolated muscle mitochondria were low in comparison with controls, with parallel decrease in the content of protein amount of respiratory chain complexes III and IV. No large scale deletions of mitochondrial DNA (mtDNA) and mtDNA point mutations A3243G, A8344G or T8993G indicating syndromes MELAS, MERRF or NARP were detected. The boy died at the age of 7 weeks. The autopsy revealed typical changes of mitochondrial cardiomyopathy-marked myocardial hypertrophy with muscle pallor, histological finding of diffuse fine granularity of the cytoplasm in the perinuclear regions, and ultrastructural findings of mitochondrial hyperplasia, enlargement (megamitochondria) and abnormal shape.

[Burned-out or depressive? An empirical study regarding the construct validity of burnout in contrast to depression]

Our study tested the discriminant validity of burnout in contrast to depression using the Maslach Burnout Inventory (MBI, Maslach u. Jackson 1986) and the Allgemeine Depressionsskala (ADS, Hautzinger u. Bailer 1993). Furthermore the relationships between burnout and depression to social support, occupational and health variables were examined. Pre-school teachers (n = 101), physician-assistants (n = 81) and their intimates were asked to complete a self-administered questionnaire. Spearman-correlations and factor analysis were conducted with SPSS. The results indicate validity for the burnout construct.

Spinal cord involvement in uncomplicated herpes zoster

We prospectively evaluated herpes zoster patients during the acute phase of the disease for central nervous system involvement. Of 24 patients with spinal zoster, 13 (54%) had spinal cord abnormality, which was asymptomatic in 12 of the 13. Age but not lack of acyclovir treatment was associated with such involvement. In all but 2, neurological involvement resolved within 6 months. Although the mechanism responsible for the neurological abnormalities is unknown, findings may support the hypothesis that zoster is associated with spread of viral infection into the spinal cord and therefore support the possibility that zoster is due to active viral replication in the ganglion.

[Aspergillosis--a rare complicating disease in patients after renal transplantation]

The authors submit a detailed analysis of the death of a 42-year-old man after a second renal transplantation. The patient died with symptoms of cardiac failure in a septic condition of obscure etiology where even detailed examination did not provide a timely answer as regards the lethal pathogen. Aspergillus fumigatus is a rare lethal pathogen. Despite this it is, as all opportune infections, for patients with immunosuppressive therapy a serious life threatening infection [1, 2]. In a group of 650 transplantations performed since 1961 in Hradec Králové it is the first death caused by generalized Aspergillus infection.

Mutation in the methylenetetrahydrofolate reductase gene might be a risk factor for cerebrovascular disease in peripartum and under oral contraceptive use

Nine women (age 22-43 years) with cerebrovascular diseases (CVD) related to pregnancy, puerperium or contraceptive use were studied. Five were pregnant, 2 were post partum and 2 were taking oral contraceptives. All under- went a complete etiological examination including assessment for the thermolabile C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene mutation. Three of the 9 patients were homozygotic for the C677T MTHFR mutation, and 3 were heterozygotic. In these 6 patients, no other etiology could be found. Mutation in the thermolabile MTHFR gene might be an important cause for CVD related to peripartum or contraceptive use.

Recurrence of acute disseminated encephalomyelitis at the previously affected brain site

BACKGROUND

Acute disseminated encephalomyelitis (ADEM) is a usually monophasic demyelinating disorder of the central nervous system. Recurrences pose a diagnostic challenge because they can be overlooked or suggest an alternative diagnosis.

OBJECTIVE

To examine the frequency, nature, and outcome of recurrent ADEM.

DESIGN

Review of the medical records of patients diagnosed in our institution as having ADEM between January 1, 1983, and May 31, 1998. Recurrences were defined as appearance of new symptoms and signs at least 1 month after the previous episode.

RESULTS

Five (24%) of 21 patients with ADEM developed recurrent disease episodes. In all, diagnosis was confirmed by brain biopsy. One patient had 4 disease episodes, 2 had 3, and the other 2 each had 2. Recurrence appeared 1.5 to 32 months after initial presentation and involved the same brain territory in 6 of 9 recurrences in 3 of 5 patients. In 2 patients, recurrences included neuropsychiatric signs. A good response to corticosteroid therapy was observed in 10 of 13 of treated ADEM attacks: in 3 of the 4 treated initial events and in 7 of 9 recurrences.

CONCLUSIONS

Recurrent ADEM may be more prevalent than previously recognized. Patients who relapse tend to have more than 1 recurrence that usually involves, clinically and radiologically, a brain territory that was affected before and can simulate a space-occupying lesion that requires histologic diagnosis. Neuropsychiatric features may be the main presentation of a relapse. Since recurrent ADEM is a corticosteroid-responsive condition, awareness and early diagnosis are mandatory.

[Cardiac myxomas]

Cardiac myxoma is the most common primary tumor of the heart. Between 1970 and 1998, 33 myxomas from patients operated at the Cardiosurgical Department were submitted for pathological examination. A review of age, sex and clinical symptoms of the patients as well as of gross and histological features of the tumors is presented. Immunohistochemical examination was performed on 10 selected myxomas-reactivity to vimentin, desmin, S-100 protein, cytokeratin and FVIIIR-Ag. The necessity of histological examination of the embolectomy material is stressed.

Infection and the etiology and pathogenesis of multiple sclerosis

Multiple sclerosis (MS) currently defies clinical and scientific definitions, and carries a prognosis that remains practically unchanged despite many years of intensive research. Although the prevailing dogma is that MS is an immune-mediated condition, it fulfills none of the criteria of an autoimmune disease. On the other hand, there is enough significant data to suggest that infectious agents(s) could be involved in either direct damage to the white matter or induce inflammatory responses that secondarily affect the brain. Our goal here is to review the data supporting the possibility that infection has a critical role in the disease, examine the list of potential candidates that have been suggested, and outline an approach regarding the potential role of infectious agents in the etiology and pathogenesis of MS.

A GPS logger and software for analysis of homing in pigeons and small mammals

A detailed analysis of homing in pigeons and small mammals has remained difficult because the paths of the animals could not be reconstructed precisely. Here, we describe a lightweight global position system (GPS) data logger (35 g including battery and casing; 40 x 68 x 18 mm) that records the flight of pigeons and the path of dogs with an accuracy of +/-12 m. With one battery, the logger runs in continuous mode (1 fix/s) for 3.5 h and in power-saving mode (1 fix/5 s) for about 16 h, and stores a maximum of 100,000 data points that are downloaded to a PC. A module of our public domain software WINTRACK permits a detailed numerical and graphical analysis of path geometry, phases of resting and moving, and path similarity. The device can be adapted to different species provided that satellite signals can be received reliably and that the loggers can be recovered. We expect it to be useful for testing hypotheses about pigeon homing, assessing natural spatial behavior and orientation of many species, and anticipate further miniaturization.

Active infective endocarditis involving all four cardiac valves

A case is presented of a 70-year-old man treated for 3 months for necrotizing pancreatitis with multiorgan failure. The autopsy revealed enterococcal endocarditis affecting all eleven valvular cusps of the four heart valves.

Coronary arteritis with marked fibrous periarteritis: case report

A case is presented of a 43-year-old man who died suddenly and unexpectedly from cardiac malignant arrhythmia. Autopsy revealed isolated coronary arteritis involving primarily the left coronary stem and extending into the proximal half of its anterior descending branch. The most striking feature of the disease was marked fibrous periarteritis. Similar changes were present segmentally in the peripheral third of the right coronary artery, and also as small isolated foci of adventitial fibrosis in the aortic base. With some hesitation, we classify the case as coronary Takayasu's arteritis.

[Monitoring of the inflammation in children before and after tonsillectomy]

A group of 54 children aged from three to 13 years was qualified to tonsillectomy for laryngological indications. In sera of all children following measurements were performed: the concentrations of C-reactive protein (CRP), alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) were measured using rocket immunoelectrophoresis according to Laurell, also concentrations of three main immunoglobulin classes (IgA, IgG, IgM) and antistreptolysin titer. The microheterogeneity of both AGP and ACT was investigated, using crossed affinity immunoelectrophoresis according to Bog-Hansen with Concanavalin A (Con A) as a ligand. Results were expressed as reactivity coefficients (RC), being the proportion of all Con A-reacting variants to the non-reacting variant. It is worth mentioning that there was no difference in all investigated parameters as well between groups obtained by categorizing children according to the presence or absence of elevated antistreptolysin titer. It may mean that at least in some cases the chronic inflammation was caused by streptococci non-producing streptolysin O. The results obtained suggest that the absence of the arthritic pain does not exclude the need of antibiotic therapy in children after tonsillectomy. Generally it is postulated that estimation of acute phase proteins concentrations and glycosylation profiles, which were previously shown to be useful in clinical assessment of various diseases may serve as additional marker in laryngology in cases where indications to tonsillectomy are still controversial.