Ocular manifestations of cavernous sinus thrombosis

A 17-year-old male presented with a 10-day history of symptoms of upper respiratory tract infection, headaches, photophobia and progressive swelling around both eyes. Clinical examination revealed a temperature of 39 °C and bilateral periorbital swelling which was worse on the left side. Initial ophthalmological examination revealed a dilated non-reactive pupil on the left side and a sluggish pupillary reflex on the right side. The patient also had a lateral rectus palsy of the left eye. Fundoscopy showed bilateral papilloedema, and visual acuity on admission was 6/12 in the right and 6/18 in the left eye. Ear, nose and throat examination revealed a rhinitic nasal mucosa with thick mucopus in the left middle meatus. The patient required surgical intervention to drain his sinuses followed by long-term intravenous antibiotic therapy and anticoagulation. After 6 weeks of therapy and close observation, he recovered with minimal sequelae.

UK and Ireland experience of cochlear implants in children with Down syndrome

OBJECTIVES

Down Syndrome (DS) is associated with a high incidence of hearing loss. The majority of hearing loss is conductive, but between 4 and 20% is sensorineural, which in the main is mild or moderate and is managed with conventional behind-the-ear hearing aids. Cochlear implantation is an elective invasive procedure, performed to provide some form of hearing rehabilitation in individuals with severe to profound sensorineural hearing loss, and initially candidacy criteria were strict--excluding patients with additional disabilities. With good results and expanding experience, more candidates with additional disabilities are now being implanted. A survey of UK and Ireland Cochlear Implant Programmes sought to identify the number of individuals with DS who have been implanted with a cochlear implant (CI) and to provide relevant information on outcomes of implantation in these individuals.

METHODS

E-mail survey of all programmes within the British Cochlear Implant Group (BCIG). Postal questionnaire to programmes identified to have implanted a child with Down Syndrome, with data collection on pre-operative assessment, surgical and post-operative outcomes. Case series review.

RESULTS

Three of 23 BCIG programmes have implanted a child with Down Syndrome. Four children have received implants. No intraoperative or post-operative surgical complications were encountered. All children had middle ear disease, but no problems with implantation were associated with their middle ear condition. All children remain implant users, 12 months to 4 years post-implantation.

CONCLUSION

Cochlear implantation is an option for a child with Down Syndrome and associated severe to profound sensorineural hearing loss. Clinicians caring for these children and their families should consider referral for assessment by a Cochlear Implant Programme.

Generation of chicken single chain antibody variable fragments (scFv) that differentiate and neutralize infectious bursal disease virus (IBDV)

Phage-displayed recombinant antibody libraries derived from splenic mRNA of chickens immunized with an Australian strain of infectious bursal disease virus (IBDV) were constructed as single chain variable fragments (scFv) by either overlap extension polymerase chain reaction (PCR) or sequential ligation of the individual heavy (V(H)) and light (V(L)) chain variable gene segments. Sequential cloning of the individual V(H) and V(L) genes into a newly constructed pCANTAB-link vector containing the synthetic linker sequence (Gly(4)Ser)(3) was more efficient than cloning by overlap extension PCR, increasing the library size 500 fold. Eighteen IBDV specific antibodies with unique scFv sequences were identified after panning the library against the immunizing antigen. Eight of the clones contained an identical V(H) gene but unique V(L) genes. In ELISA analysis using a panel of Australian and overseas IBDV strains, one scFv antibody was able to detect all strains, whilst 3 others could discriminate between Australian and overseas strains, classical and variant strains and Australian field strains and vaccine strains. In addition, some scFvs showed significant neutralization titres in vitro. This report shows that generation of chicken antibodies in vitro by recombinant means has considerable potential for producing antibodies of diverse specificity and neutralizing capacity.

Oscillations in the near-infrared signal in patients with severe head injury

OBJECTIVE

To use a non-invasive system, near infrared spectroscopy (NIRS) to detect oscillations in cerebral blood oxygenation in intensive care patients with severe traumatic brain injury.

MATERIALS AND METHODS

9 patients (7 male, 2 female) with a GCS < 8 were monitored in the intensive care units at King's College Hospital and the Royal London Hospital. A CCD-based spectrometer was coupled to the patient's forehead with one excitation and one detection optode. Spectra in the range of approximately 600-800 nm were collected at intervals of 2-4 seconds (subject to signal strength) and a curve-fitting algorithm applied, thus extracting time series data for oxyhaemoglobin (HbO), deoxyhaemoglobin (Hb) and cytochrome-c-oxidase (Cyt-c). The oxyhaemoglobin data was subjected to Fast Fourier Transform analysis.

RESULTS

In all nine patients, unequivocal oscillations in the HbO signal were observed. The frequencies of these oscillations were at: 0.013-0.042 Hz (0.78-2.5 cycles min-1), 0.11 Hz (6.7 cycles min-1) and 0.19-0.28 Hz (12-16 cycles min-1).

CONCLUSIONS

The presence of oscillations at 0.013-0.033 Hz, 0.11 Hz and 0.19-0.28 Hz are compatible with B-waves, vasomotion and respiratory cycles (respectively). However, due to the unknown contribution of the scalp to the NIR signal this data must be interpreted with care. Further work is required in order to investigate this.

Fowl adenovirus recombinant expressing VP2 of infectious bursal disease virus induces protective immunity against bursal disease

The right hand end Nde I fragment 3 (90.8-100 map units) of the fowl adenovirus serotype 10 (FAV-10) was characterised so as to allow the location of an insertion site for recombinant vector construction. Infectious bursal disease virus (IBDV) VP2 gene from the Australian classical strain 002/73, under the control of the FAV-10 major late promoter/leader sequence (MLP/LS) was inserted into a unique Not I site that was generated at 99.5 map units. This recombinant virus was produced without deletion of any portion of the FAV-10 genome. When administered to specific pathogen free (SPF) chickens intravenously, intraperitoneally, subcutaneously or intramuscularly, it was shown that the FAV-10/VP2 recombinant induced a serum VP2 antibody response and protected chickens against challenge with IBDV V877, an intermediate virulent classical strain. Birds were not protected when the recombinant was delivered via the conjunctival sac.

Reduced GABA-mediated chloride flux in entorhinal cortex-kindled rat brains

Gamma-aminobutyric acid (GABA)-mediated chloride uptake was determined in synaptoneurosomes prepared from the brains of entorhinal cortex-kindled and paired control rats. Subjects were sacrificed either 24 h or 28 days after the experimental animals had exhibited their sixth stage 5 convulsion. In the cortex and cerebellum, no difference was observed between kindled and control animals at either time period. In the brain-stem, however, a significant reduction (approximately 50%) in chloride uptake was observed in kindled subjects both 24 h and 28 days after the last seizure. These findings are consistent with the hypothesis that the 'kindled state' results from a long-lasting decrease in GABA-mediated inhibitory activity.

Time-course of changes in cardiac hypertrophy and pressor mechanisms in two-kidney, one clip hypertensive rats during treatment with minoxidil, enalapril or after uninephrectomy

In rats with severe two-kidney, one clip (2-K,1C) hypertension the time-course of changes in left and right ventricular (LV and RV) weight and LV dimensions was assessed following initiation of chronic treatment with minoxidil, enalapril or removal of the clipped kidney in relation to changes in blood pressure (BP) and sympathetic activity, as well as plasma and blood volumes. Minoxidil decreased BP markedly, but tolerance to the antihypertensive effect developed after 2-3 weeks. In contrast, enalapril or uninephrectomy caused a rapid and persistent normalization of BP. Significant increases in LV and RV weight occurred after 3-5 weeks of treatment with minoxidil. Left ventricular wall thickness decreased over the initial 1-2 weeks and then returned to untreated levels. Left ventricular internal dimensions showed an increase after 1-2 weeks of minoxidil, which persisted with more prolonged treatment. With enalapril, regression to normal occurred for both LV and RV weight within 1 week of treatment. Following uninephrectomy a more gradual regression took place and normal cardiac weight was not obtained until 3 weeks. Indices of sympathetic activity (plasma catecholamines, BP response to hexamethonium or heart rate) did not differ significantly in minoxidil treatment versus untreated hypertensive rats from 2 to 35 days of treatment. A significant increase in heart rate was found after 1 day of minoxidil and a decrease after enalapril. Plasma and blood volumes were elevated in minoxidil-treated rats from 7 to 35 days, as well as initially after uninephrectomy. Therefore, in 2-K, 1C hypertensive rats long-term treatment with minoxidil induces both RV hypertrophy and LV eccentric hypertrophy. Changes in cardiac volume load may play a major role in the differing effects of different antihypertensive therapies on cardiac hypertrophy.