Search for a Variation of the Fine Structure Constant around the Supermassive Black Hole in Our Galactic Center

Searching for space-time variations of the constants of Nature is a promising way to search for new physics beyond general relativity and the standard model motivated by unification theories and models of dark matter and dark energy. We propose a new way to search for a variation of the fine-structure constant using measurements of late-type evolved giant stars from the S star cluster orbiting the supermassive black hole in our Galactic Center. A measurement of the difference between distinct absorption lines (with different sensitivity to the fine structure constant) from a star leads to a direct estimate of a variation of the fine structure constant between the star's location and Earth. Using spectroscopic measurements of five stars, we obtain a constraint on the relative variation of the fine structure constant below 10^{-5}. This is the first time a varying constant of nature is searched for around a black hole and in a high gravitational potential. This analysis shows new ways the monitoring of stars in the Galactic Center can be used to probe fundamental physics.

Neurogenous hyperplasia in the oesophagus

Leiomyoma and gastrointestinal stromal tumours take first place among mesenchymal tumours of the oesophagus, where tumours of peripheral nerve origin are rarely seen. Schwann and enterochromaffi n cell proliferation occur in neurogenous hyperplasia, an entity observed in the appendix which has not been reported in the oesophagus in the medical literature. Oesophagogastroscopy of a 58-year-old woman showed linear erosions and nodularity at the gastroesophageal junction. The microscopic examination of biopsies taken from this area revealed proliferation of spindle cells with oval-round nuclei forming focal fascicular arrangement in the lamina propria. These cells stained positive for synaptophysin and S100-protein, while immunohistochemistry for smooth muscle actin and CD117 were negative. The case was diagnosed as neurogenous hyperplasia with these findings. Control endoscopic biopsies showed no evidence of neurogenous hyperplasia. Neurogenous hyperplasia can be considered as a distinct entity which might also be observed in the oesophagus as in the appendix.

The value of FDG-PET/CT in the post-treatment evaluation of endometrial carcinoma: a comparison of PET/CT findings with conventional imaging and CA 125 as a tumour marker

OBJECTIVES

This retrospective study was designed to assess the value of positron emission tomography/computed tomography imaging (PET/CT) in the post-treatment evaluation of the patients with endometrial carcinoma and to compare PET/CT scan with conventional imaging (CI) including computed tomography (CT), ultrasonography (US) and magnetic resonance imaging (MRI) and CA 125 with both 20U/ml and 35U/ml cut-off values.

MATERIALS AND METHODS

A total of 31 patients who were treated for histopathologically proven endometrial adenocarcinoma, underwent PET/CT examination for restaging and suspected recurrence. Thirty five PET/CT studies were performed in 31 patients. Lesion status was determined on the basis of clinical follow-up including radiological imaging (follow-up CT scan) at least 6 months and response to therapy.

RESULTS

Of the 35 PET/CT studies, 13 (37%) studies were positive, whereas 22 (63%) of them were negative. On study-based analysis the overall sensitivity, specificity, accuracy for PET/CT imaging were 100%, 96% and 97%, respectively. The corresponding information for CI were 46%, 87% and 74%, for CA 125 (cut off=20U/ml) measurement were 45%, 88% and 74%, and for CA 125 (cut off=35U/ml) measurement were 27%, 100% and 78%, respectively. On lesion-based analysis, PET/CT revealed only one false positive case. In none of 21 patients with negative 22 PET/CT studies, no subsequent clinical or radiological recurrences were observed with a follow-up of at least 6 months.

CONCLUSION

FDG-PET/CT is found more useful modality than CI and CA 125 in the evaluation of post-treatment endometrial carcinoma patients, for suspected recurrence.

Splenic and multiple abdominal metastases of endometrial carcinoma detected with FDG-PET/CT

A 58 year old female was referred for FDG-PET/CT for restaging of endometrial adenocarcinoma. For evaluation of treatment, no metastases were detected on FDG-PET/CT which was performed 18 months later after the surgery. During follow-up, FDG-PET/CT was performed 6 months later than the previous FDG-PET/CT for restaging. A lesion with increased metabolic activity (SUV max: 10.21) was detected at spleen which was not seen on previous FDG-PET/CT scan. The lesion was consistent with metastasis of endometrial carcinoma. Splenic metastasis of endometrial carcinoma is extremely rare. There are only 13 cases of splenic metastasis from endometrial carcinoma that reported in the literature before. There is only one splenic metastasis of endometrial carcinoma case reported in the literature which is imaged with FDG-PET. To best of our knowledge this is the first report of solitary splenic metastasis of endometrial carcinoma that is imaged with FDG-PET/CT.

Primary epithelioid trophoblastic tumor with a synchronous breast carcinoma detected only with FDG-PET/CT Scan

Epithelioid trophoblastic tumor is a recently described, rare and distinctive type of gestational trophoblastic tumor. We report the case of a 31-year old patient who had a full-term pregnancy 18 months before presentation. She had a right axillary lymph node metastasis and was referred for FDG-PET/CT scan for evaluation of distant metastasis and to detect primary malignancy. The axillary lymph node biopsy revealed metastatic breast carcinoma. FDG-PET/CT revealed increased uptake of right axillary lymph node, soft tissue density lesion with a diameter of 24 mm on left cervical region with increased FDG uptake, increased uptake on cervical region and left inguinal lymph node with increased uptake. Pelvic MRI imaging and ultrasonography were negative for malignancy in cervical region. Biopsy of the lesion was consistent with epithelioid trophoblastic tumor in cervical region. Gestational trophoblastic tumor was not suspected because she had no signs such as abnormal vaginal bleeding. FDG-PET/CT demonstrated the primary lesion in cervical region. We report a rare case of primary epithelioid trophoblastic tumor detected only with FDG-PET/CT scan which synchronized with breast carcinoma.

Blood pressure dynamics in hypertensive subjects during tilt table test

Blood pressure dynamicity during tilt table measurement is discussed. We analyzed ECG and BP parameters from 14 normotensive young healthy volunteers, 15 old healthy volunteers, and two groups of hypertensive patients--20 non-medicated hypertensive subjects with no other known complications and 21 hypertensive non-medicated subjects with confirmed obesity (according to waist circumference), hyperlipidemia or diabetes mellitus. The dynamic parameters, such as pulse pressure, maximum of derivative BP, difference between maximum and minimum of derivative BP and SBP peak--DBP depression time were obtained from derivative continuous blood pressure signal recordings. We have found that the age factor plays a more significant role in dynamic parameters change and in inter-group differentiation than additional risk factors of hypertensive subjects.

Noninvasive detection of vessel stiffness from continuous blood pressure recordings in hypertensive subjects

This paper presents results of blood pressure dynamicity analysis aimed at vessel stiffness detection and subsequent cardiac risk stratification. We analyzed ECG and BP parameters from 12 normotensive young healthy volunteers, 10 old healthy volunteers, and two groups of hypertensive patients -- 12 young non-medicated hypertensive subjects with no other known complications and 16 hypertensive non-medicated subjects with confirmed obesity (according to waist circumference), hyperlipidemia or diabetes mellitus. The dynamic parameters obtained from a derivative continuous blood pressure signal provide additional information about vessel compliance. They can differentiate hypertensive subjects according to the level of cardiovascular risk.

Irritable bowel syndrome in young and elderly patients with stable asthma

BACKGROUND

It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes.

AIM

To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma.

PATIENTS AND METHODS

Sixty-five young (age < 60 years) and 66 elderly (age > or = 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated.

RESULTS

The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0-3.4]; p=0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0-5.1]; p=0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1-0.8]; p=0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1-3.8]; p=0.01), and the presence of asthma (odds ratio, 1.9 [1.0-3.5]; p=0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender.

CONCLUSION

The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.

Maxillary and temporal fibrous dysplasia: three cases

PROBLEMS/OBJECTIVES

Fibrous dysplasia (FD) is a benign, expansile lesion of bone with slow progression and unknown origin. The purpose of this report is to make physicians aware of the symptoms, methods for differential diagnosis, and treatment options.

METHODOLOGY

Three cases of monostotic FD are presented; two involving the maxillary sinus, and one in temporal bone. CT scans are the definitive diagnostic and follow-up method. Surgical approaches to alleviate the symptoms, including facial deformity, are described.

RESULTS

FD went undiagnosed for three years in these patients. All three patients were relieved of the symptoms by limited surgery, and remained asymptomatic for up to two years after the surgery, with no signs of recurrence.

CONCLUSIONS

Practitioners should be alert to the possibility of FD, particularly if patients develop narrowing of the ear canal, or progressive postauricular or maxillofacial enlargement. Minimal surgery to alleviate the symptoms is the treatment of choice.

Chemoreflexes--physiology and clinical implications

The chemoreflexes are important modulators of sympathetic activation. The peripheral chemoreceptors located in the carotid bodies respond primarily to hypoxaemia. Central chemoreceptors located in the region of the brainstem respond to hypercapnia. Activation of either the hypoxic or hypercapnic chemoreflex elicits both hyperventilation and sympathetic activation. During apnoea, when the inhibitory influence of stretch of the pulmonary afferents is eliminated, there is a potentiation of the sympathetic response to both hypoxia and hypercapnia. This inhibitory influence of the pulmonary afferents is more marked on the sympathetic response to peripheral compared with central chemoreceptor activation. The arterial baroreflexes also have a powerful inhibitory influence on the chemoreflexes. This inhibition is again more marked with respect to the peripheral compared with central chemoreflexes. In patients with hypertension, there is a marked increase in the sympathetic and ventilatory response to hypoxaemia. During apnoea, with elimination of the inhibitory influence of breathing, the sympathetic response in untreated mild hypertensive patients is strikingly greater than that seen in matched normotensive controls. This potentiated peripheral chemoreflex sensitivity in hypertension may be explained in part by impaired baroreflex function in these patients. Enhanced peripheral chemoreflex sensitivity is also evident in patients with obstructive sleep apnoea. This peripheral chemoreflex enhancement is not explained by obesity, as obese individuals have a selective potentiation of the central chemoreceptors with peripheral chemoreflex responses similar to those seen in lean controls. Increased sensitivity to hypoxaemia has important implications in patients with obstructive sleep apnoea who experience repetitive and severe hypoxaemic stress. Tonic activation of the chemoreflex may also contribute to the high levels of sympathetic activity evident even during normoxic daytime wakefulness in sleep apnoea patients. Administration of 100% oxygen in patients with sleep apnoea results in reductions in heart rate, blood pressure and central sympathetic outflow. In patients with heart failure, the central chemoreflex response to hypercapnia is markedly and selectively enhanced. This increased central chemoreflex sensitivity may contribute to the development of central sleep apnoea in heart failure patients. Administration of 100% oxygen does not lower sympathetic activity in patients with heart failure, providing further evidence against any peripheral chemoreflex potentiation. The peripheral and central chemoreflexes have powerful effects on sympathetic activity in both health and disease and may contribute importantly to disease pathophysiology, particularly in conditions such as hypertension, obstructive sleep apnoea and heart failure.

Systolic and diastolic function in patients with chronic heart failure at rest and during exercise

In our study we tried to evaluate systolic and diastolic function in patients with chronic heart failure (CHF) by using some echocardiographic parameters and invasively measured pulmonary capillary wedge pressure (PCWP). We studied 19 patients with CHF NYHA II-III at rest, at the end of isometric exercise (handgrip) and during a bicycle stress test. Right heart catheterization and echocardiography were simultaneously performed. We measured exchange of blood gases, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), peak E velocity, peak A velocity, E/A ratio, deceleration time of E wave (DT), time of mitral regurgitation (MR) and effective filling period of left ventricle (FP). We divided patients according to the median of PCWP at rest into two groups: group A with PCWP< or =11 mmHg (10 pts), group B with PCWP>11 mmHg (9 pts). In group A mean PCWP at rest was 6+/-2 mmHg, during handgrip 12+/-4 mmHg and during bicycle exercise 18+/-6 mmHg. In group B mean values of PCWP were 19+/-6 mmHg, 26+/-11 mmHg and 33+/-5 mmHg, respectively. All values were significantly higher in group B (P<0.01). There was a significant difference in pVO2: in group A 18.8+/-3.5 vs. 14.7+/-3.3 ml/kg per min in group B (P<0.03). No differences between the groups were noticed in EDV, ESV and EF. The E/A ratio in group A was less than 1, in group B greater than 1 with the restrictive pattern. No differences between the groups were observed in MR and FP at rest. During bicycle exercise, MR was significantly longer (284+/-98 vs. 164+/-79 ms; P<0.05) and FP shorter (322+/-99 vs. 421+/-74 ms; P<0.05) in group B than in group A. The functional capacity of patients with CHF is influenced not only by EF and other systolic variables, but also by filling conditions. The duration of effective diastole may be one of the most important of them.

[Risk factors for cardiovascular diseases in Turks in Amsterdam and in Ankara]

OBJECTIVE

To determine the prevalence of the main risk factors for cardiovascular disease in Turks in Amsterdam and in Ankara, and to compare the results obtained in these two groups with each other and also with those obtained in a group of indigenous Dutch residents living in the same districts.

DESIGN

Cross-sectional observational study.

SETTING

Districts 'Oost' and 'De Pijp' in Amsterdam, the Netherlands, 'Camlik' and 'Beşikkaya' in Ankara, Turkey.

METHODS

Plasma glucose and lipids were determined in 149 Turkish residents living in Amsterdam and 145 Turkish subjects in Ankara with comparable socio-economic status (66 and 74% of those who were asked to participate). Blood pressure was also measured by mercury sphygmomanometry. Questionnaires were completed on smoking habits, alcohol consumption, physical activity, consumption of food containing saturated fat, and the existence of heart and vascular disease or hypertension. Results were compared between groups and also with the findings obtained in a group of indigenous Dutch subjects living in the same districts in Amsterdam by the Peilstationsproject of the Rijksinstituut voor Volksgezondheid en Milieu (Sounding station project, National Institute for Public Health and the Environment).

RESULTS

Turkish men in Amsterdam had higher systolic blood pressures, lower HDL cholesterol values and higher total cholesterol/HDL cholesterol ratios, and were more obese than men in Ankara and Dutch men in Amsterdam. Glucose concentration and total cholesterol and LDL cholesterol concentrations of Turkish men in Amsterdam were higher than the values of men in Ankara. The risk profile of Turkish women was also more unfavourable compared with that of women in Ankara, but the differences were less than in the men. They had lower HDL cholesterol values, higher LDL cholesterol and glucose and smoked more often than women in Ankara. Turkish women in Amsterdam also had higher systolic and diastolic blood pressures and were more obese than Dutch women in Amsterdam.

CONCLUSION

Turkish residents in Amsterdam have more risk factors for cardiovascular disease than their countrymen living in Ankara, and also compared with indigenous Dutch citizens living in the same districts. Their risk factor profile, therefore, is not intermediary between that of Turkish subjects in Ankara and the indigenous Dutch citizens, as might be expected in view of the mortality figures.

Tissue and cellular patterning of the musculature in chick wings

Development of the musculature involves generation of a precise number of individual muscles arranged in appropriate locations, each with the correct cellular patterning. To find out the rules that govern muscle number and arrangement, the forearm musculature of chick wing buds was analysed following grafts of the polarizing region or application of retinoic acid. Muscle patterns appear symmetrical with ‘posterior’ muscles now forming in the anterior part of the wing. When the number of muscles that develop is reduced, pattern symmetry is maintained, with loss of anterior muscles in the mid-line, especially dorsally. Strict anteroposterior ordering of muscles in duplicated patterns does not always occur. The number of muscles that develops bears some relationship to the number of forearm elements. Each muscle has a characteristic pattern of fast and slow fibres. In duplicated wings, each pair of symmetrically arranged muscles has the same fibre type pattern. Not only are proportions of fast and slow fibres similar, but local variations in fibre type arrangement within the muscle are also reproduced. This suggests that the cellular pattern within the new ‘posterior’ muscles at the anterior of the limb has been re-specified. In manipulated limb buds, which will develop a duplicated muscle pattern, there are no detectable changes in distribution and number of potentially myogenic cells, and fibre type patterning within early muscle masses also appears normal. In contrast, the splitting process that divides up muscle masses is altered. The appropriate fibre type arrangement only emerges after splitting is complete. This suggests that tissue patterning and cellular patterning occur at different times during muscle development.

Serum and CSF levels of haloperidol by radioimmunoassay and radioreceptor assay during high-dose therapy of resistant schizophrenic patients

Serum and cerebrospinal fluid (CSF) levels of haloperidol were measured in 12 chronic neuroleptic-nonresponsive schizophrenic patients after 1 month on 60 mg haloperidol daily and then again after 1 month on 120 mg haloperidol daily. Serum haloperidol and CSF haloperidol rose with increasing dose. Serum and CSF levels were significantly correlated. No clinical improvement was achieved despite the high serum and CSF drug levels.