Cavernomas of the central nervous system: clinical syndromes, CT scan diagnosis, and prognosis after surgical treatment in 25 cases

We present our clinical experience and the results of surgical management with 25 cavernomas of the CNS, treated in our hospital in the last 10 years. The location of the lesion assessed by clinical and CT scan examinations, proved to be the most significative factor determining the prognosis of cavernomas of the CNS, after surgical removal. The symptoms started in most of the cases in the third decade of life. 19 cases were located in the cerebral hemispheres and produced three well defined clinical syndromes: Irritative syndrome (seizures) present in 70% of the cases. Space-occupying lesion syndrome (20%) and haemorrhagic syndrome (10%). The remaining six cases were located within the basal ganglia, brainstem, pineal region, cerebellum and spinal cord, showing a progressive course. CT scan studies were performed on 24 cases. The characteristic image of a cavernoma is represented by a moderately hyperdense nodule with discreet contrast uptake. Calcification was observed in and around the lesions in 33% of the cases. Perilesional hypodensities suggestive of brain tissue atrophy were noted in 22% of the CT scans. On the other hand, 12% of cerebral hemisphere cavernomas showed atypical CT scan images that suggested an erroneous diagnosis of cystic gliomas. Radical surgical removal was performed in all cases. The postoperative results varied according to the location of the lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Posterior fossa epidermoid cysts

The authors present their clinical and surgical experience with 18 posterior fossa cholesteatomas, including three cases with atypical CT scan appearances that corresponded to calcification, haemorrhage or malignant change into an epidermoid carcinoma, respectively.

Ingestion of egg raises plasma low density lipoproteins in free-living subjects

In addition to their usual diet, 17 lactovegetarian college students consumed 400 kcal of test foods per day containing one extra-large egg for three weeks and similar isocaloric eggless foods for an additional three weeks in a randomised double-blind crossover trial. Ingestion of the egg increased dietary cholesterol from 97 to 418 mg per day. Mean plasma low density lipoprotein (LDL) cholesterol was 12% higher (p = 0.005) and mean plasma apolipoprotein B was 9% higher (p = 0.007) when eggs were being consumed than during the eggless period. Mean plasma high density lipoprotein cholesterol, apolipoproteins A-I and A-II, very low density lipoprotein cholesterol, and total triglycerides did not change significantly. Thus, ingestion of egg seems selectively to raise cholesterol and protein in LDL particles in the plasma of free-living normal people. Plasma LDL may be more sensitive to cholesterol at low intakes than at moderate to high intakes.

The subtalar joint: embryology and morphology

Several different aspects of the subtalar joint are studied. Embryology indicates that it is a recently acquired structure. The anterior subtalar joint does not have a uniform morphology, and it has been subdivided into three anatomical descriptions (ovoid, bean, and two part). To correct the confusion found in other papers, we intend to clearly describe the anatomy of the ligaments. The form and function of the retinacula, cervical ligament, and ligament of the canal are studied. The microscopic anatomy of ligaments is studied, dealing specifically with their innervation and the structure of their fibers.

Syringosubarachnoid shunt for treatment of syringomyelia

The experiences with a series of 9 patients with syringomyelia treated by syringosubarachnoid shunt (SSS) are presented. All of the cases were evaluated by myelography, CT scan or MNR. The cases showed satisfactory results which consisted in stabilization of the symptoms (55%) or clinical improvement (44%). These results should be continuously evaluated, due to the short follow-up period and to the variable natural history of the illness. Treatment by SSS is a technique of low morbidity. It is recommended for patients with syringomyelia without significant descent of the tonsils or in those cases where posterior fossa operations have failed to obtain good results.

Activation of annexin A1 signalling in renal fibroblasts exerts antifibrotic effects

AIM

The anti-inflammatory protein annexin A1 (AnxA1) and its formyl peptide receptor 2 (FPR2) have protective effects in organ fibrosis. Their role in chronic kidney disease (CKD) has not yet been elucidated. Our aim was to characterize the AnxA1/FPR2 system in models of renal fibrosis.

METHODS

Rats were treated with angiotensin receptor antagonist during the nephrogenic period (ARAnp) to induce late-onset hypertensive nephropathy and fibrosis. Localization and regulation of AnxA1 and FPR2 were studied by quantitative real-time PCR and double labelling immunofluorescence. Biological effects of AnxA1 were studied in cultured renal fibroblasts from AnxA1(-/-) and wild-type mice.

RESULTS

Angiotensin receptor antagonist during the nephrogenic period kidneys displayed matrix foci containing CD73(+) fibroblasts, alpha-smooth muscle actin (a-SMA)(+) myofibroblasts and CD68(+) macrophages. TGF-β and AnxA1 mRNAs were ~threefold higher than in controls. AnxA1 was localized to macrophages and fibroblasts; myofibroblasts were negative. FPR2 was localized to fibroblasts, myofibroblasts, macrophages and endothelial cells. AnxA1 and FPR2 immunoreactive signals were increased in the foci, with fibroblasts and macrophages expressing both proteins. AnxA1(-/-) fibroblasts revealed higher α-SMA (sevenfold) and collagen 1A1 (Col1A1; 144-fold) mRNA levels than controls. Treatment of murine WT fibroblasts with TGF-β (22.5 ng mL 24 h(-1)) increased mRNA levels of α-SMA (9.3-fold) and Col1A1 (fourfold). These increases were greatly attenuated upon overexpression of AnxA1 (1.5- and 1.7-fold, respectively; P < 0.05). Human fibroblasts reacted similarly when receiving the FPR2 inhibitor WRW4.

CONCLUSION

Our results demonstrate that AnxA1 and FPR2 are abundantly expressed in the renal interstitium and modulate fibroblast phenotype and extracellular matrix synthesis activity.

Long-term hypotensive and renal effects of atrial natriuretic peptide

The present study was designed to examine the short-term and long-term effects of increased plasma levels of atrial natriuretic peptide on the glomerular filtration rate, sodium excretion, and arterial pressure. Intravenous infusion of synthetic atrial natriuretic peptide (2 micrograms/kg/bolus, 50 ng/kg/min continuous infusion) for 45 minutes in six conscious dogs increased plasma levels of immunoreactive atrial natriuretic peptide from 69 +/- 10 to 233 +/- 14 pg/ml. Short-term increases in plasma levels of atrial natriuretic peptide increased the glomerular filtration rate from 53 +/- 15 to 82 +/- 16 ml/min and increased sodium excretion from 74.4 +/- 32.6 to 146.9 +/- 38.1 microEq/min. Mean arterial pressure decreased slightly, from 88 +/- 3 to 83 +/- 3 mm Hg, whereas no changes occurred in plasma renin activity (2.0 +/- 0.6 to 1.6 +/- 0.8 ng of angiotensin I per milliliter per hour) or plasma aldosterone concentration (6.9 +/- 2.3 to 8.1 +/- 3.9 ng/dl). To determine whether the short-term effects of atrial natriuretic peptide on the glomerular filtration rate and sodium excretion lead to a sustained reduction in mean arterial pressure, atrial natriuretic peptide (50 ng/kg/min) was infused intravenously for 5 days in six conscious dogs. Long-term infusion increased plasma levels of immunoreactive atrial natriuretic peptide from 27 +/- 5 to 292 +/- 31 pg/ml. The infusion caused only a transient increase in sodium excretion and had no significant long-term effect on the glomerular filtration rate. Mean arterial pressure decreased from 90 +/- 3 to 74 +/- 3 and 75 +/- 4 mm Hg by Days 4 and 5 of the infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and CT scan assessment of benign versus fatal spontaneous cerebellar haematomas

We have studied 15 cases of spontaneous intracerebellar haematomas in 9 males and 6 females. A significant correlation between the clinical presentation and the CT scan features of benign and fatal haemorrhages of the cerebellum is presented. Diagnostic computerized tomographic studies were performed in a mean interval of 31 hours after the initial symptoms. 60% were diagnosed and treated in less than 24 hours; 11 patients had haematomas larger than 3 cm, and 5 (45%) of these cases died with evidence of irreversible brain-stem damage. Twelve (80%) showed compression of the fourth ventricle, 9 (60%) obliteration of the brain-stem cisterns and 8 (53%) ventricular dilatation. 8 cases were treated with surgery; 50% of them showed neurological improvement, including two cases with signs of brain-stem compression. 7 patients who were treated conservatively were followed closely with repeated CT scans, which showed that resolution of the mass effect and isodensity of the haematomas larger than 3 cm (73%), hydrocephalus (45%) and intraventricular haemorrhage (40%). Smaller haematomas without CT scan evidence of obliteration of the brain-stem cisterns or hydrocephalus had a better outcome.

Variations in genes regulating neuronal migration predict reduced prefrontal cognition in schizophrenia and bipolar subjects from mediterranean Spain: A preliminary study

Both neural development and prefrontal cortex function are known to be abnormal in schizophrenia and bipolar disorder. In order to test the hypothesis that these features may be related with genes that regulate neuronal migration, we analyzed two genomic regions: the lissencephaly critical region (chromosome 17p) encompassing the LIS1 gene and which is involved in human lissencephaly; and the genes related to the platelet-activating-factor, functionally related to LIS1, in 52 schizophrenic patients, 36 bipolar I patients and 65 normal control subjects. In addition, all patients and the 25 control subjects completed a neuropsychological battery. Thirteen (14.8%) patients showed genetic variations in either two markers related with lissencephaly or in the platelet-activating-factor receptor gene. These patients performed significantly worse in the Wisconsin Card Sorting Test-Perseverative Errors in comparison with patients with no lissencephaly critical region/platelet-activating-factor receptor variations. The presence of lissencephaly critical region/platelet-activating-factor receptor variations was parametrically related to perseverative errors, and this accounted for 17% of the variance (P = 0.0001). Finally, logistic regression showed that poor Wisconsin Card Sorting Test-Perseverative Errors performance was the only predictor of belonging to the positive lissencephaly critical region/platelet-activating-factor receptor group. These preliminary findings suggest that the variations in genes involved in neuronal migration predict the severity of the prefrontal cognitive deficits in both disorders.

Choroid plexus papilloma with chondroma: case report

The authors report the successful total removal of a rare intracranial tumor in the right lateral ventricle of a 15-year-old girl with epileptic seizures. Histopathological examination showed a benign tumor formed by mature cartilage and choroid plexus papilloma. From our review of the literature, a mixed tumor with these histological features has not been reported previously in this location. The diagnosis, surgical approach, etiology, and prognosis of this lesion are discussed.

Genetic and biochemical studies of partially active tryptophan synthetase mutants of Saccharomyces cerevisiae

Approximately 20% of the tryptophan synthetase mutants (tr(5)) of Saccharomyces cerevisiae retain activity in one of the half reactions catalyzed by this enzyme and have been identified as indole-accumulating or indole-utilizing tr(5) mutants by complementation tests. Ten indole-accumulating and six indole-utilizing mutants have been studied. For the half reactions they catalyze, these partially active mutants have from about one-half to twice the specific activities of the wild-type enzyme. Indole-accumulating mutant enzymes showed varying responses to pyridoxal phosphate and serine in the assay mixture. The partially active mutants were further characterized by their patterns of allelic complementation and their distribution on the fine-structure map of the locus. It was concluded that these mutants define two distinct functional regions of the tr(5) locus, corresponding to the two half reactions.

Use of ultrasound for the determination of flour quality

Within the baking industry, the control of dough properties is required to achieve final product quality and consistency. Traditional methods for dough testing are slow and off-line and do not provide fundamental rheological information. There is therefore a need for the development of fast and on-line instruments capable of providing relevant data for baking. Ultrasonics provide a non-destructive, rapid and low cost technique for the measurement of physical food characteristics. In this work, the water content of dough is investigated using ultrasonic techniques. The capability of ultrasound measurements for discriminating flours for different purposes is also studied. Doughs from more than 30 flours were characterised rheologically using a Chopin Alveograph and a Brabender Extensograph. Ultrasound measurements on the doughs prepared from these flours were also performed. The measurements were correlated, showing that ultrasound was an alternative measurement method to discriminate types of flours for different purposes.

Pulmonary artery occlusion due to histoplasmosis

Histoplasma mediastinitis with complete or partial pulmonary artery obstruction due to compression and/or intraluminal granuloma was diagnosed in five patients and surgically verified in two. The patients, ages 12-27 years, had cough, dyspnea (four cases), and hemoptysis (two cases). Radionuclide imaging showed unilateral absence of pulmonary perfusion and minimal diminution of ventilation. Differentiation of this inflammatory process from other causes of ventilation-perfusion mismatch, for example, congenital hypoplasia and certain acquired causes of arterial obstruction, especially thromboembolism, may be possible by correlating radiographs, laminograms, and clinical history. Angiography can delineate the extent of perfusion impairment and may suggest its cause.

Avoidance of negative percutaneous lung biopsy using contrast-enhanced CT

Fluoroscopically guided percutaneous biopsy of pulmonary masses is an accepted procedure, but large neoplasms often have necrotic areas which, if aspirated, do not afford a pathologic diagnosis. Such tumors may require multiple punctures or procedures to establish a diagnosis. A prebiopsy contrast-enhanced CT scan selectively demonstrates the extent of peripherally located, viable tumor tissue. Three cases of initially frustrated lung biopsies in which viable, diagnostic tissue was localized for fluoroscopic aspiration using the contrast-enhanced CT scan are presented.

Consensus of experts from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology for the genotyping of DPYD in cancer patients who are candidates for treatment with fluoropyrimidines

5-Fluorouracil (5-FU) and oral fluoropyrimidines, such as capecitabine, are widely used in the treatment of cancer, especially gastrointestinal tumors and breast cancer, but their administration can produce serious and even lethal toxicity. This toxicity is often related to the partial or complete deficiency of the dihydropyrimidine dehydrogenase (DPD) enzyme, which causes a reduction in clearance and a longer half-life of 5-FU. It is advisable to determine if a DPD deficiency exists before administering these drugs by genotyping DPYD gene polymorphisms. The objective of this consensus of experts, in which representatives from the Spanish Pharmacogenetics and Pharmacogenomics Society and the Spanish Society of Medical Oncology participated, is to establish clear recommendations for the implementation of genotype and/or phenotype testing for DPD deficiency in patients who are candidates to receive fluoropyrimidines. The genotyping of DPYD previous to treatment classifies individuals as normal, intermediate, or poor metabolizers. Normal metabolizers do not require changes in the initial dose, intermediate metabolizers should start treatment with fluoropyrimidines at doses reduced to 50%, and poor metabolizers are contraindicated for fluoropyrimidines.

Limitations in knowledge of HIV transmission among HIV-positive patients accessing case management services in a resource-poor setting

HIV has increasingly become an infection of poverty. Adequate HIV transmission knowledge among HIV-positive patients is necessary to reduce the risk of secondary infection and protect those who are uninfected from transmission. This study was conducted among individuals enrolled in a program that serves impoverished HIV patients in the Boston area. Although the mean HIV transmission knowledge score was 80% for this group, a significant proportion of patients demonstrated limitations in knowledge of HIV transmission. Highly vulnerable patients, such as those who reported not accessing HIV medications, a history of sexual abuse, or problems getting clothing, had lower levels of HIV knowledge. This paper hopes to alert providers that their most vulnerable patients may be at an increased risk of re-infection or transmission due to limited HIV knowledge. Programs that serve HIV-positive patients coping with poverty and other serious problems need to ensure adequate knowledge of HIV transmission to reduce the overall burden of HIV in resource-poor settings.

Preliminary evaluation of the use of mussel adhesive protein in experimental epikeratoplasty

We have used a preliminary formulation of a bioadhesive in an experimental model of epikeratoplasty in rabbits. The adhesive, termed mussel adhesive protein (MAP), is a repeating decapeptide polymer that is the natural adhesive substance produced by the common blue mussel (Mytilus edulis) and is used here in conjunction with an enzymatic cross-linking agent. This study marked the first in vivo use of this material in adhering ophthalmic tissue planes. We used a simplified epikeratoplasty technique highlighted by freehand dissection of donor lenticules and host keratotomies. Approximately 10 microL of a combination of MAP and the cross-linking agent was applied directly to the host cornea and the donor lenticules were secured into the keratotomies using eight interrupted 10-0 nylon sutures. All of the sutures were removed 72 hours postoperatively. Eleven of the 15 animals retained their epikeratoplasty lenticules throughout the entire postoperative period. Four animals had initially intact lenticules that sloughed within the first postoperative week; this sloughing, we believe, was attributable to difficulties in tucking irregularly thickened lenticule edges into the keratotomy. In control animals that had lenticules secured with sutures alone, suture removal at 72 hours consistently produced immediate lenticule sloughing. Clinical examinations and histopathologic studies disclosed no untoward effects of the adhesive on the donor or host corneal tissue. We believe that this preliminary study indicates a potential adjunctive role for MAP in epikeratoplasty.

Iron dyshomeostasis in Parkinson's disease

Owing to its ability to undergo one-electron reactions, iron transforms the mild oxidant hydrogen peroxide into hydroxyl radical, one of the most reactive species in nature. Deleterious effects of iron accumulation are dramatically evidenced in several neurodegenerative diseases. The work of Youdim and collaborators has been fundamental in describing the accumulation of iron confined to the substantia nigra (SN) in Parkinson's disease (PD) and to clarify iron toxicity pathways and oxidative damage in dopaminergic neurons. Nevertheless, how the mechanisms involved in normal neuronal iron homeostasis are surpassed, remain largely undetermined. How nigral neurons survive or succumb to iron-induced oxidative stress are relevant questions both to know about the etiology of the disease and to design neuroprotective strategies. In this work, we review the components of neural iron homeostasis and we summarize evidence from recent studies aimed to unravel the molecular basis of iron accumulation and dyshomeostasis in PD.

Ultrasonic study of wheat flour properties

In this work, the wheat flour properties are investigated using ultrasound techniques. Moreover, the flour samples were also characterized by means of well established techniques such as protein content, Alveograph and Mixolab®. A set of 35 dough samples, made of wheat flours with diverse physical and quality properties, were studied. The obtained results shown that ultrasound measurements can detect changes in the dough consistency induced by proteins and also by gelatinization of the starch. Furthermore, ultrasound measurements can be related to parameters indicative of the proteolytic degradation or softening of the dough due to protease activity. Thus, ultrasound can be considered a low cost and rapid tool, complementary to conventional test, for wheat flour characterization.

Ventricular parasystole in acute myocardial infarction

The clinical and electrocardiographic features of 11 patients with ventricular parasystole in acute myocardial infarction are described. This arrhythmia always appeared within the first 24 hours after the beginning of the pain, and lasted usually a few hours. Only one patient received digitalis before the appearance of the arrhythmia; the others did not receive any drug of known arrhythmic potential. The treatment was mainly with lignocaine intravenously, the response to which was usually very good. There was no relation between this arrhythmia and the plasma potassium levels. The electrocardiographic finding of fusion beats, coupling, retrograde conduction, interectopic interval, ectopic cycle length, and exit block were analysed. Two of the cases were examples of intermittent parasystole. The relation between this arrhythmia and the slow idioventricular rhythm was discussed. It appears that this is a benign arrhythmia, easily controlled by treatment, produced perhaps by the same mechanisms as ventricular tachycardia, but with the existence of exit block.

Pulmonary injury in recipients of discordant hepatic and renal xenografts in the dog-to-pig model

Work in our lab demonstrated that the early post-operative course of discordant hepatic and renal xenotransplantation is complicated by a pulmonary injury. The aim of this study was to characterize the nature of this injury, as well as to determine whether endothelin-1 (ET-1) and inducible-nitric oxide synthase (iNOS) are present in this form of pulmonary injury. Dog-to-pig orthotopic liver and kidney xenografts were performed. Pulmonary artery pressures were monitored throughout all procedures. The lungs were stained with monoclonal antibodies for ET-1, endothelin converting enzyme-1, and iNOS. The lungs from pig recipients of hepatic or renal xenografts were compared to lungs from untreated pigs. Pulmonary artery pressures were elevated in recipients of liver xenografts when the suprahepatic caval cross clamp was placed and continued to rise to systolic levels following unclamping. The mean pulmonary artery pressures in recipients of renal and hepatic xenografts rose significantly following revascularization. Pathology in lungs from kidney and liver recipients was similar, showing congestion with peribronchial and septal edema, with diffuse adhesion of PMN to alveolar endothelium. ET-1, endothelin converting enzyme-1 (ECE-1), and iNOS staining was widespread and intense in alveolar and pulmonary arterial endothelium. Discordant xenotransplantation of livers and kidneys is associated with a significant early pulmonary injury that is associated with early PMN infiltration and expression of ET-1 and iNOS.