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Case report: prolonged contrast enhancement of the inner ear on magnetic resonance imaging in Ramsay Hunt syndrome.

There have been recent reports of enhancement of the inner ear in acute labyrinthitis on gadolinium enhanced magnetic resonance imaging (MRI). However, none has described persistence of enhancement beyond 6 weeks. We report a case of Ramsay Hunt syndrome with labyrinthitis, sensorineural hearing loss and facial nerve palsy in which marked enhancement of the inner ear structures was observed on MRI 6 months after the onset of symptoms. Enhancement on delayed or repeated imaging after a period of months does not exclude labyrinthitis from the differential diagnosis of the small intracanalicular acoustic neuroma, and care should be taken not to confuse them.

Diagnosis, Differential↗

Parasellar chronic inflammatory disease presenting Tolosa-Hunt syndrome, hypopituitarism and diabetes insipidus: a case report.

We describe a 60-year-old man with a history of Tolosa-Hunt syndrome associated with intermittent painful ophthalmoplegia and a visual disturbance on the left side, who presented with signs and symptoms of severe hypoadrenalism and diabetes insipidus. Magnetic resonance imaging demonstrated enlargement of the hypophysis and infundibulum and left cavernous sinus. An endocrinologic study revealed anterior pituitary dysfunction and diabetes insipidus. The patient underwent a transsphenoidal biopsy which revealed chronic inflammation in the hypophysis, mucosa of the sphenoid sinus, and dura mater. The patient was treated with steroids that decreased the size of the hypophysis and infundibulum, but the symptoms of anterior pituitary insufficiency and diabetes insipidus have persisted. The chronic inflammation of the hypophysis and infundibulum is thought to have spread from the cavernous sinus.

Anti-Inflammatory Agents↗

[Tolosa-Hunt syndrome. Troubles in diagnosis and pattern of response to prednisone].

The Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia related to granulomatous inflammatory process in the cavernous sinus. According to recent concepts, the diagnosis is established only when other causes of painful ophthalmoplegia are ruled out. A typical pattern of response to corticosteroids associated with a benign evolution may reinforce this possibility. Tumors such as lymphoma and meningioma and orbital pseudotumors can make difficult the differential diagnosis because they also may respond to steroids. Thus it is always necessary to make an extensive ancillary investigation. We performed a clinical, laboratory and radiologic study of five patients with THS. Prednisone was used in all, with dosages ranging from 40 to 80 mg/day. In four patients there was a dramatic analgesic effect in less than 48 hours. Improvement of the ophthalmoplegia was not so fast but occurred in all with a complete remission in 4 to 45 days.

Adult↗

[Is lead used in sports (hunting, shooting and angling) an underestimated public health problem?].

Ammunition and fishing weights used in recreational hunting, shooting and fishing sports have been made traditionally with lead. In Spain, for example, hunters and shooters are responsible for the dispersion of some 6000 tonnes of the heavy metal yearly, into wetland and dryland areas, and an estimated 100 tonnes are contributed by anglers to the aquatic zones. The few legal measures that several countries have adopted banning the use of the lead in these sports are based on the irrefutable proof that every year millions of birds were poisoned lethally, due to the inadvertent ingestion of lead shot and sinkers found in their habitats. We analyzed whether the present conservationist approach to the problem is suitable, and if the evidence of damage to human beings is, or is not, sufficient to warrant even more prohibitive measures, especially because, in children, there is no safe exposure to lead. We conclude that in some areas adequate information already exists, although in others the toxicological-epidemiological studies are still scanty, suggesting that the topic has been given little attention. We are concerned that the Precautionary Principle has not been applied to solve this problem whose health effects will be more long-term than immediate, especially given the array of lead substitutes available.

Adult↗

Inflammatory involvement of the hypophysis in Tolosa-Hunt syndrome.

We report a case of painful ophthalmoplegia (Tolosa-Hunt syndrome), which was complicated with diabetes insipidus (DI) and pituitary-adrenal axis hypofunction. A 42-year-old man hospitalized for left orbital pain and impairment of left cranial nerves III, IV, V, VI, developed diabetes insipidus during the corticosteroid treatment. Neuroimaging studies disclosed a thickened, highly contrast-enhanced pituitary stalk, swollen pituitary gland and widened left cavernous sinus up to the superior orbital fissure, which were accompanied by diabetes insipidus and hypofunction of the pituitary-adrenal axis. These were indicative of an extension of granulomatous inflammation of the cavernous sinus to the pituitary portal system and the gland itself.

Adult↗

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with Ramsay Hunt syndrome: report of a case and review of the literature.

A case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with Ramsay Hunt syndrome is reported. A 59-year-old man was admitted to our department for treatment of left facial pain that had persisted for three days. A left renal tumor had been diagnosed and a radical nephrectomy had been performed two months earlier. On admission, vesicular lesions were found in the left external auditory canal and ear lobe. Additionally found were left facial nerve palsy and hearing loss. Acyclovir 5 mg/kg, three times per day, was started. Five days after admission, the patient became confused and disorientated. Further investigation revealed hyponatremia 118 mEq/l, low serum osmolality, high urine osmolality, normal renal function, normal adrenal and thyroid hormones, and high plasma vasopressin 30 pg/ml. Although cerebrospinal fluid (CSF) examination revealed a mild elevation in protein and cells, no malignant cells were present and bacterial examinations were negative. Antibodies to varicella-zoster virus (VZV) in both IgG and IgM were present in high titers not only in the serum but also in the CSF. Intravenous hypertonic saline and water restriction were started, and the patient's sensorium was improved in accordance with the increase in serum sodium concentration. These results indicate that the hyponatremia in this case was due to SIADH and that SIADH was caused by an increased release of vasopressin probably because of the infection of VZV in the central nervous system.

Antibodies, Viral↗

The hunt for new tuberculosis vaccines: anti-TB immunity and rational design of vaccines.

Tuberculosis (TB) remains to be a leading infectious cause of death worldwide. Apparently, the current BCG vaccine that has been used for 80 years, has failed to control the TB epidemic. Hunting for improved TB vaccine formulations represents a daunting task to TB research community. Anti-TB host defense requires T cell-mediated immunity and we are in desperate need of enhanced understanding of how to develop a new generation of TB vaccines that are able to provoke potent and long-lasting protective cell-mediated immunity, different from almost all of the vaccines currently in use. It is of importance to successful TB vaccine development to identify the key cellular and molecular events governing the generation of anti-TB immunity, but unfortunately little has been understood as to why 90% of infected humans never develop active TB. However, waiting would not help us to win the battle and an ever-intensifying effort is being made to develop various new formulations according to the immunology that we have been learning, in large part, from experimental models. This review article attempts to unite the current understanding of anti-TB immunity with the rational design of anti-TB vaccines. It examines what may have confounded the immunogenicity of current BCG vaccine and the major obstacles to successful development of TB vaccines. It also discusses about antigen presentation, activation of Th1 and Tc1 cells, anti-TB immune effectors and the generation of memory T cells. The vaccine section describes four types of major TB vaccines under development: mycobacterial-, subunit-, plasmid DNA- and viral-based vaccines. A special section is dedicated to the rationale and current design of cytokine-based adjuvant formulations for TB vaccines. We also take this opportunity to introduce our recent development in cytokine transgene adjuvanted BCG vaccination and recombinant adenoviral-based TB vaccines.

Antigens, Bacterial↗

Orbital venography in painful ophthalmoplegia (Tolosa-Hunt syndrome).

Twenty-six patients with painful ophthalmoplegia were classified as having the Tolosa-Hunt syndrome on the basis of their clinical findings and response to steroid therapy. All patients underwent orbital venography, a review of which forms the contents of this investigation. Orbital venography, a review of which forms the contents of this investigation. Orbital venograms were normal in 16 patients and abnormal in 10. The major abnormalities were (1) obstruction of the superior ophthalmic vein in its third segment without displacement; (2) collateral venous flow through small venous channels or collateral veins; and (3) poor opacification of the ipsilateral cavernous sinus.

Adolescent↗

Tolosa-Hunt syndrome revisited: not necessarily a diagnosis of exclusion.

The Tolosa-Hunt syndrome (THS), a steroid-responsive painful ophthalmoplegia secondary to idiopathic granulomatous inflammation, historically has been categorized as a diagnosis of exclusion because of its nonspecific radiologic presentation. Five patients who satisfied the anatomic and clinical criteria of this syndrome underwent high-resolution CT of the orbital apex/cavernous sinus region. Two patients were diagnosed as having orbital apex pseudotumor, two as having cavernous sinus inflammation, and one as having a cavernous sinus epidermoid by the characteristic CT and clinical findings. Follow-up studies while the patients were asymptomatic demonstrated complete resolution of the CT abnormalities in four patients and clinical improvement in all five patients. Our data suggest that orbital apex pseudotumor and granulomatous inflammation of the cavernous sinus have similar clinical features and should be considered as part of the spectrum of THS. With the advent of high-resolution CT, THS may now be a diagnosis of inclusion. Symptomatic improvement after steroid therapy is an essential but not absolute proof of the syndrome, since lesions such as lymphomas may also respond to steroids. Resolution of the soft-tissue inflammation of CT is an additional criterion for diagnosis.

Adult↗

Tolosa-Hunt syndrome with atypical intrasellar and juxtasellar lesions--two case reports.

Two patients with Tolosa-Hunt syndrome (THS) who had atypical lesions in the intrasellar and juxtasellar regions are reported. They manifested with painful ophthalmoplegia. Magnetic resonance imaging (MRI) commonly showed an increase in the volume of the cavernous sinus occupied by homogeneously well-enhanced lesions in both cases. These lesions extended to the intrasellar and juxtasellar regions with meningela enhancement. Follow-up MRI after steroid treatment demonstrated normalized or decreased size of the cavernous sinus. These findings suggested nonspecific inflammatory granulomatosis with atypical extension.

Female↗

Variation in conformation in a cohort of National Hunt racehorses.

REASONS FOR PERFORMING THE STUDY: Assessment of conformation is commonly used in the selection of horses for performance purposes. Little information is available on the normal range of conformational traits within the Thoroughbred population. OBJECTIVES: To describe variations in conformation in a cohort of racing Thoroughbreds in order to provide a set of baseline standards within which conformational traits can be considered normal. MATERIALS AND METHODS: Ninety-eight conformational parameters were measured in a cohort of 108 National Hunt racehorses using a digital motion analysis system. The measurements consisted of segment lengths, joint angles in 2D and 3D, inclinations, deviations and circumference measurements. The differences between left and right sides were determined to obtain a measure of asymmetry. Conformational parameters were related to each horse's country of origin, preferred race distance and race type. RESULTS: The majority of parameters followed a normal distribution with the biggest relative variation in hoof related measurements and in stifle and coxal angle. All circumference measurements and the majority of the length measurements were significantly correlated with the height of the horse at the withers. No underlying pattern of combinations of conformational parameters was identified. Twenty-five per cent of the parameters showed a significant difference between left and right-sided measurements. A significant difference in girth and intermandibular width was observed between Irish and French horses. CONCLUSIONS: Thoroughbreds differ from other breeds, not only with regard to segment lengths but also with regard to joint angles and deviations. Variation in conformational parameters was relatively small and no distinct pattern of combinations of conformational traits identified. CLINICAL RELEVANCE: The variation in conformational measurements in Thoroughbred racehorses establishes a set of baseline measurements of conformational range against which individual horses can be assessed.

Animals↗

The effect of conformation on orthopaedic health and performance in a cohort of National Hunt racehorses: preliminary results.

REASONS FOR PERFORMING STUDY: There is a lack of scientific data and studies on the effect of conformation on performance or on orthopaedic health. OBJECTIVES: To investigate the relationship between conformation, injury and performance in racehorses used for racing over fences. METHODS: Over 2 years, 108 National Hunt racehorses were followed and their medical and performance data recorded. Conformation was measured in 3D with a computerised motion analysis system. Linear multiple regression models were used to evaluate the effect of conformation on measures of race performance and stepwise forward logistic regression models to assess the effect on risk of injury. RESULTS: An increase in intermandibular width, flexor angle of the shoulder joint and coxal angle (the angle between the ilium and ischium) was demonstrated to have a positive effect on performance. Performance decreased with increasing girth, length of the hind digit and valgus conformation of the metacarpophalangeal joint. The risk of suffering from superficial digital flexor tendon injury increased with increasing metacarpophalangeal joint angle and with carpus valgus conformation. The risk of pelvic fracture increased with valgus conformation of the tarsus and decreased with an increasing coxal angle. CONCLUSION: Valgus deformation was demonstrated to be detrimental to performance or increased risk of injury, perhaps resulting in higher loads on musculoskeletal structures. The coxal angle was the only parameter to have an effect on both risk of injury and performance. An alignment of the muscles with the axis of the pelvis may be beneficial for force transmission and decrease the bending moment of the muscles on the bones. The statistical power of this study is limited, however it provides preliminary data necessary for the planning of a larger scale study on the effect of conformation on performance and risk of injury. CLINICAL RELEVANCE: Studies of the effects of conformation on performance and risk of injury may aid in identifying individuals likely to perform well on the racecourse and avoid risks of injury.

Animals↗

Studies with electrocochleography and auditory brainstem response in Ramsay Hunt syndrome.

Eighteen cases of Ramsay Hunt syndrome were examined with electrocochleography and auditory brainstem response. Hearing was normal in 4 cases, while the other 14 exhibited sensorineural hearing loss ranging from mild to moderate in severity. Although the I-V interwave latency in all cases was within or slightly outside of the normal limits, the N1 latency was significantly prolonged in 8 cases proportionately to the degree of hearing loss at 4 and 8 kHz. The histopathological findings reported so far have indicated that the main lesion in this syndrome is in the internal auditory canal (2, 3, 4, 5). The results obtained in the present study, however, clearly show that the main site responsible for the hearing loss is not in the retrocochlear region, but in the cochlea. The possible mechanism of the cochlear involvement in this syndrome was discussed.

Adult↗

Effects of Aciclovir in Ramsay Hunt syndrome.

Nine patients with Ramsay Hunt syndrome were treated with Aciclovir and the effects of this treatment were observed for 6 months. The results were excellent in 5 cases, fair in 3, and poor in one case. Otalgia and auricular herpes was improved rapidly after the administration of Aciclovir. No severe side effect was observed in this study.

Acyclovir↗

The hunt for mechanisms of circadian timing in the eye of Aplysia.

The goals of our research are to understand how circadian oscillations in the eye of Aplysia california are generated and how entraining agents regulate these oscillations. These goals require identification of the molecular components of the oscillator and entrainment pathways as well as elucidation of the biochemical processes by which these components interact with one another. Our experimental strategy entails tracing environmental information along an entrainment pathway until the last component of the pathway is reached. The isolated eye of Aplysia exhibits a circadian rhythm of optic nerve impulses. This rhythm is regulated by at least two entrainment pathways. A photic pathway entrains the rhythm to light-dark cycles and an efferent serotonergic pathway relays neural information from the CNS to the oscillator. Phase shifting by light appears to involve an increase in the levels of cGMP, depolarization, and protein synthesis. Phase shifting by serotonin appears to involve an increase in the levels of cAMP, hyperpolarization, and protein synthesis. The involvement of protein synthesis in the entrainment pathways, together with the findings that brief treatments of inhibitors of protein synthesis phase shift the rhythm and that continuous treatments of these inhibitors alter the period of the rhythm, indicates that translation is part of the oscillator mechanism. Recent evidence indicates that transcription may also be part of the oscillator mechanism. Brief treatments with DRB, a reversible transcription inhibitor, phase shift the rhythm while continuous treatments with DRB lengthen the period of the rhythm. A comparison of the effects of transcription and translation inhibitors on the rhythm indicates that transcription and translation are closely coupled in the eye circadian system. To know the precise role of transcription and translation in the circadian system, it is necessary to identify and then study specific proteins and mRNAs important for circadian timing. To identify putative oscillator proteins (POPs), we have hunted for proteins whose synthesis or phosphorylation was altered by the entraining agents light and 5-HT and by other agents that perturb the circadian rhythm. By exposing eyes to labeled amino acids in the presence of phase-shifting treatments and then using two-dimensional gel electrophoresis to separate proteins, we found eight proteins that may be considered POPs. To elucidate the cellular function of POPs, we have begun to obtain their amino acid sequences. A 40,000, pI 5.6 protein (POP-1) was identified as a member of the lipocortin family of proteins. Lipocortins are Ca(2+)-phospholipid binding proteins whose functions include inhibition of PLA2.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Bushmeat hunting, deforestation, and prediction of zoonoses emergence.

Understanding the emergence of new zoonotic agents requires knowledge of pathogen biodiversity in wildlife, human-wildlife interactions, anthropogenic pressures on wildlife populations, and changes in society and human behavior. We discuss an interdisciplinary approach combining virology, wildlife biology, disease ecology, and anthropology that enables better understanding of how deforestation and associated hunting leads to the emergence of novel zoonotic pathogens.

Animals↗

Hunting of peridomestic rodents and consumption of their meat as possible risk factors for rodent-to-human transmission of Lassa virus in the Republic of Guinea.

In this population-based study, we correlated possible risk factors for rodent-to-human transmission of Lassa virus with markers of Lassa fever in two different regions of the Republic of Guinea (Prefectures of Pita and Gueckedou). Antibody prevalence was 2.6% (6 of 232) in Pita compared with 14.0% (105 of 751) in Gueckedou, with up to 35.0% seropositivity in selected villages of the higher prevalence area. We observed three major risk factors in Gueckedou favoring Lassa virus transmission: rodent infestation was much higher, food was more often stored uncovered and most strikingly, peridomestic rodents were hunted as a protein source by 91.5% of the population as opposed to 0% in Pita. To control for the confounding effects of differences in rodent infestation and food storage, rodent consumption was analyzed as a risk factor for transmission of Lassa virus comparing rodent consumers (RC) and nonconsumers (NC) in Gueckedou only: 14.6% of RC had Lassa virus antibodies versus 7.4% of NC (P = 0.1) and 23.0% of RC reported a history of a febrile illness with hearing loss (the most common sequel of Lassa fever) versus 6.1% of NC (P = 0.003).

Adolescent↗

Clinical relevance of microalbuminuria screening in self-reported non-diabetic/non-hypertensive persons identified in a large health screening--the Nord-Trøndelag Health Study (HUNT), Norway.

AIM: The aim of this study was to investigate the clinical relevance and consequences of screening for microalbuminuria (MA) in a randomly selected, apparently healthy population sample. MATERIAL AND METHODS: A total of 2,113 individuals (> or = 20 years) without known diabetes and treated hypertension, all identified in the large population-based Nord-Trøndelag Health Study (HUNT) 1995-1997, (n = 65,258), delivered 3 morning urine samples for MA analysis. Those with MA, defined as at least 2 out of 3 urine samples with albumin-to-creatinine ratio (ACR) > or = 2.5 mg/mmol, were invited to a second clinical examination. RESULTS: In total, 54 men and 54 women had MA, and 42 men (84%) and 42 women (78%) attended the second examination. All with MA had 1 or more cardiovascular risk factors, like elevated cholesterol, c-peptides and blood pressure, and they were older than those without MA. Ten men (25%) and 19 women (46%), who were defined as MA-positive at the screening, had normal albumin excretion in the overnight collected urine sample in the second clinical examination. Five men (12%) and 2 women (5%) were still followed-up at the hospital out-patient clinic 3 years later. CONCLUSIONS: Several individuals in the second examination had cardiovascular risk factors and other pathology, but the clinical benefit of discovering this was not obvious. Due to low positive predictive value and reduced reliability and validity, MA did not satisfy the criteria for a good screening test in this apparently healthy population.

Adult↗