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Computed tomography scan analysis of 35 schizophrenic patients, 26 medical patients, and 31 normal controls revealed significantly larger ventricular brain ratios and structural changes consistent with cortical atrophy in both schizophrenic and medical patients in comparison with normal controls. The schizophrenic patients, however, differed from both control groups in terms of greater prefrontal cortical markings consistent with prefrontal atrophy, and this finding correlated inversely with levels of cerebrospinal fluid homovanillic acid. Results from this study, in addition to replicating previous findings and addressing methodologic issues concerning controls, provide new evidence implicating abnormality of the prefrontal cortex in schizophrenia and link this abnormality to central nervous system dopaminergic function.
Clinical criteria cannot identify all patients who develop acute respiratory distress syndrome, which might indicate the need to develop new tools that improve reliability and diagnostic accuracy. Nevertheless, being conscious of the limitations of the American-European consensus conference criteria continues to be useful in clinical daily practice because these patients would benefit from treatments. This and other management strategies have been evaluated in patients who, fulfilling the clinical criteria of acute respiratory distress syndrome, could not have diffuse alveolar damage.
The term "spondyloarthritis" encompasses a variety of conditions that manifest as inflammation of the synovial membranes and entheses. The synovial inflammation lacks specificity and shares many features with rheumatoid synovitis. The hallmark of spondyloarthritis is inflammation of the entheses, which manifests as a combination of hyperostosis, osteitis, and periostitis. The entheses include not only the sites where tendons, ligaments, and joint capsules attach to bone, but also other fibrous structures such as the amphiarthroses (pubic symphysis, manubriosternal symphysis, and discovertebral junctions) and the diarthro-amphiarthroses (sacroiliac area, chest wall joints, and tips of the fingers and toes). This vast entheseal territory is the target selectively involved in patients with spondyloarthropathy.
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Patulin, a secondary metabolite produced by species of the genera Penicillium and Aspergillus, was administered to male Sprague-Dawley rats, weighing 50-60 g, by the oral, sc and ip routes. The 72-hr LD50 values (in mg/kg weight) were: oral, 55.0; sc, 11.0; ip, 10.0. Mortality was greatest 0-24 hr after administration by the oral and sc routes and 49-72 hr after ip dosing. Gross alterations consisted of gastric and intestinal hyperaemia and distention. Histopathological alterations consisted principally of ulceration and inflammation of the stomach. Patulin was administered orally to rats daily or every other day for 2 wk at doses of 50 or 75% of the oral LD50. Mortality in the treated groups was greater than in controls but was similar for all treated groups. No evidence of cumulative toxicity was found and the gross and histopathological alterations were similar to those found in the LD50 studies. Clinicopathological alterations included metabolic alkalosis with respiratory compensation, oliguria, decreased serum sodium, elevated blood glucose, reduced plasma protein and an elevated total leucocyte count which differential leucocyte counts indicated to be due to neutrophilia. The inflammatory alterations observed in the gastro-intestinal tract may be due to the irritant properties of patulin or to an alteration in the gastro-intestinal flora by the antibiotic activity of patulin.
Cardiac disease constitutes a common complication among patients with renal failure. This is partly due to the high incidence of shared risk factors, such as hypertension or diabetes mellitus, and some to specific factors inherent in renal disease. It implies a high incidence of cardiac failure and ischemic heart disease (frequently without significant coronary artery obstructions) with important associated morbidity and mortality. Pericardial disease, valvular involvement and arrhythmia are also common among these patients. The management of these complications in patients with endstage renal disease has some particularities, specially in the field of drug therapy.
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Interest has recently focused on the role of the placental bed in the pathogenesis of a variety of pregnancy disorders. Considerable advances have been made in the understanding of the complex relationships between maternal and fetal trophoblast in the placental bed in normal pregnancy. Invasion of uterine spiral arteries by extravillous trophoblast effects the physiological changes required to accommodate increased blood flow to the fetoplacental unit. Control of trophoblast invasion may depend on intrinsic properties, such as production of proteolytic enzymes and expression of a non-classical class I MHC antigen, but maternal cells within decidua may also play a role. Leukocytes form a major component of human decidualized endometrium and in the first trimester consist of granulated lymphocytes, macrophages and T lymphocytes. Suggested roles for decidualized leukocytes include natural killer cell activity, cytokine secretion, antigen presentation and immunosuppression. Several pregnancy disorders, including pre-eclampsia and intrauterine growth retardation, may be due to abnormal maternofetal cellular relationships within the placental bed causing inadequate invasion of spiral arteries and acute atherosis. However, the role of immunological factors in the pathogenesis of these disorders is uncertain since deposition of immunoglobulins and complement has also been detected in spiral arteries in normal pregnancy. Placenta accreta may reflect undue invasiveness of trophoblast and immunohistochemical studies of subinvolution of uteroplacental arteries also suggest an abnormal maternofetal relationship in the placental bed. Although the in vivo role of decidual leukocytes is not known, studies of infertile endometrium have reported a deficiency of granulated lymphocytes, suggesting a possible role in early implantation and placentation. Granulated lymphocytes may also play a role in pregnancy loss. There have been considerable advances in understanding of the abnormal maternofetal relationships in the placental bed which can lead to pregnancy disorders. However, the aetiology and pathogenesis of the various clinical conditions is unlikely to be fully established until regulatory mechanisms in normal pregnancy are elucidated.
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The majority of lung neoplasms are malignant. Many of these are central and have an associated endobronchial component. Most such neoplasms are of surface epithelial origin; however, neoplasms of submucosal gland, mesenchymal, and lymphoreticular origin may also demonstrate an endobronchial component. Because of their endobronchial location and associated symptoms, these patients often present at an earlier stage than purely parenchymal lung malignancies. The radiographic features in such cases may be similar to those associated with benign endobronchial tumors; however, there are certain radiological signs that are more suggestive of a malignant process. Despite these circumstances, conservative management such as endoscopic excision are inappropriate in most instances. The clinicopathologic and radiological features of these lesions are detailed.
A 83 years old woman presents to our hospital with fatigue and dyspnea since 2 weeks, followed by a painless icterus. On laboratory we discover a pancytopenia with severe haemolytic anaemia, thrombopenia and schistocytosis. This association suggest a thrombotic microangiopathy. In the presence of macrocytes, hypersegmented neutrophils and a low reticulocytes count, a vitamin screening was performed witch leads to the discovery of a vitamin B12 and folic acid deficiency. After initiation of a vitamin therapy we observe a reticulocytic crisis and thereafter the normalisation of the haematological parameters.
Extension injury to the arthritic spine of elderly individuals involves rupture of the anterior longitudinal ligaments and disks at several levels, but no bony injury can be observed on X-ray. There are many small focal haemorrhages in the central portion of the spinal cord and the injury is often accompanied by incomplete paresis. As the injury is a stable injury with the posterior ligament complex being intact, it is only necessary to immobilise the cervical spine conservatively. Laminectomy is not indicated. In hyperextension injury of the rigid cervical spine and in momentary posterior dislocation observed in middle aged individuals, rupture of the anterior longitudinal ligament and disk is observed at a single site, but being spontaneously reduced, traumatic findings cannot be observed on X-ray. The spinal cord is crushed at the site of injury to bring about severe neural damage. When this type of injury is diagnosed or suspected, further damage may be inflicted on the spinal cord if skull traction is made with calipers in the extended position and the condition at the time of injury is reproduced. Therefore, the patient should be nursed in a shell or between sandbags in a neutral position or even in a position of slight flexion. In extension fracture dislocation with compression which resembles on X-ray a flexion injury, all of the three columns of the spine are destroyed to bring about an extremely unstable condition. As the spinal cord is extensively injured to involve several segments, decompression surgery for relief of neuroparalysis should not be performed when complete paralysis develops simultaneously with fracture dislocation. Therefore, it should be first treated conservatively with skull traction, and in cases where stability cannot be restored, surgical fixation of the spine should be performed.
Histologic variants of idiopathic focal segmental glomerulosclerosis (FSGS) may have prognostic value. A recent working classification system has distinguished five FSGS variants. We evaluated a cohort of adult patients with biopsy-proven FSGS diagnosed between March 1982 and July 2001 to determine if subtypes were associated with renal outcome. Renal biopsies were reviewed by two pathologists. Demographic and clinical data were obtained from charts. Outcomes were partial and complete remission of the nephrotic syndrome, and renal failure. The frequency of FSGS variants was: 3% cellular (N=6), 11% collapsing (N=22), 17% tip lesion (N=34), 26% perihilar (N=52), and 42% not otherwise specified (NOS) (N=83). Collapsing FSGS affected younger and more often black patients. Black race was uncommon in tip variant. Collapsing and tip variants had higher proteinuria and lower serum albumin than perihilar and NOS variants. Better renal function and less severe tubulointerstitial injury were observed in patients with tip variant. These patients were more likely to receive steroids and more often achieved complete remission (50%). After a median follow-up of 1.8 years, 23% of patients were on dialysis and 28% had renal failure. Collapsing FSGS had worse 1-year (74%) and 3-year (33%) renal survival compared to other variants (overall cohort renal survival at 1 and 3 years: 86 and 67%). Different histologic variants of FSGS have substantial differences in clinical features at the time of biopsy diagnosis and substantial differences in renal outcomes.
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