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PubMed1997

Texture analysis of cerebral white matter in SIV-infected macaque monkeys.

Image texture analysis is used in a wide variety of applications in medical research. Neurovirulent simian immunodeficiency virus (SIV) infection in monkeys is considered a good model for HIV-1 infection in humans and causes neuropathological changes in white matter which can include diffuse myelin pallor, subtle white matter astrocytosis, perivascular macrophage infiltrates, and microglial nodules with multinucleated giant cells. The ability of image texture analysis to quantify these changes was evaluated. Sections of thionin-stained brain tissue from eight male rhesus macaques ranging in age from 42-59 months were used. Four animals served as controls and four animals were infected with neurovirulent SIVmac239/17E-R71 by bone marrow inoculation. Images of cerebral white matter were captured and analyzed by calculating 13 textural features based on statistical analysis of spatial co-occurrence matrices. Statistical analysis of the results included multiple comparisons using the Newman-Keuls multiple range test. The effect of variation in background illumination used at image acquisition was also evaluated. Ten of the 13 textural features used in this study successfully discriminated between tissue from control and SIV-infected animals and were consistent with independent neuropathological assessment. Three textural features were highly sensitive to variation in background illumination and found not useful in this application.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Selective metabolism of kynurenine in the spleen in the absence of indoleamine 2,3-dioxygenase induction.

The kynurenine pathway of L-tryptophan degradation is differentially regulated dependent on the level of immune system activation. During inflammation and disease, activity of the hepatocellular enzyme tryptophan 2,3-dioxygenase (TDO) decreases and a second enzyme, indoleamine 2,3-dioxygenase (IDO), is induced in extrahepatic sites. Substantial formation of a metabolise downstream of this step, quinolinic acid (Quin), subsequently occurs only in select regions of the lymphoid tissues, such as spleen, in a temporally restricted manner. The goal of this study was to determine the localization of Quin in unstimulated mice under conditions where rate-limiting control of the pathway by both TDO and IDO was by-passed. Supplementation of drinking water with L-kynurenine, a pathway intermediate that lies between tryptophan and Quin, resulted in a dose-dependent increase in Quin immunoreactivity in the follicles and discontinuous regions of the marginal zones of the spleen. Strongly immunoreactive cells in the periarteriole lymphoid sheaths adopted a highly reactive morphology despite the lack of immunostimulation and IDO induction. In contrast, a patchy to diffuse pallor of staining was observed in the liver parenchyma with 1 and 10 mM L-kynurenine ingestion, respectively. These data show that selective tryptophan metabolism can occur in discrete subcompartments of the lymphoid tissues beyond the level of IDO. In vivo manipulation of Quin synthesis in the absence of IDO induction may serve as a model for studying regulation and function of the kynurenine pathway activation in the immune system.

Animals↗
PubMed1999

Paroxysmal vertigo in children--an epidemiological study.

BACKGROUND: Little is currently known about the prevalence of vertigo in children. METHODS: In a questionnaire designed to examine the prevalence of migraine and migraine equivalents in children of school age, we included an item on 'attacks of dizziness in the past year'. The questionnaire was applied to 2165 children (10% of the school population in the city of Aberdeen, Scotland). RESULTS: 314 children had experienced at least one episode of dizziness in the previous year, unexplained in 44% of cases. A total of 57 children with three attacks, either unexplained or attributed to migraine, were interviewed and examined. Forty-five fulfilled our criteria for benign paroxysmal vertigo. Other symptoms suggestive of migraine were found in a small majority, but in 47% paroxysmal vertigo was an isolated symptom. The age of onset peaked at 12 years, but it was seen in all age groups. Paroxysmal vertigo was commonly accompanied by features that are common in migraine, i.e. pallor, nausea, phonophobia and photophobia, and migraine was twice as common in first degree relatives compared to controls. CONCLUSIONS: Paroxysmal vertigo is common in children and although it is seldom diagnosed, it appears to cause few major problems to the affected children. In common with previous studies, we found that it appears to be related to migraine.

Adolescent↗
PubMed2004

Coexistence of erythromelalgia and Raynaud's phenomenon.

Erythromelalgia is characterized by spontaneous recurrent episodes of redness, heat, and pain of the extremities that can be triggered or worsened by heat. Raynaud's phenomenon occurs in response to cold exposure and presents as pallor of the fingers or toes, often followed by cyanosis and rubor. Although the 2 conditions may appear to be opposites in symptomatology and clinical presentation, there are very rare reports of their coexistence. A case of coexistent erythromelalgia and Raynaud's phenomenon is presented. The pathophysiology is reviewed to elucidate a common mechanism underlying some cases of the 2 seemingly opposite conditions. A review of the literature indicates that causative and pathophysiologic similarities between the 2 conditions may exist in some cases. Rare reports of coexistence of the 2 disease processes further strengthen such research findings.

Adult↗
PubMed1984

Cutaneous findings in hairy cell leukemia.

Hairy cell leukemia is a distinctive clinicopathologic entity that is histologically characterized by infiltration of the spleen, bone marrow, and blood by uniform mononuclear cells--"hairy cells." We reviewed the prevalent cutaneous findings, specific and nonspecific, in 113 cases of hairy cell leukemia. Only one patient had specific lesions (skin infiltration by leukemic cells). Nonspecific cutaneous findings included recurrent infections, ecchymoses, petechiae, pallor, drug reactions and reactions to transfusions, and nonherpetic ulcerations. Although leukemic infiltration of the skin in hairy cell leukemia is rare, cutaneous histopathologic features may be diagnostic, particularly when cytomorphologic examination is coupled with staining of a fresh specimen with tartrate-resistant acid phosphatase. Cutaneous and extracutaneous infections, often extensive and with opportunistic organisms, were the most common nonspecific findings and demonstrated severely deficient immunologic responsiveness. Associated malignant diseases, cutaneous and extracutaneous, were few in number and are of uncertain significance.

Aged↗
PubMed1986

Neonatal citrullinemia associated with cutaneous manifestations and arginine deficiency.

A patient with neonatal citrullinemia (argininosuccinic acid synthetase deficiency), a heritable disorder of the urea cycle, developed a generalized cutaneous eruption at 35 days of age. The skin lesions consisted of erosive, erythematous, scaling patches and plaques. The plasma arginine concentration at that time was low. After treatment with oral arginine supplements, the cutaneous lesions rapidly resolved and the plasma arginine concentration normalized. Histologic features of pretreated lesions included parakeratosis, crust formation, absence of a granular cell layer, pallor of the upper epidermal cells, and a mild, superficial, perivascular, mononuclear-cell infiltrate. Since the patient's skin lesions responded to arginine supplements, and since arginine is a component of keratin, we postulate that the skin lesions are the result of arginine deficiency.

Amino Acid Metabolism, Inborn Errors↗
PubMed1986

Structural and functional changes of normal aging skin.

Solar-induced cutaneous changes are more prevalent and profound in older persons and, thus, are often inappropriately attributed to the aging process, per se. Structural and functional alterations caused by intrinsic aging and independent of environmental insults are now recognized in the skin of elderly individuals. Structurally the aged epidermis likely becomes thinner, the corneocytes become less adherent to one another, and there is flattening of the dermoepidermal interface. The number of melanocytes and Langerhans cells is decreased. The dermis becomes atrophic and it is relatively acellular and avascular. Dermal collagen, elastin, and glycosaminoglycans are altered. The subcutaneous tissue is diminished in some areas, especially the face, shins, hands, and feet, while in others, particularly the abdomen in men and the thighs in women, it is increased. The number of eccrine glands is reduced and both the eccrine and apocrine glands undergo attenuation. Sebaceous glands tend to increase in size but paradoxically their secretory output is lessened. The nail plate is generally thinned, the surface ridged and lusterless, and the lunula decreased in size. There is a progressive reduction in the density of hair follicles per unit area on the face and scalp, independent of male-pattern alopecia. The hair shaft diameter is generally reduced but in some areas, especially the ears, nose, and eyebrows of men and the upper lip and chin in women, it is increased as vellus hairs convert to cosmetically compromising terminal hairs. Functional alterations noted in the skin of elderly persons include a decreased growth rate of the epidermis, hair, and nails, delayed wound healing, reduced dermal clearance of fluids and foreign materials, and compromised vascular responsiveness. Eccrine and apocrine secretions are diminished. The cutaneous immune and inflammatory responses are impaired, particularly cell-mediated immunity. Clinical correlates of these intrinsic aging changes of the skin include alopecia, pallor, xerosis, an increased number of benign and malignant epidermal neoplasms, increased susceptibility to blister formation, predisposition to injury of the dermis and underlying tissues, delayed onset and resolution of blisters and wheals, persistent contact dermatitis, impaired tanning response to ultraviolet light, increased risk for wound infections, prolongation of therapy necessary for onychomycosis, and thermoregulatory disturbances.

Adult↗
PubMed1989

Annular erythema: a possible association with primary Sjögren's syndrome.

In four patients with primary Sjögren's syndrome a distinct annular erythema developed, which was characterized by a wide, elevated border (which can be likened to a doughnut ring) and central pallor. Histologically, there was a coat sleeve-like infiltration of lymphocytes around blood vessels and nuclear debris in the connective tissue. Vasculitis or epidermal changes suggestive of lupus erythematosus were not observed, and there was no immunoglobulin deposition along the basement membrane zone. This annular erythema may be a cutaneous manifestation of Sjögren's syndrome.

Adult↗
PubMed1989

Annular erythema associated with primary Sjögren syndrome: analysis of T cell subsets in cutaneous infiltrates.

Immunohistochemical analysis was performed on the annular erythema associated with Sjögren syndrome. This type of annular erythema is characterized by a doughnutlike appearance with an elevated border and central pallor; it is distinct from subacute cutaneous lupus erythematosus. Histologically this erythema is characterized by coat sleeve-like infiltration of lymphocytes around blood vessels and by nuclear debris in the connective tissue. Vasculitis or epidermal changes suggestive of lupus erythematosus were not observed in any of the cases, although immunoglobulin or complement deposition along the basement membrane zone and focal liquefaction degeneration of the basal layer in involved skin were seen in some cases. Major dermal infiltrates consisted primarily of CD4+ and 4B4+ lymphocytes.

Adult↗
PubMed1985

Yohimbine: a new street drug.

Following the ingestion of an alleged aphrodisiac known as "yo-yo," a 16-year-old girl experienced an acute dissociative reaction accompanied by weakness, paresthesias, and incoordination. Subsequent symptoms included anxiety, headache, nausea, palpitations, and chest pain. Hypertension, tachycardia, tachypnea, diaphoresis, pallor, tremors, and an erythematous rash were noted on physical examination. Serum epinephrine and norepinephrine levels were found to be elevated. Symptoms resolved spontaneously but lasted approximately 36 hours. The ingested substance was identified as yohimbine. The pharmacology of yohimbine and the treatment of yohimbine poisoning are discussed.

Adolescent↗
PubMed2004

[Gaucher's disease in Tunisia (multicenter study)].

UNLABELLED: Gaucher's disease is one of the rare lysosomial disease that could receive substitutive enzymatic treatment which may improve considerably the prognosis of certain forms. The purpose of this work is to study the epidemiology of the disease in Tunisia, to highlight the diagnostic and therapeutic difficulties and also to precise our subsequent needs for substitutive medication. PATIENTS AND METHODS: We have conducted a retrospective survey of the hospital wards that were susceptible to take care of patients having Gaucher's disease. These wards are the paediatric, neonatology, internal medicine, haematology, neurology and cardiology wards. RESULTS: In this study we have observed 27 cases of Gaucher's disease over a period of 18 years (1983-2001). The age at onset ranges from birth to 73 years of age, with an average age of 14.5 years. According to the age at onset and the clinical presentation, we classify our patients into: 20 cases of type 1 (74%), three cases of type 2 (12%), and three cases of type 3 (12%), and one case of unspecified type.Gaucher's disease type 1: The age at onset ranged from 10 months to 73 years with an average of 19 years. The main clinical signs that we have observed were splenomegaly, hepatomegaly, pallor, haemorrhagic appearance and also osteoporosis and bone pain observed in 40% of the cases. The diagnosis was based on histology showing the Gaucher's cells in various tissues while the diagnosis obtained by the dosage of glucocerebrosidase took place only in 50% of the cases. The treatment has always been symptomatic (analgesics, transfusion). A splenectomy was performed in 47% of the cases and none of the patients received a specific treatment. The follow-up period ranged from 1 month to 18 years with an average follow-up of 4 years. Among the 12 patients having a follow-up of at least 1 year, we have noticed an improvement after splenectomy in three cases, a stability in three cases and two worsening cases dealing mainly with bone problems. One patient aged 73 died from respiratory problem and three were lost to follow-up. Gaucher's disease type 2: We have observed three cases of Gaucher's disease type 2 diagnosed at 1 day, 45 days and 3 months of age. The visceral manifestations were serious and the neurological features included seizures, hypertony, ocular-nerve palsies and psychometric decline. The three patients died. Gaucher's disease type 3: Three patients were probably suffering from Gaucher's disease type 3 with visceral manifestations observed at the ages of 9 months, 1 year and 3 years, and also neurological signs observed at respective ages of 2.5 and 3 years. Two patients died and the remaining one was lost to follow-up. CONCLUSION: Gaucher's disease is not exceptional in Tunisia. Type 1 is by far the most common one. We have noticed some insufficiency in the diagnosis as the glucocerebrosidase enzymatic dosage was performed only in 50% of the cases as well as therapeutic insufficiency with no prescription of the specific treatment.

Adolescent↗
PubMed1987

Differences between membranoproliferative glomerulonephritis types I and III in clinical presentation, glomerular morphology, and complement perturbation.

Data for 26 patients with membranoproliferative glomerulonephritis, type I (MPGN I) and 22 with membranoproliferative glomerulonephritis, type III (MPGN III), as distinguished by glomerular ultrastructure, were analyzed to determine differences in presentation, complement perturbation, and glomerular morphology by light microscopy. MPGN III was detected with greater frequency by the chance discovery of hematuria and proteinuria in the otherwise healthy individual (MPGN III, 63%; MPGN I, 30%; P = .01) and never, in the absence of renal failure, presented with systemic symptoms such as ease of fatigue, weight loss, and pallor, as may patients with MPGN I. The more frequent detection of MPGN III by chance is evidence that its onset is insidious and that for long periods it produces no symptoms or signs. Glomerular proliferation is also less than in MPGN I. Further, in MPGN III, the complement perturbation and glomerular immunofluorescence give no evidence of classical pathway activation, for which there is abundant evidence in MPGN I. Even with severe hypocomplementemia in MPGN III, C3 nephritic factor, another cause of hypocomplementemia, is rarely detectable and then in very low concentration. The cause of the complement perturbation in MPGN III has so far escaped identification. Although these observations give evidence that MPGN III is distinct from MPGN I, there is compelling evidence from other studies that a predisposition to both types is inherited and that similar genetic factors are operative in the two types. Because their genetic basis appears to be the same, it must be concluded that despite their differences, types I and III are variants of the same disease.

Complement C3↗
PubMed2002

Incidence of Haemonchus spp. and effect on haematocrit and eye colour in goats farmed under resource-poor conditions in South Africa.

The diversity and predominance of nematode genera in goats of resource-poor farmers at Rust de Winter, Gauteng Province, Impendle, KwaZulu-Natal Province, and Kraaipan, North-West Province, South Africa, was determined by means of a longitudinal study of the nematode faecal egg counts (FECs) and differential third-stage nematode larvae. The animals were bled for haematocrit determination and scored for pallor of ocular mucous membranes using the FAMACHA( Copyright) method, an assay for clinical evaluation of anaemia caused by Haemonchus spp. Animals considered to be in danger of dying from anaemia caused by haemonchosis were selectively treated with an anthelmintic. Lower haematocrit values were registered during periods of heavier Haemonchus infection, which occurred from December/January to March for Rust de Winter; from December to March/April for Impendle; and from November/December to February or April for Kraaipan. There was agreement too between the lower haematocrits and paler mucous membranes scored according to the FAMACHA( Copyright) method. The use of this system may be recommended as part of an integrated approach to worm control in goats kept in the resource-poor areas studied.

Anemia↗
PubMed2001

Papillitis as an onset sign of Leber's hereditary optic neuropathy: a case report.

Leber's hereditary optic neuropathy is a maternally transmitted disease resulting from a point mutation in mitochondrial (mt) DNA. In this report we describe a case of Leber's disease with typical clinical findings but atypical ophthalmoscopic presentation. A 14-year-old boy developed severe loss of vision acuity in the left eye, with only partial recovery, followed 4 months later by the same symptoms in the right eye. Fundoscopic examination showed hyperemic papilla on the right eye and optic disc pallor on the left eye. Polymerase chain reaction analysis of lymphocytic mt-DNA revealed a point mutation at 11778. Leber's disease should be considered in young patients (not always male) with sudden visual loss and simple papillary involvement at fundoscopic examination but without the typical telangiectatic microangiopathy.

Adolescent↗
PubMed2001

An unusual case of clarithromycin associated ergotism.

A 41-year-old woman presented to the Emergency Department complaining of a 4-day history of worsening lower leg pain, pallor, and a sensation of coolness aggravated by exertion. Evaluation revealed severe lower extremity vasospasm. She recently had been prescribed clarithromycin for "flu-like" symptoms, and for many years had been taking a caffeine-ergotamine preparation for migraine headaches. Clarithromycin is known to interfere with ergotamine metabolism. This drug interaction is often not recognized. Ergot alkaloids are commonly used for migraine headaches and have vasoconstrictive properties. In a patient with ergotamine toxicity, these vasoconstrictive properties can lead to frank ischemia. We reviewed the literature for reports of ergotamine-associated ischemia and for reports of ergotamine toxicity caused by drug-drug interaction.

Adult↗
PubMed1990

[Analgesic and respiratory effects of nalbuphine during the immediate postoperative period in thoracotomy].

As most patients undergoing pulmonary surgery by postero-lateral thoracotomy have decreased preoperative pulmonary function, efficient postoperative analgesia is mandatory. Nalbuphine, a new agonist-antagonist opioid analgesic, and nefopam were compared in a double blind trial involving 60 patients. Intravenous injections of 0.3 mg.kg-1 of either drug were started when the patient evaluated his pain as being above 60 mm on a visual scale graduated from 0 to 100 mm. Repeated injections were carried out at the same dose, at the patient's request, after a minimal interval of 3 h for nalbuphine, and 6 h for nefopam. Analgesia was assessed by the visual scale, and by the patient's verbal appraisal. The respiratory and cardiovascular repercussions were evaluated clinically, and by monitoring breathing rate, blood gases, systolic and diastolic blood pressures, heart rate, and consciousness. Nalbuphine provided a convenient analgesia to all patients whereas analgesia with nefopam was insufficient in 15 out of 30 patients. No significant respiratory depression with either drug occurred. Nefopam led to a 30% increase in heart rate for one hour (p less than 0.01). Whereas patients given nalbuphine were more drowsy, although easily aroused, (p less than 0.001), nefopam was responsible for adverse effects (sweating, nausea, tachycardia with pallor, vertigo, malaise) requiring the exclusion of 7 patients from the study. Nalbuphine, although not ideal, would therefore seem to be a better analgesic than nefopam in thoracotomy patients.

Aged↗
PubMed2004

[Disseminated Mycobacterium chelonae infection during HIV. ].

INTRODUCTION: An atypical mycobacterium, Mycobacterium chelonae is a saprophyte germ in the environment, but rarely pathogenic. A few disseminated infections can be noted in immunodepressed patients. OBSERVATION: A 30 year-old man infected by HIV was hospitalised for deterioration in his general status of health with, on clinical examination, pallor, several superficial lymph nodes and hepatosplenomegaly. A biopsy of an axillary node and the liver revealed numerous granulomas with many atypical M. chelonae-like mycobacteria. Adapted treatment led to complete remission. DISCUSSION: Immunodepression facilitates the occurrence of M. chelonae infections, often of severe evolution and leading to dissemination. This mycobacterium is resistant to many antibiotics.

Adult↗
PubMed1998

The use of phentolamine in the prevention of dopamine-induced tissue extravasation.

PURPOSE: The purpose of this study was to determine whether dopamine-induced tissue extravasation injury could be prevented with phentolamine. MATERIALS AND METHODS: This was a prospective, randomized, blinded, and controlled animal study. Forty rats were evaluated to document the effects of dopamine compared with normal saline on tissue integrity, whether any tissue damage was concentration or volume dependent, and to determine the minimum concentration of dopamine resulting in tissue injury. Dopamine concentrations of 0.8 mg/mL and 3.2 mg/mL were tested. In a second part of this study, an additional 40 rats were evaluated to assess the efficacy of two different doses of phentolamine (0.5 mg and 1 mg) or normal saline, when injected within 10 minutes of dopamine administration to prevent or reverse tissue extravasation. Extravasation sites were evaluated clinically and histologically at 2, 4, 6, and 8 hours and were compared with a baseline sample. Outcome measures were as follows: (1) prebiopsy was ectodermal erythema, induration, and blanching; (2) postbiopsy was bubbling, darkening, pallor, and hematoma of the muscle fascia. Histology included neutrophil migration, mast cell degranulation, edema, and hemorrhage. Fisher's Exact Test with the Bonferroni method were used for statistical analysis. RESULTS: Dopamine-induced extravasation resulted in tissue injury characterized by blanching and hematoma. Damage did not appear to be volume dependent, but may be related to the duration of infiltration. Subcutaneous injection with either dose of phentolamine appeared to be clinically effective in preventing tissue injury. However, microscopic evaluation of tissue samples was inconclusive. CONCLUSION: This study clinically supported the use of phentolamine for the prevention of dopamine-induced extravasation injury.

Adrenergic alpha-Antagonists↗