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Clinical descriptions of Creutzfeldt-Jakob disease by the classical authors are compared with 209 transmitted cases at NIH between 1968-1992. Clinical comparison between Kuru, Gertsmann-Sträussler-Sheinker Syndrome and Creutzfeldt-Jakob disease. Fatal Familial Insomnia is included into the latter. Familial forms: new acquisitions.
In Africa, certain traditional treatments for eye diseases can produce ocular damage and visual loss. However, many practices do not cause harm, and some may be beneficial. Traditional healers are often valuable resource persons, helping to provide an understanding of cultural beliefs and practices relating to eye disease, and delivering eye care at community level. These matters are discussed below with special reference to conditions in Zimbabwe.
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The authors report a case of centropontine myelinosis associated with demyelinising lesions of the tectum mesencephali, the cerebellum, the central grey nuclei and the white matter of the hemispheres. This case is compared with similar observations already studied in the literature. From an aetiological standpoint, attention is drawn to the apparent causative role of diuretic therapy which had resulted in severe water and electrolyte disturbances.
PHENOTYPING INTERSTITIAL INFILTRATIONS: Recent progress has led to the distinction between type I and type II fibroblasts in the renal interstitium. The cellular phenotype of pathological infiltrations can be identified with monoclonal antibodies. DRUG-INDUCED INTERSTITIAL NEPHROPATHIES: Extrarenal manifestations (skin eruptions, fever, joint pain) often suggests the diagnosis but may be absent, in which case renal histology is required. CAUSAL DRUGS: Among the different causal agents, nonsteroid anti-inflammatory drugs cause abnormal leakage from glomerular capillaries favoring the development of a nephrotic syndrome associated with renal failure and major cell infiltration into the interstitial tissue. CHRONIC DISEASE: Chronic interstitial nephropathy is nearly asymptomatic and may only be discovered at an advanced stage. Briefly, there are three categories which result from long-term administration of 5-aminosalicylate, use of Chinese herbal medicines to lose weight, and chronic intoxication with ochratoxin (a mycotoxin). COMPLEX PHYSIOPATHOLOGY: Immunological mechanisms are involved although it is not always easy to distinguish between manifestations of humoral and cellular reactions. Both could be implicated as indicated in recent experimental animal models which throw more light on the pathological process in humans. RENAL PROGNOSIS: Different strategies can be used to halt or limit the development of fibrosis and thus improve prognosis of toxic interstitial nephropathies: counteract cellular immunity reactions, inhibit fibroblast proliferation and activation, reduce synthesis and stimulate degradation of the extracellular matrix, and inhibit collagen formation.
The most feared complication after a rectal examination of horses and ponies is to cause a tear of all the layers in the intraperitoneal part of the rectum. The description of the anatomy is an attempt to explain that the rectal tear is mostly located in the dorsal or dorsolateral part of the rectum. This article describes a relatively simple suture technique for the rectal tear by using the needle of Deschamp which is modified by Professor B. Huskamp. Furthermore there is a description of this method as treatment of two horses in practice circumstances. The issue whether causing a rectal tear should be regarded as a case of malpractice is discussed. Advises as prevention of rectal tears are given.
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Two cases of perforation of the normal colon during barium contrast examination are reported. Overdistention of the colon with air and barium contrast examination are reported. Overdistention of the colon with air and barium should be avoided in a patient with a competent ileocecal value. While rare, this complication can be life-threatening.
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Over the past 2 years, Creutzfeldt-Jakob disease (CJD) has affected several patients who received cadaver pituitary-derived growth hormone (pit-hGH) and one patient who received a cadaveric dura mater graft. The risk of iatrogenic transmission of CJD has long been recognized, but until recently, the low prevalence of the disorder and minimal use of therapeutic products derived from human tissues may have limited the risk. From 1963 to 1985, approximately 10,000 children received pit-hGH. These patients, exposed to pooled products potentially contaminated with the CJD agent, may have significantly increased the number of individuals whose blood and tissues could transmit CJD. This possibility as well as data on the pathophysiology of CJD and scrapie, a related disease of animals, should guide the development of practices that would limit iatrogenic spread of CJD.
The first case of Creutzfeldt-Jakob disease (CJD) related to the use of a dura mater graft of cadaveric origin was identified in 1987 and this procedure is now considered as one of the main causes of iatrogenic CJD. Although the decontamination procedure for the preparation of graft material was modified, the product was withdrawn from the market in many countries a few years later and replaced by synthetic material. In this context, two patients treated in our institution developed CJD following a cadaveric dural graft performed after cerebral and lumbar trauma. Their clinical presentation, showing predominant cerebellar symptoms, late deterioration and myoclonic jerks, and a rapid disease course until death, was similar to that of previously reported cases involving the iatrogenic form. As the graft for one of the patients was performed in 1991 (several years after modification of the decontamination procedure), this fourth reported case suggests that the risk of iatrogenic CJD may have persisted in some patients treated after 1987, when grafts of cadaveric origin were totally abandoned.