Adenomyosis:common and uncommon manifestations on sonography and magnetic resonance imaging.

OBJECTIVE: The purpose of this presentation is to show the imaging findings of the common and uncommon variants of adenomyosis as seen on sonography and magnetic resonance imaging (MRI). METHODS: A 3-year database search was performed to identify women who had pelvic sonography and pelvic MRI within a 6-month interval. Images of these cases were retrospectively reviewed. RESULTS: Eighty women were identified. Adenomyosis was diagnosed on MRI, which was used as the reference standard, in 45 of these women. The correct diagnosis was made on sonography in 73% of the cases. CONCLUSIONS: Awareness of the spectrum of imaging features of adenomyosis is important to use sonography effectively for diagnosing this entity and to help avoid misdiagnosis.     

Altered interleukin-2 production in schizophrenia: association between clinical state and autoantibody production.

Mitogen-stimulated interleukin-2 (IL-2) production was measured in 122 patients who met Research Diagnostic Criteria for schizophrenia and 98 normal control subjects. The presence of autoantibodies against seven common antigens was also determined. There was no relationship between the presence of circulating autoantibodies and IL-2 production in control subjects. In patients, however, autoantibody-positive, acutely ill patients had significantly lower IL-2 production as compared with other patients and control subjects. Never-medicated patients showed the same trends for decreased IL-2 production in association with autoantibodies. These data suggest that decreased IL-2 production is associated with acute illness in schizophrenic patients who produce autoantibodies, a trait known to be associated with increased vulnerability to autoimmune disease.     

Ophthalmoplegia in an adult with chronic inflammatory demyelinating polyradiculoneuropathy

The authors present a 75-year-old patient with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and ophthalmoplegia. The patient had recurrent exacerbations and remissions of her polyneuropathy over the course of one year. Antibodies to ganglioside GM-I were not detected. Ophthalmoplegia in CIDP is uncommon, but is reported to occur in 3-8% of patients. Ophthalmologists should be aware of the association of CIDP and ophthalmoplegia.     

Decrease in the Frequency of Circulating CD56+CD161+ NK Cells in Human Visceral Leishmaniasis

Background: Natural Killer (NK) cell plays an important role in the innate immune system and is known to produce IFN-γ at an early stage of infection that is essential to eliminate intracellular infection like Leishmania spp. It is already established that Leishmania parasite inhibits the activity of NK cells, avoiding the encounter with the early innate immune response. This, in turn, favors establishment and further dissemination of the infection. Methods: In the present study, we have tried to measure the frequency of different phenotypic subsets of NK cells among visceral leishmaniasis (VL) patients. Results: We have phenotyped three distinct three distinct subsets (CD56^–CD161⁺, CD56⁺CD161^–, and CD56⁺CD161⁺) of NK (CD3^–) cell using their specific markers CD161 and CD56. Conclusion: Interestingly, we observed selective loss of CD56⁺CD161⁺ subset of circulating NK (CD3^–) cells. Importantly, the other subsets (i.e., CD56^?CD161⁺ and CD56⁺CD161^–) of circulating NK cells remain unaffected as compared with healthy subjects.     

In utero presentation of aggressive systemic mastocytosis in a neonate

Mastocytosis is a clinically heterogenous disease characterized by mast cell hyperplasia in skin, bone marrow and/or visceral organs. Cutaneous mastocytosis is more frequently observed in children, whereas indolent systemic mastocytosis is more commonly observed in adults. Aggressive systemic presentation, particularly of the neonate, is exceptionally rare. We present a rare case of congenital aggressive systemic mastocytosis. The patient was a 37‐week‐old male, born by caesarean section owing to hepatosplenomegaly and ascites diagnosed in utero, who exhibited extensive cutaneous and systemic manifestations of mastocytosis at birth. Mutation analysis of c‐KIT identified D816V mutation in exon 17. Although initial bilateral bone marrow aspirates demonstrated no mast‐cell infiltrates or haematological neoplasm, subsequent bone‐marrow biopsies postmortem exhibited multifocal mast‐cell aggregates. Clinical course was complicated by bacteraemia and cardiorespiratory failure, leading to death at 10 weeks.     

The antihypertensive chromogranin a peptide catestatin acts as a novel endocrine/paracrine modulator of cardiac inotropism and lusitropism

Circulating levels of catestatin (Cts; human chromogranin A352-372) decrease in the plasma of patients with essential hypertension. Genetic ablation of the chromogranin A (Chga) gene in mice increases blood pressure and pretreatment of Chga-null mice with Cts prevents blood pressure elevation, indicating a direct role of Cts in preventing hypertension. This notable vasoreactivity prompted us to test the direct cardiovascular effects and mechanisms of action of wild-type (WT) Cts and naturally occurring human variants (G364S-Cts and P370L-Cts) on myocardial and coronary functions. The direct cardiovascular actions of WT-Cts and human variants were determined using the Langendorff-perfused rat heart. WT-Cts dose-dependently increased heart rate and coronary pressure and decreased left ventricular pressure, rate pressure product and both positive and negative LVdP/dt. WT-Cts not only inhibited phospholamban phosphorylation, but also the inotropic and lusitropic effects of WT-Cts were abolished by chemical inhibition of beta2-adrenergic receptors, Gi/o protein, nitric oxide or cGMP, indicating involvement of beta2-adrenergic receptors-Gi/o protein-nitric oxide-cGMP signaling mechanisms. In contrast, G364S-Cts did not affect basal cardiac performance but abolished isoproterenol-induced positive inotropism and lusitropism. P370L-Cts decreased rate pressure product and inhibited only isoproterenol-induced positive inotropism and lusitropism by 70%. Cts also inhibited endothelin-1-induced positive inotropism and coronary constriction. Taken together, the cardioinhibitory influence exerted on basal mechanical performance and the counterregulatory action against beta-adrenergic and endothelin-1 stimulations point to Cts as a novel cardiac modulator, able to protect the heart against excessive sympathochromaffin overactivation, e.g. hypertensive cardiomyopathy.     

The education and employment status of patients with inflammatory bowel diseases

Inflammatory bowel disease (IBD) has the propensity to affect patients who are in their late teens and early 20s, an age when most people decide on their educational and career directions. This review describes the effects that IBD has on the continuum of education and employment. Patients with Crohn's disease and ulcerative colitis attain a similar level of education as that of the general population. The quality of life of such patients in school, as measured by both patients' and teachers' perceptions, indicates that, despite the difficulties that students face in terms of missed school time and physical inconveniences, teachers are generally perceived by students to have favorable attitudes toward helping them. Even though earlier work in the area of employment has suggested that the occurrence of IBD is clustered among people in white-collar positions, recent data have suggested that certain environmental risks for IBD (i.e., sedentary or indoor jobs) may be associated with jobs classified as being white-collar, and therefore having a white-collar job may in itself not be a risk factor for the development of IBD. Patients with IBD have a higher rate of nonparticipation in the labor force, and the participation rate seems to maintain steady levels over time. A majority of patients with IBD continue in the same employment positions over a period of years. Patients with IBD, especially those who have undergone surgery, took more sick leave than their counterparts without IBD. A majority of patients with IBD favored the disclosure of their diagnosis to their employers and perceived little discrimination in the workplace. Furthermore, most employers were perceived by their employees with IBD as having fair attitudes toward the compensation provided for their employees with IBD.