Cardiac Amyloidosis

ABSTRACT. Two male patients with primary cardiac amyloidosis are described. Patient 1 presented with typical effort angina pectoris with no ischemic electrocardiographic changes and a normal coronary angiogram. At necropsy, a severe diffuse, intravascular amyloid deposition was observed in the intramural coronary arteries. In patient 2 the presenting symptom was congestive heart failure with echocardiographic evidence of asymmetric septal hypertrophy and pericardial effusion. Technetium-99m pyrophosphate scintigraphy showed diffuse myocardial uptake, and the diagnosis of cardiac amyloidosis was confirmed in the postmortem examination. The diagnostic and therapeutic problems associated with cardiac amyloidosis are discussed in the light of these case reports.     

Frequency of initial caries lesions as predictor of future caries increment in children

Abstract — The aim of this study was to evaluate the predictive power of the frequency of initial caries lesions in selecting persons at high risk for caries. The subjects ( n = 124) were 11–13 yr old at the beginning of the follow-up. Caries was registered initially and after 5 yr. Evaluation of the predictions was based on cross-tabulations of the subjects according to their predicted caries risk and the actual 5-yr caries increment. Logistic regression analyses were used to produce the individual risk scores. In addition to the caries scores, age of the subjects, was included in the prediction function. In bivariate analyses the total initial caries score at baseline correlated better with caries increment than FS and DS scores did (r = 0.40, 0.13, and 0.31, respectively). When past caries experience was used as predictor, 69% of the children were classified correctly into the low and high risk groups. Surprisingly, only two more subjects (2%) were classified correctly when initial caries score was included in the function. These results suggest that inclusion of initial caries score adds little to the predictive power of the conventional DS and FS scores.     

Pain and activity disturbance after paediatric day case adenoidectomy

Over the past two decades outpatient surgery has become standard practice in paediatric surgery. Adenoidectomy is a common surgical procedure in children. In this prospective survey pain and pain-related outcomes such as sleep and activity disturbance were evaluated in 167 children aged 1–7 years who had undergone adenoidectomy as a day case in Kuopio University Hospital. The survey questionnaire consisted of 76 structured questions about pain, pain medication, adverse effects and daily activities during first week after the operation. Eighty-three per cent of children had pain at home and 17% of them had moderate or severe pain on a four point verbal rating scale. Eighty per cent of children used pain medication at home. Pain medication did not cause any major adverse effects. Over 90% of children were back to normal daily activities during the first three postoperative days and nearly all were able to drink during the whole postoperative period. We conclude that pain is a common problem after adenoidectomy in children but most of the children return to normal activities within three days.     

Covert bronchogenic cyst as a cause of life-threatening cardiopulmonary impairment

We present a case in which a covert bronchogenic cyst resulted in two hospital admissions within three years, the second of which was characterised by life-threatening cardiopulmonary compromise requiring sustained support on the intensive therapy unit.     

Expression of ezrin,Bcl‐2, and Ki‐67 in chondrosarcomas

Söderström M, Palokangas T, Vahlberg T, Böhling T, Aro H, Carpen O. Expression of ezrin, Bcl‐2, and Ki‐67 in chondrosarcomas. APMIS 2010; 118: 769–76. The aim of the present study was to investigate whether the expression of ezrin, a membrane‐cytoskeleton linker and regulator of cellular signaling, is associated with clinical features of chondrosarcoma. For this purpose, we studied the expression of ezrin in 54 chondrosarcomas by immunohistochemistry and correlated the expression with other tumor characteristics, markers of proliferation, apoptosis and with clinical parameters. The intensity of ezrin staining increased with the histologic grade, and a significant positive association existed between the tumor grade and ezrin expression (p = 0.0475). In addition, there was a positive correlation between the expression of ezrin and Bcl‐2, an anti‐apoptotic protein (r = 0.83, p < 0.0001), as well as between ezrin expression and increased proliferation as measured by Ki‐67 index (r = 0.70, p < 0.0001). The positive correlation of ezrin expression with Bcl‐2 and Ki‐67 as well as with tumor grade suggests that an aggressive behavior of chondrosarcoma may be related to activation of ezrin and that ezrin inhibitors could provide a much needed adjuvant therapy in chondrosarcomas. In conclusion, our results indicate that high ezrin expression correlates with aggressive features of chondrosarcomas. Further analyses on the pathways downstream of ezrin are warranted.     

The role of drinking water in the transmission of antimicrobial-resistant E. coli

To determine whether drinking water contaminated with antimicrobial-resistant E. coli is associated with the carriage of resistant E. coli, selected households sending water samples to Ontario and Alberta laboratories in 2005-2006 were asked to participate in a cross-sectional study. Household members aged ≥12 years were asked to complete a questionnaire and to submit a rectal swab. In 878 individuals, 41% carried a resistant strain of E. coli and 28% carried a multidrug-resistant strain. The risk of carriage of resistant E. coli was 1·26 times higher for users of water contaminated with resistant E. coli. Other risk factors included international travel [prevalence ratio (PR) 1·33], having a child in nappies (PR 1·33), being male (PR 1·33), and frequent handling of raw red meats (PR 1·10). Protecting private water sources (e.g. by improving systems to test and treat them) may help slow the emergence of antimicrobial resistance in E. coli.     

Experimental sports drinks with minimal dental erosion effect

Abstract – The effects of new experimental sports drinks on dental enamel were studied in vitro using bovine tooth specimens. Profilometric analysis was used to measure the loss of tooth material after immersion of the specimens in the drinks. Thereafter the specimens' surface hardness was measured and scanning electron microphotographs were taken. In addition, 13 commercial sports drinks and experimental drinks containing either citric acid or malic acid were tested for their capacity to dissolve hydroxyapatite in vitro. The erosive effect increased markedly with decreasing pH. The citric acid containing drinks were more erosive than malic acid containing drinks. No erosion was observed with the malic acid containing drink (pH 5.90) but the drink of similar composition containing citric acid caused an erosion 1.3± 1.1μm deep and a commercial citric acid containing drink caused a lesion 12.3± 4.5μm deep after 120 min immersion. Softening of enamel was greater in specimens immersed in citric acid than in those immersed in malic acid containing drink. The in vitro hydroxyapatite dissolving effect of the commercial sports drink samples studied (all having a pH under 4.22) was markedly greater (0.48–4.38 mmol/l) than that of the malic acid containing experimental drink (pH 5.50, Ca⁺⁺ concentration in the supernatant 0.19 mmol/l) and of the similar citric acid containing drink (0.35 mmol/l). The hydroxyapatite dissolving effect of both drinks started to be marked at a pH level of about 5.0 but increased thereafter exponentially with decreasing pH. At pH levels above 4.0 the hydroxyapatite dissolving effect of citric acid containing drinks was greater than that of malic acid containing drinks.     

Immunoelectron microscopic findings in oral mucosa of patients with dermatitis herpetiformis and linear IgA disease

Abstract – Two patients with dermatitis herpetiformis and one with linear IgA disease were examined. Two of the patients had oral lesions and all three showed IgA deposits detected by direct immunofluorescence in apparently normal buccal mucosa. To localize the target structures for IgA deposition, biopsy specimens were taken from normal appearing buccal mucosa for immunoelectron microscopy. The patients with dermatitis herpetiformis had distinct IgA deposits in the upper connective tissue. These were often associated with elastic fibers and occasionally also with capillary walls. In contrast, the patient with linear IgA disease had IgA deposition at the subbasal lamina. Though the clinical expressions may be similar the present immunoelectron microscopic fmdings in oral mucosa clearly differentiate dermatitis herpetiformis from linear IgA disease.