Nerve alterations showing autophagy in 2 patients with lichen aureus

Lichen aureus is a rare, chronic, persistent purpuric dermatosis clinically characterized by striking yellow‐ to bronze‐colored lesions. Histologically, lichen aureus differs from other pigmented purpuric dermatoses in containing dense, band‐like infiltrates closely associated with the epidermis. This report describes 2 patients with lichen aureus, a 20‐year‐old woman with a lesion on her right arm and a 51‐year‐old man with a lesion on the right side of his groin. Skin biopsy specimens revealed almost identical findings in both patients, including dense band‐like infiltrates containing lymphocytes, histiocytes with hemosiderin deposits scattered extravasated red blood cells and nerve alterations at the dermo‐epidermal interface. The nerves within the lesions were filled with granules, which stained positive with antibody to microtubule‐associated protein 1A/1B‐light chain 3, suggesting autophagy within the nerves. These altered nerves were present only in areas of band‐like dermal lymphocytic infiltration. Electron microscopy of the lesions showed the accumulation of autophagosomes in Schwann cells.     

直肠癌Dixon手术中保留盆腔自主神经对男性性功能的保护作用

目的 探索直肠癌经腹直肠前切除术(Dixon手术)术中保留盆腔自主神经对男性性功能的保护作用.方法 按TME原则,对56例60岁以下的男性直肠癌患者施行了保留盆腔自主神经(PANP)的Dixon手术(治疗组),同期相同条件的病人,未行保留盆腔自主神经,作为对照组,观察2组术后勃起功能、射精功能和局部复发率.结果 治疗组和对照组术后勃起功能障碍率分别为12.5％(7/56)和54.5％(36/66),射精功能障碍发生率分别为19.6％(11/56)和56.1％(37/66),治疗组明显低于对照组,治疗组和对照组局部复发率分别为8.3％(4/48)和8.8％(5/57),无明显差异.结论 直肠癌Dixion手术术中保留盆腔自主神经对男性性功能有保护作用,并不增加局部复发率.     

Assessment of the Outcomes of Cerebral Blood Flow Measurements After Electrical Stimulation of Upper Right Incisor Tooth in Rabbits

The cerebral vessels are innervated by sympathetic, parasympathetic, and sensory nerves. A sensory innervation of the cerebral vessels originating in the trigeminal ganglion has been described in a number of species by several investigations. It has been shown that the electrical stimulation of the trigeminal ganglion causes an increase of cerebral cortical blood flow (CCoBF). The aim of the present study was to determine the effects of dental electrical stimulation the CCoBF in rabbits. A stimulating electrode was located in the upper right incisor tooth of rabbits and trigeminal ganglion was stimulated orthodromically via the infraorbital nerve. Variations in the cortical CCoBF were evaluated by laser-Doppler flowmetry. In experiment group, CCoBF increased together with the beginning of electrical stimulation (5 V, 0.5-ms impulse duration, square-shaped, 10-Hz frequency). The right and left hemisphere CCoBF values of stimulation period at 15s, 30s, 45s, 60s, 75s, and 90s were significantly higher than those of baseline and 105 and 120s (p < 0.05). The maximum increase in right and left CCoBF was 15.6% and 15.1% respectively. In post-stimulation period, the right CCoBF decreased gradually and returned to the baseline values at 120 s. In experiment groups, the CCoBF values of right hemisphere were comparable that of left hemisphereL (p > 0.05). This study demonstrated that the electrical stimulation of the trigeminal nerve's infraorbital branch via dental pulp increases the cortical right and left CCoBF under physiological conditions.     

A HYPOTHALAMIC DIGOXIN-MEDIATED MODEL FOR AUTISM

The isoprenoid pathway and its metabolites--digoxin, dolichol, and ubiquinon--were assessed in autism. The isoprenoid pathway and digoxin status was also studied for comparison in individuals of differing hemispheric dominance to determine the role of cerebral dominance in the genesis of autism. There was an upregulation of the isoprenoid pathway as evidenced by elevated HMG CoA reductase activity in autism. Digoxin, an endogenous Na+-K+ ATPase inhibitor secreted by the hypothalamus, was found to be elevated and RBC membrane Na+-K+ ATPase activity was found to be reduced in autism. Membrane Na+-K+ ATPase inhibition can result in increased intracellular Ca2+ and reduced magnesium levels. Hypothalamic digoxin can modulate conscious and subliminal perception and its dysfunction may lead to autism. Digoxin can also preferentially upregulate tryptophan transport over tyrosine resulting in increased levels of depolarizing tryptophan catabolites--serotonin, quinolinic acid (NMDA agonist), strychnine (blocks glycinergic inhibitory transmission), and nicotine (promotes dopamine release) and decreased levels of hyperpolarizing tyrosine catabolites--dopamine, noradrenaline, and morphine--contributing to membrane Na+-K+ ATPase inhibition. Increased nicotine levels can produce increased dopaminergic transmission in the presence of low dopamine levels. NMDA excitotoxicity could result from hypomagnesemia induced by membrane Na+K+ ATPase inhibition and quinolinic acid, an NMDA agonist acting on the NMDA receptor. Hypomagnesemia and increased dolichol level can affect glycoconjugate metabolism and membranogenesis leading on to disordered synaptic connectivity in the limbic allocortex and defective presentation of viral antigens and neuronal antigens contributing to autoimmunity and viral persistance important in the pathogenesis. Membrane Na+-K+ ATPase inhibition can produce immune activation, a component of autoimmunity. Mitochondrial dysfunction consequent to altered calcium/magnesium ratios and reduced ubiquinone levels can result in increased free radical generation and reduced free radical scavenging and defective apoptosis leading to abnormal synaptogenesis. Autism can thus be considered a syndrome of hypothalamic digoxin hypersecretion consequent to an upregulated isoprenoid pathway. The biochemical patterns including hyperdigoxinemia observed in autism correlated with those obtained in right hemispheric chemical dominance. Right hemispheric chemical dominance is a predisposing factor for autism     

Manifest latent and congenital nystagmus waveforms in the same subject A need to reconsider the underlying mechanisms of nystagmus

We report a unique case of a horizontal manifest latent nystagmus (MLN) that is converted to a congenital nystagmus (CN) on covering the subjectþs only seeing eye. The subject is a 65-year-old female who, at five days after birth, had her right eye ennucleated. A prosthetic eye was fitted soon after. Horizontal eye movements were recorded using an IRIS (Skalar Medical) infrared system. The effect of visual feedback on primary and secondary gaze, smooth pursuit, optokinetic responses, and the role of selective attention on fixation stability were examined. On primary gaze with the left eye open and under normal viewing conditions, the patient exhibited a typical MLN waveform. The slow phase was a decreasing velocity and the fast phase beat to the left. On covering the left eye, the nystagmus slow phase immediately increased in velocity and the fast phase beat to the right. Removal of visual feedback (darkness or stabilising the retinal image) also brought about a change from MLN to CN. Both the MLN and CN states were strongly influenced by gaze. The decreasing velocity MLN slow phase was also seen to change to a grossly extended slow phase during periods of visual disengagement. On occasions, these oscillations became a short burst of right-beating CN whenever the patient lost interest in the visual task. This is the first report of an adult subject who can exhibit either of two separate and sustained nystagmus states, an MLN or a CN, whenever the only eye is covered. Two explanations are offered to account for the presence of the two separate waveforms. Central to our interpretation is that the neural integrator has an eccentric null and that it is under a variable gain control. Furthermore, we propose that future models of nystagmus generation will need to include retinal image and attention control loops.     

Mandibular access osteotomy: Gate way to parapharyngeal space – A case report

IntroductionPara pharyngeal tumors often pose a challenge to surgeons for surgical interventions. Maxillofacial access osteotomies offer excellent visualization and permit unhindered surgical manipulation. Access osteotomy allows the surgeon an adequate access of the surgical field to resect the tumor completely and to preserve vital structures. Though numerous techniques exist, selection of the proper technique is the key factor in reestablishing the function and cosmesis. This article describes our experience with mandibular swing approach that has facilitated complete removal of a parapharyngeal space tumor.Case presentation35years old female complained of deviation of tongue to one side and swallowing difficulty. Clinical and radiographic examinations were suggestive of a skull base lesion involving the hypoglossal nerve. After evaluation the tumor was excised through a mandibulotomy approach. Post operatively the patient was relieved completely of the symptoms and without any postoperative sequalae.Clinical discussionAccessibility is the main concern while dealing with skull base lesions. But the success of surgery lies on the selection of right approach. Paramedian mandibular swing approach has its own advantages over various other facial osteotomies. The swinging of the mandible gives advantage of accessing neck and skull base together, which is not possible with other facial osteotomies.ConclusionManagement of skull base tumors involve a multidisciplinary approach. Choosing the right approach is often a major dilemma. Access osteotomies of facial skeleton is a hatchway to the skull base lesions. Of which mandibular swing approach is a good option for skull base tumors because of the ease of surgical technique even in inexperienced hands.     

A high-concentration NaCl solution does not stimulate the human trigeminal nerve at the tip of the tongue

Conclusion. A 3 M NaCl solution does not stimulate the trigeminal nerve in the human tongue. Objectives. In rats, the trigeminal nerve has been reported to respond when the tongue is stimulated by a solution with an NaCl concentration of 0.4 M or greater. We have attempted to clarify whether or not relatively high concentrations of NaCl stimulate the trigeminal nerves of the human tongue. Materials and methods. We examined four patients whose bilateral chorda tympani nerves were resected during middle ear surgeries. We performed subjective tactile and taste tests. Next, we conducted objective examinations of the subjects’ tactile and gustatory functions by magnetoencephalography (MEG). Results. The subjective examination confirmed that all four subjects maintained normal tactile sensory functions in their tongues and that the gustatory sensation at their lingual apexes was totally abolished. Furthermore, the objective examination of the tactile function using MEG indicated that their brain responses to trigeminal nerve stimulations were normal. Further examination using MEG failed to produce brain responses to a 3 M NaCl solution in spite of their normally functioning trigeminal nerves. Therefore, we concluded that a 3 M NaCl solution does not stimulate the trigeminal nerve at the tip of the human tongue.     

Is carpal tunnel syndrome present in acute stroke patients? An investigative study using clinical and imaging screening tools

Carpal tunnel syndrome (CTS) is known to develop post-stroke. Median nerve ultrasound (US) is an inexpensive, effective means of screening. In this prospective feasibility study, we compared the ability of the physical exam, the Boston Carpal Tunnel Questionnaire (BCTQ) and median nerve US to screen for carpal tunnel syndrome (CTS) within 72 hours of stroke onset. We enrolled 24 consecutive patients. Using US, 19 (79%, p = 0.0386) of the 24 patients screened positive for CTS on the paretic side and 20 (83%, p = 0.0042) on the nonparetic side. With clinical examination, only 11 out of 24 (46%) screened positive for CTS on the paretic side and 8 (33%) on the nonparetic side. The BCTQ did not predict CTS. US can be an effective screening tool post-stroke. Further research is needed to determine specificity and efficacy compared to electrodiagnostic testing in this population.