Thyrotoxicosis Associated Wernicke’s Encephalopathy

Summary Background Wernicke’s encephalopathy is a rare disorder resulting from nutrition deficiency in thiamine (vitamin B1). It is most often associated with chronic alcohol abuse. It can accompany other disorders such as hyperemesis gravidarum and hyperthyroidism. Case We present a case of severe Wernicke’s encephalopathy that developed in a male non-alcoholic inpatient that was precipitated by poor nutritional intake and development of thyrotoxicosis. It is likely that the hypermetabolic state from thyrotoxicosis contributed to the development of Wernicke’s encephalopathy, which was extremely debilitating. Conclusion Wernicke’s encephalopathy is a severe, life-threatening illness that can be a consequence of hyperthyroidism in addition to alcohol abuse and can be easily prevented with appropriate supplementation of thiamine.     

Morphological and physiological features of Arthroderma benhamiae anamorphs isolated in northern Germany

The anamorph of Arthroderma benhamiae is an upcoming zoophilic dermatophyte that only in recent years has gained importance as a cause of tinea in humans. Its identification by conventional methods can cause problems. In this study we have subjected seven genetically confirmed strains of A. benhamiae anamorphs from northern Germany recently identified in our laboratory to a comprehensive assessment. Their macroscopic and microscopic morphology was checked on various agars and enzyme release stimulated by substrates with keratin, hair perforation and other physiological characteristics were tested. All strains were related to the previously described yellow phenotype of the A. benhamiae anamorph and showed a high resemblance among themselves. Coherent features were their uniform thallus morphology on Sabouraud glucose agar with yellow pigmentation, the formation of circuit‐like hyphal structures and hyphal connections that had not been described previously, a lack of conidia, thiamine dependence, the spectrum of released enzymes and a good growth on human stratum corneum. With exception of the latter two these criteria are suggested for the identification of this anamorph phenotype that should be evaluated by future observations. Different phenotypes of the A. benhamiae anamorph may prevail in other geographic regions.     

Mechanisms of cell death in cholinergic basal forebrain neurons in chronic alcoholics

Tau immunoreactivity was examined in post mortem tissue from patients in three groups: neurologically-asymptomatic and neuropathologically normal alcoholics, alcoholics with Wernicke's Encephalopathy (WE) and age matched non-alcoholic controls. Tau-positive granular and fibrillary inclusions were frequently observed within the magnocellular neurons of the cholinergic nucleus basalis, within occasional nucleus basalis neurons in non-WE alcoholics, but not in controls. Tau immunoreactivity was not however observed in cortical, brainstem, diencephalic or non-cholinergic forebrain structures. Peroxidase activity was also examined within the nucleus basalis using diaminobenzidine as an indicator. The majority of neurons in the basal forebrain showed increased peroxidase activity in all WE alcoholics and in some nucleus basalis neurons of non-WE alcoholics, but was rarely seen in controls. Neighboring astrocytes also showed increased peroxidase activity. These results suggest a link between peroxidase activity and the abnormal accumulation of phosphorylated tau. The presence of tau in the nucleus basalis of alcoholics with WE suggests a thiamine-dependent mechanism in tau accumulation and cell death in the cholinergic basal forebrain.     

No difference in blood thiamine diphosphate levels between Swedish Caucasian patients with congestive heart failure treated with furosemide and patients without heart failure

Abstract. Yue Q-Y, Beermann B, Lindstrom B, Nyquist 0 (Huddinge University Hospital, Huddinge, and the Medical Product Agency, Uppsala, Sweden). No difference in blood thiamine diphosphate levels between Swedish Caucasian patients with congestive heart failure treated with furosemide and patients without heart failure. Intern Med 1997; 242:49 1-49 5.
Objectives: To determine whether furosemide treatment in congestive heart failure (CHF) patients is associated with thiamine deficiency.
Design: Patients without heart failure and without diuretic treatment were included to compare with patients with CHF belonging to New York Heart Association (NYHA) functional class I1 and 111-IV, respectively, and receiving furosemide therapy.
Setting: All patients were recruited from the emergency ward of the cardiology section, Huddinge University Hospital, where they were admitted due to CHF or acute myocardial infarction.
Subjects: Ninety-nine patients were included from whom a blood sample was taken, as well as routine admission blood samples for the analysis of thiamine diphosphate (TPP)
concentrations: Patients taking vitamin preparations were excluded.
Main outcome measures: Blood TPP concentrations were measured by high performance liquid chromatography (HPLC) and compared between the patient groups by the use of ANOVA.
Results: No significant difference was found between the groups in blood TPP concentrations.
Conclusions: Thiamine deficiency may not be a complication of furosemide treatment in the studied Swedish patient population.     

The effect of thiamine deficiency on the structure and physiology of the rat forebrain

Dietary thiamine deficiency, enhanced by pyrithiamine administration in adult rats, produces overt lesions in the brain that are especially prominent in the thalamus. The present study was undertaken to determine whether the thalamic lesions could be correlated with alterations in the physiological properties of neurons in the thalamus and somatosensory cortex. The regimen for experimentally inducing thiamine deficiency produced large lesions in the thalamus of every case; the lesions included most, if not all, of the neurons in the intralaminar thalamic nuclei. The extent of the lesion in the intralaminar thalamus was highly correlated with the loss of bilaterally synchronous spontaneous activity in the cerebral cortex. This correlation was seen in animals analyzed as early as 1–18 hr after the appearance of opisthotonus, the crisis state of thiamine deficiency, and as late as 2–9 weeks of recovery following thiamine replacement therapy. The loss of bilateral synchronous bursting neuronal activity following intralaminar thalamic lesions is consistent with the proposed role of the intralaminar thalamus as a pacemaker for rhythmic cortical activity (Armstrong-Jameset al.,Exp. Brain Res., 1985; Fox and Armstrong-James,Exp. Brain Res. 63: 505–518, 1986). The location and size of the central lesions within the thalamus suggest that the observed neuronal loss could result from a nonhemorrhagic infarction in the ventromedial branches of the superior cerebellar arteries. Experimental thiamine deficiency also produced alterations in the receptive field properties of the somatosensory cortex neurons in all animals examined. Changes in cortical receptive field properties were correlated with the destruction of sensory relay neurons in the thalamic ventrobasal complex. The loss of the central lateral thalamic input to the cortex and the loss of somatosensory relay neurons in the ventrobasal thalamus in experimental thiamine deficiency produce alterations in cortical function which may contribute to deficits in memory and cognition analogous to those which characterize Korsakoff's psychosis in humans.     

舌下含地尔硫卓的降压作用

高血压病５８例（男性３４例，女性２４例；年龄５４±ｓ１０ａ），采用随机单盲法分２组，其中３０例以国产地尔硫９０ｍｇ舌下含化为治疗组，２８例采用维生素Ｂ１２０ｍｇ舌下含化为对照组。含药后５ｍｉｎ开始观察其降压作用。结果：治疗组于含药后１０，３０，６０和１２０ｍｉｎ时降压总有效率为６０％，９０％，９３％和９３％，而对照组及另外１３名正常人血压均无明显变化。地尔硫含化的缺点为药味苦涩。     

Effect of thiamine on glucose utilization in hepatic cirrhosis

Thiamine, an essential co-enzyme, improves glucose utilization. Thiamine hydrochloride (50 mg per capita per day for 30 days), given to 25 patients with liver cirrhosis who had hyperglycaemia, produced a significant reduction (P less than 0.001) in blood glucose levels. It is therefore suggested that thiamine supplements be given to cirrhotics with hyperglycaemia, to improve glucose utilization.     

深圳市学龄前儿童硫胺素,核黄素及铁的营养状况

深圳市学龄前儿童缺铁性贫血检出率为10．6％，1～3岁年龄组（13．5％）高于4～6岁年龄组（9．72％）；男童（14．4％）明显高于女童（5．3％）．提示儿童的缺铁性贫血与性别有关。学龄前儿童中硫胺素缺乏者占20．4％．1～3岁年龄组（30．9％）高于4～6岁年龄组（17．2％）；核黄素不足者占13．2％，1～3岁年龄组（25．5％）高于4～6岁年龄组（9．4％）．核黄素不足儿童的缺铁性贫血检出率（16．1％）高于核黄素营养正常儿童（9．3％）硫胺素缺乏儿童的核黄素不足检出率（31．3％）明显高于硫胺素营养正常的儿童（8．6％），提示核黄素不足与硫胺素营养状况有关。     

Toxicity of flavoglaucin from Aspergillus chevalieri in rabbits

Female rabbits were injected intraperitoneally (i.p.) with purified flavoglaucin from Aspergillus chevalieri. After 2 h the rabbits were bled and the livers removed for enzyme assays. No changes were found for plasma lactate dehydrogenase (LDH) and its isozymes or liver transketolase (TK) activities. A small but not statistically significant increase was found in plasma glutamate pyruvate transaminase activity. A highly significant increase in plasma glutamic oxaloacetate transaminase activity was observed along with an increase in liver LDH which was, however, not quite significant. The liver also showed some histological evidence of hepatic damage.