Formation of pseudodiscs in chronic recurrent Vogt-Koyanagi-Harada syndrome

We report an unusual form of chorioretinal anastomosis in a 20-year-old man with chronic recurrent Vogt-Koyanagi-Harada syndrome. Several subretinal optic disc-like lesions of subretinal fibrosis were found in the vicinity of the equator. No evidence of neovascularization or arteriovenous shunt was noted.     

Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic

Hum. Reprod., 19, 2313–2318, 2004 The following mistake     

Hyperoxaluria, nephrolithiasis, nephrocalcinosis and renal failure after massive resection of the small intestine: report of a case.

Hyperoxaluria is frequently seen in patients with inflammatory bowel disease, or after resection of the ileum. It is assumed to be responsible for the development of nephrolithiasis, nephrocalcinosis (oxalate nephrosis) and progressive renal impairment in these patients. Steatorrhea may aggravate the severity of hyperoxaluria. A 60-year-old male underwent massive resection of the jejunum and ileum 10 years prior to admission, due to strangulation of the small bowel, with occlusion of the superior mesenteric artery. He remained well except for steatorrhea which developed two-and-a-half years prior to admission, when microhematuria, proteinuria and oxaluria developed progressively. Since that time, the nephrolithiasis, nephrocalcinosis and renal failure have continued to worsen despite therapy with oxalate restriction and oxalate-binding agents. A renal biopsy, performed late in the clinical course, showed severe changes in the renal parenchyma. The decline in renal function proved irreversible. The unusual metabolic consequences of massive resection of the small intestine and their mechanisms are discussed.     

1141154113Expression of natural cytotoxicity receptors in peripheral blood NK cell subsets of women with recurrent spontaneous abortions (RSA) or implantation failures

Aim:  To determine if IgA is required for protection against Chlamydia infection in the male reproductive tract (MRT).
Materials and Methods:  Male polyimmunoglobulin receptor knockout mice (PIgR^-/-) and wild-type C57BL/6 (WT) mice were immunised intranasally with chlamydial major outer membrane protein (MOMP) and cholera toxin (CT). MOMP-specific IgG and IgA in serum and prostatic fluids were measured by ELISA. Serum and PF were also assayed for inhibition of in vitro chlamydial infection. Immunized WT and PIgR^-/- mice were challenged by direct inoculation of C. muridarum into the meatus urethra. Four weeks post challenge Chlamydia levels in the penile urethra, epididymis and testis were determined by PCR.
Results:  Equivalent levels of IgG were found in the serum of both WT and PIgR^-/- mice however IgA in serum of PIgR^-/- mice was 19- to 20-fold higher than in WT animals consistent with the lack of the PIgR IgA transport molecule. IgA levels were significantly lower in PIgR^-/- PF compared to WT PF after both immunization and infection. Only PF from WT but not PIgR^-/- animals was able to inhibit in vitro chlamydial infection. Following challenge significantly higher levels of Chlamydia were recovered from the MRT of PIgR^-/- mice compared to WT animals.
Conclusions:  Male mice lacking a functional PIgR were unable to clear a genital tract Chlamydia infection despite high levels of serum IgA. These data show that mucosal IgA plays a major role in preventing chlamydial infection of the male genital tract and suggest that immunization strategies to protect males should target a strong mucosal IgA response.     

Image-directed percutaneous biopsies with a biopsy gun

Core tissue for histologic study is believed by many pathologists to be more diagnostic than material from needle aspiration. Recently, a biopsy "gun" has been introduced, which simplifies core biopsies. With this device, 182 biopsies of multiple anatomic sites were performed with ultrasonic, computed tomographic, and fluoroscopic guidance and 18-gauge needles. High-quality histopathologic specimens were obtained in 177 of the biopsies, and diagnostic target tissue was obtained in 167. Only three significant complications occurred: one bleeding complication that required transfusion and two cases of pneumothorax that necessitated placement of chest tubes. The biopsy gun eliminated the disjointed movements of conventional "skinny" needle biopsies, and none of the samples demonstrated significant "crush" artifact or obscuring blood, problems that are commonly associated with manual biopsy techniques. Patient discomfort was decreased with this system compared with that of manual biopsies, and the total procedure time was reduced. Because of these distinct advantages, the authors now use the biopsy gun exclusively for all percutaneous biopsies and recommend that other institutions consider the use of this biopsy method.     

The Kinmen women-health investigation (KIWI): a menopausal study of a population aged 40-54

OBJECTIVES: This paper aims to report the methodology of a study of a cohort of middle-aged women in Taiwan, their age at menopause, and related factors and prevalence of menopausal symptoms, and to examine the relationships between symptoms and sociodemographic variables. METHODS: An epidemiological study of neuropsychological change during the menopausal transition among Chinese women aged 40-54 years old on the islet of Kinmen. RESULTS: Of a targeted population of 2256 individuals, 1497 (66%) participated in the study. The mean age at menarche was 15.6 years and that at menopause was 48 years. The hormone use rate at the time of study was 23% in surgical menopausal women, and 9% were past users. After excluding surgical menopausal and premenopausal women, 6% reported a current use of estrogen replacement therapy and 6% were past users. The most frequently reported discomforts for those women aged >45 were troubled sleep, backaches, and joint pain. Four symptom clusters: musculoskeletal, non-specific somatic complaints, urogenital, and vasomotor, were identified. After adjustment for age, the urogenital and vasomotor symptoms were significantly associated with menopausal status. CONCLUSIONS: The age at menopause did not differ much from Western studies, but the menopausal symptoms, especially the vasomotor symptoms, were much lower in our study population. Nevertheless, vasomotor symptoms were still significantly associated with menopausal status.