Calcium metabolism in Alzheimer's disease. A case-control study

Aluminium is present in senile plaques and in neurofibrillary tangle-bearing neurones in brains of cases of Alzheimer's disease. Evidence linking aluminium absorption to calcium metabolism prompted a case-control study of physiological markers of calcium homeostasis in patients with Alzheimer's disease. Mean plasma 25-hydroxyvitamin D concentration was lower in cases than in controls but no difference in median parathyroid hormone concentrations or other evidence of altered calcium metabolism was found. The difference in 25-hydroxyvitamin D concentrations may be secondary to differences in exposure to sunlight.     

A clinicopathological study of pulmonary cryptococcosis--chest CT and pathologic correlation]

We reviewed the clinicopathological features in 12 patients (7 males and 5 females; mean age 54 yr) with pulmonary cryptococcosis. Eleven of the patients were asymptomatic and the disease was detected by chest radiograph abnormalities. The underlying systemic disease had been diagnosed as diabetes mellitus in two. Chest CT scans showed a solitary nodule in 9 of the 12 patients, multiple nodules in 2, and infiltration in 1. The nodular diameter was less than 2 cm in 10 of the 12. All nodules were located in the subpleural region. On the chest CT, cavitary nodules, scattered nodules, or both, and spiculated nodules were difficult to distinguish from pulmonary tuberculosis and primary lung cancer, respectively. According to McDonnell's pathological classification of pulmonary cryptococcosis, the resected 8 lungs revealed peripheral pulmonary granuloma in 5 and granulomatous pneumonia in 3. It is important to perform a pathological examination for the diagnosis of pulmonary cryptococcosis to avoid misdiagnosis as lung cancer or pulmonary tuberculosis.     

A case-control study of maternal age in Alzheimer's disease

A case-control study of maternal age as a risk factor for Alzheimer's disease was conducted in Washington state. Clinically diagnosed cases of Alzheimer's disease (n = 64) were identified from two sources, an outpatient clinic at the University of Washington and an organization of relatives of patients with Alzheimer's disease. Controls were spouses of the Alzheimer's disease cases and spouses of 87 patients with Parkinson's disease, also identified at the University of Washington. Mail questionnaires were sent to all subjects; responses were received for 90 cases and 96 controls, although nine of those cases, whose medical records of diagnostic evaluations were incomplete, were excluded. Among the 69 cases and 94 controls whose mothers' ages were known, there was no evidence that the mothers of cases were significantly older than the mothers of controls (chi-square test for trend, P = 0.82). These findings do not support the theory that persons born to older mothers are at increased risk of developing Alzheimer's disease.     

A clinicopathological study on pericardial heart disease in the aged

A total of 87 cases of pericardial heart disease (73 of pericarditis and 14 of hemopericardium) among 870 consecutive autopsies of aged patients was studied. Fibrinofibrouspericarditis was found in 80.8% of pericarditis, neoplastic in 13.7% and purulent in 5.5%. Representative cases of each type of pericarditis were illustrated. Among fibrinofibrous pericarditis, idiopathic was the most common and the other causes included irradiation, myocardial infarction, renal failure, rheumatoid arthritis and hypothyroidism. Frequent association of congestive heart failure or anasarca with mild to moderate fibrinofibrous pericarditis was noted. Clinical and morphologic evidences of pulmonary tuberculosis were present in nearly one third of cases with fibrinofibrious pericarditis, but actual incidence of tuberculous pericarditis could not be determined. Incidence of clinical signs and symptoms of acute pericarditis was evaluated with the stress on the relatively high incidence of supraventricular tachyarrhythmias, especially in cases with histological evidence of sinus node involvement in aged cases.     

A sero-epidemiological study of conventional infectious agents in Alzheimer's disease

Serum antibody titres to Adenovirus, Chlamydia Group B, Coxiella burnettii, Cytomegalovirus, Herpes simplex virus, Influenza A, Influenza B, Measles and Mycoplasma pneumoniae were measured in 33 patients with a clinical diagnosis of Alzheimer's disease, and in 28 non-demented controls suffering from functional psychiatric disorders. No statistically significant differences were found between the patients and controls, and it is concluded that these agents play no role in the aetiology of Alzheimer's disease.     

猫抓病性淋巴结炎38例临床病理分析

目的：探讨猫抓病性淋巴结炎的病理诊断、鉴别诊断及病因。方法：应用免疫组织化学ABC法对38例猫抓病性淋巴结炎标本分别标记CD20、CD45RO、Mac387；每例均作PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色和Warthin—starry染色。结果：早期星形脓肿改变9例，脓肿周围为B淋巴细胞(CD20^ )和组织细胞(Mac387^ )；肉芽肿改变29例，组织细胞源性类上皮细胞(Mac387^ )呈放射状排列，其间散在分布T淋巴细胞(CD45RO^ )。38例中，29例Warthin-starry染色阳性，PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色均为阴性。结论：猫抓病性淋巴结炎的病理特征为星形脓肿和肉芽肿形成。免疫组织化学可识别增生的细胞类型，结合：PAS反应、吉姆萨染色、Gram染色、六胺银及抗酸染色等，对猫抓病性淋巴结炎具有鉴别诊断意义。     

White matter low attenuation on CT in Alzheimer's disease

White matter low attenuation (WMLA) was seen on CT in 19.7% of 61 patients with probable Alzheimer's disease. Presence of WMLA was associated with higher age, more severe degree of dementia, and increased CSF/serum albumin ratio, but not with cardiovascular disorders. WMLA on CT might be related to minor vascular events, or Alzheimer patients with WMLA could even constitute their own subtype.     

Alzheimer's disease in Down's syndrome. A review

Alzheimer's disease is a progressive dementing illness accompanied by characteristic neuropathologic changes. Although its etiology is unknown, its risk of occurrence increases with age and in relatives of affected individuals. An additional risk factor is the presence of Down's syndrome. Almost all individuals with Down's syndrome over the age of 40 have the characteristic neuropathologic changes of Alzheimer's disease at autopsy. Although clinical evidence for Alzheimer's disease in Down's syndrome is less consistent, the association between Alzheimer's disease and Down's syndrome may contribute to an understanding of Alzheimer's disease in the general population. This article summarizes the neuropathologic and clinical observations of Alzheimer's disease in Down's syndrome and reviews the hypotheses that attempt to account for this association.     

A preliminary study of dietary aluminium intake and risk of Alzheimer's disease.

BACKGROUND: epidemiological studies of Alzheimer's disease and aluminium intake have focused on aluminium in drinking water. There have been no studies investigating the relation between the disease and the consumption of foods containing large amounts of aluminium additives. OBJECTIVES: to conduct a pilot study to determine whether dietary intake of aluminium additives differs in individuals with and without Alzheimer's disease. DESIGN: matched case-control study. Controls were matched to cases on age, gender and date of admission to the centre. SETTING: Syracuse, New York, USA. SUBJECTS: 46 participants comprising 23 matched sets. METHODS: residents of the Loretto Geriatric Center with and without newly-diagnosed Alzheimer's disease were selected. Next-of-kin were asked to complete information on the resident's medical history, lifestyle behaviour and dietary intake before admission to the centre. An expanded form of the Health Habits and History Questionnaire was used to determine dietary intake. Consumption of foods containing elevated levels of aluminium additives was compared between cases and controls. RESULTS: the crude odds ratio for daily intake of foods containing high levels of aluminium was 2.0 and, when adjusted for covariates, was 8.6 (P=0.19). Intake of pancakes, waffles, biscuits, muffins, cornbread and/or corn tortillas differed significantly (P=0.025) between cases and controls. Adjusted odds ratios were also elevated for grain product desserts, American cheese, chocolate pudding or beverages, salt and chewing gum. However, the odds ratio was not elevated for tea consumption. CONCLUSION: past consumption of foods containing large amounts of aluminium additives differed between people with Alzheimer's disease and controls, suggesting that dietary intake of aluminium may affect the risk of developing this disease. Larger studies are warranted to corroborate or refute these preliminary findings.     

Diagnosis of nontuberculous mycobacterial disease in the era of surveillance chest CT scans

The radiologic surveillance of smokers with low-dose CT scan has led to a significant surge of radiologic incidental findings, including the detection of early stages of pulmonary infections including nontuberculous mycobacteria (NTM). This causes a state of overdiagnosis and potential overtreatment of NTM lung disease. Here we propose a new approach to NTM pulmonary disease in the era of increased CT scanning.     

Interstitial lung disease in dermatomyositis: clinicopathological study

We studied 14 cases of polymyositis-dermatomyositis (PM-DM) and found roentgenographic evidence of interstitial lung disease in 9 patients with DM (64.3%). Serum anti-Jo-1 antibody was demonstrated in only one case. Histologically, interstitial pneumonitis and fibrosis were noted in all cases. Deposition of immunoglobulins along the alveolar interstitium was not found in any case. Response to corticosteroid therapy was poor, and 6 cases (67%) succumbed to respiratory failure and died. We conclude that interstitial lung disease in DM occurs more frequently than previously reported and may be an important prognostic factor.     

肝转移瘤螺旋CT双期扫描诊断的研究

研究少血供和富血供肝转移瘤螺旋CT双期表现。128例肝转移瘤行螺旋CT全肝双期扫描，扫描后图象重建。扫描结果98例为少血供，30例为富血供。结果证实螺旋CT双期扫描动脉期有利于富血供病灶的检出，门静脉期易于少血供的转移瘤检出。双期扫描提高了肝转移瘤的检出率，对于肝转移瘤的定性和鉴别诊断有很重要意义。     

Driving in Alzheimer's disease.

OBJECTIVE: To determine if the impaired mental skills in Alzheimer's Disease (AD) may adversely affect driving ability. DESIGN: Retrospective survey. SETTING: The Alzheimer's Clinic of the University of Kansas Medical Center. PATIENTS: We interviewed 67 AD patients and their families and compared them with 100 elderly, non-spousal controls. MEASURES: The questionnaire was designed to obtain information on their driving habits, with emphasis placed on whether they were still driving, and the number of accidents per year for the past 10 years. RESULTS: Forty-six of the AD subjects had stopped driving because of safety concerns expressed by the subjects, their families, or health care providers, and two had stopped for other reasons. Only two of the normal controls had stopped driving (P < 0.0001, Chi-square test). Over the past 3 years, the 19 AD subjects who were still driving had 263.2 motor vehicle accidents per million vehicle miles of travel compared with 14.3 for the controls (P < 0.002, Mann-Whitney U test) and 5.7 for the general driving population age > or = 55 years (P < 0.05, Students one group, two-tailed t test). CONCLUSION: This study suggests that a significant traffic safety problem exists in subjects with AD who continue to drive. Efforts should be directed to detect patients with AD whose driving presents a traffic safety problem.     

Alcohol consumption in Alzheimer's disease. A case report

As late-onset alcohol consumption is rare, it often indicates a different underlying disorder. We present a case where late-onset alcohol drinking occurred during the onset of Alzheimer's disease.     

Relationship between autoimmune thyroid disease and nephropathy: A clinicopathological study

The association of nephropathy with autoimmune thyroid disease (AITD) has been reported previously. However, there is limited information on the relationship between thyroid autoantibodies and nephropathy. A retrospective study was conducted using the medical records of 246 patients with nephropathy, 82 of whom had concurrent AITD. General characteristics, thyroid function, autoantibodies, and the pathological types of nephropathy were analyzed. Immunohistochemistry was used to detect the thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) in the kidneys. We found nephropathy patients with AITD exhibited higher serum levels of TPO-Ab, TG-Ab, thyroid-stimulating hormone receptor antibody (TR-Ab), and immunoglobulin G (IgG) (P < .05). Compared with the nephropathy without AITD group, the nephropathy with AITD group exhibited higher proportions of membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), and relatively lower proportions of mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephropathy (MCN) (P = .005). TPO-Ab and TG-Ab levels in the kidney were more prevalent in nephropathy patients with AITD than those without AITD (P = .015 and P = .026, respectively). Subgroup analysis demonstrated that serum levels of thyroid stimulating hormone (TSH), TG-Ab, TPO-Ab, immunoglobulin M (IgM), and IgG in the MN group were significantly higher, whereas the levels of free thyroxine (FT4) and estimated glomerular filtration rate (eGFR) were lower, as compared with MN with Hashimoto thyroiditis (HT) group (P < .05). TPO-Ab and TG-Ab expression levels in the kidneys were more prevalent in the MN group than in the MN with HT group (P = .034). The expression levels of FT4, TG-Ab, TPO-Ab, and thyroid-stimulating hormone receptor antibody (TSHR-Ab) in the serum were significantly higher in the MN group than in the MN with Graves disease (GD) group (P < .05). The expression of TPO-Ab in the kidneys was more prevalent in the MN group than in the MN with GD group (P = .011). In sum, the expressions of TPO-Ab and TG-Ab were more prevalent in the kidneys of patients with nephropathy and AITD. Our findings indicate that TPO-Ab and TG-Ab may play a role in the development of AITD-related nephropathy.     

Self-recognition in Alzheimer's disease: a mirror and video study.

Twenty-nine subjects with Senile Dementia of the Alzheimer Type (SDAT) were tested for self-recognition when confronted with their reflection in a mirror and with a noncontingent video image. All subjects at stage 5 (moderately severe cognitive decline) on the Global Deterioration Scale (GDS) showed self-recognition in the mirror condition, whereas 25% of GDS stage 6 subjects (severe cognitive decline) did not self-recognize. Only seven subjects showed signs of self-recognition on video (six at GDS 5, one at GDS 6). The results confirm two hypotheses: the first, based on studies with infants, is that contingency cues in the mirror condition facilitate self-recognition; the second is that SDAT patients may show "regression" of at least some cognitive functions.     

Colitis complicating chronic granulomatous disease. A clinicopathological case report.

BACKGROUND--This report concerns a female patient now aged 24 years, diagnosed at the age of 7 years as suffering from chronic granulomatous disease. At age 20 she developed diarrhoea accompanied by rectal bleeding. Endoscopy showed extensive colitis. She failed to respond to medical treatment and underwent total colectomy two years later. AIMS--To discuss the histological changes in the colon in chronic granulomatous disease. RESULTS--There was extensive mucosal inflammation throughout colon and rectum resembling ulcerative colitis. In addition characteristic large pigmented macrophages were distributed in the basal mucosa and superficial submucosa. Similar cells accompanied by granulomata were present in mesenteric lymph nodes. CONCLUSIONS--Colitis is an unusual clinical manifestation of chronic granulomatous disease but the presence and characteristic distribution of such pigmented macrophages in colonic biopsy in children and young adults may suggest the diagnosis.