Cerebellar abscess and syringomyelia due to isoniazid-resistant Mycobacterium tuberculosis.

A 19-year-old immunocompetent man was admitted to hospital with diplopia, nausea, vomiting and change in mental status. The patient had a history of tuberculous meningitis that was diagnosed at another hospital 6 months before the present admission, and at that time anti-tuberculosis treatment was initiated using a first-line drug combination. A computed tomography (CT) scan of the brain revealed non-communicating hydrocephalus. A ventriculo-peritoneal shunt was inserted surgically. Two months later, the patient was hospitalized again for fever, dysphagia and left hemiparesis. At that time, his cranial CT findings were within normal limits; however, magnetic resonance imaging (MRI) revealed an irregular multilocular peripheral contrast-enhancing lesion in the posterior fossa. The abscess was surgically drained. The presence of acid-fast bacilli in the abscess material was demonstrated by Ziehl-Neelsen staining. Mycobacterium tuberculosis grew on Lowenstein-Jensen culture medium, and the strain was found to be resistant to isoniazid. One month after the operation, the patient became quadriparetic. Cervical MRI revealed a cervico-thoracic syringomyelitic cavity, after which a syringoperitoneal shunt was placed. Treatment with four drugs was continued for 10 months, and then treatment with three drugs for a total period of 18 months. The patient recovered, with residual quadriparesis. Even though very rare, isoniazid-resistant M. tuberculosis may be the causative agent of progressive tuberculosis.     

Relative nocturnal hypertension in children with insulin-dependent diabetes mellitus

Twenty-four-hour blood pressure and heart rate measurements were carried out in 14 newly diagnosed diabetics and in 28 diabetics with 5–13 years' duration of the disease; 8 healthy children were used as controls. Mean arterial blood pressure increased at night in 5, decreased slightly (less than 10%) in 5 and decreased markedly (more than 10%) in 18 diabetics with longer duration of the disease. The diurnal-nocturnal differences in heart rates were significantly lower in diabetics with relative "nocturnal hypertension" compared to the control group ( p < 0.05). A significant negative correlation was found between maximal arterial blood pressure during physical exercise and the diurnal-nocturnal differences in mean arterial blood pressure in diabetics ( r =−0.58; p < 0.02). In conclusion, we found elevated nocturnal blood pressure in a subgroup of children with longer duration of diabetes and without increased albumin excretion. However, longitudinal studies of blood pressure profiles are needed to identify the candidates for diabetic vasculopathy among diabetic children.     

Influence of calcium channel blocker drugs in neuromuscular transmission.

OBJECTIVE: Calcium channel blockers are commonly used in some cardiovascular disorders. These drugs can act at neuromuscular transmission, at both pre- and postsynaptic levels and may produce neuromuscular dysfunction. Therefore, they may result in misdiagnosis in electrophysiological testing of healthy subjects. This study aimed to investigate the influence of calcium channel blockers on neuromuscular transmission, using single fiber electromyography, in subjects who were healthy excepting controlled arterial hypertension condition. METHODS: Single fiber electromyography during voluntary contraction of the extensor digitorum communis muscle, nerve conduction studies of upper and lower extremities, and concentric needle electromyography of the extensor digitorum communis were performed on 16 verapamil users, 16 amlodipine users, and 16 age-matched normal controls. Twenty potential pairs were recorded from each subject. Twenty individual jitter values and a mean jitter value were calculated for each subject. Both mean jitter values and numbers of abnormal individual jitter values were compared in verapamil and amlodipine users versus normal controls. RESULTS: Eight of 16 verapamil users and 7 of amlodipine users showed evident neuromuscular transmission abnormalities by single fiber electromyography. Two subjects from verapamil and one subjects from amlodipine users group had borderline dysfunction of neuromuscular transmission. CONCLUSIONS: These results suggest that both verapamil and amlodipine impair neuromuscular transmission in subjects without neuromuscular disease. SIGNIFICANCE: The effects of verapamil and amlodipine are at a level, which may cause misinterpretation of single fiber electromyography studies carried out to investigate neuromuscular junction disorders.     

Enzyme supplementation of dry and wet wheat-based feeds for broiler chickens: performance and gut responses

To test whether the improvements in digestive efficiency due to either wetting of the food or inclusion of enzymes are accompanied by the same changes in gut function, foods with a high content of wheat were fed to broiler chicks from 1-42 d old. Twenty-four birds were caged individually while a further sixty-four were in group pens in experiments of 2 x 2 factorial design with two levels of enzyme (0 or 1 g/kg, designed for wheat) and two levels of water addition (0 and 1300 g/kg). Food intake and live-weight gain were significantly increased by wet feeding (from 89.3 to 153.4 g/d and from 39.7 to 65.4 g/d respectively), the differences increasing with age, while the enzyme had no significant effect (120.5 and 122.2 g/d and 51.9 and 53.1g/week respectively). The viscosity of digesta was greatly reduced both by wetting (from 4.40 to 2.64 kPa. s) and enzyme (from 4.47 to 2.57 kPa. s) but there was a significant interaction with age in which the viscosity was low throughout in the wet only, enzyme only and wet + enzyme treatments but declined with age from a very high level in the dry, no enzyme treatment (11.5 kPa. s at 14 d). While wetting increased weight and length of digestive tract and thickness of some parts of the gut, enzyme had no significant effect, tending to reduce gut wall thickness. Crypt cell proliferation rate (CCPR) was significantly reduced by wet feeding (from 39.4 to 28.7 cells/crypt per 2 h) and by enzyme supplementation (from 38.9 to 29.2 cells/crypt per 2 h). Therefore, while both wetting and enzyme addition to the food reduced digesta viscosity and CCPR to a similar extent, the former had marked stimulatory effects on food intake and weight gain while the latter had little effect. The mode of action of wet feeding is therefore deduced to be not primarily through its effects on viscosity and CCPR.     

紫杉醇化疗方案对乳腺癌患者血清Th1/Th2细胞因子水平的影响

目的探讨紫杉醇化疗方案对乳腺癌患者血清Th1/Th2细胞因子水平的影响。方法将100例乳腺癌术后辅助化疗患者随机(1︰1)分为2组,常规组行AC(阿霉素-环磷酰胺,每3周1次)-P(紫杉醇80mg·m~(-2),每周1次)方案化疗,剂量密集组,行AC(阿霉素-环磷酰胺每2周1次)-P(紫杉醇175mg·m~(-2),每2周1次)方案化疗,化疗前后观察患者血清细胞因子水平变化。结果常规组及剂量密集组化疗后患者血清IL-2、TNF-α及IFN-γ浓度均显著增高(P<0.05),血清IL-4、IL-6及IL-10水平显著降低(P<0.05)。结论常规组及剂量密集组均能够改善乳腺癌患者细胞免疫功能;剂量密集组较常规组具有更强的恢复细胞免疫为主的抗肿瘤免疫能力,且未显著增加毒性和不良反应。