Studies on condensed 1,4-dihydropyridine derivatives and their calcium modulatory activities

Hexahydroquinoline and furoquinoline derivatives were synthesized and their calcium modulatory activity was investigated on isolated rat ileum and lamb carotid artery. In addition, the in vitro hepatic microsomal biotransformation of one hexahydroquinoline derivative was studied in rat microsomes.     

Topical cyclosporine in the management of shield ulcers

PURPOSE: To report our experience with 0.05%-2% topical cyclosporine in the treatment of 4 cases of severe, corticosteroid-resistant, vernal keratoconjunctivitis with shield ulcers. METHODS: Four patients with shield ulcers not responding to medical treatment with topical steroids, antihistamines, and mast-cell stabilizers were treated with 0.05%-2% topical cyclosporine. The frequency of application was 4 times daily in all cases, and the concentration was adjusted according to the clinical status starting with 2%. RESULTS: Healing of ulcers with no epithelial defect occurred in 10 days with the 2% concentration in all cases. The patients experienced no side effects except for a burning sensation during administration. Recurrences occurred when the concentration was decreased to 0.05% in 3 cases. The recurrences were effectively treated with 1% concentration in all cases, and patients were stable with this concentration for at least 6 months. CONCLUSIONS: Topical cyclosporine is an effective treatment alternative in the management of shield ulcers in patients with vernal keratoconjunctivitis. The 1% concentration seems to be the minimal effective concentration in such cases in our experience, but further controlled studies are needed to support our findings.     

Gliofibroma: an incompletely characterized tumor

Although gliofibroma is a rare and incompletely characterized tumor, recent publications have revealed new aspects of this entity. The case of a 16-year-old boy who was diagnosed as having a gliofibroma is presented here, and the problems regarding nosology are discussed in the light of the recent literature.     

The in-vitro effects of medroxyprogesterone acetate on acidic pH induced apoptosis of periferal blood mononuclear cells

Medroxyprogesterone acetate (MPA) which has a steroid structure, is widely used in oncology practice in the treatment of the cachexia of cancer and to reduce hematologic toxicity in patients receiving chemotherapy. However, the mechanisms of MPA on these effects are unclear. In this study, we investigated the effects of two different doses of MPA (10(-5) and 10(-6) M/L) on acidic pH induced apoptosis of periferal blood mononuclear cells (PBMC) derived from 10 healthy volunteers. Compared with the control group, we found that MPA at the dose of 10(-5) M/L had a negative effect on apoptosis (32.88 +/- 4.61 and 20.7 +/- 1.53% respectively, p < 0.05), a positive effect on cell count of PBMC (1395 +/- 151 x 10(3) and 1100 +/- 139 x 10(3) respectively, p < 0.05) and no effects on cell viability and its proliferation. More comprehensive trials are needed to clarify this effect of MPA.     

Incidence of canine impaction and transmigration in a patient population

In this study, 4500 consecutive panoramic radiographs were prospectively reviewed. The incidence of canine impaction was found to be 3.58% and the incidence of canine transmigration was 0.31%. There were six maxillary and eight mandibular transmigrant canines. The incidence of impacted canine teeth and transmigration of maxillary and mandibular canines may be more frequent than was previously thought, at least in some populations.     

Assessment of the optimal time interval and background region of interest in the measurement of differential renal function in Tc-99m-EC renography

BACKGROUND: Differential renal function (DRF) measurements are routinely corrected for background, which mainly affects the reproducibility and accuracy of the measurement. The present study was conducted to identify the most appropriate background ROI and optimal time interval in the calculation of DRF for EC renography. MATERIALS AND METHODS: Nineteen patients were studied. For determination of DRF in EC renography, the selected time intervals were 0.5-1.5; 0.5-2; 1-2; 1.5-2.5; 2-3 min, and the background ROI types were inferolateral crescent, lateral crescent, and perirenal shaped. The reference DRF was obtained through DMSA study. For low functioning kidney of each patient, relative uptake differences between the DMSA and EC scans were calculated. Then, the mean differences and the standard deviations were found. RESULTS: The highest correlation was between the DRF values obtained using inferolateral background ROI in 0.5-2 minutes of EC scintigraphy and the DRF values obtained through posterior DMSA images (r = 0.9889). However, there were no statistically significant differences between the mean DRF values obtained for each time interval with each ROI type (p > 0.05). For all the time intervals and background ROIs, the mean of the differences was <0.9%. In conclusion, in obtaining comparable DRF values from EC and DMSA studies, none of the background types proved superior. Also our research for optimal time interval showed that EC scintigraphy underestimates the DRF when compared to DRF obtained from DMSA study. The DRF has a tendency to decrease as the later time intervals are used. The time intervals less than 2.5 minutes show lower underestimation of DRF values.     

Effects of chronic ingestion of sodium fluoride on myocardium in a second generation of rats

Possible effects of long term exposure (6 months) to sodium fluoride (NaF) through drinking water on the morphology and biochemistry of myocardial tissue in second generation adult male rats were investigated. Wistar strain female and male rats were reared until the second generation of rats obtained, during which they were given 1, 10, 50 and 100 mg/L NaF in drinking water. Of the second generation, 28 male rats were divided into four groups and had the same treatment. All the second generation rats were sacrificed and autopsied at the end of the 6 months. In the samples of myocardial tissues, the levels of serum fluoride and the activities of principal antioxidant enzymes were determined, and a histopathological examination was conducted. Significant histopathological changes were found in the myocardial tissue of rats treated with 50 and 100 mg/L NaF. These were myocardial cell necrosis, extensive cytoplasmic vacuole formation, nucleus dissolution in myosits, swollen and clumped myocardial fibers, fibrillolysis, interstitial oedema, small hemorrhagic areas and hyperaemic vessels. Additionally, the increased activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and thiobarbituric acid-reactive substance (TBARS) levels were observed in the myocardial tissues of rats treated with 10 and 50 mg/L NaF. On the other hand, the activities of SOD, GSH-Px, and CAT decreased, but the TBARS levels increased in the myocardial tissues of rats treated with 100 mg/L. The present results revealed that prolonged ingestion of fluoride through drinking water, particularly with high doses, induced significant histopathological and biochemical changes leading to myocardial tissue damage.     

Macular retinitis as a first sign of subacute sclerosing panencephalitis: the importance of early diagnosis

PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a subacute inflammatory and neurodegenerative encephalitis related to the measles (rubeola) virus and usually affecting children and young adults. The overwhelming majority of cases follow a progressive downhill course leading to death, although there have been a few case reports of patients who have apparently gone into remission. Ocular changes occur in up to 50% of SSPE cases. Visual complaints, if present, generally antedate the onset of neurological symptoms by a few weeks or months. Here, we report two cases of SSPE presenting with ocular findings and their prognoses. METHODS: Case reports. In the first case, a 17-year-old male presenting with macular retinitis, the macular findings were mistaken for a heredodegenerative disorder and diagnosis was postponed until neurological findings took place. He died six months after the appearance of his first ophthalmic symptoms despite intravenous immune globulin and isoprinosine therapy. The second case was a 14-year-old male, who presented with only ophthalmological complaints. His diagnosis was based on both ophthalmological findings and high doses of measles IgG in the cerebrospinal fluid (CSF); isoprinosine and intramuscular beta-interferon therapy was started before the onset of neurological findings and in the follow-up time of about 18 months, neurological findings consistent with SSPE did not develop. RESULTS: The characteristic finding of macular retinitis in SSPE patients is rapid recovery in about one month without therapy. After improvement, neurological findings take place. Once suspected, the diagnosis of SSPE is easily established by the demonstration of high levels of measles antibody in the serum and CSF. Early diagnosis can be made with typical ocular findings and high IgG titers for rubeola in CSF. CONCLUSION: We suppose that ophthalmic manifestations, especially macular retinitis, may be useful in the diagnosis and management of SSPE cases with elevated IgG titers for rubeola in CSF. The typical clinical findings must be familiar to every ophthalmologist so that diagnostic pitfalls can be prevented and early therapy started. It may be discussed if early diagnosis and therapy will be possible before neurological signs appear, the prognosis of this relentless disease may show a more favorable course.     

Aggressive spinal germinoma with ascending metastases

Summary We report the case of a 28-year-old young man who presented with progressive paraparesis and urinary incontinence. Initial spinal MR scans showed a sausage-like lesion that extended between L1 and S2. At surgery, an encapsulated intradural extramedullary tumor was removed en bloc. The initial histopathological diagnosis was ependymoma. The tumor recurred locally to double its original size only 4months later. After second surgery, 5100 cGy of local spinal radiation was given since the pathologist believed that the new tumor exhibited anaplastic features. Subsequently tumor recurred at T6-10 levels and later in the right parasellar region. Surgery was undertaken for both recurrences and radiation to whole spine and to whole brain respectively followed surgery. At 11months after the initial presentation, a new tumor was diagnosed at T11-T12 levels. After fifth surgery, chemotherapy with cisplatin, doxorubicin and vincristine was started. At this stage, review of all five surgical specimens by an outside neuropathologist was considered crucial. The new and correct histological diagnosis was germinoma. A new chemotherapy regimen targeted for germinoma was then started. The patient remains alive with no evidence of disease at 22months after initial presentation. Primary spinal germinomas are exceedingly rare. A review of the literature revealed only 14 biopsy-proven spinal germinoma cases. Our case is clearly unique in aggressivity of the tumor, a feature often unexpected for germinomas. This case proves that the dissemination risk may be very serious for germinomas and that the craniospinal radiation may be a more secure treatment mode.