Bilateral renal malacoplakia in systemic lupus erythematosus and adrenogenital syndrome

We report a case of an 8-year-old girl with adrenogenital syndrome secondary to adrenocortical hyperplasia. Thirteen years later systemic lupus erythematosus developed with lupus nephritis. In spite of complex continuous immunosuppressive therapy, she died from terminal renal failure. At autopsy, extensive bilateral renal malacoplakia was discovered. The role of recurrent urinary tract infections and of immunological disturbances in the pathogenesis of malacoplakia is discussed.     

The infant's "post-isthmus" region of the eustachian tube in health and disease

The size of the eustachian tube post-isthmic lumen in infants and children less than 2 years old is discussed. The material in our study consisted of serially sectioned eustachian tubes of twenty-six normal temporal bones and fourteen temporal bones harboring acute and secretory otitis media. The size of the eustachian tube lumen was measured with the aid of a millimetric grid mounted on a microscope. These measurements have shown that: There is no increase in the lumen size of the post-isthmic region of the eustachian tube from birth to 2 years of age. Each age group presents a considerable range in luminal area, compatible with the natural biologic distribution. No obstruction of the eustachian tube lumen was encountered in any of the pathologic specimens. There is no significant statistical difference between the lumen size of the post-isthmic region coming from normal temporal bones as compared with those from temporal bones with acute or secretory otitis media.     

Juvenile ossifying fibroma of the facial skull. Computerized tomography and nuclear magnetic resonance tomography

The clinical and radiological features in a case of a juvenile ossifying fibroma of the skull were studied with CT and MRI. The combination of both imaging modalities allows a precise prediction of tumor components and extension.     

The effects of total sleep deprivation and subsequent treatment with clomipramine on depressive symptoms and sleep electroencephalography in patients with a major depressive disorder

In the present study patients with a major depressive disorder were first subjected to total sleep deprivation (TSD) and then treated with clomipramine. Sleep electroencephalography (EEG) was registered prior to and after TSD, during the 2 initial nights of antidepressive treatment and after 19 days. A negative correlation between response to TSD and clomipramine was found. TSD did not differentially influence the sleep EEG (responders vs nonresponders): responders tended, however, to show a more classical depressive sleep pattern prior to TSD. Clomipramine profoundly suppressed rapid eye movement (REM) sleep; the amount of initial REM sleep reduction, however, did not correlate significantly with therapy response after 3 weeks of treatment.     

REM sleep and cortisol response to the cholinergic challenge with RS 86 in normals and depressives

The influence of the muscarinic agonist RS 86 on rapid-eye-movement (REM) sleep and on hypothalamic-pituitary-adrenocortical (HPA) axis was studied in healthy subjects and in patients with a major depression. In both groups, RS 86 induced a shortening of REM latency and an increase in REM sleep; these effects were more pronounced in the depressives than in the controls. This finding supports the assumption that in depression the REM sleep regulating neurons are hypersensitive to cholinergic stimuli. However, neither in the healthy subjects nor in the depressed patients was an RS 86 induced increase in plasma cortisol seen. This observation does not agree with the assumption that, in humans, the HPA axis is stimulated by muscarinic neurons and that hypercortisolemia in depression is due to an overactivity of muscarinic neurons activating the HPA axis.