Athetosis-dystonia in intramedullary lesions of spinal cord

Athetosis and dystonia are well known clinical signs, described in disorders of basal ganglia. As opposed to pseudoathetosis, true athetosis was hitherto not reported in cord lesions. We here report three patients with athetosis and dystonia of hands due to intramedullary lesions of cervical cord: two patients with syringomyelia and one with glioma. Even though pseudoathetosis can be produced by lesions of posterior columns and likely to be confused with the involuntary movements of our patients, they had clinical and EMG findings consistent with true athetosis. A possible explanation for the athetosis and dystonia due to cord lesion is being postulated.     

Symposium: reproduction in baboons. The baboon oviduct: characteristics of an oestradiol-dependent oviduct-specific glycoprotein

The baboon oviductal epithelium differentiates into a tall columnarepithelium consisting of ciliated and secretory cells duringthe follicular phase of the menstrual cycle in response to risingoestradiol levels. The apical tips of these secretory cellsare filled with membrane-bound secretory granules. During theluteal phase when progesterone levels are elevated, the epitheliumregresses and deciliation occurs. Analysis of secretory proteinsobtained from explant culture media by SDS-PAGE followed byfluorography or Western Blots has revealed that the baboon oviductsynthesizes and secretes a high molecular weight glycoproteinduring the follicular phase of the cycle. Immunocytochemistrydemonstrated that the oviductal glycoprotein is localized tothe secretory granules of epithelial secretory cells, is oviductspecific, and that following secretion the oviductal glycoproteinbinds to the zona pellucida and periviteline space of ovulatedoocytes and embryos within the oviduct. Similar proteins havebeen characterized in other mammalian species. cDNA data showthat the complete coding sequence is 2228 bp for a protein of623 amino acids. A Genbank search showed that baboon oviductalglycoprotein has high homology to other oviductal glycoproteinsequences at both the nucleotide and amino acid levels. Studiesconducted to date probing the biological function of oviductalglycoprotein indicate that this protein plays a role in prefertilizationreproductive events (sperm capacitation; sperm-zona binding;zona penetration). Additional experiments are needed to reveala specific function and mechanism for this molecule.     

Immunohistochemical and ultrastructural evidence that dendritic cells infiltrate stenotic aortocoronary saphenous vein bypass grafts

We earlier speculated that antigen-presenting dendritic cells may be involved in the immune reactions leading to saphenous vein bypass graft failure. The purpose of this study was to confirm whether dendritic cells are present in stenotic human saphenous vein bypass grafts. Segments of stenotic saphenous vein grafts were explanted from 14 patients at re-do bypass operation and ten normal saphenous veins were harvested during femoro-popliteal grafting. Sections of specimens were analysed using cell type specific antibodies to identify dendritic cells (CD1a, S-100), T-lymphocytes (CD3), macrophages (CD68), smooth muscle cells (alpha-SMA) and endothelial cells (FVIII). Dual immunostaining, confocal immunofluorescent laser scanning microscopy and electron microscopy were used. Stenotic grafts showed structural alterations of intimal hyperplasia and varying degrees of atherosclerotic degeneration. No cells expressing CD1a and S-100 were observed in the intima and media of normal saphenous veins. Cells expressing these antigens were present around areas of medial neovascularization and within intimal atherosclerotic lesions in saphenous vein bypass grafts. Electron microscopy demonstrated the presence of cells containing a well-developed tubulovesicular system which is unique to cells from the dendritic cell family. Double immunohistochemistry and confocal immunofluorescent microscopy revealed the co-localization of T-lymphocytes with dendritic cells. Dendritic cells are present in stenotic saphenous vein bypass grafts. Dendritic cells may be responsible for antigen presentation and modulation of immune reactions in accelerated graft atherosclerosis through their interaction with T-lymphocytes.     

Expression of apoptosis-related proteins and structural features of cell death in explanted aortocoronary saphenous vein bypass grafts.

This study aimed to investigate the features of cell death occurring in aortocoronary saphenous vein bypass grafts. Human aortocoronary saphenous vein bypass grafts with angiographic luminal stenosis of > 75% were explanted from 14 patients at redo coronary artery bypass grafting. Proteins associated with apoptotic pathways were identified immunohistochemically using antibodies to Bcl-2, Fas, BAX, p53 and CPP32. Cells undergoing DNA fragmentation were identified by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). DNA synthesis was investigated using the antibody to proliferating cell nuclear antigen (PCNA). Ultrastructural features of cell death were examined by electron microscopy. Anti-apoptotic (Bcl-2) and pro-apoptotic (Bax, p53, CPP32 and Fas) proteins were expressed throughout the graft wall, but marked differences in the characteristics of cell death were noted between atherosclerotic and non-atherosclerotic areas of the intima. In atherosclerotic areas, pro-apoptotic proteins were widely expressed, but ultrastructural analysis failed to identify cells showing typical features of apoptosis. In these areas, necrotic cells were frequently observed, with negative correlation of Bcl-2 expression with TUNEL. Pro-apoptotic proteins showed no correlation with TUNEL. In contrast, in non-atherosclerotic areas of vein grafts, the expression of both anti-apoptotic (Bcl-2) and pro-apoptotic proteins (p53, Bax and CPP32) correlated with TUNEL. In atherosclerotic areas, non-atherosclerotic intimal areas, and in the underlying media, the numbers of TUNEL+ cells correlated with PCNA positivity. Ultrastructurally, apoptotic bodies and features of necrosis were observed in non-atherosclerotic areas of grafts. The present observations indicate that in atherosclerotic areas, cell death occurs mainly by necrosis, while in non-atherosclerotic areas, cell death occurs by both necrosis and apoptosis. An imbalance between DNA fragmentation and DNA synthesis may contribute to graft instability and failure.     

Laparoscopic liver resection： western versus eastern experience

Hepatocellular carcinoma （HCC） is the most common primary liver tumor. It is the seventh world＇s most common cancer and rank second of all cancer deaths （I）. It incurs a global health burden, with 782,451 new cases diagnosed worldwide in the year 2012 and a morality of 745,517： a high incidence to morality ratio of 1.05. Majority of patients resides in the developing world and often presented late resulting in poor prognosis. Early detection is thus crucial for capturing early disease whereby curative resection can offer the best survival outcome （2）.