SDF-1alpha is expressed in astrocytes and neurons in the AIDS dementia complex: an in vivo and in vitro study

Recent in vitro studies suggest that the alpha chemokine stromal-derived factor-1alpha (SDF-1alpha) and its receptor CXCR-4 may contribute to neuronal apoptosis in HIV infection of the brain. The cellular and regional expression of this chemokine and its relationship to the AIDS dementia complex (ADC), however, have remained undetermined. Using immunohistochemistry and semiquantitative RT-PCR, we examined the expression of SDF-1alpha in the frontal cortex (FC), the adjacent deep white matter (DWM). and the basal ganglia (BG) of 17 patients with ADC and 5 normal controls, and the FC and temporal cortex of 6 patients with Alzheimer disease (AD). Additionally, SDF-1alpha expression was studied in 3 different neuronal cultures: differentiated SK-N-MC cells, primary human fetal neuronal, and mouse hippocampal cultures. SDF-1alpha staining was predominantly localized to astrocytes in all 3 groups in the gray matter of the FC and the BG, often in the vicinity of cortical and basal ganglia neurons, but was generally absent in the DWM. Further, the number of positive neurons was significantly greater in the BG of AIDS subjects with advanced brain disease compared to subjects with lesser disease (p = 0.029). All cultures showed prominent SDF-1alpha staining of neurons within the cytoplasm and in neurites, whereas preferential expression in GABA-ergic neurons was found in hippocampal cultures. This is the first study to show that SDF-1alpha is constitutively expressed in astrocytes of the deep and cortical gray matter as well as in neurons of the human brain. Its increased expression in basal ganglia neurons of patients with advanced HIV CNS disease suggests it may also contribute to pathogenesis.     

Cepacia-like syndrome caused by Burkholderia multivorans

The variable severity of Burkholderia cepacia complex infections in cystic fibrosis (CF) has recently been ascribed to differences in the virulence between genomovars. Specifically, genomovar III isolates have been associated with higher transmission rates and adverse outcomes compared to other B cepacia genomovars, and consequently further segregation between genomovar III and non-genomovar III B cepacia infected patients is advocated in some centres. The important role of non-genomovar III isolates is presented in the context of a clinical case whereby a patient with long-standing pulmonary infection with B multiovorans developed bacteremic infection reminiscent of the fatal ''cepacia syndrome''. Key Words: Burkholderia, Cepacia syndrome, Cystic fibrosis, GenomovarBurkholderia cepacia (previously known as Pseudomonas cepacia) complex consists of nine species that, based on molecular differences, are divided into genomovars of which only some have received species names (1,2). B cepacia complex was first reported as a human pathogen in the 1960s, and until the mid-1980s case reports were sporadic and mainly limited to ill, chronically hospitalized patients (3). In 1984, the clinical impact of B cepacia complex in cystic fibrosis (CF) patients was first published (4). As well, nosocomial B cepacia complex outbreaks are being reported with increasing frequency from hemodialysis (HD) units (5). Therapy with aminoglycosides, quinolones, and most Β-lactams is ineffective and in-vitro susceptibilities often don''t correlate with in-vivo activity, complicating successful treatment (6,7). These bacteria can also survive in commonly used antiseptic solutions (8).In CF, acquisition of B cepacia complex results in increased morbidity and mortality (4,9). Consequently, segregating B cepacia complex positive and negative patients has become standard of care (9,10). CF patients with B cepacia complex are frequently categorized into one of three clinical syndromes: 1) infection/colonization without change in pulmonary status, 2) infection with accelerated pulmonary decline and 3) acute pulmonary deterioration with bacteremia, necrotizing pneumonia, leukocytosis, and death within weeks to months. The latter has been named ''cepacia syndrome'' (4). A recent study suggests genomovar III B cepacia is responsible for cepacia syndrome (11).     

Trichotillomania: a review and case report

Although patients with trichotillomania typically present to dermatologists, the diagnosis and treatment lie in the field of psychiatry. We report an unusual case of a 33-year-old woman with severe trichotillomania. We review common clinical and pathologic findings of this often chronic and socially debilitating disorder. In addition, we discuss treatment options for dermatologists and how collaboration with psychiatrists is the most effective management for these difficult-to-treat patients.     

Quality of life assessment in men and women with urinary incontinence

PURPOSE: The literature on assessment of quality of life from 1993 to 2001 was reviewed to evaluate and compare existing measures through their psychometric value and make adequate recommendations on their clinical use and future research. MATERIALS AND METHODS: We selected quality of life articles and abstracts from Current Content 1996 to 1997 and MEDLINE 1993 to 1996 for our first report presented at the first consultation on incontinence in Monaco in 1998. This report was then updated up to September 2001 using the same strategy. We made our recommendations based on our clinical and research experience with these tools. RESULTS: Several quality of life generic or disease specific questionnaires have been published for male and female urinary incontinence. However, their psychometric value is far from uniform and for most of them responsiveness is weak or has never been reported. CONCLUSIONS: Few quality of life questionnaires are at an advanced enough stage of development to be applied in clinical practice. However, even with these questionnaires more study remains to be done to make them shorter, sometimes even more specific and easier to use in different populations.     

Elevated serum parathormone level after "concise parathyroidectomy" for primary sporadic hyperparathyroidism

BACKGROUND: Cure after parathyroid exploration is traditionally assessed by serum calcium concentration 6 months postoperatively. Postoperative normocalcemic elevation of serum parathormone (PTH) level has been described but is of unclear significance. METHODS: In a 6-year prospective study of outcomes in 380 patients undergoing initial parathyroidectomy for primary sporadic hyperparathyroidism, we measured intact serum PTH and calcium levels at more than 5 months. Those with normocalcemic high PTH levels were begun on oral calcium + vitamin supplements and monitored. RESULTS: At more than 5 months postoperatively, normocalcemic elevation in serum PTH level occurred in 28% of patients, was more common after resection of double adenomas (P =.01), and predated the onset of recurrent hypercalcemia in 3 of 3 patients with unrecognized multiglandular disease. Although delayed treatment with calcium and vitamin supplements produced no clear benefit, patients who took such supplements from the date of surgery were much less likely to have an elevated serum PTH level more than 5 months later (P =.0005). CONCLUSIONS: After successful parathyroid surgery, compensatory normocalcemic elevation in serum PTH level is frequent and may arise from dietary deficiency. Monitored supplemental intake of calcium and vitamin D appears to prevent or to normalize the condition in most patients. Patients with normocalcemic elevation in serum PTH level should receive evaluation for dietary deficiencies as well as follow-up for possible residual disease.