LUPOID HEPATITIS: COMPUTER ANALYSIS DEFINING “HEPATITIS” AND “CIRRHOSIS” PHASES AND RELATIONSHIPS BETWEEN HEPATOCELLULAR DAMAGE AND IMMUNE REACTIONS IN THE LIVER

The interrelationships between histopathological, clinical, biochemical, and serological indices in 30 patients with lupoid hepatitis were analysed by a digital computer which was used to calculate 225 correlation coefficients. First, the study defined two groups of significantly interrelated histological indices corresponding to “hepatitis” and “cirrhosis” phases of the disease. The hepatitis phase comprised liver cell necrosis, Kupffer cell hyperplasia and plasma cell accumulation, and the cirrhosis phase comprised loss of architecture, fibrosis, bile duct proliferation, and lymphocyte and plasma cell accumulation. Secondly, the study defined significant interrelationships in the hepatitis phase between hepatocellular damage and an immune reaction as shown by plasma cell accumulation in the liver, gamma globulin increase in the serum and lupus erythematosus (LE) cell positivity. The immune reaction is, in part at least, to antigens of damaged liver cells; it may be entirely a consequence of damage from a primary process, such as a virus infection, or it may be an autoimmune cause of continuing cell injury. The analysis did not discriminate between these two possibilities.     

Drug Management of Fetal Tachyarrhythmias: Are We Ready for a Systematic and Evidence-Based Approach?

Fetal tachyarrhythmias are a life-threatening condition complicating a small proportion of normal pregnancies. Despite major advances in the (intrauterine) pharmacologic treatment of these arrhythmias over the last years major uncertainties remain. Among these are controversies in the choice of agents in relation to arrhythmia type, and timing and duration of treatment. Currently, no evidence-based approach to the management of fetal tachyarrhythmias is available. An international registry is proposed as an important step toward obtaining the necessary data to develop evidence-based management strategies.     

Long‐term follow up of root canal treated primary molars

International Journal of Paediatric Dentistry 2010; 20: 207–213 Background. Root canal treatment (RCT) is commonly performed to preserve primary molars with an infected or necrotic pulp. Aim. This study evaluates the long‐term effects of RCT in primary molars on the development and eruption of their permanent successors. Methods. This is a retrospective study of treatment of pulpectomised primary molars in a public dental clinic. All teeth were treated by the same operator using the same material (Endoflas F.S.) and the same method. Records of 194 patients with 242 pulpectomised primary molars (124 in 97 boys and 118 in 97 girls) met the inclusion criteria. The children’s age at the time of treatment ranged from 5 to 11 years (mean 6.72). Follow‐up time ranged from 6 to 113 months (mean 33.5). Results. Eight (3.3%) of the 242 primary molars presented a new radiolucent defect or enlargement of existing periapical radiolucency. Of the 106 molars followed until eruption of the permanent successor, none had radiographic pathological signs. Of 17 permanent teeth evaluated clinically, three were erupted into a rotated alignment, and one premolar presented hypocalcified defect in the enamel. Conclusions. Failure of root canal treatment in primary molars may be evident from development of new radiolucent defects or enlargement of existing defects. No relationship was found between RCT in the primary molars and the appearance of enamel defects or the ectopic eruption of following permanent teeth.     

Evolution of Action Potential Propagation and Repolarization in Cultured Neonatal Rat Ventricular Myocytes

INTRODUCTION: Cultured neonatal rat ventricular myocytes (NRVM) reestablish gap junctions as they form synchronously and spontaneously beating monolayers, thus providing a useful model for studying activation and repolarization. METHODS AND RESULTS: We used the multielectrode array data acquisition system with 60 unipolar electrodes to investigate the functional organization of cultured NRVM, by determining propagation and repolarization patterns. Activation maps were constructed from the local activation times at each electrode. During days 3 to 8 in culture, QRS amplitude and dV/dt(max) increased with age. Concomitantly, with the culture maturation, QT interval (representing action potential duration) decreased, and T wave amplitude and slopes of the T wave ascending and descending limbs progressively increased. The changes in conduction velocity were different than those of the electrogram properties, slightly increasing during the first 3 to 5 days and gradually declining toward day 8 in culture. CONCLUSION: Establishment of uniform activation patterns in spontaneously firing or driven myocytes in monolayer cultures is accompanied by organization of activation and repolarization whose evolution appears in concert with that of a mature connexin43 staining pattern. The experimental techniques developed in this study provide useful tools to investigate the complex relations among gap junctions, conduction velocity, and propagation patterns, as well as a means to learn how gap junctional remodeling under pathophysiologic conditions predisposes the myocardium to arrhythmias.     

Periocular Squamous Cell Carcinoma

BACKGROUND We present a case report of periocular squamous cell carcinoma and a review of the literature with emphasis on early diagnosis, proper follow-up and management, reconstructive options, and new immunomodulatory therapies.
OBJECTIVE The objective is to guide the dermatologist and the dermatologic surgeon in proper management and continued care of patients with periocular squamous cell carcinoma in light of its propensity for perineural involvement and regional lymphatic metastases.
MATERIALS AND METHODS A MEDLINE, Ovid, and PubMed search was conducted for recent relevant articles pertaining to "periocular,""periorbital,""squamous cell" carcinoma, and their "surgery""treatment" modalities.
CONCLUSIONS Periocular squamous cell carcinoma is an aggressive tumor, characterized by perineural involvement and an overall rate of regional lymph node metastases reported to range from 10% to as high as 20% to 25%. Increased vigilance must be undertaken when treating these high-risk tumors. Mohs micrographic surgery or excision with frozen section analysis is the standard of care for periocular squamous cell carcinoma. Multiple options exist for the reconstruction of the postoperative defect that allow for excellent function and cosmesis. Finally, research into new immunomodulators will hopefully lead to an increased understanding of the aggressive nature of periocular squamous cell carcinoma and potential aid in the treatment of the tumor.     

THE THYMUS: EXPERIMENTAL PHYSIOLOGY,AND PATHOLOGY IN MAN

The thymus is an integral part of the immunological system. It is a site of intense lymphopoiesis, especially in early life. Neonatal thymectomy in mice causes runting and death due to gross immunological deficiencies. These deficiencies are determined by lymphopenia, and by lack of a lymphotrophic hormone secreted by the epithelial cells of the medulla; this hormone confers on lymphocytes the capacity to respond to antigenic stimulation. The thymus may be the main source of lymphoid cells carrying new or primary patterns of immune reactivity; it is thus “first-level” or “central” lymphoid tissue, which seeds cells to “second-level” or “peripheral” lymphoid tissues in the lymph nodes and spleen. Pathological lesions of the thymus in man include aplasia, hyperplasia, dysplasia and neoplasia. Gross aplasia characterizes the immunological deficiency diseases of infancy, including the lymphopenic type of congenital agammaglobulinæmia. Hyperplasia accompanies thyrotoxicosis. Dysplasia refers to the lymph follicle-germinal centre development in myasthenia gravis, probably an autoimmune disease, and to the proliferation in the medulla of spindle-epithelial cells in lupus erythematosus, an autoimmune disease. Neoplasia occurs as benign thymoma, which may be accompanied by extrathymic diseases which are possibly autoimmune in origin; these include myasthenia gravis, red cell aplasia, polymyositis, agammaglobulinæmia and lupus erythematosus. These diseases may in some way be caused by the thymoma; alternatively, the thymoma may represent the result of continuing hyperplasia of the thymus provoked by a primary autoimmune process. The place of thymectomy in the treatment of autoimmune disease is discussed. It is an established procedure in myasthenia gravis, and has been successful in two cases of autoimmune hæmolytic anæmia in infancy. We review our experience with thymectomy for three patients with systemic lupus erythematosus.     

A Prospective study of septic complications of endoscopic retrograde cholangiopancreatography

Abstract Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinical sepsis following the procedure and third, to evaluate the effectiveness of our antibiotic prophylaxis.
One hundred and fifty successive patients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemias were more likely to complicate therapeutic procedures ( P = 0.015), biliary obstruction ( P = 0.045) or underlying pathology ( P = 0.022).
Although 61% of ERCP received antibiotics, 22 septic events occurred. Five bacteraemic patients were septic despite antibiotics. Septic complications were associated with the same factors as bacteraemia.
It was concluded that patients with biliary obstruction and undergoing therapeutic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.     

Purification and mass spectrometry-based sequencing of yellow mustard (Sinapis alba L.) 6 kDa proteins Identification as antifungal proteins

Three basic proteins, M1, M2A and M2B, that are substrates for plant Ca²⁺ -dependent protein kinase (CDPK) were purified from seeds of yellow mustard (Sinapis alba L.) by a protocol involving batchwise chromatography on carboxymethylcellulose (CM52), cation-exchange HPLC on an SP5PW column and reversed-phase HPLC on a C18 column. The complete amino-acid sequences of these proteins have been determined employing Edman sequencing and electrospray ionization mass spectrometry (ESMS) applied to the proteins and their tryptic and chymotryptic fragments. M1 (observed mass 5676.8 ± 1.0 Da; calculated mass 5677.57 Da), M2A (observed mass 5704.8 ± 0.8 Da; calculated mass 5704.60 Da) and M2B (observed mass 5839.5 ± 1.2 Da; calculated mass 5838.78 Da) have been identified as γ-thionins, which are potent antifungal proteins. M1, M2A and M2B are phosphorylated by plant CDPK on Ser residues, the site of phosphorylation on M2A being S⁸ as directly confirmed by Edman sequencing and mass spectrometry of the chymotryptically generated phosphopeptide CQRPS(HPO₃)GTW¹¹. M1 and M2A have apparent calmodulin (CaM) antagonist activity with IC₅₀ values of 4.8 ± 1.3 μM and 5.5 ± 1.5 μM, respectively, for inhibition of CaM-dependent myosin light chain kinase (MLCK). M2A and/or M2B interacts with dansyl-CaM in both the presence and absence of calcium. © Munksgaard 1996.