Thyroid storm induced by strangulation

Thyroid storm most often occurs in patients with known thyrotoxicosis. This report discusses a severe case of thyroid storm developing as a direct result of strangulation in a patient without a preexisting history of thyroid disease. Classification and treatment of this entity are discussed.     

Spinal myoclonus with giant somatosensory evoked potentials and enhanced long-loop reflex: a case report

We describe a patient with an ischaemic lesion of the cervical spinal cord who presented with clinical evidence of stimulus-sensitive, multisegmental myoclonic jerks restricted to the truncal and proximal limb muscles and accompanied by electrophysiological features (giant somatosensory evoked potentials and enhanced long-loop reflex) of cortical myoclonus. We hypothesize that these features might result from a loss of inhibitory influences on the sensory input to cortical structures: a concomitant contribution of spinal and cortical hyperexcitability seems to have played a crucial role in inducing myoclonus in our patient.     

The histamine H3 receptor as a novel therapeutic target for cognitive and sleep disorders

Histamine H3 receptor pharmacology, functions and biochemistry are far from being fully understood; however, progress is being made. Activation of this Gi/GO-protein-coupled receptor affects cognition, the sleep-wake cycle, obesity and epilepsy, which are physiological and pathological conditions that are the main focus of research into the therapeutic potential of selective H3 receptor ligands. This heterogeneity of targets can be reconciled partially by the fact that the histamine system constitutes one of the most important brain-activating systems and that H3 receptors regulate the activity of histamine and other neurotransmitter systems. Furthermore, the H3 receptor shows functional constitutive activity, polymorphisms in humans and rodents with a differential distribution of splice variants in the CNS, and potential coupling to different intracellular signal transduction mechanisms. In light of the genetic, pharmacological and functional complexity of the H3 receptor, the importance of the histamine system as a therapeutic target to control the sleep-wake cycle and cognitive disorders will be discussed.     

Posterior ischemic optic neuropathy related to profound shock after penetrating thoracoabdominal trauma

Ischemic optic neuropathy is a rare cause of blindness reported most commonly in association with collagen-vascular diseases, infectious processes, and systemic hypotension related to massive exsanguinating hemorrhage. We report what we believe to be the first case of posterior ischemic optic neuropathy due to perioperative hypotension in a patient who had a penetrating thoracoabdominal injury with massive hemorrhage, severe hypotension, massive microcapillary circulatory leak, multiple system organ failure, and acute respiratory distress syndrome. Although the incidence of postoperative visual loss is low (-0.002%), awareness of this entity must be raised within the trauma surgical community.     

Identification of a novel DNase I hypersensitive site within the far upstream region of the human HLA-DRA gene

The class II products of the major histocompatibility complex have a distribution restricted to certain tissues and cells. For instance, they are constitutively expressed by B lymphocytes, but not by resting T lymphocytes. In this study, we report the identification of a novel DNase I hypersensitive site within a putative regulatory region of the human HLA-DRA gene, the so-called far upstream region. This hypersensitive site was present in the genome of the DRalpha-positive human B-lymphoid Raji cell line, and absent in the DRalpha-negative T-lymphoid Jurkat cell line. In addition, this hypersensitive site was also present in transgenic B lymphocytes isolated from the murine transgenic line TG 53, carrying a single integrated copy of the human HLA-DRA gene per haploid genome. The correlation between DRA expression and the presence of this far upstream hypersensitive site suggests novel long distance chromatin remodeling mechanisms possibly shared by human and murine class II genes.     

Common conditions of the achilles tendon

The Achilles tendon, the largest tendon in the body, is vulnerable to injury because of its limited blood supply and the combination of forces to which it is subjected. Aging and increased activity (particularly velocity sports) increase the chance of injury to the Achilles tendon. Although conditions of the Achilles tendon are occurring with increasing frequency because the aging U.S. population is remaining active, the diagnosis is missed in about one fourth of cases. Injury onset can be gradual or sudden, and the course of healing is often lengthy. A thorough history and specific physical examination are essential to make the appropriate diagnosis and facilitate a specific treatment plan. The mainstay of treatment for tendonitis, peritendonitis, tendinosis, and retrocalcaneobursitis is ice, rest, and nonsteroidal anti-inflammatory drugs, but physical therapy, orthoties, and surgery may be necessary in recalcitrant cases. In patients with tendon rupture, casting or surgery is required. Appropriate treatment often leads to full recovery.