Conjunctival Biopsy as an Aid in the Evaluation of the Patient with Suspected Sarcoidosis

Conjunctival biopsy is an underused but simple technique in the evaluation of the patient with sarcoidosis and occasionally other systemic diseases. In 55% of patients with biopsy-proven sarcoidosis from other sites, a blind conjunctival biopsy was positive. Bilateral conjunctival biopsies and the examination of multiple sections of each biopsy were essential to obtain this high of a yield. There was no relationship between an anterior uveitis and a positive conjunctival biopsy.     

Nitroprusside-induced cyanide poisoning: antidotal effect of hydroxocobalamin.

Sodium nitroprusside was investigated as a potential source of cyanide poisoning, Whole-blood cyanide determinations were performed on arterial samples from baboons receiving nitroprusside while anesthetized. There was a statistically significant increase in cyanide levels, as well as development of tachyphylaxis and severe metabolic acidosis. Hydroxocobalamin (vitamin B12a) infused simultaneously with nitroprusside significantly lessened the increase in cyanide levels and eliminated the development of metabolic acidosis. Nitroprusside can cause cyanide intoxication in the baboon, and hydroxocobalamin appears to be an effective antidote.     

Molecular prognosticators and genomic instability in papillary thyroid cancer

OBJECTIVES/HYPOTHESIS: Tumor progression has been attributed to the accumulation of DNA damage concurrent with selection of advantageous mutations; this DNA damage may result from failure to maintain genomic integrity or from susceptibility to carcinogens. Glutathione S-transferases (GSTs), enzymes that metabolize many carcinogens, may play a role in preserving genome integrity. The objectives of this study are to assess the relationship of GST genotypes with prognosis, clinicopathologic parameters, and genomic instability in papillary thyroid cancer. STUDY DESIGN: Prospective analysis. METHODS: GSTM1 and GSTT1 genotypes of 35 matched normal and papillary thyroid cancer specimens were determined by polymerase chain reaction (PCR) using primers specific for the coding sequences of each gene. Genomic instability was measured by intersimple sequence repeat PCR for each tumor/normal pair and compared with the GAMES prognostic scoring system and clinicopathologic parameters including age, extrathyroidal extension, tumor grade, size, stage metastasis, sex, and smoking history. RESULTS: GSTM1 and GSTT1 null genotypes were found in the normal tissues of 46% and 45%, respectively. No gene losses were detected in the tumor specimens. A significant association between the GSTM1 null genotype and increased risk of recurrence and death was observed. Elevated GII correlated with smoking and tumor stage but not with GST genotype. CONCLUSION: The association of GSTM1 null genotype with intermediate and high risk GAMES categories suggests that GSTM1 provides some protection against disease progression. However, this protection does not confer resistance to disease onset. GST genotyping may be a useful adjunct prognosticator with GAMES.     

Plasticity and reorganization of the uninjured brain

Brain capacity is dependent not so much on the number of neurons but on the number of synaptic connections with functional connections that develop over a lifetime of genetic programming and life experiences. In the uninjured human brain, cortical reorganization that occurs in response to learning and experience is referred to as brain plasticity. Motor learning and complex environments result in a greater number of synapses and an increase in dendritic branching, whereas repetitive movements alone, in the absence of motor learning, do not. Learning and experience lead to an expansion of cortical representation, while failure to maintain training results in a contraction of cortical representation. In animals, loss of sensory peripheral afferent input results in an expansion of the forelimb representation of the intact adjacent cortex. Prolonged periods of peripheral nerve stimulation in both animals and humans can lead to reorganization of related sensorimotor cortical maps.     

The use of mid-level providers in dermatology: a liability risk?

The use of mid-level providers, nurse practitioners, and physician assistants is growing in the practice of dermatology, fueled by a perceived shortage of dermatologists and the promise of practice enhancement. Exactly how the physician extender is used in the dermatology practice can either increase or decrease the risk of malpractice liability and ultimately may be a factor in whether the dermatologist prevails in a malpractice case. Although dermatologists can delegate care to physician extenders, they cannot delegate the liability risk. It is up to the dermatologist to embrace those principles and practices that enhance patient care, decrease medical errors, and improve physician/practice patient relationships to ultimately decrease the risk of malpractice liability.     

Auditory P3 indexes personality traits and cognitive function in healthy men and women

The relationship of the auditory P3 event-related potential to major personality dimensions and neuropsychological performance was examined in psychiatrically healthy men and women (28 male, 15 female) recruited from the community. An auditory oddball paradigm was used to collect P3 amplitude and latency data. Personality traits were measured with the NEO Five-Factor Inventory. Several Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtests, the Digit Symbol Test, and the Trail Making Test comprised the neuropsychological tests. A multivariate statistical procedure (Partial Least Squares) was used to quantify the relationships between P3 variables and personality and neuropsychological performance variables. P3 amplitude was negatively related to Neuroticism and positively related to Extraversion, Openness, Agreeableness and Conscientiousness. Better neuropsychological performance was associated with greater P3 amplitude and earlier latency. Thus, greater P3 amplitude was associated with less deviant personality scores and better neuropsychological performance in healthy subjects. Earlier P3 latency was also associated with better neuropsychological performance. The physiological significance of these relationships is not yet clear, but these results suggest that neural assemblies indexed by P3 may subserve both elemental cognition and healthy personality function.