Chronic paroxysmal hemicrania-tic syndrome

We report the coexistence of both chronic paroxysmal hemicrania (CPH) and trigeminal neuralgia (tic douloureux) in a female patient. The clinical features combined to make a configuration of CPH-tic syndrome. The two components of the syndrome appeared synchronously in the same orbital region—first branch of the trigeminal nerve—with a latency of several years after the onset of isolated tic attacks of the second and third trigeminal divisions. The concurrence of both types of pain in the same symptomatic area may have some significance for pathogenic, clinical, and pharmacological aspects of such a syndrome. We discuss all these and postulate a provisional distinction between CPH-V_2,3 tic and CPH-V₁ tic.     

Sonographic characteristics of small cerebral blood vessels. An in vivo and postmortem study

The ultrasound appearance of small cerebral blood vessels was investigated with in vivo and postmortem sonography. Linear echoes corresponding in distribution to small branches of major cerebral blood vessels, particularly deep medullary veins, were seen during cranial sonography of living neonates, neonatal postmortem brains, and adult postmortem brains following intravascular injection of a barium sulfate-gelatin suspension. Ease of visualization of the echoes was angle dependent, a phenomenon termed anisotropy. When imaged in cross-section, these reflectors appeared as tiny, closely spaced dots, demonstrating their tubular nature. Additionally, the barium-injected adult postmortem specimens were studied by computed tomography and plain-film radiography, enabling correlation between radiography and sonography. This study demonstrates that small branches of the major intracranial blood vessels can be imaged as linear echoes and closely spaced dots by high-resolution sonography. It is important to recognize the vascular origin of these echoes to avoid the pitfall of misinterpreting them as originating from pathologic processes such as periventricular leukomalacia.     

NGF and TGF‐β mRNA expression during pregnancy in a rat corneal wound healing model

Background: Growth factors seem to play a major role in corneal wound healing and TGF‐β seems to be associated with abnormal healing after corneal surgical procedures. Few studies have analysed the role of NGF and TGF‐β on corneal wound healing during pregnancy. The aim of the present study was to create an animal model to evaluate the expression of NGF and TGF‐βs during corneal wound healing in two groups: control and pregnant rats. Methods: Corneal mRNA for NGF and the three isoforms of TGF‐β were analysed by RT‐PCR, in a time‐course experiment on different days after epithelial wounding (2, 7, 14 days) in pregnant and control groups Results: The results show high corneal mRNA expression for NGF and TGF‐β1 without any variation throughout the healing process or pregnancy evolution. However, we detected a different expression of corneal mRNAs for TGF‐β2 and TGF‐β3 in the control group. This data was not detected in the pregnant group. Discussion: Our results suggested that pregnancy could have a relevant role on TGF‐β2 and TGF‐β3 mRNA expression during the corneal wound healing process. Additional research should be performed to corroborate these findings.     

Pemphigus in Families

A family in which two sisters are affected by pemphigus is described. Literature research has revealed the presence of 25 families, comprising 53 patients, in which pemphigus existed in more than one member. The relationships between those affected were mainly parent-child or sibling-sibling. Pemphigus was found to be associated with specific HLA antigens: A26, Bw38, DRw4, and additionally occurred with a higher frequency in certain ethnic groups. The variety of etiologic factors in the pathogenesis of pemphigus is discussed and the significance of a genetic role elucidated.     

Assessment of myocardial perfusion during CABG surgery with two-dimensional transesophageal contrast echocardiography

No reliable, quantifiable index of tissue perfusion is currently available to assess the efforts of coronary artery bypass graft (CABG) surgery. We used two-dimensional transesophageal contrast echocardiography with sonicated Renografin-76 microbubbles to determine the distribution of myocardial blood flow during coronary artery bypass graft surgery in 15 patients. Sonicated Renografin-76 contrast agent was injected into the aortic root of all patients after institution of cardiopulmonary bypass and application of the aortic occlusive clamp. Eight patients had contrast agent injected directly into the free proximal end of the vein-CABG anastomosis. All patients again received aortic root injections during reperfusion after anastomosis of the proximal aortovein and distal coronary artery. Echocardiographic images of the left ventricle short axis at the level of the papillary muscles were obtained in real time and analyzed retrospectively from videotape. Injection of contrast provided information about the magnitude and geometric distribution of coronary artery-vein bypass run-off and enabled identification of poorly perfused myocardial regions. When predicted myocardial perfusion patterns, based on preoperative evaluation of epicardial vessel distribution derived from coronary angiography, were compared to actual perfusion patterns assessed with intraoperative echocardiography, contrast regional myocardial perfusion patterns were predicted 84% of the time (71-97%, 95% confidence limit). Regional myocardial perfusion deficits detected after coronary bypass grafting were associated with regional wall motion abnormalities detected after separation from cardiopulmonary bypass. Our technique makes possible on-line visualization of changes in regional blood flow in the heart before, during, and after CABG.(ABSTRACT TRUNCATED AT 250 WORDS)