Dual origin extracranial vertebral artery: case report and embryology.

Duplication of the vertebral artery origin is a rare vascular anomaly. The authors describe this finding in a patient who underwent neurointerventional treatment for a midbasilar aneurysm. The embryology and clinical significance is also presented.     

Evolution of temporal lobe hypoperfusion in transient global amnesia: a serial single photon emission computed tomography study.

Previous functional neuroimaging studies performed during transient global amnesia (TGA) have not answered the central question regarding the etiology of TGA, namely: whether the observed hypoperfusion in the mesial temporal lobe structures reflects a primarily ischemic process or whether it represents a secondary phenomenon resulting from locally decreased metabolism. The authors performed Tc 99-m-bicisate brain single photon-emission computed tomography (SPECT) scanning in a 66-year-old man during an episode of TGA, 24 hours after the episode and 3 months after the episode. To the authors' knowledge, this is the only reported study in which a follow-up SPECT scan was performed within 24 hours. The initial study showed bilateral mesial temporal lobe hypoperfusion that partially resolved after 24 hours and returned to normal at 3 months. Resolution of the SPECT scan abnormalities correlated well with resolution of the memory loss. These findings agree with previously reported SPECT, positron-emission tomography (PET), and diffusion magnetic resonance imaging (MRI) studies that indicate the mesial temporal lobe structures as the major site of pathology in TGA. The authors suggest that a process causing decreased local metabolism, such as cortical spreading depression, constitutes the primary pathophysiologic mechanism in this case.     

Snake bites by the jararacucu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in Sao Paulo State, Brazil

The jararacucu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in Sao Paulo State, Brazil. We examined 29 cases of proven jararacucu bites recruited over a 20-year period in two Sao Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care- unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.      

Inducible nitric oxide synthase (iNOS) expression in monocytes during acute Dengue Fever in patients and during in vitro infection

 

Mononuclear phagocytes are considered to be main targets for Dengue Virus (DENV) replication. These cells are activated after infection, producing proinflammatory mediators, including tumour-necrosis factor-α, which has also been detected in vivo. Nitric oxide (NO), usually produced by activated mononuclear phagocytes, has antimicrobial and antiviral activities.

Methods

The expression of DENV antigens and inducible nitric oxide synthase (iNOS) in human blood isolated monocytes were analysed by flow cytometry using cells either from patients with acute Dengue Fever or after DENV-1 in vitro infection. DENV-1 susceptibility to iNOS inhibition and NO production was investigated using N^G-methyl L-Arginine (N^GMLA) as an iNOS inhibitor, which was added to DENV-1 infected human monocytes, and sodium nitroprussiate (SNP), a NO donor, added to infected C6/36 mosquito cell clone. Viral antigens after treatments were detected by flow cytometry analysis.

Results

INOS expression in activated monocytes was observed in 10 out of 21 patients with Dengue Fever and was absent in cells from ten healthy individuals. DENV antigens detected in 25 out of 35 patients, were observed early during in vitro infection (3 days), significantly diminished with time, indicating that virus replicated, however monocytes controlled the infection. On the other hand, the iNOS expression was detected at increasing frequency in in vitro infected monocytes from three to six days, exhibiting an inverse relationship to DENV antigen expression. We demonstrated that the detection of the DENV-1 antigen was enhanced during monocyte treatment with N^GMLA. In the mosquito cell line C6/36, virus detection was significantly reduced in the presence of SNP, when compared to that of untreated cells.

Conclusion

This study is the first to reveal the activation of DENV infected monocytes based on induction of iNOS both in vivo and in vitro, as well as the susceptibility of DENV-1 to a NO production.     

云南恶性疟原虫氯喹抗药性基因76位点突变研究

目的研究云南恶性疟原虫氯喹抗药性基因（pfcrt）76位点突变的情况,以及与抗药性表现型的关系. 方法应用PCR和限制性酶切片段长度分析方法,检测现症病人干滤纸血样的恶性疟原虫pfcrt基因点突变. 结果 云南省恶性疟原虫pfcrt基因76位点的突变型很高,占85.0%（51/60）;野生型和混合型较少,分别占8.3%（5/60）和6.7%（4/60）.体内法测定的氯喹抗性和敏感样本均有pfcrt76突变型;体外法测定的17份氯喹抗性样本中,有13份带有pfcrt76突变型. 结论 云南省恶性疟原虫pfcrt基因氨基酸编码76位点突变频度很高.体内和体外法测定的氯喹抗性表现与pfcrt76突变型有较高的一致性.     

A colony assay for in vitro transformation by human T cell leukemia viruses type I and type II

We report here the development of a rapid and quantitative method for measuring in vitro T cell transformation by human T cell leukemia viruses type I (HTLV-I) and type II (HTLV-II). This method is based on our finding that cocultivation of lethally irradiated HTLV-producing cells with peripheral blood lymphocytes (PBLs) preactivated for 24 hours with phytohemagglutinin and interleukin-2 (IL-2) induces colony formation in methylcellulose-containing medium. Colonies of about 200 cells can be clearly distinguished from background aggregates within four to six days after cocultivation. These colonies gradually increase in size and reach 300 to 1,000 cells within 14 days after cocultivation. Cells of these colonies were infected, as evidenced by expression of viral p19 antigen and the presence of HTLV proviral sequences. These cells proved to be transformed in terms of IL-2- independent continuous growth in liquid medium. Colony formation was found to depend in a linear fashion upon the percentage of the infected cells present in the irradiated cell population and is sufficiently sensitive to detect as few as 1% of virus-producing cells.     

Successful direct thrombin injection of a femoral artery pseudoaneurysm in an anticoagulated patient with a mechanical mitral valve

Femoral pseudoaneurysm is a complication of cardiac catheterization and may be related to the use of anticoagulants, antiplatelet agents, larger diameter sheaths and prolonged duration of sheath insertion. The treatment ranges from direct compression with or without direct thrombin injection to surgical repair. The present report describes a unique scenario of postcardiac catheterization femoral artery pseudoaneursym in a patient with a pre-existing mechanical mitral valve requiring anticoagulation. The potential systemic effects of thrombin made the patient reluctant to undergo treatment and made thrombin administration a challenging proposition. The present report suggests that thrombin injection for treating femoral pseudoaneursym in patients with mechanical heart valves on chronic anticoagulation can be performed safely.