IgM antibody-related polyneuropathies: B-cell depletion chemotherapy using Rituximab.

Current treatments for anti-GM1 ganglioside or antimyelin-associated glycoprotein (anti-MAG) antibody-associated polyneuropathies are toxic or very costly. In this preliminary study the authors treated five patients with neuropathy and immunoglobulin M antibodies to GM1 ganglioside or MAG by depleting B cells using Rituximab--a monoclonal antibody directed against the B-cell surface membrane marker CD20. Within 3 to 6 months after treatment, all five patients had improved function, significantly increased quantitative strength measurements, and reduced titers of serum autoantibodies.     

Abnormal intestinal permeability to sugars in diabetes mellitus

Summary A test of intestinal mucosal function which utilizes the differential permeability of L-rhamnose and lactulose has been reported to be helpful in the diagnosis of gluten-sensitive enteropathy. We have applied this test to 48 male subjects with diabetes mellitus to evaluate its usefulness as a screening test in diabetic patients and to further study sugar absorption in these individuals. Total urinary lactulose excretion in the 13 healthy control subjects was 54.5 ± 8.5 mg/5 h, while excretion by diabetic patients was increased at 116.1 ± 15.7 mg/5 h (p < 0.01). Similarly, total L-rhamnose excretion by diabetic patients was significantly higher (139.7 ± 14.3 mg/5 h vs 84.3 ± 18.4 mg/5 h, p<0.05). The ratio of percent urinary excretion for lactulose/L-rhamnose (L/R ratio) for diabetic patients (0.197 ± 0.024) was not different from the control subjects (0.151 ± 0.2). Nine out of 48 diabetic patients studied had lactulose/L-rhamnose ratios higher than the mean plus two standard deviations of the control group, which might lead to the diagnosis of small bowel mucosal disease. Although we may have been detecting subclinical mucosal disease or gluten sensitive enteropathy in a subgroup, it appears that this test of intestinal mucosal function should be interpreted with caution in diabetic patients.     

The Quality Initiative in Rectal Cancer (QIRC) trial: study protocol of a cluster randomized controlled trial in surgery

Background  

Two unfortunate outcomes for patients treated surgically for rectal cancer are placement of a permanent colostomy and local tumor recurrence. Total mesorectal excision is a new technique for rectal cancer surgery that can lead to improved patient outcomes. We describe a cluster randomized controlled trial that is testing if the above patient outcomes can be improved through a knowledge translation strategy called the Quality Initiative in Rectal Cancer (QIRC) strategy. The strategy is designed to optimize the use of total mesorectal excision techniques.     

Nor-binaltorphimine decreases deprivation and opioid-induced feeding

We evaluated the effect of the kappa antagonist, nor-binaltorphimine (nor-BNI) on deprivation and opioid-induced feeding in rats. Intracerebroventricular administration of nor-BNI (100 nmol) decreased deprivation-induced feeding for as long as 24 h, albeit in a fairly weak manner (maximum decrease of approximately 28%). Nor-BNI (1, 10 and 100 nmol) decreased feeding induced by the kappa ligand U-50,488H by as much as 85% during the first hour of the study. This kappa antagonist also decreased feeding induced by the delta agonist DSLET and the mu agonist DAMGO. Based on previous studies indicating that nor-BNI is a selective kappa antagonist, we conclude that not only U-50,488H (kappa), but also DSLET (delta) and DAMGO (mu)-induced feeding are dependent upon an active kappa receptor.     

Leg ulcers: differential diagnosis in the elderly

Leg ulcers are a common problem encountered in the elderly. Because their origins are often multifactorial, it is essential for the primary care physician to have a sound knowledge of differential diagnosis to institute proper treatment. This review discusses salient historical points as well as bedside physical examination techniques useful in patients presenting with leg ulcer. Also discussed are pathophysiology of most common types of ulcer, including venous disease, arterial disease, diabetes, and physical agents. Less common causes of leg ulcer are also reviewed.     

Peduncular hallucinosis associated with isolated infarction of the substantia nigra pars reticulata

We report the clinicopathological study of an 83-year-old man who abruptly developed complex visual hallucinations, disordered sleep, and mild cognitive impairment that persisted until his death 6 months later. Postmortem neuropathological examination including serial sections through the diencephalon, midbrain, and pons disclosed isolated bilateral infarcts confined to the medial substantia nigra pars reticulata. The findings suggest that destruction of the pars reticulata may be the essential feature to the development of peduncular hallucinosis.