Chlamydia pneumoniae infection and its role in asthma and chronic obstructive pulmonary disease.

Chlamydia pneumoniae (CP) is a common cause of respiratory tract infections, and several studies have asked whether it may play a pathogenic role in connection with bronchial asthma and chronic obstructive pulmonary disease (COPD). Evidence that CP infection is associated with these diseases is a cardinal item. However, evaluation of CP infection is hampered by difficulties in obtaining agreement on the definition of a gold standard. In the literature, serology is based on different cutoff points of antibody titres, which complicates the definition of CP seropositive findings and the classification of acute infection, chronic and past infection. In connection with acute and chronic infection, it is important to demonstrate the presence of CP by culture or polymerase chain reaction (PCR) in the respiratory tract, especially in the lower airways. Often, the results of serology is not associated with the findings by culture or PCR testing, which may involve the risk of inconclusive evidence. Evaluation of a possible presence of CP by clinical improvement after treatment with antibiotics is difficult since uncontrolled studies have been used and other microorganisms are also affected by antibiotics. Furthermore, many patients improve without antibiotics, and improvement has also been observed in patients remaining culture positive after treatment with antibiotics. It should also be noted that the antiinflammatory effects of antibiotics may improve the clinical status of patients. Despite these obstacles, studies point to the possibility that in some patients acute CP infections may lead to acute exacerbations of bronchial asthma. Whether a persistent CP infection contributes to chronic asthma or severe COPD, or whether it incites the diseases in previously healthy individuals is a question for further studies. Whether a causal relationship exists between CP infection and obstructive pulmonary disease or whether these patients are more susceptible to CP infection is unknown. Nevertheless, a cooperative role of CP in the proinflammatory mechanisms involved in these diseases remains to be examined since cellular studies show that CP stimulates the production and expression of cytokines, chemokines and adhesion molecules, actions that may amplify and prolong the inflammation.     

Palliation of rectosigmoid neoplasms with Nd:YAG laser treatment

PURPOSE: The aim of this study was to evaluate the effect of Nd:YAG laser treatment as palliation for rectosigmoid neoplasms. METHODS: Indications for laser therapy, the degree and duration of symptom relief, complication rate, and survival time were recorded in consecutive patients. RESULTS: Seventy-four patients entered the study. Poor general health in older patients, and disseminated or complicating disease were the most frequent indications for therapy. Fifty-five (74 percent) patients experienced good symptomatic effect from the treatment. Six complications occurred: five cases of perforation and one case of moderate bleeding. There was no mortality. The median survival was seven months (range, 14 days–39 months). CONCLUSION: Laser treatment is a good palliative method in patients with colorectal cancer, especially in patients with local recurrence or symptoms from nonresected tumors.     

Effects of intracoronary melatonin on ischemia–reperfusion injury in ST-elevation myocardial infarction

Acute coronary occlusion is effectively treated by primary percutaneous coronary intervention. However, myocardial ischemia–reperfusion injury is at the moment an unavoidable consequence of the procedure. Oxidative stress is central in the development of ischemia–reperfusion injury. Melatonin, an endogenous hormone, acts through antioxidant mechanisms and could potentially minimize the myocardial injury. The aim of the experimental study was to examine the cardioprotective effects of melatonin in a porcine closed-chest reperfused infarction model. A total of 20 landrace pigs were randomized to a dosage of 200 mg (0.4 mg/mL) melatonin or placebo (saline). The intervention was administered intracoronary and intravenous. Infarct size, area at risk and microvascular obstruction were determined ex vivo by cardiovascular magnetic resonance imaging. Myocardial salvage index was calculated. The plasma levels of high-sensitive troponin T were assessed repeatedly. The experimenters were blinded with regard to treatment regimen. Melatonin did not significantly increase myocardial salvage index compared with placebo [melatonin 21.8 % (16.1; 24.8) vs. placebo 20.2 % (16.9; 27.0), p = 1.00]. The extent of microvascular obstruction was similar between the groups [melatonin 3.8 % (2.7; 7.1) vs. placebo 3.7 % (1.3; 7.7), p = 0.96]. The area under the curve for high-sensitive troponin T release was insignificantly reduced by 32 % in the melatonin group [AUC melatonin 12,343.9 (6,889.2; 20,147.4) ng h/L vs. AUC placebo 18,285.3 (5,180.4; 23,716.8) ng h/L, p = 0.82]. Combined intracoronary and intravenous treatment with melatonin did not reduce myocardial reperfusion injury. The lack of a positive effect could be due to an ineffective dose of melatonin, a type II error or the timing of administration.     

Arthroscopy of the elbow: Diagnosis and extraction of loose bodies

Arthroscopy of the elbow was performed in 35 cases of suspected loose bodies. Loose bodies were found in 13 cases. Preoperative radiographs were falsely negative in two cases and falsely positive in 12. In ten cases arthroscopic removal was attempted; it succeeded in six cases. When no loose bodies were found, the most common diagnosis was degenerative joint disease.

Arthroscopy is recommended for diagnosis and treatment of loose bodies in the elbow joint.     

Cerebrospinal fluid from amyotrophic lateral sclerosis has no effect on intracellular free calcium in cultured cortical neurons

The data from the literature regarding the presence of a neurotoxic factor in amyotrophic lateral sclerosis (ALS) plasma or cerebrospinal fluid (CSF) remain controversial. As a new approach to this question, we have studied the effect of CSF from ALS patients on the temporal dynamics of the intracellular free calcium concentration ([Ca²⁺]_i) of murine cortical neurons in cultures using Fura-2 fluorescence videomicroscopy and single-cell imaging. CSF from seven ALS patients and controls was added at dilutions up to 20% to cortical neuronal cultures. The in vitro inhibition of CSF on [³H]kainic acid binding showed that the CSF did not contain any substances other than glutamate itself in larger amounts. At the concentrations used, the CSF did not have any effect on [Ca²⁺]_i or on the neuronal responsiveness as defined by the ability of the cells to respond with a transient increase in [Ca²⁺]_i to depolarization induced by KCl. The disturbance of the intracellular calcium homeostasis is one of the key mechanisms of action of excitotoxic compounds mediating delayed neuronal cell death by stimulation of glutamate receptor subtypes. In this study, CSF from ALS patients did not induce immediate rises in [Ca²⁺]_i or disturbances of the intracellular calcium homeostasis when measured over a period of 2 h.     

The Landau-Kleffner syndrome: A review

The Landau-Kleffner syndrome or the syndrome of acquired epileptic aphasia was first described in 1957. The disorder is characterised by gradual or rapid loss of language in a previously normal child. All children have abnormal EEG compatible with the diagnosis of epilepsy, however, only 70% have clinical seizures. The present article presents a review of the current knowledge concerning this disorder. Information is provided related to the clinical picture, etiology, pathogenesis, treatment and outcome.

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Zusammenfassung Das Landau-Kleffner-Syndrom oder das Syndrom der erworbenen epileptischen Aphasie wurde erstmals 1957 beschrieben. Die Störung ist charakterisiert durch den allmählichen oder raschen Verlust der Sprache eines zuvor normal entwickelten Kindes. Alle Kinder haben abnorme EEG-Befunde, die mit der Diagnose einer Epilepsie vereinbar sind. Jedoch haben lediglich 70% der Betroffenen klinisch apparente Krampfanfälle. Der vorliegende Artikel faßt den gegenwärtigen Wissensstand zu dieser Störung zusammen. Es werden Informationen zum klinischen Bild, zur Ätiologie, Pathogenese, Behandlung und Verlauf vermittelt.

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Résumé Le syndrome Landau-Kleffner, ou bien le syndrome de l'aphasie épileptique acquise, a été découvert en 1957. Ce dysfonctionnement se charactérise par la perte graduelle ou rapide du langage chez un enfant jusque là normal. Tous les enfants présentent des électro-encéphalogrammes anormaux correspondant à des critères diagnostiques de l'épilepsie, mais 70% d'entre eux seulement ont des attaques cliniques. Cet article présente un survol des connaissances actuelles relatives à ce dysfonctionnement, et se propose de donner des informations quant à son aspect clinique, son étiologie, sa pathogénie, son traitement ainsi que son issue.

     

Intrauterine capsules for incubation of gametes and subsequent release of embryos

In order to obtain incubation in uteri of spermatozoa, oocytes, and embryos, for treatment of patients referred for in vitro fertilization, a capsule was produced which could contain the human gametes and allow human fertilization and embryo growth after intrauterine introduction. Agar was chosen for capsule material and a mold was constructed for the production of capsules. The material was tested in vitro using mouse embryos and human oocytes and sperm. Intrauterine resolution was tested on mice and by insertion on 11 women. Empty capsules were inserted into the uterine cavity in 15 cycles the day after the luteinizing hormone peak and followed by daily ultrasound examinations. The resolution time was adjusted by changing the wall thickness of the capsules. The final type was dissolved after 3 to 4 days. No complications were observed and capsules could be inserted on all occasions. The major problem was expelling of capsules, which occurred in seven cycles. The problem seemed to be solved by the administration of indomethacin at the day of insertion.     

Solvent-induced chronic toxic encephalopathy

Chlorinated solvents, especially trichloroethylene, have been extensively used for metal degreasing since the beginning of this century. There have been case reports of cranial nerve damage and symptoms of acute and reversible encephalopathy. However, another issue during the last decade is the possible existence of a syndrome of chronic cerebral dysfunction. Our study deals with the risk of developing a state of psychoorganic syndrome after long-term exposure to solvents, mainly trichloroethylene. In this historical cohort study, 96 metal degreasers participated in a clinical medical and psychological examination. The risk of developing psychoorganic syndrome was proportional to the exposure duration, to increasing age, and to decreasing primary intellectual level. Using logistic regression analysis, there was a significantly increased risk of developing psychoorganic syndrome from solvent exposure. There was an odds ratio of 5.6 (0.93–34.3) for psychoorganic syndrome in the medium-exposed group. In the most highly exposed group, with a mean full-time exposure duration of 11 years, there was a significantly increased risk of psychoorganic syndrome, the adjusted odds ratio was 11.2 (1.9–66.6). None of four other potential confounders (arteriosclerotic disease, neurologic/psychiatric disease, alcohol abuse, and current solvent exposure) had any significant associations to psychoorganic syndrome. © 1993 Wiley-List, Inc.