Apoptosis in brain biopsies of subacute sclerosing panencephalitis patients

Subacute sclerosing panencephalitis (SSPE) is associated with inflammatory infiltration, neuronal loss, and demyelination. The pathogenesis of these changes is unclear. We examined DNA fragmentation and Bcl-2 expression in brain biopsies of nineteen SSPE patients to investigate the role of apoptosis in tissue damage. DNA fragmentation was present in oligodendroglia, and, in tissues with neuronal loss, in neurons. Reactive astrocytes had no DNA fragmentation, but strong Bcl-2 expression. These results suggest apoptosis as one of the mechanisms for oligodendroglial and neuronal death in SSPE.     

Ocular toxicity of intravitreal clarithromycin.

OBJECTIVE: To investigate the ocular toxicity and clearance of intravitreal clarithromycin lactobionate (Klaricid) and to determine the highest nontoxic dose. MATERIALS AND METHODS: To evaluate toxicity, 24 New Zealand white rabbits were divided into six groups (four rabbits each). Rabbits were examined preoperatively and electroretinography (ERG) was performed. The left eyes of the animals served as controls and received intravitreal injection of 0.1 mL sterile water. Klaricid (0.1 mL) was injected into the midvitreous cavity of the right eyes at concentrations of 25 microg, 250 microg, 500 microg, 1.0 mg, 2.0 mg, and 4.0 mg/0.1 mL. The animals were followed up to 15 days postinjection by clinical examination and ERG. The animals were killed and the eyes were enucleated and processed for light microscopy. Ten New Zealand rabbits were used for the vitreous clearance study as drug test rabbits and two additional rabbits were used to generate control retina and vitreous. The highest nontoxic dose (1 mg) was injected into the vitreous and the concentration of clarithromycin in the vitreous was determined using high-performance liquid chromatography at various time intervals after injection. RESULTS: Cataract occurred after intravitreal doses of 2.0 and 4.0 mg. Electroretinography showed decreasing b-wave amplitude with both dark- and light-adapted stimulus in the 4.0-mg group; it was normal in other groups. Histopathologic sections showed localized retinal necrosis and disorganization with the 2.0 and 4.0 mg dosage. No histologic changes were found in the other groups. The half-life of intravitreal clarithromycin was found to be 2 hours. No metabolites of clarithromycin were observed in the vitreous samples. CONCLUSION: Intravitreal clarithromycin lactobionate is nontoxic to rabbit eyes up to a dose of 1.0 mg. Because of its broad-spectrum antibiotic effect and appropriate half-life in the vitreous, it may be a good choice for intravitreal treatment of susceptible organisms.     

Diagnostic power of the vaginal washing-fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes.

OBJECTIVE: The purpose of this study was to determine the reliability of the vaginal washing-fluid prolactin assay for the diagnosis of premature rupture of membranes (PROM) and to determine a diagnostic cut-off value. STUDY DESIGN: Seventy pregnant women between 11 and 40 weeks of gestation who were admitted with vaginal fluid leakage were included in the study group, and were then further subdivided into two subgroups according to amniotic fluid pooling and nitrazine paper test results. Group 1 was the 'confirmed PROM group', positive for both pooling and nitrazine (38 patients). Group 2 was the 'suspected but unconfirmed PROM group' which had possible pooling and/or nitrazine (32 patients). Seventy pregnant women between 11 and 40 weeks of gestation without any complaint and complication were included in the control group (group 3). All patients underwent vaginal washing-fluid sampling and prolactin level determination. For the statistical analysis one-way analysis of variance, Tukey multiple comparison test, chi2 test and receiver operating characteristic (ROC) curve analysis were used. RESULTS: Geometric mean values of vaginal washing-fluid prolactin levels were 616.59 microIU/ml for group 1, 23.98 microIU/ml for group 2 and 10 microIU/ml for group 3 (p < 0.0001). The optimal diagnostic cut-off value was found to be 30 microIU/ml with 95% sensitivity, 78% specificity, 84% positive predictive value, 93% negative predictive value, 87% accuracy and 11.30 relative risk. CONCLUSIONS: We recommend vaginal washing-fluid prolactin level determination as an alternative diagnostic method for PROM.     

Pain induced by phacoemulsification performed by residents using topical anesthesia.

BACKGROUND AND OBJECTIVE: To evaluate patient-reported pain induced by phacoemulsification performed by residents using topical anesthesia. PATIENTS AND METHODS: This prospective study comprised 81 eyes of 76 consecutive patients having phacoemulsification under topical anesthesia. Surgery was performed by an experienced surgeon (group 1; n=41 eyes) or by two residents (group 2; n=40 eyes). No sedation or intracameral anesthesia was used in either group. Eighty eyes had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Patients were asked postoperatively to grade the pain they experienced during the procedure using a visual analog pain scale from 0 to 10. RESULTS: The median pain score for the overall pain was 1.59 +/- 1.43 (range: 0 to 6) in group 1 and 1.95 +/- 1.64 (range: 0 to 7) in group 2 (P = .291). The mean pain score for the maximum pain perceived was 2.39 +/- 1.86 (range: 0 to 7) in group 1 and 2.53 +/- 1.67 (range: 0 to 7) in group 2 (P = .734). There was no significant correlation between the duration of surgery and the overall pain score (r = 0.102, P = .365). CONCLUSION: Topical anesthesia had sufficient analgesic effects in selected patients undergoing phacoemulsification cataract surgery by resident surgeons. The pain felt during the operation was low and tolerable.     

Activity of adenosine deaminase in mothers who have conceived a fetus with central nervous system malformations

OBJECTIVE: To establish the adenosine deaminase (ADA) activity in women who had been pregnant with a child suffering from central nervous system (CNS) anomaly. METHODS: The study group comprised 68 women who had been pregnant with an affected child, and 68 controls matched for age, gestational age and body mass index. Maternal venous blood was collected for measurement of ADA levels. We defined the diagnostic sensitivity, specificity and area under receiver-operating characteristic curve for ADA. RESULTS: Plasma ADA activity was significantly higher in the study group (12.3 U/L, range 1.7-33.3) compared to the median value of 3.3 U/L (range 1.1-34.4) in normal pregnancies (P<0.05). The cut-off point of ADA >5.9 U/L was associated with the highest combination of specificity (58.8%) and sensitivity (86.8%). CONCLUSION: ADA activity in women who have conceived a fetus with CNS malformations was significantly higher than that in normal pregnant women.     

Prognostic value of expression of p53, proliferating cell nuclear antigen, and c-erbB-2 in laryngeal carcinoma.

BACKGROUND: The molecular mechanisms in malignant transformation of laryngeal mucosa are unknown; many clinical and pathological factors affect prognosis. We investigated a possible correlation between overexpression of p53, proliferating cell nuclear antigen (PCNA), and c-erbB-2, and the clinicopathologic features of laryngeal squamous cell carcinoma (SCC) and clarify their prognostic value. MATERIAL/METHODS: Thirty-three men with laryngeal SCC participated; all underwent primary surgery or surgery plus radiotherapy between 1999 and 2004 at our department. Paraffin sections of laryngeal SCC were immunohistochemically stained for p53, PCNA, and c-erbB-2. RESULTS: Overall, p53 overexpression was found in 16 patients. There was no relation between p53 immunohistochemical staining and tumor region. PCNA immunostaining was significantly stronger in supraglottic tumors compared with glottic tumors. Immunostaining of c-erbB-2 was not different in either location. There was no relation between the T stage of the tumor and p53 and c-erbB-2 immunostaining. However, there was a statistically significant positive correlation between the PCNA staining and T stage (stronger staining was present in T3 and T4 stages than in T1 and T2 stages). CONCLUSIONS: We could not find a statistically significant correlation between p53, PCNA, and c-erbB-2 and lymph node status, histologic differentiation, and survival rate. We demonstrated only a statistically significant positive correlation between PCNA staining and T stage. These data suggest that overexpression of p53, PCNA, and c-erbB-2 is not prognostic in laryngeal SCC.