Bullous eosinophilic cellulitis (Wells'' syndrome) associated with Churg–Strauss syndrome

We report a patient with Churg-Strauss syndrome (CSS) with asthma, eosinophilia, nasal polyposis and ANCA-associated multisystem vasculitis, who's skin eruption started with erythematous urticarial-plaques followed by haemorrhagic bullae. Histology of the plaques revealed 'flame figures' in the dermis with no granulomatous or vasculitic process, consistent with the diagnosis of eosinophilic cellulitis or Wells' syndrome. The association of CSS and Wells' syndrome observed in this patient may have a common pathogenesis. CSS may induce Wells' syndrome by an unknown factor.     

Vasopressin secretion during hyperglycemia in insulin-dependent diabetics

Plasma levels of vasopressin (AVP) were measured in ten insulin-dependent diabetic patients before and during intravenous administration of hypertonic glucose. Plasma glucose and plasma osmolality increased from 12.4 +/- 1.2 to 47.0 +/- 2.3 mmol/l and from 293 +/- 2.0 to 307 +/- 2.8 mosm/kg respectively. Plasma vasopressin increased in parallel from 5.6 +/- 0.6 to 7.7 +/- 0.6 pg/ml. The present results demonstrate that hyperglycemia may be an effective stimulus for AVP secretion in insulin-deficient diabetics.     

Physiological and anatomical consequences of infraorbital nerve transection in the trigeminal ganglion and trigeminal spinal tract of the adult rat

Single-unit recording and retrograde tracing techniques were used to assess the receptive field properties, topography, and projections of rat trigeminal primary afferent neurons subsequent to transection of the infraorbital (IO) nerve in adulthood. Four hundred and fifty-eight units were recorded in the trigeminal ganglion ipsilateral to nerve section. Of these, 66.6% had IO receptive fields. Thirty percent responded to innocuous stimulation of vibrissae, 39.1% to guard hair deflection, 8.2% to gentle indentation or stretch of the skin, and 22.3% to noxious stimuli (compared to 77.2% vibrissa, 12.0% guard hair, 4.5% skin, and 6.3% noxious in normal animals). An additional 15 units were driven by a stimulating electrode placed on the IO nerve proximal to the site of the lesion but had no receptive field. Of the cells with vibrissa receptive fields, 33.3% were slowly adapting type I (SAI), 6.6% were slowly adapting type II (SAII), 32.2% were low velocity rapidly adapting (RA-LV), 20.0% were high velocity rapidly adapting (RA-HV), and 7.7% were nociceptive (NX, in normal animals 43.8% were SAI, 10.3% SAII, 27.6% RA-LV, 16.8% RA-HV, and 1.5% NX). A number of cells had receptive field properties not seen in normal animals. The single-unit recordings indicated that the topography of mandibular and ophthalmic representations in the ganglion were essentially normal, while the organization of the maxillary region of the ganglion was slightly abnormal. The ganglion physiology experiments were augmented by records from primary afferents in the trigeminal spinal tract (TrV). Eighty-one (72.2%) of the 112 fibers recorded in the TrV of normal rats had IO receptive fields. Of these, 73.2% responded to innocuous vibrissal stimulation, 14.6% to guard hair deflection, 8.5% to gentle indentation of the skin, and 2.5% to noxious stimuli. Of the 61 vibrissa units, 37.8% were SAI, 19.7% SAII, 37.8% RA-LV, 3.3% RA-HV, and 1.6% NX. In adult-lesioned animals, 81 (61.3%) of the recorded fibers had IO receptive fields. Of this number, 38.2% responded to vibrissae, 29.6% to guard hairs, 16.0% to skin, and 19.7% to noxious simuli. Of the vibrissa-sensitive units, 16.1% were SAI, 3.2% were SAII, 45.2% were RA-LV, 35.5% were RA-HV, and 3.2% NX. As in the ganglion recording studies, a number of abnormal receptive fields were documented.(ABSTRACT TRUNCATED AT 400 WORDS)     

Structure-function relationships in the rat brainstem subnucleus interpolaris: VI. Cervical convergence in cells deafferented at birth and a potential primary afferent substrate

Possible substrates for peripheral injury-induced receptive field (RF) changes were assessed in the trigeminal (V) subnucleus interpolaris (SpVi). In adult rats with infraorbital nerve section at birth, 449 cells were studied ipsilateral to the lesion by using electrophysiological methods. Of these, 33 (7.4%) had RFs that included facial vibrissae, guard hairs, and skin, as well as ipsilateral regions normally innervated by cervical primary afferents (ear, neck, shoulder, arm, forepaw). Such non-V convergence was never seen in 373 normal SpVi cells or in 641 V ganglion cells ipsilateral to the lesion. SpVi cells with cervical RFs discharged to V ganglion shocks and their latencies (1.6 +/- 0.7 ms, mean +/- s.d.) did not differ from normal (1.4 +/- 0.5). Most (71%) projected to the thalamus. None were nociceptive-biased, and many had unusually discontinuous RFs (48%). Possible pathways by which cervical inputs might reach SpVi neurons were investigated in additional anatomical and electrophysiological experiments. Eight SpVi cells with cervical RFs were intracellularly labeled with HRP. Although all had dendrites that were polarized toward SpVi regions containing spared mandibular and/or ophthalmic primary afferents, none had dendrites which extended out of SpVi. In other neonatally nerve-damaged adults, WGA-HRP was injected bilaterally into forepaw, arm, and shoulder regions. Transganglionic transport was restricted to normal targets. However, WGA-HRP injections into SpVi retrogradely labeled a total of 46 +/- 20 (mean +/- s.d.) cells in ipsilateral C1-3 dorsal root ganglia, and 24 +/- 8 cells in C4-8 ganglia. In controls, labeled cells were seen only in C1-3 ganglia (32 +/- 9). The distribution and number of labeled cells in the somatosensory cortex did not differ in experimental and control cases. No labeled cells were visible in the dorsal column nuclei of either the normal or experimental rats. Thus, retrograde labeling studies suggest that a cervical primary afferent projection to SpVi is a potential substrate for cervical convergence expressed in neonatally deafferented SpVi cells.     

Acute otomastoiditis and its complications: role of CT

Acute bacterial (suppurative) otomastoiditis responds to antibiotic treatment; radiologic study is required only when there is clinical suggestion of coalescent mastoiditis, intracranial complications, or an underlying chronic disease. Computed tomography (CT) is the method of choice for evaluating otogenic intra- or extra-cranial complications. CT scans can show stages of disease progression when infection has spread by way of soft tissue, blood, and bone pathways into the dural venous sinuses, meninges, labyrinth, facial nerves, epidural and other intracranial spaces. When there is clinical suggestion of acute coalescent mastoiditis, a CT scan of the temporal bone can confirm the presence of rarefying osteitis, coalescence of the air cells, and subperiosteal abscess.     

Neuronal Apoptosis and Necrosis Following Spinal Cord Ischemia in the Rat

We examined the characteristics of neuronal death induced by ischemia in the spinal cord. Spinal cord ischemia was induced in Long–Evans rats by occlusion of the descending aorta with a 2F Fogarty catheter for 20 min (model 1) or more limited aortic occlusion (15 min) coupled with blood volume reduction (model 2); rats were sacrificed 6 h–7 days later. The animals developed variable paraparesis in model 1 and reliable paraplegia in model 2. The extent of histopathological spinal cord damage, being maximal in the lumbar cord, correlated well with the severity of paraparesis. Two distinct types of spinal cord neuronal death were observed, consistent with necrosis and apoptosis. Neuronal necrosis was seen in gray matter laminae 3–7, characterized by the rapid (6 h) onset of eosinophilia on hematoxylin/eosin-stained sections, and gradual (1–7 days) development of eosinophilic ghosting. Although TUNEL positivity was present, disintegration of membranes and cytoplasmic organelles was seen under electron microscopy. Neuronal apoptosis was seen after 1–2 days in dorsal horn laminae 1–3, characterized by both TUNEL positivity and electron microscopic appearance of nuclear chromatin aggregation and the formation of apoptotic bodies. DNA extracted from the ischemic lumbar cord showed internucleosomal fragmentation (laddering) on gel electrophoresis. These data suggest that distinct spinal cord neuronal populations may undergo necrosis and apoptosis following transient ischemic insults.     

Central projections of the normal and ‘regenerate’ infraorbital nerve in adult rats subjected to neonatal unilateral infraorbital lesions: a transganglionic horseradish peroxidase study

The visuotopic organization of the primary visual cortex (area 17) and the extrastriate visual regions surrounding it (areas 18a and 18) has been studied in gray rats using standard microelectrode mapping techniques. The results confirm and extend previous observations in the rat. Apart from the representation of the contralateral visual field (VF) in area 17, in which the upper VF is represented caudally and the nasal VF laterally, there are additional representations of the VF in the extrastriate cortex. In lateral extrastriate cortex (area 18a) there are at least 4 such representations, namely lateromedial (LM), anterolateral (AL), laterointermediate (LI) and laterolateral (LL). In LM (second visual area) the upper VF is represented caudally and the nasal VF medially, being thus a mirror image of V1. In AL (third visual area) the upper VF is represented rostrally and the nasal VF, medially, being thus a mirror image of LM. In LI, the upper VF is medial and the nasal VF, lateral, being thus a mirror image of LM, or a reduced copy of V1. In medial extrastriate cortex (area 18) there are two representations of the temporal VF, labeled anteromedial (AM) and posteromedial (PM). In AM, the upper temporal VF is medial and the lower temporal VF, lateral, the extreme temporal field being rostral. The 30 degrees azimuth provides the boundary between AM and PM. Thus, AM is organized as a counter-clockwise rotation by 90 degrees of the V1 representation. In PM, the upper lower VF topography is like in AM, but the extreme temporal VF is caudal, being thus a mirror image of AM.