Macular corneal dystrophy including histologic and ultrastructural changes

PURPOSE: The study reports the results of a histological and ultrastructural examination of the corneal button, obtained during penetrating keratoplasty from patient with clinically recognized macular corneal dystrophy. MATERIAL AND METHODS: 34-year-old male patient suffering from macular corneal dystrophy (MCD) has been treated on corneal epithelium defect and photophobia since his early childhood. Visual acuity was decreased on the Snellen test chart to 0.02. Slit-lamp examination, and ultrasonographical measurement of the cornea's thickness were performed. Removed during penetrating keratoplasty corneal button was divided into two pieces. One of them was prepared in standard procedure for histological examination in the light microscopy after having been stained with hematoxylin and eosin, alcian blue and paS-method. From the other part, slides for ultrastructural examination in the transmission electron microscopy were prepared with the use of standard method. The family history from the patient was also taken, and available relatives have undergone examination in search of typical MCD symptoms. RESULTS: Slit-lamp examination findings revealed diffuse, from limbus to limbus, stromal opacification. In measurement by pachymeter cornea's thickness was reduced. In the light microscopy, in typical stained slides, delaminations within stroma and deficit of endothelial cells were observed. After being stained with alcian blue, dark blue deposits in the places of delamination became visible. By transmission electron microscopic examination, intracellular and extracellular deposits were detected in the stroma, Descemet membrane and endothelium. Distended keratocytes with enormous vacuoles containing abnormal material were found. Pedigree was typical for autosomal recessive inherited disease. CONCLUSIONS: Histological and ultrastructural diagnosis is a basis of recognition of macular corneal dystrophy. Analysis of the pedigree as well as ultrasonographical measurement of the cornea's thickness is very helpful to establish the right diagnosis.     

Lessons in sports medicine: advice from experience

When addressing the politics of sports medicine, it is often helpful to obtain the advice of people who work in the trenches and who have experiences that can be of benefit to clinicians in the field or who are contemplating going into the field. The goal of this project was to obtain advice from physicians who have dealt with these political issues. It is hoped that their insights will prove helpful for physicians and others who are involved in the care of athletes, regardless of the athlete's level of the play.     

Color Doppler Imaging Predicts Portal Invasion by Pancreatic Adenocarcinoma

Background Tumor infiltration of the intima of the portal vein (PV) and superior mesenteric vein (SMV) by pancreatic adenocarcinoma is classically considered a criterion for unsuitability for resection and poor prognosis. This study was performed to evaluate modern color duplex imaging (CDI) for the assessment of PV/SMV infiltration by pancreatic adenocarcinomas. Method From 1994 to 2005, Whipple’s procedure or pylorus-preserving pancreato-duodenectomy (PPPD) was performed in 303 patients with pancreatic adenocarcinoma; 35 of these underwent partial PV/SMV resection. Applying a previously reported CDI score, we evaluated the integrity of the echogenic border layer between the vein and tumor (mural demarcation) and maximum blood flow velocity (V _max) in the PV segment in contact with the tumor. The results were compared to the final histological findings in the resected venous walls. Results CDI findings correlated well with the histological invasion grades. By measuring V _max and evaluating mural demarcation, we observed a sensitivity of 66.7% and 100% and a specificity of 98.3% and 93.9%, respectively, in predicting full thickness vein invasion, including the intima. V _max above 80 cm/s and lack of mural demarcation were predictors of PV/SMV invasion. The postoperative survival rates depended on the depth of tumor infiltration into the PV/SMV. Conclusions Modern CDI is a reliable and valid technique for evaluation of morphological and hemodynamic parameters in the portal vein segment adjacent to pancreatic adenocarcinoma. Maximal blood-flow velocity in the portal segment in contact with the tumor and absence of the echogenic vessel-parenchymal sonographic interface are parameters predictive of tumor infiltration of the portal intima.     

Outcome of Invasive and Noninvasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas (IPMN): A 10-year Experience

BACKGROUND: Intraductal papillary-mucinous neoplasms (IPMN) were officially introduced into the TNM classification in 1996. Based on a two-center database, we reevaluated histopathological findings, clinicopathological pattern, predictive markers for malignancy, and outcome. METHODS: Between 1996 and 2006, a total of 1424 pancreatic resections were performed in the University Hospitals Dresden and Mannheim. Pathologists of both institutions reviewed the IPMN diagnoses and other with cystic or solid tumor diagnoses. All possible markers, such as diabetes, jaundice, etc., were analyzed for prediction of malignancy. We performed a survival analysis based on the morphologic classification to determine the prognosis of IPMN. RESULTS: There were 43 patients of primarily diagnosed IPMN along with 1174 patients with diagnoses, such as ductal adenocarcinoma. In 207 patients, the diagnoses revealed other cystic or small solid tumors. A histopathological review of the latter patients revealed 54 IPMNs, resulting in a total of 97 IPMN patients (29 noninvasive, 68 invasive). All IPMN patients had a median survival of 36 months. Recurrence occurred more frequently in invasive IPMN. Predictive markers of malignancy were pain, preoperative weight loss, jaundice, and elevated CA 19.9. The strongest independent prognostic factor was invasive growth. The survival analysis revealed excellent prognosis for noninvasive IPMN. CONCLUSIONS: Since the introduction of IPMN in 1996, even specialized centers have had to deal with a learning curve. By reevaluating all cystic or small solid tumors, centers can improve and their patients' treatment can be optimized. Because the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions, surgery is advocated for all main duct IPMN, because they have a high malignant potential. For branch duct IPMN, surgery is advocated if the lesion is symptomatic, >3 cm, or has enlarged nodules.     

Mutagenesis of acetobacter methanolicus MB58 with the transposon Tn5

Transposon mutagenesis was applied to the isolation of mutants of the facultatively methylotrophic Acetobacter methanolicus MB 58. The transposon Tn5 (pSU2011) was transferred from Escherichia coli SM 10 by means of conjugation to Acetobacter methanolicus MB 58. Four out of 1850 stable Km-resistant transconjugants were identified that were formaldehyde sensitive and failed to grow on methanol.     

Sodium intake determines the role of adenosine A2 receptors in control of renal medullary perfusion in the rat.

BACKGROUND: In the kidney, adenosine (ADO) can induce either vasoconstriction or vasodilatation, mediated by A1 or A2 receptors, respectively. The vasodilator influence may be of special importance in the renal medulla which operates at low tissue pO(2) levels and is susceptible to ischaemic damage. It has not been established if ADO induced vasodilatation is modified by salt intake. METHODS: We examined effects of stimulation or inhibition of ADO receptors (A2R) on perfusion of the renal cortex and medulla on low- or high- sodium intake (LS, HS). Effects of suprarenal aortic ADO (0.03 mmol/kg/h), A2R agonist (DPMA), 0.08-0.4 mmol/kg/h, or antagonist (DMPX), 1.7 micromol/kg/h, were examined in anaesthetized rats maintained on LS (0.15% Na) or HS (4% Na) diet for 3 weeks. Whole kidney blood flow (RBF) and the perfusion (laser-Doppler) of the superficial cortex and outer and inner medulla (OM-BF, IM-BF) were measured. RESULTS: In LS rats neither drug changed renal perfusion. In HS rats ADO increased RBF 18 +/- 3%, OM-BF 16 +/- 7% and IM-BF 16 +/- 6%. IM-BF increased after DPMA 18 +/- 5% and decreased after DMPX 13 +/- 3%; neither drug consistently changed perfusion of the cortex. CONCLUSIONS: On HS intake, medullary perfusion is controlled by ADO vasodilator (A2) receptors, which may help provide adequate oxygen to the medulla, the zone which normally operates under relative hypoxia. On LS intake, the vasodilator and vasoconstrictor effects are probably in balance and ADO has little role in control of intrarenal circulation.     

Catalytic properties, tissue and intracellular distribution of neurofibromin.

The neurofibromatosis type 1 (NF1) gene encodes a protein, neurofibromin, that shows homology with members of the GTPase-activating protein (GAP) family. To study neurofibromin, rabbit polyclonal antisera were raised against two synthetic peptides. These antisera immunoprecipitated a specific protein of about 240 kDa in lysates of adult murine and rat tissues both in the soluble (S100) and to a lesser degree in the particulate (P100) fractions. The neurofibromin immunoprecipitated from the lysates of several murine organs stimulated the intrinsic GTPase activity of p21 c-Ha-ras protein. Based on immunoblotting, immunoprecipitation and GTPase assays, neurofibromin appears to be at least 10-fold more abundant in the brain than in the other murine organs. The GTPase-stimulatory activity of full-length neurofibromin, like the catalytic GAP-related domain, is inhibited by arachidonic acid and the detergent dodecyl maltoside, while phosphatidic acid, containing arachidonic and stearic acid, is non-inhibitory. Immunofluorescence analysis with anti-neurofibromin sera in NIH3T3 cells suggests that at least some of the cellular protein associates with cytoplasmic structures that are distinct from actin or tubulin filaments.     

Prognostic value of beta human chorionic gonadotrophin in blood serum of patients with urinary bladder tumous

Beta human chorionic gonadotrophin levels have been assessed in blood serum of 79 patients with bladder tumours before and seven days after transurethral electroresection (TUR). With the growth grade of anaplasia and staging the mean serum beta HCG level increased. Beta HCG was a good biological marker to differentiate between superficial and deep tumours.     

Mutations in the phenylalanine hydroxylase gene identified in 95 patients with phenylketonuria using novel systems of mutation scanning and specific genotyping based upon thermal melt profiles

Phenylketonuria (PKU, MIM 261600; EC 1.14.16.1) results from mutations in the phenylalanine hydroxylase (PAH) gene. Newborn metabolic disease screening uses blood dried on filter paper (DBS) to prospectively identify candidate newborns affected with PKU via an elevated concentration of phenylalanine. However, it is then important to confirm the specific category of PKU since classical PKU requires a stringent diet while milder categories may not require diet and a very important BH4-responsive category may be treated with the PAH cofactor 6R-tetrahydrobiopterin (BH4). Since there is a close genotype-phenotype correlation in PKU, determining the PAH genotype can be extremely important for therapy as well as prognosis. A simple and rapid method of accurately determining the PAH genotype would be a valuable addition to the diagnosis of PKU. Described herein is a means to identify variants in the PAH gene using high-resolution melt profiling, which compares the thermal denaturation profile of a patient sample to that of a control. Regions where the patient and control samples produce a common profile were not further evaluated, while those regions where the patient profile deviates from the control were assessed by DNA sequencing. Additionally described is a scheme utilizing redundant analysis with melt profile controls and a novel multiplex genotyping assay to triage deviation owing to known polymorphisms. Two mutations were identified in 93 of the 95 patients assessed and in the remaining two patients a single mutation was identified. Melt profiling provided 99% sensitivity to identify sequence variants in the PAH gene.