Traumatic injuries to the oculomotor nerve

PURPOSE OF THE STUDY: A collective summary of the pathogenesis, character and clinical significance of damage to the oculomuscular innervation, arising from closed head trauma, based on our own clinical observations, together with a review of literature on the topic. MATERIALS AND METHODS: The clinical and pathophysiological evaluation of injuries to the oculomotor (III) nerve based on a prospective study in our clinic, dating from 1994 onwards: the clinical material consisted of 600 patients admitted to our Department of Neurosurgery following head trauma, the subgroup consisted of 38 patients, who died following major head trauma. RESULTS: Few authors focus on damage to the innervation of oculomotor muscles, the diagnosis of damage being difficult due to the usually poor clinical condition of such patients, the interdisciplinary nature of the resulting damage, and their delayed ophthalmological evaluation. The oculomotor (III) nerve is the nerve most frequently damaged amongst the cranial nerves, taking into account the innervation of the ocular system nerves (II-VII). Of clinical importance is differentiating between the mechanism of damage, paying particular attention to intracranial damage. The mechanisms of damage can be distinguished by: 1) partial tearing of the parasympathetic fibres contused against the petroclinoid ligament, 2) total tearing of the parasympathetic nerve root, 3) complete tear of one or both oculomotor nerves at the interpeduncular base, 4) nerve root tear, resulting from vessel perforation. The oculomotor nerve has the ability to regenerate. The regenerative process should occur within 3 to 5 months, that is without pathological synkinesis. If this process prolongs, this may lead to unpleasant consequences, such as the "misdirection phenomenon". CONCLUSIONS: Primary damage to the oculomuscular innervation resulting from closed head trauma is an integral component of such conditions. Early diagnosis and neuroprotective therapy may prevent pathological regeneration.     

Somatostatin analogs in the treatment of carcinoid syndrome: a case report and review of literature

We report the case of 48-year old patient with carcinoid syndrome successfully treated with somatostatin analogues. We also present the review of published literature about the use of somatostatin analogues in the treatment of carcinoid syndrome. In addition, reported case shows difficulties in access to this treatment, caused by economical reasons.     

Immunologic aspects of phototherapy

The article collates selected subjects from the recent progress in the photoimmunology. Experimental detection of percentage of apoptotic cells in the circulation and among keratinocytes residing in the skin can be applied for following treatment of conducted phototherapies. Considerable progress was made in recognition of pro-inflammatory and anti-inflammatory cytokines governing of suppressive immune response as a result of light therapies. The shift towards suppressive lymphocytes by change of cytokine profile of T cells circulating in the peripheral blood seems to be the principal physiologic reaction. The circulation of cytokines in the serum and their engulfing by nonirradiated cells consists a part of an intricated network of immune response of the whole system.     

Serum arginase activity in postsurgical monitoring of patients with colorectal carcinoma

BACKGROUND: Colorectal carcinoma (CRC) is one of the most common malignancies. In the current work, the role of arginase as a diagnostic marker in patients with recurrent CRC and colorectal liver metastases (CRCLM) was studied. METHODS: Arginase activity was monitored in serum from 40 patients with primary CRC and from 100 patients with CRCLM. Blood was taken before and after patients underwent tumor resection. Studies were conducted for 3 years. RESULTS: Preoperative arginase activity in serum from patients with CRC and CRCLM was much greater compared with the arginase activity in serum from healthy control blood donors. One and two cut-off levels of increased arginase activity were observed in patients with CRC and CRCLM, respectively. After patients underwent tumor resection, the arginase activity decreased to normal values in both patients with CRC and patients with CRCLM. Activity levels remained low in patients who did not develop recurrent CRC or CRCLM (first or second). In patients who developed subsequent recurrences or metastases that appeared after surgery, during 3 years of surveillance, a significant rise in serum arginase activity was observed. The clinical prognosis for patients was worst when the postoperative serum arginase activity was very high, because those patients more often developed second liver metastases or died. CONCLUSIONS: The authors conclude that the determination of serum arginase activity may be a complementary test to confirm the occurrence of CRC and may be useful for the early diagnosis of patients who develop recurrent CRC and/or CRCLM.     

Metachromatic leukodystrophy in adult patient initially diagnosed as multiple sclerosis

The article presents a case of metachromatic leucodystrophy (MLD) of the adult onset type, in which atypical initial course could suggest multiple sclerosis. MLD is an inherited, metabolic, degenerative disease of the nervous system. It is caused by a deficiency of a lysosomal enzyme--arylsulphatase A, with the storage of cerebroside sulphate and demyelination affecting mainly the central and peripheral nervous system. In the reported case of a female aged 21 the clinical onset of the disease was at the age 20. The first neurological symptoms included a mild spastic paraparesis, ataxia of lower limbs, and imbalance. The neurological deterioration has been progressing since the onset. There was no family history of neurological or metabolic diseases, but the patient's parents were near relatives (first cousins). T-2 weighted MRI showed high intensity areas in the white matter, mainly periventricular. The clinical symptoms could suggest multiple sclerosis (of the primary progressive type). The patient was admitted to our Dept. in Oct. 2000, i.e. about a year since the onset. Her increasing spastic triparesis, cerebellar ataxia, neuropathy in lower limbs and cognitive deterioration were confirmed. Re-analysis of the patient's clinical picture and family history, her MRI scans and repeated neurophysiological examinations which demonstrated a damage of the central and peripheral nervous system, suggested metachromatic leucodystrophy. Therefore, it was decided to assay arylsulphatase A activity. The result confirmed the diagnosis of the late onset MLD. Additionally, molecular genetic examination was performed of a DNA sample obtained from the patient.     

Catecholaminergic activity of the baroreceptor areas of the brain in response to bilateral dorsolateral transection of medulla oblongata in rats

Central catecholaminergic activity was studied by measurement of norepinephrine (NE), epinephrine (EPI), their metabolites: total 3-methoxy-4-hydroxyphenylglycol (MHPG) and 3,4-dihydroxyphenylglycol in brain nuclei in response to bilateral dorsomedullary knife-cut (DMK-cut) in rats. In saline-pretreated conscious rats DMK-cut caused a marked hypertension, tachycardia and increases in plasma NE, EPI and vasopressin. Chlorisondamine (CHL) prevented the rise in plasma catecholamines and the tachycardia but failed to prevent the hypertension and the increment in plasma vasopressin. DMK-cut decreased NE and EPI in the nucleus tractus solitari (NTS) and A2 area; there were no catecholamine changes in A1 area or the periventricular nucleus but an increase in the paraventricular nucleus (PVN), the latter effect reversed by CHL, CHL alone or combined with DMK-cut had no effect on catecholamine concentrations in NTS-A2 area but lowered MHPG content. It is suggested that DMK-cut decreases the activity of the catecholaminergic system originating in A1 and terminating in PVN, where it causes catecholamine accumulation and may be involved in vasopressin release and thereby contribute to hypertension. In NTS-A2 area, however, the DMK-cut appears to increase catecholaminergic activity since catecholamines are depleted. Central effects of DMK-cut differ from those of ganglionic blockade-induced inhibition of the baroflex presumably due to sectioning of other pathways in addition to the primary baroreceptor input.     

Comparison of the FIGO and TNM staging systems for uterine cervix cancer based on classification of 6193 cases

A total of 6193 patients treated for uterine cervix cancer was studied by a collaborative study, aiming to compare the applicability of the TNM versus FIGO clinical staging systems. Retrospective assays of gynecological status were performed. It was found that the FIGO classification system is superior to the TNM system concerning uterine cervix cancer in the aspects of simplicity, recording procedures, and prognostic value.