Abnormal cellular energy and phospholipid metabolism in the left dorsolateral prefrontal cortex of medication-free individuals with bipolar disorder: an in vivo1H MRS study

Objectives:  While the pathophysiology of bipolar disorder (BD) remains to be elucidated, postmortem and neuroimaging studies have suggested that abnormalities in the dorsolateral prefrontal cortex (DLPFC) are implicated. We compared the levels of specific brain chemicals of interest measured with proton magnetic resonance spectroscopy (¹H MRS) in medication-free BD subjects and age- and gender-matched healthy controls. We hypothesized that BD subjects would present abnormal cellular metabolism within the DLPFC, as reflected by lower N -acetyl-aspartate (NAA) and creatine + phosphocreatine (Cr + PCr).
Methods:  Thirty-two medication-free BD subjects (33.8 ± 10.2 years) and 32 matched controls (33.8 ± 9.0 years) underwent a short echo-time (TE = 30 ms) ¹H MRS. An 8-cm³ single voxel was placed in the left DLPFC, and individual concentrations of NAA, Cr + PCr, choline-containing compounds (GPC + PC), myo -inositol, and glutamate were obtained, using the water signal as an internal reference.
Results:  BD subjects had lower Cr + PCr [ F _(1,62) = 5.85; p = 0.018; one-way analysis of variance (ANOVA)] and lower GPC + PC [ F _(1,62) = 5.79; p = 0.019; one-way ANOVA] levels in the left DLPFC. No significant differences were observed for other brain metabolites.
Conclusions:  These findings provide further evidence that the pathophysiology of BD involves impairment in the DLPFC. Our findings can be interpreted as evidence for reduced cellular energy and phospholipid metabolism, consistent with the hypothesis of mitochondrial dysfunction in BD.     

High-dose inhaled beclomethasone treatment in patients with chronic cough: a randomized placebo-controlled study.

BACKGROUND: It is important to determine whether chronic cough is associated with asthma and can be helped by treatment with inhaled corticosteroids. OBJECTIVE: To compare the effects of beclomethasone and placebo in patients with chronic cough for at least 8 weeks after excluding those with cough due to postnasal drip and gastroesophageal reflux disease. METHODS: A prospective, randomized, double-blind, placebo-controlled study comprising 64 patients was performed for 2 weeks. The active group received metered-dose inhaler chlorofluorocarbon-beclomethasone (1,500 microg/d), and the placebo group received identical-appearing placebo inhalers. All the participants completed a respiratory questionnaire and underwent bronchoprovocation testing (BPT) with methacholine and allergy skin testing. The primary outcome measure was a decrease in daily cough scores (symptom diary and visual analog scale) during the 2-week treatment period. RESULTS: The active group comprised 44 patients and the placebo group 20 patients. Cough duration averaged 20 weeks. At the end of treatment 82% of the active group and 15% of the placebo group had complete resolution of cough. In the active group 22 patients (50%) had positive BPT results, and in the placebo group 10 patients (50%) had positive results. There was no correlation between treatment response and responses on the respiratory questionnaire, allergy skin testing, or BPT. CONCLUSION: Therapy with high-dose inhaled beclomethasone provided an excellent response in a subgroup of patients with chronic cough that did not correlate with atopy or airway hyperresponsiveness.     

Hepatitis C in liver transplantation: preliminary study of prognostic factors

Abstract At the University of Miami liver transplantation for chronic liver disease in HCV-positive patients has shown good results, with a 92% patients survival rate (follow up 8 to 57 months, median 21). None the less, we found that a large number of patients are expected to develop serious histological graft damage and may need retransplantation, which may place a further strain on the already scarce donor resources. We have conducted a preliminary investigation on the importance of parameters which may correlate with the prognosis of HCV grafts. We found no impact of HLA match or typing. An interesting hypothesis, which deserves further investigation, is that some HCV strains could be more virulent than others and play a role as an independent risk factor. We have identified six strains among our patients and the BK serotype shows a trend to be associated with a worse outcome. We have found that patients developing and maintaining higher liver enzyme levels (ALT and GGT) after transplant and those with higher levels of viremia may be at risk to develop serious damage to their grafts.     

Acro-osteolysis prior to diagnosis of leprosy

lysis (bone resorption) has been observed in a heterogeneous group of congenital and acquired bone disorders. Leprosy is the main cause of peripheral neuropathy leading to acro-osteolysis in endemic countries. Pure neuritic leprosy, a less common form of the disease, is difficult to diagnose. Two unrelated leprosy patients with acropathy whose disease began as pure neuritic are discussed.     

Cutaneous thermal sensitivity in diabetic neuropathy

BACKGROUND: The goal of this investigation was to determine if cutaneous thermal sensitivity could be used as a discriminator of peripheral neuropathy in diabetic subjects who were sensate to the Semmes-Weinstein 5.07 monofilament. METHODS: Sixty adult subjects were separated into two groups. The control group (A) was composed of 30 young healthy individuals without a history of diabetes. The focus group (B) was composed of 26 individuals with adult onset diabetes and four with juvenile onset. All of the subjects underwent thermal sensitivity testing in peripheral nerve root dermatomes of their hands and feet. Testing was performed with custom devices fabricated from materials with different thermal conduction capacities (copper, steel, glass, and plastic). Similar tests were performed with glass tubes containing heated or cooled water to develop a range of thermal sensitivity for the subjects. RESULTS: There was a strong relationship between cold perception and stimulation with the copper probe in dermatomes of the radial nerve of the upper limb and the superficial peroneal dermatome of the lower limb. CONCLUSIONS: Thermal sensitivity to copper and cold stimulation may be more discriminative and have a higher threshold than sensitivity to the Semmes-Weinstein monofilament. This simple method may have a role in the early detection of peripheral neuropathy in adult-onset diabetes mellitus.     

Donor intracaval thrombus formation and pulmonary embolism after simultaneous piggyback liver transplantation and aortic valve replacement

Pulmonary embolism (PE) is a well known and serious complication that may develop after abdominal surgery. Liver transplant recipients are not immune to PE and tend to share many of the same risk factors with surgical patients who are stricken with this potential fatal complication. Liver transplantation using the piggyback (PB) technique is widely accepted, although there are reports of technique-specific-related vascular complications. We present a case of a 49-yr-old male liver transplant recipient who received his graft using the PB while simultaneously undergoing aortic valve replacement. His post-operative course was complicated by a PE 15 d after his surgery and was the result of an intracaval thrombus of the graft liver. The current case should alert clinicians to think of a donor intracaval thrombus as a complication of PB liver transplantation and a possible source of PE.     

Histochemical analysis of the dogs' dental pulp after pulp capping with calcium,barium, and strontium hydroxides

Dogs' dental pulps were capped with calcium hydroxide, barium hydroxide, or strontium hydroxide. Forty-eight hours after treatment, all pulps had a layer of large carbonate granulations that were von Kossa positive, birefringent to polarized light, and localized mainly in the area between the necrotic and the living pulp tissue. In the pulps treated with barium or strontium hydroxide, the histochemical analysis showed that the metal of these granulations came from the capping material. These data suggest that the calcium from calcium hydroxide may participate in the composition of the birefringent granulations observed in the calcium hydroxide group.     

Dentition of monozygotic twins concordant for Down's syndrome: a case report.

Examination of the dental casts of Down's syndrome twins showed a high percentage of concordance and mirror-imaging relative to crown morphology and static occlusion. These supplemental dental findings supported an earlier diagnosis of monozygosity determined by other clinical means. Reduction of mesiodistal dimension of the dental crowns and deviations in their morphology is consistent with Down's syndrome.