The superior orbital fissure syndrome

The superior orbital fissure syndrome is a very rare condition, characterized by a fixed dilated pupil, ptosis and proptosis of the eye and ophthalmoplegia. We have had the opportunity to observe a number of such cases, and now report four of them.     

Fractures of the facial skeleton in the edentulous patient

An evaluation was made of 112 fractures that occurred in 66 edentulous patients in a 10 year period. There was an average of 1.7 fractures per person. 104 fractures occurred in the mandible and 75% of these were treated without intermaxillary fixation or were not treated at all. In 28.5% of the cases no treatment was provided other than soft or liquid diet and appropriate instructions. As a group, the condylar fractures were those that were left with no treatment to a greater extent than any other group, apart from the Le Fort type of fracture; the latter being very few in absolute numbers. The age group associated with the edentulous state quite often suffers from conditions that may prohibit aggressive treatment. These conditions may be aggravated by the accident and, by the time the patient is ready for maxillofacial surgery, one has to contemplate (and discuss with the patient) the advantages and disadvantages of a procedure. It appears that aesthetics are of minor importance (to a certain degree) for elderly patients and small deviations from the normal (both in appearance and function) are acceptable to them, considering the prospect of an operation or of the prolonged discomfort, such as that associated with intermaxillary fixation. The advisability of the latter should be assessed carefully in view of the respiratory impairment that it may cause in patients whose airway may already be compromised.(ABSTRACT TRUNCATED AT 250 WORDS)     

一个男运动员的性腺机能低下与富含胡萝卜素饮食的关系(英文)

目的:报道了一个年轻男运动员大量摄入胡萝卜素后引发性腺机能低下的独特病例。病例报告:一名20岁的患者,在先前一年里坚持自己设计的高胡萝卜素、低动物脂肪的饮食,就诊时症状为肌肉逐渐萎缩、身体活动能力以及性欲减低、勃起功能下降。临床上,他表现出明显的胡萝卜素过量的体征:掌心和脚底都呈黄色。当他的饮食正常化二周后,胡萝卜素 B 值达到了正常范围的上限。方法:在恢复均衡饮食前和恢复均衡饮食3、6和12个月后,分别进行下丘脑、垂体和睾丸功能的重复刺激测试。结果:在均衡饮食数月后,促性腺激素和性腺类固醇由最初测得的非常低的基础值和刺激值逐渐恢复正常,并且胡萝卜素 B 值也有所恢复。诊断9—12个月后,荷尔蒙分泌物和性反应完全恢复。结论:这是第一个与摄入过量胡萝卜素有关的下丘脑式性腺机能低下的病例。     

Periodic Therapeutic Plasma Exchange in Patients With Moderate to Severe Chronic Myasthenia Gravis Non‐Responsive to Immunosuppressive Agents: An Eight Year Follow‐Up

Few patients with moderate or severe myasthenia gravis (MG) do not respond to immunosuppressive treatment. We present our experience with periodic therapeutic plasma exchange (TPE), in 11 patients with MG resistant to intravenous immunoglobulin (IVIg) therapy, who had frequent relapses even whilst on high doses of immunosuppressive drugs, over a period of 8 years. All patients underwent TPE until control of their symptoms was achieved, and afterwards TPE sessions were continued periodically in an attempt to achieve remission of the disease, without immunosuppressant therapy. Two of the patients were progressively weaned off immunosuppressive agents, as well as TPE, and they are now symptom free. The other nine patients are still under a periodic TPE regime. Seven of them were weaned off all medications and required an average of 3.7 TPE sessions per year during the last 5 years. In the other two patients, those with the most severe form of the disease, the immunosuppressant dosage has been decreased and a TPE session every 2–3 weeks is required in order to control their symptoms. Through all these years TPE has been well tolerated and only minor side‐effects were observed in two patients. Finally, during this 8 year follow‐up period, nine of the patients treated with periodic TPE have been in good control of their symptoms over the last 5 years, and the other two patients live a normal life without any treatment in the last 3 years. Our results suggest that periodic TPE is safe and effective in the control of symptoms in patients with moderate to severe MG who do not respond to immunosuppressive therapies.     

Genome analysis of two type 6 echovirus (E6) strains recovered from sewage specimens in Greece in 2006

Echovirus 6 (E6) is one of the main enteroviral serotypes that was isolated from cases of aseptic meningitis and encephalitis during the last years in Greece. Two E6 (LR51A5 and LR61G3) were isolated from the sewage treatment plant unit in Larissa, Greece, in May 2006, 1 year before their characterization from aseptic meningitis cases. The two isolates were initially found to be intra-serotypic recombinants in the genomic region VP1, a finding that initiated a full genome sequence analysis. In the present study, nucleotide, amino acid, and phylogenetic analyses for all genomic regions were conducted. For the detection of recombination events, Simplot and bootscan analyses were carried out. The continuous phylogenetic relationship in 2C–3D genomic region of strains LR51A5 and LR61G3 with E30 isolated in France in 2002–2005 indicated that the two strains were recombinants. SimPlot and Bootscan analyses confirmed that LR51A5 and LR61G3 carry an inter-serotypic recombination in the 2C genomic region. The present study provide evidence that recombination events occurred in the regions VP1 (intraserotypic) and non-capsid (interserotypic) during the evolution of LR51A5 and LR61G3, supporting the statement that the genomes of circulating enteroviruses are a mosaic of genomic regions of viral strains of the same or different serotypes. In conclusion, full genome sequence analysis of circulating enteroviral strains is a prerequisite to understand the complexity of enterovirus evolution.