Antifungal treatment in sarcoidosis--a pilot intervention trial

BACKGROUND: Sarcoidosis is generally treated with corticosteroids that are not always an effective therapy. OBJECTIVES: To assess if treatment with antifungal drugs would improve the clinical status of patients with sarcoidosis. METHODS: Patients (n=18) with sarcoidosis grades II and III according to established criteria and without clinical and immunological signs of fungal infection, were treated with antifungal medication together with corticosteroids for 3-6 months. Pulmonary X-ray infiltration, lung function, and severity of symptoms were registered before and after the treatment and at follow up 9-58 months later. RESULTS: The treatment resulted in statistically significant decreases in the degree of pulmonary infiltration with an average decrease in the group from 2.0 to 1.0. There were also significant increases in diffusion capacity and decreases in the severity of symptoms. CONCLUSION: It is suggested that treatment with antifungal drugs may be useful, at least in certain cases of sarcoidosis.     

Gastric hemangioma in a 5-year-old boy

We report a rare cause of gastrointestinal bleeding in a 5-year-old boy with hematemesis and melena for a month. Upper gastrointestinal endoscopy and an abdominal magnetic resonance image suggested a large hemangioma on the gastric fundus. The patient underwent an exploratory laparotomy with partial gastrectomy limited to the gastric fundus. An intraoperative endoscopy helped to ensure a complete resection of the tumor. Histopathology showed a cavernous hemangioma of the gastric fundus.     

Body shape, body size and cigarette smoking relationships

Objectives:  The aim of the present study was to explore whether smoking is positively related with the abdominal obesity. Methods:  Cross-sectional data was analyzed from a random sample of 1,342 subjects, stratified by their age and gender. Cigarette smoking habits were assessed and anthropometric measures obtained during the health examination. Results:  Statistically significant differences in waist circumference and waist-hip ratio were found among males in some of the age groups, body mass index however, was lower in older smokers. There were no differences between female smokers and non-smokers in all parameters. Conclusion:  The results of the study do not support the hypothesis that smoking affects an abnormal fat distribution profile predominantly in the form of central adiposity as reported earlier. Submitted: 27 March 2008; revised: 14 November 2008; accepted: 28 November 2008     

Neurokinin3 receptor modulation of the behavioral and neurochemical effects of cocaine in rats and monkeys

Neurokinin3 (NK3) receptors and their endogenous ligands (e.g. the neuropeptide substance P and its C-terminal fragment) have been implicated in psychomotor activity and reinforcement mechanisms. We review here recent findings on the involvement of NK3 receptors in the behavioral and neurochemical effects of cocaine. Although NK3 receptors can modulate dopamine (DA) activity in the brain, recent results suggest that this modulation does not occur during spontaneous behavioral activity. However, NK3 receptors play a role in the regulation of cocaine-induced DA responses in the nucleus accumbens core and shell subregions. NK3 receptor agonism as well as antagonism potentiate cocaine's effects on nucleus accumbens DA subregions specifically, and modulate the acute behavioral effects of cocaine in rats and non-human primates (Callithrix penicillata). However, conditioned place preference studies in rats have, so far, failed to provide evidence for an involvement of NK3 receptors in the reinforcing effects of cocaine.     

Subpopulations of Human Granulosa–Luteal Cells Obtained from Gonadotropin- or Gonadotropin-Releasing Hormone Agonist/ Gonadotropin-Treated Follicles in In Vitro Fertilization–Embryo Transfer Cycles

Purpose: Our purpose was to find the differences in granulosa–luteal cells obtained from gonadotropin- versus gonadotropin-releasing hormone (GnRH) agonist/gonadotropin-treated follicles in in vitro fertilization–embryo transfer (IVF-ET) cycles. Methods: Granulosa–luteal cells were obtained from 45 follicles of women undergoing IVF-ET with gonadotropin releasing hormone (GnRH) agonist and human menopausal gonadotropin (hMG) and from 45 follicles of women with hMG IVF-ET cycles. Subpopulations of granulosa–luteal cells were observed by computerized image analysis in which human chorionic gonadotropin (hCG) was localized using immunoperoxidase staining. Results: The luteinized granulosa–luteal cells from hMG-treated follicles were larger than those from GnRH agonist/hMG-treated follicles. The hMG-treated follicles contained more hCG-stained cells, particularly those with cytoplasmic hCG localization. Conclusions: We found differences in morphometric characteristics and hCG localization in granulosa–luteal cells obtained from hMG- versus GnRH agonist/hMG-treated follicles. We presume that the results indicate the influence and importance of luteal-phase support on the clinical pregnancy rate in GnRH agonist/hMG-treated IVF-ET cycles.     

Adult metachromatic leukodystrophy: a new mutation in the schizophrenia-like phenotype with early neurological signs

OBJECTIVES: The adult type of metachromatic leukodystrophy can manifest itself as motor or as psycho-cognitive form, the latter is very similar to schizophrenia. We report on two sisters with adult metachromatic leukodystrophy who display symptoms of both forms. METHODS: Presented are genotype analyses and 4-year follow-up data regarding clinical manifestations as well as neurocognitive and neuroimaging results for two adult sisters with metachromatic leukodystrophy. RESULTS: Whereas the younger sister developed disorganized schizophrenia-like symptoms, the other exhibited schizophrenia-like, negative symptoms. In both sisters, neurological signs were already present at the onset of the disease and progression towards dementia was documented within 1-2 years. In peripheral leukocytes, the activity of arylsulphatase A was reduced to 2 and 5% of the mean normal activity in both women. Genotype analysis revealed compound heterozygosity for a known severe splice site mutation, (c.459+1G>A) together with two known polymorphisms, [(c.937G>T), (p.Trp193Asp)] and [(c.1530C>G), (p.Thr391Ser)], and a novel missense mutation, (c.1194C>T). The latter results in the exchange of a conserved polar amino acid, threonine 279, to hydrophobic isoleucine (Thr279Ileu), which could not be found among >100 control alleles. A family analysis identified T279I as the paternal allele, whereas (c.459+1G>A) as well as the two polymorphisms were inherited from the mother. This is consistent with a disease-causing effect of the novel mutation. CONCLUSIONS: The novel mutation, T279I detected in our patients, correlates with a specific phenotype with schizophrenia-like symptoms, neurological signs and cognitive impairment early in the course of the disease and a relatively fast progression towards dementia. This is in contrast to previous reports on adult metachromatic leukodystrophy patients with the psycho-cognitive phenotype who did not show any neurological signs for decades, however, most of these patients were heterozygous for another specific missense mutation, I179S.     

Treatment of tongue cavernous haemangioma with direct puncture and sclerotization with ethanol

Background

Haemangiomas of tongue are rare type of malformations. They can be treated mostly conservatively but in some cases they need more aggressive treatment with preoperative intra arterial embolization and surgical resection. Lesions of tongue that are localized superficially can also be treated with direct puncture and injection of sclerosing agent (absolute ethanol).

Case report

We present a case of a 48 years old female patient, where we performed embolization of cavernous haemangioma with mixture of absolute ethanol and oil contrast. After the procedure the patient received analgetics and antioedematous therapy. After the sclerotization the planed surgery was abandoned. Control MRI examinations 6 and 12 months after the procedure showed only a small remnant of haemangioma and no signs of a larger relapse.

Conclusions

In our case the direct puncture of haemangioma and sclerotherapy with ethanol proved to be a safe and effective method to achieve preoperative devascularization of the lesion. Direct puncture of the lesion is not limited by the anatomy of the vessels or vasospasm, which can occur during the intra-arterial approach.     

From the Cover: Pulvinar neurons reveal neurobiological evidence of past selection for rapid detection of snakes

Snakes and their relationships with humans and other primates have attracted broad attention from multiple fields of study, but not, surprisingly, from neuroscience, despite the involvement of the visual system and strong behavioral and physiological evidence that humans and other primates can detect snakes faster than innocuous objects. Here, we report the existence of neurons in the primate medial and dorsolateral pulvinar that respond selectively to visual images of snakes. Compared with three other categories of stimuli (monkey faces, monkey hands, and geometrical shapes), snakes elicited the strongest, fastest responses, and the responses were not reduced by low spatial filtering. These findings integrate neuroscience with evolutionary biology, anthropology, psychology, herpetology, and primatology by identifying a neurobiological basis for primates’ heightened visual sensitivity to snakes, and adding a crucial component to the growing evolutionary perspective that snakes have long shaped our primate lineage.Snakes have long been of interest to us above and beyond the attention we give to other wild animals. The attributes of snakes and our relationships with them have been topics of discussion in fields as disparate as religion, philosophy, anthropology, psychology, primatology, and herpetology (1, 2). Ochre and eggshells dated to as early as 75,000 y ago and found with cross-hatched and ladder-shaped lines (3, 4) resemble the dorsal and ventral scale patterns of snakes. As the only natural objects with those characteristics, snakes may have been among the first models used in representational imagery created by modern humans. Our interest in snakes may have originated much further back in time; our primate lineage has had a long and complex evolutionary history with snakes as competitors, predators, and prey (1). The position of primates as prey of snakes has, in fact, been argued to have constituted strong selection favoring the evolution of the ability to detect snakes quickly as a means of avoiding them, beginning with the earliest primates (2, 5). Across primate species, ages, and (human) cultures, snakes are indeed detected visually more quickly than innocuous stimuli, even in cluttered scenes (6–11). Physiological responses reveal that humans are also able to detect snakes visually even before becoming consciously aware of them (12). Although the visual system must be involved in the preferential ability to detect snakes rapidly and preconsciously or automatically, the neurological basis for this ability has not yet been elucidated, perhaps because an evolutionary perspective is rarely incorporated in neuroscientific studies. Our study helps to fill this interdisciplinary gap by investigating the responses of neurons to snakes and other natural stimuli that may have acted as selective pressures on primates in the past.Here, we identify a mechanism for the visual system’s involvement in rapid snake detection by measuring neuronal responses in the medial and dorsolateral pulvinar to images of snakes, faces of monkeys, hands of monkeys, and geometric shapes in a catarrhine primate, Macaca fuscata. The medial and the dorsal part of the traditionally delimited lateral pulvinar are distinctive in primates, with no homologous structures found in the visual systems of nonprimate mammals (13), and the medial pulvinar appears to be involved in visual attention and fast processing of threatening images (14). Based on this and other indirect evidence, the Snake Detection Theory (2) hypothesized that these primate-specific regions of the pulvinar evolved in part to assist primates in detecting and thus avoiding snakes. If true, then we would expect snake-sensitive neurons to be found in those regions. Here we present unique neuroscientific evidence in support of the snake detection theory (2).     

Phacoemulsification in isolated endogenous Candida albicans anterior uveitis with lens abscess in an intravenous methadone user

We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.