“All that glitters is not gold”: sialomegaly,xerostomia, and dry eye is not always Sjögren’s syndrome

Although dry mouth, dry eye, and swollen salivary glands are the hallmark manifestations of Sjögren’s syndrome (pSS), a wide spectrum of other conditions should be considered for differential diagnosis. The diagnostic challenge is mainly encountered in patients presenting with dry eyes and/or dry mouth, who do not meet the full established classification criteria for pSS. Presented case-based review highlights the relationship between dry eye, parotid swelling, and psychiatric disorders. The obsessive-compulsive disorder may be separately be a cause of dryness symptoms even were not using any psychiatric drugs. The presented review widely discussed this problem and the aim is to shed new light on the interpretation of the dryness symptom and the necessity of individual patient assessment, excluding causes other than pSS before making a final diagnosis and making a decision on the treatment method.     

The subjective estimation of integration into a new society and the level of distress

There is a lack of socio‐demographic data and psychological variables on subjects suffering distress a few years after immigration. A total of 201 subjects, 80 men and 121 women, were investigated 5 years after immigrating from the former USSR to Israel. The level of distress was compared in subjects who differed in their level of education, employment status, subjective estimation of the immigration stress and integration into society. The level of distress was higher in women, especially in those who are not employed according to their level of education. It was also higher in subjects (21.4 per cent) who feel that their life crisis is ongoing, that they are not integrated into society and have a negative experience as a result of immigration. Thus, the level of distress corresponds to the subjective estimation of integration into the new society. Copyright © 2000 John Wiley & Sons, Ltd.     

Cardiac disease in pregnancy

Cardiac disease in pregnancy remains the leading cause of maternal mortality. In this review article we discuss our approach to caring for pregnant women with cardiac disease, and how the physiological changes of pregnancy can impact pre-existing conditions. This is illustrated by case discussions and practice points. Multi-disciplinary, individualised care is paramount to optimising outcomes for pregnant women with cardiac disease and their babies.     

Cloning and characterization of Aplysia neutral endopeptidase, a metallo-endopeptidase involved in the extracellular metabolism of neuropeptides in Aplysia californica

Cell surface metallo-endopeptidases play important roles in cell communication by controlling the levels of bioactive peptides around peptide receptors. To understand the relative relevance of these enzymes in the CNS, we characterized a metallo-endopeptidase in the CNS of Aplysia californica, whose peptidergic pathways are well described at the molecular, cellular, and physiological levels. The membrane-bound activity cleaved Leu-enkephalin at the Gly3-Phe4 bond with an inhibitor profile similar to that of the mammalian neutral endopeptidase (NEP). This functional homology was supported by the molecular cloning of cDNAs from the CNS, which demonstrated that the Aplysia and mammalian NEPs share all the same amino acids that are essential for the enzymatic activity. The protein is recognized both by specific anti-Aplysia NEP (apNEP) antibodies and by the [125I]-labeled NEP-specific inhibitor RB104, demonstrating that the apNEP gene codes for the RB104-binding protein. In situ hybridization experiments on sections of the ganglia of the CNS revealed that apNEP is expressed in neurons and that the mRNA is present both in the cell bodies and in neurites that travel along the neuropil and peripheral nerves. When incubated in the presence of a specific NEP inhibitor, many neurons of the buccal ganglion showed a greatly prolonged physiological response to stimulation, suggesting that NEP-like metallo-endopeptidases may play a critical role in the regulation of the feeding behavior in Aplysia. One of the putative targets of apNEP in this behavior is the small cardioactive peptide, as suggested by RP-HPLC experiments. More generally, the presence of apNEP in the CNS and periphery may indicate that it could play a major role in the modulation of synaptic transmission in Aplysia and in the metabolism of neuropeptides close to their point of release.     

The removal of a traumatic iridodialysis by closed iridoplasty

The authors describe their method for removal of iridodialysis, without surgical incision, by means of a hollow needle with the aperture for a thread on the working end and a cannula on the other end of the needle. The scheme of the operation is described in detail and the effectiveness of the new method of treatment in 24 patients with traumatic iridodialysis is analysed. Clinical approbation has shown high effectiveness of the proposed surgical method of treatment and its technical simplicity, allowing to recommend it for the usage in wide clinical practice.