Vasoactive intestinal and calcitonin gene-related peptides,tyrosine hydroxylase and nitrergic markers in the innervation of the rat central retinal artery

The vascular supply of the optic nerve has been studied with different methods including corrosion casts both in humans and in other mammals. In man, primates and some other mammals, such as the rat, a distinct central retinal artery accompanies the optic nerve, and runs through the lamina cribosa to reach the optic nerve head. Similarities between human and rat central retinal artery could serve to understand changes in the autonomic perivascular innervation in glaucoma using the rat as an animal model. Nitric oxide, calcitonin gene-related peptide, neuropeptide Y, substance P and vasoactive intestinal peptide have been identified around the monkey central retina artery. Innervation of the rat central artery, however, has not been described in detail. Using immuno- and histochemical methods, the present study investigates the peptidergic, adrenergic and nitrergic innervation of the rat posterior ciliary artery as well as the central retina artery. Numerous nitric oxide positive nerve fibers were visualized posterior and anterior to the lamina cribosa of the optic nerve. They colocalized with NADPH-diaphorase positive fibers, which could also be observed in two of six specimens studied at the level of the optic nerve head. Calcitonin gene-related peptide, tyrosine hydroxylase, and VIP positive fibers were also observed surrounding the vessels of the rat optic nerve. The presence of neuronal nitric oxide/NADPH-diaphorase and vasoactive intestinal peptide positive nerve fibers surrounding the posterior ciliary and central retinal arteries indicates a vasodilator effect in the rat optic nerve. Tyrosine hydroxylase positive innervation indicates the presence of sympathetic activity, and calcitonin gene-related peptide positive fibers indicate sensory innervation by trigeminal primary efferents.     

Correction of leg-length discrepancy after hip transposition

Four patients were treated with limb lengthening to correct a leg-length discrepancy that developed after a hip transposition after pelvic resection for sacroma of the pelvis. Three patients had Ewing's sacroma and one patient had osteosarcoma. All patients received chemotherapy; radiotherapy also was administered to the three patients with Ewing's sacroma. Femur lengthening was started at an average of 5.7 years (range, 4.4-6.8 years) after tumor surgery. At the start of elongation, the average age of the patients was 17.3 years (range, 10.3-20.8 years). The average leg-length discrepancy was 10.3 cm (range, 6-12 cm). The average of achieved lengthening was 6.4 cm (range 6-7.5 cm). The average healing index was 32 days (range, 27-40 days) per 1-cm elongation. According to the classification of Paley, two problems and two minor complications were treated by additional interventions. At the final followup, the average functional score was 22 (73%) according to the system of the Musculoskeletal Tumor Society. Leg-length discrepancy after hip transposition can be corrected with distraction osteogenesis. All patients who wore a stiff ankle-foot orthosis before lengthening wore an ordinary shoe lift after lengthening. The problems of the lengthening procedure are similar to the general complication rate of bone lengthening. Because the 5-year survival after resection of a pelvic sarcoma is only 20% to 30%, leg lengthening after hip transposition should be offered only to long-term survivors with at least 5 years event-free survival.     

Candida albicans clinical isolates inactivated by formalin with different adherence to buccal epithelial cells induce proinflammatory and regulatory cytokines in human peripheral blood mononuclear cells

Besides the activation of phagocytes, the release of cytokines is the most important immunological defence mechanism of an organism against infection with Candida albicans. On the other hand cytokines induced in the organism by the yeast itself are able to modulate the immune responses of the host. We investigated whether eight clinically isolated strains of C. albicans inactivated by formalin as well as a laboratory strain were able to induce proinflammatory and regulatory cytokines in peripheral blood mononuclear cells (PBMC) of four different donors. Under our assay conditions the yeast strains induced the cytokines interleukin-1 beta (IL-1 beta), interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) in PBMC to varying extents, but not the cytokine interleukin-4 (IL-4). We observed a difference in the reaction of the individual donors to the stimulus C. albicans but on the other hand the extent of the cytokine signal seemed to be dependent on the yeast strain as well. No correlation was found between the ability of the individual C. albicans strains to induce cytokines in PBMC and their ability to adhere to buccal epithelial cells. Determination of the cytokine induction potential of C. albicans strains possibly may contribute to the detection of new virulence factors of this yeast.     

Sleep disorders and depression in patients with Parkinson''s disease

OBJECTIVES: Sleep disorders and depression are frequent in patients with Parkinson's disease (PD). However, the exact prevalence and the causality are still unknown. PATIENTS AND METHODS: We interviewed 56 consecutive PD patients and 59 age-matched healthy controls concerning sleep disorders and depression. Sleep Disorders Questionnaire (SDQ) and Zung Depression Scale (ZDS) were used as standardized valid and reliable psychometric tests. RESULTS: Patients with PD had significantly higher values in the clinical-diagnostic scale narcolepsy (P=0.01), correlating with the L-dopa dose (P=0.007). Concerning sleep apnea (P=0.49), psychiatric sleep disorder (P=1.00) and periodic limb movement disorder (P=0.12), no significant difference could be identified. PD patients showed significantly higher depression scores than healthy control subjects (P=0.01), increasing with the duration of PD (P=0.04). CONCLUSION: The significant higher narcolepsy score in PD patients must be seen due to dopaminergic medication and PD-specific neurodegeneration and immobility rather than due to narcolepsy. This leads to the conclusion that extreme caution is advised when carrying out the SDQ and interpreting the results in various persons and patient groups with motor problems. The strong association of depression, disease severity and sleep disorders in PD patients underlines the importance of identifying and treating both conditions in these patients.     

Mycosis fungoides and Sézary syndrome. A retrospective study of 60 patients with correlation between histologic classification and survival time

47 patients suffering from mycosis fungoides and 13 with Sézary's syndrome were retrospectively studied with regard to prognosis in relation to the histologic substrate of cutaneous lesions. On account of the wide spectrum of T-cell cytomorphology as well as the pattern and composition of the infiltrate, we distinguished 4 histopathological types: small cell lymphoid type (45%), mixed cell polymorphic type (40%), large cell type (immunoblastic and pleomorphic, 10%), and medium-sized cell type (5%). Statistical analysis revealed survival rates of 10 years in 68.3% for the small cell lymphoid type and in 30.3% for the mixed cell polymorphic type. All patients showing the large cell type died within 6 years after diagnosis; those bearing the medium-sized cell type died within 2 years after diagnosis. The forms of mycosis fungoides showing the last two types of infiltrate may be classified as lymphomas of extreme malignancy. The different histological features are not only significant with regard to the diagnosis but also permit prognostic estimation before systemic signs have become evident.     

Tuberculoid lymph node reaction in malignant melanoma

We report on epitheloid cell reactions, forming small and large nodules within the primarily affected regional lymph nodes in malignant melanoma. The importance of such granulomas for the interpretation of lymphoscintigraphic findings is pointed out. We discuss the histogenesis and different patterns of these tumor-specific reactions. In addition, the question whether these granulomas are the result of an enhanced immunologic tumor surveillance will be under discussion.     

The role of low-molecular-weight heparins in cardiovascular medicine

Low-molecular-weight heparins (LMWHs) have been shown to be as effective and safe as unfractionated heparin (UFH) for acute phase treatment of acute coronary syndrome in the absence of ST-elevation [unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI)]. LMWHs have practical advantages over UFH, including usual lack of requirement for laboratory monitoring of the anticoagulant response because of their favourable pharmacokinetic properties, and thus represent a simpler and more cost-effective option in clinical practice. The LMWH dalteparin has been shown to provide extended therapy benefit to high-risk UA/NSTEMI patients and can provide a protective bridge until revascularization. While revascularization procedures are now an established intervention for patients with UA/NSTEMI, a new approach for patients who cannot undergo immediate catheter intervention is to continue with medical treatment until revascularization is possible. LMWHs are currently being investigated for use in the catheterization laboratory, in patients undergoing percutaneous coronary intervention procedures, and in conjunction with thrombolytics for treatment of acute myocardial infarction.     

Self-expanding mesh stent for esophageal cancer stenosis.

The implantation of new self-expanding mesh stents (20 mm in diameter, when fully expanded) in a 67-year-old woman with extensive esophageal cancer stenosis is reported. Prosthesis insertion was easily accomplished without the need for general anesthesia. The patient has been doing well since. The potential advantages of the new stenting procedure suggest further investigation.