Primary hyperparathyroidism and monoclonal gammopathy

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal gammopathy, benign or malignant, in patients with primary hyperparathyroidism, and some practical implications of this interesting coexistence are presented.     

Encephalo-myelo-radiculo-ganglionitis presenting as pandysautonomia

A 68-year-old man developed pandysautonomia with severe orthostatic dysfunction, fixed heart rate, low serum levels of norepinephrine and epinephrine, absent sympathetic skin responses, and pupillary abnormalities. CSF protein was 92 mg/dl. In spite of a good recovery following corticosteroid administration, a relapse occurred, with accompanying sensory symptoms confined to both arms. Fatal sudden cardiac arrest occurred after 4 months. Autopsy revealed numerous lymphocytic infiltrates, predominantly in autonomic and sensory ganglia and, to a lesser extent, in the nerve roots, spinal cord, and brainstem without evidence for an underlying tumor. This case provides histopathologic evidence for an inflammatory etiology of panautonomic neuropathy in some patients.     

A model-based detector of vertex waves and K complexes in sleep electroencephalogram.

A model of sleep phasic events such as vertex waves, K complexes, delta waves and sleep spindles is proposed. It consists of feedback loops that are driven by white noise (simulating tonic delta and sigma activity) and by isolated random impulses, simulating vertex waves or K complexes, depending on the background tonic activity. A model-based method for the detection of sleep phasic events was implemented in a personal computer. Its performance was investigated using simulated and real whole-night EEG signals. The method was able to detect K complexes and vertex waves in a reliable way in spite of their variable shapes and in the presence of a variety of background activities. The detector appears to have superior performance to those so far reported in the literature. The performance of the detector was also compared to that of an electroencephalographer using normal sleep EEG records of 8 h duration from 6 subjects. The performance was satisfactory both in terms of accuracy and reliability. The problem of detecting K complexes in stages 3 and 4 of sleep is discussed.     

Gas chromatographic assay of methyltestosterone in tablets.

A simple gas chromatographic procedure has been developed for the determination of methyltestosterone in bulk powders and in tablets. Two new silyl ether derivatives of methyltestosterone have been prepared using dimethylethylsilylimidazole (DMESI) and dimethylisopropylsilylimidazole (DMiPSI). The method is accurate and selective for methyltestosterone within the concentration range 0.1-1.5 micrograms microliters-1.     

Cultures of Langerhans cells and co-culture with lymphoid cells: Relevance to toxicology and pharmacology

Langerhans cells are an essential component of cutaneous immunological defence mechanisms. They are mononuclear dendritic cells derived from bone marrow, which are present in the squamous epithelia, particularly skin. Langerhans cells show marked changes in phenotype and function when epidermal cell suspensions are prepared according to a trypsinization protocol and placed in culture for 1–3 days. They seem to mature and acquire most of the features of lymphoid dendritic cells, especially the interdigitating dendritic cells present in lymph nodes. This observation supports the assertion that resident Langerhans cells take up foreign antigens and then migrate through dermal lymphatics to local lymph nodes where they function as antigen-presenting cells. Thus, Langerhans cells play a pivotal role in the primary immune response and in the pathogenesis of skin diseases. In the past, most therapeutic treatment of skin diseases was achieved by administration of pharmacological agents by epicutaneous application. More recently, the determination of the toxicity of drugs and their pharmacological mechanisms has required the development of in vitro models to explore their potential effects at the cellular level. The effects of different agents (physical and chemical) on the density and function of fresh or cultured Langerhans cells are reviewed.     

Frühes Ovarialkarzinom

Patients with early ovarian carcinoma have a much better survival outcome than patients with more advanced disease. Comprehensive surgical staging is crucial for the determination of prognosis and treatment planning. During 2003, the first randomized trials were published demonstrating that adjuvant platinum based chemotherapy improves recurrence free and overall survival. Current treatment recommendations are largely based on the results of these studies. Accordingly, systemic adjuvant therapy should be offered to patients with disease stage Ib or higher and to patients with moderately differentiated or undifferentiated tumors. Due to incomplete surgical staging, the stage of disease in the patients included in these studies is probably underestimated, and only a fraction of the actual advanced stage patients is included.