CEREBRAL VENOUS THROMBOSIS OCCURRING DURING AN ECTOPIC PREGNANCY AND COMPLICATED BY INTRACRANIAL HYPERTENSION

Thrombosis of the cerebral dural sinuses and veins has been described since the early 19th century.^1,2 Clinically the process is characterised by diverse symptomatology and physical findings and in spite of advances in diagnostic radiological techniques it remains an under-recognised condition. It has been most commonly associated with sepsis, trauma, pregnancy, the puerperium and many other hypercoagulable states. We describe an apparently unique case of sagittal sinus thrombosis occurring during an ectopic pregnancy. This was subsequently complicated by intracranial hypertension in spite of clinical improvement and magnetic resonance imaging (MRI) evidence suggesting a return of venous patency. The clinical presentation, radiological features and management is discussed.     

Multinuclear MR imaging: a technique for combined anatomic and physiologic studies

With the use of specially designed multiple-tuned probes for magnetic resonance (MR) imaging, data collection schemes can be developed for obtaining images of different nuclei simultaneously. Both phantom and in vivo MR images of two nuclei (either hydrogen-1, phosphorus-31, lithium-7, or fluorine-19) were obtained in the time span necessary to collect the image of the less sensitive nuclei. This technique offers a means by which physiologic and anatomic information can be gathered in a highly efficient fashion.     

CO2 LASER – A NEW TOOL IN THE SURGEONS ARMAMENTARIUM

One hundred and sixty five patients, treated with carbondioxide (CO₂) laser for benign and malignant lesions of the head and neck were studied. Alveolo-buccal complex (68/165) had the majority of benign and malignant tumors followed by larynx (23/165) and tongue (21/165). All lesions were widely excised, none were reconstructed and all defects healed well with minimal scarring. The post-operative morbidity was minimal and the hospitalization period was 1 to 5 days. Complications were not serious and could be managed easily. This study confirms the usefulness of CO₂ laser surgery for both benign and malignant conditions in head and neck.KEYWORDS: Carbondioxide laser, Head and neck, Malignant neoplasm, Premalignant lesions     

Prognosis in Patients with Left Ventricular Dysfunction and Ventricular Tachycardia Following Programmed Ventricular Stimulation

We performed programmed ventricular stimulation on 69 patients with left ventricular ejection dysfunction (ejection fraction < 50%) and clinically recognized ventricular tachycardia including 28 patients with sustained ventricular tachycardia and 41 patients with nonsustained ventricular tachycardia. An inducible arrhythmia (> 6 beats ventricular tachycardia) was found in 74% of patients. Patients with clinically sustained arrhythmias were frequently inducible (89%) with a high incidence of inducible monomorphic ventricular tachycardia (82%). Patients with clinically nonsustained ventricular tachycardia had a lower rate of inducibility (63%) including a high incidence of inducible polymorphic ventricular tachycardia (27%). Inducible patients with left ventricular dysfunction and ventricular tachycardia had a low incidence of electrophysiologically demonstrated effective drug therapy (16%). However, if an effective drug was found, the prognosis was good. Empirical drug therapy was associated with a poor prognosis in inducible and noninducible patients. Finally, an unfavorable prognosis was associated with a clinically sustained arrhythmia, a lower ejection fraction, and the presence of a left ventricular aneurysm. An inducible arrhythmia did not predict an unfavorable course. Indeed, patients with noninducible ventricular tachycardia in this group of patients were still at risk for sudden cardiac death.     

Concomitant Therapy of Oral Isotretinoin with Multiplex Pulsed Dye Laser and Nd: YAG Laser for Acne

ObjectiveTo evaluate concomitant therapy of oral isotretinoin with multiplex pulsed dye laser and Nd:YAG laser.MethodsA retrospective chart review of patients who received treatment of oral isotretinoin and non-ablative laser therapy to treat acne vulgaris at a single outpatient dermatology clinic site in Ontario, Canada between 2009 and 2017. Results187 patients were included, consisting of 45.5 percent males (n=85) and 54.5 percent females (n=102) with a mean age of 21.4 years. 31.6 percent (n=59) of patients reported experiencing side effects from concomitant isotretinoin and NAL therapy, the most common being eczema (n=14), erythema (n=11), significant dry skin/lips/eyes (n=8), flushing (n=6), and bruising (n=6). 99.2 percent of patients achieved clear or almost clear at treatment completion. Of those who expressed satisfaction, 65.2 percent (n=122) reported being satisfied with the treatment and the remaining patients did not report satisfaction nor dissatisfaction.Limitations Limitations exist mainly due to the absence of standardized lesion counts and a comparator cohort. Thus, it is not possible to comment on whether the combination of isotretinoin and NAL is more efficacious that either treatment alone.ConclusionConcomitant use of isotretinoin and non-ablative laser therapy is a safe and effective treatment option for acne vulgaris that provides patient satisfaction.     

Interactions of plasma kallikrein and C1-s with normal and dysfunctional C1(-)-inhibitor proteins from patients with hereditary angioneurotic edema: analytic gel studies

Purified preparations of normal C1(-)-inhibitor (C1(-)-INH) formed high mol wt complexes with plasma kallikrein that were stable during sodium dodecyl sulfate (SDS)-gel electrophoresis, but most of the dysfunctional C1(-)-INH proteins isolated from plasma of patients with type II hereditary angioneurotic edema (HANE) did not. Two of eight dysfunctional C1(-)-INH proteins were cleaved to lower mol wt forms that were not seen following the reaction of normal C1(-)-INH with equimolar amounts, or less, of plasma kallikrein. Only the higher mol wt component of normal C1(-)-INH (106,000 mol wt) appeared to form a stable complex with the plasma kallikrein, whereas both the 106,000 and 96,000 mol wt forms made stable complexes with C1-s. When a preparation of normal C1(-)-INH containing a homogeneous single band of C1(-)-INH was exposed to C1-s or kallikrein, a "doublet" form evolved in which the heaviest band was in the original position of native C1(-)-INH; C1- s cleavage provided a second band of 96,000; and cleavage by kallikrein, a second band of 94,000 mol wt. We conclude that dysfunctional C1(-)-INH proteins from plasma of persons with type II hereditary angioneurotic edema have impaired interactions with plasma kallikrein and are heterogeneous with respect to these interactions. Moreover, the requirements for the formation of stable complexes between normal C1(-)-INH and plasma kallikrein differed from those for stable complex formation with C1-s. The doublet form of C1(-)-INH, which purified preparations frequently demonstrate, may be due to prior cleavage by C1-s or kallikrein.     

The ATM tumour suppressor gene is down‐regulated in EBV‐associated nasopharyngeal carcinoma

A micro‐array analysis using biopsies from patients with EBV‐positive undifferentiated nasopharyngeal carcinoma (NPC) and from cancer‐free controls revealed down‐regulation of tumour suppressor genes (TSG) not previously associated with this disease; one such gene was the ataxia telangiectasia mutated (ATM) gene. Q‐PCR confirmed down‐regulation of ATM mRNA and ATM protein expression in tumour cells was weak or absent in almost all cases. In NPC cell lines, however, ATM was down‐regulated only in the EBV‐positive line, C666.1, and in none of five EBV‐negative lines. In vitro infection of EBV‐negative NPC cell lines with a recombinant EBV was followed by the down‐regulation of ATM mRNA and protein, and only EBV‐positive cells showed a defective DNA damage response following γ‐irradiation. Our data suggest that loss of ATM function could be an important step in the pathogenesis of NPC, and may have implications for the treatment of this disease. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.