The treatment of multiple sclerosis in Los Angeles and the United States, 1947-1960

Two sets of multiple sclerosis (MS) patient records located in Los Angeles County from the 1940s and 1950s were analyzed within the historical perspective and biomedical context of the time. It was found that there were divergent treatment patterns, and a continuum of therapeutic activism in the treatment of MS: some physicians attempted to intervene aggressively in an attempt to prevent relapses or lessen the severity of attacks, while others adopted milder interventions, basing their therapeutic decisions on their knowledge of the pathology of MS. As long as a physician had a reasonable theory of the pathogenesis of the disease, it was thought permissible to experiment with therapies, despite equivocal evidence, as long as no harm was done. Indeed, for physicians faced with declining and suffering patients, there was a strong emotional imperative to attempt treatments without waiting for an agreed-upon proof of efficacy. This was sustained, in part, by pressure to treat from many patients who shared their physicians' willingness to experiment with treatments.     

Zoophilia in Men: A Study of Sexual Interest in Animals

This article presents a study of 114 self-defined zoophile men who were researched primarily through the use of an on-line questionnaire. We describe how the participants acquired the identity label of zoophile, what it meant to them, and their relationships among themselves. Also examined are how they eroticized animals and how human and feral characteristics combined to form this object choice. Finally, participants' sexual profiles with animals and humans, and how the balance of animal and human desires creates different forms of zoophilia, are described.     

Immunolocalization of ClC-K chloride channel in strial marginal cells and vestibular dark cells

Secretion of K⁺ into endolymph depends on a particular constellation of ion transport proteins in the apical and basolateral membranes of strial marginal cells and vestibular dark cells. One fundamental component is the large chloride conductance of the basolateral membrane, which recycles chloride taken up by the Na⁺-K⁺-Cl⁻ cotransporter in the same membrane. Evidence has been reported recently that supports ClC-K, a channel subunit previously thought to be specific to the kidney, as being the molecular entity underlying this conductance. We have isolated protein from the gerbil kidney, stria vascularis and vestibular labyrinth and found by Western blot analysis a 60 kDa band, a 48 kDa band and 54 and 70 kDa bands, respectively, specifically labeled by ClC-K antibody. Subsequent immunohistochemical observations of the inner ear tissues with a confocal microscope on fluorescently labeled tissue sections showed the staining to be restricted to the basolateral region of strial marginal cells and vestibular dark cells. The cochlear staining was distinct from the distribution of the Kir4.1 (KCNJ10) K⁺ channel, known to be present only in strial intermediate cells. These findings support the contention that ClC-K is an important component of the basolateral Cl⁻ conductance that participates in K⁺ secretion by these epithelia.     

Potential association of pseudoexfoliation syndrome (PEX) with age-related macular degeneration (ARMD)

PURPOSE: Authors report an unexpected association between PEX and ARMD. It was an additional result of a study, that analysed possible systemic symptoms of pseudoexfoliation material in visceral organs. They reviewed literature data for both, concerning epidemiology and physiopathogeny. MATERIAL AND METHODS: We conducted an age-and sex matched study of 142 patients in Brittany, 71 PEX and 71 controls, 31 men and 40 women in the 2 groups. The statistical study was performed with Epi Info 6.0 software using the X2 of Mantel-Haenszel Test. RESULTS: Statistical positive relation was found between PEX and ARMD (p=0.02), both increasing with age. DISCUSSION AND CONCLUSION: Part of epidemiology seems to be similar in PEX and ARMD, especially environment role (particularly solar radiations), individual factors, and genetic predisposition. For the first time, in may 1999, a genetic localization of PEX was discovered on the chromosome II, and nearly of one loci of ARMD multiple localizations.     

Excimer surface photoablation versus Lasik for correction of mild myopia

INTRODUCTION: Above -6 diopters, Lasik procedure has shown its superiority in term of predictibility, efficacy and stability. In the adverse, in the field of low myopia, Lasik and surface excimer photoablation (PRK) are very controversial. We compare quantitative and qualitative outcome achieved in series of 25 PRK operated patients and 25 Lasik. MATERIAL AND METHOD: 2 homogeneous groups were constituted: group A for Excimer patients and group B for Lasik. Initial ametropia had to be ranged between -2 and -6 diopters (D), eventually associated to a myopic astigmatism that needed to be under -1,75 D. Excimer laser model was a Visx (Visx 20/20 or Star S2). In case of Lasik, flap was performed with an Automated corneal shaper microkératom (Baush & Lomb) or with a Flap Maker (Ioltech). Evaluation of refraction and visual results was associated to measurements of contrast and glare sensitivities and collection of functional complaints. RESULTS: A retrospective analysis is performed with a 2 years follow-up. At that term, rate of eyes, that achieved 20/20 or better is comparable in the two groups (62% in group A and 64% in group B). However, profile of visual recovery goes faster after Lasik. Best corrected visual acuity is favorably preserved in two groups, but is altered with glare in Lasik group. Cycloplegic refraction shows a tendency to regression more important in case of surface ablation (10% versus 4%), especially above -4 D (28%). No significant difference is noted concerning contrast sensitivity, correctly unchanged in the two groups. No case of severe complication is mentioned after both surgical methods. DISCUSSION-CONCLUSION: In the field of low myopia, PRK and Lasik appear to guarantee same predictibility and safety, in conditions of preliminary learning curve. Stability and visual recovery are earlier achieved after Lasik, in addition to postoperative indolence. However, application of this technique to all degrees of myopia requires its perfect control and an adjustment of ablation nomograms.     

Central and extrapontine myelinolysis in a patient in spite of a careful correction of hyponatremia

We report the case of a 54-year-old alcoholic female patient who was hospitalized for neurologic alterations along with a severe hyponatremia (plasma Na+: 97 mEq/l). She suffered from potomania and was given, a few days before admission, a thiazide diuretic for hypertension. A careful correction of plasma Na+ levels was initiated over a 48-hour period (rate of correction < 10 mEq/l/24h) in order to avoid brain demyelination. After a 2-day period of clinical improvement, her neurologic condition started to deteriorate. By the 5th day of admission, she became tetraplegic, presented pseudobulbar palsy, ataxia, strabism, extrapyramidal stiffness and clouding of consciousness. Scintigraphic and MRI investigations demonstrated pontine and extrapontine lesions associated with Gayet-Wernicke encephalopathy. After correction of ionic disorders (hyponatremia, hypokaliemia) and vitamin B (thiamine) deficiency, the patient almost completely recovered without notable disabilities. This case illustrates that profound hyponatremia, in a paradigm of slow onset, can be compatible with life. It also demonstrates that demyelinating lesions, usually considered as a consequence of a too fast correction of hyponatremia, may occur despite the strict observance of recent guidelines. There is increasing evidence to suggest that pontine swelling and dysfunction may sometimes occur in alcoholic patients even in absence of disturbance in plasma Na+ levels. It is therefore of importance, while managing a hyponatremic alcoholic patient, to identify additional risk factors (hypokaliemia, hypophosphoremia, seizure-induced hypoxemia, malnutrition with vitamin B deficiency) for brain demyelination and to correct them appropriately.     

Transient urethral obstruction predisposes to ascending pyelonephritis and tubulo-interstitial disease: studies in rats

Chronic tubulo-interstitial disease, an important cause of end-stage renal disease, often results from the combined effects of a disturbed urinary outflow tract and urinary tract infection. Acute unilateral ureteral obstruction in rats rapidly induces foci of medullary necrosis, confined to the region of the papilla and fornices. This injury may provide a nidus for bacterial invasion and may invoke reactive and regenerative changes, ultimately leading to chronic pyelonephritis and tubulo-interstitial nephropathy. To explore this possibility, adult rats underwent renal morphological evaluation 2–7 days following transient 24-h unilateral ureteral obstruction. In some experiments the bladder was inoculated with bacteria (10⁸–10⁹ cfu/ml Escherichia coli in 0.5 ml) after release of ureteral obstruction, with subsequent cultures obtained from the pelvis of both kidneys and from the urinary bladder. Morphologic evaluation of perfusion-fixed kidneys, 2–7 days after the release of 24-h ureteral obstruction disclosed papillary necrosis, urothelial proliferation, marked inner-stripe interstitial expansion, and fibrosis and proximal tubular (S₃) dilatation. The lateral (perihilar region) was predominantly affected, with lesions spreading from the fornices. There was some progression of interstitial fibrosis during the postobstructive time course or following more prolonged ureteral obstruction. By contrast, infection hardly contributed to the tubulointerstitial changes. In rats subjected to infection, cultures were positive in all 15 postobstructive kidneys, as opposed to five contralateral kidneys (P < 0.0001). Viable counts from the postobstructive kidney were also higher than those from the contralateral side (79,000 ± 12,000 vs 2900 ± 1600 cfu/ml, mean ± SEM, P < 0.0001), and were comparable to those obtained from the bladder (77,000 ± 13,000 cfu/ml). We conclude that transient ureteral obstruction predisposes to ascending pyelonephritis and to tubulointerstitial disease. This vulnerability may relate to altered urodynamics and medullary tissue destruction. Received: 28 December 1999 / Accepted: 28 September 2000     

Supraconservative breast surgery

Currently, 30% of the breast biopsies are performed for patients with nonpalpable lesions. The surgical management of these lesions had to evolve to a better three-dimensional targeting and a reduction of the tissue traumatism. The ABBI procedure allows the percutaneous one bloc excision of suspicious mammographically detected lesions with a diameter of less than 2cm. We prospectively evaluated this procedure as a therapeutic tool. Of the 10 malignant lesions with a pathologic size <10mm, 9 (90%) were completely resected with the ABBI device (no residual disease at re-excision of the biopsy site). The results of this preliminary study suggest a potential therapeutic role of the ABBI procedure in the therapeutic arsenal against mammary lesions.