What are the symptoms of internal rectal prolapse?

Aim Although high‐grade internal rectal prolapse is believed to cause functional symptoms such as obstructed defaecation, little has been published on the exact distribution and frequency of symptoms. The aim of this study was to identify the most common symptoms of patients with high‐grade internal rectal prolapse. Method Patients were diagnosed with high‐grade prolapse (grade 3 and 4) on proctography using the Oxford Rectal Prolapse Grade. Information from a prospectively collected database was supplemented by a retrospective case note review. Results Eighty eight patients (94% of them women) were included for analysis. Faecal incontinence (56%) was the most common symptom at presentation. Symptoms related to obstructed defaecation syndrome were the next most common, including incomplete evacuation (45%), straining (34%), digital assistance (34%) and repetitive toilet visits (33%). Conclusion A variety of symptoms may be caused by high‐grade internal rectal prolapse Although symptoms of obstructed defaecation were frequent, urge faecal incontinence was the most common.     

Impact of antibiotic treatment for pulmonary exacerbations on bacterial diversity in cystic fibrosis

BackgroundA diverse array of bacterial species is present in the CF airways, in addition to those recognised as clinically important. Here, we investigated the relative impact of antibiotics, used predominantly to target Pseudomonas aeruginosa during acute exacerbations, on other non-pseudomonal species.MethodsThe relative abundance of viable P. aeruginosa and non-pseudomonal species was determined in sputa from 12 adult CF subjects 21, 14, and 7 days prior to antibiotics, day 3 of treatment, the final day of treatment, and 10–14 days afterwards, by T-RFLP profiling.ResultsOverall, relative P. aeruginosa abundance increased during antibiotic therapy compared to other bacterial species; mean abundance pre-antibiotic 51.0 ± 36.0% increasing to 71.3 ± 30.4% during antibiotic (ANOVA: F_1,54 = 5.16; P < 0.027). Further, the number of non-pseudomonal species detected fell; pre-antibiotic 6.0 ± 3.3 decreasing to 3.7 ± 3.3 during treatment (ANOVA: F_1,66 = 5.11; P < 0.027).ConclusionsAntibiotic treatment directed at P. aeruginosa has an additional significant impact on non-pseudomonal, co-colonising species.     

Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum

INTRODUCTIONThis case report outlines the investigation and management of a young patient presenting with left iliac fossa pain and sepsis. A CT was performed which was initially reported as not showing a perforation, however closer analysis provided evidence of subcutaneous emphysema in the anterior abdominal wall. This evidence justified urgent operative intervention. We review the evidence with regard to this presentation.PRESENTATION OF CASEA previously fit 24-year-old male presented with left iliac fossa pain and features of sepsis. A CT provided subtle but distinctive evidence of retroperitoneal perforation secondary to diverticulitis, in the form of surgical emphysema in the anterior abdominal wall. In view of this, urgent operation was considered justified on suspicion of visceral perforation. A diverticular perforation was confirmed intra-operatively, and a sigmoid colectomy with primary anastomosis was performed, together with a covering ileostomy. The patient made a good post-operative recovery.DISCUSSIONDiverticular disease and its complications are becoming more common in a younger age group, in whom perforation may present late or may not be suspected. In this context special attention must be paid to any radiological evidence of perforation.CONCLUSIONSurgical emphysema in the abdominal wall is an indicator of retroperitoneal perforation, and its presence should be excluded before the possibility of perforation is dismissed. This may be of especial value in younger age groups amongst whom perforation may be less clinically obvious.     

Synaptic alterations in the rTg4510 mouse model of tauopathy

Synapse loss, rather than the hallmark amyloid‐β (Aβ) plaques or tau‐filled neurofibrillary tangles (NFT), is considered the most predictive pathological feature associated with cognitive status in the Alzheimer's disease (AD) brain. The role of Aβ in synapse loss is well established, but despite data linking tau to synaptic function, the role of tau in synapse loss remains largely undetermined. Here we test the hypothesis that human mutant P301L tau overexpression in a mouse model (rTg4510) will lead to age‐dependent synaptic loss and dysfunction. Using array tomography and two methods of quantification (automated, threshold‐based counting and a manual stereology‐based technique) we demonstrate that overall synapse density is maintained in the neuropil, implicating synapse loss commensurate with the cortical atrophy known to occur in this model. Multiphoton in vivo imaging reveals close to 30% loss of apical dendritic spines of individual pyramidal neurons, suggesting these cells may be particularly vulnerable to tau‐induced degeneration. Postmortem, we confirm the presence of tau in dendritic spines of rTg4510‐YFP mouse brain by array tomography. These data implicate tau‐induced loss of a subset of synapses that may be accompanied by compensatory increases in other synaptic subtypes, thereby preserving overall synapse density. Biochemical fractionation of synaptosomes from rTg4510 brain demonstrates a significant decrease in expression of several synaptic proteins, suggesting a functional deficit of remaining synapses in the rTg4510 brain. Together, these data show morphological and biochemical synaptic consequences in response to tau overexpression in the rTg4510 mouse model. J. Comp. Neurol., 521:1334–1353, 2013. © 2012 Wiley Periodicals, Inc.     

Sustained outcomes of a peer‐taught family education program on mental illness

Objective: This study examines 6‐month follow‐up data from participants in a randomized trial of a peer‐driven 12‐session family support and education program, called family‐to‐family (FTF) and offered by the US National Alliance on Mental Illness, to determine whether improvements in distress, family functioning, coping and empowerment were sustained. Method: Individuals randomized to the FTF condition were assessed after program completion and then 3 months later on measures of distress, family functioning, coping, and empowerment. We used a multilevel regression model (sas proc mixed ) to test for significant changes over time (baseline, 3 and 9 months). Results: All significant benefits that FTF participants gained between baseline and immediately post‐FTF were sustained at 9 months including reduced anxiety, improved family problem‐solving, increased positive coping, and increased knowledge. Greater class attendance was associated with larger increases in empowerment and reductions in depression and displeasure with ill relative. Conclusion: Evidence suggests that benefits of the FTF program were sustained for at least 6 months without any additional boosters or supports. Peer‐based programs may produce sustained benefits for individuals seeking help in addressing challenges and stresses related to having a family member with a mental illness.     

Effect of familiar content on paragraph comprehension in aphasia

Background: Previous research has shown that context improves aphasic individuals' auditory comprehension. The specific contextual information that has been identified as beneficial includes semantic constraints, semantic plausibility, both predictive and non‐predictive information, and familiar topics. However, context can also include familiar content such as the names of relatives, friends, local schools, and local stores.

Aims: The purpose of the present study was to assess the influence of familiar content on comprehension in individuals with aphasia. Specifically, it assessed whether individuals with aphasia answer questions about paragraphs more accurately when the paragraphs contain familiar content than when they do not.

Methods & Procedures: Eleven participants with aphasia and eleven participants without brain damage listened to short paragraphs that differed in the familiarity of the content included. In half of the paragraphs, the people and places were generic and not known specifically by the participants. In the other half, the people and places were known by the participants (as provided by a spouse or other close individual). Approximately half of the subsequent questions asked of the participants related to this targeted information and half related to other, more generic, information in the paragraphs.

Outcomes & Results: The questions relating to the paragraphs with the familiar content were answered more accurately than were the questions relating to the paragraphs with neutral content. For the participants with aphasia, this result occurred for the questions relating to both the targeted (and thus familiar) information and the non‐targeted or neutral information. The extent to which each participant with aphasia benefited from the familiar content did not relate to age, education, time‐post‐onset, or comprehension and naming skills.

Conclusions: These results suggest that familiar content may be another type of context that enhances comprehension skills in individuals with aphasia. The results are interpreted with respect to attention and domain knowledge concepts.     

The alien limb phenomenon

Alien limb phenomenon refers to involuntary motor activity of a limb in conjunction with the feeling of estrangement from that limb. Alien limb serves as a diagnostic feature of corticobasal syndrome. Our objective was to determine the differential diagnoses of alien limb and to determine the features in a large group of patients with the alien limb with different underlying etiologies. We searched the Mayo Clinic Medical Records Linkage system to identify patients with the diagnosis of alien limb seen between January 1, 1996, and July 11, 2011. One hundred and fifty patients with alien limb were identified. Twenty-two were followed in the Alzheimer’s Disease Research Center. Etiologies of alien limb included corticobasal syndrome (n = 108), stroke (n = 14), Creutzfeldt Jakob disease (n = 9), hereditary diffuse leukoencephalopathy with spheroids (n = 5), tumor (n = 4), progressive multifocal leukoencephalopathy(n = 2), demyelinating disease (n = 2), progressive dementia not otherwise specified (n = 2), posterior reversible encephalopathy syndrome (n = 1), corpus callosotomy (n = 1), intracerebral hemorrhage (n = 1) and thalamic dementia (n = 1). Ten of 14 cerebrovascular cases were right hemisphere in origin. All cases involved the parietal lobe. Of the 44 patients with corticobasal syndrome from the Alzheimer’s Disease Research Center cohort, 22 had alien limb, and 73 % had the alien limb affecting the left extremities. Left sided corticobasal syndrome was significantly associated with the presence of alien limb (p = 0.004). These findings support the notion that the alien limb phenomenon is partially related to damage underlying the parietal cortex, especially right parietal, disconnecting it from other cortical areas.