Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient

A 20‐year‐old woman presented with a 2‐month history of an acute symmetrical eruption, manifesting as asymptomatic ill‐defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post‐transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T‐cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.     

Retrospectively gated MRI for in vivo assessment of endothelium‐dependent vasodilatation and endothelial permeability in murine models of endothelial dysfunction

Endothelial dysfunction is linked to impaired endothelial‐dependent vasodilatation and permeability changes. Here, we quantify both of these phenomena associated with endothelial dysfunction by MRI in vivo in mice. Endothelial function was evaluated in the brachiocephalic artery (BCA) and left carotid artery (LCA) in ApoE/LDLR^?/? and high‐fat diet (HFD)‐fed mice as compared with control mice (C57BL/6J). The 3D IntraGate® FLASH sequence was used for evaluation of changes in vessels’ cross‐sectional area (CSA) and volume following acetylcholine (Ach) administration. Evaluation of endothelial permeability after administration of contrast agent (Galbumin, BioPAL) was based on the variable flip angle method for the assessment of parameters based on the relaxation time (T₁) value. In order to confirm the involvement of nitric oxide (NO) in response to Ach, L‐NAME‐treated mice were also analyzed. To confirm that endothelial permeability changes accompany the impairment of Ach‐dependent vasodilatation, permeability changes were analyzed in isolated, perfused carotid artery. In C57BL/6J mice, Ach‐induced vasodilatation led to an approximately 25% increase in CSA in both vessels, which was temporarily dissociated from the effect of Ach on heart rate. In ApoE/LDLR^?/? or HFD‐fed mice Ach induced a paradoxical vasoconstriction that amounted to approximately 30% and 50% decreases in CSA of BCA and LCA respectively. In ApoE/LDLR^?/? and HFD‐fed mice endothelial permeability in BCA was also increased (fall in T₁ by about 25%). In L‐NAME‐treated mice Ach‐induced vasodilatation in BCA was lost. In isolated, perfused artery from ApoE/LDLR^?/? mice endothelial permeability was increased. MRI‐based assessment of endothelium‐dependent vasodilatation induced by Ach and endothelial permeability using a retrospectively self‐gated 3D gradient‐echo sequence (IntraGate® FLASH) enables the reliable detection of systemic endothelial dysfunction in mice and provides an important tool for the experimental pharmacology of the endothelium in murine models of diseases in vivo. Copyright © 2016 John Wiley & Sons, Ltd.     

Preeclampsia-associated alterations in sphingolipid composition of the umbilical cord artery

ObjectivesPreeclampsia, the most common pregnancy-associated pathological syndrome, is accompanied by significant remodelling of the extracellular matrix and alteration in lipid composition of the umbilical cord artery (UCA).Design and methodsWe evaluate the sphingolipid composition of UCA and its alteration in preeclampsia. Thin layer chromatography, solid-phase extraction and high-performance liquid chromatography were employed for these analyses.ResultsThe UCA wall is abundant in sphingomyelins and ceramides, whereas the amounts of sphingoid bases are rather low. Preeclampsia is associated with significant increases in sphingomyelins and sphinganine with a decrease in ceramides and other sphingoid bases.ConclusionsSphingoids, as secondary messengers, may evoke preeclampsia-associated decrease in hyaluronate and accumulation of collagen, sulphated glycosaminoglycans and cholesterol in the UCA wall. This we propose corresponds to an “early ageing” of the umbilical cord and may be a potential mechanism by which preeclampsia evokes an initiation of hypertension in utero and its amplification through childhood and adult life.     

Association between the – 1562 C/T MMP-9 polymorphism and cerebrovascular disease in a Polish population

Background and purposeMatrix metalloproteinase 9 (MMP-9) is an endopeptidase degrading extracellular matrix. There is growing evidence that changes in extracellular matrix play an important role in vascular pathology, especially in cardiovascular and cerebrovascular disease. Previous studies have demonstrated that MMP-9 activity is controlled by –1562 C/T polymorphism. Genotypes with T allele (CT, TT) have higher enzymatic activity. Thus, this polymorphism could be responsible for the higher risk for cerebrovascular disease and death. The aim of this study was to assess the significance of MMP-9 polymorphism as a risk factor for cerebrovascular disease in a Polish population.Material and methodsA total of 775 consecutive patients with a diagnosis of cerebrovascular disease (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage) admitted to the Stroke Unit, Jagiellonian University, Krakow, Poland between 2000 and 2004 were studied and compared with 766 matched controls. The polymorphism was studied by polymerase chain reaction (PCR) and restricted enzyme digestion.ResultsAmong 418 patients with ischaemic stroke of various aetiologies and among 146 patients with primary intracerebral haemorrhage and 211 patients with subarachnoid haemorrhage due to ruptured intracranial aneurysm, statistical analysis did not show a significant difference between occurrence of CC, CT, TT genotypes or C and T alleles in patients with stroke of various aetiology compared with controls.ConclusionsWe found no association between the –1562 C/T MMP-9 polymorphism and ischaemic stroke, subarachnoid haemorrhage or spontaneous intracerebral haemorrhage in the studied Polish population.     

Partial potentials of selected cardiac muscle regions and heart activity model based on single fibres

We present single fibre heart activity model (SFHAM) based on the current flow through the five bunches of fibres of the cardiac muscle (CM). The five effective fibres are identified and assigned to the appropriate segments of CM. Analytical functions describing ionic flows along the fibres are derived and proposed. The parameters determining the shapes and amplitudes of the functions proposed are obtained on the basis of standard 12-lead ECG measurements after numerical fitting procedures concentrating on the QRS-waves. As a consequence, five independent courses of partial, transient potentials are obtained representing: anterior, inferior, lateral, posterior walls, and interventricular septum activities, respectively. Moreover, to check our theoretical results we compare the potentials calculated with those from physical measurements performed on the patient’s body surface. We expect that SFHAM will permit detection of pathological changes in particular fragments of CM.     

Anti-Vaccination Movement and Parental Refusals of Immunization of Children in USA

Despite an enormous success of the vaccination programs in the USA and an all time low incidence rate of vaccine preventable diseases (VPDs) pediatricians and family doctors are seeing increasing numbers of parents who refuse to vaccinate their children. Vaccine coverage decreases causing outbreaks of VPDs in the USA. Fear of potentially deadly diseases has been replaced by the fear of real and, more often, imaginary side effects of vaccination. This fear fuels an anti-vaccination movement with the help of media (especially Internet), celebrities, and politicians. Parents are being misled and are not trusting their doctors. After all attempts to persuade parents to vaccinate their children have failed, some doctors are refusing to see those patients. There is no easy solution to the problem, however, most important is to continue public education and persuasion and addressing vaccine refusal by respectfully listening to parental concerns and discussing the risks of nonvaccination.     

Soft tissue rebalancing procedures with and without internal rotation osteotomy for shoulder deformity in children with persistent obstetric brachial plexus palsy

Introduction  

Children with obstetric brachial plexus palsy (OBPP) frequently have problems related to their shoulder. The aim of the investigation was to determine our results in treating shoulder deformity with tendon transfers and soft tissue releases with and without internal rotational osteotomy. We also evaluated the relationships between neurological status, age and selected clinical parameters.     

Neurogenic stunning of left ventricle following epileptic seizures in a patient with aortic regurgitation and Niemann-Pick disease

A case of a 19 year-old female with the Niemann-Pick disease and transient left ventricular dysfunction following epileptic seizures is presented. Electrocardiographic features and differentid diagnosis of this condition are presented. Kardiol Pol 2011; 69, 12: 1276-1279.