Creutzfeldt-jacob disease: a comparative light-microscopic, histochemical and electron-microscopic study.

The morphological and histochemical findings in a brain biopsy of a case of Creutzfeldt-Jacob disease are compared. The histochemical changes in the cytoplasm of the neurons precede the morphological alterations found with the electron microscope. In this way the neuronal enzymatic failure can explain the clinical picture of this disease.     

Thoracic wall involvement by Hodgkin disease and non-Hodgkin lymphoma: CT evaluation

Thoracic computed tomographic (CT) scans of 250 patients with newly diagnosed or recurrent lymphoma revealed thoracic wall involvement in 24 patients (11 with Hodgkin disease, 13 with non-Hodgkin lymphoma). Thoracic wall involvement occurred without contiguous mediastinal or parenchymal involvement in 17 patients. Of these, 13 patients had masses beneath the pectoralis muscles or within the breast, and four had masses arising from the ribs. Five additional patients had mediastinal masses with thymic involvement and parasternal extension through the thoracic wall. Pulmonary parenchymal lymphoma with thoracic wall invasion was noted in the remaining two patients. In five of nine patients receiving radiation therapy, treatment plans were modified by CT demonstration of thoracic wall lymphoma.     

Neuroradiologic findings in a young patient with characteristics of Sturge-Weber syndrome and Klippel-Trenaunay syndrome

The patient presented here has extensive hemangiomata plana, especially on the right forehead, right upper eyelid, and right leg, as well as right leg hypertrophy and macrocephaly. Cerebral magnetic resonance imaging (MRI) showed abnormalities in only one occipital lobe consisting of focal cortical atrophy, leptomeningeal enhancement, and ipsilateral choroid plexus enlargement. Mental and motor development is normal, and he has no seizures. The parents are consanguineous. Leg hypertrophy associated with ipsilateral cutaneous vascular malformations is suggestive of Klippel-Trenaunay syndrome. The patient's central nervous system abnormalities on MRI and the hemangiomata plana on the ipsilateral upper eyelid and forehead point to Sturge-Weber syndrome. We conclude that the patient has an overlap syndrome between Klippel-Trenaunay syndrome and Sturge-Weber syndrome.     

Glutamine: metabolism and application in nutrition support

Glutamine is the most abundant free amino acid in the body. It is avidly consumed by rapidly dividing cells, such as those lining the gut, because its 5-carbon skeleton can provide energy whilst the nitrogen molecules support the synthesis of nucleic acids. Patients who are maintained using conventional solutions of parenteral nutrients become depleted in glutamine, which has led to the reclassification of glutamine as a conditionally essential nutrient. Unfortunately, glutamine is unstable in solution and produces toxic byproducts on decomposition. This means that solutions of nutrients containing glutamine have a relatively short half-life, which has led to the commercialisation of stable dipeptides containing glutamine. Although it is evident that glutamine enhances nitrogen metabolism, there is a lack of consistent evidence from the initial clinical trials demonstrating that supplementation with glutamine has specific clinical advantages. The next few years will witness the performance of larger scale clinical trials and the results of these studies should define a more certain role for glutamine in routine clinical practice.     

A rapid agglutination assay to detect anti-streptokinase antibodies

Background Streptokinase resistance may cause suboptimal thrombolytic therapy. Aim To develop a rapid latex-bead assay to detect streptokinase antibodies. Methods Sera were obtained from 16 patients presenting with acute myocardial infarction (MI) before treatment with streptokinase and 1 and 6 months post treatment, and from 100 controls. Sera were assayed for anti-streptokinase antibodies using a functional streptokinase-neutralising assay. Results Streptokinase-neutralising activity was low in controls (54±5U/ml) and patients prior to treatment (101±18), increasing to 2,110±823 and 1,017±169 at 1 and 6 months (mean±SEM). The latex assay had a sensitivity of 94% and a specificity of 93% for detecting individuals with >350U/ml of streptokinase resistance, which is sufficient to neutralise the drug clinically. Conclusions Estimation of streptokinase resistance using an enzyme immunoassay and a latex bead assay correlated well with serum neutralising activity. This assay can rapidly identify patients who have a high level of streptokinase-neutralising activity.