Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. Autopsy evidence for respiratory acquisition.

Microsporidia are obligate intracellular protozoal parasites that infect a variety of cell types in a broad range of invertebrates and vertebrates. They have recently come to medical attention due to the increased frequency with which members of two microsporidian genera, Enterocytozoon and Encephalitozoon, are being diagnosed in patients with the acquired immunodeficiency syndrome (AIDS). The majority of published reports of human microsporidiosis describe Enterocytozoon infection of small intestinal enterocytes. In addition, a growing number of AIDS patients have been identified with infection due to the two species of Encephalitozoon-Encephalitozoon cuniculi and Encephalitozoon hellem, observed in conjunctival, corneal, and, recently, sinonasal tissues. However, there are scant data regarding the systemic pathology and epidemiology of these infections. This article describes a patient with AIDS who died with systemic Encephalitozoon infection. The etiologic microsporidian was found to be E hellem by using antemortem biochemical and antigenic analyses. A complete autopsy, the first to be reported in a patient with this infection, revealed organisms in the eyes, urinary tract, and respiratory tract. A surprising observation was the occurrence of numerous organisms within the lining epithelium of almost the entire length of the tracheobronchial tree, suggestive of respiratory acquisition. Detailed light and electron microscopic findings and the biological and diagnostic features of microsporidiosis are discussed.     

Differential modulation of Purkinje cell activity by enkephalin and corticotropin releasing factor.

Several peptides have been localized within afferents to the opossum's cerebellum, including cholecystokinin (15), enkephalin (16, 17) and corticotropin releasing factor (7, 9). Each of these peptides has a heterogeneous laminar and lobular distribution. Two peptide, enkephalin (ENK) and corticotropin releasing factor (CRF) are present in specific populations of climbing fibers and mossy fibers, which have an overlapping distribution in several areas of the cerebellum, in particular the lateral aspect of vermal lobules VII and VIII. Within this location ENK and CRF are co-localized in individual climbing fibers and mossy fibers (7). In the present study, the physiological effects of these peptides on Purkinje cell activity were analyzed. The data indicate that ENK and CRF have opposite effects on Purkinje cell activity. ENK suppresses spontaneous activity as well as that induced by application of glutamate and aspartate, as described previously (5). In contrast, CRF enhances both spontaneous and amino acid-induced unit activity. Further, when applied simultaneously, CRF blocks the suppressive effect induced by ENK. Previous studies have shown that climbing fibers, as well as the mossy fiber-parallel fiber pathway, are excitatory to Purkinje cells (11). However, immunohistochemical data have shown that these afferents are heterogeneous with respect to their chemical content (7-9, 15-17, 25). As found in the current and previous studies (3, 5) peptides in climbing and mossy fibers modulate the responsiveness of Purkinje cells to primary excitatory neurotransmitters in selected areas of the cerebellar cortex. However, the firing rate of individual Purkinje cells is differentially altered depending on which neurochemical messenger(s) are released.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dissociation of the Medial Prefrontal, Posterior Parietal, and Posterior Temporal Cortex for Spatial Navigation and Recognition Memory in the Rat

Rats with lesions of the medial prefrontal, posterior parietal,or posterior temporal cortex were tested in five spatial navigationtasks, which varied in egocentric or allocentric demands, avisual discrimination task, and two delayed nonmatching-to-sampletasks. Rats with prefrontal lesions were impaired at every spatialnavigation task, whereas rats with posterior parietal lesionshad selective spatial navigation impairments. Rats with prefrontallesions were also impaired at a visual delayed nonmatching-to-sampletask, as they were unable to learn the task, even with no delay.The results are consistent with the idea that the basic planof mammalian cortex includes prefrontal, posterior parietal,and posterior temporal regions, each of which have generallysimilar functions across mammalian taxa. There are, however,species-typical differences that reflect specific ecologicalpressures on the development of the different regions.     

Frame-based immobilization and targeting for stereotactic body radiation therapy.

Frame-based stereotactic body radiation therapy (SBRT), such as that conducted with Elekta's Stereotactic Body Frame, can provide an extra measure of precision in the delivery of radiation to extracranial targets, and facilitates secure patient immobilization. In this paper, we review the steps involved in optimal use of an extra-cranial immobilization device for SBRT treatments. Our approach to using frame-based SBRT consists of 4 steps: patient immobilization, tumor and organ motion control, treatment/planning correlation, and daily targeting with pretreatment quality assurance. Patient immobilization was achieved with the Vac-Loc bag, which uses styrofoam beads to conform to the patient's shape comfortably within the body frame. Organ and motion control was assessed under fluoroscopy and controlled via a frame-mounted abdominal pressure plate. The compression screw was tightened until the diaphragmatic excursion range was < 1 cm. Treatment planning was performed using the Philips Pinnacle 6.2b system. In this treatment process, a 20 to 30 noncoplanar beam arrangement was initially selected and an inverse beam weight optimization algorithm was applied. Those beams with low beam weights were removed, leaving a manageable number of beams for treatment delivery. After planning, daily targeting using computed tomography (CT) to verify x-, y-, and z-coordinates of the treatment isocenter were used as a measure of quality assurance. We found our daily setup variation typically averaged < 5 mm in all directions, which is comparable to other published studies on Stereotactic Body Frame. Treatment time ranged from 30 to 45 minutes. Results demonstrate that patients have experienced high rates of local control with acceptable rates of severe side effects - by virtue of the tightly constrained treatment fields. The body frame facilitated comfortable patient positioning and quality assurance checks of the tumor, in relation to another set of independent set of coordinates defined by the body frame fiducials. The ability to impose abdominal compression proved to be a simple way to reduce target and tissue motion. SBRT with Stereotactic Body Frame enables comfortable patient immobilization and facilitates repeated registering and re-registering of the patient to the frame. With the body frame, large-dose-per fraction treatment is possible for localized tumor deposits with the aim of attaining a more therapeutic result.     

Variable power output during cycling improves subsequent treadmill run time to exhaustion.

The aim of this study was to investigate the effect of constant versus variable power output cycling exercise on subsequent high-intensity, running performance. Eight triathletes completed two testing sessions (in a random order), which required the subjects to perform 30 min of cycling at either, a constant power output (90% of the lactate threshold), or a variable power output with power output alternating every 5 min (+/-20% of the constant workload). Each cycling bout was immediately followed by a high-intensity treadmill run (16.7+/-0.7 km h(-1)) to exhaustion. No significant differences were found for mean metabolic values or power output between cycling conditions. However, a significant (P<0.05) improvement in run time to exhaustion was reported after 30 min of variable cycling (15:09+/-4:43 min) compared to constant cycling (10:51+/-3:32 min). The results of this study demonstrate that, despite similar average physiological responses during 30 min of cycling, variable-intensity cycling results in an improved running performance compared to constant-intensity cycling. It is hypothesised that the reduced power output in the final 5 min of variable cycling protocol may allow recovery before transition, however the mechanisms involved cannot be determined from the current study.     

Randomized comparison between two microlaparoscopic techniques for partial salpingectomy.

OBJECTIVE: We compared 2 techniques for performing a partial salpingectomy by using microlaparoscopy and either bipolar coagulation or loop ligation. METHODS: A 3-mm transumbilical laparoscope with secondary midline port sites midway and suprapubically was used to perform a partial salpingectomy in 109 women desiring permanent sterilization. Each patient was randomly assigned to undergo a tubal resection either after Pomeroy ligation (n= 54) or after bipolar coagulation with Kleppinger forceps (n=55). Postoperative pain, as assessed using a 10-point visual analog scale, was the primary comparison endpoint. RESULTS: No technical difficulties with either technique required conversion to a minilaparotomy. The mean time to remove both tubal segments was not different between techniques (7 minutes, 21 seconds; range, 4 minutes, 25 seconds to 15 minutes, 43 seconds). Each segment (mean, 1.6 cm; range, 0.8 to 3.5 cm) was confirmed in the operating room, then histologically. Postoperative pain at 6 hours was scored similarly (median, ligation 4.6, coagulation 4.0 of 10). Outpatient recovery was the same, unless pelvic pain required overnight observation (ligation, 4 patients; coagulation, 2 patients). CONCLUSION: Partial salpingectomy, using microlaparoscopy with either bipolar coagulation or loop ligation, was performed with comparable ease, confirmation of the removed tube, and similar postoperative discomfort.