Mechanisms of ischemic brain damage

This article provides a brief review of recent developments regarding the pathophysiology of ischemic brain damage, and offers hypotheses explaining the pathogenesis of selective neuronal vulnerability and of tissue infarction, respectively. It is suggested that selective neuronal vulnerability, observed after brief periods of ischemia and after hypoglycemic coma, qualifies as an excitotoxic lesion, which causes postsynaptic damage to neurons innervated by excitatory amino acids by enhancing calcium influx. However, ischemic damage often involves glial and vascular cells as well, and causes infarction. It is hypothesized that this type of brain damage is related to acidosis and that enhanced acidosis is detrimental because it accelerates delocalization of protein-bound iron, with an ensuing free-radical damage to membrane lipids and proteins.     

Distal nephron carcinoma: a rare kidney tumor

Bellini's duct carcinoma is a very rare tumor originating from the collecting tubules of the kidney. It should be part of differential diagnosis in cases with gross hematuria, failed diagnostic proof of a tumor within the collecting system and a centrally located hypovascular mass. Analysis of the cytoskeleton by means of cytokeratin patterns enables classification as a tumor of urothelial origin.     

Alcoholic hepatitis in females

In the period 1970-1984 alcoholic hepatitis was diagnosed by liver biopsy in 52 females. Thirty-six patients with cirrhosis were generally in a worse clinical and biochemical state than those without cirrhosis. Biochemical tests for liver function showed significant improvement from admission to the time of liver biopsy. At follow-up liver function tests were generally better in patients who had stopped drinking alcohol compared to those who continued to do so. The 5-year survival rate was 82% for females without cirrhosis, and 45% for those with cirrhosis (p less than 0.03). Considering the sex-related differences in alcohol abuse in the general population we found no evidence of increased susceptibility to the hepatotoxic effect of alcohol in females.     

Low molecular weight heparin and prevention of postoperative thrombosis in abdominal surgery.

In a prospective, double-blind, randomized multicenter trial the efficacy and safety of low molecular weight heparin and unfractionated heparin were compared for the prevention of postoperative deep vein thrombosis in patients undergoing abdominal surgery. Six hundred and seventy-three patients were randomly allocated to the two prophylaxis groups; 20 of these, however, did not undergo surgery and did not receive any prophylaxis. Of the remaining 653 patients 323 received one subcutaneous injection of 3,000 anti-Xa units of low molecular weight heparin and 330 received subcutaneously 5,000 U heparin three times a day. Treatment was initiated 2 h preoperatively and continued for 7 to 10 days. The occurrence of DVT was determined by the 125I-labelled fibrinogen uptake test and phlebography. Venous thrombosis was diagnosed in 24 of 323 patients (7.4%) treated with low molecular weight heparin and in 26 of 330 patients (7.9%) treated with low-dose heparin. DVT of proximal veins was detected in four patients of the low molecular weight heparin group and in three patients of the low-dose heparin group. During the observation period three pulmonary emboli - one fatal and two non-fatal - occurred in patients receiving prophylaxis with low-dose heparin. No pulmonary embolism was found in patients treated with low molecular weight heparin. Both prophylactic schemes were well tolerated. Intra- and postoperative blood loss, incidence of wound hematoma, frequency and volume of intra- and postoperative blood transfusion were similar in both groups with a slight advantage for the low molecular weight heparin group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ethanolamine oleate sclerotherapy for hydroceles and spermatoceles: a survey of 158 patients with ultrasound followup.

Sclerotherapy with 5% ethanolamine oleate was used to treat 102 hydroceles in 100 patients and 63 spermatoceles in 58 patients. Scrotal ultrasound examination was performed before the sclerotherapy and at each followup visit. Of the hydroceles 98% were cured completely and 68% were cured after only 1 sclerosant instillation, while 60% of the spermatoceles resolved completely and 33% partially, with 7% failures. No hydroceles recurred during an average followup of 43 months, whereas spermatocele recurred in 4 patients more than 1 year after successful treatment, with a mean followup of 46 months. Approximately half of the patients experienced pain after treatment, 3 had infection and 2 had hematoma. No changes in the structure or size of the testicles were found by ultrasound during followup. Ethanolamine oleate sclerotherapy is a safe, effective and economical form of outpatient therapy that can be recommended as primary treatment for hydroceles in adults and as an alternative to surgery for spermatoceles with 1 to 3 cysts in elderly men in whom fertility is not important.     

Occurrence of antinuclear antibodies in an unselected pregnancy population.

The occurrence of antinuclear antibodies (ANA) in an unselected population of pregnant women was studied by an indirect immunofluorescence method. Six women out of 116 were ANA-positive (5.2%), 2 of them having a moderately high titre (1:160 and 1:320) and 1 complement-fixing ANA. The antigenic specificity of ANA was anti-single-stranded DNA in 2 cases and RNAase-sensitive anti-extractable nuclear antigen in 1 case. Two of the ANA-positive women had pre-eclampsia laevis and 1 had a premature delivery. None of the infants of the ANA-positive women had symptoms of connective tissue disease. The occurrence of ANA among pregnant women was not significantly higher than among 70 non-pregnant female control subjects (7.1%).     

The grand multipara--an obstetric problem?

At the Medical Central Department of Obstetrics and Gynecology in Sibenik over 1970-1991 period there were 26,116 deliveries (multiple births excluded), of which 254 (0.97%) occurred in grand multiparas (five and more deliveries). The authors have found that the number of grand multiparas decreased by 38.3% (P < 0.001) over the past eleven years. Control subjects were 7920 multiparas (two to four deliveries, 20-34 years of age, from the same period). In 84.3% of the cases grand multiparas were delivered of their fifth or sixth infant, and 68.5% were > or = 35 years of age. Spontaneous abortion occurred in 16.9%, and 14.2% had no antenatal visit. EPH gestosis (8.3%), glucose intolerance (9.9%), preterm delivery (8.3%) and meconium-stained amniotic fluid (15.0%) were more common in the grand multiparas, whereas cervical cerclage (5.4%) and 7-to-12-hour duration of labour (12.8%) were more common in the control group. No significant differences were found in weight gain, prolonged pregnancy, caesarean delivery, assisted breech and vacuum extraction between two groups. There was also no difference in the incidence of neonatal morbidity and congenital abnormalities between the grand multiparas and controls. Late fetal and early neonatal deaths in the grand multiparous and control group occurred in 1.18% and 1.57, respectively, resulting in a 2.75% overall perinatal death rate for both groups (P > 0.05). No case of maternal death or uterine rupture occurred in either group. The authors conclude that pregnancy and delivery in grand multiparas are at higher risk due to poorer antenatal care and advancing maternal age.(ABSTRACT TRUNCATED AT 250 WORDS)     

beta-Amyloid deposits within the cerebellum of persons older than 80 years of age.

The cerebellum, frontal cortex, hippocampal and parahippocampal regions of 100 patients older than 80 years, most of whom had died of stroke, were examined. Eighteen percent were diagnosed as clinically demented. On the specimens labeled previously with Thioflavin S and Bielschowsky method, immunohistochemical studies were performed with Fab (antigen-binding fragment) of the anti beta-amyloid antibody 4G8. Positive amyloid immunoreactivity was observed in the cerebrum in 71 of 100 cases, Cerebella of 31 subjects of 71 with cerebral amyloidosis also revealed amyloid deposits. They appeared in various morphological forms, such as diffuse plaques and focal subpial deposits, as well as classical and primitive neuritic plaques. Cases with amyloid in the cerebellum alone were not observed. Beta-amyloid deposits in the cerebellum were associated with a significant number of beta-amyloid plaques in the cerebrum, which showed other Alzheimer-type pathology, also in individuals without clinical symptoms of dementia. There was no correlation either between cerebellar amyloid deposits and clinical cerebellar symptoms or between the presence of diabetes mellitus, arterial hypertension, and neuropathological changes. A clear association of microglial cells with amyloid deposits in the cerebellum was demonstrated. In our experience, LN-1 and RCA-1 were not as suitable for formalin-fixed paraffin-embedded tissue, as was anti-ferritin. Negative staining for tau-1 and positive staining for anti-ubiquitin characterized neurites within primitive and classical plaques. No neurofibrillary pathology was detected in the cytoplasm of cerebellar neurons when we used anti tau-1 labeling.