The evolving face of human immunodeficiency virus-related progressive multifocal leukoencephalopathy: Defining a consensus terminology

There is a need for consistent definition of human immunodeficiency virus (HIV)-associated cases of progressive multifocal leukoencephalopathy (PML), especially following the profound disease changes that have resulted from the use of highly active antiretroviral therapy (HAART). According to the criteria used for diagnosis, PML cases should be either referred to as “histology-confirmed,” with evidence of JC virus (JCV) infection in brain, “laboratory-confirmed,” with detection of JCV DNA in cerebrospinal fluid (CSF), or “possible,” in the presence of typical clinical and radiological picture, but no demonstration of JCV infection. Disease outcome should be defined by the evidence or lack of evidence of disease activity, rather than using survival or other variables. Disease activity should be based on clinical (scored neurological examination), radiological (magnetic resonance imaging), and virological (JCV DNA levels in CSF) indicators, to be assessed regularly, e.g., every 3 months until evidence of disease arrest or death. Furthermore, parallel assessments of other HIV-associated manifestations, including CD4+ cell counts and viral load, are required. A standard patient classification would be helpful for clinical management of PML patients, for their inclusion in clinical studies, and also will increase our current knowledge of PML and its evolution in relation with HAART.     

Different proliferative activity of the glandular and myoepithelial lineages in benign proliferative and early malignant breast diseases.

The aim of the present study was to explore cell biological characteristics of normal breast, benign proliferative breast diseases and noninvasive breast malignancies based on the recently published adult progenitor cell concept from our group. Here, we investigated the proliferative activity of CK5/14(+), CK8/18/19(+) and alpha-smooth muscle actin(+) cellular phenotypes encountered in normal mammary gland, in a series of usual ductal hyperplasias and early malignant breast diseases, such as atypical ductal and lobular hyperplasias, as well as ductal and lobular in situ carcinomas. Immunohistochemical double labeling was performed on frozen sections from diagnostic breast biopsies by using antibodies to basal cytokeratins (CK5/14), glandular cytokeratins (CK8/18/19), smooth muscle actin and the Ki-67 antigen (MIB1). Normal breast tissues and usual ductal hyperplasias were characterized by a heterogeneous cellular composition of the growth fraction. The proliferative cell compartment consisted of CK8/18/19(+) glandular and, in a variable proportion, CK5/14(+) progenitor phenotypes. In contrast, noninvasive breast malignancies were composed of a monotonous proliferation of CK 8/18/19(+) neoplastic glandular cells. These findings indicate a significant role of progenitor cells in the development of benign proliferative breast diseases and lend support to the view that malignant transformation in the human breast usually occurs in a cell committed to the glandular lineage. Our results provide cell kinetic support to the functional progenitor cell hypothesis, and we propose this concept as an operative model for understanding benign proliferative and malignant breast diseases.     

CHRONIC ANGLE－CLOSURE GLAUCOMA MANAGEMENT BY RECONSTRUCTION OF THE ANTERIOR CHAMBER ANGLE

Aim: to estimate the efficacy of anterior chamber angle reconstruction with lens extraction and IOL implantation in chronic angle-closure glaucoma The results of treatment in 60 eyes of 52 patients (12 males and 40 females) are analyzed. Mean age of the patients was 63.7±3.7 years. Mean IOP before operation was 38 mm Hg (Mentor pneumatonograph Model 30), mean visual acuity 0.32. All the patients used hypotensive eyedrops, 18     

Development of spatial orientation during pilot training

The problem of spatial orientation of pilots flying high-altitude aircraft is in the focus of present-day aviation medicine because of a growing number of accidents in the air. One of the productive lines of research is to study spatial orientation in terms of active formation and maintenance of its imagery in a complex environment. However investigators usually emphasize the role of visual (instrumental) information in the image construction, almost ignoring the sensorimotor component of spatial orientation. The theoretical analysis of the process of spatial orientation has facilitated the development of the concept assuming that the pattern of space perception changes with growing professional experience. The concept is based on an active approach to the essence, emergence, formation and variation in the pattern of sensory perception of space in man's consciousness. This concept asserts that as pilot's professional expertise increases, the pattern of spatial orientation becomes geocentric because a new system of spatial perception evolves which is a result of the development of a new (instrumental) type of motor activity in space. This finds expression in the fact that perception of spatial position inflight occurs when man has to resolve a new motor task--movement along a complex trajectory in the three-dimensional space onboard a flying vehicle. The meaningful structure of this problem which is to be implemented through controlling movements of the pilot acts as a factor that forms this new system of perception. All this underlies the arrangement of meaningful collection of instrumental data and detection of noninstrumental signals in the comprehensive perception of changes in the spatial position of a flying vehicle.     

Gastric ulceration caused by heater probe coagulation

A double-contrast upper gastrointestinal examination on a woman who had undergone endoscopic heater probe therapy one day earlier for multiple arteriovenous malformations revealed shallow, irregular, and linear ulcers at the sites of heater probe coagulation. Multiple shallow ulcers may therefore develop as a direct complication of heater probe therapy. Radiologists should be aware of this complication to avoid diagnostic confusion in these patients.     

Experience in rendering medical care to infectious patients in Afghanistan]

For the first time it was Afghanistan where the 40th Army had faced with mass polyinfection morbidity which had a severe course and unfavourable outcome. In these conditions a new effective system of medical care to infectious patients was elaborated and applied. This system comprised a four-staged complex of medical and diagnostical measures. That made it possible to reduce the number of fatal cases by 16 times (from 0.49 to 0.03%) in 1983-1989. The total number of servicemen returned to active duty was brought up to 99.6%. The most important factors in this new system were the following: at prehospital stage--new methods in early definition of infectious patients, opportune diagnosis and emergency care; at hospital phase--new methods of triage, schemes of complex treatment for various nosological forms working principles of intensive therapy.