Ocular pathology in acquired immunodeficiency syndrome

The gross and microscopic ocular findings were prospectively studied in 38 human immunodeficiency virus (HIV)-seropositive subjects undergoing postmortem examination. Pathologic lesions were detected in 27 patients (71%), including cytomegalovirus retinitis in 7, cytoid bodies in 6, cryptococcosis in 6, and choroidal histoplasmosis, mycobacteriosis, choroidal lymphoma, optic nerve demyelination, and microglial nodule formation in the optic nerve in 1 patient each. Of the abnormal ocular findings, 67% were detected only microscopically. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Redistribution of regional and organ blood volume and effect on cardiac function in relation to upright exercise intensity in healthy human subjects

To determine the effect of relative exercise intensity on organ blood volume and its relation to cardiac function, changes in relative blood volume and cardiac function were monitored with radionuclide techniques in 14 healthy volunteers. After labeling the subject's red cells with technetium 99m, we acquired data at rest, zero-load cycling, and at 50%, 75%, and 100% of maximal oxygen uptake. From rest to zero-load cycling, leg blood volume decreased 32 +/- 2% (mean +/- SEM), whereas relative end-diastolic blood volume increased 9.6 +/- 1.2%, and lung blood volume increased 18 +/- 2%, suggesting that the lungs may act as a blood volume buffer during periods of acutely increased venous return. With relative increasing exercise, leg blood volume stabilized, and then the blood volume in the abdominal organs decreased, further augmenting cardiopulmonary blood volume; leg blood volume and abdominal blood volume decreased by 23 +/- 2% and 19 +/- 2% from baseline, respectively, whereas thoracic blood volume increased 38 +/- 4%. In the abdomen, large decreases in blood volume were observed in the spleen (46 +/- 2%), kidney (24 +/- 4%), and liver (18 +/- 4%). In contrast, lung blood volume increased 50 +/- 4%, with the upper lung fields increasing more than the lower. Blood sampling revealed an increase in the hematocrit level by 4.3 +/- 0.4 units at peak exercise that paralleled the decrease in splenic blood volume (r2 = -0.64, p less than 0.001), suggesting a role for the spleen in augmenting cardiovascular performance by the release of concentrated red blood cells into general circulation. We conclude that upright exercise results in marked blood volume shifts from the legs and abdominal organs to the heart and lungs in a dynamic process correlating closely with oxygen consumption.     

Juvenile sea bass (Dicentrarchus labrax L.) enzymatic and non-enzymatic antioxidant responses following 17β-estradiol exposure

In the context of 17β-estradiol (E2) as an environmental contaminant, this study was designed to test the hypothesis whether it can modulate antioxidant defenses in Dicentrarchus labrax, taking gills as the target organ. Enzymatic (GPX−glutathione peroxidase; CAT-catalase; GR-glutathione reductase; GST-glutathione S-transferase) and non-enzymatic antioxidants (NP-SH-non protein thiols; GSHt-total glutathione) were measured following 10-day exposure to E2 in two different ways: water diluted (WD, 200 or 2,000 ng/L) and intraperitoneally injected (IP, 0.5 or 5 mg/kg). WD exposure caused a single alteration—CAT increase, whereas IP exposure decreased all the enzymatic antioxidants. Similarly, NP-SH and GSHt were reduced by IP exposure. Thus, different E2 exposure routes determined clear differences on the assessed responses. Despite gills close contact with water, their defenses were not strongly affected in WD experiment. Differently, IP injected fish showed an overall decrease in both enzymatic and non-enzymatic antioxidants, more pronounced at the highest concentration, pointing out the E2 oxidative stress inducing potential in fish.     

First case of deletion of the faciogenital dysplasia 1 (FGD1) gene in a patient with Aarskog–Scott syndrome

Mutations within the faciogenital dysplasia 1 (FGD1) gene in individuals with clinical features of Aarskog–Scott syndrome (AAS) include missense mutations and insertions and deletions that result in frameshifts and premature terminations. Whole gene deletion and duplication represent other mutational possibilities not yet reported for FGD1 but known to exist for other genes such as MECP2. We report the first case of a boy with clinical features of AAS with deletion of FGD1 gene identified using an oligonucleotide-based X chromosome-specific microarray after attempts to generate amplicons for all of the FGD1 coding exons failed and BAC microarray analysis showed no abnormality.     

A study of the knowledge and attitudes of emergency physicians and plastic surgeons in the management of snakebites

Snakebites in the UK are uncommon. In the UK and Europe, they occur less frequently compared to the Americas, Africa and Asia. In the UK, there is only one known indigenous poisonous snake, Vipera berus, the adder, but other snake species may be found in private collections or zoos. Snakebites in the UK tend to occur in certain ‘hotspots’ namely rural areas, forestry or in national parklands; parts of Scotland, Wales and the counties of Norfolk, Devon and Cornwall where the largest population of snakes exist. In the UK, the majority of snakebites are managed by emergency physicians; however, a small but significant proportion can develop complications which necessitate management by plastic and reconstructive surgeons and/or other medical specialists. Fortunately in the UK, very few indigenous snakes envenomate; therefore, we do not see the devastating and, in some cases, fatal consequences of snakebites including the cardiovascular, neurological and cutaneous sequelae. The objective of the survey performed was to provide insight into the knowledge and attitude of emergency physicians and plastic surgeons in the management of snakebites. In general, there was a good level of previous experience of managing snakebites abroad in the vast majority of cases. However, the survey findings indicated poor knowledge of the consequences of snakebites and the administration of antivenom. The authors feel better awareness and training for clinical staff who may be asked to deal with such problems would be of great benefit. Further, public awareness for holiday makers should be improved in an effort to reduce the numbers of snakebites which commonly occur in the UK.     

Accuracy of CT in the measurement of stapes prostheses using a temporal bone model

Objectives. Current 3D temporal bone models have either lacked the resolution (if volume‐rendered from imaging)¹ or lacked the interactivity (if surface‐rendered from sections)² necessary for surgical training. The objective was to produce a 3D volume‐rendered temporal bone model from serial sections. Method. High resolution images were acquired from serial histological sections of the temporal bone using a Canon SLR digital 8‐megapixel camera. Image registration was performed by aligning in Adobe Photoshop on a PC with a 256 Mb graphics card. Segmentation of surgically relevant anatomical structures was performed followed by 3D volumetric reconstruction. The model was finally checked for anatomical accuracy and interactivity by practicing otologists. Results. An anatomically accurate, high resolution 3D volume‐rendered model of the temporal bone was produced, containing many of the surgically relevant structures the otologist may come across during surgery. The course of the facial nerve, the labyrinth, internal carotid artery, jugular vein and all the ossicles where visualised (including the stapes footplate) along with the internal and external auditory meati and even the chorda tympani nerve in some projections. The model was interactive with the ability to rotate it in any plane, zoom into areas of interest and ‘cut’ volume to reveal underlying structures. Conclusions. To the best of our knowledge, this is the world's first 3D volume‐rendered model of the temporal bone from histological sections. At a time of difficulty in procuring cadaveric bones, this model could be a major aid to improving the future training of surgeons performing procedures on the temporal bone. References. 1 Wiet G.J., Schmalbrock P., Powell K. & Stredney D. (2005) Use of ultra‐high‐resolution data for temporal bone dissection simulation. Otolaryngol. Head Neck Surg. 133, 911–915 2 Mason T.P., Applebaum E.L., Rasmussen M., Millman A., Evenhouse R. & Panko W. (2000) Virtual temporal bone: creation and application of a new computer‐based teaching tool. Otolaryngol. Head Neck Surg. 122, 168–173