Anterior ischaemic optic neuropathy secondary to cluster headache

This report describes a patient with cluster headache who developed anterior ischaemic optic neuropathy during an attack of headache, an association not previously described. A possible pathophysiologic mechanism based upon the understanding of optic disc physiology and ocular vascular pathology in headache syndromes is proposed.     

Characterization of a naturally occurring protease inhibitor in the hemolymph of the scorpion, Heterometrus bengalensis.

A protease inhibitor has been purified by ultracentrifugation, affinity chromatography on trypsin-sepharose 4B, and chromatofocusing on PBE-94 from hemolymph of the scorpion Heterometrus bengalensis. Homogeneity of the protease inhibitor was demonstrated by high performance liquid chromatography (HPLC). The protease inhibitor is a monomeric glycoprotein with a molecular weight of 120,000 dalton, which is stable between pH 4 and pH 8. The molecule inhibits serine proteases like trypsin and -chymotrypsin and shows a noncompetitive mode of inhibition towards trypsin, with a Ki value of 6.1 × 10⁻⁶ mM. Amino acid analysis shows a preponderance of aspartic acid, glutamic acid, serine, and glycine. The protease inhibitor is efficient in inhibiting phenoloxidase activity in both the hemolymph and the isolated phenoloxidase. Melanin synthesis by phenoloxidase may be influenced by this protease inhibitor.     

Thermotropic polyesters with flexible spacers in the main chain and oligo(oxyethylene) substituents

An expanded series of alkoxy-and oligo(oxyethylene)-substituted thermotropic polyesters with flexible decamethylene spacers in the main chain, which have higher molecular weights than those described in an earlier report, were prepared and characterized. All of the polymers in the series are soluble in common organic solvents, and have low melting temperatures (T_m) and isotropization transition temperatures (T_i). The members of the series with oligo(oxyethylene) substituents form both smectic and nematic phases.     

T-lymphocytes escape membrane defect in paroxysmal nocturnal haemoglobinuria

Erythrocytes, granulocytes and platelets from patients with paroxysmal nocturnal haemoglobinuria (PNH) are abnormally sensitive to lysis by complement. We studied T-lymphocytes from PNH patients for abnormal complement lysis sensitivity. T-lymphocytes free of other contaminating blood cells were prepared by sedimentation, nylon wool filtration, and density gradient centrifugation. The lymphocytes were then labelled with ⁵¹Cr and lysis induced by antithymocyte globulin and rabbit complement. PNH lymphocytes were no more susceptible to complement-mediated lysis than lymphocytes from normal individuals. The unusual sensitivity of PNH erythrocytes could still be demonstrated when rabbit serum was a source of complement so the lack of any difference in the sensitivity of normal and PNH lymphocytes was probably not attributable to the inability of rabbit serum to elicit the membrane defect. PNH erythrocytes and granulocytes also acquire more membrane-bound C3 when human complement is activated. Therefore we also searched for increased membrane C3 binding on PNH lymphocytes using anti-I antibody and human serum as a complement source. C3 binding was measured using ¹²⁵I labelled monoclonal mouse anti-human C3. While we verified increased membrane C3 binding on PNH granulocytes during complement activation we were unable to show similar differences between PNH and normal T-lymphocytes. Thus PNH T-lymphocytes do not share the membrane abnormalities of PNH erythrocytes and granulocytes.     

Effects of prostatectomy on testicular androgenesis and serum levels of gonadotropins in mature albino rats

The effects of prostatectomy on testicular steroidogenic enzymes, and on serum levels of gonadotropins, prolactin, and testosterone were studied. Adult male rats were prostatectomized and sacrificed after 14 and 21 days. There was augmentation of both Δ⁵-3β-hydroxysteroid dehydrogenase (Δ⁵-3β-HSD) and 17β-hydroxysteroid dehydrogenase (17β-HSD) activities in the testes along with increased levels of FSH, prolactin, and testosterone in the serum, while no changes were observed in serum levels of LH. Hence it may be concluded that the prostate gland has an inhibitory effect on testicular androgenesis and can exert some influence in the regulation of FSH and prolactin secretion.     

Plasma thyroxine levels in freshwater perch: Influence of season,gonadotropins, and gonadal hormones

Plasma thyroxine (T₄) of a freshwater female perch Anabas testudineus (Bloch) has been measured by specific radioimmunoassay (RIA). Monitoring of plasma T₄ throughout the year showed that July to early September (spawning stage) had the highest T₄ and late September to January (postspawning stage) had the lowest T₄. The plasma T₄ cycle was coincident with the ovarian cycle. Treatment of intact perch with salmon gonadotropin (SG-G100) or ovine LH (500 ng/100 g body wt) markedly enhanced plasma T₄ levels. Ovine FSH was without any effect. Ovarian steroids, estrone and 17β-estradiol (100 ng/100 g body wt), also significantly augmented T₄ level whereas estriol or progesterone had no such effect. There was a striking fall of plasma T₄ in ovariectomized fish. The drop of T₄ due to ovariectomy could not be reversed by SG-G100 but administration of estrone or 17β-estradiol to ovariectomized fish effectively reversed the drop of plasma T₄ level. These findings suggest that gonadotropin's stimulatory effect on perch thyroid is mediated via the release of ovarian steroids.     

Risk group stratification in patients undergoing permanent (125)I prostate brachytherapy as monotherapy

PURPOSE: Patients undergoing prostate brachytherapy (PB) as monotherapy are often selected on the basis of favorable pretreatment factors. However, intermediate and high-risk prostate cancer patients are commonly offered PB as monotherapy without the addition of external beam radiotherapy (EBRT) or hormonal therapy. This series reports the outcome of patients undergoing PB as monotherapy who were stratified into low, intermediate, and high-risk groups with extended follow-up. METHODS AND MATERIALS: A total of 102 patients with clinically localized prostate cancer underwent PB alone as monotherapy. EBRT or hormonal therapy was not part of their initial treatment. Prostate-specific antigen (PSA) relapse-free survival (PRFS) was determined in accordance with the American Society for Therapeutic Radiology and Oncology consensus statement. Patients were stratified as at favorable risk (Stage T1-2a, pretreatment PSA < or =10.0 ng/mL, and Gleason score < or =6), intermediate risk (one prognostic indicator with a higher value), or unfavorable risk (> or =2 indicators with higher values). The median follow-up period for patients in this series was 7 years (range 2.1-9.7). The median age at treatment was 71 years (range 54-80), and the median prescribed dose of (125)I was 145 Gy. RESULTS: Forty patients experienced a biochemical relapse at a median of 1.9 years (range 0.4-4.2). The 5-year actuarial PRFS rate for patients with favorable, intermediate, and unfavorable risk was 85%, 63%, and 24%, respectively (p <0.0001). All but 1 patient had the relapse within the first 5 years of treatment. When stratifying patients on the basis of their pretreatment PSA level, the 5-year PRFS rate for men with a PSA < or =10 ng/mL vs. >10 ng/mL was 78% vs. 35%, respectively (p = 0.0005). Furthermore, the 5-year PRFS rate for men with a Gleason score of < or =6 vs. > or =7 was 74% vs. 33%, respectively (p = 0.0001). No difference was found between Stage T1-T2a and Stage T2b or higher (64% vs. 54%, respectively; p = 0.353). CONCLUSION: On the basis of risk stratification, PB as monotherapy produces comparable PRFS to EBRT and surgery at 7 years of follow-up. PB as monotherapy is particularly ineffective in patients with unfavorable risk factors, and additional therapy is warranted.     

Is procedural sedation with propofol acceptable for complex imaging? A comparison of short vs. prolonged sedations in children

Background

Concerns exist in the community of non-anesthesiologist sedation providers regarding the appropriateness of prolonged sedations using propofol for outpatient procedures.

Objective

To investigate interventions required, completion rate and resource use in prolonged vs. short sedations using propofol in outpatients.

Materials and methods

We reviewed retrospectively 213 children sedated with propofol by a non-anesthesiologist sedation service. Cohorts were composed a priori of children sedated for ≥1 h and <1 h. Comparisons were made regarding need for interventions, sedation duration, sedation completion to discharge time, and procedural completion rate.

Results

Most sedations were for MRI (87.5% short vs. 94.5% prolonged) with no statistically significant difference in overall need for interventions (75.2% prolonged vs. 65.4% short) nor completion to discharge times (30.7?±?11.5 min [prolonged] vs. 30.3?±?11.7 min [short]) between both groups. One child failed to complete the intended scan. No one required endotracheal intubation or unplanned admission.

Conclusion

Prolonged outpatient sedations with propofol conducted by appropriately trained non-anesthesiology sedation providers appears effective for imaging procedures with no increase in interventions or increased resource burden compared to short sedations. This information can assist all stakeholders in determining scope of practice and guidelines for moderately longer pediatric sedations with propofol.     

Comparison of Accessibility among Vision-impaired Patients Visiting Mobile and Stationary Hospitals in Rural Bangladesh

The aim of this study is to compare accessibility of vision-impaired (VI) patients to other eyecare centres before attending the mobile and stationary hospitals. Under a cross-sectional study design, VI patients were consecutively enrolled if they visited one of the three Impact Foundation Hospitals—one mobile and two stationary hospitals. The cost and service output of all hospitals were also reviewed; 27.7% of patients at the mobile and 36.8% at the two stationary hospitals had sought eyecare at other health facilities in the past. Mobile hospital patients lived closer to the hospital but spent more time in travelling, bore less direct cost, needed less extra support, and had a higher level of satisfaction on the service. They also identified more barriers to access eyecare in the past. The mobile hospital had a higher percentage of patients with accessibility problems and should continue to help the remote population in overcoming these problems.Key words: Health science accessibility, Mobile hospital, Vision impairment, Bangladesh