Subdural hematomas and isolated transient aphasia

Chronic subdural hematoma (CSDH) is particularly common in the older patient. Chronic subdural hematoma can present with atypical, and sometimes unusual, manifestations. It has an insidious onset and can, at times, be very difficult to diagnose. The most frequent presenting symptoms are headache, changes in mental status, and hemiparesis. Chronic subdural hematoma might also present as a transient ischemic attack. Here we report a case of CSDH that presented with intermittent aphasia and no other neurological deficit. Chronic subdural hematoma usually begins with a hemorrhage into the subdural space, which then becomes encapsulated by a membrane with abundant abnormal vessels in the outer portion of the membrane. Chronic subdural hematoma is a distinct and interesting clinical entity with diverse and insidious onset. A high index of suspicions is needed to make the early diagnosis and to start appropriate treatment to avoid morbidity and mortality.     

Prevalence of hypothyroidism in a southeastern nursing home

BACKGROUND: It is common to find older patients who have received thyroid hormone replacement for years without clear-cut documentation of hypothyroidism. The diagnosis of hypothyroidism in older patients presents a difficult problem. OBJECTIVE: We sought to determine the prevalence of hypothyroidism and the sensitivity of clinical determinants for hypothyroidism during withdrawal of thyroid hormone therapy (vital signs, weight, MMSE, and depression scale) in a nursing home population. METHODS: We studied a cohort of patients in two nursing centers in southeast Georgia. Those receiving thyroid hormone without documented hypothyroidism had complete a physical examination and serum TSH, MMSE,depression scale assessment at baseline and 3 and 6 weeks after discontinuation of thyroid therapy. Weights and vital signs were monitored throughout the study. The hypothyroid state was defined by an attending physician by clear documentation of elevated TSH > 10 microIU/mL and clinical manifestation of hypothyroidism. RESULTS: Thirteen of 129 patients were receiving thyroid supplement; seven had documented hypothyroidism. Five of the six without documented hypothyroidism completed the study. Three of those five were found to be hypothyroid (TSH: 69.4-110.4 microIU/mL at 6 weeks of thyroid therapy). Among the clinical determinants, only weight correlated with elevated TSH and hypothyroidal state. At 6 weeks, the other two patients had borderline elevation of TSH, and one patient normalized at 4 months. Both had negative antimicrosomal antibodies and were considered euthyroid. CONCLUSIONS: The prevalence of true hypothyroidism ranged from 6.2% to 7.8%. We identified unnecessary therapy in two of 13 patients. Increased weight was the most sensitive indicator of evolving hypothyroidism.     

Oestrogen and cortisol producing adrenal tumour.

A 14 year old boy is presented who was admitted to the psychiatric ward because of delirium. He also had gynaecomastia, facial oedema, striae, and hypertension. He was finally proved to have a mixed oestrogen and cortisol producing adrenal tumour which was removed surgically with complete improvement and no relapse.     

Effect of Different Rest Intervals on the Exercise Volume Completed During Squat Bouts

The purpose of this research was to compare effect 3 different rest intervals on the squat volume completed during a workout. Twenty college-aged men volunteered to participate in this study (age 20.73 ± 2.60 years; body mass 80.73 ± 10.80 kg). All subjects performed 3 testing sessions, during which 4 sets of the squat was performed with 85% of a 1RM load. During each testing session, the squat was performed with a 1, 2, or 5-minute rest interval between sets. Volume was defined as the total number of repetitions completed over 4 sets for each rest condition. Statistical analysis was conducted separately for the squat. One-way repeated analyses of variance with Bonferroni post hocs demonstrated significant differences between each rest condition for both exercises tested (p < 0.05). The 5-minute rest condition resulted in the highest volume completed, followed in descending order by the 2- and 1-minute rest conditions. The ability to perform a higher volume of training with a given load may stimulate greater strength adaptations.

Key Points

• There is no significant difference in the squat volume between the 1- and 2-minute rest conditions.
• A 5-minute rest interval between sets allow for the highest volume to be completed when training with 85% of a 1RM load.

Key words: Strength training, recovery, squat, recruitment     

Vascular dysfunction of venous bypass conduits is mediated by reactive oxygen species in diabetes: role of endothelin-1

Diabetes is associated with increased risk for complications following coronary bypass grafting (CABG) surgery. Augmented superoxide (*O2*) production plays an important role in diabetic complications by causing vascular dysfunction. The potent vasoconstrictor endothelin-1 (ET-1) is also elevated in diabetes and following CABG; however, the effect of ET-1 on *O2* generation and/or vascular dysfunction in bypass conduits remain unknown. Accordingly, this study investigated basal and ET-1-stimulated *O2* production in bypass conduits and determined the effect of *O2* on conduit reactivity. Saphenous vein specimens were obtained from nondiabetic (n = 24) and diabetic (n = 24) patients undergoing CABG. Dihydroethidium staining and NAD(P)H oxidase activity assays (5380 +/- 940 versus 16,362 +/- 2550 relative light units/microg) demonstrated increased basal *O2* levels in the diabetes group (p < 0.05). Plasma ET-1 levels were associated with elevated basal *O2* levels, and treatment of conduits with exogenous ET-1 further increased *O2* production and augmented vasoconstriction. Furthermore, vascular relaxation was impaired in the diabetic group (75 versus 40%), which was restored by *O2* scavenger superoxide dismutase. These findings suggest that ET-1 causes bypass conduits dysfunction via stimulation of *O2* production in diabetes. Novel therapies that attenuate *O2* generation in bypass conduits may improve acute and late outcome of CABG in diabetic patients.     

Pick bodies in a family with presenilin-1 Alzheimer's disease

Presenilin-1 (PS-1) mutations can cause Pick's disease without evidence of Alzheimer's disease (AD). We describe a family with a PS-1 M146L mutation and both Pick bodies and AD. Sarkosyl-insoluble hyperphosphorylated tau showed three bands consistent with AD, although dephosphorylation showed primarily three-repeat isoforms. M146L mutant PS-1 may predispose to both Pick's disease and AD by affecting multiple intracellular pathways involving tau phosphorylation and amyloid metabolism.     

Comparison of necrosis in human ovarian tissue after conventional slow freezing or vitrification and transplantation in ovariectomized SCID mice

This paper examines and compares necrosis in human ovarian tissue after conventional slow freezing or vitrification and ensuing xenotranplantation. Slow cryoconserved or vitrified ovarian tissue samples and fresh controls from nine patients were subcutaneously transplanted into SCID mice. The tissue samples were explanted after 6 weeks and the necrotic areas were examined by staining with Lucifer yellow SV. The size of the necrotic areas in parallel cultivated ovarian tissue samples was compared, as was necrosis in cultivated prostate tumour spheroids where the emergence of necrosis and its pathophysiological correlation have been described. Examinations showed no significant rise in the proportion of necrotic areas after slow cryoconservation/transplantation and in the controls (transplanted fresh tissue, not transplanted fresh tissue, long-term culture). The proportion of necrotic areas in the tumour spheroids was significantly higher than in the ovarian tissue. Vitrification could, after these results, be presented as an alternative to conventional slow cryoconservation.     

Antithymocyte globulin is associated with complement deposition in cardiac transplant biopsies

Polyclonal antithymocyte globulin preparations contain antibodies with reactivity to endothelial cells. Therefore, we investigated whether treatment with this reagent caused complement deposition in human cardiac transplants. Frozen tissue was available from endomyocardial biopsies of 75 patients, who were transplanted between April 1995 and April 2000. Nine of these patients were converted from cyclosporin A (CsA) to horse antithymocyte globulin (ATGAM) in the first month after transplantation. All of the biopsies were stained by immunofluorescence for C4d as evidence of activation of the classical pathway of complement. In addition, biopsies from patients treated with ATGAM and control patients were stained for deposition of horse immunoglobulin (Ig)G. All nine patients who received ATGAM had deposition of horse IgG and C4d. Two color stains demonstrated that the horse IgG colocalized with the C4d staining. No staining for horse IgG or C4d was evident in biopsies obtained before ATGAM treatment. Likewise, no staining for horse IgG was detected in seven control patients who had C4d staining. Most patients treated with ATGAM had no histologic evidence of rejection, but did have myocyte damage and macrophage infiltration. Thus prophylactic treatment with ATGAM is associated with the deposition of horse IgG and activation of complement in the transplant.     

Transfected human dendritic cells to induce antitumor immunity

Dendritic cells are professional antigen-presenting cells able to prime naive T lymphocytes and regulate steadily the delicate balance between tolerance and activation during the immune response. In past years several reports have shown that genetically engineered dendritic cells (DCs) can be a powerful tool for inducing an antigen-specific immune response. The use of such modified antigen-presenting cells is a real working hypothesis in preclinical studies and in clinical vaccination approaches for cancer treatment. The definition of optimal transfection conditions for preserving DC survival and functionality is necessary to design a correct immunotherapeutic protocol. Different lipid-based transfection compounds were studied for their effects on DC survival, phenotype and functional properties. All the transfection procedures were able to select DCs with a higher expression of activation and costimulatory molecules (ie MHCII-DR, CD83, CD86, CD25) than the untreated DCs. However, only two compounds (LipofectAMINE PLUS and FuGENE 6), preserved or even increased the immunopotency of DCs as antigen-presenting cells. These protocols were applied to modify DCs in order to express an epithelial tumor-associated antigen, MUC1, and such cells were able to induce in vitro a specific immune response in healthy donors.