Congenital tuberculosis

Congenital tuberculosis is a rare disease. The non-specific nature of presenting signs and symptoms (because of the lack of host response) and the fatal outcome in the absence of early therapy all underscore the importance of early diagnosis and treatment in infants. Recognition requires awareness that tuberculosis at this age has manifestations not found in older children. Here a case of congenital tuberculosis is presented, where changes were confined only to the thorax. Tuberculosis in the mother could be diagnosed only retrospectively.     

Thyroid dysfunction after mantle irradiation of Hodgkin's disease patients

Thyroid dysfunction can develop in patients with Hodgkin's disease who are treated with mantle irradiation. During the period 1970-89, the records of 320 patients who received mantle irradiation and who had thyroid function tests (TFT) were retrospectively reviewed. The median age was 30 years (range, 7-69 years). The median mantle and thyroid dose was 36 Gy (range, 30-40 Gy) and 39.8 Gy (range, 32-65 Gy), respectively. Overall thyroid dysfunction was present in 39% of the patients. Clinical hypothyroidism was seen in 10% and biochemical hypothyroidism was noted in 25%. Hyperthyroidism was found in 4% of patients. Thyroid nodules had developed in six patients (2%), of which those in four patients were malignant. Age, sex, histological subtype, stage of disease, dose, lymphangiogram and treatment with chemotherapy were not significant factors in the development of thyroid dysfunction. The narrow dose range prevented adequate analysis of dose effect. The results indicate that the incidence of thyroid abnormalities is high enough to warrant regular TFT assessment with pre-irradiation levels and follow-up testing for life because the development of abnormalities can occur many years later. Thyroid examination should form part of the routine follow-up examination and any abnormality should be promptly investigated.     

Abwägung oder doch harte Kriterien in der Begutachtung von Läsionen der Rotatorenmanschette

The majority of rotator cuff tears are related to a natural aging process and caused by multifactorial influencing factors. A pure or essentially extrinsic origin due to a traumatic event is rare and is particularly difficult to differentiate because of the frequency of age-related degenerative alterations to the tendons. As the basic understanding of the development of traumatic cuff tears is based mainly on biomechanical studies and empirical observations, assessing the potential link between structural tendon damage and a traumatic event involves a weighing up process of all available medical evidence. This includes the initial clinical examination, assessment of pain and clinical function over time, radiographic imaging, analysis of the injury mechanism and patient history of pre-existing shoulder dysfunction or inherent risk factors as well as operative findings and histological results.     

HIV-Associated Kaposi's Sarcoma

A 25-year-old man was diagnosed with HIV infection and a CD4 count of 21/μl. He presented with chills, fever up to 39.5°C and dry cough since 1 week. Antibiotic treatment for suspected pneumonia resulted in some clinical improvement. He had a blackish spot on his right forearm, which slowly evolved into a firm nodule (panel A), and a small purple spot on the hard palate. Both were interpreted as Kaposi's sarcoma (KS). Endoscopy revealed no gastrointestinal or pulmonary lesions. Human herpes virus 8 (HHV8) IgG EIA was negative both initially and after starting highly active antiretroviral therapy (HAART). Despite an increase of CD4 to 207/μl, the oral nodule evolved into a prominent tumor of 2.5x2.5 cm (panel B). Biopsy confirmed KS, showing irregular vascular spaces, prominent endothelium, extravasated erythrocytes, and atypical spindle cells positive for CD31, CD34 and HHV8 (panel C). Several weeks later, the patient developed increasing dyspnea; a CT scan revealed perihilar, radially configured pulmonary infiltrates predominantly of the left lower lobe (panel D), consistent with pulmonary KS. HIV-associated KS affects the skin and/or mucous membranes and is strictly associated with HHV8 coinfection. However, HHV8 serology may be unreliable especially in the setting of severe immunodeficiency. Usually, immune reconstitution with HAART leads to resolution of KS, but in some cases chemotherapy may be necessary. Treatment with liposomal doxorubicin led to rapid improvement of his dyspnea, weight gain of 3 kg within 6 weeks, and complete flattening of the lesion on the palate within 9 weeks.     

Immunofluorescence localization of thyroid hormone receptor protein beta 1 and variant alpha 2 in selected tissues: cerebellar Purkinje cells as a model for beta 1 receptor-mediated developmental effects of thyroid hormone in brain.

Rat c-erbA beta 1 mRNA rises in cerebrum during the first 10 days of life, coincident with an increase in tissue triiodothyronine (T3) levels and T3-dependent brain development. These data suggest that the beta 1 receptor may mediate the T3 effect. However, in cerebellum c-erbA beta 1 mRNA levels were very low. Since cerebellar development, including dendritic arborization of Purkinje cells, is a T3-sensitive process, we assessed the levels of the beta 1 receptor protein in cerebellum during development. Antisera to unique peptide regions of beta 1 were raised. Their specificity was demonstrated by specific immunoprecipitation of the in vitro translated product, 85% immunoprecipitation of the T3 binding activity in hepatic nuclear extracts, and Western blot analysis of tissue extracts. Immunohistochemical studies using anti-beta 1 antiserum stained liver nuclei but not testis nuclei, which contain no T3 binding activity or beta 1 mRNA. In cerebellar Purkinje cells, an immunofluorescent signal, localized to the nucleus and more intense than that seen in the liver, was observed. A positive but weaker signal was also present in the granule cells. Thus, we may infer that the cerebellum contains significant concentrations of beta 1 receptor protein despite the low beta 1 mRNA content. Both the intensity of staining in Purkinje cell nuclei and immunoprecipitable beta 1 receptor binding capacity rose in the neonatal period. Antiserum to the non-T3 binding alpha 2 variant protein was also prepared and a distinctive pattern of fluorescence was observed. Strong fluorescence was seen in the nuclei of granule cells, but none was seen in Purkinje cells. The alpha 2 fluorescence in testis was high, consistent with the high levels of alpha 2 mRNA in this tissue. The fluorescent signal appeared to originate primarily in dividing spermatogonia. Our findings support the concept that the beta 1 receptor plays a central role in T3-induced brain development and strongly suggest that the Purkinje cell is a direct target for T3.     

Nodding syndrome in Mundri county,South Sudan: environmental,nutritional and infectious factors

Background

Nodding Syndrome is a seizure disorder of children in Mundri County, Western Equatoria, South Sudan. The disorder is reported to be spreading in South Sudan and northern Uganda.

Objective

To describe environmental, nutritional, infectious, and other factors that existed before and during the de novo 1991 appearance and subsequent increase in cases through 2001.

Methods

Household surveys, informant interviews, and case-control studies conducted in Lui town and Amadi village in 2001–2002 were supplemented in 2012 by informant interviews in Lui and Juba, South Sudan.

Results

Nodding Syndrome was associated with Onchocerca volvulus and Mansonella perstans infections, with food use of a variety of sorghum (serena) introduced as part of an emergency relief program, and was inversely associated with a history of measles infection. There was no evidence to suggest exposure to a manmade neurotoxic pollutant or chemical agent, other than chemically dressed seed intended for planting but used for food. Food use of cyanogenic plants was documented, and exposure to fungal contaminants could not be excluded.

Conclusion

Nodding Syndrome in South Sudan has an unknown etiology. Further research is recommended on the association of Nodding Syndrome with onchocerciasis/mansonelliasis and neurotoxins in plant materials used for food.     

Sekundäre posttraumatische Schulterendoprothetik

Trauma und Berufskrankheit - Skapulafrakturen sind seltene Bruchverletzungen, welche sich prinzipiell in extra- und intraartikuläre Formen unterteilen lassen. Sie können selbst bei...     

Plasma clots gelled by different amounts of calcium for stem cell delivery

Purpose

Freshly prepared autologous plasma clots may serve as a carrier matrix for expanded multipotent mesenchymal stromal cells (MSCs) or bone marrow cells. By varying the calcium concentration, plasma clots with different properties can be produced. The purpose of this in vitro study was to determine the optimal calcium concentrations for the clotting process, intra-clot cell viability, and clot lysis.

Methods

Different plasma clots were prepared by adding an equal volume of RPMI1640 (with or without MSCs) to citrate plasma (either containing platelets or platelet-free). Clotting was initiated by the addition of CaCl₂ (10 g/100 ml H₂O, 10 % solution). The final concentration of CaCl₂ ranged from 1 to 10 % by volume of plasma. Viability and distribution of the MSCs were analysed by calcein-AM/propidium iodide staining. MSC-embedded plasma clots were dissolved with trypsin (0.25 %), and recovered cells were further incubated for 1 week under cell culture conditions.

Results

The viability of MSCs embedded in clots formed by the addition of 1–8 % by volume CaCl2 was not affected by incubation of up to 1 week. In contrast, clots produced by higher volumes of CaCl₂ solutions (9–10 % by volume of plasma) showed decreased numbers of viable cells. Intra-clot cell proliferation was highest in clots produced by addition of 5 % CaCl₂ by plasma volume. Osteocalcin release was not influenced in platelet-free plasma but decreased in platelet-containing plasma. Morphological analysis of stained recovered MSCs revealed that lysis of the plasma clot did not affect cell morphology or subsequent spontaneous proliferation.

Conclusions

Clot formation and clot stability can be controlled by changing the concentration of CaCl₂ added to plasma. The addition of 5 % CaCl₂ produced a plasma clot with optimal results for stem cell delivery.