Giant cell arteritis causing bilateral sequential anterior ischaemic optic neuropathy--a case report

Giant cell arteritis is a chronic granulomatous inflammation of unknown aetiology involving large and medium size arteries in the elderly. It causes acute visual loss from ischaemia to the optic nerves or central retinal artery occlusion. This is a rare cause of anterior ischaemic optic neuropathy in our local population. We present a patient who had bilateral loss of vision from sequential arteritic ischaemic optic neuropathy. She was treated with intravenous steroids immediately. Diagnosis was based on histopathological studies of temporal artery biopsies.     

Primary Transitional Cell Carcinoma of the Fallopian Tube: A Case Report and Review of the Literature

Primary carcinoma of the fallopian tube is extremely rare and the preoperative diagnosis is often misdiagnosed as an ovarian carcinoma. We report a patient with primary carcinoma of the fallopian tube, strongly suspected preoperatively on the basis of characteristic clinical symptoms, elevated CA125 levels, and transvaginal sonography, computed tomography, and magnetic resonance imaging findings. The histology of fallopian tube carcinoma was demonstrated as transitional cell carcinoma. Extensive review of the literature showed that our case seemed to be the 14th case of primary transitional cell carcinoma of the fallopian tube.     

N-methyl-D-aspartate receptor subunit NR2B is widely expressed throughout the rat diencephalon: an immunohistochemical study

Glutamate (Glu), a major excitatory neurotransmitter within the hypothalamus and thalamus, acts upon many receptors, including the N-methyl-D-aspartate (NMDA) subtype. Abundant evidence suggests that variations in the subunit composition of NMDA receptors (NMDA-Rs) contribute to differences in Glu's immediate electrophysiological effects as well as to the patterns of signal transduction cascades it triggers to mediate long-term changes in neuronal function. We have previously shown that hypothalamic NMDA-Rs containing the NR2B subunit may be involved in the control of eating as well as in the mediation of physiological responses to osmotic stimuli. To broaden our understanding of diencephalic NMDA-R participation in other functions, we localized the NR2B subunit in the diencephalon of the adult male rat using immunoperoxidase, immunogold, and immunofluorescence techniques and an affinity-purified polyclonal antibody specific for the NR2B subunit of the NMDA-R. In addition, we used a monoclonal NR2B antibody with immunoperoxidase detection to confirm the NR2B distribution seen with the polyclonal antibody. In the hypothalamus, the highest levels of NR2B immunoreactivity (-ir) were found in the magnocellular neurosecretory system, including the paraventricular and supraoptic nuclei. A new finding was that intense NR2B-ir was present within perivascular "accessory" magnocellular groups of this system, including the nucleus circularis, anterior fornical nucleus, and scattered clusters of lateral hypothalamic cells apposed to blood vessels. Robust NR2B-ir was also present within the arcuate nucleus, the median eminence, and the tuberal nucleus, and light immunostaining was found in all other hypothalamic nuclei examined. In the thalamus, the highest NR2B-ir was observed in the medial habenula and the anterodorsal, paraventricular, rhomboid, reticular, and dorsal lateral geniculate nuclei. As in the hypothalamus, all thalamic nuclei examined displayed at least light immunostaining for this subunit. Control sections, including those incubated with the polyclonal NR2B antibody preadsorbed with its fusion protein, were virtually devoid of immunostaining. This demonstration that the NR2B subunit of the NMDA-R is widely distributed in the diencephalon, implicates it in a wide variety of functions, and provides a useful anatomical framework for establishing a comprehensive map of Glu receptor populations within this major subdivision of the brain.     

Effects of skyrin, a receptor-selective glucagon antagonist, in rat and human hepatocytes

Peptidic glucagon antagonists have been shown to lower blood glucose levels in diabetic models (1-3), but attempts to identify small molecular weight glucagon receptor-binding antagonists have met with little success. Skyrin, a fungal bisanthroquinone, exhibits functional glucagon antagonism by uncoupling the glucagon receptor from adenylate cyclase activation in rat liver membranes (1). We have examined the effects of skyrin on cells transfected with the human glucagon receptor and on isolated rat and human hepatocytes. The skyrin used was isolated from Talaromyces wortmanni American Type Culture Collection 10517. In rat hepatocytes, skyrin (30 micromol/l) inhibited glucagon-stimulated cAMP production (53%) and glucose output (IC50 56 micromol/l). There was no detectable effect on epinephrine or glucagon-like peptide 1 (GLP-1) stimulation of these parameters, which demonstrates skyrin's selective activity. Skyrin was also evaluated in primary cultures of human hepatocytes. Unlike cell lines, which are largely unresponsive to glucagon, primary human hepatocytes exhibited glucagon-dependent cAMP production for 14 days in culture (EC50 10 nmol/l). Skyrin (10 micromol/l) markedly reduced glucagon-stimulated cAMP production (55%) and glycogenolysis (27%) in human hepatocytes. The inhibition of glucagon stimulation was a specific property displayed by skyrin and oxyskyrin but not shared by other bisanthroquinones. Skyrin is the first small molecular weight nonpeptidic agent demonstrated to interfere with the coupling of glucagon to adenylate cyclase independent of binding to the glucagon receptor. The data presented in this study indicate that functional uncoupling of the human glucagon receptor from cAMP production results in metabolic effects that could reduce hepatocyte glucose production and hence alleviate diabetic hyperglycemia.     

Retrograde nailing of femur fractures in patients with myelopathy and who are nonambulatory

The authors studied 10 consecutive patients with closed femoral shaft or supracondylar fractures who were nonambulatory and who were treated by reamed retrograde intramedullary nailing via an intercondylar notch approach. The study consisted of five women and five men with an average age of 60.7 years (range, 40-89 years). Six patients had spinal cord lesions, one had a brain injury, one had cerebral palsy, one had multiple sclerosis, and one had progressive myelopathy. Three fractures were supracondylar, and seven fractures involved the mid-distal diaphysis. The average time of surgery was 110 minutes (range, 70-225 minutes) with an average estimated blood loss of 288 mL (range, 150-400 mL). There were two postoperative deaths (at 15 days and 2 months, respectively) after the procedure that were attributable to pneumonia. The remaining eight patients were observed for an average of 13 months (range, 6-20 months) after surgery. All fractures healed as evaluated radiographically. Retrograde intramedullary nailing is a simple, safe, and effective alternative to nonoperative treatment for femoral shaft or supracondylar fractures in patients who are nonambulatory. Stabilization by this method allows fracture healing and rapid return of patients to their previous level of function. There were no nonunions, malunions, significant shortening, implant failure, or wound infections.     

Video-fluoroscopic study of swallowing in children with neurodevelopmental disorders

BACKGROUND: Children with neurodevelopmental disorders can have feeding problems. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Video-fluoroscopic study of swallowing (VFSS) is essential in understanding the pathological mechanisms involved during swallowing. METHODS: The aim of the present study was to assess the role of VFSS in assessment and management of four children with various neurodevelopmental disorders in a multidisciplinary feeding team. We describe the team approach, with the participation of child neurologist, radiologist with the rehabilitation team including the speech therapist, occupational therapist and dietician, in the assessment and plan of management. RESULTS: Video-fluoroscopic study of swallowing had been useful in assessing the type of swallowing problems with treatment goals targeted to the basic underlying pathophysiological mechanism. CONCLUSION: A child neurologist should be involved in the multidisciplinary oromotor rehabilitation program for neurologically impaired children with feeding problems.     

Congenital cysts of the third and fourth pharyngeal pouches or pyriform sinus cysts

Cysts arising from the III and IV pharyngeal pouches, although uncommon, are typical in their presentation. They occur in neonates, invariably in the left anterior neck and cause respiratory distress. Excision of the cyst with ligation of the tract at the level of the pyriform sinus is curative.     

小肠无管法动力位双对比造影的价值分析

目的　介绍一种简易的小肠双对比造影法———小肠动力位无管法双对比造影。方法　口服钡剂进入小肠后再服产气粉 ,通过改变体位及配合促胃肠蠕动药物的使用 ,使气体进入小肠形成双对比相。对照组采用传统方法。结果　试验组小肠疾病阳性检出率显著高于对照组。结论　小肠动力位无管法双对比造影是小肠疾病检查的首选方法