Perineural tumor extension to the cavernous sinus from superficial facial carcinoma: CT manifestations

The mechanism of cavernous sinus involvement by metastatic carcinoma from a facial primary tumor is poorly understood. The lack of lymphatic and obvious direct extension implicate either a vascular or perineural method of spread. The authors describe four patients who exhibited cavernous sinus metastases from facial carcinoma, all of whom experienced cranial nerve symptoms before the diagnosis of cavernous sinus involvement was made. Furthermore, the pathologic specimens from these patients exhibited extensive perineural involvement. The authors propose that the mechanism of metastasis in these patients is perineural extension.     

Cervical spinal cord injury complicating ankylosing spondylitis

Within a period of 12 years 466 patients with acute spinal cord injury were admitted to our Centre, seven of these having ankylosing spondylitis (AS). A history of alcohol consumption preceding the accident was present in five patients, and in four there was a history of neurological deterioration before their admission. An epidural hematoma was found in one patient and four expired within 3 months of their injury. The incidence of ankylosing spondylitis in cervical cord injury was 1.5%, and an associated epidural hematoma was present in some 14% of the patients. The mortality rate was 57%. There was a high incidence of alcoholic use before the accident. Neurological deterioration commonly occurred before admission.     

The relationship among platelet-associated IgG, platelet lifespan, and reticuloendothelial cell function

Platelet-associated IgG (PAIgG) has been reported to be elevated in nonthrombocytopenic patients who have a normal platelet lifespan. This has been interpreted as indicating that PAIgG is a nonspecific finding in these patients and not a determinant of platelet survival. It is important to recognize that the reticuloendothelial (RE) system plays an important role in the clearance of antibody-sensitized cells. In this study, we related the level of PAIgG and the platelet lifespan to the RE function in patients with: (A) idiopathic thrombocytopenic purpura (ITP), and (B) five patients with elevated levels of PAIgG yet normal or near-normal platelet counts. RE function was assessed by measuring the clearance of autologous chromium-labeled red cells sensitized with a precise amount of alloantibody (2,000-3,600 molecules of IgG/cell). Eight patients with immune thrombocytopenia had significantly shortened platelet survivals (less than 2-113 hr). In contrast, the five patients with elevated PAIgG, yet normal or near- normal platelet counts, all had normal autologous platelet survivals (186-222 hr). These patients also had significantly impaired clearance of IgG-sensitized red cells, with an average of 85% of the infused red cells remaining in the circulation at 60 min (normal 42% +/- 14%, n = 10). In this study, every patient with elevated PAIgG and normal RE function had a shortened platelet lifespan. Those patients with elevated PAIgG and impaired RE function did not invariably have a shortened platelet lifespan. The observation that the PAIgG is elevated in some patients whose platelet survival is normal does not indicate that PAIgG is not biologically relevant. It indicates that these patients may have RE blockade and do not clear IgG-sensitized cells.     

Movement-related discharge of ventromedial medullary neurons

Studies in anesthetized animals implicate nonserotonergic cells in the ventromedial medulla (VMM) in opioid modulation of nociceptive transmission but do not reveal the conditions that engage VMM cells in unanesthetized rats. The few studies of VMM cells in unanesthetized rats show that VMM cells change their discharge across the sleep-wake cycle and during active movements. Since active movements are more likely to occur during waking than sleep, state-related discharge may in fact represent movement-related discharge. In this study, we recorded the discharge of VMM neurons in unanesthetized, drug-free, freely moving rats and examined whether neuronal activity was related to wake/sleep state, to motor activity, or to both factors. Most cells (45/67) were more active during waking states than sleeping states, 1 cell was more active during sleep states, and the remaining 21 cells did not fire preferentially across the sleep-wake cycle. Most wake-active cells (36/45) showed discharge bursts during movement bursts, and 9/11 wake-active cells were excited by noxious heat and innocuous air puff stimulation. In contrast, few state-independent cells (9/21) showed movement-related bursts in discharge. These results suggest that VMM neurons modulate spinal processes during phasic motor activity.     

Production of nitric oxide and superoxide by activated macrophages and killing of Leishmania major

Murine macrophages can be activated to produce nitric oxide (NO) and superoxide and these two radicals can react to form peroxynitrite, a powerful oxidant which may be involved in parasite killing. We now show that murine macrophages activated with zymosan and interferon-γ (ZYM/IFN-γ) produced both superoxide (peaking 1–2 h after stimulation, then rapidly declining) and NO (barely detectable at 6 h, peaking by 24 h). Macrophages activated with ZYM alone produced only superoxide, while stimulation with lipopolysaccharide (LPS) and IFN-γ induced NO but not superoxide. Cells stimulated with ZYM/IFN-γ or LPS/IFN-γ killed Leishmania major to a similar degree, an effect that was completely blocked by the addition of N-iminoethyl-L -ornithine. However, macrophages stimulated with ZYM alone were unable to kill L. major. S-nitroso-acetyl-penicillamine, which release NO, was highly leishmanicidal when added directly to the parasites. 3-morpholino-sydnonimine hydrochloride which releases both NO and superoxide simultaneously, was also efficient at killing L. major and this cytotoxicity was greatly enhanced by the addition of superoxide dismutase. Finally, authentic peroxynitrite failed to induce any cytotoxic effect, even at a high concentration. Thus macrophages can produce either NO, superoxide or both, depending on the stimulus. However, the killing of L. major is dependent only on the production of NO.     

Chlorhexidine-impregnated sponge dressing for prevention of catheter exit-site infection in peritoneal dialysis patients: a pilot study

International Urology and Nephrology - The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients. This single-center...