Comparative analysis of dimethyl fumarate and fingolimod in relapsing–remitting multiple sclerosis

Journal of Neurology - Dimethyl fumarate and fingolimod are oral disease modifying treatments (DMTs) that reduce relapse activity and slow disability worsening in relapsing–remitting multiple...     

Changes in canine skeletal muscles during experimental tibial lengthening

In 24 beagles, lengthening of the right tibia was performed by callus distraction after osteotomy and application of a ring fixator. Distraction was started at the fifth postoperative day, with a distraction rate of 0.5 mm twice per day, and ended after 25 days. A control group of six additional dogs underwent tibial osteotomy and external fixation without distraction. Twelve animals with and three animals without leg lengthening were euthanized immediately after the distraction period of 25 days (Group A); the remaining 15 dogs were euthanized after an additional consolidation phase of another 25 days (Group B). From the distracted right leg and from the left control leg the tibialis anterior muscle, extensor digitorum longus muscle, peroneus longus muscle, and gastrocnemius muscle were removed and studied by means of routine histologic, histochemical, and immunohistochemical analyses, and electron microscopic examination. The muscles of the control group showed no differences between the right and left sides. However, in the other 24 dogs of Groups A and B, the authors saw marked alterations affecting only the lengthened muscles but not the muscles of the control limbs. These changes were highly significant and included muscle fiber degeneration and regeneration, target fibers, central cores, minicores, marked endomysial and perimysial fibrosis, and atrophy of Type 1 and Type 2 fibers. In the consolidation period (Group B) fiber type grouping indicated that reinnervation had occurred. In addition, an increase in satellite cells and myoblasts and proliferation of nuclei were observed. The findings of the current study indicate that leg lengthening results not only in muscle fiber degeneration followed by regeneration and reinnervation but also in formation of new muscle tissue.     

Uric acid and multiple sclerosis

Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Its etiology is not known, but it is well established that auto-reactive T-cells and monocytes play an important pathogenetic role. Experimental allergic encephalomyelitis (EAE) of mice serves as disease model for MS. In both EAE and MS inflammatory cells produce nitric oxide and its oxidizing congeners such as peroxynitrite. Peroxynitrite and other reactive nitrogen oxide species exert a toxic effect on neurons, axons and glia cells and enhance apoptosis. In addition, they increase the blood-CNS-barrier permeability and can therefore promote invasion of inflammatory cells into the CNS. On the other hand, uric acid, a peroxynitrite scavenger inhibits blood-CNS-barrier permeability changes, CNS inflammation and tissue damage in EAE. Epidemiological studies have shown that MS and gout are almost mutually exclusive diseases. Uric acid levels in MS patients are lower than in controls and in patients with active disease lower than in MS patients in remission. Inosine, a uric acid precursor, can be used to raise uric acid levels in serum and may provide some benefit in MS patients. A small study of ten patients with progressive MS has demonstrated some improved function in three of them and no sign of progression or relapse in the other. However, this study does not justify a recommendation for use of inosine in MS patients yet. At present, uric acid can solely be regarded as a marker of disease activity in MS. In addition, the current knowledge of uric acid and MS supports hypotheses which predict a positive effect of radical scavengers in MS.     

Inter-observer comparisons of ophthalmoscopic assessment of diabetic retinopathy

Abstract
Five hundred patients attending a general diabetic clinic were examined ophthalmoscopically both by a non-ophthalmic practitioner (NOP) and by an ophthalmologist. The findings were recorded on separate data sheets and the staging of diabetic retinopathy (DR) and grading of diabetic maculopathy by the NOP is compared with that of the ophthalmologist.
Comparisons are made for NOPs collectively and for subgroups of NOPs of different levels of experience in ophthalmoscopic assessment of DR. A profile is presented of DR occurring in this diabetic clinic population. The comparison studies show significant variations in ability of different observer groups and also between observers of the same status. It is concluded that an ophthalmologist is a necessary member of a diabetic care team.     

Lung cancer in young females.

Previous studies suggested that the characteristics of young female lung cancer patients may differ from those of other patients. Using the cancer registry at the Lungenklinik Heckeshorn hospital, all female patients under the age of 46 yrs with primary lung cancer 1986-1995 were identified. The clinical records were reviewed for risk factors, stage, histology, therapy, and survival. The data were compared with those of other patients. Of the 4,939 patients 96 (1.9%) were females aged <46 yrs. The percentage of young females doubled within ten years from 1 to 2% of all patients (p=0.03). The main risk factor in young females was smoking. Adenocarcinoma and carcinoids were overrepresented, whereas squamous cell and small cell carcinoma were significantly rarer in the young female group. Young females and young males were more likely to have advanced disease and underwent surgery and/or combined treatment significantly more often than older patients. The overall survival was only moderately better in younger patients. The clinical features of young female patients differed from those of young males and older females, the prognosis likewise depended on tumour stage and therapy.     

Longisectional interaction structure analysis (LISA) in psychopharmacology and developmental psychopathology

Longisectional interaction structure analysis (LISA) is a method for evaluating multivariate observations in a sample of individuals (patients) at two or more than two subsequent times (stages). It combines cross-sectional configural frequency analysis (CFA) for defining interactions between variables at a given stage with longitudinal interaction structure analysis (ISA) in relating variables observed at two subsequent stages, nonparametrically. The interactions are identified locally as types rather than globally as contingencies, where types are defined as (cross-sectional or longitudinal) patterns occurring in more individuals than expected under H0 of no (cross-sectional or longitudinal) interaction. LISA is applied to data sets from a clinical follow-up study and from a longitudinal study within developmental psychology. It is shown to be a useful technique for the interpretation of such data.     

Beitrag zum lumbalen Scheuermann

Zusammenfassung Es wird auf das relativ häufige Auftreten der lumbalen Form der Sch.E. hingewiesen. Mögliche Verbindungen zum jugendlichen Flachrücken mit kurzem Eingehen auf die Faktoren, die bei der Entstehung des letzteren zur Auswirkung kommen, werden erörtert. Die schwerwiegenden Auswirkungen der Erkrankung werden gestreift und die Verhinderung bzw. Abschwächung derselben betont.Mit 2 Textabbildungen.     

The role of laparoscopy and robotic surgery in the management of small renal masses

Increased utilization of cross-sectional abdominal imaging has led to a significant increase in the incidence of small renal masses. There is a growing body of literature suggesting that these lesions have a low malignant potential, thus supporting surveillance as a therapeutic option, particularly in the elderly population. Over the last decade, there has been an explosion of minimally invasive techniques for managing these lesions, including laparoscopic nephrectomy, laparoscopic partial nephrectomy, cryotherapy, radiofrequency ablation and, more recently, robotic-assisted surgery. The aim of this article is to review recent literature and assess the role of laparoscopic and robotic-assisted surgery in the management of small renal masses.     

Treatment of duodenal adenomas with endoscopic argon plasma coagulation

BACKGROUND: Surgical resection has been the standard treatment for duodenal adenomas. It has a high associated morbidity rate and a significant recurrence rate. The aim of this study was to evaluate endoscopic treatment of these lesions with argon plasma coagulation. METHODS: We retrospectively identified patients with non-ampullary duodenal adenomas without a polyposis syndrome and who were treated endoscopically between 1st January 1999 and 31st December 2003. Their management, follow up and outcomes were reviewed. RESULTS: Fifteen patients were included, with mean age 72 years (range 46-85 years). All were treated with at least one session of argon plasma coagulation. Initially, 13 adenomas were macroscopically cleared. Of these, eight (61%) had no recurrence during mean follow up of 40 months (26-68 months). The mean time to recurrence was 14 months (6-30 months). Eradication was possible a second time in four of five recurrent adenomas. There was one complication, of haemorrhage, from 37 sessions of argon plasma coagulation. No patient developed duodenal adenocarcinoma during the study period. CONCLUSION: Argon plasma coagulation may be safe and effective for the treatment of duodenal adenomas, but further research is required. Progression of adenomas is slow and perhaps no treatment is required.