Diagnosis of serous neuroretinal detachments of the macula in severe preeclamptic patients with optical coherence tomography.

OBJECTIVE: Visual symptoms are common in patients with preeclampsia, and are caused by various underlying pathological changes in the retina. Blurred vision may be one of these symptoms. We describe three cases in which the underlying retinal pathology of blurred vision was clarified using optical coherence tomography (OCT), a novel, non-invasive ophthalmic imaging technique that provides micrometer-scale resolution images of the human retina. METHODS: Three patients with preeclampsia complained of blurred vision postpartum. In all cases, ophthalmoscopy was performed at the bedside, followed by the assessment of best corrected visual acuity, slit-lamp biomicroscopy, fluorescein angiography (FLA), and OCT. In all cases, the presence of central visual defects was examined by an Amsler-grid. RESULTS: In one case, the symptoms were bilateral. In all affected eyes, the patients complained of a relative central scotoma. Ophthalmoscopy showed edema in the affected maculae, while OCT examination clarified a serous neurosensory detachment of the macula. In one case, a neurosensory detachment was also detected in the papillomacular region of a fellow eye with no symptoms. In two cases, FLA was performed, but only in one case could we detect late leakage and subretinal exudates. The serous detachments observed showed total resolution in all cases within 5 to 10 weeks, with restoration of visual acuity. CONCLUSION: In patients with preeclampsia, OCT may provide a useful method for the precise assessment of retinal changes, distinguishing retinal edema from serous neurosensory detachments. This finding may help to clarify the pathophysiological circulatory changes seen in preeclampsia.     

Time dependent loss of tissue GABA content and immunoreactivity in hippocampal slices

Immunohistochemical detection of GABA was used to evaluate changes of the GABA innervation in hippocampal slices maintained in vitro. In parallel experiments the amount of GABA, glutamate and aspartate was measured with high performance liquid chromatography. The results showed that while glutamate and aspartate levels remained fairly constant, GABAergic neurons suffered remarkable alterations. During 8 hours' incubation the GABA content of the tissue and the number of GABA containing neuronal cell bodies decreased by 79.7% and 84.6%, respectively. The qualitative features of the immunoreactivity of the neuropil did not change. In conclusion, while in hippocampal slices tissue glutamate and aspartate levels are only slightly affected by the in vitro maintenance, more than half of the tissue GABA content is lost during prolonged in vitro incubation. As a consequence of the GABA loss, the ratio of endogenous inhibitory and excitatory amino acid transmitters has been altered, which could influence the viability of adult hippocampal tissue in vitro conditions.     

Analgesic nephropathy in Hungary: the HANS study.

BACKGROUND: The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem. METHODS: Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively. RESULTS: Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01). CONCLUSIONS: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.     

Post-ischemic administration of diazoxide attenuates long-term microglial activation in the rat brain after permanent carotid artery occlusion

Diazoxide is a putative mitochondrial, ATP-sensitive potassium channel opener that has been implicated in neuroprotection in cerebral ischemia. Administered as pretreatment, diazoxide can attenuate ischemia-related neuronal injury, but little is known about the potential neuroprotective properties of the drug when it is given after the onset of an ischemic insult. In a previous study, we applied diazoxide after imposing chronic cerebral hypoperfusion by means of permanent, bilateral occlusion of the common carotid arteries (2VO) in rats. We observed that ischemia-induced learning impairment assessed in the Morris water maze, and microglial activation visualized by immunocytochemistry, were prevented by diazoxide as determined at 13 weeks after 2VO. However, dimethyl sulfoxide, the organic solvent of diazoxide also prevented memory deficits, without any effect on microglial activity. Therefore, we have repeated our experiments with the use of an inorganic solvent, aqueous NaOH solution in order to clarify the effect of diazoxide independent of dimethyl sulfoxide. The present results demonstrated that diazoxide alone did not improve learning performance, but it prevented microglial activation in the hippocampus 13 weeks after the onset of 2VO. These data provide evidence that post-treatment with diazoxide is not effective in impeding a long-term memory deficiency, but it can attenuate ischemia-induced microglial activation, independently of the solvent used.     

Investigation of the role of the serotonergic activity of certain subtype-selective alpha1A antagonists in the relaxant effect on the pregnant rat uterus in vitro

Results from recent studies have shown that alpha(1A)-adrenergic receptor (alpha(1A)-AR) antagonists could offer a new alternative in the treatment of preterm delivery. However, members of this group [2-(2,6-dimethoxyphenoxyethyl)aminomethyl-1,4-benzodioxane hydrochloride (WB4101), 5-methylurapidil (5-MU)] are known to influence serotonin (5-hydroxy-tryptamine) (5-HT(1A)) receptors, too. Our objective was to clarify the role of their 5-HT(1A) activities in the uterus relaxant effect. RT-PCR was used to determine mRNA expression of the receptor subtypes in 22 day pregnant rat uteri. Isolated uteri were stimulated by 5-HT or electrical field to investigate the contraction-inhibiting effect and the 5-HT(1A) activity of the alpha(1A) antagonists. Both receptor subtypes are present in rat myometrium. 5-HT induced contractions were inhibited by the alpha(1A) antagonists. Besides shifting the dose-response curve of 5-HT to the right, 5-MU decreased its maximal effect. The alpha(1A) antagonists inhibited electrical field stimulation-induced contractions. 5-HT(1A) blockade increased the maximal effect of 5-MU but did not change that of WB4101. These results suggest that the contraction increase caused by 5-HT is mediated by alpha(1A) receptors. Serotonergic activity of alpha(1) antagonists and especially alpha(1A) antagonists should be investigated as it may alter their efficacy and could interfere with their side-effects. It is proposed that novel alpha(1A) antagonists should be designed with no 5-HT(1A) activity to achieve maximal relaxant effect.     

Neuronal expression of Raf protooncogene in the brain stem of adult guinea pig

The Raf protooncogenes encode for cytoplasmic serine/threonine-specific protein kinases which can be activated via growth factor receptors by phosphorylation. Immunohistochemical and Western blotting studies have proven the existence of Raf protein kinases in neurons of the cerebral cortex of rats and guinea pigs. The aim of the present study was to map the immunohistochemical distribution of Raf kinase-like staining in the brain stem of guinea pig. Polyclonal antibodies were used that were raised against a recombinant viral protein in combination with the avidin-biotin-peroxidase system for detection of immunoreactivity. Specificity of the antibodies was tested in Western blotting experiments. Cytoplasmic immunostaining was observed in motor nuclei of hypoglossal, accessory, vagus, facial, trigeminal, abducent, oculomotor and trochlear nerves, and in the nucleus ambiguus, nucleus retroambigualis, lateral vestibular nucleus, mesencephalic nucleus of the trigeminal nerve, the red nucleus, raphe nuclei and reticular formation. Scattered neurons were stained in other sensory nuclei, such as solitary tract nuclei, medial, dorsal and ventral vestibular nuclei and cochlear nuclei. The spinal trigeminal nucleus and the main sensory nucleus of the trigeminal nerve contained few medium-sized immunoreactive cells. In general, staining was mainly somatodendritic; the axonal plexus was not positive. It is concluded, that the widespread neuronal appearance of cytoplasmic Raf kinase suggests an important role in transmission of trophic and growth factor signals in these neurons.     

Viral and rickettsial etiology of an outbreak of acute respiratory tract infection

An outbreak of 111 cases of acute respiratory tract infection was recorded in a community of the town "T" in April-May 1984. The clinical picture was severer than usual; 28% of the cases had to be hospitalized, average absenteeism being as high as 26 days per case. Serological investigations demonstrated the previous circulation of influenza virus B/Singapore/222/79 and the simultaneous circulation during the outbreak of influenza virus A/England/333/80 (H1N1) and of Rickettsia burneti (as also ascertained by isolation in the chick embryo of the former and by visualization by immunofluorescence in exfoliated cells of the latter pathogen). The association of the two etiological agents appears to account for the severe and protracted course of the disease.     

Carotid atherosclerotic lesions in stroke patients with diabetes mellitus]

The aim of the study was to assess the incidence of atherosclerotic lesions on carotid arteries among diabetic subjects suffering from cerebrovascular accident. A further aim was to investigate the relationship between the severity of the carotid lesion, the stroke subtype and the fatal outcome. One hundred and sixty eight patients treated because of cerebrovascular accident at the Dept. of Neurology University Medical School of Debrecen were studied. The age of the patients, the duration of diabetes and hypertension were registrated. Base on duplex scanning carotid lesions were divided in 6 groups of severity (normal, intimal sclerosis, slight, moderately severe, severe stenosis and occlusion). Based on clinical signs and CT results stroke subtypes were divided into five groups (lacunar and non-lacunar infarctions, hemorrhages, normal CT and others). The relationship between severity of carotid lesions, stroke subtype and lethal outcome was assessed using statistical tests. Carotid stenosis of different severity was detected in 60% of the cases. Severity of stenosis was independent from duration of diabetes, but it was positively related to duration of hypertension (p = 0.016). In 1/3 of the patients lacunar strokes, in another 1/3 non-lacunar strokes were observed. No significant relationship was found between severity of carotid stenosis, stroke subtype and lethal outcome of the patients (p = 0.53 and p = 0.26 respectively). Diabetic patients suffering from stroke have a higher incidence of carotid artery atherosclerotic lesions than diabetics without stroke. A special attention should be paid to the carotid duplex sonography in order to detect diabetic cerebral macroangiopathies in early, asymptomatic stage.     

The interrelations of genital lesions-urinary tract infections in girls

This investigation was aimed at emphasizing the importance of early detection and elimination of the favoring factors which associated with an adequate treatment of urinary tract infection (UTI) represent the only way to prevent the recurrences that with time might cause severe kidney dysfunctions. It is a retrospective study of 220 girls aged 1 month to 16 years referred in the interval 1993-1997 to Ia?i Polyclinic No. 1 for pediatric gynecological examination and diagnosed with urinary tract infection. The clinical and laboratory evaluations were directed at determining the site of UTI, the factors that favored the recurrences, and the effects on renal function. The following favoring factors were found: disorders of the genital tract (22.2%), constipation (11.6%), oxyuriasis (4.5%), urinary tract obstructions (5.9%). The genital tract disorders were represented by inflammation (70%) (vaginitis, vulvovaginitis) and malformations (30%) (labia minora fusion, imperforate hymen, etc). The specific inflammation (48.5%) was mycotic (41.1%), bacterial (29.3%), the same pathogen being detected both in urine and vaginal discharge, trichomonal (17.6%), and gonococcal (11.6%). The high rate of recurrence in some UTI cases has proved once again the important role played by the favoring factors (genital tract disorders, urinary tract obstruction, constipation) and suggested that the correction of these conditions should be the only reasonable way to prevent recurrences.