Effect of obstructive sleep apnoea on retinal microvascular function: a randomised controlled trial

Graefe's Archive for Clinical and Experimental Ophthalmology - Retinal microvascular endothelial dysfunction is thought to be of importance in the development of ocular vascular diseases....     

An intra-articular vascular malformation with a ganglion in a knee

We report a case of an intra-articular vascular malformation occurring simultaneously with a ganglion in a knee joint. We believe this to be the first reported case of an intra-articular vascular malformation occurring simultaneously with a ganglion. The malformation was cauterized resulting in resolution of knee pain. We suggest that vascular malformations be considered in the differential diagnosis of knee pain.     

Extramammary Paget's disease of the perineal skin: role of radiotherapy.

We have reviewed our treatment results in 65 patients with extramammary Paget's disease arising in the vulva, perianal area, or scrotum. In 30 patients with primary disease, positive surgical margins were found in 53%, and there was an actuarial local recurrence rate of 40% within 5 years. The median follow-up period for primary extramammary Paget's disease patients treated with surgery alone was 198 months, and none died of this disease. Three patients treated with definitive radiotherapy were without recurrence at 12, 21, and 60 months after 56 Gy of supervoltage x-rays. In 22 patients with extramammary Paget's disease and associated adnexal or rectal adenocarcinoma, nine treated with surgery alone had a 75% local control rate. Three patients treated with surgery and adjuvant radiotherapy all had local control; of two patients treated with radiotherapy alone, one had persistent adenocarcinoma. The median survival for all patients with extramammary Paget's disease and adenocarcinoma was 22 months. We conclude that patients with extramammary Paget's disease have excellent survival but that local recurrence and morbidity from surgery, especially in the elderly, can be high. Radiotherapy greater than 50 Gy as primary treatment for extramammary Paget's disease in those medically unfit for surgery, or as an alternative to further surgery for recurrence after surgery and for anyone wishing to avoid mutilating surgery, is indicated. For those with adenocarcinoma and extramammary Paget's disease, the use of adjuvant postoperative radiotherapy in doses greater than 55 Gy is indicated because of the high risk of local recurrence after surgery alone.     

Fatal carbon monoxide poisoning at a motel

One man died and four other persons required hospitalization following accidental exposure to carbon monoxide at a motel. In spite of prompt diagnosis of the index cases, a search for the source of exposure and for other possible victims was delayed more than ten hours. Subsequent investigation revealed that air conditioning units drew carbon monoxide from the gas heaters for the motel's indoor swimming pools into three adjacent guest rooms through structural defects in the walls. Emergency care providers must remember that in environmental exposures, other persons may continue to be at risk, and efforts must be made to identify them.     

Equine cytomegalovirus: Cultural characteristics and properties of viral DNA

Equine cytomegalovirus (equine herpesvirus type 2; ECMV) exhibited cultural characteristics typical of the cytomegalovirus group. Ninety-six to one hundred twenty hours were required to reach a maximum titer of 1 × 10⁷ PFU/ml in infected cells, from which no more than 50% of infectious virus produced was released into the supernatant fluid. Only cells of equine or rabbit origin were permissive for virus replication. Ultrastructural investigation of ECMV-infected cells revealed the presence of three types of intranuclear nucleocapsids (empty capsidc, capsidc with a cross-shaped, electron-lucent core, and mature capsidc with an electron-dense core). The mature capsids appeared to acquire their envelope at the nuclear membrane. Infected cells were characterized by nuclei containing marginated chromatin in a large, electron-dense inclusion substance. Viral DNA extracted and purified from virions, nucleocapsids, or infected cells (Hirt fractionation) demonstrated an average density of 1.716 g/cm³ which corresponds to a G+C content of 57.7%. Sedimentation analyses of ECMV DNA in neutral sucrose gradients using phage T4 and equine herpesvirus type 1 (EHV-1) DNA as markers indicated a sedimentation coefficient of approximately 61 S. Sedimentation in alkaline sucrose suggested that the ECMV genome is a non-cross-linked, double-stranded DNA, possibly possessing nonligated areas either within the sugar phosphate backbone of the molecule or within specific alkali-labile regions. Sedimentation analyses of ECMV DNA yielded a molecular weight of approximately 121 × 10⁶ which was confirmed by restriction endonuclease analyses which indicated a value of 126 × 10⁶ Determination of the number, size, and molarity of ECMVDNA fragments generated by digestion with restriction enzymes revealed that ECMV DNA differs markedly in molecular structure from the genome of EHV-1.     

Atrial amyloid deposits in the failing human heart display both atrial and brain natriuretic peptide-like immunoreactivity

Atrial amyloid deposits are common in the ageing human heart and contain alpha-atrial natriuretic peptide (proANP99-126) immunoreactivity. However, atrial myocytes secrete both amino and carboxy terminal fragments of the ANP prohormone (proANP1-126) and also express an homologous, but separate brain natriuretic peptide (BNP). Characteristic amyloid deposits were identified in the atria of 9/22 patients (26-63 years of age) with end-stage heart failure. Amyloid fibrils displayed immunoreactivity for both amino and carboxy terminal fragments of proANP1-126 and for the distinct BNP sequence. As in other endocrine organs, both mature and precursor peptide sequences appear to be constituents of amyloid fibrils. Whilst immunoreactivity for cardiac peptide hormones is co-localized in atrial amyloid deposits, it is uncertain whether the increase in natriuretic peptide expression which accompanies cardiac failure contributes to the incidence of isolated atrial amyloidosis.     

Postnatal development of the innervation and paraganglia in the porcine pulmonary arterial bed

The innervation of the pulmonary trunk and pulmonary arterial bed was studied in 17 pigs from birth to 6 months of age. After birth, the pulmonary trunk and extra- and intra-pulmonary arteries contained neurofilament and protein gene-product-immunoreactive nerve fibres in both the adventitia and media. The density of nerve fibres increased from birth to 2 months, this being most marked during the first 2 weeks of life. Most of the fibres in the media were presumed to be sympathetic in origin as they contained both neuropeptide tyrosine and tyrosine hydroxylase immunoreactivity. Fibres were associated with the vasa-vasorum and vascular smooth muscle running around the vessel, between the elastic laminae and smooth muscle cells, in the outer two-thirds of the media. Vasoactive intestinal polypeptide and calcitonin gene-related peptide-immunoreactive nerve fibres were found to be associated with the pulmonary trunk and extra-pulmonary artery, but generally not with the intra-pulmonary arteries. Tyrosine hydroxylase immunoreactivity was detected in the glomus cells at birth, but peptide immunoreactivity (enkephalin) was not demonstrated in paraganglia until 14 days of age. Adaptation to extra-uterine life is associated with rapid development changes in the innervation of the pig pulmonary trunk, extra- and intra-pulmonary arteries and in the expression of peptide immunoreactivity in both nerve fibres and glomus cells. These changes may have a role in the postnatal adaptation of the pulmonary circulation.     

Effects of N-6 essential fatty acids on glioma invasion and growth: experimental studies with glioma spheroids in collagen gels

OBJECT: Intracranial infusions of gamma-linolenic acid (GLA), an essential fatty acid, have been used as an adjuvant therapy following malignant glioma resection; however, little is known about the dose response of glioma cells to this therapy. In this in vitro study the authors address this important pharmacological question. METHODS: Glioma spheroids derived from U87, U373, MOG-G-CCM, and C6 cell lines were grown in collagen gel and exposed to a range of GLA concentrations (0-1 mM) for 5 days. The diameter of glioma spheroids was measured, the apoptotic index was assessed using both the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling technique and cell morphological testing, and the levels of proliferating cell nuclear antigen were also measured. CONCLUSIONS: The dose-response patterns were similar for all four glioma spheroids. Low concentrations of GLA (<100 microM) increased both apoptosis and proliferation with a net increase in tumor growth and invasion, whereas high-dose GLA (>100 microM) significantly impaired spheroid cell growth. The proliferative effects of low-dose GLA could be a hazard in the clinical treatment of malignant glioma; however, because of the low toxicity of GLA against normal cells, local delivery of millimolar doses of GLA could significantly reduce tumor size.     

Angiotropic large B-cell lymphoma with clinical features resembling subacute combined degeneration of the cord

Angiotropic large cell lymphoma is a rare neoplastic disorder associated with a high mortality. The hallmark of the disease is lymphoid proliferation confined to the intravascular compartment without local tissue or vessel wall infiltration [1]. This feature is so striking that the disease was originally thought to arise from endothelial tissue and early cases were described as malignant angioendotheliomatosis. However, application of immunohistochemical methods for detection of lymphoid markers such as the CD45 and CD20 cell surface markers has confirmed its lymphoid origin, usually of B-cell lineage [2]. Clinical manifestations of the disease are protean and are due to multifocal medium and small vessel occlusion by tumour cells [3]. Characteristic sites of involvement are skin and central nervous system and although an ante-mortem diagnosis can be made from a biopsy specimen, it is often unsuspected [4]. We present a case of angiotropic large B-cell lymphoma in a 74-year-old man who presented with urinary symptoms and had a neurological picture resembling subacute combined degeneration of the cord.