Grading of minor salivary gland immuno-histopathology post-allogenic hematopoietic cell transplantation.

The oral cavity commonly displays mucosal lichenoid lesions and salivary gland dysfunction, which are considered different chronic Graft-versus-Host Disease (cGVHD) pathophysiology's. However, diagnostics of salivary gland (sg-)cGVHD are limited. The objectives of the current study are to evaluate the minor salivary gland (MSG) histo-immunopathological profiles post allogenic hematopoietic cell transplantation based on sg-cGVHD criteria. Design: Histopathology was characterized according to two published grading strategies. Firstly, the National Institute of Health (NIH) assessed peri-ductal/acinar infiltration, exocytosis, damage, and fibrosis, and a points-based grading scheme was established (0-16 points, Grade (G) 0 to IV). Second, a modified Sjögren's Syndrome focus-score with parenchymal damage was also adapted, (0-10 points, Score 0 to 2). 146 MSG biopsies from 79 patients were compared, using the histopathological specific criteria for sg-cGVHD pathology. Quantitative immunohistochemistry for T-cells (CD4, CD8), B-cells (CD19, CD20), monocytic cells (CD68) and dendritic cells (CD1a) were also assessed. Results: The large-scale cohort validated the use of both grading schemes. GIII-GIV and score 2 signified a histopathological diagnosis of "likely" sg-cGVHD. Immunopathological severity was associated with increased T-cells (CD4 and CD8) and monocytic (CD68) infiltrate, with minimal involvement of B-cells (CD19 and CD20), and Langerhans cells (CD1a). Conclusions: Both schemes were verified as being suitable for histological grading to improve assessment and diagnosis of sg-cGVHD. The NIH cGVHD grading appears to be more beneficial for research purposes, including final diagnostics of "no/inactive", "possible" or "likely" cGVHD. The study highlights the intricacies of sg-cGVHD pathology; and the need for standardized assessment to improve patient management associated to sg-cGVHD.

Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.

BACKGROUND: Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB. METHODS: Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Diagnosis was based on new onset ocular motor disturbances and detection of cerebrospinal fluid (CSF) pleocytosis and intrathecal synthesis of Bb IgM and/or IgG antibodies by lumbar puncture. The children were evaluated before and after antibiotic treatment with a follow-up time of 1-7 months. Videos were obtained both pre and post treatment in four patients. RESULTS: Two children presented with acquired nystagmus, one with combined nystagmus and partial sixth nerve palsy, one with partial sixth nerve palsy, one with ptosis and one with Adie's pupil. Five of the patients presented with severe fatigue, malaise, nausea, headache and fever. Four had recognised a tick bite recently, and two developed erythema migrans. Intrathecal synthesis of IgM and/or IgG antibodies specific for Bb was positive in all children, and five showed CSF pleocytosis. Cerebral MRI or CT of the brain were normal. Treatment with intravenous or oral antibiotics produced rapid clinical improvement in five of the six children. CONCLUSIONS: LNB can present as acute ocular motor disorders in conjunction with fatigue and other clinical manifestations. In endemic areas, children with unexplained, acquired ocular motor abnormalities should be evaluated for LNB, a treatable medical condition.

Recovered or dead? A Swedish study of 321 persons surveyed as severely mentally ill in 1995/96 but not so ten years later.

AIM: The aim was to follow-up a group of persons who were considered severely and persistently mentally ill (SMI) at the time of the 1995 Swedish mental health-care reform but not so ten years later. METHODS: Surveys were conducted in 1995/96 and 2006 in an area of Sweden. Of 602 persons surveyed as SMI in 1995/96, 321 were not found to be so in a similar survey in 2006. These persons were followed up concerning death rates and causes, as well as concerning recovery and present care. Comparisons between subgroups were made using the results of interviews conducted in 1995/96. RESULTS: Nineteen percent of the persons considered SMI in 1995/96 were recovered in 2006 in the sense that they no longer were considered SMI. The only variable found to predict recovery was diagnosis. Half of the persons in the sample given a diagnosis of neurosis were recovered but only 6% of those given a diagnosis of psychosis. Death rates and death causes seemed to be in line with previous research. CONCLUSIONS: Relatively few persons were considered recovered after ten years. Most persons in the sample were still in contact with care and services.

Needs and care of migrants considered as severely mentally ill--cross-sectional and longitudinal studies of a Swedish sample.

PURPOSE: Higher incidence of mental illnesses and less access to care is previously reported concerning migrants but few studies focus on the needs and care of migrant groups in psychiatry. The aim of this study was to compare differences in needs and care between migrant and nonmigrant groups of severely and persistently mentally ill (SMI) after the 1995 Swedish mental health care reform. METHODS: In a Swedish area, inventories were made in 2001 and 2006 of persons considered as SMI. These persons were interviewed and their needs were assessed. In a cross-sectional study in 2006, needs and care were compared between migrants and nonmigrants. In a longitudinal study, migrants and nonmigrants interviewed in both 2001 and 2006 were compared concerning the development of needs and care. RESULTS: The needs of the migrant group were less taken care of. In 2006, there were more unmet needs in this group concerning accommodation, physical health, psychological distress, basic education and economy. CONCLUSION: The improvement of groups considered as SMI concerning functional disability and efforts of care found in the actual area did not seem to include the migrant group, at least not to the same degree.

Needs assessed by patients and staff in a Swedish sample of severely mentally ill subjects.

The Psychiatric care reform in Sweden 1995 points out the importance of considering the patients' own experienced needs. Earlier research has shown that staff and patients differ in their assessment of needs, and the main aim of this study was to increase the understanding of these differences. The sample consisted of people in the city of Jönköping, Sweden, with a mental illness that cause a disability, influencing daily life. Four hundred and eighty-five patients were interviewed, half of them with a diagnosis of schizophrenia. Staff assessed the patients' needs by using the Camberwell Assessment of Need. Of the 485 patients 372 also assessed their own needs with the same instrument. The main finding of this study is that staff and patient ratings are not interchangeable. Staff rated more needs, both met and unmet, in nearly all areas. The results differ from those of earlier British studies. These differences may be due to methodologic and cultural circumstances. Decisions about interventions must be based on negotiations between staff and patient and should include relatives and friends.

Electrical stimulation of vastus medialis and stretching of lateral thigh muscles in patients with patello-femoral symptoms.

Thirty patients with unilateral patello-femoral symptoms and a hypotrophic vastus medialis muscle were treated with transcutaneous electrical stimulation of the vastus medialis obliquus and stretching of the lateral thigh muscles twice daily for 10 weeks. Before and after treatment the position of the patella at fixed knee flexion angles and the area of the vastus medialis and vastus lateralis muscles were studied by computed tomography. Isokinetic quadriceps torque was registered with a Cybex II Dynamometer. An evaluation with a functional knee score was carried out. The healthy contralateral leg served as control in all the examinations. Clinically two-thirds of the patients had improved after 10 weeks of treatment and this improvement remained at follow-up 3.5 years later. The area of the vastus medialis and the quadriceps torque of the treated leg increased significantly, while the area of the vastus lateralis and the position of patella did not change. We conclude that transcutaneous electrical muscle stimulation of the vastus medialis and stretching of the lateral thigh muscles might be of benefit in patients with patello-femoral symptoms and a hypotrophic vastus medialis. An improvement after 10 weeks of treatment seems to predict a good long-term result.

Transrectal ultrasound and computed tomography in preoperative staging of lower rectal adenocarcinoma.

A comparison of transrectal ultrasound (TRUS) and computed tomography (CT) for staging of rectal carcinoma was performed. Thirty-two patients were examined by TRUS and 30 by CT. The results of these preoperative examinations were compared with postoperative histopathological findings. TRUS had an accuracy of 81% and it predicted perirectal tumor growth with a sensitivity of 90% and a specificity of 67%, whereas the corresponding figures for CT were 52%, 67%, and 27%. These findings indicate that TRUS is more efficient than CT in staging local tumor growth in rectal cancer. Neither technique, however, can reliably identify lymph node metastases, since no correlation was found between lymph node size as observed on CT and TRUS and tumor involvement as evaluated histopathologically.

Prevention of quadriceps wasting after immobilization: an evaluation of the effect of electrical stimulation.

Eighteen male and 20 female patients who underwent reconstruction of their anterior cruciate ligament (ACL) with a flap from the patellar tendon were randomly assigned into either closed cast, isometric muscle training and electric stimulation (ES group), or closed cast and isometric training alone (control group). The degree of quadriceps wasting was determined from computerized tomographic scans (CT) before and 6 weeks after surgery. Electrical stimulation was given with a battery operated stimulator that produced a rectangular asymmetric balanced biphasic pulse shape. The pulse rate was 40 Hz and the pulse width 300 microseconds. Patients received 30 min of stimulation three times daily during 5.5 weeks. Female control patients showed a larger decrease in quadriceps area on CT than male control patients (P less than .001). No significant difference was found between male electrically stimulated patients and control patients. In female patients, there was on the contrary, a highly significant difference in favor of electrical stimulation (P less than .001) When the different parts of the quadriceps were studied, a significantly lower degree of atrophy of the vastus medialis was found after electrical stimulation. Vastus lateralis did not show any difference. Measurements of CT attenuation, pre- and post-operatively, showed a decrease in attenuation of 17% for the vastus medialis and lateralis of the operated leg after immobilization, indicating an increase in fat content. In the rectus femoris, however, there was an increase in attenuation of 14.6%. Percutaneous muscle biopsies from the vastus lateralis obtained before, one week after, and 6 weeks after surgery revealed that the cross-sectional area of the individual muscle fibers decreased less in the electrically stimulated than in controls, but the difference was not significant. There were no differences between the two groups in the activity of an oxidative enzyme, citrate synthase, or a glycolytic enzyme, phosphofructokinase (PFK). We conclude that females reacted more favorably than males to electrical stimulation of quadriceps during an immobilization period after knee surgery.

Diagnostic and operative arthroscopy of the hip.

Diagnostic and operative arthroscopies of the hip joint have been performed from an anterior approach after extension of the joint. The force needed to achieve a sufficient visualization of the hip joint was studied. In an anesthetized patient 300 Newtons (N) to 500 N was required, whereas up to 900 N was needed in an unanesthetized subject to achieve sufficient joint extension. Hip arthroscopy has been performed with a standard 5 mm Storz arthroscope. Alternatively, fluid and gas was used. It was possible to achieve good visualization of the anterior parts of the hip. Gas gave better information about the degree of degenerative arthritis while fluid was preferable for operative arthroscopy, eg, arthroscopic synovectomy. Synovial biopsies, removal of loose bodies, and partial arthroscopic synovectomy have been performed. The advantage was a very short time of rehabilitation. No serious complications occurred.

Compression of the inferior caval vein--a rare complication of a large non-parasitic liver cyst.

A patient with massive edema of the legs and scrotum is presented in whom non-parasitic cysts of the liver were found. Surgical evacuation of one large lobulated liver cyst completely relieved the patient of his edema. It is concluded that in this patient the peripheral edema was caused solely by cystic obstruction of the inferior caval vein.